PA-SMP Help to Indict Podiatrist

Rebecca Nurick, PA-Senior Medicare Patrol (SMP) Program Director, wrote this account of SMP’s involvement with Medicare beneficiaries who reported on the fraudulent activities of a Philadelphia area podiatrist. In September 2011, the PA-SMP did a fraud prevention program for Asian elders at a community center in Philadelphia’s Chinatown neighborhood. At the conclusion of the presentation, many audience members approached the SMP presenters to talk about a podiatrist who had been billing for an array of services that had never been provided. The beneficiaries had either never seen the provider or hadn’t used her services for several years. With an interpreter, we later met with four beneficiaries who were upset over the charges, but also extremely nervous about coming forward. Under conditions of anonymity, they were willing to provide their MSNs (Medicare Summary Notices) showing claims for services never received. It was meaningful that they trusted us enough to share their information. While anonymity is not the easiest road in terms of data gathering, these beneficiaries should be commended for their willingness to speak out to stop this fraudster. We put together paperwork and sent the documents for investigation to Medicare’s Part B contractor. We also submitted this documentation to the U.S. Attorney’s Office, Eastern District of Pennsylvania. In 2012, we were told that the investigation was still in progress and could not receive any further information on the status of the case. Finally, in October of 2014, we learned, through news articles and a Department of Justice press release, that the provider has been indicted on several counts of Medicare fraud, aggravated identity theft, and wire fraud and faces up to $3 million in fines and nearly 180 years in prison. The attorney on this case at the U.S. Attorney’s Office confirmed that the PA-SMP documentation played a significant role in their investigation and the subsequent indictment. We were happy to see the system work and that the PA-SMP played an important role in stopping this fraudster.  The beneficiaries who came forward deserved to have some kind of answer or resolution, and I’m pleased to say that they got one. If you you like to learn more about Medicare Fraud and the SMP program, please visit our page or contact us at 1-800-356-3606.