Question
On May 22, 2007, a Miami federal grand jury returned a 46-count indictment against eight defendants in United States v. Mabel Diaz, et al, 07-20398-CR-Ungaro.
"On May 22, 2007, a Miami federal grand jury returned a 46-count indictment against eight defendants in United States v. Mabel Diaz, et al, 07-20398-CR-Ungaro. The indictment charges Mabel and Abner Diaz, wife and husband, with operating All-Med Billing Corp., a Miami medical billing company, and executing a scheme to submit tens of millions of dollars in fraudulent claims to Medicare from 1998 to 2004 for reimbursement for durable medical equipment (DME) and related services. The indictment alleges that All-Med submitted approximately $80 million in false claims on behalf of 29 DME companies. The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient." It's 2005. You are a new employee at All-Med, and you are asked to conduct an audit of the company's billing practices. Using your knowledge gained from this class and the facts presented above, write a short memorandum addressing the following: (1) What are two processes that you would like to look at first, with respect to preparing the claims before they go out, and why? (2) When looking at sample files, you note that 9 out of 10 files do not have a verification of delivery. What step would you take next, and why? (3)When you ask to see the billing policy manual, the procedures required for supporting documentation and verification of delivery appear to be sound. As the auditor, what might this mean? (4) You deliver your audit report to management. In the report, you note concerns about employees not following procedure and recommend education and training. You also note that many of the claims that have been filed are not valid. When management reads your report, you are called into the office and told to change the report to "better support the company". What do you do next?
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