Eleventh Circuit Explains How Doctor Defrauded Medicare and Medicaid

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Moss was sometimes billing Medicare for services that added up to more than 24 hours a day. He did that on 275 days. And on some days he billed for services that would have taken him more than 70 hours on that day. The services Moss billed on one stellar day would have required him to put in nearly 100 hours in that one 24-hour period.

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In United States Of America v. Douglas Moss, Nos. 19-14548, 19-14565, United States Court of Appeals, Eleventh Circuit (April 12, 2022) the Eleventh Circuit affirmed the conviction, sentence, restitution and forfeiture of millions taken in Dr. Moss’ crime.


Most of the fraud in this case involves claims for visits to nursing homes. For Medicare to pay a claim several requirements must be met. To properly bill Medicare at the physician’s rate for services provided in a nursing home setting, the physician must be the one in the patient’s room directly providing the service to the patient.


Between January 2012 and January 2015 Moss billed 31,714 claims to Medicare for nursing home visits.

If truthful Moss proved Einstein wrong and was able to stop the running of time and work harder than humanly possible.

Moss went to trial. After a seven-day trial, a jury found him guilty on all counts. The court sentenced Moss to 97 months imprisonment, the top of the guidelines range. It also ordered him to forfeit $2,507,623.69 and to pay $2,256,861.32 in restitution.


The Eleventh Circuit admitted that, because Medicare and Medicaid payments are made on the “honor system” it is wide open to fraud perpetrated by health care professionals with no honor. Moss was a provider with no honor. That the scheme succeeded for many years is because the system believes all of the health care professional are honorable and just paid Moss what he asked even when a simple calculation would have shown that that he was billing for 70 hours of service in a single day. Moss made a great deal of dishonest money and is now required to practice medicine in the federal prison. Hopefully this will deter other doctors from trying to emulate his crime.
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Barry Zalma, Esq., CFE is available at http://www.zalma.com and [email protected].

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