Healthcare Fraud Lawyer Blog

At the Brod Law Firm, we are honored to work with brave individuals who come forward to report Medicare fraud. These admirable people help the government recover money that has been stolen from its coffers, ensuring the funds are available to the many honest Americans who rely on the program for their health care needs. In this post, we look at a ruling by a federal judge seated in California that discusses what needs to be alleged to bring a successful Medicare fraud claim. Attorney Brod, our office’s California health care fraud lawyer, believes in communicating closely with his clients and helping them to understand the law and the legal process. While it is not a substitute for meeting with our team (the first consultation is free), we hope this post helps readers begin to understand the complex law of Medicare fraud and the False Claims Act.

Former Employee Alleges Manipulation of Medicare Risk Scores to Increase Payments

A website aimed at executives in the health care industry (an unusual source for our blog, but one that provided useful coverage) reported on a ruling this summer in a whistleblower case alleging Medicare Advantage fraud. Medicare and Medicaid use a risk-scoring system, developed in the mid-to-late 200s, to adjust monthly payments. In 2009, Swoben, a former data manager for the SCAN health plan which serves California and Arizona, accused SCAN and other insurers of manipulating these scores. He claimed HealthCare Partners, a managed care group serving 570,000 patients in California, engaged in a scheme to artificially raise patient risk scores. According to Swoden, the insurer defendants knew that the group did not properly review codes and that an independent review actually concealed the fraud.

Can individuals really make a difference in the effort to recover money that scammers have stolen from the nation’s coffers? This question recognizes that health care fraud impacts individuals and the nation. As detailed below, vigilance goes a long way in avoiding being the target of fraud and individual whistleblowers, including program beneficiaries in addition to company insiders, are crucial in helping the government recover lost funds. With offices in San Francisco, Oakland, and Sacramento, The Brod Firm is dedicated to helping prevent Medicare fraud, serving as a law firm for Medicare fraud victims nationwide.

Medicare Fraud and Individual Beneficiaries: How it Can Harm You, How You Can Fight It

Medicare fraud can harm individual beneficiaries in a number of ways. Scammers can deplete allotted services so that things like physical therapy and durable medical equipment are not available when needed. Fraud can also result in an individual receiving inappropriate treatment, such as providing medication for conditions that the patient does not have (which may carry risky side effects) while failing to treat actual health care needs. A New York Times piece from last fall catalogs some of these threats and the very real people that have been impacted by Medicare fraud.

At The Brod Firm, we believe that the law can be a powerful instrument of good, helping people in times of need and bringing justice to our communities. Sometimes, however, justice requires the bravery of honest individuals willing to stand

up for what is right. An example is the important role of whistleblowers in shedding light on health care fraud, including Medicare fraud, pursuant to the False Claims Act. We have referenced some of these cases before, but wanted to provide a more general overview of this area of law. We hope this brief primer helps people gain a better understanding of these cases and our work as a California whistleblower’s law firm. This is merely an overview; witnesses to healthcare fraud are encouraged to call us and arrange a free consultation to discuss specific concerns (including the contours of attorney confidentiality) and the role of health care fraud whistleblowers in more detail.

Fraud & The False Claims Act

Uncovering health care fraudfrequently invovles whistleblowers. People are often curious about whistleblowers, likely because they relate more to those reporting fraud than those committing it. The following story is continuing proof that whistleblowers are often ordinary people who are motivated to take extraordinary steps. Whistleblowers play a vital role in identifying and bringing an end to health care fraud. As a California health care whistleblowers’ law firm, we are proud to work alongside these individuals who epitomize the term “everyday hero.”

63 Year Old Vet Brings Down Multi-Billion Dollar Company’s Medicaid Fraud Scheme

In late 2011, ABC News reported on a Medicaid fraud lawsuit that they called “a real-life David versus Goliath story.” United States Congressman Rep. Trey Gowdy (R-SC) referred to the underlying fraud as the type of behavior that made people lose trust in the government. The fraud, committed by a multi-billion dollar company, was brought down by an ailing 63 year old man.

In recent years, as health care becomes more of a business than a service, there has been a steady increase in cases of health care fraud. Companies and individuals are manipulating the system for profit and Medicare fraud has become especially prevalent. These schemes are tough to identify and it often takes insiders willing to risk their careers to shed light on these operations. Our San Francisco whistleblowers law firm is proud to work alongside these brave individuals, protecting Medicare fraud whistleblowers from retaliation and helping them put an end to fraudulent practices that hurt us all.

The Alleged Fraud: Under-billing Clients to Cut Competition While Billing Medicare at Full Price

Earlier this week, a California-based medical laboratory agreed to a settlement with the federal and state governments as well as two former employees. As reported by The San Francisco Chronicle, this agreement concludes a lawsuit brought by the state of California and the two former employees accusing the defendant corporation of cheating Medicare and Medi-Cal by billing the agencies at standard rates while simultaneously charging only cut-rate fees to their clients. More specifically the lawsuit alleged that the lab charged fees that were up to 80% less than their standard rate in exchange for the client’s commitment to use the company for future Medicare and Medi-Cal services. The defendant is Diagnostic Laboratories and Radiology (“Diagnostic”), a company that is the largest supplier of both X-ray and laboratory services to nursing homes on the West Coast.

Medicare fraud impacts all of us. The misuse of public funds places an increased burden on taxpayers. The abuse of the health care system leads to higher insurance premiums and contributes to the rising cost of medical services. Additionally, fraud misdirects limited funds away from those truly in need of health care assistance. As a California Medicare fraud law firm, we work with the brave people who report fraud to take legal action against the perpetrators.

Court Hands Down Sentence for Doctor in Medicare Fraud Scheme

A Brooklyn federal court handed down a sentence this week in a Medicare fraud case that involved more than $77 million in false claims. The Staten Island Advance reported that the court sentenced Dr. Gustave Drivas to 151 months in prison and ordered him to pay $51 million in restitution for his role in the fraudulent scheme. He was also ordered to forfeit $511,000 and will be subject to post-release supervision for three years following his prison term. Dr. Drivas’ sentence follows his conviction in April for health care fraud and health care fraud conspiracy, a verdict that followed an eight-week trial. In July, he was stripped on his medical license. He is one of thirteen suspects who have either pled guilty or been convicted for taking part in the fraud. He is appealing.