Medicare fraud- potentially fraudulent billing practices, wh

[Ace844]

Actually both.. if the service billed and the PCR describes a non-valid reason. Just because the physician signs a form does not excuse the EMS. The physician can be held liable for signing the document, or falsifying the need, which I have seen is a simple warning, until there is a pattern set. But when there is charges billed it is a total different thing.

That is why coding and billing reviewers are essential in EMS. They are supposed to weed out or be able to enforce proper documentation to "justify" or an EMS will have to eat the bill.

Our policy, is to assess the patient, inform the physician or ask the need for required stretcher. See if there can be an alternative transportation. Then, if all else fails inform the patient/family they might be responsible for a $800.00 bill, and have them sign insurance/medicare acknowledgement form that have been informed. That is all one can do...

R/r 911

"rid,"

I know of only one local agency which is really proactive with this like you describe. But I think among the many big important questions for us all here are:

• A.) What is the individual EMS clinicians liability and responsibilty in this case and how does one limit it?

B.) How far are you willing to go to either 'CYA' or try to 'fix' the issue.?

C.) My friend believes that by allowing this to be pervasive we are taking EMS resources away from 'real pt's' who need them, and further 'hurting-straining an overburdened' system. Do you agree?

D.) Now that the process is started and the individual is involved, how could he remain employed in the industry after they 'retailiate' against the complainant?

I posted this because I thought it would yield some interesting discussion.....

Hope this helps,

ACE844

[Ridryder 911]

Although I totally agree with what everyone is saying, we have a problem.... a big problem. There are so many patients that fall through the crack...

For example.. granny who falls, no hip fracture, however; cannot bare weight and needs assistance has friends to check on her later.. Not a stretcher patient, but definitely if I was the ER Doc, I would not send in a cab alone, unless you want to see her again, in a few minutes & with our attorney later. This is the dilemma... and it is only going to get worse!.

We are going to have more and more ambulatory with assistance and potential risks for fall patients that do not meet admission criteria, however cannot get into a vehicle or walk up flight of stairs etc.. without risks.

So the solution ...more w/c vans, supplemental reimbursements for non-emergency transports, ??

Who knows... we are on the ship Titanic & we have just seen the tip of the iceberg..

R/r 911

[Sdowler]

Working for my service I have seen some shady things with medicare and medicaid. The patient that has dementia and is traveling by EMS. Why is this patient going by ambulance? Well for safety and security of the patient and the driver. I will document what I see. On the pcs the patient is not ambulatory but when you enter the room that same person is walking around. Do patients traveling with hip precautions need ambulance how about knees. Non emergent evals are interesting. Read the FAQ for medicare just because 911 is called does not mean transport was indicated.

[Richard B the EMT]

Part One, on the youngest brother of a girl I dated in my early teens, referencing Medicare Fraud.

From New York Daily News, Link http://www.nydailynews.com/news/2006/12/31..._city_hust.html

