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MEDICARE FRAUD Agency target of investigation



Published: Sat, August 13, 2005 @ 12:00 a.m.



The fraud exceeds $50,000 monthly, a former Visiting Physicians worker alleges.

CLEVELAND (AP) -- Federal authorities are investigating an organization that has tried to help revive doctors' house calls to determine whether it cheated national health care programs for the elderly, a newspaper reported.

The criminal inquiry into the Visiting Physicians Association surfaced last week when federal prosecutors moved to end a lawsuit from a suburban-Cleveland whistleblower, The Plain Dealer reported in a story published Saturday. That lawsuit accuses the organization of cheating Medicare and could hinder the criminal case if it goes forward, prosecutors argued.

The prosecutors told two federal judges in Columbus that the case filed by Laura Pajestka should be stopped pending completion of the government's probe.

"Because both the civil case and the criminal investigation involve several overlapping issues, a stay is in the interests of justice and necessary to protect the government's criminal investigation," Assistant U.S. Attorney Kenneth F. Affeldt wrote in a court filing.

What whistleblower contends

Pajestka, a 50-year-old Brecksville nurse, once managed the organization's Cleveland branch. She has said that medically unnecessary services were billed to Medicare and other government programs from her office. Pajestka's lawsuit also accuses the organization of manipulating payment codes in an effort to inflate reimbursement amounts.

"The fraud exceeds $50,000 per month just for the Cleveland office," Pajestka said in a statement attached to her lawsuit. "Considering the total number of offices which are still in operation and still engaging in the same fraudulent activities, I would conservatively project that the Medicare fraud exceeds $500,000 per month."

The for-profit group practice sends doctors to visit patients in their homes. The practice cares for more than 25,000 patients in Ohio, Michigan, Texas, Georgia and Wisconsin.

Pajestka has said she was fired shortly after reporting what she believed to be illegal conduct to Visiting Physicians officials.

Ronald Levine, a Maryland lawyer representing the organization, said Tuesday that the firm is fully cooperating with the government.

"Of course, an investigation doesn't mean that anything wrong has been done, and VPA maintains that it has acted properly." Levine said. "We're cooperating. We think this will sort itself out."

A message seeking additional comment from the medical group was left Friday night at the association's headquarters in the Detroit suburb of Farmington Hills, Mich.

Keeping more patients home

Some health professionals and elected officials have been trying to redirect routine medical care away from hospitals and institutions like nursing homes and back into residential settings. They argue that it could be cheaper and better for patients to stay at home.

Kathleen Anderson, executive director of the Ohio Council for Home Care, said she is concerned that a criminal investigation of Visiting Physicians could harm the home care movement.

"Absolutely, it's a black eye if there is fraud against the government," she said.

The U.S. Department of Health and Human Services office of inspector general opened a Medicare fraud probe this year. The federal agency told Congress it has been closely examining the types of payments doctors across the nation are receiving for pathology services, cardiography and physical therapy. Possible double billing is also under scrutiny, according to the inspector general's work plan for 2005.

The office said it is trying to determine "whether duplicate payments were made to either the physicians and the nursing homes for the same patient services."




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