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Major Medicare Offender Sentenced to Prison for Multi-Million Dollar Health Care Fraud Scheme

By Lance O. Leider, J.D., The Health Law Firm

The former owner of four mental health facilities in South Florida and North Carolina was sentenced to fourteen (14) years in federal prison on February 25, 2013. The former business owner pleaded guilty to defrauding Medicare out of tens of millions of dollars from 2004 through 2011, according to the Department of Justice (DOJ). He had previously been convicted of cocaine trafficking but decided to move to Medicare fraud supposedly because he thought it would be safer. In total the former mental health facility owner was indicted for defrauding the government of nearly $63 million. As part of his plea, he was ordered to repay $28 million.

Click here to read the press release from the DOJ.

Unnecessary Services, Illegal Kickbacks and Fake Mental Health Records.

The scheme, headed by the former business owner, involved three mental health clinics in Miami, Florida, and one in Hendersonville, North Carolina. All four facilities allegedly billed Medicare and Medicaid for services that were unnecessary or otherwise not provided. The clinics also paid bribes to local assisted living facilities (ALFs) in order to provide a steady stream of patients that were in no need of services. Employees of the clinic would then fabricate entire mental health records for the patients in order to bill the government programs. The former mental health facility owner and his employees allegedly thought that creating the medical records would aid them in avoiding detection by federal auditors, according to an article in the Miami Herald.

To read the Miami Herald article, click here.

Co-Conspirators Feeling the “Heat.”

Fifteen (15) of the former business owner’s co-conspirators have been charged for their alleged roles in the health care fraud scheme. Ten (10) defendants have already pleaded guilty, according to the DOJ.

This case was investigated by the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) and the Medicare Fraud Strike Force. These departments help make up the Health Care Fraud Prevention and Enforcement Action Team (HEAT) that works to stop Medicare fraud across the country.

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 the former business owner’s sentence? Do you think it is enough to deter other would-be criminals from scamming the government? Please leave any thoughtful comments below.

Sources:

Weaver, Jay. “Miami Businessman Who Stole Millions from Medicare Sentenced to 14 Year.” Miami Herald. (February 26, 2013). From: http://www.miamiherald.com/2013/02/26/3254507/miami-businessman-who-pleaded.html

Department of Justice. “Owner of Mental Health Facilities Sentenced to 168 Months in Prison in Connection with $63 Million Health Care Fraud Scheme.” Department of Justice. (February 25, 2013). From: http://www.justice.gov/opa/pr/2013/February/13-crm-234.html

About the Author: 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.

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|2024-03-14T10:00:45-04:00June 1, 2018|Categories: Assisted Living Facilities, In the News, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|Tags: assisted living facility (ALF), defense attorney, defense lawyer, Department of Health and Human Services (HHS), fabricating medical records, false billing, false medical records, Federal Bureau of Investigation (FBI), Florida health care attorney, Florida health care lawyer, Florida Medicare defense attorney, Florida Medicare defense lawyer, health care fraud, Health Care Fraud Prevention and Enforcement Action Team (HEAT), health care fraud scheme, illegal kickbacks, kickbacks, medicare, medicare audit, Medicare beneficiaries, Medicare fraud, Medicare Fraud Strike Force, mental health facility, Office of Inspector General (OIG)|Comments Off

Strike Force Busts 89 People, Mostly Health Care Professionals, in Nationwide Crackdown on Medicare Fraud

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

In a nationwide takedown nearly 100 people, including doctors, nurses and other medical professionals, in eight cities were all allegedly charged in separate Medicare fraud schemes. These individual scams involved approximately $223 million in false billing, according to the Department of Justice (DOJ) and the Department of Health and Humans Services (DHHS). On May 14, 2013, more than 400 law enforcement officials with the Medicare Fraud Strike Force spread out between Miami, Detroit, Los Angeles, New York, New Orleans, Houston, Chicago and Tampa to make the arrests of these 89 people, according to the DOJ.

Click here to read the press release from the DOJ.

Medicare Schemes Could Not Have Happened Without the Help of Health Professionals.

