According to court documents, Janice Troisi, a clinical director and registered nurse at the home nursing agency has been convicted of a total of 10 counts of healthcare fraud, 7 counts of money laundering, and conspiracy to commit healthcare fraud for her involvement for her involvement in the Medicare scheme. Troisi has been sentenced to a 92 month prison term.
Troisi’s co-conspirator in the scheme, registered nurse Michael Galatis, submitted more than $27 million in for medically unnecessary, fraudulent claims to Medicare and Medicaid that spanned over a period of six years. Several physicians and nurses complained stating that patients did not need the home health services, but those complaints went ignored to insure the revenue being billed was consistent. Investigations by the Department of Justice revealed that Troisi and Galatis trained nurses to manipulate Medicare assessment forms. Nearly 1,400 patients were misleadingly documented as having been treated.
In spite of a regulation passed by Medicare in 2011 that required a physician certify that she or he had a face-to-face encounter with the patient about the need for home health care, Troisi continued to prepare certifications and orders for home health care for a doctor to sign with the full knowledge that the physician had not examined any of the patients. The scheme allowed the two to bill Medicare for millions of dollars’ worth of home health care at the expense of taxpayers.
When someone commits fraud in healthcare for their own gain, it hurts everyone. Federal regulators are becoming more diligent in the investigation of alleged fraud of healthcare agencies such as Medicare and Medicaid. Investigators are now scrutinizing the details of claims and are on the lookout for those who would commit fraud. Everyone is affected by fraudulent claims since everyone helps to pay for these services with our taxpayer dollars. The high cost of healthcare can at least in part be traced to claims that are fraudulent or excessive.
If you suspect that there may be health care fraud when dealing with any medical procedure or claim, contact the law offices of Bottar Leone PLLC today. We are here for you and to protect your rights. When you call our offices, we can schedule a free consultation and legal analysis to discuss your case.