Medicare Fraud | The Health Law Firm Blog

CMS Fights Medicare Fraud With Ban on New Home Health Agencies and Ambulance Suppliers in Three Cities

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare and Medicaid Services (CMS) announced it will temporarily ban new home health providers and ambulance suppliers from enrolling in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three fraud “hot spots.” According to CMS, the six-month moratorium begins July 30, 2013. It applies to newly enrolling home health agencies (HHAs) in Miami, Florida, and Chicago, Illinois. It also applies to newly enrolling ambulance suppliers in Houston, Texas. Existing providers and suppliers can continue to deliver and bill for services. The goal of the ban is to fight healthcare fraud.

Click here to read the press release from CMS.

Authority to impose a moratorium was included in the Patient Protection and Affordable Care Act (PPACA). According to a summary of the anti-fraud provisions in the Affordable Care Act, the Act allows CMS to prohibit new providers from joining the program where necessary to prevent or fight fraud, waste or abuse in certain geographic areas or for certain categories of services. This is the first time CMS is exercising its authority.

Why Moratorium Was Imposed in These Areas.

According to CMS, the decision to impose the moratorium was based on a number of factors, including a disproportional number of providers and suppliers relative to beneficiaries, a quick increase in enrollment applications from providers and suppliers, and extremely high utilization in these areas.

Miami Area a Hot Bed for Healthcare Fraud and Abuse.

The Miami area has stood out as one of the nation’s hubs of Medicare fraud, according to CMS. For example, in May 2013, a Miami patient recruiter for an HHA was sentenced to 37 months in prison for participating in a $20 million Medicare fraud scheme. Click here to read a previous blog. In that same month, workers from a Miami-area HHA were accused of bribing Medicare beneficiaries for their Medicare information, which was used to bill for home health services that were never rendered or not medically necessary. To read more, click here.

According to the Miami Herald, with a large number of elderly Medicare beneficiaries living in Miami, it’s not a surprise that healthcare fraud is so prevalent. South Florida allegedly accounts for one-third (1/3) of all healthcare fraud prosecutions in the nation. Click here to read the entire Miami Herald article.

The Affordable Care Act Offers the Government New Tools to Fight Healthcare Fraud.

In 2011 and 2012, the government reported recovery of $14.9 billion in healthcare fraud judgments, settlements and administrative impositions, according to CMS. In addition, CMS has revoked 14,663 providers and suppliers’ ability to bill the Medicare Program since 2011. The Affordable Care Act seeks to improve anti-fraud and abuse measures by focusing on prevention rather than the traditional “pay-and-chase” model of catching crooks after they have committed fraud. Click here to read a blog on the Affordable Care Act’s other fraud fighting tools.

What This Means for Health Care Professionals and Providers.

By knowing the government is beefing up measures to fight healthcare fraud, providers can attempt to avoid practices that are likely to lead to Zone Program Integrity Contractor (ZPIC) or Recovery Audit Contractor (RAC) audits. Additionally, a provider can be prepared for potential audits by increasing its documentation and compliance efforts.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think of CMS’ decision to invoke the moratorium? Do you think this should have been done sooner? Please leave any thoughtful comments below.

Sources:

Centers for Medicare and Medicaid Services. “CMS Imposes First Affordable Care Act Enrollment Moratoria to Combat Fraud.” CMS.gov. (July 26, 2013). From: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-26.html

Chang, Daniel. “Feds Ban New Home Healthcare Agencies in Miami to Fight Medicare Fraud.” Miami Herald. (July 26, 2013). From: http://www.miamiherald.com/2013/07/26/3524612/feds-ban-new-home-healthcare-agencies.html

Beasley, Deena. “U.S. Bans New Home Health, Ambulance Providers in Three Regions.” Miami Herald. (July 26, 2013). From: http://www.reuters.com/article/2013/07/26/us-medicare-moratoria-idUSBRE96P14P20130726

