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FOR IMMEDIATE RELEASE
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July 18, 2013
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Doctor Made More Than Half a Million Dollars Illegally
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.
U.S. Attorney Fishman credited special agents of the FBI in
Newark, under the direction of Special Agent in Charge Aaron T. Ford, and
special agents of the Department of Health and Human Services, Office of
Inspector General, under the direction of Special Agent in Charge Tom F.
O’Donnell of the New York Regional Office, with the investigation leading to
today’s sentence.
The government is represented by Assistant U.S. Attorneys
Deborah J. Gannett and R. David Walk Jr. of the U.S. Attorney’s Office Health
Care and Government Fraud Unit in Newark.
13-294
Defense counsel: Rocco Cipparone Jr. Esq., Haddon Heights,
N.J.
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