A Boston-area doctor pleaded guilty this week for his role in a home health fraud scheme that allegedly bilked Medicare out of more than $27 million.
Dr. Spencer Wilking, former Medical Director for Waltham, Mass.-based MJG Management Company, which operated as At Home VNA, faces a maximum penalty of 10 years in prison plus supervised release and repayment to Medicare for his participation in the scheme.
According to the Department of Justice, from April 2011 through March 2012, Wilking signed certifications and decertifications to provide At Home VNA home health series to hundreds of Medicare beneficiaries who did not qualify for Medicare-covered services. Under law, doctors must verify eligibility through face-to-face encounters with patients; these encounters were not conducted by Wilking, however.
Typically, Wilking certified services following minimal time spent reviewing patient assessment forms or after discussing patients’ conditions with nurses or the company’s clinical director, Janice Troisi.
While many patient files documented the fact the patients were not homebound, Wilking proceeded to certify their home health services, available only to those who are homebound.
At Home VNA owner Michael Galatis and the Troisi have been charged with conspiracy to commit health care fraud and 11 counts of health care fraud; Galatis as also charged with seven counts of money laundering. They pleaded not guilty to the charges.
Over the course of the scheme, the company submitted more than $27 million in false and fraudulent claims to Medicare, the DOJ found.
Sentencing for Wilking is scheduled for May 20.
Written by Elizabeth Ecker