About the Authors: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Categories: Affordable Care Act, In the Know, In the News, Medicare, Medicare Fraud, The Health Law Firm Blog|Tags: ambulance providers, ban on ambulance providers, ban on home health agencies, Centers for Medicare and Medicaid Services (CMS), Chicago, Children’s Health Insurance Program (CHIP), defense lawyer, healthcare fraud, healthcare fraud hot spots, HHA fraud, home health agencies (HHAs), home health agency (HHA), Houston, medicaid, medicare, Medicare abuse, Medicare defense, Medicare defense attorney, Medicare defense lawyer, Medicare fraud, Medicare schemes, Miami, moratoria, moratorium, RAC audits defense attorney, Recovery Audit Contractor (RAC), the health law firm, Zone Program Integrity Contractor (ZPIC), zpic audit|Comments Off

Phony Medical Equipment Supplier will Spend 30 months in Prison for Medicare Fraud

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The claims were almost all for expensive, high-end power wheelchairs. The man was sentenced on October 5, 2012.

To see the press release from the Department of Justice (DOJ), click here.

Man Owned and Operated a Phony Durable Medical Equipment Supply Company.

In February 2012, the defendant in this case pleaded guilty to owning and operating a fake durable medical equipment (DME) supply company, which he used to submit false claims to Medicare. He would allegedly pay kickbacks to co-conspirators for prescriptions and other documents needed to pull off the fraud. About ninety-five percent (95%) of all of his claims were for power wheelchairs. The wheelchairs were allegedly supplied to Medicare beneficiaries who were illegally solicited by recruiters.

Feds Taps the Brakes on Wheelchair Medicare Fraud.

In September of 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration. Durable Medical Equipment Suppliers (DMES) protested the program because it requires advanced approval prior to the delivery of a power wheelchair to the consumer.

Federal health officials argue that these changes are necessary because eighty percent (80%) of the power wheelchair claims that were submitted in 2011 to Medicare did not meet program requirements, according to the government. That error rate means more than $492 million of improper payments.

I recently wrote on blog on this hot-button topic, click here to read it.

Beware of Patient Recruiters.

We have seen several big cases recently involving prosecution for Medicare fraud in which patient recruiters were involved. It would probably be a good idea, if you are a legitimate Medicare provider, to have nothing to do with patient recruiters. If you are not a legitimate Medicare provider, you don’t care about this anyway.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.
The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid Program and administrative hearings.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think about this story? Please leave any thoughtful comments below.

Sources:

U.S. Department of Justice. “Los Angeles Medical Equipment Supplier Sentenced to 30 Months in Prison for Medicare Fraud Scheme.” FBI. (October 5, 2012). Press Release. From: http://www.justice.gov/opa/pr/2012/October/12-crm-1213.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Oncologist Accused of Billing Medicare for Unnecessary Chemotherapy-Employee Whistleblowers Filed First Claim

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Michigan oncologist is accused of deliberately misdiagnosing patients with cancer so he could allegedly administer chemotherapy treatments and bill the government for those treatments, according to the Department of Justice (DOJ). For more than two years the oncologist allegedly billed Medicare for $35 million in fraudulent claims. The oncologist was charged on August 19, 2013, with one count of Medicare fraud, according to the DOJ.

On top of submitting false claims to Medicare, a criminal complaint alleges a number of other serious charges. These include hiring doctors who may not have been properly licensed to practice medicine, administering controlled substances to patients at dangerous levels, and delaying hospital care for a patient with serious injuries, among others.

The complaint is allegedly based on interviews with several nurse practitioners, medical assistants and another doctor who worked for the oncologist at Michigan Hematology Oncology Centers (MHO), according to the DOJ. These whistleblowers allegedly approached federal authorities with this information.

Click here to read the press release from the DOJ.

We are aware of similar stories regarding dermatologists misdiagnosing lesions as cancer. Some of these have been widely publicized in media reports, television news and magazine stories, such as “American Greed.”

