White Collar Crime

Published on: June 26, 2018

Florida Medicare Fraud Defense Lawyer: Doctor and 2 Nurses Found Guilty

by Whittel & Melton, LLC

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

Published on: May 29, 2018

Fort Myers Doctor Admits Involvement in $470K Medicare Fraud Scheme

by Whittel & Melton, LLC

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.

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 23, 2018

Gainesville Man Charged in Hotel Fraud Scheme

by Whittel & Melton, LLC

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.

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: April 2, 2018

Megachurch Pastor Charged with Defrauding Elderly Investors

by Whittel & Melton, LLC

Federal authorities have charged the pastor of a Texas megachurch and a Louisiana financial planner with defrauding elderly investors out of more than $1 million.

The two men were charged Friday with six counts of wire fraud and five counts of money laundering, as well as one count of conspiracy to commit wire fraud and one count of conspiracy to commit money laundering.

The Securities and Exchange Commission has also filed civil charges against the men for the alleged fraud, which occurred from 2013 to 2014.

One man, 64, is the senior pastor of a church Houston, which is described by the SEC as “one of the largest Protestant churches in the U.S.” The Louisian man, 55, is the manager of a financial group in Shreveport.

They’re accused of bilking 29 mostly elderly investors by selling them Chinese bonds issued before the revolution of 1949, saying that their historical value made them “worth tens, if not hundreds, of millions of dollars” according to a court document from the SEC.

The bonds have no investment value.

The SEC says the bonds have been in default since 1939, and the “current Chinese government refuses to recognize the debt.”

The funds collected were used to pay for personal expenses, including mortgage payments and luxury automobiles.

The DOJ says they allegedly defrauded the investors out of more than $1 million. The SEC places that figure higher, at $3.4 million.

The maximum sentence, if they’re convicted, is 20 years with a $1 million fine, as well as restitution and forfeiture, according to the DOJ.

The crime of money laundering uses financial transactions to conceal the origin of money obtained through illegal activity, to make it appear that the money came from a legitimate source. This is a very serious offense that can carry severe penalties, including steep fines and jail time if you are found guilty.

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.