Healthcare Fraud

September 14, 2015

Who Brings Government Fraud Whistleblower Claims?

We frequently write about healthcare fraud and other forms of government contract fraud. We cannot overemphasize the role that whistleblowers play in prosecuting these cases. According to the Justice Department, nearly $3 billion of the $5.69 billion recovered through settlements and judgments in civil False Claims Act (“FCA”) litigation in Fiscal Year 2014 stemmed from qui tam lawsuits filed by private whistleblowers. Who are these whistleblowers? In some cases, they are high-ranking executives in companies that committed fraud. However, whistleblowers can also be “rank and file” employees, the “everyday” workers who form the majority of any large operation, or even company outsiders. Our law firm for government fraud whistleblowers works with people from all ranks of society who take step forward and join the fight against fraud.

Settlement In Suit Brought By Medical Technician

Last month, the Sacramento Bee reported that Quest Diagnostics agreed to pay $1.8 million to settle Medicare fraud claims. According to the allegations, Quest submitted duplicate claims for Medicare reimbursement for the same test performed on a single day and a single patient. A Quest spokesperson suggested IT issues caused rare cases of duplicate payments impacting a “miniscule percentage” of the company’s annual Medicare claims and said Quest is updating its billing systems to prevent a recurrence.

September 7, 2015

Whistleblower Litigation: Fighting Drug Promotion Plots Involving Many Active and Passive Participants

by Gregory J. Brod

No matter how long we serve as a law firm for Medicare fraud matters, we continue to be appalled by the nature of these crimes. These crimes often involve more than just shifting money into the perpetrators’ wallets. Medicare fraud often directly impacts the care beneficiaries receive or, in some cases, the care they don’t receive. We are also disturbed by the number of people involved in certain frauds like the wide-ranging scheme to profit from prescribing unneeded medications to nursing home residents. While there are often more active participants than we’d like to imagine (i.e. more people willing to risk others’ well-being for profit), many more are silent observers. It is these individuals who have the most power when it comes to fighting fraud – they can become the whistleblowers in False Claims Act whistleblower litigation.

A Drug Marketing Scheme Involving Numerous Companies and Individuals

Earlier this year, The Kentucky Center for Investigative Reporting examined a plot to profit from using pushing the (over)use of certain medications by nursing home residents. To understand the schemes, one needs to know that specialized companies operate nursing home pharmacies. These providers, including PharMerica and Omnicare “occupy a strategic place in the flow of drugs to nursing home patients,” buying medications from pharmaceutical manufacturers and often repackaging them in foil packs referred to as “bingo cards” before dispensing them to nursing home residents via the company’s consulting pharmacists.

August 31, 2015

Indictment Alleges Beneficiaries Complicit in Chiropractor’s Fraudulent Billing Scheme

by Gregory J. Brod

As a law firm for beneficiary whistleblowers in health care fraud cases, we are committed to staying informed about developments involving fraud and related wrongs across the country. When a beneficiary reporting health care fraud (or a beneficiary who simply feels something is amiss) calls our office, we can evaluate the facts and discuss the law, including the very latest cases involving federal and state anti-fraud statutes. This week, a case from Illinois caught our eye. It involves alleged fraud by a chiropractor, a field many view as new and/or alternative despite having roots in Ancient Greece and practitioners being recognized in all 50 states (American Chiropractic Association). Notably, the allegations suggest some beneficiaries were complicit in the scam. While patients probably didn’t know the extent of the fraud, perhaps accepting a dubious explanation, the clinic’s fishy behavior likely set off alarm bells; alarm bells we hope lead others to contact our team rather than assent to wrongful acts.

The Allegations: Chiropractor’s Fraudulent Billing Scheme Supported by Beneficiary Cooperation

According to the Journal & Topics Newspapers, a Wheeling, Illinois chiropractor and members of his family are facing charges they fabricated medical records and billed insurance carriers for services that were medically unnecessary or never rendered at all (indictment available via the FBI). The charges include health care fraud and aggravated identity theft. In all, the defendants are accused of filing $28,775,000 in insurance claims from 2006 through November 2012 and receiving $10,47,000 in insurance payments.

August 24, 2015

Hospice Care Fraud: A Wrong Amounting to Theft from the Terminally Ill

by Gregory J. Brod

Hospice care workers are some of the most amazing people you’ll ever encounter. Not only do they care for people in their final days, they also care for the patient’s families. All forms of Medicare fraud result in theft of taxpayer’s money and endanger the health of beneficiaries, but there’s something particularly insidious about hospice fraud. Our Medicare fraud attorney is honored to work with private individuals who observe these wrongs and step forward to help stop them.

