Illegal Marketer of Medicare Information Admits Role in Detroit-area Home Health Care Fraud Scheme

[Erica Absetz <eabsetz () opensecurityfoundation org>]

http://www.phiprivacy.net/?p=11780

A health care worker who sold Medicare beneficiary information to
Detroit-area home health agency operators as part of a $24.7 million
home health care fraud conspiracy pleaded guilty this week for his
role in the scheme, which sought to profit by billing for home
healthcare services that were medically unnecessary and not provided.

Clarence Cooper, 54, of Detroit, pleaded guilty before U.S. District
Judge Victoria A. Roberts in the Eastern District of Michigan to one
count of conspiracy to commit health care fraud. He had been indicted
in September 2012.

According to court documents, Cooper and others conspired to defraud
Medicare through purported home health care companies operating in the
Detroit area, including now-defunct First Choice Home Health Care
Services Inc. and Reliance Home Care, LLC. Cooper admitted that he
sold Medicare information he obtained from Detroit-area Medicare
beneficiaries to other conspirators at these and other health care
companies, knowing that it was to be used to submit claims to Medicare
for home health services that were not medically necessary and/or not
provided. According to court documents, from 2008 through May 2012,
Cooper sold co-conspirators the Medicare information of hundreds of
Medicare beneficiaries, at $200 to $300 per beneficiary, and this
Medicare information was used at these companies to bill Medicare for
nearly $1 million in home health care services.

Court documents show that the larger scheme in which Cooper
participated resulted in more than $24.7 million in claims to Medicare
for the cost of home health services, psychotherapy and other medical
services.

Cooper faces a maximum potential penalty of 10 years in prison and a
$250,000 fine. Sentencing is currently scheduled for July 23, 2013.
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