For people who have experience with a relative who is so ill they are unable to leave the house, in-home care is a valuable tool to ensure their loved one receives the health care services they need without having to risk transportation to a facility. However, federal officials now claim that an Illinois nurse who runs a company that provides such services has committed health care fraud. If found guilty of the criminal charges against her, she could face a $250,000 fine and up to 10 years in prison -- in addition to court-ordered restitution.
The 45-year-old has been a registered nurse in Ilinois for approximately 13 years. At the time of her arrest, she operated a company known as Doctor At Home. According to papers filed by federal investigators, multiple home health care agencies claimed they received orders from Doctor At Home for patients to receive home health services. As a result, over $20 million has been reimbursed to these agencies by Medicare.
Investigators claim that the woman frequently claimed that patients were homebound when they were not and exaggerated the need for services. She is also accused of double-billing for some visits, billing them as both well-visits and patient visits. Investigators claim that Medicare was often billed $1,000 a month for multiple patients, when $120 when have been the appropriate charge. It is also alleged that Doctor At Home ordered several unnecessary medical tests that were to be conducted by a business with ties to it.
While there are many people who are extremely dedicated to their jobs, especially health care providers, many people might find the process of billing Medicare difficult. In a case such as this, it might be hard to determine what is simply an error due to a complicated system, or differing opinions over the need for medical testing and treatment, versus health care fraud. What is clear, however, is that this Illinois nurse has important rights as she navigates the criminal justice system. While the average American is aware of the basic rights those accused of a crime are afforded, many may have difficulty identifying a violation of those rights or in knowing the proper response for such a violation. It only makes sense that those in a situation such as this seek experienced guidance to ensure fair treatment.
Source: fbi.gov, "Doctor at Home Manager Arrested on Federal Health Care Fraud Charge, Allegedly Ran Extensive Medicare Fraud Scheme", , July 29, 2014