Two Nursing Home Co-Conspirators Sentenced in $19 Million Fraud Kickback Scheme

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

On July 9, 2018, two co-conspirators in a $19.4 million healthcare fraud scheme involving a nursing home chain, American Senior Communities, were sentenced in Indiana federal court. Both pled guilty to various conspiracy and money laundering charges.

The Multi-Million Dollar Scheme.

Prosecutors allege that the men reached side deals with vendors who handled things like nurse call systems, food and medical supplies for the nursing home chain. According to the U.S. Department of Justice (DOJ), the kickback scheme generated nearly $19.4 million that the men spent on vacation homes, private planes, golf trips, Rolex watches, gold bullion and casino chips. Both were charged in 2016, along with two others for their roles in the same scheme. Read more about their involvement here.

The Sentencing.

The DOJ said Steven Ganote received a five-year sentence with two years of supervised release and was ordered to pay $7 million in restitution. Additionally, Joshua Burkhart was handed a four-month sentence with two years of supervised release and ordered to pay $420,000 in restitution. Each of the men is charged with one count of conspiracy to commit mail, wire and health care fraud, money laundering and conspiracy to violate the Anti-Kickback Statute (AKS).

To learn more about these types of illegal kickback schemes, click here to read one of my prior blogs on health care fraud.

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

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, 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.

 

Sources:

Fowler, Haylay. “Nursing Home Schemer Sentenced In $19M Kickback Scheme.” Law360. (July 9, 2018). Web.

Kass, Dani. “Ex-Nursing Home Execs Indicted In $16M Kickback Scheme.” Law360. (October 12, 2016). Web.

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.

KeyWords: Medical billing fraud, fraudulent billing representation, fraudulent billing attorney, representation for overbilling, representation for submitting false claims, False Claims Act (FCA) violations, representation for submitting false claims, false claims lawyer, FCA defense attorney, Anti-Kickback Statute(AKS) violations, AKS representation, AKS attorney, representation for fraudulent reimbursement, representation for illegal kickback scheme illegal kickback scheme attorney, legal representation for health care professionals, health fraud defense lawyer, health law defense attorney, health law, The Health Law Firm

“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 © 2018 The Health Law Firm. All rights reserved.

Home Health Care Company Admits to FCA Violations, Agrees to Pay Millions

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On July 7, 2016, a Kentucky-based home health care chain, MD2U Holding Co. (MD2U), agreed to pay up to $21.5 million and admit False Claims Act (FCA) violations. According to the U.S. Department of Justice (DOJ), the deal is in connection with “extreme” billing practices that saw Medicare billed for false and unnecessary treatments.

The Complaint.

According to a complaint filed, MD2U frequently utilized billing codes reserved for the highest level of treatment when delivering primary care services in residential settings. The frequency with which the codes were used by MD2U made the company an “extreme outlier” among Medicare providers, the complaint said. The DOJ also described several other aspects of MD2U’s scheme. For example, it said that MD2U overbilled Medicare by “embellishing and, at times, fabricating the homebound and home-limited status of its patients.” “MD2U’s corporate culture was a one-code-fits-all mentality,” regardless of medical necessity, the DOJ wrote.

Click here to read the complaint in full.

The Deal.

MD2U and its various subsidiaries struck a deal with the DOJ that denies any intentional wrongdoing but also accepts responsibility for the submission of false claims from the time frame of mid-2007 to late 2014. The fraudulent overbilling was “due in part to the actions of a former employee,” according to a consent judgment. Click here to read the consent judgement in full.

MD2U, which also operates in Florida, agreed to dish out $21.5 million through a payment structure. Specifically, MD2U agreed to an up front payment sum of $300,000 and guaranteed payments over the next five years totaling $3 million. Additionally, MD2U also promised to hand over 25 percent to 50 percent of its net income annually through the year 2021. Click here to read the DOJ’s press release.

To learn more about the repercussions of fraudulent overbilling, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), 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.

Sources:

Overley, Jeff. “Home Care Co. Inks $21.5M FCA Deal Over ‘Extreme’ Billing.” Law360. (July 7, 2016). Web.

Greer, Carolyn. “MD2U, owners admit violating federal law, agree to pay millions.” Louisville Business Journal. (July 8, 2016). Web.

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.

KeyWords: Home health care, Health care fraud defense lawyer, False Claims Act (FCA) violations, False Claims Act defense attorney, submitting false claims to the government, fraudulent reimbursements, fraudulent overbilling, unnecessary medical tests and procedures, questionable billing practices, U.S. Department of Justice (DOJ) prosecutions for healthcare fraud, civil monetary penalties lawyer, Medicare audit defense attorney, Medicare appeal legal, Medicare claims appeals lawyer, Medicare defense attorney, federal administrative complaint defense lawyer, home health care legal counsel, Medicare investigation defense, health law attorney, Florida health law attorney, The Health Law Firm

“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 © 2016 The Health Law Firm. All rights reserved.

Florida Federal Judge Triples Award to $347 Million in Rare Whistleblower Case

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

On March 1, 2017, a Florida federal judge tripled a $115 million damages award for the government to $347 million after a jury found that the operators of 53 nursing facilities submitted false claims to Medicare and Medicaid. U.S. District Judge, Steven D. Merryday, upheld the jury’s $115 award affirming that the operators of the 53 nursing facilities had violated the False Claims Act (FCA). The case is U.S. ex rel. Ruckh v. CMC II LLC et al., case number 8:11-cv-01303, in the U.S. District Court for the Middle District of Florida.

The whistleblower in the case, Angela Ruckh, a former nurse at two of the facilities, brought the allegations against four defendants that they had submitted false claims and fraudulent records to the government. The four defendants in the case are CMC II LLC, Salus Rehabilitation LLC, 207 Marshall Drive Operations LLC and 803 Oak Street Operations LLC.