Whistleblowers Come Forward with Serious Charges Against Oncologist.

The oncologist’s employees allege the doctor submitted fraudulent claims to Medicare for medically unnecessary services, including chemotherapy treatments, Positron Emission Tomograph (PET) scans, and a variety of cancer and hematology treatments for patients who did not need them. According to an article in Time, the complaint also alleges the oncologist administered unnecessary chemotherapy to patients in remission, deliberately misdiagnosed patients as having cancer to justify unnecessary cancer treatment, and administered chemotherapy to end-of-life patients who would not have benefitted from the treatment.

The criminal complaint also alleges, according to Time, that the oncologist distributed controlled substances to patients without medical necessity and employed foreign doctors who might have been unlicensed to practice medicine in the U.S.

According to Time, the complaint also cited one case in which the oncologist’s patient fell and hit his head at the oncologist’s office, and was told he needed chemotherapy before he could be taken to the hospital. The patient allegedly later died from the head injury.

Click here to read the entire Time article.

Oncologist Faces Prison Time and Fine.

According to Detroit News, the oncologist could face up to 10 years in prison and a $250,000 criminal fine if convicted. The oncologist has entered a not guilty plea in this case. At this point, these accusations are just that, allegations. A check of the oncologist’s license status from the Michigan Department of Health (DOH) shows that his license is active.

To read the Detroit News article, click here.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Department of Justice. “Oakland County Doctor and Owner of Michigan Hemotology and Oncology Centers Charged in $35 Million Medicare Fraud Scheme.” Department of Justice. (August 6, 2013). From: http://www.justice.gov/opa/pr/2013/August/13-crm-885.html

Pickert, Kate. “Medicare Fraud Horror: Cancer Doctor Indicted for Billing Unnecessary Chemo.” Time U.S. (August 15, 2013). From: http://nation.time.com/2013/08/15/medicare-fraud-horror-cancer-doctor-indicted-for-billing-unnecessary-chemo/

Hunter, George. “Michigan Cancer Doctor Formally Charged in Medicare Fraud Scheme.” Detroit News. (August 19, 2013). From: http://bit.ly/14T8A2A

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Categories: In the News, Medicare, Medicare Fraud, The Health Law Firm Blog, Whistleblower|Tags: chemotherapy, chemotherapy treatment, defense attorney, defense lawyer, Department of Health (DOH), Department of Health and Humans Services (HHS), Department of Justice (DOJ), false billing, false claims, false claims act, legal representation, medicare, medicare audit, Medicare false claims, Medicare fraud, oncologist, qui tam, qui tam lawsuits, the health law firm, unnecessary procedures, whistleblower, whistleblower attorney, whistleblower lawyer, whistleblower protection|Comments Off

Former Daytona Beach Chiropractor Will Spend More Than 15 Years Behind Bars

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A former Daytona Beach chiropractor will spend more than 15 years in federal prison for an alleged health care fraud scheme and illegally prescribing pills, according to the Federal Bureau of Investigation (FBI), Jacksonville Division. He was also ordered to pay more than $2 million in restitution to his victims. The former chiropractor was sentenced on November 29, 2012, by a United States District Judge who called his fraud scheme “sophisticated.”

Click here to read the press release from the FBI.

I previously wrote about this scheme in August 2012, when the former chiropractor was found guilty. To read that blog, click here.

Complex Scheme Involved a Number of Co-Conspirators.

According to the Daytona Beach News Journal, the former chiropractor is thought to have worked with five other doctors in a scheme. The group allegedly split the money they collected from sending inflated bills to insurance companies, including Medicare.

Former Chiropractor Allegedly Prescribed Controlled Substances to Patients.

FBI investigators also accused the former chiropractor of writing prescriptions for controlled substances. Since the man could not prescribe controlled substances, he would use the names of medical doctors who most likely knew their names were being used illegally. It’s believed that there were about a dozen patients who overdosed on controlled substances prescribed by the former chiropractor, according to the Daytona Beach News Journal.

