daniel-frank-201417-copy-300x200The U.S. Department of Justice (DOJ) announced mid-March that a dentist based in Los Angeles has been charged with conducting an identity theft and health care fraud scheme. Benjamin Rosenberg, D.D.S., 58, faces six counts of health care fraud and two counts of aggravated identity theft. According to the unsealed court documents, Rosenberg allegedly billed a number of insurance companies for dental procedures he never actually provided. Rosenberg would bill insurance companies using patients’ personal identification information without their consent. One of the insurer’s Rosenberg allegedly defrauded was Denti-Cal, a Medicaid-funded dental program.

Are you aware of a dental fraud scheme? Call a San Francisco health care fraud lawyer at Brod Law Firm to discuss your situation and possible legal options.

Penalties for Health Care Fraud

jennifer-burk-118076-unsplash-copy-200x300In February, Julian Omidi, 49, a former physician, and Dr. Mirali Zarrabi, 55, were charged with multiple counts of fraud in regard to a scheme surrounding their business, 1-800-GET-THIN. Two corporations, partly controlled by Omidi, were also named in the 37-count federal indictment, Surgery Center Management, LLC (SCM) and Independent Medical Services, Inc. (IMS).

Fraudulent Scheme Against Insurers

Omidi and Zarrabi promoted lap-band weight loss surgeries. Omidi created a process requiring prospective Lap-band patients to have at least one sleep study before the procedure could occur. Employees of SCM and IMS were incentivized with commissions to ensure sleep studies occurred.

hush-naidoo-382152-copy-300x200The federal government’s False Claims Act (FCA) case against United Health Group (UHG) continues after major developments. In the case of U.S. ex rel. Benjamin Poehling v. UnitedHealth Group, Inc., The U.S. District Court in the Central District of California dismissed half of the claims brought through the initial qui tam suit and the government’s revised complaint. A short time later, the Department of Justice (DOJ) decided to not continue with a part of the suit and to focus on the remaining claims.

The District Court’s Decision

In February 2018, the district court analyzed the government’s amended complaint based on the FCA’s materiality requirement. Based on the Supreme Court’s decision in Universal Health Servs. Inc. v. United States ex rel. Escobar, the government must plead that their allegations are material to the government’s payment decision. They must demonstrate that, if the facts are true, the unlawful conduct influenced how much the government paid the other party.

israel-palacio-463979-copy-300x200While qui tam cases brought under the False Claims Act (FCA) are often related to health care, qui tam cases can be in connection to any type of claim made to the federal government for payment. In addition to the health care industry, defense contractors are another area in which the government is vulnerable to fraudulent schemes. For example, Lockheed Martin Corporation has agreed to settle FCA allegations by paying the federal government $4.4 million. Lockheed is accused of providing defective communications systems to the U.S. Coast Guard.

Defective Equipment for the Military

The defense contractor provided Radio Frequency Distribution System (RFDS) for the Coast Guard’s National Security Cutters. According to the U.S. attorneys, the RFDS failed to be able to conduct simultaneous operations, meaning it could receive and transmit different radio signals at the same time without interference.

hush-naidoo-382152-copy-300x200In January 2018, the California Division of Workers’ Compensation (DWC) suspended 18 medical providers. These providers, many of whom are physicians, can no longer work in the state’s workers’ compensation system due to the loss of their medical license, criminal conduct, or fraud.

DWC Require to Suspend Certain Providers

AB 1244 went into effect January 1, 2017. This law requires the DWC to suspend any doctor or other medical provider from participating in the workers’ compensation system if:

patrick-tomasso-40279-copy-300x225Jimmy and Ashley Collins, a married couple from Tennessee, have been charged with operating a health care fraud scheme that unlawfully caused TRICARE to reimburse more than $65 million in funds. TRICARE is the federal health care program for U.S. military members, veterans, and their dependents. The Collins conspired with CFK, Inc., the owner of The Medicine Shoppe based in Utah, to submit false claims for compound medications that would be mailed to active duty marines and sailors in southern California.

Health Care Fraud Scheme

According to the government’s indictment, the Collins worked with numerous recruiters within the Marines to try and induce TRICARE beneficiaries to obtain compound medications. Compound medications are specialty drugs mixed by a pharmacist when a patient has a specific medical need. These are not approved by the U.S. Food and Drug Administration, but they are obtained through prescriptions. Compound medications are used when an FDA-approved drug is not effective for a patient for a specific reasons, such as a patient needing a specialized dose.

samuel-zeller-360588-copy-200x300Two California urologists, Dr. Aytac Apaydin and Dr. Stephen Worsham, have agreed to pay $1.085 million based on allegations of violating the False Claim Act, the Anti-Kickback Statute, and Stark Law, which prohibits physician self-referral, between April 2008 and December 2014.

Apaydin and Worsham currently own and run Salinas Valley Urology Associates. They also owned the Advance Radiation Oncology Center (AROC), which was shut down in 2016. The physicians were accused of submitting and causing to be submitted false claims to Medicare in relation to image guided radiation therapy (IGRT), which is used to treat cancer patients at AROC. The claims were false based on the fact that the services arose from illegal kickbacks and self-referrals.

An Illegal Referral and Kickback Scheme

hush-naidoo-382152-copy-300x200Scripps Health, a San Diego-based health care system, will pay $1.5 million to resolve allegations of False Claims Act (FCA) violations. Scripps is accused of seeking reimbursements from federal health care programs for physical therapy services rendered by therapists who lacked billing privileges.

If you have any information regarding an individual or business within the health care industry providing the government with incorrect claims in order to increase their reimbursements, then contact a San Francisco health care fraud attorney at Brod Law Firm right away. You may have the right to bring a claim under the FCA or take your information to the proper authorities.

Unauthorized Physical Therapists

vladimir-kudinov-71455-copy-300x241On January 12, the former owner of Pacific Hospital in Long Beach, California was sentenced to 63 months in prison. The owner, Michael D. Drobot, 73, was charged with crimes related to running a 15-year health care fraud scheme. In 2014, he pleaded guilty to conspiracy and paying illegal kickbacks to physicians. In addition to the prison sentence, Drobot has been ordered to liquidate numerous assets in order to forfeit $10 million to the government and pay a $500,000 criminal fine. A restitution hearing is scheduled for May 11, which may result in additional financial consequences for Drobot.

Owner Created Massive Kickback Scheme

Between 1997 and 2013, Drobot created a scheme in which he would bill workers’ compensation insurers for spinal surgeries performed on patients who had been referred by physicians who received illegal kickbacks from Drobot for sending patients to his facility. Drobot had dozens of physicians, chiropractors, and others involved in sending patients to his hospital for services in exchange for illegal payments.

jonathan-perez-409943-copy-300x200Kmart Corporation, a subsidiary of Sears Holding Corporation, will pay the federal government $32.3 million to settle allegations of violations of the False Claims Act. A whistleblower alleged that Kmart stores did not report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, thereby receiving larger reimbursements than it was entitled to.

Kmart Wrongdoing Exposed by Whistleblower

In 2008, pharmacist James Garbe filed a qui tam suit under the FCA against Kmart. He alleged that Kmart pharmacies offered discounted generic drug prices to customers who paid cash through various programs, yet knowingly failed to disclose those prices to federal health programs. Instead, between 2004 and 2016, it reported to Medicare, Medicaid, and TRICARE its customary prices for drugs, which were then used to establish reimbursement rates. The incorrect claims lead to Kmart receiving higher reimbursements than the business was entitled to.