Is the Government being short-sighted on this one? Medicare and Medicaid
are skeptical about claims that ob/gyns are giving group counseling to
nursing home residents. But surely if a group of you in your nursing home
are 80 and pregnant, you need counseling?! It’s hard enough giving
birth in your 20’s and 30’s, but giving birth at 80 has got
to be a challenge.
For some reason, Medicare and Medicaid are having a hard time believing
that three Illinois ob/gyns and a thoracic surgeon gave regular psychotherapy
sessions to patients pulled out of nursing homes. The four doctors charged
Medicare for 37,864 group sessions in just one year. With that sort of
epidemic of octogenarians giving birth, surely we
need to pay doctors to give a whole lot of counseling!
Medicare also was charged for transporting these nursing home patients
to offsite locations for the counseling. Probably the “counselors”
were just trying to accommodate the potential embarrassment that the pregnant
residents might have felt. Losing your girlish figure at 80 can be a tough
The problem may sound like the punch line for a joke, but taxpayers shouldn’t
be laughing. The Chicago Tribune, in a Sunday article, reports that
Illinois leads Medicare billings for group therapy: Some top providers
are not specialists in mental health. According to the paper, Medicare paid $730,000 to the four doctors for
the group counseling sessions. Medicare was charged extra for the transportation,
While these four doctors led the pack in terms of sheer numbers of counseling
sessions, according to the Illinois Medicare director Theresa Eagleson,
obstetrician/gynecologists, oncologists and urologists billed for counseling
even though they “didn’t have any training really in psychiatry.”
For every case of Medicare fraud that the Government uncovers, scores more
go undetected. The Government desperately needs whistleblowers who are
courageous enough to file False Claims Act qui tam lawsuits to stop medical
fraud, defense contractor fraud, highway contractor fraud, etc. As a lawyer,
I am proud to represent these courageous
whistleblowers in lawsuits to stop fraud. These whistleblowers (known as qui tam relators) can help the government
eliminate losses caused by fraud. As an incentive for the whistleblowers
to come forward, and in appreciation of the risks they are taking, the
Government pays them a percentage of what the Government gets back.
According to the Chicago Tribune, one of the four biggest-billing doctors,
Dr. Josephine Kamper, billed Medicare for an impressive 10,400 sessions
in 2012 alone. Medicare shelled out $207,980 for these sessions. Just
the year before, the Illinois Department of Financial and Professional
Regulation had put Dr. Kamper on probation, saying she failed to evaluate
a patient undergoing an abortion prior to anesthesia, and did not collaborate
with a certified registered nurse anesthetist.
Another of the doctors, Dr. Philip Okwuje, billed Medicare for 8584 group
sessions in 2012. Although he had been barred from Medicare and Medicaid
from 2002 to 2005, the moratorium apparently was over by the time he billed
for the counseling sessions in 2012.
The paper also reports that the thoracic surgeon, Mark Lubienski, had turned
to group psychotherapy because he had begun losing consciousness for temporary
periods. Although he felt he no longer could do surgery when he was unconscious,
apparently he believed psychotherapy for the elderly was still an option.
Illinois cannot afford to waste Medicaid monies, and U.S. taxpayers are
way too strapped to hand over Medicare funds for counseling sessions by
people with no counseling training. Medicare and Medicaid apparently caught
these false claims on their own — but obviously only after large
numbers of claims had been filed.
Let’s hope more whistleblowers will have the courage to come forward
with information about fraudulent bills to Medicare. Whistleblowers who
come forward can get 15% – 30% of what the Government recovers –
and the taxpayers can stop their losses much faster, plus get back a lot
of what they lost.