Articles Posted in Federal Crime

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 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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