Click here to read the entire Daytona Beach News Journal article.

Effects of Voluntarily Relinquishing a Professional License.

Back in December of 2011, the former chiropractor voluntarily relinquished his license. We almost always counsel our clients to refrain from voluntarily relinquishing their licenses. A voluntary relinquishment of a license in the face of a pending investigation is treated, for all practical purposes, the same as a disciplinary revocation.

The consequences will usually include:

1. Mandatory report to the National Practitioner Data Base (NPDB) (Note: Healthcare Integrity and Protection Data Bank or HIPDB recently folded into NPDB) which remains there for 50 years.

2. Any other states or jurisdictions in which the client has a license will also initiate action against him or her in that jurisdiction. (Note: I have had two clients who had licenses in seven other states).

3. Action to revoke, suspend or take other action against the clinical privileges and medical staff membership of those licensed health professionals who may have such in a hospital, ambulatory surgical center, skilled nursing facility, or staff model HMO or clinic.

4. The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) will take action to exclude the provider from the Medicare Program. If this occurs (and most of these offenses require mandatory exclusion) the provider will be placed on the List of Excluded Individuals and Entities (LEIE) maintained by the HHS OIG.

5. If the above occurs, the provider is also automatically “debarred” or prohibited from participating in any capacity in any federal contracting and is placed on the U.S. General Services Administration’s (GSA’s) debarment list.

6. The U.S. Drug Enforcement Administration (DEA) will act to revoke the

professional’s DEA registration if he or she has one.

7. The board certified health professional’s certifying organization will act to revoke his or her certification.

For more reasons why a health care provider should not relinquish a professional license, click here.

Innocent Until Proven Guilty.

Remember, all person are presumed innocent until convicted in a court of law. In this case, the chiropractor has been convicted in a court of law.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.
Medicare fraud is a serious crime and is vigorously investigated by the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), state Medicaid Fraud Control Units (MFCUs) and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.

The Health Law Firm’s attorneys routinely represent physicians, nurses, chiropractors, medical groups, clinics, pharmacies, home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think this sentence is too steep? Do you think the doctors the former chiropractor worked with will receive the same sentence? Please leave any thoughtful comments below.

Sources:

Pavuk, Amy. “Chiropractor gets 15 Years Prison for Illegally Writing Prescriptions and Healthcare Fraud.” Orlando Sentinel. (November 28, 2012). From: http://www.orlandosentinel.com/news/local/breakingnews/os-chiropractor-painkillers-sentence-20121128,0,60766.story

Federal Bureau of Investigation. “Former Daytona Beach Chiropractor Sentenced to More Than 15 Years in Federal Prison.” FBI. (November 29, 2012). From: http://www.fbi.gov/jacksonville/press-releases/2012/former-daytona-beach-clinic-owner-sentenced-to-more-than-15-years-in-federal-prison

Longa, Lyda. “Judge Sentences Chiropractor Joseph Wagner to 15-Year Term.” Daytona Beach News Journal. (November 28, 2012). From: http://www.news-journalonline.com/article/20121128/NEWS/311289998/1025?p=2&tc=pg

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

By The Health Law Firm|2024-03-14T10:00:41-04:00June 1, 2018|Categories: DEA, Medicare, Medicare Fraud, The Health Law Firm Blog|Tags: board of chiropractic medicine, chiropractor, chiropractor licensing, criminal charges, defense attorney, defense lawyer, Department of Justice, DOJ, Federal Bureau of Investigation (FBI), healthcare fraud, legal defense for chiropractors, legal representation for chiropractors, license relinquishment, medicare, medicare audit, Medicare fraud, Office of Inspector General (OIG) of the Department of Health and Human Services (HHS), painkillers, prescription, quality assurance, U.S. Drug Enforcement Administration (DEA)|Comments Off

New York-Based MRI Company to Pay $3.57 Million Settlement to Resolve False Claims Act Allegations in Whistleblower/Qui Tam Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 27, 2013, the Department of Justice (DOJ) announced a settlement between the government and New York-based Imagimed LLC, its former owners and its former chief radiologist. This $3.57 million settlement resolves whistleblower/qui tam allegations of false reimbursement claims for radiology scans. The payment also settles accusations that the company violated the Stark Law and the Anti-Kickback Statute.

