28 December 2009

Focus Is On Detroit In Probe Of Medicare Fraud

Detroit Free Press

Now-shuttered Ritecare Urgent Care at 16904 Warren Ave. in Detroit was closed Oct. 28 as part of an FBI probe into fraudulent billing practices. Patients still inquire at a neighboring insurer about the clinic.

Detroit is part of expanded federal scrutiny of Medicare fraud.

Since 2007, a joint task force from the U.S. Justice and Health and Human Services departments has indicted more than 460 people  nationwide on charges of bilking the federal program out of more than $1 billion in fraudulent claims, particularly unnecessary medical tests.

The investigations started in Miami and Los Angeles and were expanded this year to Detroit, Houston and Brooklyn.

Some of the cases, including one against Ritecare LLC, a Livonia-based company with urgent care centers in Detroit and Westland, involve unnecessary medical testing and services, as well as alleged kickbacks some centers gave to staff and patients to increase business.

In Detroit, the Ritecare owners hired patient recruiters to drum up business for the company's clinic in Detroit, according to the Dec. 15 indictment brought by the U.S. Attorney's Office, Eastern District. In return, the recruiters paid people money to fake symptoms and undergo unnecessary tests, according to the indictment.

Attorneys listed in court records for Alejandro, Emilio and Maria Haber, the clinic's owners, could not be reached for comment Wednesday.

Ritecare's administrator and two patient recruiters also were indicted, as were two patient recruiters and the owner of a third clinic who referred patients to Ritecare, the U.S. Attorney's Office said in a statement. The cases are pending in Detroit's U.S. District Court, with two of the patient recruiters scheduled for a jury trial Feb. 16.

No one answered phones this week at Ritecare Inc.'s Livonia headquarters, at its Detroit center or a new urgent care center it opened in Westland at 769 S. Wayne Road. Ritecare was created in 2008 through a merger of Ritecare LLC and CompleteHealth LLC of Livonia, the indictment said.

The Detroit clinic, which opened in April, was authorized to bill Michigan Medicare and Medicaid for its services. "That was one busy place," said Katrina Daniels, a member of the State Farm office operating next door to the clinic. "The parking lot always seemed to be full," she said. The office doesn't know what to tell people who come daily to inquire about the clinic, she said.

Teri Chamberlain, Medicaid enrollment supervisor with the Michigan Department of Community Health, said the center was approved as a Medicaid provider because the clinic and its owners had no prior record of problems. Dr. Richard Chesbrough, a Bingham Farms radiologist who reads tests for Ritecare, has 20 ultrasound tests for patients he didn't know how to reach. He said he believes the incident underscores the need to better regulate diagnostic testing that occurs in doctor's offices and urgent care centers.

Too often, the work is substandard or unnecessary but no one regulates these tests, except for mammograms, the way they are in hospitals, he said. He called the quality of tests he got from Ritecare to read marginal.

Records with a second state agency, the state Department of Labor and Economic Growth, show that the clinic had incorporated as a limited liability company, which requires only cursory information. Owners and medical doctors are not required to be listed on the forms, said Ann Baker, deputy director of Commercial Services for the Michigan Department of Labor and Economic Growth.

Baker said it was up to the Department of Community Health to determine whether patients were harmed.

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