Medicaid and Medicare Fraud

Published on: May 21, 2018

Foot Clinic in St. Louis Settles Medicare Fraud Charges

by Whittel & Melton, LLC

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.

Published on: May 1, 2018

Illinois Physician and One Las Vegas Practice Accused of $2 Million Healthcare Fraud

by Whittel & Melton, LLC

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.

Published on: April 10, 2018

Cancer Center Slapped with Lawsuit Alleging $8 Million in Medicare Fraud

by Whittel & Melton, LLC

An Arizona medical company that serves thousands of cancer patients is battling a federal lawsuit alleging that it ripped off Medicare and other government programs with millions of dollars in fraudulent charges.

The whistleblower complaint moving through U.S. District Court says principals at Arizona Center for Cancer Care improperly collected nearly $8 million from U.S. health care agencies since 2011.

The lawsuit alleges AZCCC engaged in double billing, charged for unnecessary medical services and overcharged for testing and treatments.

The Peoria-based company, known legally as Arizona Center for Hematology and Oncology PLC, has 35 offices in Maricopa County, with 65 physicians specializing in oncology, urology, hematology and gynecological oncology. The company advertises treating more than 30,000 patients.

The civil action was filed in 2016 under the federal False Claims Act by the company’s billing manager, who asserts that he repeatedly warned AZCCC its charging methods were improper and excessive.

Civil charges of Medicare fraud can lead to criminal charges as well. Health care providers found to have committed Medicare fraud face pretty severe penalties and major consequences. In most cases, offenders will be required to repay the overpayments, along with hefty fines. Criminal prosecution by the federal government is also highly likely. The usual prison term is up to five years for each offense, which can add up to a lot very quick.

Our Florida Medicare Fraud Defense Attorneys at Whittel & Melton defend patients, doctors, medical clinics, nursing homes, assisted living facility personnel, and all other healthcare personnel accused of filing fraudulent Medicare claims for supposed non-qualifying health care services. We know Medicare fraud is one of the most serious charges a health care provider may ever face.

Published on: April 4, 2018

New Orleans Woman Gets Nearly 3 Years in $3.2M Medicare Fraud

by Whittel & Melton, LLC

A 63-year-old New Orleans woman has been sentenced to two years and eight months in prison for her part in a $3.2 million Medicare fraud and kickback scheme.

She was also ordered to pay $277,000 in restitution, according to federal prosecutors.

She was convicted in November and sentenced Wednesday in a five-year scheme to supply power wheelchairs and other durable medical equipment to people who didn’t need it.

Evidence showed that the woman got more than $47,000 in kickbacks from an equipment supply company owner, according to a news release from the U.S. Department of Justice.

The equipment supply company owner was convicted in 2016 and sentenced to six years and eight months in prison. Evidence showed she caused Medicare to pay more than $3.2 million for unnecessary equipment from 2004 to 2009, based on illegal referrals.

The New Orleans woman apparently provided information about Medicare beneficiaries and got doctors to sign order forms for the unnecessary equipment, according to the statement. She was convicted on two counts of conspiracy, two counts of health care fraud and five counts of receiving health care kickbacks.

When the government investigates you for Medicare fraud, you need to know that they have a huge amount of resources at their disposal. The FBI, the HHS Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit, and federal and state prosecutors are simply a few of the entities that will be involved in mounting a case against you.

An investigation is a serious matter that you must take seriously. You must retain the legal help of an experienced criminal defense attorney who understands the complex health care laws and regulations. Our Florida Medicare Fraud Defense Lawyers at Whittel & Melton are highly experienced trial attorneys that will fight to protect your rights.

Published on: March 29, 2018

Miami Mental-health Worker Receives 5 Years in Prison for Medicare Fraud

by Whittel & Melton, LLC

A 70-year-old Miami man was convicted of illegally steering state-court defendants to a corrupt clinic, which in turned fraudulently billed Medicare for more than $63 million.

He was sentenced to five years in prison, plus three years of supervised release. And he must pay back a staggering $9.9 million in restitution.