Click here to read the press release from the DOJ.

Imagimed owns and operates 15 magnetic resonance imaging (MRI) facilities under the name Open MRI.

MRI Company Accused of Not Following Proper Safety Precautions and Committing Health Care Fraud.

According to the DOJ, from July 2001 through April 2008, Imagimed, the company’s former owners and the former chief radiologist submitted claims to Medicare, Medicaid and TRICARE for MRI scans performed with a contrast dye without the direct supervision of a qualified doctor, as required by federal regulations.

The DOJ also alleges that from July 2005 to April 2008, Imagimed also had sham on-call arrangements with, and gave improper gifts to referring physicians, which is in violation of the Stark Law and the Anti-Kickback Statute.

Local Radiologist Blew Whistle and Receives a Cut of the Settlement.

According to the Associated Press, a local radiologist filed the lawsuit against Imagimed under the False Claims Act. The radiologist will receive $565,500 for coming forward. To read the Associated Press article, click here.

Whistleblowers stand to gain substantial amounts, sometimes as much as thirty percent (30%), of the amount the government recovers under the False Claims Act (31 U.S.C. Section 3730). Such awards encourage employees and contractors to come forward and report fraud. To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Department of Justice. “MRI Diagnostic Testing Company, Imagimed LLC, and Its Former Owners and Chief Radiologist to Pay $3.57 Million to Resolve False Claims Allegations.” Department of Justice. (August 27, 2013). From: http://www.justice.gov/opa/pr/2013/August/13-civ-958.html

Associated Press. “Federal Authorities Settle MRI Case for $3.75M.” The Wall Street Journal. (August 29, 2013). From: http://online.wsj.com/article/APcf5d7d677786468bb9d446b6c3082e5d.html?KEYWORDS=medicare

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Categories: Medicare Fraud, The Health Law Firm Blog, Whistleblower|Tags: anti-kickback statute, defense attorney, defense lawyer, Department of Justice (DOJ), doctor, false billing, false claims, false claims act, Imagimed LLC, legal representation, medicaid, medicaid audit, Medicaid fraud, medicare, medicare audit, Medicare false claims, Medicare fraud, MRI, Open MRI, physician, qui tam, qui tam lawsuits, radiologist, radiology scans, settlement agreement, stark law, the health law firm, TRICARE, tricare false billing, Tricare fraud, whistleblower, whistleblower attorney, whistleblower lawyer, whistleblower protection|Comments Off

Signing False Medicare Claims Lands Nurse Behind Bars for 30 Months

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Detroit-area registered nurse was sentenced on November 19, 2012, to 30 months in federal prison for his alleged part in a nearly $13.8 million Medicare fraud scheme. According to a Department of Justice (DOJ) press release, he will serve probation after being released from prison. He was also ordered to pay more than $450,000 in restitution, together with his co-defendants.

Click here to read the entire press release from the DOJ.

Nurse Signed Medical Records for Services Never Rendered.

According to the nurse’s plea agreement, from December 2008 through September 2011, he was paid to sign medical records for a home health care agency that billed Medicare for services that were allegedly never rendered. The man reportedly admitted to not seeing or treating the Medicare beneficiaries for whom he signed medical documentation. He also admitted to knowing that the documents he signed were being used for false claims. According to an article from Health Exec News, the man was paid around $150 for each fake file that he signed.

To read the article from Health Exec News, click here.

A Handful of Alleged Co-Conspirators Waiting to Be Sentenced.

Nine alleged co-defendants in this case have pleaded guilty and are waiting to be sentenced, while three others are fugitives and six more are awaiting trial, according to the DOJ. In total, the home health agency was paid close to $13.8 million by Medicare.

