Healthcare Fraud

March 30, 2018

Physician Awaiting Sentencing for Health Care Fraud

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

March 23, 2018

Owner of Riverside Regional Surgery Center Charged With Healthcare Fraud

by Gregory J. Brod

vladimir-kudinov-71455-copy-300x241 On March 8, the Riverside County District Attorney announced that four men had been arrested in connection with an $8 million health care fraud scheme. The men were Jeffrey D. Ogletree, of Meridian, Idaho; Brian Andrew La Porte, of Poway, California; Dennis Davin Bonavilla, of Murrierta, California; and Babar Iqbal, of Irvine, California, who was also the owner of Riverside Regional Surgery Center. The men were allegedly involved in a scheme to provide fake health insurance to patients in the Midwest.

Fake Health Insurance Scheme

In 2013, La Porte formed Free Choice Healthcare Foundation (FCHF), which allegedly was created to help low-income individuals pay health insurance premiums. The foundation was never registered as a charity in California. After meeting with Ogletree, a vice president of a hospital group in the Midwest, the hospital donated more than $5 million to FCHF in 2015. The donation was purported to be used to provide year-long health insurance for 333 residents in the Midwest.

March 16, 2018

California Dentist Faces Health Care Fraud Charges

by Gregory J. Brod

daniel-frank-201417-copy-300x200 The 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

March 9, 2018

Weight Loss Physicians Charged With Fraud

by Gregory J. Brod

jennifer-burk-118076-unsplash-copy-200x300 In 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.

March 2, 2018

Developments in FCA Cases Against United Health Group

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 The 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.

February 16, 2018

More Physicians Suspended From California’s Workers’ Comp System

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 In 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:

February 9, 2018

Couple Indicted for Using Active Duty Military Members in California to Defraud TRICARE

by Gregory J. Brod

patrick-tomasso-40279-copy-300x225 Jimmy 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.

February 2, 2018

Two Urologists Settle False Claims Act Allegations for More Than $1 Million

by Gregory J. Brod

samuel-zeller-360588-copy-200x300 Two 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

January 25, 2018

Scripps Health to Pay $1.5 Million Settlement for Alleged FCA Violatoins

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 Scripps 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

January 19, 2018

Former California Hospital Owner Sentenced to Prison

by Gregory J. Brod

vladimir-kudinov-71455-copy-300x241 On 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.