Articles Posted in Medicaid and Medicare Fraud

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Five Tampa Bay area residents are facing charges due to an alleged  billion-dollar telemedicine scheme.

Starting in 2015, the men and their pharmacy companies are accused of setting up an elaborate scheme that fraudulently solicited insurance coverage information and prescriptions from tens of thousands of consumers across the country, according to a 40-page indictment. They then are accused of using the information to sell pain creams and other similar products.

Doctors apparently approved the prescriptions not knowing that the men and their companies had “massively marked up the prices” of the invalidly prescribed drugs, federal prosecutors said. For instance, several of the pharmacies paid $27 for a lidocaine numbing ointment and billed up to $381, an increase of more than 1,300 percent.

Police allege the men “directed their employees to ‘test bill’ or ‘phish’ for the highest reimbursement items” to ensure the most profit. According to the indictment, “These employees routinely submitted claims … for this purpose, contrary to one of more provider agreements.”

Federal prosecutors believe the alleged scheme bilked $174 million from private health care companies, including Blue Cross Blue Shield. In addition, the five men and their companies allegedly submitted at least $931 million in fraudulent claims.

The five men and their companies face a total of 32 counts. All four men were charged with mail fraud, conspiracy to commit health care fraud and introducing misbranded drugs into interstate commerce. If convicted, they face up to 20 years in prison for each mail fraud charge, up to 10 years for each conspiracy charge and up to three years for the third charge. They and their companies could also be required to forfeit up to $154 million.

Last week, four of the men were released on bond after appearing in a federal courtroom in Tampa’s Middle District of Florida. The indictment was filed in the Eastern District of Tennessee.

The fifth man charged has already pleaded guilty to felony conspiracy for his role in the case, according to a statement from the U.S. Attorney’s Office in Tennessee.

He also pleaded guilty to conspiring to commit wire fraud in a separate case.

While the man faces up to 5 years in prison for each conspiracy charge, helping federal prosecutors with the case against the other men could help reduce his sentence.

At Whittel & Melton, our Tampa Bay area Health Care Fraud Defense Attorneys handle criminal cases in Tampa and throughout the U.S. We represent health care practitioners, including doctors, nurse practitioners, therapists, clinics, hospitals, providers of medical equipment and billing companies facing criminal charges with the federal government, including:

  • Overbilling for services
  • Billing for services or tests not rendered
  • Prescribing unnecessary or additional services in order to bill more
  • Incorrectly reporting diagnoses, treatments or procedures to increase payments
  • Unbundling billed services
  • Using false billing codes
  • Submitting duplicate claims
  • Changing dates, services or names of patients on claims
  • Altering medical records or reports
  • Referral kickbacks or self-referrals

Health care fraud may be investigated by the FBI, the state Attorney General’s office, U.S. Postal Service or the Office of the Inspector General. Regardless of what department your case is being pursued by, we can apply the best possible defense strategy with the hopes of securing the best possible outcome.

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A Clearwater doctor has pleaded guilty to one count of health-care fraud and has agreed to surrender her DEA registration number, her Florida medical license and to a permanent exclusion from Medicare and Medicaid programs, according to the justice department.

The 66-year-old woman violated a Florida law that requires doctors to perform an in-person office visit and examine the patient before prescribing a Schedule II controlled substance, according to the Department of Justice.

The woman owned a pain management clinic on Druid Road East in Clearwater.

From as early as July 2011 through December 2017, she billed Medicare for face-to-face patient visits to prescribe controlled substances like oxycodone, but some of those visits didn’t take place on those dates, according to the Department of Justice. Instead, she filled the prescriptions for patients’ families who came by her office, without examining the patients.

She also submitted at least $51,500 false and fraudulent Medicare claims, according to a department of justice news release.

The case was investigated by the Opioid Fraud and Abuse Detection Unit.

Being a healthcare professional means you are subject to extensive regulations and civil statutes. If you fail to comply with the current health care regulations, you can expect to be the target of a federal prosecution. Our Tampa Bay Medicare Fraud Defense Attorneys at Whittel & Melton can help you fight allegations of health care fraud, including allegations relating to:

  • Medicare fraud
  • Medicaid fraud
  • Billing fraud
  • Kickbacks and Gratuities
  • Bribes
  • Conflicts of interest

Prosecutors also file charges against health care providers who allegedly lie about the number of patients they treat or the types of services they perform. We are ready and able to defend doctors and other healthcare professionals who find themselves wrapped up in such inquiries.

