Former Chief Operating Officer of Nevada Endoscopy Center Pleads Guilty to Medicare/Medicaid Fraud Billing Scheme
LAS VEGAS, NV—The former chief operating officer of a defunct Nevada endoscopy center, pleaded guilty today to conspiring with the former owner/physician of the center, Dipak Desai, to defraud Medicare, Medicaid and other private health insurance companies by inflating and overcharging for anesthesia services it provided, announced Daniel G. Bogden, United States Attorney for the District of Nevada.
Tonya Rushing, 46, of Las Vegas, pleaded guilty before U.S. District Judge Larry R. Hicks to one count of conspiracy to commit health care fraud, and is scheduled to be sentenced on Sept. 25, 2014, at 1:00 p.m. Rushing faces up to five years in prison and a $250,000 fine.
“Those perpetrating Medicare and Medicaid fraud cheat both taxpayers and vulnerable patients,” said U.S. Attorney Bogden. “We will hold criminals accountable and will seek to recover stolen dollars in each case of healthcare fraud we prosecute.”
According to the guilty plea agreement, between about January 2005 and February 2008, Desai and Rushing conspired to overcharge Medicare, Medicaid, and other private health insurance companies at the Endoscopy Center of Southern Nevada by significantly overstating the amount of time the certified registered nurse anesthetists spent with patients on a given procedure. Desai and Rushing created a separate company, Healthcare Business Solutions, owned by Rushing, to handle the billing for the anesthesia services. This company received approximately nine percent of all money collected for anesthesia services rendered at the endoscopy center. Desai and Rushing imposed intense pressure on the endoscopy center employees to schedule and treat as many patients as possible in a day, and instructed the nurse anesthetists to overstate in their records the amount of time they spent on the anesthesia procedures. Desai and Rushing also instructed the office staff to rely on the false anesthesia records when preparing the claims for reimbursement which were sent to Medicare, Medicaid and the insurance companies. The plea agreement states that Rushing received approximately $1.3 million as her share of the inflated anesthesia billing scheme.
Co-defendant Desai is currently being evaluated for his competency to face trial.
This case was investigated by the FBI, Office of the Nevada Attorney General, Health and Human Services Office of Inspector General, Department of Labor Office of Inspector General, Food and Drug Administration Office of Criminal Investigations, and the United States Postal Inspection Service, and prosecuted by Assistant U.S. Attorney Crane M. Pomerantz and Mark N. Kemberling, who was designated as a Special Assistant U.S. Attorney on this case and is Chief Deputy Nevada Attorney General.
According to a recent report by the Inspector General for the U.S. Department of Health and Human Services, for every dollar the Departments of Justice and Health and Human Services have spent fighting health care fraud, they have returned an average of nearly eight dollars to the U.S. Treasury, the Medicare Trust Fund and others. To learn more or to report Medicare fraud, go to http://www.stopmedicarefraud.gov/.