This case was investigated by the Federal Bureau of Investigation (FBI) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) as part of the Medicare Fraud Strike Force.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, Department of Justice (DOJ) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think the registered nurse received a sentence that was too harsh? Please leave any thoughtful comments below.

Sources:

Health Exec News. “Medicare Fraud Scheme: Nurse Gets Jail Time for Signing False Claims.” Health Exec News. (November 23, 2012). From: http://healthexecnews.com/nurse-medicare-fraud-scheme

Department of Justice. “Detroit-Area Nurse Sentenced to 30 Months in Prison for Role in $13.8 Million Home Health Care Fraud Scheme.” Department of Justice. (November 19, 2012). From: ttp://www.justice.gov/opa/pr/2012/November/12-crm-1389.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Hawaii Hospital to Pay More Than $451,000 to Resolve Whistleblower/Qui Tam Allegation of Improper Claims

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Wahiawa General Hospital in Honolulu, Hawaii, agreed to pay $451,428 to settle two lawsuits alleging that the hospital improperly billed Medicare, Medicaid and Tricare. The settlement stemmed from a civil whistleblower/qui tam lawsuit. The lawsuit was filed by a doctor who allegedly worked at an outpatient clinic operated by Wahiawa General Hospital, according to the Department of Justice (DOJ). Wahiawa General Hospital signed the settlement agreement on August 29, 2013.

To read the press release from the DOJ, click here.

Whistleblower Receives Money in Settlement and Attorneys’ Fees Paid by Hospital.

According to the DOJ, the federal and state governments alleged that Wahiawa General Hospital wrongfully submitted claims to Medicare, Medicaid and Tricare from April 2008 through March 2011. The investigation was initiated after a doctor alleged the hospital submitted bills for services provided by resident doctors without the level of supervision required by law.

On top of the more than $451,000 settlement, Wahiawa General Hospital agreed to pay $75,000 in attorneys’ fees and costs to the attorneys who represented the doctor. The doctor will also receive more than $84,600 as part of the settlement, under the False Claims Act. To learn more on whistleblower/qui tam cases, read our two-part blog. Click here for part one, and click here for part two.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of whistleblower/qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Associated Press. “Wahiawa General Hospital to Pay $450K Settlement.” Star Advertiser. (August 30, 2013). From: http://www.staradvertiser.com/news/breaking/221856781.html

Department of Justice. “Community Hospital Pays $451,428 to Resolve Allegation of Improper Claims.” Department of Justice. (August 30, 2013). From: http://www.justice.gov/usao/hi/news/1308wgh.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Categories: False Claims Act, Medicare Fraud, The Health Law Firm Blog, Whistleblower|Tags: defense attorney, defense lawyer, Department of Justice (DOJ), doctor, false billing, false claims, false claims act, Hawaii health care fraud, health care fraud, improper claims, legal representation, medicaid, medicaid audit, Medicaid false claims, medicare, medicare audit, Medicare false claims, Medicare fraud, physician, qui tam, qui tam lawsuits, qui tam lawyer, settlement agreement, the health law firm, TRICARE, Tricare false claims, Tricare fraud, Wahiawa General Hospital, whistleblower, whistleblower attorney, whistleblower lawyer, whistleblower protection|Comments Off

South Florida Pharmacy Owner Pleads Guilty to $23 Million Health Care Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks, according to a Department of Justice (DOJ) press release.

Click here to read the entire press release from the DOJ.

Pharmacy Owner Used Kickbacks and Referrals to Allegedly Scam Medicare and Medicaid.

According to court documents, the pharmacy owner allegedly admitted to paying illegal kickbacks to an unnamed number of co-conspirators in return for Medicare and Medicaid beneficiary information. That information was then used to submit fraudulent claims. A majority of the beneficiaries referred to the owner’s pharmacies reportedly resided at assisted living facilities (ALFs) in Miami.