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A Columbus doctor has been indicted as part of the nation’s largest health-care fraud enforcement action by the federal government, according to reports.

The 44-year-old Columbus podiatrist was indicted on June 19 in the Southern District of Florida and charged with one count of conspiracy to defraud the United States and receive health-care kickbacks and three counts of receiving health-care kickbacks.

The man’s charges are part of a broader investigation by the Medicare Fraud Strike Force and includes 601 defendants across 58 federal districts, including 76 doctors, as well as nurses and other licensed medical professionals. They are accused of participating in health-care fraud schemes involving approximately $2 billion in false billings.

According to the man’s indictment, he allegedly received kickback payments from PGRX, a Weston, Fla.-based business that recruited and paid doctors to prescribe compounded medications for TRICARE and private commercial insurance beneficiaries.

During the course of the conspiracy, the man and his co-conspirators allegedly signed false medical director and speaker agreements in order to conceal that PGRX was paying the defendant for writing prescriptions, according to the indictment. As a result of these prescriptions, TRICARE made payments to Atlantic Pharmacy, a pharmacy located in the Southern District of Florida.

Medicare fraud is classified as a felony as well as a federal crime that carries some pretty steep penalties, both criminal and civil. The monetary liabilities can be huge. The possibility of being held accountable for Medicare, Medicaid, Tricare, and other health care fraud means you need to be proactive in your defense strategy and seek expert legal help right away. You could be branded a criminal and lose everything you have worked so hard to create in your career as a medical professional.

Regardless of how organized your practice and its operations are, the chances of being audited by Medicare are quite real, especially if you have a successful practice and submit high volume claims to the Centers for Medicare and Medicaid Services (CMS). Keep this in mind: according to government statistics, claims of approximately $50 billion per year are considered suspicious and subject to Medicare fraud investigation.

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A physician and two nurses have been convicted of health care fraud in what authorities claim was a $12 million plus Medicare billing scam.

On Friday, a federal jury in Dallas convicted a 70-year-old doctor and a 47-year-old nurse of conspiracy to commit health care fraud. Both were also convicted of three counts of health care fraud.

Another nurse, 42, was convicted of four counts of health care fraud.

Prosecutors believe the scheme ran from 2007 through 2015. The trio was convicted of defrauding Medicare through false claims through a home health agency and a physician house call company. Evidence showed medically unnecessary home health services were ordered and often not provided.

Sentencing is pending.

The government is aggressively cracking down on Medicare fraud throughout the country like never before. These cases usually mean the government has been investigating a clinic, doctor or facility for months, maybe even years. The government performs a hard investigation into patients’ procedures and billing to find any errors. At Whittel & Melton, our Medicare Fraud Defense Attorneys are here to protect you from the consequences of a conviction. We will help you fight Medicare fraud charges head on.

The most common types of Medicare fraud charges include:

  • False invoicing
  • Improper coding
  • Billing for medical services not provided to the patient
  • Charging for unbundled services
  • Charging for medical devices not provided
  • Billing for patients that do not exist
  • Multiple billings of the same procedure

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A Fort Myers doctor has apparently admitted to defrauding taxpayer-supported Medicare and Tricare by receiving kickbacks for prescribing certain durable medical equipment and pain medications.

The doctor pleaded guilty in federal court Friday to taking more than $470,000 in illegal payments from the supplies and pharmacy businesses between 2010 and 2016, court documents show.

Investigators say the physician paid medical supplier A&G Spinal Solutions $50,000 to put his wife on their payroll and give her 10 percent of the profit stemming from equipment referrals he made to them.

According to related court documents, two co-conspirators and managing partners in the supply business needed the money to pay a tax bill of that same amount. Both have pleaded guilty to their roles in the scheme.

The physician also put together a similar arrangement with an unnamed co-conspirator to receive a share of prescription sales, according to reports.

Finally, between 2013 and 2015, the doctor allegedly received kickbacks from sales representatives and other employees to receive fees for his participation in “largely bogus” speaker event programs, the plea agreement states.

Medicare fraud charges are not uncommon in today’s times. Thousands of unsuspecting and innocent health care providers are forced to defend their actions or face serious criminal consequences every day. Many of these investigations are the result of unfair and overzealous state and federal officials. These federal agents and regulators, who specialize in health care fraud, will raid a practice and demand health care records, computers, etc. and then tell the doctors they are basically out of business. The important thing to understand is that you must assert your rights.