According to an article in Reuters, one out of every four defendants in this crackdown was some type of health professional. Authorities say most of these allegedly complex scams could not have happened without the participation of a doctor signing off on a bogus service, or a nurse filling out false paperwork.

Click here to read the entire article from Reuters.

Florida Health Professionals Involved.

According to the DOJ, in Miami, a total of 25 people, including two nurses and a paramedic, were allegedly part of numerous Medicare scams, totaling about $44 million in false claims. In one case involving a home health agency, defendants allegedly bribed Medicare beneficiaries for their Medicare information, which was used to bill for home health services that were never rendered or not medically necessary. The DOJ believes the lead defendant spent a majority of the money from the scam on luxury cars.

Phony Health Care Clinics Set Up.

In Tampa, nine individuals were charged in a variety of schemes, ranging from pharmacy fraud to health-care related money laundering. According to the DOJ, in one case four individuals allegedly established four health care clinics. The individuals allegedly used these clinics to steal more than $2.5 million from Medicare for surgical procedures that were never performed.

This Marks the Sixth Time the Medicare Fraud Strike Force Has Executed a Nationwide Crackdown.

This crackdown marks the sixth time the Medicare Fraud Strike Force has taken nationwide action against Medicare fraud. To date, the Medicare Fraud Strike Force is credited with making more than 1,500 arrests on charges related to $5 billion in allegedly false Medicare claims since 2007. According to the DOJ, it’s believed Medicare fraud costs the program between $60 billion and $90 billion each year.

Medicare operates under a pay-and-chase system, but according to the Washington Post, authorities are beginning to use new technology that flags suspicious claims before Medicare makes a payment. To read the entire Washington Post article, click here.

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 health care 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 these nationwide crackdowns on Medicare fraud? Do you think they work as a deterrent for others committing health care fraud? Please leave any thoughtful comments below.

Sources:

Department of Justice. “Medicare Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing.” Department of Justice. (May 14, 2013). From: http://www.justice.gov/opa/pr/2013/May/13-crm-553.html

Kennedy, Kelli. “Doctors and Nurses Among Nearly 100 Charged in $223 Million Medicare Fraud Busts in 8 Cities.” Washington Post. (May 14, 2013). From: http://www.washingtonpost.com/politics/health_care/doctors-nurses-among-nearly-100-charged-in-223-million-medicare-fraud-busts-in-8-cities/2013/05/14/fbb0de3a-bcbc-11e2-b537-ab47f0325f7c_story.html

Morgan, David. “U.S. Charges 89 People in $223 Million Medicare Fraud Scheme.” Reuters. (May 14, 2013). From: http://www.reuters.com/article/2013/05/14/usa-healthcare-fraud-idUSL2N0DV3GZ20130514

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.

Health Care Professionals and Providers Beware: The Health Care Fraud Prevention and Enforcement Action Team (HEAT) Is Catching Fire

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

In May 2009, the Department of Health and Humans Services (HHS) and the Department of Justice (DOJ) created the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT’s mission is to focus its efforts on preventing and deterring fraud and to enforce current anti-fraud laws around the country. To date, almost 1,400 individuals have been charged in connection with schemes involving more than $4.8 billion in fraudulent billings in these HEAT takedown operations.

To learn more about HEAT, click here to visit the website.

The Success of the HEAT Team.

According to the website, between 2008 and 2011, HEAT actions led to a seventy-five percent (75%) increase in individuals charged with criminal health care fraud. So far there have been six nationwide HEAT sting operations.

In 2011, HEAT agents led the largest-ever federal health care fraud takedown involving $530 million in fraudulent billing. To read more on this sting, click here.

On May 14, 2013, the DOJ announced that more than 400 law enforcement officials with HEAT spread out between eight cities including Miami and Tampa Bay to arrest 89 people accused of false billing. A majority of these arrests were allegedly of health care professionals. Click here to read a blog with more information on this takedown.

HEAT Captures One of Medicare’s Most-Wanted Fugitives.

