Dr. Andrea Almond, owner of a chiropractic clinic in northern Kentucky, was indicted this week on a charge that she attempted to defraud a federal health care program. The federal grand jury in Covington, Kentucky came back with an indictment that charged Almond with a single count of conspiracy to commit health care fraud.
According to the indictment, from 2008-10, Almond submitted health care claims to Medicaid for a number of chiropractic services that she did not actually perform. The indictment further alleges that Almond knew that the chiropractors that actually did the services were not enrolled as medical providers with Medicaid in Kentucky, so they were not eligible to be reimbursed by the program.
The indictment states that during the entire conspiracy, Almond submitted almost 2000 claims for payment in the amount of $483,000, and she got about $95,000 in reimbursement from Medicaid.
Agents from the various parts of the federal government made the announcement about the indictment this week, including the US Attorney for the Eastern District of KY, the special agent in charge from the FBI, the Postal Inspector in Charge, and the Kentucky Attorney General.
The investigation that took place before the indictment was done by the FBI, the US Postal Inspection Service and investigators with the Medicaid Fraud and Abuse Control Unit.
Almond has not yet been scheduled to appear before the US District Court. If she is convicted, she faces a maximum penalty of 10 years in prison.
About US Health Care Fraud
According to the National Health Care Anti-Fraud Association, financial losses to health care fraud against Medicare and Medicaid total tens of billions of dolalrs every year.
No matter if you get your health care plan through work or on your own, health care fraud makes you pay higher premiums and pay more out of pocket. It also can reduce your coverage. For employers, health care fraud boosts costs of providing insurance to workers, and increases costs of doing business.
However, the financial losses caused by health care fraud are just a small part of the picture. Health care fraud hurts people too. For example, some people are exploited and are given unnecessary medical procedures. Others have their medical records compromised and their insurance information is used to submit fake claims.
Some of the most common types of health care fraud include:
- Billing for work that was not done. Sometimes it is billed with real patient information, or sometimes the ID of the patient is gotten via identity theft.
- Billing for procedures that are more costly than the ones that were provided. This is called ‘upcoding.’
- Performing medical work that is not necessary, with the sole purpose to generate more insurance payments for the provider.
- Accepting a kickback for a patient referral.
- Billing every step of the procedure as if it were separate, which increases costs.
In response to these types of crimes, Congress set up stiff penalties in the HIPAA law that was passed in 1996. The crime of health care fraud carries a maximum prison sentence of up to 10 years, along with major financial penalties. Also, if the fraud hurts a patient, you can get up to 20 years, and if the fraud kills a patient, you can get life in prison.