Tuesday, July 16, 2013

Lori Reaves Sentenced To Two Years In Prison For Fraud Scheme Involving Home Health Care For Elderly Patients


TRENTON, N.J. – A doctor who was the owner and founder of Visiting Physicians of South Jersey (VPA) – a Hammonton, N.J., provider of home-based physician services for seniors – was sentenced today to 24 months in prison for charging lengthy visits to elderly patients that they did not receive, U.S. Attorney Paul J. Fishman announced.

Lori Reaves, 52, of Waterford Works, N.J., previously pleaded guilty before U.S. District Judge Freda L. Wolfson to an information charging her with one count of health care fraud. Judge Wolfson imposed the sentence today in Trenton federal court.

According to documents filed in this case and statements made in court:

Reaves admitted lying in Medicare billings about the amount of face-to-face time she spent with patients, which led to her receiving at least $511,068 in criminal profits. Reaves was the highest billing home care provider among the more than 24,000 doctors in New Jersey from Jan. 1, 2008, through Oct. 14, 2011.

VPA provided home-based physician health care for elderly and homebound patients in New Jersey, offering services throughout South Jersey. As part of her responsibilities at VPA, Reaves was responsible for Medicare billings as a Medicare-approved provider. The claim submitted by the health care provider requires a physician to state a diagnosis and provide a procedure code – called a Current Procedural Technology (CPT) code – identifying services rendered. Medicare regulations require that each provider certify that the services rendered were medically necessary and were furnished by that provider. A warning at the bottom of the form specifically states that any false claims or statements in relation to the submission of a claim for reimbursement are prosecutable under federal or state law.

In most instances during the relevant time period, Reaves submitted forms that falsely claimed she had provided prolonged service visits to her patients in order to induce Medicare to make payments to her that were significantly higher than the payments she should have received. She routinely billed Medicare using codes that would have required her – under Medicare regulations and depending on the corresponding service – to spend between 60 and 150 minutes with a patient. Many of the claims Reaves submitted would have required her to spend a minimum of 2.5 hours of face-to-face time with her elderly clients, when she actually spent far less. As a result, Medicare reimbursed Reaves more than $511,068 for the fraudulent prolonged service visits Reaves claimed to have made.

In addition to the prison term, Judge Wolfson sentenced Reaves to three years of supervised release. In addition to Reaves forfeiture of $511,068, Judge Wolfson ordered Reaves to pay restitution of $511,068 and pay a fine of $5,000.

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