Healthcare Fraud

June 7, 2018

Healthcare Fraud is Widespread, but Whistleblowers can Help Stop it

ken-treloar-385255-copy-300x200 Medicare and Medicaid are taxpayer-funded healthcare programs instituted for the purpose of ensuring that all Americans have access to basic health services. Fraud on the part of health care providers is a major threat to these programs and to the health of millions of Americans who benefit from their services. Every year, physicians and other members of the healthcare industry enrich themselves by diverting funds from Medicare and Medicaid to themselves and by fraudulently billing these publicly funded programs. Whistleblowers who have helped bring legal action against purveyors of healthcare fraud have helped the nation recover billions of dollars for healthcare. If you are aware of healthcare fraud at your workplace, contact an attorney to discuss filing a qui tam lawsuit.

How Big a Problem is Healthcare Fraud?

The Department of Justice collects data on healthcare fraud, and the figures are alarming. For 2014, the most recent year for which the DOJ has published statistics, it is clear that healthcare fraud was widespread, but that the government, with the help of whistleblowers, was taking effective measures to stem it.

May 30, 2018

Authorities Uncover $20 Million Health Care Scheme in California

by Gregory J. Brod

piron-guillaume-96228-copy-300x200 Federal authorities arrested five individuals connected to San Fernando Valley clinics and a significant health care fraud scheme. On May 22, a federal grand jury indictment was unsealed. The indictment alleges that the five individuals engaged in a health care fraud conspiracy over multiple years and targeted at least eight health insurance companies and the International Longshore and Warehouse Union, the Pacific Maritime Association Benefit Plan, and the Federal Employees Health Benefits Program.

The Conspirators

According to the Department of Justice (DOJ) press release, the co-conspirators included:

May 25, 2018

The Anti-Kickback Law

by Gregory J. Brod

aidan-bartos-313782-copy-300x200 One 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.

May 18, 2018

Federal Government Joins Whistleblower Suit Against Insys Therapeutics

by Gregory J. Brod

jonathan-perez-409943-copy-300x200 On 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.

May 11, 2018

Alere to Pay $33.2 Million to Settle FCA Violation Allegations

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 Alere, 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

May 4, 2018

Kmart Settles Allegations of False Medi-Cal Billings

by Gregory J. Brod

clark-young-143622-unsplash-copy-300x200 In 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.

April 27, 2018

Ambulance Company Employee Sentenced for Medicare Fraud

by Gregory J. Brod

osman-rana-193633-copy-300x169 In 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

April 20, 2018

Physicians Plead Guilty to TRICARE Fraud

by Gregory J. Brod

freestocks-org-126848-1-copy-300x200 In 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.

April 13, 2018

Executives of California Counseling Facility Arrested for Fraud

by Gregory J. Brod

andres-de-armas-103880-copy-300x200 In 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

April 6, 2018

California Lawmakers Attempt to Limit Third-Party Insurance Premium Payments

by Gregory J. Brod

daan-stevens-282446-copy-300x191 California 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.