Articles Posted in Medicaid and Medicare Fraud

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Federal prosecutors have said that two owners of psychological service companies have been convicted of an $8.9 million fraud scheme that billed Medicare for unnecessary or nonexistent tests on nursing home patients in four Gulf Coast states.

The owners, a Slidell, Louisiana man and his 63-year-old mother, plan to appeal, according to reports.

Each owned companies in Louisiana, Mississippi, Alabama and Florida.

A jury convicted them Tuesday of conspiracy to commit health care fraud and of conspiracy to make false statements about health care. According to reports, the jurors also found them responsible for $8.9 million in fraudulent payments.

Two psychologists who worked for them pleaded guilty last year, admitting $5.6 million in fraudulent claims.

Medicare fraud is rampant across the United States. Medicare fraud prosecutions are highly specific and headed by the U.S. Attorney’s Health Care Fraud Division. With that said, defense of Medicare fraud allegations requires an attorney that understands billing practices, compliance issues, and medical necessity.

Some examples of medicare fraud include:

  • Submitting false claims
  • Billing for services or supplies not provided
  • Billing for medical equipment not prescribed by doctors
  • Submitting claims for services or supplies for a patient who does not exist or who the provider has no physician-patient relationship
  • Up-Coding or billing a higher code than the service actually performed
  • Performing additional treatments or tests which are not clinically necessary
  • Duplicate billing

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The Justice Department announced Wednesday it’s charging hundreds of individuals across the country with committing Medicare fraud worth hundreds of millions of dollars.

This is the largest takedown in history, in regards to the number of people charged and the loss amount, according to the Justice Department.

The majority of the cases being prosecuted involve separate fraudulent billings to Medicare, Medicaid or both for treatments that were never provided.

In one case, a Detroit clinic that was actually found to be a front for a narcotics diversion scheme billed Medicare for more than $36 million, the Justice Department said.

The actual numbers:

  • $900 million in false billing
  • $38 million sent from Medicare and Medicaid to one clinic to carry out medically unnecessary treatments
  • $36 million billed to Medicare by a Detroit clinic that was actually a front for a narcotics diversion scheme
  • 1,000 law enforcement personnel involved
  • 301 defendants charged across the United States
  • 61 of those charged are medical professionals
  • 36 federal judicial districts involved
  • 28 of those charged are doctors

A doctor in Texas has been charged with participating in schemes to bill Medicare for “medically unnecessary home health services that were often not provided.”

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A Wesley Chapel doctor and his office manager are accused of defrauding the Florida Medicaid program out of more than $100,000.

The male doctor and his office manager, who is also his ex-wife, were arrested Wednesday. Investigators allege the pair billed the Florida Medicaid program for services that were never performed.

The man is an ear, nose and throat specialist. The officer manager’s arrest report lists her as a registered nurse at Moffitt Cancer Center.

Both are facing one count each of Medicaid provider fraud, one count of first-degree scheming to defraud and one count of second-degree criminal use of personal identification information.

6127243966_e9189f1099_mIf they are convicted, they face up to 30 years in prison. They could also be ordered to pay more than $100,000 in restitution.

The case will be prosecuted by Attorney General Pam Bondi’s Office of Statewide Prosecution.

Medicaid is a federal and state cost-sharing program that provides healthcare to people who are unable to pay for such care. Medicaid Fraud usually targets the providers of services who accept Medicaid and can be prosecuted on the State or Federal jurisdictions.

Common examples of Medicaid fraud can include:

  • Phantom Billing: Billing for medical services not actually performed
  • Upcoding: Billing for a more costly service than was actually rendered or Billing for sessions that are longer than what was actually performed
  • Unbundling: Billing for multiple services that should be combined into one billing
  • Billing twice for the same medical service
  • Dispensing generic drugs and billing for brand-name drugs
  • Kickback: Accepting something in return for medical services
  • Bribery
  • Providing unnecessary services
  • False cost reports
  • Embezzlement of recipient funds

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A Gainesville doctor who was under federal investigation for years has been charged with 210 counts of health care fraud and money laundering.

