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Mar
22
Written by:
Chuck Gallagher
3/22/2008 9:05 PM
To some it is easy to cheat the government. Years ago I taught courses on proper coding of medicare and medicaid billing. The courses were successful, but often, I would get people following the course to tell me an "inside" tip about how to circumvent the system in order to maximize the return - fraudulent coding in effect. My response - You'll go to jail for that.
The former Chief Executive Officer of Oasis Medical Clinic in Plainview, Texas, Angela Michelle Edwards, was sentenced today to 30 months in prison for health care fraud. Edwards admitted that from January 2002 through August 2005, she caused “up-coded” and improperly coded claims and diagnosis codes to be submitted to Medicaid, Medicare and private insurance companies in order to receive higher payments than those authorized by the payors. Even though she knew that only clinicians were authorized to make diagnoses and determine the level of a patient visit for payment purposes, Edwards personally changed bills submitted by the clinicians and taught her billing staff to routinely change bills by submitting claims for visits that were marked at higher levels than the ones indicated by the clinician and by adding patient diagnoses and procedures to the claims before they were submitted to the payors.
According to the US Attorney's news release: Edwards admitted that she is personally responsible for the restitution in this case because: she caused Oasis to be overpaid; she caused poor banking and accounting records to be kept; she unlawfully took money f rom Oasis’ accounts for personal expenses during her tenure as CEO; and Oasis is now in bankruptcy. As a result of her actions, health care payors, including Medicare, Medicaid, Children’s Health Insurance Program and commercial insurance companies, paid Oasis $370,657 for fraudulent billings.
Not only did this fraud cost Edwards her freedom, but she also lost her license as a nurse since she was a convicted felon.
Every choice has a consequence. As a white collar crime and business ethics speaker, I speak from first hand experience about the truth about consequences. Reality is - no one escapes the consequences of their choices. While Edwards avoided the consequences for a time - they are not avoided forever. You do reap what you sow.
Perhaps Edwards will find her time in prison reflective so that she can use her talents in a productive way to help others upon her release. Every choice has a consequence and good choices can yield positive results - even for convicted felons!
White Collar Crime Speaker - Chuck Gallagher - signing off...
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