Patient Recruiter Pleads Guilty for Role in Fraudulent Medical Testing Scheme

Detroit-area resident Emma King, 61, pleaded guilty April 13 to one count of conspiracy to commit health care fraud, announced the Departments of Justice and Health and Human Services. The woman faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been scheduled.

According to the plea documents filed with the U.S. District Court for the Eastern District of Michigan, King began recruiting and transporting patients to a clinic called Ritecare LLC beginning in approximately September 2007. Ritecare was owned and operated by co-conspirators and had locations in Detroit and Livonia, Mich. King admitted that she and a co-conspirator paid kickbacks to Medicare beneficiaries that she recruited and transported to Ritecare. According to the plea documents, the owners and operators of Ritecare were the source of the funds used by King to pay the Medicare beneficiaries she recruited. King admitted that she would keep part of the funds she received from the owners and operators of Ritecare to secure patients as a kickback for referring the Medicare beneficiaries she recruited. Typically, the owners of Ritecare would provide $100-$150 per patient King recruited, with King retaining $50-$75 of that amount for the referral.

The plea documents note that the patients King recruited had to subject themselves to medically unnecessary tests to receive the money. Per instructions from the owners and operators of Ritecare, King admitted that she instructed the patients to claim they had certain symptoms to trigger medically unnecessary tests. Consequently, the patients’ medical records contained false symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.

King admitted that she was responsible for recruiting at least 269 patients to Ritecare. Through her recruitment efforts, King caused the submission of approximately $940,760 in false or fraudulent billings by Ritecare. Medicare paid approximately $533,643 on those claims.

The case was investigated by the FBI and the HHS Office of Inspector General (OIG), and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Eastern District of Michigan.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for approximately $1.1 billion. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

comments powered by Disqus

OH&S Digital Edition

  • OHS Magazine Digital Edition - July August 2019

    July/August 2019

    Featuring:

    • CHEMICAL SAFETY TRAINING
      Getting It Right
    • PROTECTIVE APPAREL
      Navigating Standards to Match Your Hazards
    • CONSTRUCTION SAFETY
      Just Add Water
    • FACILITY SAFETY
      Creating Safe Facilities
    View This Issue