The best reaction you can have is to call an attorney that is skilled in health care fraud. Our Florida Medicare Fraud Defense Attorneys specialize in health care fraud and can establish a strong defense against these allegations. We understand that healthcare providers are dedicated to their line of work and deserve the most powerful defense when their integrity and actions are called into question.

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A chain of podiatry clinics in St. Louis settled with the federal government for $125,000 for Medicare fraud on false claims from 2010 to 2016.

The clinics apparently knowingly billed Medicare for medically necessary toenail removals, when the services provided were routine nail clippings that are not covered by the government insurance program for people older than 65 and others with disabilities, according to the U.S. Department of Justice.

The president of the company issued the following statement:

After becoming aware almost five years ago of some billing errors, we successfully worked with the government to correct this. At all times we have been, and remain in good standing with Medicare. We appreciate that the government worked constructively and cooperatively with us to resolve this matter.

The podiatry clinic has six locations in the St. Louis area: Brentwood/Clayton, Chesterfield, Creve Coeur, Shrewsbury, St. Peters and Ballwin/Valley Park.

Under the settlement, the clinic will repay the government $125,000 for the false claims. The company also signed a three-year agreement with the government for extra oversight in its compliance with Medicare regulations.

The U.S. attorney’s office for the Eastern District of Missouri announced the settlement on Monday.

Toenail care for older Americans is a common source of Medicare fraud. About one-fourth of the podiatry services paid out by Medicare are for nail debridement (removal of a diseased toenail), according to a 2002 report from the U.S. Department of Health and Human Services’ Office of Inspector General.

The investigation found that nearly one-fourth of the nail debridements paid out by Medicare were not justified medically, for an estimated $51.2 million in inappropriate payments in 2000. An additional $45.6 million was paid out in unnecessary related services, according to the report.

Medicare fraud is a very serious charge that carries very real civil and criminal consequences, including stiff monetary fines and the possibility for jail time. If you are a Florida doctor, medical clinic, hospital, or even a recipient of Medicare benefits, and you have been accused of Medicare fraud, you need representation from an experienced and and qualified Medicare Fraud Defense Attorney at Whittel & Melton who is familiar with these types of cases.

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The Department of Justice recently announced that a Las Vegas medical practice will pay $1.5 million to settle allegations that they violated the False Claims Act through illegal billing.

The settlement involved allegations that from January 1, 2006 through May 31, 2011, the practice violated the False Claims Act by billing federal healthcare programs, including Medicare and the U.S. Department of Veterans Affairs, for surgical services that were never actually rendered to its cardiac patients.

The allegations further state that the practice billed for more expensive surgical, evaluation and management services than were provided.

No liability has been determined in this case.

The second case comes from suburban Illinois where a physician has been indicted on federal fraud charges for allegedly receiving almost $1 million in Medicare and private insurer payments for services that apparently never happened.

The physician is the subject of a 12-count indictment alleging that he submitted fraudulent claims for medical tests and examinations that were never performed, as well as used some patients’ names without their knowledge to submit fraudulent claims, according to the DOJ. The indictment claims that from 2008 to 2013, the physician fraudulently obtained, or caused his clinic to obtain, at least $950,000 in payments from Medicare and Blue Cross and Blue Shield of Illinois.

The man is charged with seven counts of healthcare fraud, three counts of making false statements in relation to a healthcare matter, and two counts of aggravated identity theft.  

Health care providers and institutions have a wide range of rules and guidelines they must abide by. Many people forget that these facilities are businesses and must operate as so while providing medical care to patients. Because of ever changing criminal laws and extensive regulations and civil statutes, we have seen an upward rise of doctors, hospitals and medical professionals subject to allegations of health care fraud in the recent years.

Prosecutors actively pursue health care providers who allegedly lie about the number of patients they treat or the types of services they perform, as well as for referring patients to a facility in which the physicians have a hidden financial interest. On that same note, a doctor who receives payment from a company whose medical products they use could potentially face federal prosecution if the payment is used as a kickback or bribe to keep the doctor using the product in question. Medical device distributors and manufacturers can also find themselves under fire for healthcare fraud in these situations. The reality is that there are a plethora of potential pitfalls that plague health care workers and providers on a daily basis.

If you have found yourself ensnared in a federal health care or Medicare fraud investigation, let our Florida Medicare Fraud Defense Attorneys at Whittel & Melton guide you through what to expect. We handle civil and criminal health care fraud matters throughout the state of Florida.

