tci Medicare Compliance & Reimbursement - 2003 Issue 24

Fraud & Abuse: LIE TO AN AUDITOR, LINGER IN JAIL

When it comes to dealing with Medicare and Medicaid auditors, a lack of straight talk could lead to a perp walk. Take the case of Dana McGovern, owner of McGovern's Ambulance Service in Calais, ME. McGovern pleaded guilty to 40 fraud and obstruction-related criminal counts after prosecutors accused him of using ambulance run sheets for van transports, counting non-reimbursable destinations (e.g., doctors' offices) as reimbursable destinations (such as hospitals), billing for advanced life support when MAS only supplied basic life support, and other misconduct. When sentencing time came around, the judge slapped him with a steeper sentence based...

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