aidan-bartos-313782-copy-300x200One of the ways in which physicians and other health care professionals commit fraud against the federal government is through accepting or providing illegal payments or gifts to generate certain business. This type of scheme is also known as kickbacks.

One of the most common kickback schemes associated with this field is paying a health care professional for referrals to a certain physician, facility, or medical device provider. The person or place that receives the referral is then able to use the new business to grow their claims to a federal health care program and unlawfully increase their reimbursements. In many cases, the services or products they bill for are medically unnecessary or fraudulent in another way. However, not all kickback schemes involve referrals. Payments or gifts intended to generate any health care business, which is then unlawfully invoiced to Medicare or Medicaid for reimbursement, is illegal.

If you know of a physician or other health care professional who is paying or accepting kickbacks that lead to false claims against Medicare or Medicaid, contact a San Francisco anti-kickback lawyer from Brod Law Firm today. The information and evidence you have may be enough for you to file a qui tam case under the False Claims Act against those participating in the fraudulent scheme.

howard-lawrence-b-652037-unsplash-copy-300x169The U.S. Department of Justice (DOJ) announced that Lance Armstrong, a former professional cyclist, has agreed to pay the U.S. $5 million to resolve a whistleblower lawsuit regarding allegations that he violated the False Claims Act (FCA) by using performance-enhancing drugs and methods (PEDs) while sponsored by the U.S. Postal Service (USPS).

If you are aware of a professional athlete or team violating a federal or state government sponsorship agreement, contact a San Francisco qui tam attorney at Brod Law Firm.

Armstrong’s Doping Case

jonathan-perez-409943-copy-300x200On April 13, the U.S. intervened in five lawsuits against Insys Therapeutics Inc., which all accuse the company of violating the False Claims Act in regard to its opioid painkiller, Subsys. The painkiller is a sublingual spray form of fentanyl, an extremely potent and addictive drug.

Fentanyl has made the news in recent years as a replacement for heroin and other illegal street drugs, which has led to an increase in drug overdoses. Fentanyl analogues are hundreds of times more potent than heroin, and thousands of times stronger than morphine. Considering the risk of addiction and dependence on opioid painkillers, and the risk of death, the government takes accusations of improper marketing and prescribing of the drug seriously.

If you are aware of illegal activity regarding opioid drugs at a doctor’s office or medical facility, contact an experienced San Francisco health care fraud lawyer at Brod Law Firm today. Not only may the activity be a crime under California or federal law, it may also give rise to a civil claim.

hush-naidoo-382152-copy-300x200Alere, Inc. and its wholly owned subsidiary Alere San Diego agreed to pay the U.S. $33.2 million to resolve allegations that the medical device manufacturer violated the False Claims Act. (Alere was acquired by Abbott, one of the world’s largest healthcare companies, in October 2017.) According to the Department of Justice (DOJ) press release, Alere caused hospitals to submit inaccurate claims to Medicare, Medicaid, and other federal healthcare programs by willfully selling unreliable point-of-care diagnostic testing devices.

If you are aware of a company knowingly selling inaccurate medical devices, call a San Francisco healthcare fraud attorney at Brod Law Firm today.

Fraudulent Medical Devices Lead to False Claims

clark-young-143622-unsplash-copy-300x200In March, the Department of Justice for the Eastern District of California announced the federal government and California reached a settlement agreement with Kmart. The retailer, based in Illinois with locations throughout California, will pay $525,000 to resolve allegations that it violated the federal False Claims Act by knowingly submitting false claims to Medi-Cal. The claims for reimbursement were not supported by appropriate diagnoses and documentation.

