2010 Award Winners
Investigation of the Year
Investigation of the Year: Honorable Mention
Excellence in Public Awareness
Investigative Excellence Award
Medical Director
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United States of America v. Stephen J. Schneider, D.O and Linda K. Schneider, L.P.N. Presented to United States Department of Justice, United States Attorney's Office United States Department of Health and Human Services, Office of Inspector General United States Department of Justice, Federal Bureau of Investigation United States Department of Justice, Drug Enforcement Administration United States Postal Inspection Service Kansas Office of the Attorney General Kansas Bureau of Investigation Preferred Health Systems BlueCross BlueShield of Kansas IntegriGuard, L.L.C. (Medicare) HP Enterprise Services (Kansas Medical Assistance Program/Medicaid) A four-year investigation into the operation of a pain management clinic in a small community south of Wichita, Kansas, uncovered evidence of extensive over-prescribing of controlled substances. More than 100 drug overdoses requiring visits to area emergency rooms and the deaths of at least 68 persons are linked to this case. A 34-count indictment charged the husband and wife defendants with health care fraud resulting in death, unlawfully dispensing controlled substances resulting in death, and money laundering. After an eight-week trial, the defendants were convicted and sentenced to prison-30 years for the physician husband and 33 years for his nurse wife-well exceeding the minimum 20-year sentence. The jury found that the couple directly contributed to the deaths of 10 patients. In summing up the case, the presiding federal judge called it "an avoidable tragedy motivated by greed." Congratulations to
AUSA Tanya J. Treadway Senior Special Agent William V. Roland Investigator C. Martin Redd S.I.U. Investigator Jaime Leyden Medical Review Nurse Jaime Dahlberg, RN, BSN Special Agent James D. Greer Special Agent Rebecca L. Martin Inspector Barry L. Rausch S.I.U. Auditor Marguerite Mzhickteno Supervisor Tracy W. Wagner, RN, BSN United States of America v. Michel De Jesus Huarte et al. Presented to United States Department of Justice United States Department of Justice, Federal Bureau of Investigation United States Department of Health and Human Services Department of the Treasury, Internal Revenue Service Florida Department of Law Enforcement Congratulations to
AUSA Ryan Stumphauzer Special Agent David Graupner Special Agent Christopher Vastine Craig A. Bodway Susan Kennedy, SIU Team Leader Danielle Van De Hey Maria E. Diaz, Senior Investigator Special Agent Liz S. Santamaria Special Agent Lydia Chabrier Detective Steven Sinatra Investigator Jayne Cabaliw Michael A. Paluselli, SIU Manager Presented to Senior Medicare Patrol Program, Administration on Aging
The National Health Care Anti-Fraud Association is proud to name the Senior Medicare Patrol Program as the recipient of the 2010 NHCAA Excellence in Public Awareness Award. This award is bestowed annually upon an organization or individuals who have done the most in the past year to raise public awareness about the problem of health care fraud in our nation's health care system. Senior Medicare Patrol (SMP) is a program of the Administration on Aging, itself an agency within the U.S. Department of Health & Human Services. SMP is being recognized for its important work in helping Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. The program recruits and trains retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Through their work, SMPs not only protect seniors, they also help preserve the integrity of the Medicare and Medicaid programs. The activities of the SMP program also "enhance the financial, emotional, physical and mental well-being of older adults - thereby increasing their capacity to maintain security and independence in retirement, and to make better financial and healthcare choices." In choosing this year's awardee, NHCAA was impressed by SMP's quantifiable achievements. In 2009, its staff and force of more than 4,400 volunteers held over 7,100 group education sessions and more than 33,800 individual counseling sessions. It has also fielded over 60,000 inquiries, referring 966 of those inquiries to authorities for further action. And its cooperation with authorities in every state, territory and the District of Columbia has been critical to raising awareness among seniors about Medicare fraud and what they can do to help combat it. Overall, the Senior Medicare Patrol's efforts have helped Medicare, Medicaid and other payers save $101 million since 1997, monies that would otherwise have been lost to fraudulent claims. NHCAA is proud to award and recognize SMP and its administrators for performing these invaluable services for our nation's seniors. Presented to Capital BlueCross An intensive two-year fraudulent billing practices investigation concluded on June 15, 2010, when the physician at the center of the case was sentenced to eight years' imprisonment, three years supervised release and ordered to pay over $7 million in restitution to various health plans defrauded in the scheme. Uncovered by Capital BlueCross, it was determined that the provider, Saroj Parida, M.D. was billing for interpreting comprehensive sleep studies when, in fact, he was reviewing recordings of respiration and heart rates produced by home apnea monitors used to ensure the safety of premature infants while they slept. These interpretations are reimbursed at a lower level than the comprehensive studies billed by Parida. Data analysis also showed that he was billing for reviewing recordings on infants not yet born and for months after the equipment had been removed by the DME supplier. The investigation identified other health plans victimized by the same scheme when it was determined that DME suppliers in other states were sending recordings to Parida for interpretation. Capital BlueCross contacted the special investigations units of these plans, asking them to request Parida's interpretation reports from the DME suppliers. Review of these documents provided the additional evidence necessary to demonstrate the extent of the scheme and its multiple victims. Congratulations to
Kathleen A. Amato, RN, BSN, CPC, CPC-H, AHFI Angela M. Shoop, CPC Tina M. Beall, RN, BSN, CPC, CPC-H Presented to Edwin C. Fischl, MD, MS, MBA, AHFI
Dr. Fischl's accomplishments in the health care anti-fraud field are well documented and profound. Dr. Fischl has assisted in more than 450 cases-reviewing medical records and claims, assisting with onsite audits, spearheading revisions to medical policy and providing invaluable information and training to law enforcement. He has worked with Highmark's Financial Investigation and Provider Review department on many prominent cases, including:
Dr. Fischl is generous with his knowledge, having served several times as a speaker and educator for NHCAA. In addition to being a board-certified general surgeon, Dr. Fischl has a Master of Business Administration and has earned the Accredited Health Care Fraud Investigator (AHFI) designation, one of a very few physicians to do so. Senior Vice President and Chief Medical Officer for Highmark Donald R. Fischer, MD writes of Dr. Fischl: "His insights, integrity, and willingness to collaborate have been key success factors for our program." |
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