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An Arizona medical company that serves thousands of cancer patients is battling a federal lawsuit alleging that it ripped off Medicare and other government programs with millions of dollars in fraudulent charges.

The whistleblower complaint moving through U.S. District Court says principals at Arizona Center for Cancer Care improperly collected nearly $8 million from U.S. health care agencies since 2011.

The lawsuit alleges AZCCC engaged in double billing, charged for unnecessary medical services and overcharged for testing and treatments.

The Peoria-based company, known legally as Arizona Center for Hematology and Oncology PLC, has 35 offices in Maricopa County, with 65 physicians specializing in oncology, urology, hematology and gynecological oncology. The company advertises treating more than 30,000 patients.

The civil action was filed in 2016 under the federal False Claims Act by the company’s billing manager, who asserts that he repeatedly warned AZCCC its charging methods were improper and excessive.

Civil charges of Medicare fraud can lead to criminal charges as well. Health care providers found to have committed Medicare fraud face pretty severe penalties and major consequences. In most cases, offenders will be required to repay the overpayments, along with hefty fines. Criminal prosecution by the federal government is also highly likely. The usual prison term is up to five years for each offense, which can add up to a lot very quick.

Our Florida Medicare Fraud Defense Attorneys at Whittel & Melton defend patients, doctors, medical clinics, nursing homes, assisted living facility personnel, and all other healthcare personnel accused of filing fraudulent Medicare claims for supposed non-qualifying health care services. We know Medicare fraud is one of the most serious charges a health care provider may ever face.

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A 63-year-old New Orleans woman has been sentenced to two years and eight months in prison for her part in a $3.2 million Medicare fraud and kickback scheme.

She was also ordered to pay $277,000 in restitution, according to federal prosecutors.

She was convicted in November and sentenced Wednesday in a five-year scheme to supply power wheelchairs and other durable medical equipment to people who didn’t need it.

Evidence showed that the woman got more than $47,000 in kickbacks from an equipment supply company owner, according to a news release from the U.S. Department of Justice.

The equipment supply company owner was convicted in 2016 and sentenced to six years and eight months in prison. Evidence showed she caused Medicare to pay more than $3.2 million for unnecessary equipment from 2004 to 2009, based on illegal referrals.

The New Orleans woman apparently provided information about Medicare beneficiaries and got doctors to sign order forms for the unnecessary equipment, according to the statement. She was convicted on two counts of conspiracy, two counts of health care fraud and five counts of receiving health care kickbacks.

When the government investigates you for Medicare fraud, you need to know that they have a huge amount of resources at their disposal. The FBI, the HHS Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit, and federal and state prosecutors are simply a few of the entities that will be involved in mounting a case against you.

An investigation is a serious matter that you must take seriously. You must retain the legal help of an experienced criminal defense attorney who understands the complex health care laws and regulations. Our Florida Medicare Fraud Defense Lawyers at Whittel & Melton are highly experienced trial attorneys that will fight to protect your rights.

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A 70-year-old Miami man was convicted of illegally steering state-court defendants to a corrupt clinic, which in turned fraudulently billed Medicare for more than $63 million.

He was sentenced to five years in prison, plus three years of supervised release. And he must pay back a staggering $9.9 million in restitution.

He was found guilty of getting illegal payments from a corrupt clinic called in Miami, which fraudulently billed the Medicare system for more than $63 million.

The man got a flat monthly rate based on the number of patients he referred to the clinic.

In all, the clinic apparently paid him$432,829 over six years, aside from his regular salary as a mental health care worker.

The clients referred to the clinic cost taxpayers between $9.5 million and $25 million in bogus claims between 2006 and 2012.

The man was arrested in June 2017. He pleaded guilty to one count of conspiracy to defraud the United States and receive healthcare kickbacks.

The federal government has numerous laws in their back pocket in which they can pursue legal actions against those they believe are committing Medicare or healthcare fraud, including the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Law, the Exclusion Statute, and the Civil Monetary Penalties Law.

Common claims brought under Medicare fraud include:

  • Overbilling for services provided
  • Unbundling services for higher payouts
  • Upcoding for a higher level of service than that which was actually performed
  • Billing for patients who do not exist
  • Submitting bills for services that were not actually performed

The consequences of a government prosecution against you for Medicare fraud could include the following:

  • Hefty fines
  • Exclusion from all government health care payment programs
  • Further disciplinary actions by other administrative agencies
  • Loss of your professional license
  • Criminal charges and jail time

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