The 57-year-old is accused of submitting fraudulent claims for needless tests, buying drugs from outside the U.S. that are not permitted for use here and providing those drugs to patients without their knowledge or consent, according to a news release from the U.S. Department of Justice.

The incidents allegedly occurred at a clinic she owned in Hawthorne from 1998 to 2009 and at a clinic on Northwest 16th Avenue in Gainesville from 2010 to 2013.

A female doctor consults her computer at the Bangkok Samitivej hospital.The woman surrendered on Tuesday and entered a plea of not guilty, according to reports. Her trial is scheduled for June 14.

The woman faces up to 10 years in prison for each of the health care fraud counts, up to three years for each of the Federal Drug Administration counts and up to 10 years on each of the money laundering counts.

Prosecutors allege that the woman submitted fraudulent claims to insurance companies for unnecessary medical procedures and services that were not actually performed or provided. According to reports, the claims were submitted to Medicare, Medicaid and Blue Cross Blue Shield of Florida.

The woman is accused of using some of the money from fraudulent claims to buy non-FDA-approved drugs and devices from outside the U.S., and submitted fraudulent claims for the dispensation of the drugs. Prosecutors also allege that she gave these drugs to patients without their knowledge.

Several state and federal agencies were involved in the investigation that led to the woman’s indictment.

The woman apparently closed her clinic in January 2013 because the investigation tarnished her reputation and wrecked her financially.

Reports indicate that the woman donated all of her medical equipment to a children’s hospital in Guatemala and has been volunteering for various local programs since her officer closed its doors.

If you are under investigation for federal health care fraud charges, you must take swift action and protect yourself by consulting with a federal criminal defense attorney as soon as possible. The sooner you enlist legal help, the more likely your lawyer can put a stop to further investigations and possibly prevent charges from ever being filed.

Health care fraud charges often arise from the following:

A conviction for health care fraud carries extremely serious consequences. Not only do you face prison time and substantial fines, but you also risk losing everything you have worked so hard for, including any professional licenses or certifications that you hold as a medical provider.

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A Florida man plead guilty in early 2014 to attempting to defraud Medicare of more than $28 million after buying several rehabilitation clinics, including one in Venice.

The U.S. Department of Justice claims the man bought up the clinics so he could gain access to the clinics’ Medicare provider numbers.

medicare

A Florida man faces up to 15 years in prison for attempting to defraud Medicare of more than $28 million after buying several rehabilitation clinics.

The 53-year-old man, formerly of Southwest Florida, pleaded guilty to conspiracy to commit healthcare fraud and making a false statement relating to healthcare matters.

He faces up to 15 years in prison.

According to a Department of Justice statement, the man was the head of a Delaware holding company that he allegedly used to buy several comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers throughout Florida in the mid-2000s.

Those offices included clinics in Venice, Fort Myers, Lake Wales and Port St. Lucie.

Once they owned the clinics, the man and other company executives apparently obtained identifying information of both Medicare beneficiaries and physicians, which they then used to create and submit false claims for therapy services that were not prescribed and not provided.

DOJ officials claim the man and his co-conspirators forged patient records in order to hide the services they billed Medicare for that had not actually been provided.

The man and his co-conspirators are accused of filing $28.35 million in fraudulent claims with Medicare from 2005 through 2009. Medicare paid approximately $14.4 million on those claims, according to reports.

Authorities allege that once the man received enough Medicare money out of clinics, he sold the storefronts to “straw owners,” who were all recent immigrants to the United States and had no experience working in the healthcare industry.

The DOJ unsealed a 30-count indictment against the man and one of his co-conspirators, a 57-year-old disbarred attorney, in April 2012.

The 53-year-old man has pleaded guilty to two of those charges – conspiracy to commit health care fraud and making a false statement relating to health care matters.

Healthcare fraud cases cost the government millions of dollars each year. The government often makes mistakes and accuses innocent medical professionals and clinic owners of committing federal crimes in order to try and recover their losses from fraudulent claims. Unfortunately, when you are accused of committing Medicare or any other type of healthcare fraud, your family, career and reputation are at risk.

