'Upcoding' investigation snares physician and CEO

Fraud made house calls, according to the FBI’s Chicago Division. A physician and the CEO of Chicago-based Mobile Doctors, which manages physicians who make house calls in six states, were arrested late last month on federal healthcare fraud charges. At the same time, federal agents executed search warrants at Mobile Doctors’ offices in Chicago, Detroit, and Indianapolis, as well as warrants to seize more than $2.5 million in proceeds from the alleged fraud from various bank accounts.

The charges allege a scheme to fraudulently increase (also known as “upcoding”) Medicare bills for in-home patient visits that Mobile Doctors falsely claimed were more complicated and longer than they actually were. The charges also allege that Mobile Doctors’ physicians falsely certified that patients were confined to their homes, enabling home healthcare agencies to claim fees for additional services for patients who were not actually qualified to receive them.

Agents from the FBI, the U.S. Department of Health and Human Services Office of the Inspector General, and other law enforcement agencies executed the arrest, search, and seizure warrants in connection with the charges and also a broader ongoing investigation that includes allegedly illegal billing practices for medically unnecessary tests and services not performed by a physician, the FBI reported.

Source: FBI