The court documents state that the pharmacy owner also allegedly paid kickbacks to physicians in exchange for prescription referrals which were also billed to Medicare.

Unused and Partially Used Medicine Part of Scheme.

As part of the scheme, the pharmacy owner allegedly instructed drivers working for his pharmacies to pick up unused medications from ALFs around Miami. The medications were then allegedly placed back into pill bottles. Unused and partially used medications were billed back to Medicare and Medicaid, according to court documents.

Click here to read the court documents on this case.

The pharmacy owner and his co-conspirators allegedly submitted more than $23 million in false and fraudulent claims to Medicare and Florida Medicaid programs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think of this case? Is the Miami area just a hotbed for Medicare and Medicaid schemes? Please leave any thoughtful comment below.

Sources:

United States of America v. Jose Carlos Morales. Case Number 12-23374, Preliminary Injunction and Supporting Memorandum of Law. (September 14, 2012). From: http://www.thehealthlawfirm.com/uploads/USA%20v%20Morales.pdf

Department of Justice. “Pharmacy Owner Pleads Guilty in Miami for Role in $23 Million Health Care Fraud Scheme.” Department of Justice . (December 6, 2012). From: http://www.justice.gov/opa/pr/2012/December/12-crm-1461.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Miami “Rock Doc” Arrested on Medicare Fraud Charges

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

An osteopathic physician in Miami, Florida, dubbed the “Rock Doc,” was arrested on September 30, 2013. He is charged with twelve (12) counts of health care fraud, according to the Department of Justice (DOJ). The “Rock Doc” is accused of falsely billing the Medicare program for physical therapy procedures, such as massages and electrical stimulation, which were not necessary. If convicted the doctor faces up to ten (10) years in prison and a $250,000 fine.

Click here to read the press release from the DOJ.

In 2010, this osteopathic physician was the feature of a Wall Street Journal article called “Confidentiality Cloaks Medicare Abuse.” The article looked into the billing practices of the “Rock Doc” and many other doctors performing physical therapy and reaping the reimbursements from Medicare.

The physician’s nickname, “Rock Doc,” stems from his appearance of spiked, punk-styled hair, along with accessories of chains, bangles and leather bracelets.

Indictment Accuses Doctor of Spending Reimbursements on Himself.

According to the indictment, the “Rock Doc” is accused of falsely and fraudulently representing that his physical therapy treatments and services were medically necessary and had been provided to Medicare beneficiaries between December 2007 and August 2009. The indictment also alleges that he used the Medicare payments on himself or others.

To read the indictment against the osteopathic “Rock Doc” physician, click here.

Medicare regulations require that physical therapists billing under a physician must have completed an accredited physical-therapy education program. However, in the Wall Street Journal article, the “Rock Doc” said that he trained his “office girls” to do the work because hiring a physical therapist was too expensive.

Wall Street Journal Article Highlighted Physician’s High Medicare Reimbursements.

According to the Wall Street Journal article released in 2010, the “Rock Doc” admitted to receiving more than $2.6 million from Medicare between 2007 and 2009. His gross payments were allegedly more than 24 times the Medicare income of the average family doctor.

In 2009, Medicare administrators caught onto the doctor’s billing activity and began scrutinizing his bills. That increased oversight led him to sell his business.

According to the Miami Herald, the doctor was currently working at a hospital in Larkin County, Florida, when he was arrested.

To read the Miami Herald article, click here.

Fraud Charges Must Be Taken Seriously.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. There are many times audit investigators must make a judgment on whether overcharges are simply an honest mistake or fraud. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Do you think that being the subject of the Wall Street Journal article back in 2010, the “Rock Doc” basically alerted the government to his fraudulent billing practices? Please leave any thoughtful comments below.