FBI Reports on Case of Hospice Fraud

Last week, the FBI posted a report dealing with a case of hospice care fraud in Oklahoma (note: all assertions in this post regarding the case are per the FBI’s report). P.K. owned a hospice center and, together with certain colleagues, submitted fraudulent claims to Medicare totaling in the millions of dollars. From June 2010 to July 2013, the conspirators did not comply with the rules and regulations governing Medicare-eligible hospice centers. They actively concealed the actual health status of patients and falsely reported the treatment provided, including claiming nurse visits that never actually occurred and altering files to make patients appear sicker than they actually were. While hospice is intended for the terminally ill, specifically patients with a life expectancy of six months or less, many patients remained at the center for five to seven years. When an audit was performed to review services in the state, P.K. provided falsified documents to those conducting the audit.

August 10, 2015

Major Ruling on Medicaid Overpayments is a Victory in the Fight Against Health Care Fraud

by Gregory J. Brod

gavel2 A decision handed down by a federal court in New York last week further evidences the government’s commitment to fighting health care fraud. The court finds the clock begins to run on the duty to return Medicaid and Medicare overpayments (also known as reverse false claims) when the provider is put on notice that an overpayment likely occurred, rejecting the defendants’ position that the period only begins when an overpayment is conclusively proven. Our health care fraud whistleblowers’ law firm applauds the decision fight back against health care fraud.

Understanding Motions to Dismiss

Before turning to the substance of the ruling, it is worth taking a brief look at legal procedure. When a complaint is filed, the defendant typically responds with an answer, a paragraph-by-paragraph response. If the defense believes the claim is entirely without legal merit, they may file a motion to dismiss instead. One basis is Federal Rule of Civil Procedure 12(b)(6) whereby the defendant asserts the complaint should be dismissed for “failure to state a claim upon which relief can be granted.” In essence, the defendant asserts that even if everything the plaintiff alleges is true, there is no actionable violation of law.

July 27, 2015

Medi-Cal Fraud Targeting Drug Rehab Clinics

by Gregory J. Brod

As a health care fraud law firm, we work with private whistleblowers nationwide to protect taxpayer money and ensure the health of millions of Americans. Often, scammers who defraud the federal system also target state health care programs. We work to fight this type of fraud too, recognizing that these systems are also vital to the health and well-being of countless individuals. While we can handle health care fraud matters across the country, we have particularly strong ties to California and Florida. In today’s post, we look at a problem plaguing California – Medi-Cal fraud involving drug treatment clinics.

Director Apologizes for Medi-Cal Fraud

Last September, The Center for Investigative Reporting (“CIR”) reported on legislative hearings in which Toby Douglas, the director of Medi-Cal, apologized for systemic problems involving the failure to effectively monitor taxpayer-funded drug rehabilitation programs. In the course of those hearings, it became clear that the agency knew about widespread sham billing by “rogue clinics” as early as 2007. In 2014, the agency temporarily suspended 73 clinics and 101 other counseling sites, locations that had bilked Medi-Cal out of more than $36 million in the previous fiscal year alone. At the time of the report, there were at least 64 on-going fraud investigations looking into these scams.

July 13, 2015

Health Care Fraud Spotlight: Kickbacks and Other Fraud in Nursing Home Pharmacy Services

by Gregory J. Brod

Few things are more important that health. We all worry about it, especially when we think about our senior years. In addition to worrying about our physical and mental well-being, many of us are plagued by questions like “Will I be able to afford the health care that I need?” Medicare and Medicaid exist to ease these concerns, but they are struggling. As an experienced health care fraud law firm, we know that fraud is a big part of the problem. Nursing home fraud and other forms of Medicare/Medicaid fraud deplete already limited resources and impede the quality of care as (so-called) professionals place profit over people’s health. Scammers target lucrative arenas so it is no surprise that our firm is seeing repeated cases of Medicaid and Medicare fraud involving nursing home pharmacy providers.