On June 1, 2013, a former Los Angeles physical therapy clinic owner, and one of Medicare’s most-wanted fugitives, was arrested by HEAT agents at the Los Angeles International Airport on his return flight. According to a Los Angeles Times article, the clinic owner was an acupuncturist who billed Medicare for $2.1 million in false claims and was paid about $1.2 million. To read more from the Los Angeles Times, click here.

Expanding the Medicare Fraud Strike Force Efforts.

HEAT is a multi-agency team of federal, state and local investigators who combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

The Affordable Care Act has given HEAT additional tools to preserve Medicare by expanding the team’s authority to suspend Medicare payments and reimbursements when fraud is suspected.

To better combat fraud, the government has established HEAT in a number of cities, such as Los Angeles, Miami, Tampa Bay, Houston, Dallas, Chicago, Brooklyn, Baton Rouge and Detroit.

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 health care 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?

Have you heard of HEAT? Do you think the team’s efforts are curbing Medicare fraud around the country? Please leave any thoughtful comments below.

Sources:

Department of Justice. “Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing.” Department of Justice. (May 14, 2013). From: http://www.justice.gov/opa/pr/2013/May/13-crm-553.html

Terhune, Chad. “One of Medicare’s Most-Wanted Fugitives is Arrested in L.A.” Los Angeles Times. (June 3, 2013). From: http://www.latimes.com/business/money/la-fi-mo-medicare-most-wanted-fugitive-arrest-20130603,0,7474342.story

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.

First Year Pioneer ACO Results: Medicare Money Saved But Some Physicians Leave Program

By Lance O. Leider, J.D., The Health Law Firm

On July 16, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a press release summarizing the performance results for the first year of the Pioneer Accountable Care Organization (ACO) Model. Made possible by the Patient Protection and Affordable Care Act (PPACA), the Pioneer ACO Model encourages providers and care givers to deliver more coordinated care ans services for Medicare beneficiaries. ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use health care dollars more wisely, according to CMS.

Click here to read the entire press release from CMS.

Pioneer Model ACOs Increase Quality.

The press release states that all thirty-two (32) participants in the program successfully increased the quality of care received by their beneficiaries. Consequently, each participant received incentive payments for achieving these results.

Some examples of the quality improvements were lower readmission rates and better blood pressure and cholesterol control among diabetic patients. Some examples of the quality control measures that were implemented were:

– dispatch of hospital trained nurses to beneficiaries’ homes for management of prescriptions, blood-sugar readings, healthy eating education and delivery and set up of durable medical equipment (DME); and

– care coordination by trained healthcare professionals at no cost.

Pioneer Model ACOs Increase Savings.

Of the thirty-two (32) Pioneer ACOs, thirteen (13) of them produced shared savings with CMS. This means that they exceeded the cost reduction benchmarks and were eligible to receive a percentage of those savings from CMS as compensation additional to the fee-for-service payments. In total CMS estimates that approximately $87.6 million in Medicare expenditures was saved.

However, two (2) of the Pioneer ACO participants had shared losses. This means that their per beneficiary fee-for-service expenditures exceeded the stated goal and they were required to share in the losses suffered by CMS. These losses were approximately $4 million.

Some Pioneer Model ACOs Withdrawal From Program.

Of the Pioneer ACOs that did not produce shared savings, seven (7) of them have decided to leave the Pioneer program and enroll in the standard Medicare Shared Savings Program. This program offers lower risks and lower rewards and does not have the option of moving to a capitated payment model after the first two (2) successful years.

The two (2) Pioneer ACOs that experienced shared losses with CMS have signaled their intent to withdraw from the ACO model entirely.

The First-Year Pioneer ACO Lesson: Win Some, Lose Some.

While not a total success, the Pioneer ACO program did manage to produce net savings to Medicare and improve the quality of care provided to its beneficiaries. Many news outlets who oppose PPACA are citing this as a failure of the program and yet more bad news for President Obama’s healthcare overhaul. However, many other sources share CMS’s somewhat rosier view of the program. These sources state that while the program may not have been as big a success as hoped, it was only the first year in operation and is nowhere near a failure.