Kmart’s Fraudulent Billing

Medi-Cal uses a formulary list that designates restrictions for the drugs listed, known as Code 1 drugs. Certain restrictions are related to approved diagnoses. Medi-Cal will reimburse pharmacies for Code 1 drugs, but only if their use is in line with the formulary’s restrictions. For instance, a pharmacy may not be reimbursed for a drug prescribed and dispenses for an unapproved diagnosis.

osman-rana-193633-copy-300x169In mid-April, Aharon Aron Krkasharyan, 54, a former employee of Mauran Ambulance Inc. (Mauran) of San Fernando, was sentenced for his part in a health care fraud scheme. He pleaded guilty to one count of conspiracy to commit health care fraud in November 2017. U.S. District Judge George H. Wu sentenced Krkasharyan to 36 months in prison and to jointly and severally pay $484,556 in restitution to Medicare.

If you know of any type of a fraudulent scheme against a federal or state health care program, do not hesitate to seek legal advice. An experience San Francisco qui tam lawyer from Brod Law Firm can help.

The Medicare Fraud Scheme

freestocks-org-126848-1-copy-300x200In April 2018, the U.S. Attorney’s Office for the Southern District of California announced that two physicians pled guilty to participating in a health care fraud scheme against TRICARE, the health care program for U.S. service members and their families. Carl Lindblad, 53, and Susan Vergot, 31, were charged with fraudulently obtaining more than $65 million by unnecessarily prescribing expensive compound medications for patients they did not see in person.

Fraud Related to Compound Medications

Compound medications are specialty medications created when a patient has a specific need that cannot be addressed with a regularly existing prescription. Compound medications are not approved by the U.S. Food and Drug Administration, yet they typically involve a variation on a previously FDA-approved drug. For instance, a patient may need a specific drug yet be allergic to a dye or one of its ingredients. A patient may require a dosage that a certain drug is not manufactured in. Compound medications are expensive because they must be mixed by a pharmacist in regard to the patient’s needs.

andres-de-armas-103880-copy-300x200In early April, two executives for a business offering alcohol and drug abuse treatment services were arrested for healthcare fraud. Mesbel Mohamoud, 45, and Erlinda Abella, 63, both of Inglewood, are accused of submitting bills to Medi-Cal for services that were either not provided or were not eligible for reimbursement. Authorities allege Mohamoud and Abelle fraudulently sought more than $2 million in reimbursements.

If you have any information regarding a healthcare business fraudulently billing a federal or state medical program, contact a San Francisco health care fraud lawyer at Brod Law Firm right away.

Further Details of Alleged Healthcare Fraud

daan-stevens-282446-copy-300x191California lawmakers are concerned with health care providers who may be taking advantage of patients by unnecessarily enrolling them into commercial health care plans in order to maximize the provider’s reimbursement rates. Lawmakers believe some providers are encouraging sick individuals to enroll in commercial health care plans, which the providers then pay the premiums for in addition to providing the patient medical services. The providers financially benefit from the patients utilizing these health plans by receiving reimbursements for their services.

While providers claim their third-party premium payments are intended to help people get the medical care they need, lawmakers are concerned it is a way for providers to get greater reimbursements than the individual’s Medicare or Medicaid coverage would provide. While the scheme may not rise to the level of health care fraud, legislators worry that it takes advantage of the system and patients.

Lawmakers also worry about the providers ceasing premium payments. Many providers choose to end payments at a certain point, causing sick patients to lose their coverage. A recently introduced bill would create safeguards against such occurrences.

jonathan-perez-409943-copy-300x200The sentencing of a physician convicted of health care fraud was continued in March. Paul Matthew Bolger, 46, will not be sentenced until May 22 for committing health care fraud. In August 2017, he pleaded guilty to 18 counts of making false claims related to health care and five counts for crimes related to misbranded drugs. While Bolger’s case took place in Bettendorf, Iowa, one count of false statements began in California and was transferred from the Central District of California, demonstrating that many health care fraud schemes cross state lines.

Intentional False Statements Regarding Prescriptions

Bolger pleaded guilty to knowingly and willfully making false statements by signing numerous prescription forms that authorized prescription drugs and indicated they were necessary. However, he did not know that to be true. He signed and supported the validity of each prescription based on an intake form created by non-medical staff at a call center located outside of the U.S. He did not talk with any of the patients personally, he did not conduct any physical exams, and he did not review any of the patient’s medical records.