The Department of Justice periodically sends out memos identifying wins in its fight against healthcare fraud and abuse.
I’ll quote the DOJ verbatim.
Charges were filed in the District of Arizona against four individuals who allegedly filed $900 million in false and fraudulent claims to Medicare for amniotic wound grafts used on Medicare patients. As alleged, the defendants targeted elderly Medicare patients, many of whom were terminally ill. The defendants caused medically unnecessary and expensive amniotic grafts to be applied to these vulnerable patients’ wounds indiscriminately, without coordination with the patients’ treating physicians and without proper treatment for infection, to superficial wounds that did not need this treatment, and in sizes that far exceeded the size of the wound. In just 16 months, Medicare paid two defendants more than $600 million as a result of their fraud scheme, paying on average more than a million dollars per patient for these unnecessary grafts. These two defendants owned wound care companies in Arizona and received more than $330 million in illegal kickbacks in exchange for purchasing the grafts billed to Medicare. In connection with the charges, the government seized over $70 million, including four luxury vehicles, gold, jewelry, and cash.
“Every dollar saved by investigating fraud is critical to the sustainability of the Medicare program and the needs of the people who depend on it,” said Administrator Chiquita Brooks-LaSure of the Centers for Medicare & Medicaid Services (CMS). “In addition to the actions taken by the Justice Department, CMS took 127 administrative actions in the last six months separately against providers for their alleged involvement in health care fraud schemes. We thank our partners at the Department of Justice and Department of Health and Human Services Office of Inspector General for working closely with us to identify, investigate, and eliminate waste, fraud, and abuse in our federal health care programs.”
One phrase bears repeating – “paying on average more than a million dollars per patient for these unnecessary grafts.”
Separate reporting:
The owners of the wound care companies, Alexandra Gehrke and Jeffrey King, were arrested at the Phoenix airport as they were boarding a flight to London, perhaps attempting to flee the country. The article states that, “Gehrke and King lived lavishly off the scheme, prosecutors allege, citing luxury cars, a nearly $6 million home and more than $520,000 in gold bars, coins and jewelry.” Prosecutors said they seized more than $52 million from Gehrke’s personal and business bank accounts after her arrest.
Pics from the defendant’s February 25th wedding show them handsomely dressed.
Linkedin profile: “Experienced Founder with a demonstrated history of working in the medical device industry. Experienced in sales and marketing.”
I’ll say.
What do you think?
