Federal prosecutors claim Houston doctor was go-to man for fraud

The Houston Chronicle on May 22, 2012 released the following:

“By Terri Langford

A Houston physician accused of Medicare fraud prescribed costly home health care to hundreds of patients who didn’t need it – the majority of whom he never examined – resulting in more than $5.2 million in phony Medicare claims, according to federal data presented to jurors Tuesday.

In an unflattering snapshot of the home health care industry, the case brought by the government against Dr. Ben Echols aims to show he easily was able to sign off on home health care prescriptions for 352 patients and that the nation’s Medicare system, a $700 billion-plus behemoth, relies on an honor system where doctors and home health care agencies police their own claims.

Echols’ attorney, Connie Williams, insists his client has done nothing against the law or Medicare rules.

“He’s a good doctor. I think a lot of people in the community love him,” Williams said of his client. “However, he’s not the best manager in world.”

Echols’ signature was found on the patients’ plans of care forms, also known as a “485” form, paperwork needed by home health care companies before they can submit a claim for their services to Medicare.

The forms never make it to Medicare claims officials.

The home health care agencies and doctors keep them in their files in case a claim is questioned.

All of the requests for home health care for the 352 patients in question came from two home health care companies: Family Healthcare Services and Houston Compassionate Care.

Owners pleaded guilty

The owners of Family Healthcare, Clifford Ubani and Princewill Njoku, have already pleaded guilty to one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks and 16 counts of payment of kickbacks to Medicare beneficiary recruiters.

A record kept by Family Healthcare and recovered from a storage facility by federal investigators showed how the company went to Echols after patients’ own physicians rejected Family Healthcare’s request to provide services. The company dubbed the record, a “Re-Bill Doctor Log.”

However, most of the patients – 204 – were referred by Echols for home health care services from Compassionate Care, the same company that paid him $103,400 to serve as “medical director,” a position that requires him to make sure the company is following proper health care protocol.

Nurse indicted

The signature on the payments to Echols was that of Valnita Turner, a registered nurse with Compassionate Care.

Turner was indicted this month in the nation’s largest Medicare fraud sweep and is accused of conspiracy to disclose health information, conspiracy to commit health care fraud and five counts of health care fraud.

The second day of testimony in Echols’ trial, in U.S. District Judge Sim Lake’s court room, focused on how the two companies outmaneuvered Medicare through unsophisticated paperwork sleights-of-hand.

In one example, Family Healthcare Services tried to get a patient in Crockett, 120 miles from Houston, approved by his hometown physician for home health care.

The doctor’s office in Crockett faxed their denial back to Family Healthcare Services.

“He wasn’t home-bound,” testified nurse practitioner Toni McDonald, who worked for the doctor in Crockett. “He was driving.”

Not long after the denial, that same patient’s request for home health care was approved by Echols.

But Family Healthcare submitted paperwork to Medicare, under the Crockett physician’s Medicare number, not Echols’, according to testimony from U.S. Health and Human Services Office of Inspector General agent Korby Harshaw.

Rules tightened

A year ago, the Centers for Medicare and Medicaid Services (CMS) tightened home health care rules because too many doctors were approving patients for home health care without seeing the patient.

Of the 352 patients approved for home health care services by Echols, 200 did not have an office visit with him beforehand.

And at least one patient he approved for care got it for 2½ years before he was seen by the physician.

As Echols left the courthouse Tuesday he declined comment, then added, “Except to say I am not the monster you think I am.””


Douglas McNabb – McNabb Associates, P.C.’s
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The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.

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