CALL HIM KING CON! But slippery city hustler finally faces big squeeze

Sunday, December 31st 2006, 12:00 AM

THE CALLER talked a blue streak. "I'm an NYPD cop," he told a reporter in a thick Brooklyn accent. "I'm in Queens Hospital with a perp on another case. There is a guy here who's got no family, no friends, he's paralyzed from the waist down and they are abusing the hell out of him." Then he launched into a lengthy spiel about how he was sticking his neck out and somebody had to help this poor "genius." "Why not you?" the reporter asked. "You're a cop." The caller's voice dropped to a whisper. "I could jeopardize the badge," he said. "This is not my turf. Badda beep, badda boom. I just can't. It's complicated." Complicated indeed. The "cop" making the call was actually the patient, Scott Fredricks, and this wasn't the first time he tried to pull a fast one. Using various disguises and myriad aliases, Fredricks, 45, has been pulling cons for more than half his life, according to police records. Fredricks is not just a colorful crook. His cons have cost taxpayers more than $1 million, according to a Daily News analysis of his two-decade rap sheet. He has posed as cops and an abuse victim and, most recently, he was arrested for allegedly embezzling $114,000 in Medicaid funds by posing as his own home health aide. Now prosecutors believe he is faking paralysis so he can be housed, fed and tended to, costing taxpayers as much as $1,350 a day for his public hospital stays. And he has exasperated some of the city's top legal minds. "I run into a lot of strange people in my work," said Robert Helweil, one in a long line of Fredricks' court-appointed guardians. "This guy was probably the strangest and the most intelligent. He is like an idiot savant. He could charm the pants off of people." When a reporter recently visited him at Queens Hospital Center, she found a bedridden wild man and a master manipulator who alternately flirted with the nurses and ranted about being beaten up by hospital staffers. "Now he says he can't move his arms and hands," lamented one attorney recently. "They [nurses] have to feed him, hold the phone up to his ear. In fact, at some point I had to feed him! I said to myself, 'What the hell am I doing?' " Born on New Year's Day in 1961, Fredricks was the youngest of three and grew up on the Rockaway peninsula in Queens. His mother, Dorothy Fredricks, was involved in local Democratic politics. His father, Milton, worked on the docks. Bright and blessed with a photographic memory, Fredricks soaked up foreign languages like a sponge and took violin lessons with a teacher at Carnegie Hall when he was 10. He sailed through private schools before heading off to Ohio State University. "The man is brilliant, probably too smart for his own good," said Mitchel Fredricks, who lives in San Diego and has not spoken to his brother in 15 years. Nobody is quite sure what turned Fredricks into a felon. But Scott Fredricks was 20 when he had his first run-in with the law. He and a pal were arrested for stealing a $29,000 replica of a 1929 Mercedes-Benz that was on display at LaGuardia Airport. Scott Fredricks, who had become an auxiliary cop three years earlier, had forged a new vehicle identification number with a fake bill of sale and had registered the car in his own name, police said. His next arrests came in 1983 and 1984 while living in Columbus, Ohio. He impersonated the chief of the fictitious Georgetown Police Department. During a raid on his apartment, police confiscated a dark blue police uniform, various police identification cards and a .357 magnum revolver. They also confiscated his car, which was equipped with a flashing light and siren. He was found guilty and given probation. When Scott Fredricks returned to New York, he began compiling a rap sheet several pages thick and served several prison stints - never more than two years at a time. Scott Fredricks was a patient at Kings County Hospital in 1997 when his parents died within two weeks of each other. He drew up fake wills that disinherited his brother and sister, Gwen, leaving him the sole heir to the $530,000 family home. Since his March 2004 arrest for impersonating a police commissioner and driving with forged license plates and a forged ID, Scott Fredricks has allegedly perpetrated his most complicated fraud yet: He added paraplegia to his con, winning himself a warm, comfortable hospital bed instead of a prison cell. During the past 18 months, Fredricks has worn out his welcome at several hospitals and nursing homes - including Queens Hospital Center, Coler-Goldwater Specialty Hospital and Bronx-Lebanon Hospital. He was moved to the Kingsbridge Terrace Nursing Home in the Bronx on Dec. 5, where he is awaiting trial on federal health care fraud charges. "Our hospital did everything it could to get him placed in an alternative setting," said Errol Schneer, a spokesman at Bronx-Lebanon, noting that doctors found no medical reason for his three-month hospitalization there. "We are a busy hospital at capacity level and there are 25 sick people every day in our emergency room who need that bed." Rabbi Joshua Hertzberg, whom Scott Fredricks tricked into bringing him bagels and pastrami, said the con man has a brilliant mind. "He spoke with people in my presence in Chinese, in Farsi, in French, Italian and Spanish as if he were a native. He had a brilliant mind and memory," Hertzberg said. But after years of flimflamming, Scott Fredricks may have finally met his match in U.S. District Court Judge Paul Crotty. When Scott Fredricks missed several court appearances, the judge had him arrested in his hospital bed and ordered him to undergo physical and neurological exams he had resisted for years - or go straight to jail. His trial has been rescheduled - for the fourth and possibly last time - for March 19. If convicted on health care fraud charges, he faces up to 10 years in prison. "He is a unique person in the system," said Acting Supreme Court Justice Barry Kron, who presided over Scott Fredricks' police impersonation case last year. "The real problem comes after he has served his time. What do you do with someone like him?" hevans@nydailynews.com

[Richard B the EMT]

...and Part two, on the youngest brother of a girl I dated in my early teens, referencing Medicare Fraud. Link http://www.nydailynews.com/news/crime_file...to_slammer.html

Scammer's off to slammer

Con 'king' gets 21 months for 114G Medicaid shenanigans

BY HEIDI EVANS

DAILY NEWS STAFF WRITER

Friday, July 27th 2007, 4:00 AM

Irrepressible "king of con" Scott Fredricks was sentenced to 21 months in federal prison for his latest caper - impersonating a home health care aide and pocketing $114,000 in Medicaid funds.

Fredricks, 46, pleaded guilty on March 19, the day his trial was set to start. Using the alias Richard Spears, Fredricks pretended to be his own live-in health aide and tricked the city's Human Resources Administration into depositing Spear's salary into Fredricks' personal checking account for three years.

In a rambling, narcissistic rant that included a Gaelic aphorism, Fredricks asked Manhattan Federal Court Judge Paul Crotty if he could come work for him in the courthouse rather than do time. He also complimented the judge on his former post as the city's corporation counsel.

"Mr. Fredricks is quite loquacious, very smart and has a good mind. But he has used all those talents to commit a crime. Even now, he turns it into a job application," Crotty said at the sentencing Wednesday.

Sentencing guidelines called for 21 to 27 months imprisonment.

Despite Fredricks' 15 prior arrests and 10 convictions for fraud, theft and impersonation which began when he was 20 and living with his parents in Rockaway, the judge gave him the more lenient sentence.

Fredricks also could cut time off the 21 months with good behavior.

Crotty ordered Fredricks be incarcerated at a federal facility that can address his psychiatric and health problems.

The judge also ordered that Fredricks be supervised for three years after his release, and pay a $3,000 fine.

The scraggly-haired Fredricks, who speaks five languages, has cost taxpayers more than $1 million for his lawyers and medical care tied to his legal troubles.

He appeared in federal court in a wheelchair, dressed in his blue hospital gown.

Fredricks claims to be a paraplegic, but when he was forced by the court to undergo neurological tests this year, some doctors doubted that is the case.

Fredricks' court-appointed lawyer, Toni Messina, pleaded with the judge to be lenient with her client, blaming his troubles on a difficult family life and an accident and coma he allegedly suffered 14 years ago.

Fredricks will remain at Coler-Goldwater Hospital on Roosevelt Island until he must surrender to federal authorities in October.

hevans@nydailynews.com