He was found guilty of getting illegal payments from a corrupt clinic called in Miami, which fraudulently billed the Medicare system for more than $63 million.

The man got a flat monthly rate based on the number of patients he referred to the clinic.

In all, the clinic apparently paid him$432,829 over six years, aside from his regular salary as a mental health care worker.

The clients referred to the clinic cost taxpayers between $9.5 million and $25 million in bogus claims between 2006 and 2012.

The man was arrested in June 2017. He pleaded guilty to one count of conspiracy to defraud the United States and receive healthcare kickbacks.

The federal government has numerous laws in their back pocket in which they can pursue legal actions against those they believe are committing Medicare or healthcare fraud, including the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Law, the Exclusion Statute, and the Civil Monetary Penalties Law.

Common claims brought under Medicare fraud include:

Overbilling for services provided
Unbundling services for higher payouts
Upcoding for a higher level of service than that which was actually performed
Billing for patients who do not exist
Submitting bills for services that were not actually performed

The consequences of a government prosecution against you for Medicare fraud could include the following:

Hefty fines
Exclusion from all government health care payment programs
Further disciplinary actions by other administrative agencies
Loss of your professional license
Criminal charges and jail time

Published on: March 21, 2018

Fort Lauderdale Eye Doctor Gets 17 Years for Medicare Fraud

by Whittel & Melton, LLC

A Fort Lauderdale eye doctor received a 17-year sentence in February for apparently stealing $73 million from Medicare by persuading elderly patients to undergo excruciating tests and treatments they didn’t need for diseases they didn’t have.

The man was convicted of 67 crimes including health care fraud, submitting false claims, and falsifying records in patients’ files.

Prosecutors showed that between 2008 and 2013, he became the nation’s highest-paid Medicare doctor, building his practice by giving elderly patients unnecessary eye injections and laser blasts on their retinas that some compared to torture.

The 63-year-old was ordered to pay $42.6 million in restitution to Medicare.

Prosecutors argued he stole $136 million but his attorneys insisted the proven total was $64,000. US District Judge Kenneth A. Marra said the evidence shows the theft was at least $73 million.

The man could have been given a life sentence. Prosecutors had been seeking 30 years. Defense attorneys sought less than 10.

The man has been in custody since his April 28 conviction.

Our Florida Medicare Fraud Defense Lawyers at Whittel & Melton are here to help defense those accused of these charges. Recently, the government has started seriously cracking down on medicare fraud, so our Medicare Fraud Defense Lawyers are even more necessary now than in the past. Congress has introduced multiple bills to increase fines and jail time for medicare fraud, and the government now has several entities armed with the task of uncovering alleged medicare fraud. Facing a medicare fraud accusation is scary and the consequences are very real.

Financial penalties for the medicare fraud are severe and fines can be $10,000 or more per claim. Moreover, any healthcare providers convicted of fraud can be excluded from participating in the medicare program in the future. Those convicted can also face lengthy jail sentences as well as the loss of their practices. The government will usually try to claim multiple law violations for a single fraudulent claim, which will only result in more punishments if a conviction is achieved.

Published on: January 27, 2017

2 Convicted Of $8.9 Million Medicare Scam In Florida And Three Other Gulf Coast States

by Whittel & Melton, LLC

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

Published on: July 5, 2016

Hundreds Arrested for $900 Million Worth of Health Care Fraud

by Whittel & Melton, LLC

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.”

Published on: July 15, 2015

Pasco County Doctor, Office Manager Accused of Medicaid Fraud

by Whittel & Melton, LLC

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.

If 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

Published on: April 28, 2014

Gainesville Doctor Charged with 210 Federal Charges

by Whittel & Melton, LLC

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.

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:

Medicaid and Medicare Fraud
Insurance Fraud
Kickbacks
Fraudulent Billing for Medical Services
Up-coding Medical Treatments or Services
Fraudulent Billing for Medications or Medical Equipment

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.