Articles Posted in White Collar Crime

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Authorities have arrested a Jacksonville elementary school principal accused of trying to defraud his insurance carrier in the wake of Hurricane Irma.

According to a statement provided through a spokesperson, Duval County Public Schools has assigned the man to an off-campus role until the district’s investigation is complete.

The man allegedly sought $16,000 in reimbursements from State Farm for home repairs linked to damage from Irma, but two invoices he filed were apparently altered and a third was completely made up.

Investigators determined that invoices submitted for repairs to his roof, A/C and entertainment system were not related to Irma. According to the man’s arrest report, they were from 2013.

The man turned himself in to the Clay County Sheriff’s Office to face unspecified charges Nov. 16. If convicted, he faces up to five years in prison.

The consequences of an insurance fraud investigation go beyond just having your claim denied – you could end up in prison. Our Florida White Collar Crimes Defense Attorneys at Whittel & Melton will work to aggressively protect your interests when facing insurance fraud allegations.

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Nearly two dozen men are accused of massive construction fraud, according to the Hillsborough County Sheriff’s Office.

They were arrested last week as part of an undercover sting, and now authorities are warning the public about protecting themselves against unlicensed contractors.

The nine-day undercover sting was designed to catch unlicensed contractors that authorities believe were targeting senior citizens in the area.

Detectives posed as homeowners and responded to advertisements placed by the alleged unlicensed contractors.

The contractors gave the detectives $117,000 in alleged fake estimates, the Sheriff’s Office said.

Sixteen people were arrested and six more are facing charges related to this alleged scam.

Contractor laws in the state of Florida are very important to follow. These laws can be confusing, though. If you are a contractor, it is important to follow all laws related to your profession so that you can avoid any unwanted run-ins with the law. However, mistakes do happen and if you find yourself facing criminal charges, our Tampa Bay Criminal Defense Attorneys at Whittel & Melton are here to help.

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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 former Jacksonville Jaguars player faces insurance fraud charges linked to dental treatment authorities said he never received.

Marlon McCree is accused of filing nearly $78,000 in bogus insurance claims, according to reports. McCree allegedly received $31,000 in reimbursements as a result.

McCree, 41, turned himself into the Nassau County jail Saturday morning, where he remains in custody on five counts of filing false insurance claims, jail logs show.

The former NFL defensive back and one-time Jaguars assistant defensive backs coach faces up to 30 years in prison and $30,000 in fines if convicted of all charges.

The state Bureau of Insurance Fraud was tipped off in April by Cigna, which accused McCree of submitting bogus paperwork to the Gene Upshaw Health Reimbursement Account, or HRA.

An investigation found McCree falsified invoices that listed All Smiles Dental, Patronis said. The Jacksonville dental practice had no records indicating he was a patient there.

Insurance fraud happens when a policyholder tried to collect insurance payments that they would not have otherwise been entitled to receive. Make no mistake, this is a very serious crime that carries very serious consequences if convicted. You could be looking at hefty fines, restitution and jail time. If you have been accused of insurance fraud, it is important that you have an experienced Florida Criminal Defense Attorney at Whittel & Melton by your side from the start.

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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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A 35-year-old unemployed Gainesville man is accused of devising a scheme to use dark web-bought identification information to rent hotel rooms and then sublease the rooms to people for illicit activity, according to Gainesville police.

The man faces 11 fraud-related charges and two counts of using a communications device — his cell phone — to commit a felony.

He allegedly schemed to scam the Hampton Inn at 101 SE First Ave. in Gainesville, as well as a Doubletree by Hilton, also in Gainesville, the report said.

In at least two cases, police claim he sent bogus letters to hotels attempting to secure accommodations, suggesting that GEICO and AAA were paying for rooms, when they were not, the report said.

The total damages from the scheme for two victims whose credit card information was stolen and used allegedly by the man came to $3,005.69, his arrest report said.

The alleged fraud began early in 2018 and continued through March, the report said.

The man was arrested Friday.

Fraud charges are very serious matters and are usually the result of in depth police investigations. The penalties for a conviction are very serious. You could be looking at decades-long prison sentences and pretty large fines. If you have been charged with any type of fraud, it is critical that you enlist the help of an expert Alachua County Criminal Defense Lawyer at Whittel & Melton to protect your rights.

We are extremely experienced in complicated legal defense cases involving white collar crimes, such as fraud. You can rest assured that we will give your case the personal attention it deserves, as well as examine all evidence thoroughly, and come up with an aggressive legal strategy to protect your rights.

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