Sources:

Weaver, Jay. “Miami Beach’s ‘Rock Doc’ Busted on Medicare Fraud Charges.” Miami Herald. (September 30, 2013). From: http://www.miamiherald.com/2013/09/30/3660611/miami-beachs-rock-doc-busted-on.html

Department of Justice. “Miami Physician Indicted in Medicare Fraud Scheme.” Department of Justice. (September 30, 2013). From: http://www.justice.gov/usao/fls/PressReleases/130930-01.html

United States of America vs. Christopher Gregory Wayne. Case Number 13-206912. Indictment. (September 30, 2013). From: http://www.thehealthlawfirm.com/uploads/RockDoc.Indictment.pdf

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:52-04:00June 1, 2018|Categories: Health Care Industry, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|Tags: defense attorney, defense lawyer, Department of Justice (DOJ), doctor, false claims, florida health attorney, Florida health lawyer, health care fraud, Health Care Fraud Prevention and Enforcement Action Team (HEAT), health care fraud scheme, health care kickbacks, health law The Health Law Firm, M.D., medically necessary services, medicare, medicare audit, Medicare beneficiaries, Medicare fraud, Medicare fraud scheme, Miami Medicare fraud, Miami Medicare scheme, osteopathic physician, physical therapy fraud, physical therapy services, physician|Comments Off

Tennessee-Based Nursing Care Company Being Investigated for Medicare Fraud

By Danielle M. Murray, J.D.

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer’s centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal.

Click here to read the entire article from the Wall Street Journal.

Therapists Allegedly Encouraged to Perform Unnecessary and Costly Treatments.

According to the federal complaint, the nursing care company is accused of encouraging its employed therapists to perform unnecessary and expensive therapy treatments that were billed to Medicare. The document mentioned specific cases of patients who allegedly didn’t need therapy or could have been harmed by it, but received it anyway.

In addition to Medicare, Tricare was also allegedly billed for high-priced nursing care performed at facilities that are affiliated with the nursing care company.

Company Denies Fraud Accusations.

Representatives from the nursing care company posted an open letter on its website. It calls the lawsuit an attempt by the federal government to target companies that provide rehabilitation therapy services. It also denies the allegations of fraudulent billing.

Click here to read the entire letter.

Two Former Employees File Similar Cases Against Nursing Care Company.

Two former employees filed separate cases against the nursing care company, according to a Times Free Press article. In 2008, a former staff development coordinator working in Tennessee filed a complaint alleging Medicare fraud. In the same year, a former occupational therapist who had worked for the company in Florida, made similar complaints. The government decided to combine their lawsuits and is currently investigating. Be sure to check this blog in the future for updates to this story.

To read the Times Free Press article, click here.

More on Medicare and Medicaid Audits.

The Health Law Firm’s President and Managing Partner George F. Indest III wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat assisted living facility (ALF) and SNF residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. To learn more on the areas being targeted and how to respond to different types of audits, click here for the first blog and here for the second.

Contact Health Law Attorneys Experienced with Medicaid and Medicare Qui Tam or Whistleblower Cases.
In addition to our other experience in Medicare, Medicaid and Tricare cases, attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.

To learn more on our experience with Medicaid and Medicare quit tam or whistleblower cases, visit our website. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do nursing care companies need stricter oversight? Have you noticed an increase in Medicare or Medicaid audits in your practice area? Please leave any thoughtful comments below.

Sources:

Burton, Thomas. “Medicare Fraud is Charged.” Wall Street Journal. (December 3, 2012). From: http://online.wsj.com/article/SB10001424127887323717004578157640024945594.html?mod=googlenews_wsj

Harrison, Kate and South, Todd. “Probe Reveals Claims of Unnecessary Therapies at Cleveland-based Life Care Centers.” Times Free Press. (December 16, 2012). From: http://www.timesfreepress.com/news/2012/dec/16/dying-patients-unneeded-therapy-life-care-center/?print

Life Care Centers of America. “Open Letter to Life Care Associates and Medical Professionals.” Life Care Centers of America. (November 30, 2012). From: http://lcca.com/openletter/

About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.