Tentative Settlement in Case Alleging Pharmacy Accepted Kickbacks in Exchange for Promoting Drug

According to Modern Healthcare, Omnicare, the country’s largest provider of pharmacy services for long-term care facilities, reached a tentative agreement with the federal government to settle accusations it accepted millions of dollars in illegal kickbacks from Abbott Laboratories. According to the government, Abbott paid kickbacks in exchange for Omnicare promoting the drug Depakote as treatment for behavioral disturbances in dementia patients. The FDA has not approved Depakote for that purpose. Nonetheless, Omnicare purportedly promoted the off-label use and had its pharmacists review patient charts and recommend the drug to doctors. In return, Abbott allegedly paid kickbacks in a range of different disguises from “educational funding” and grants to tickets to sporting events and money used to fund corporate meetings.

July 6, 2015

A Startling Example of Health Care Fraud Involving False Cancer Diagnoses (and a Castle!)

by Gregory J. Brod

One of the reasons we write about health care fraud is to make people aware of the true cost of these schemes. These crimes are ultimately financial in nature, with scammers stealing billions (not a typo!) each year from government programs that are already operating on strained budgets. As if stealing money that is supposed to go towards ensuring the health of some of our nation’s most deserving (including military families and seniors) isn’t bad enough, these crimes also have a direct impact on individual beneficiaries. The broad, sometimes life-threatening impact of these crimes is why we urge private citizens to join the fight against health care fraud and why we are proud to serve as a law firm for health care fraud whistleblowers.

A Scheme Founded Upon False Cancer Diagnoses and Other Lies Told by a Michigan Doctor

A case from 2014 stands out as a particularly egregious example of how scammers put individuals at risk, ignoring the duties of the health care profession and risking people’s lives for profit. The FBI’s news article paints the picture:

June 21, 2015

Prescription Drug Fraud: A Form of Beneficiary-Committed Health Care Fraud

by Gregory J. Brod

Our discussions of Medicare and Medicaid fraud on this blog include a wide-range of schemes and schemers. In most cases, however, the people running the scam are on the provider-side of the health care equation; they are medical professionals, medical supply companies, health care facilities, or otherwise involved in the provision of care to patients. While rarer, beneficiary-committed health care fraud does occur, meaning cases in which a beneficiary is the primary fraudulent actor rather than a pawn in a provider’s scheme. Perhaps the subset of health care fraud that is most often committed by beneficiaries is prescription fraud. Of course, beneficiaries aren’t the only ones involved in prescription fraud, but our Medicaid and Medicare prescription drug fraud lawyer finds their role makes this form of fraud a unique threat.

Pennsylvania Woman Indicted for Prescription Fraud

While the specific case involves fraud against private insurers, charges filed in Pennsylvania provide an example of this type of fraud. Pittsburgh’s WTAE reports that Kari Richards of Latrobe, PA was indicted in a U.S. District Court last week on charges including health care fraud and obtaining prescription medication via fraud. According to police, Richards visited in excess of 100 hospitals spanning 11 states to obtain prescription medication for shoulder injuries that she actually inflicted on herself. Over 16 months, she allegedly sought hospital care more than 300 times. Authorities claim that, between January 2014 and April 2015, Richards ultimately obtained 190 prescriptions for opiate medications including oxycodone. The grand jury indictment suggests the frauds against Highmark Community Blue Shared Cost plan totaled more than $600,000. Richards was arrested and then released pending trial.

June 15, 2015

Focusing on the Victims: Medicare Fraud, Mental Health, and a Partial Hospitalization Program Scam

by Gregory J. Brod

Who are the victims of Medicare fraud? As a law firm specializing in health care fraud matters, we understand that question requires a multi-part answer. At the broadest level, Medicare fraud is theft and the target is a taxpayer-funded government program, meaning every U.S. taxpayer is a victim. Narrowing the focus a bit, Medicare fraud depletes an already strained budget and thus it jeopardizes the health and well-being of all Medicare beneficiaries. Medicare fraud also has more specific victims, individuals who are treated as mere pawns by the scammers. A recent case involving mental health benefit fraud in Texas brings these individual victims to the forefront of our minds.

Medicare and Mental Health

Medicare recognizes that true health involves both physical and mental well-being. In order to understand the Texas case, it is helpful to understand a bit about Medicare’s mental health coverage. Medicare Part B includes outpatient mental health services holdinghand for all program beneficiaries. This coverage includes an annual depression screening and necessary outpatient mental health treatment such psychotherapy and medication management. If a beneficiary requires inpatient mental health treatment, coverage is provided via Medicare Part A, the hospital insurance arm of the program.