Details of the Case.

On February 15, 2017, the jury found that the four defendants had falsely increased the amount of resources needed for their patients needed, in order to get more money from Medicare and Medicaid. In the jury’s verdict, the four defendants were ordered to pay $115 million in damages for violating the FCA. Click here to read the jury’s verdict in full.

Treble Damages for FCA.

This rare FCA case that both went to trial and received a jury verdict, called for treble damages. The four defendants received penalties proportionate to the jury’s allocated findings. Sea Crest Health Care Management, L.L.C. and CMC II, LLC were ordered to pay $291,160,608 to the U.S. government and $39,897,291 to the Florida government. Salus Rehabilitation LLC was required to pay $484,000 to the U.S. government. 207 Marshall Drive Operations L.L.C. incurred $6,266,424 of damages owed to the federal government and 803 Oak Street Operations, LLC was penalized $10,055,961 to be paid back to the U.S. government. Click here to read the order from this case in full.

To learn more about FCA violations and cases of fraud involving a relator or whistleblower, click here to read one of our prior blogs.

Nurses and Other Employees Are Often Whistle Blowers in These Big Cases.

It is often a nurse or other health professional employed by the facility that is the whistle blower in such cases. They are in a position to know whether or not services are being provided and whether or not they are medically necessary. They are often in a position to see if false bills are being submitted for the patients.

In a case such as this one, where the U.S. did not intervene to take the case forward and the whistleblower and her attorneys did, she can receive an award of up to thirty percent (30%) of the recovery or $104,100,000.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim.

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

Sources:

Smith, Mara. “Florida Judge Trebles Award to $347 Million in Whistleblower Case.” AHCA. (March 1, 2017). Web.

Bolado, Carolina. “Judge Triples Nursing Home Cos.’ Fraud Penalty To $347M.” Law360. (March 6, 2017). Web.

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.

KeyWords: False Claims Act (FCA) violations, FCA defense attorney, Medicare and Medicaid fraud defense attorney, Medicare false claims, legal representation for FCA violations, legal representation for overbilling Medicare and Medicaid, legal representation for submitting false claims to the government, Legal representation for Medicare fraud, legal counsel for Medicare audit, legal representation for whistleblower, qui taim, qui tam suits, qui tam relator, whistleblower defense attorney, Medicare fraud defense attorney, Medicaid fraud defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Florida Federal Judge Triples Award to $347 Million in Rare Whistleblower Case

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

On March 1, 2017, a Florida federal judge tripled a $115 million damages award for the government to $347 million after a jury found that the operators of 53 nursing facilities submitted false claims to Medicare and Medicaid. U.S. District Judge, Steven D. Merryday, upheld the jury’s $115 award affirming that the operators of the 53 nursing facilities had violated the False Claims Act (FCA). The case is U.S. ex rel. Ruckh v. CMC II LLC et al., case number 8:11-cv-01303, in the U.S. District Court for the Middle District of Florida.

The whistleblower in the case, Angela Ruckh, a former nurse at two of the facilities, brought the allegations against four defendants that they had submitted false claims and fraudulent records to the government. The four defendants in the case are CMC II LLC, Salus Rehabilitation LLC, 207 Marshall Drive Operations LLC and 803 Oak Street Operations LLC.

Details of the Case.

On February 15, 2017, the jury found that the four defendants had falsely increased the amount of resources needed for their patients needed, in order to get more money from Medicare and Medicaid. In the jury’s verdict, the four defendants were ordered to pay $115 million in damages for violating the FCA. Click here to read the jury’s verdict in full.

Treble Damages for FCA.

This rare FCA case that both went to trial and received a jury verdict, called for treble damages. The four defendants received penalties proportionate to the jury’s allocated findings. Sea Crest Health Care Management, L.L.C. and CMC II, LLC were ordered to pay $291,160,608 to the U.S. government and $39,897,291 to the Florida government. Salus Rehabilitation LLC was required to pay $484,000 to the U.S. government. 207 Marshall Drive Operations L.L.C. incurred $6,266,424 of damages owed to the federal government and 803 Oak Street Operations, LLC was penalized $10,055,961 to be paid back to the U.S. government. Click here to read the order from this case in full.

To learn more about FCA violations and cases of fraud involving a relator or whistleblower, click here to read one of our prior blogs.

Nurses and Other Employees Are Often Whistle Blowers in These Big Cases.

It is often a nurse or other health professional employed by the facility that is the whistle blower in such cases. They are in a position to know whether or not services are being provided and whether or not they are medically necessary. They are often in a position to see if false bills are being submitted for the patients.

In a case such as this one, where the U.S. did not intervene to take the case forward and the whistleblower and her attorneys did, she can receive an award of up to thirty percent (30%) of the recovery or $104,100,000.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim.

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

Sources:

Smith, Mara. “Florida Judge Trebles Award to $347 Million in Whistleblower Case.” AHCA. (March 1, 2017). Web.

Bolado, Carolina. “Judge Triples Nursing Home Cos.’ Fraud Penalty To $347M.” Law360. (March 6, 2017). Web.

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.

KeyWords: False Claims Act (FCA) violations, FCA defense attorney, Medicare and Medicaid fraud defense attorney, Medicare false claims, legal representation for FCA violations, legal representation for overbilling Medicare and Medicaid, legal representation for submitting false claims to the government, Legal representation for Medicare fraud, legal counsel for Medicare audit, legal representation for whistleblower, qui taim, qui tam suits, qui tam relator, whistleblower defense attorney, Medicare fraud defense attorney, Medicaid fraud defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

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