According to an article in American Medical News, the American Medical Association (AMA) supports ACO programs that have allowed physicians practicing in groups of various sizes to participate in new care models. The AMA states that the first-year pioneer results are encouraging, and have the potential to improve quality and decease costs. To read the entire article from American Medical News, click here.

Data should be released on the standard Shared Savings Program ACOs in the near future.

Contact Health Law Attorneys Experienced With Healthcare Business Practices.

The Health Law Firm routinely represents physician groups and practices with issues involving establishing, licensing, selling, merging, and intergroup affiliation. If you are considering establishing an ACO or have been approached to become a participant in one, you can contact The Health Law Firm at (407) 331-6620 or (850) 439-1001 or you can visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of the performance results summery for the first year Pioneer ACO Model? What do you think about the number of groups dropping out? Please leave any thoughtful comments below.

Sources:

Centers for Medicare and Medicaid Services. “Pioneer Accountable Care Organizations Succeed in Improving Care, Lowering Costs.” CMS.gov. (July 16, 2013). From: http://cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html

Fiegl, Charles. “Medicare pioneer ACOs save money but lose physicians.” American Medical News. (July 29, 2013). From: http://www.amednews.com/article/20130729/government/130729933/1/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130729

About the Author: 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.

“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.

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

Miami Medical Clinic Owner Pleads Guilty to $20 Million in Medicare Fraud

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

The owner of a Miami-based medical clinic pleaded guilty on January 8, 2014, for her involvement in several health care fraud schemes that allegedly cost the Medicare program around $20 million. The schemes allegedly involved fraudulent billing for home health care services and therapy prescriptions to patients that may not have required them, according to the Associated Press. The owner operated Merfi Corp., a medical clinic that employed physicians, physician assistants and other medical professionals authorized to dispense prescriptions for home health care services.

Click here to read the Associated Press article.

The medical clinic owner faces up to 10 years in prison and is scheduled to be sentenced in March 2014.

Medicare Fraud Scheme Involved Kickbacks and Brides.

According to an article on Home Health Care News, through Merfi, the owner and her co-conspirators were allegedly given kickbacks and brides for providing fraudulent home health and therapy prescriptions and other medical documentation to owners and operators of other home health agencies and patient recruiters. The fraudulent documents were then used to bill Medicare.

To read the entire article from Home Health Care News, click here.

Case Investigated by Medicare Fraud Strike Task Force.

This case was investigated by the Medicare Fraud Strike Task Force. This task force has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion since the agency’s inception in March 2007. To learn more about the Medicare Fraud Strike Force’s anti-fraud efforts, click here to read a previous blog.

What You Need to Know about Medicare and Medicaid Audits.

I previously wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat home health care, assisted living facility (ALF) and skilled nursing facility (SNF) residents. 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 click here for the second.

Physicians, Nurse Practitioners and Physician Assistants Must Check Out Their Employers.

I have previously written blogs warning licensed health practitioners about illegal health care clinics. Often the individuals involved in fraudulent acts will use an unlicensed health clinic as a vehicle to process false claims. Licensed health professionals should jealously protect their Medicare and Medicaid provider numbers and make sure that they do not allow their name or numbers to be used in false billing activities. Check out any company or corporation that employs you to be sure it is properly licensed, as necessary. To read a previous blog I wrote on unlicensed health clinics, click here.

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 similar schemes are fairly common? Do you think we will see more news stories like this with the increased anti-fraud efforts of the Medicare Fraud Strike Task Force? Please leave any thoughtful comments below.

