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Nurse pleads to altering records for audit

Posted: Thursday, December 5, 2019 | Views: 3332

Nurse pleads to altering records for audit

Press Release from the U.S. Attorney's Office:

NEW ORLEANS - U.S. Attorney Peter G. Strasser announced that Suzanne C. May, 61, of Mandeville, pled guilty on December 3, 2019 to conspiracy to alter or falsify records in connection with a federal investigation, namely, a Medicare audit of a hospice facility located in New Orleans, identified in court documents as Company 1.

According to court documents, May was a registered nurse in the State of Louisiana and served as the administrator of Company 1. In 2015, Medicare audited Company 1 and concluded that Company 1 did not have the proper patient documentation to justify Company 1’s level of billing for hospice services. As a result, Medicare reversed all the claims for hospice services under review in that audit, which amounted to $383,107.26. In connection with that audit, Medicare sent an education letter to May regarding what was required of Company 1 in order to bill for hospice services.

In August 2017, Medicare performed another audit of Company 1 and requested patient documentation for 99 beneficiaries for whom Company 1 submitted claims for purportedly providing hospice care services. May was in charge of gathering the documents requested by the August 2017 audit. After reviewing Company 1’s files for these beneficiaries, May understood that Company 1 did not have the required records to justify Company 1’s billings to Medicare for purported hospice care services for the claims under review.

According to court documents, between August 2017 and October 2017, May admitted that she and other employees of Company 1 altered and falsified patient records to hide the fact that Company 1 lacked required medical records to justify bills submitted to Medicare for purported hospice services for the beneficiaries at issue in the audit. May admitted that she knew that Company 1 employees added the initials of deceased beneficiaries to certain paperwork that Medicare had requested in the audit. May also admitted that she placed white-out on one patient record and created a false note on that record indicating she treated the patient as a nurse in November 2014. May caused the falsified patient records to be submitted to Medicare in response so Company 1 would pass the audit. Despite the falsifications, Medicare nonetheless determined that Company 1’s patient records were still largely deficient.

May faces a possible maximum sentence of 5 years imprisonment, a $250,000 fine, and up to three years supervised release in addition to a $100 special assessment.

U.S. Attorney Strasser praised the work of the Federal Bureau of Investigation, the Department of Health and Human Services, and the Louisiana Attorney General’s Office’s Medicaid Fraud Control Unit for their work investigating the case.

The case is being prosecuted by Jared Hasten of the Criminal Division’s Fraud Section and Assistant United States Attorney Kathryn McHugh.
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