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A doctor from New Jersey was charged with three counts of health care fraud for his involvement in a billing fraud scheme. He was accused of billing Medicaid, Medicare, and private insurance for millions of dollars worth of services that were undocumented, provided while he was overseas, or billed at excessive daily rates over 900 times. The case highlights the need for new regulations and accountability to prevent fraudulent billing and ensure quality of care. It also serves as an example for organizations to avoid such offenses through oversight and transparency.

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DENNIS GITAHI
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96 views3 pages

Order 3150231

A doctor from New Jersey was charged with three counts of health care fraud for his involvement in a billing fraud scheme. He was accused of billing Medicaid, Medicare, and private insurance for millions of dollars worth of services that were undocumented, provided while he was overseas, or billed at excessive daily rates over 900 times. The case highlights the need for new regulations and accountability to prevent fraudulent billing and ensure quality of care. It also serves as an example for organizations to avoid such offenses through oversight and transparency.

Uploaded by

DENNIS GITAHI
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Health Care Fraud Billing Scheme

Name

Institutional Affiliation

Course Name

Prof. Name

Date
2

Health Care Fraud Billing Scheme

On Monday, November 9, 2020, a doctor from South Jersey was accused of participating

in a long-running billing fraud scheme. Three counts of wire, mail, and healthcare fraud were

filed against Morris Antebi, 68, of Long Branch, New Jersey. According to investigations,

Antebi was involved in various types of billing fraud that saw him charge millions of dollars for

services purportedly offered. He could frequently bill Medicaid, Medicare, and other private

insurance companies even when he had traveled overseas and was out of office. Another quality

issue was excessive billings for one-day periods. Over a reasonable duration, he billed insurance

plans over 24 hours’ services in one day on over 900 occasions. To reduce and eventually

eliminate fraud, new regulations and requirements must be implemented.

The violations stated in the case include health fraud where Antebi gave inaccurate

misrepresentation of services offered, billing undocumented services, misrepresentation of the

person offering services, wire fraud, and mail fraud. Antebi deceived the insurance companies by

requesting ineligible benefits. In this case, the prosecution realized that Antebi fraudulently

obtained millions of dollars through misrepresentation.

The case can be a useful tool in my organization because my work would be based on

DHHS-OIG to keep my services checked and free from flaws such as fraudulent billing and

quality issues. The case has also shown the punishment for these offenses and therefore it would

be important to avoid getting involved. Doctors need to be accountable and transparent in their

proceedings as this will not only affect their services to patients but also bring ‘sanity’ in the

entire professionalism including professional associations such as Medicare, Medicaid, and

insurance companies.
3

References

The United States Department of Justice. (2020, November 9). South Jersey Doctor Charged In

Health Care Fraud Billing Scheme. Www.justice.gov.

https://www.justice.gov/usao-nj/pr/south-jersey-doctor-charged-health-care-fraud-billing-

scheme

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