What’s the Big Rush?? | Nonprofit Fraud Blog

Reposted from the This Week in Nonprofit Fraud Blog – May 12, 2014

The Brain Game
Brain
​Photo courtesy of Concepts Mastery Education Services, LLC

May 6, 2014: Baptist Health Systems, the parent company for a network of hospitals in Jacksonville, FL has agreed to a $2.5 million settlement related to two neurologists misdiagnosing patients with neurological disorders (e.g. multiple sclerosis). The actions of these two neurologist led Baptist Health Systems to bill for medically unnecessary services from September 2009 through October 2011.  Baptist Health Systems put one of the physicians on administrative leave beginning in October 2011, but failed to disclose any misdiagnoses to the government, who had paid the billings, until September 2012.  The government investigation began when a former employee filed a whistleblower lawsuit under the False Claims Act.  The whistleblower will share in the government recovery and receive over $400,000 for their efforts.

See more on this case at The Federal Bureau of Investigation

Lesson Learned

  • The government is fortunate that an employee of Baptist Health was willing to stand up and blow the whistle on the actions of the company. Without the efforts of the whistleblower, this overbilling scheme could have gone undetected indefinitely.

Raffa Forensic Practice Tips:

  • Tips, especially from employees, are far and away the top mechanism to uncover ongoing fraud in an organization.
  • Does your organization have an anonymous hotline for employees and others to report when they suspect fraud?

What’s the Big Rush??
Ambulance


May 5, 2014:
  Aleksey Muratov and Alex Kapri – owners of now-defunct Los Angeles ambulance transportation company, Alpha Ambulance, Inc. – have been sentenced to nine and six years in prison, respectively, for their roles in a health care fraud.  Between June 2008 and July 2012, Muratov and Kapri knowingly provided non-emergency ambulance transportation to patients whose conditions did not require it.  The owners would then order Alpha employees to conceal patients’ conditions by altering Medicare documentation and creating fictitious justifications for the transportation.  After learning the company would be subject to a Medicare audit the owners further instructed Alpha employees to alter documents to be submitted to Medicare in connection with the audit. Over the four years of the scheme, Alpha Ambulance submitted $49 million in reimbursement claims, of which $13 million were paid, many under false pretenses.

See more on this case at The Federal Bureau of Investigation

Lesson Learned

  • Remember, a person who is willing to lie once is often willing to lie again!
  • Indeed, the owners of this company instructed employees to forge two sets of documentation in relation to this fraud; one set to initially commit the fraud and one set to try to mislead the external auditors.

Raffa Forensic Practice Tips:

  • External audits rarely catch ongoing frauds, in part, because they can give an organization just enough time to forge supporting documentation to pass tests they know will occur.
  • Does your organization design and conduct surprise audits of procedures?

DON’T BE THE NEXT VICTIM OF FRAUD!

The Raffa Forensic Accounting Services Practice offers a wide variety of fraud prevention and detection services including Fraud Risk Assessments, Background and Workplace Investigations, Fraud and Internal Investigations, Transactional Due Diligence Investigations, Anti-Fraud Consulting and Training, and Computer Forensic Analysis.

For more information on the Raffa Forensic Accounting Services Practice please visit us at www.raffa.com/ProfessionalServices/Forensic/ and the Nonprofit Fraud Prevention Institute at www.raffa.com/Fraud.

You can also contact the following Raffa professionals with any questions or if your organization needs assistance in fraud prevention:

Lawrence J. Hoffman, CPA/CFF, CVA, CFE, Senior Partner:  Lhoffman@raffa.com
Leslie C. Kirsch, CFE, Manager:  Lkirsch@raffa.com

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