In a significant legal development, a federal jury delivered a conviction against a California man for his involvement in a sophisticated scheme aimed at defrauding Medicare by falsely billing $2.8 million for hospice services that were deemed unnecessary for the patients involved.
The Accused and Scheme Details: Dr. John Thropay’s Role in Medicare Fraud:
Court documents and trial evidence revealed that Dr. John Thropay, a 74-year-old resident of Arcadia, played a key role in the fraudulent activities.
Serving as the medical director for various hospice companies, including Blue Sky Hospice Inc. located in Van Nuys, California, Thropay orchestrated the scheme from October 2014 to March 2016.
Fraudulent Certification and Billing Tactics:
During this period, Thropay engaged in certifying Medicare patients of Blue Sky as having terminal illnesses, even when the patients did not possess such conditions.
This strategic misrepresentation enabled Blue Sky Hospice to bill Medicare for hospice services that were not genuinely required.
Remarkably, in 2015, Thropay topped the list as the attending provider for the highest number of hospice claims paid by Medicare across the nation.
Jury Verdict and Conviction Charges:
The federal jury unanimously convicted Thropay on one count of conspiracy to commit health care fraud and four counts of health care fraud.
The charges stemmed from his active participation in the deceptive scheme to exploit Medicare for financial gains.
Sentencing Details: Potential Maximum Penalties and Judicial Process:
Thropay is slated to face sentencing on May 28, with each count carrying a maximum penalty of 10 years in prison.
The ultimate sentence will be determined by a federal district court judge, taking into account the U.S. Sentencing Guidelines and other statutory factors.
Official Statements and Announcements: Government Authorities on the Case:
Acting Assistant Attorney General Nicole M. Argentieri of the Justice Department’s Criminal Division, Special Agent in Charge Timothy B.
DeFrancesca of the Department of Health and Human Services Office of Inspector General (HHS-OIG), and Acting Assistant Director in Charge Amir Ehsaei of the FBI Los Angeles Field Office jointly announced the jury’s verdict.
Investigation Details and Legal Proceedings: HHS-OIG and FBI’s Role:
The investigation into this case was conducted collaboratively by HHS-OIG and the FBI.
Assistant Deputy Chief Niall M. O’Donnell and Trial Attorney Eric C. Schmale of the Criminal Division’s Fraud Section are prosecuting the case.
Health Care Fraud Strike Force Program and Continuing Efforts:
The Fraud Section, leading the Criminal Division’s fight against health care fraud, operates the Health Care Fraud Strike Force Program.
Since its inception in March 2007, the program, comprising nine strike forces in 27 federal districts, has pursued over 5,400 defendants collectively responsible for billing federal health care programs and private insurers over $27 billion.
Government Initiatives Against Health Care Fraud: CMS and HHS-OIG Collaboration:
Centers for Medicare & Medicaid Services (CMS), in collaboration with HHS-OIG, is actively taking measures to hold providers accountable for their involvement in health care fraud schemes.
Detailed information about these initiatives can be found on the official website at www.justice.gov/criminal-fraud/health-care-fraud-unit.