A New Jersey doctor has been indicted for a Medicare fraud scheme that allegedly conned the government into paying him millions of taxpayers’ dollars.

Although criminal proceedings are still pending, the doctor in question, anesthesiologist Amgad Hessein, has already been punished by the New Jersey state Board of Medical Examiners. The Board revoked his medical license in 2011 and ordered him to pay $438,750 in fines and reimbursements.

Hessein’s criminal trial is scheduled to start in June.

Doctor’s Medicare Fraud Scheme

Hessein allegedly ran his deceptive operation via three pain management offices operating in New Jersey. The scheme, which NJ Attorney General Robert Lougy called “gross malpractice,” is said to have involved:

  • Overbilling and falsifying $52 million in Medicare claims, including $5 million he kept in his pocket
  • Changing medical billing codes to those for more expensive procedures
  • Submitting claims for treatments he never rendered, including treatments that required equipment he didn’t have and treatments given to patients by unlicensed “doctors”
  • Prescribing addictive painkillers indiscriminately and giving non-medically justified steroid injections

Using our tax dollars, Hessein treated himself to high-end BMW and Mercedes-Benz automobiles, commercial properties, coastal real estate, and a $1.6 million home.

Medicare Fraud Strike Force

Medicare fraud has become such a lucrative crime that the US Department of Health & Human Services (HHS) has teamed up with the US Department of Justice (DOJ) to create a Medicare Fraud Strike Force (MFSF).

The MFSF uses sophisticated techniques to nab fraudsters – such as automated screening of ineligible doctors, geographic data analysis, predictive modeling, unannounced visits to doctors’ offices, and real-time claims data. Its successes through September 2015 are impressive: nearly 2,000 indictments involving $1.8 billion.

An All-Volunteer Army of Seniors

In addition to the professional law enforcement involved with the MFSF, the HHS and DOJ have also created the all-volunteer Senior Medicare Patrol, dedicated to preventing Medicaid and Medicare fraud.

Through 2012, the SMP has educated more than 3.5 million Medicare recipients, reviewed over 300,000 fraud complaints, and saved patients and taxpayers over $106 million by preventing fraud.

How to Protect Yourself From Fraudulent Doctors

Even though the money to pay for the millions lost in Medicare fraud doesn’t come directly out of your pocket, it affects all patients and taxpayers by driving up medical costs.

What’s more, if a doctor is willing to defraud Medicare, he or she probably won’t think twice about ripping off patients in other ways, too. Fortunately, there are things you can do to protect yourself from shady doctors.

  • Safeguard your Medicare card like you would your Social Security card or a credit card.
  • Don’t accept undocumented medical care for free or in trade for anything “under the table.”
  • Keep a “medical diary” in writing that includes the date and description of all your medical visits, tests, procedures, and diagnoses. Match up your diary with doctor bills and Explanations of Benefits (EOBs).
  • Don’t let a doctor talk you into any tests or procedures that you don’t need. Get a second opinion if you’re unsure.
  • Medicare doesn’t deploy door-to-door salespeople to sell products or services so don’t buy from someone who knocks on your door.
  • Count the pills in your prescriptions to make sure you’re getting all the medication you’re paying for.

 

If you think you may be the victim of a Medicare fraud scheme or other form of medical malpractice, talk to our malpractice lawyers