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Med-Care Diabetic and Medical Supplies Inc., based in Boca Raton, FL has fallen under intense scrutiny after a recent investigation into medical equipment suppliers has indicated signs of Medicare fraud.

The federal government is concerned that loopholes in the law and a lapse in management has allowed the Boca Raton company, and others like it, to exploit Medicare, resulting in tax payers footing the bill.

Democratic Missouri U.S. Sen. Claire McCaskill, who has opened a congressional investigation into the company, claims that these medical supply companies are harassing the elderly and their doctors through phone calls and unsolicited faxes for everything from diabetic testing materials to power scooters, even though the patients do not need these items. This is apparently a problem that has cost Medicare – and taxpayers – $27 billion over the past four years.

735910_old_people.jpgFrom 2009 to 2012, Medicare apparently paid $43 billion for medical equipment supplies such as back braces, sleep apnea monitors and power scooters. However, according to research by staffers of a Senate subcommittee on financial oversight lead by McCaskill, more than 60 percent of those payments – $27 billion to be exact – may have been improper. According to reports, the federal government has only been able to recover around 3 percent of overpayments.

The Boca Raton company was asked by McCaskill to testify before her subcommittee on April 24, but reports indicate that no one showed up. At this time, the senator is considering compelling testimony by subpoena on the grounds that because the company makes a profit on taxpayer money they are obligated to provide that information to the government.

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Authorities in Palm Beach County filed charges against 22 individuals Wednesday, alleging they stole nearly $1 million.

“Operation Leap Fraud,” apparently one of the biggest public assistance fraud roundups ever in Palm Beach County netted suspects from across Palm Beach County Jupiter to Delray Beach, and from Pahokee to West Palm Beach on charges ranging from mortgage and insurance fraud to public assistance fraud.

According to the Palm Beach County State Attorney’s Office, only 15 of those charged have been arrested at this time; seven others remained at large Wednesday evening.

Authorities claim the 22 individuals racked up $967,647.37 in fraud.

Authorities did not mention how long the operation took place, but the investigation, which included the U.S. Department of Housing and Urban Development and U.S. Department of Agriculture, apparently targeted people suspected of defrauding housing and other agencies.

At a press conference Wednesday afternoon, the State Attorney’s Office and the Sheriff’s Office said more arrests will follow and there will be no tolerance for even minor cases.

One of the men arrested in the sting, allegedly only defrauded $817.14. Authorities claim the man bilked an elderly woman out of her government-issued Electronic Benefit Transfer card, leaving her without the means to buy food.

It will definitely be interesting to see how the State Attorney’s Office will prosecute these cases. The government and insurance companies do not look fondly on those that attempt to defraud various benefits meant to assist qualifying individuals with their day-to-day needs. There are many ways to defraud the government, and the Florida White Collar Crime Lawyers at Whittel & Melton can assist those facing various fraud charges, including:

• Health Insurance Fraud
Petty Theft & Grand Theft

• Organized Fraud
• Identity Theft
Insurance Fraud

• Welfare Fraud
Medicare/Medicaid Fraud

• Public Assistance Fraud
Florida public assistance fraud can be charged as a misdemeanor or felony depending on the amounts wrongfully obtained. The fraud charge can be classified as a felony if the amount of the assistance illegally gained is worth more than $200 over a 12-month period. Misdemeanor charges can be filed if the value of the assistance is less than $200. If convicted of public assistance or insurance fraud you will be required to pay back the amount of wrongfully obtained benefits and may be perpetually prohibited from receiving future benefits. You may also face jail or prison time, community service or a variety of other criminal punishments.

If you have been arrested for any public assistance fraud in Florida, it is crucial to your defense to consult with the Florida White Collar Crime Lawyers at Whittel & Melton as soon as possible. We will do everything in our power to protect your Constitutional rights. At Whittel & Melton, we can provide you with the aggressive legal representation you need for every stage of your criminal case up to and including trial.

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