Chicago Area Medical Biller Sentenced To 45 Months For Role In $4 Million Home Healthcare Fraud Scheme

By: James W. Kraus

On Friday, September 18, the medical biller for a Chicago-area visiting physician practice was sentenced to 45 months in prison, by U.S. District Judge Gary Feinerman of the Northern District of Illinois, for her role in a $4 million healthcare fraud scheme.  Mary Talaga was convicted in May of this year following a jury trial on numerous charges relating to a billing scheme, including conspiracy to commit healthcare fraud.  Ms. Talaga was also sentenced to pay approximately $1 million in restitution.

From 2007-2011, Talaga was the primary medical biller for Medicall Physicians Group, Ltd., a physician practice that visited patients in their home and prescribed home healthcare.  The primary method of billing fraud that came to light at trial was the billing of Medicare for a service known as “Care Plan Oversight” or “CPO,” which would have indicated that the doctors had provided oversight of patient care plans.  In fact, the doctors at Medicall rarely provided the service.

Talaga and her co-conspirators also billed Medicare for other services that were never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall and services purportedly provided by medical professionals who, based on billing records would have had to have worked over 24 hours per day.  In all, the evidence presented at trial indicated that, through the period of the 5-year conspiracy, Medicall submitted bills to Medicare for more than $4 million in services never provided and Medicare paid more than $1 million on those claims.

Talaga’s co-conspirators, Rick Brown and Roger A. Lucero, Medicall’s former medical director, were also convicted in this matter.  Brown was convicted as part of the same trial with Talaga, and has been sentenced to serve more than 7 years in prison.  Lucero pleaded guilty and will be sentenced at a later date.

According to the government, since its inception in March 2007, the Medicare Fraud Strike Force, which investigated and prosecuted this case, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion.

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