LINCOLN, Neb. — A man who ran the business operations of a Nebraska health care provider bilked Medicare, the state's Medicaid program and private insurers out of nearly $1.4 million while defrauding a local bank, prosecutors say.
Federal prosecutors charged Mark Koehler of Norfolk this week with health care and bank fraud for the alleged scam between 2007 and 2010.
Koehler worked as the business manager for Heartland Physical Therapy in Norfolk, according to documents filed in U.S. District Court of Nebraska. His job included filing reimbursement claims to Medicare, Nebraska Medicaid and private insurers for physical therapy services.
Prosecutors say Koehler also defrauded BankFirst of Norfolk by including the false billings in reports that were used to collect cash advances. They say bank officials relied on the inflated reports when they advanced Heartland Physical Therapy about $500,000, which the company should not have received. The amount shown in the company's accounts receivable reports determined how much the bank was willing to advance.
Koehler routinely included the "phantom billings" in the company's daily reports to the bank, Assistant U.S. Attorney Alan Everett said in court papers.
A woman who answered the phone Thursday at Heartland Physical Therapy's Norfolk office said Koehler hasn't worked for the company for nearly two years. She declined to comment further. Koehler's home phone number was unlisted.
Prosecutors say Medicare, the federal health care program for the elderly and disabled, paid more than $190,000 to Heartland Physical Therapy for services not provided. The company received more than $279,000 from Nebraska Medicaid, a program for low-income residents, and more than $931,800 from private insurers, according to court documents.
Heartland Physical Therapy runs offices in Norfolk, Pierce and Humphrey, according to its website.
In September, Nebraska Attorney General Jon Bruning announced a settlement with a health care company that was to return $275,000 to the state's Medicaid program.
The settlement revolved around allegations that Maxim Health Care Services, Inc. submitted claims for services not rendered and did not provide documentation. The investigation began with a whistleblower lawsuit filed in U.S. District Court that alleged a number of false claims filed on behalf of a single Medicaid recipient. The settlement totaled $130 million and involved 41 states.
Since its inception in 2004, the state's Medicaid Fraud and Patient Abuse unit has recovered more than $39 million from violating service providers and drug companies.