Sources:

Associated Press. “South Florida Woman Guilty in $20M Medicare Fraud Scheme.” Miami Herald. (January 8, 2014.) From: http://www.miamiherald.com/2014/01/08/3858269/fla-woman-guilty-in-20m-medicare.html

Oliva, Jason. “Miami Clinic Owner Pleads Guilty to $20 Million Home Health Fraud.” Home Health Care News. (January 8, 2013). From: http://bit.ly/1h87Xv4

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|2024-03-14T10:00:54-04:00June 1, 2018|Categories: Medicare, Medicare Audit, The Health Law Firm Blog|Tags: defense attorney, defense lawyer, Department of Justice (DOJ), false claims, Florida health care attorney, Florida health care lawyer, health care fraud, Health Care Fraud Prevention and Enforcement Action Team (HEAT), health care fraud scheme, health care kickbacks, health law, home health care company, kickbacks, medical clinic, medicare, medicare audit, Medicare beneficiaries, Medicare fraud, Medicare fraud scheme, Medicare Fraud Strike Task Force, patient recruiter, the health law firm|Comments Off

CMS Issues Conditions of Participation for Community Mental Health Centers

By Lance O. Leider, J.D., The Health Law Firm

On October 28, 2013, the Centers for Medicare and Medicaid Services (CMS) announced a Final Rule establishing conditions of participation (CoPs) for Medicare-certified community mental health centers (CMHCs). The Final Rule is CMS 3202-F. These conditions are the health and safety regulations Medicare providers must meet in order to participate in the Medicare program and receive reimbursements. The stated purpose of the CoPs is to improve client care, establish requirements for staff and provider operations, and encourage clients to participate in their own treatment. According to CMS, many CMHCs are currently not required to meet any health and safety standards.

To read the Final Rule from the CMS, click here.

A CMHC is a provider that meets applicable licensure and certification requirements in the state in which it is located and provides certain care and services.

Mental Health Centers Must Meet These New CoPs.

CMS finalized six new CoPs. All clients will have a treatment team, an active treatment plan, and coordination of services providing individualized client care. Clients must be provided with an initial evaluation, a comprehensive assessment, and a discharge or transfer plan that identifies each client’s needs and how those needs will be met on a timely basis. Also, CMHCs must use outcome and client satisfaction data to identify specific program needs and improve the quality of care provided. The regulations also promote continuity of care by emphasizing the need for communication with other service providers regarding client needs at the time of discharge or transfer.

In a press release, CMS stated that the new CoPs will help raise standards for the 100 CMHCs that participate in Medicare. The conditions will supposedly ensure a higher quality of care and safety for more than 13,000 Medicare beneficiaries being treated at mental health centers.

Click here to read the press release from the CMS.

Effective Date for New Requirements is October 29, 2014.

The regulations take effect on October 29, 2014. To verify CMHCs are meeting the new requirements, CMS will survey these centers at least once every five years. However, if CMS receives a complaint on a CMHC, surveys may occur more frequently. Considering the scrutiny that has been applied recently to the provision of mental health services, we expect surveys to be much more frequent.

Contact Health Law Attorneys Experienced in the Mental Health Counselors, Therapists and Facilities.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers and family therapists in Department of Health (DOH) investigations, FBI investigations, audits and other types of investigations of health professionals and providers. Our attorneys also represent community mental health centers and other types of mental health facilities.

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

Comments?

What do you think of the new CoPs for CMHCs? How do you think these conditions will improve patient care? Please leave any thoughtful comments below.

Sources:

Centers for Medicare and Medicaid Services. “CMS Issues New Patient Safety Standards for Community Mental Health Centers.” CMS. (October 28, 2013). From: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-10-28.html

Bourque, Dianne. “CMS Finalizes Conditions of Participation for Community Mental Health Centers.” American Health Lawyers Association. (November 5, 2013).
About the Author: 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.

“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|2024-03-14T10:01:09-04:00May 15, 2018|Categories: CMS, Mental Health Centers|Tags: Centers for Medicare and Medicaid Services, CMCH regulations, CMHC, CMHC certification, CMHC licensure, community mental health centers, conditions of participation, CoP, defense attorney, defense lawyer, Final Rule, florida health attorney, Florida health lawyer, health law firm, medicare, Medicare beneficiaries, Medicare CoP, Public Health Service Act, the health law firm|Comments Off

Doctor Dubbed “King Of Nursing Homes” Downplayed Patient Harm From Illegal Kickback Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 8, 2016, federal prosecutors blasted Dr. Venkateswara Kuchipudi, a Chicago physician nicknamed the “King of Nursing Homes,” convicted of sending nursing home patients to a hospital he believed was subpar allegedly in exchange for free staff. According to prosecutors, the doctor attempted to “whitewash his actions” when asking for a lenient sentence and caused actual harm to patients to satisfy his “callous greed” (words prosecutors reportedly used).

Prosecutors argued that U.S. District Judge Matthew Canaille should give Dr. Venkateswara Kuchipudi a sentence that reflects how vulnerable his victims were and how much Dr. Kuchipudi profited from billing insurers for the work he didn’t pay his staff to do. In March 2016, Dr. Kuchipudi was convicted of a charge related to the illegal kickback scheme. Click here to read more.

The “King of Nursing Homes”

Dr. Kuchipudi earned the nickname “King of Nursing Homes,” from the hundreds of nursing home patients he treated and allegedly from accepting kickbacks for referring Medicare patients to Sacred Heart Hospital (in the Chicago area) in exchange for staff in 2016. The victims of Kuchipudi’s kickback scheme were “elderly and physically and/or mentally impaired nursing home-bound patients,” whose vulnerability gave Kuchipudi “nearly limitless discretion” over where they were treated, the government said in a sentencing memorandum. Dr. Kuchipudi allegedly chose a hospital he constantly criticized as “substandard” and that was located far from many of his patients, prosecutors said. Click here to read the sentencing memorandum in full.

Jeopardizing Quality of Care.

The government pointed out the victims at were brought to Sacred Heart Hospital on Dr. Kuchipudi’s orders, despite it not being the closest hospital, when they were suffering conditions that could have been life threatening, including heart attack, embolism and stroke. Other patients were forced to undergo unnecessary testing, stay at the hospital longer than necessary or, in one case, stay nine days to wait for surgery because the hospital lacked the proper equipment.

“Kuchipudi should never have sent an elderly patient with a broken hip to Sacred Heart if Sacred Heart did not have the equipment, such as a surgical table, already in place to provide necessary patient care,” the government said. “The table should wait for the patient. The patient should not have to wait nine days for the table.”

Additionally, Dr. Kuchipudi refused to work weekends or take calls at night, but wouldn’t let other doctors see his patients, so that he himself could bill for them, the memorandum states. Eventually Sacred Heart had to hire another doctor to take on Dr. Kuchipudi’s patients, for which he would then bill (according to prosecutors). This, by itself, would probably violate the Anti-Kickback Statute. According to prosecutors, when he was at the hospital, he would see his patients for 10 to 15 minutes total and make no notes, leaving the work to physician assistants and nurses.

He would often bill Medicare for the work done by these other physician assistants, nurses and the doctor the hospital hired for his patients, as if he did the work himself, the government stated.

In addition to having Sacred Heart pay for Dr. Kuchipudi’s staff, the physician received “well over $750,000” from insurers for their labor, the government said. As the kickback is more than $550,000, the offense level under the sentencing guidelines should increase, according to prosecutors.

Kuchipudi’s sentencing memorandum showed no signs of his acknowledging or feeling remorse for his crimes, the government said. Click here to read more.

To read a prior blog I wrote on illegal kickback schemes, click here.

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.

Sources:

Kass, Dani. “’King Of Nursing Homes’ Downplayed Patient Harm, Feds Say.” Law360. (August, 8, 2016). Web.

Eltagouri, Mawra. “Doctor known as ‘king of nursing homes’ convicted in kickback scheme.” The Chicago Tribune. (March 16, 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: King of Nursing Homes, Medicare fraud scheme, Medicare audit, submitting false claims, Department of Justice (DOJ), health care fraud scheme, illegal kickback scheme, Medicare beneficiaries, services not rendered, unnecessary tests and procedures, improper billing, nursing home health facilities, health care kickbacks, Florida health care lawyer, 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.

By The Health Law Firm|2024-03-14T10:01:12-04:00May 15, 2018|Categories: Health Facilities Law Blog|Tags: Department of Justice (DOJ), health care fraud scheme, illegal kickback scheme, King of Nursing Homes, medicare audit, Medicare beneficiaries, Medicare fraud scheme, services, submitting false claims|Comments Off