Articles Posted in Whistleblowers and Qui Tam Lawsuits

ken-treloar-385255-copy-300x200Elaine C. Lat, 47, of Fontana, California, owned and operated the Star Home Health Resources, Inc., a home health agency. As the chief operating officer, Lat implemented an illegal kickback scheme through which she would pay physicians, marketers, and other professionals in cash or checks from Star Home’s accounts for referrals of Medicare patients. Between May 2008 and May 2016, she paid more than $1.25 million in illegal kickbacks for these referrals. She then received more than $8.5 million in reimbursements from Medicare for services provided to patients the facility gained through the illegal kickback scheme.

Sentencing for Illegal Kickbacks

Lat pleaded guilty in May 2017 to one count of conspiracy and four counts of paying illegal kickbacks. She was sentenced in November 2017 to 30 months in federal prison and ordered to pay $41,930 in restitution to Medicare.

daan-stevens-282446-copy-300x191Michael Mirando, 40, previously a resident of Aliso Viejo, CA, was found guilty in May of 2017 on 15 counts of health care fraud. It took a federal jury less than half an hour to reach a verdict following the trial. At the end of October, Mirando was sentenced to eight years in prison and $3 million in restitution. Mirando’s current home in Portland is also being forfeited to the authorities since he admitted it was purchased by the financial proceeds of the fraud.

Medical Facility Owner Submits False Bills

Mirando owned Holter Labs, which offered patients cardiac monitoring services using what was called a Holter monitor. It is an ambulatory electrocardiography device, also known as an EKG device that can be used while a patient walks and performs normal activities. Holter Labs would provide these devices to physicians who then prescribed the devices to patients in order to monitor their heart rates for 24 to 48 hours. Mirando would bill the patients’ insurance companies for the day or two of use of the device. However, at the same time, he would tack on additional services that were not ordered or provided, like 30-day EKG tests, brain scans, and oxygen studies.

how-soon-ngu-34-copy-199x300The Department of Justice (DOJ) for the Eastern District of California announced in October that two individuals pleaded guilty to health care fraud charges. These announcements continue to prove that the DOJ is focused on prosecuting all forms of health care fraud throughout the state and federal levels.

If you have information regarding health care fraud, contact an experienced San Francisco health care fraud lawyer at Brod Law Firm to learn about your rights and options. You may be in the position to file a qui tam lawsuit on behalf of California or the federal government. Call us today at (800) 427-7020.

Fresno Podiatrist Pleads Guilty

hush-naidoo-382152-copy-300x200The California Division of Workers’ Compensation (DWC) announced new suspensions twice in October. It suspended eight medical providers from participating in the state’s workers’ compensation system in early October and then three more shortly after. The total suspensions for 2017 are now up to 49.

These suspensions are part of the DWC’s new policy passed into law in 2016 by Assembly Bill 1244. The new law, which went into effect on January 1, requires the DWC to suspend any medical provider that is convicted of any offense involving abuse or fraud of the federal Medicare program, the state Medi-Cal program, any workers’ compensation system, or a patient. Medical providers can also be suspended for other types of misconduct that led to their license being revoked or surrendered.

The Suspended Medical Providers  

samuel-zeller-360588-copy-200x300In early October, a California federal judge dismissed without prejudice a False Claims Act (FCA) lawsuit against UnitedHealth Group Inc. (UHG). The suit, U.S. ex rel. Swoben v. Secure Horizons, et al., alleged UHG ignored questionable diagnoses that led to higher reimbursements through the Medicare Advantage program. This is significant news for the U.S. Department of Justice (DOJ). The UHG case was the first FCA suit related to the Medicare Advantage program that the DOJ joined. This was essentially a test case to determine the strength of the DOJ’s position and the ability to bring similar cases in the future. Unfortunately, this dismissal signals there were numerous weaknesses in the DOJ’s FCA case.

The Basis for the FCA Claim

This qui tam suit was brought by a whistleblower who alleged UHG knowingly ignored questionable patient charts reviewed by another company, Healthcare Partners LLC. These charts, whether or not they had appropriate evidence, contained diagnoses that would increase the insurer’s risk adjusted payments under the Medicare Advantage program. Under Medicare Advantage, healthcare providers receive higher reimbursements for caring for sicker patients.

vladimir-kudinov-71455-copy-300x241There is a misconception that the U.S. Department of Justice (DOJ) is mainly interested in health care fraud and violations of the False Claim Act (FCA) from large corporations like major insurers or pharmaceutical manufacturers. However, this is not true. The DOJ is on a mission to uncover health care fraud at all levels of care, including with individual physicians, local hospitals, regional insurers, and multi-national businesses. This is evidence by two recent DOJ announcements regarding settlements with a family practice chain in South Carolina and a hospital operator in New York.

South Carolina Family Medicine Centers

The Family Medicine Centers of South Carolina LLC (FMC) agreed to pay the U.S. $1.56 million to resolve allegations of FCA violations. FMC is a physician-owned chain of five, previously six, medical practices located in Columbia, South Carolina, and the surrounding area. FMC’s principal owner and chief executive officer Dr. Stephen F. Serbin and FMC’s former laboratory director Victoria Serbin will pay $443,000 to personally resolve allegations of FCA violations.

daan-stevens-282446-copy-300x191CHRISTUS St. Vincent Regional Medical Center, located in Santa Fe, New Mexico, and CHRISTUS Health, located in Irving, Texas, have agreed with the U.S. Department of Justice to resolve allegations of violating the federal False Claims Act (FCA) with a settlement of $12.24 million plus interest.

A Qui Tam Suit

The allegations against the CHRISTUS health care companies were made by a former indigent healthcare administrator under the qui tam provision of the FCA. This whistleblower provided information that the two health care companies were making illegal donations to county governments. Between 2001 and 2009, the CHRISTUS companies allegedly made donations in bad faith to various counties, which in turn caused New Mexico to present false claims to the federal government through the Medicaid program.

christina-sicoli-19892-copy-300x212Whistleblower George Gage has made it clear he is not happy with the current judge for his qui tam case, U.S. District Judge Sam Sparks. Gage claims that throughout his False Claims Act (FCA) case against Rolls-Royce North America Inc., Judge Sparks has handed down orders that attempt to divest him of jurisdiction in order to try and have Gage’s case thrown out before Rolls-Royce submitted an answer. He has tried two different ways to obtain a different judge on his case and each time has failed. That is because it takes a great deal of evidence of bias or impartiality to get a judge taken off a case.

If you are currently part of a qui tam case and believe the judge is not able to be partial, contact the experienced California qui tam attorneys of Brod Law Firm as soon as possible.

Gage’s Attempts for a New Judge

daan-stevens-282446-copy-300x191The U.S. Department of Justice (DOJ) announced August 18 that the owner and operator of five home health agencies located in the Houston area, Godwin Oriakhi, 61, was sentenced to 480 months in prison for conspiring to defraud Medicare and the Texas’ Medicaid programs: Home and Community-Based Service (HCBS) and Primary Home Care (PHC), which are known as provider attendant services (PAS). The authorities found Oriakhi defrauded Medicare and the Medicaid programs for more than $17 million, making this the largest PAS fraud case in all of Texas’ history.

More on Oriakhi’s Fraud

Oriakhi pleaded guilty to two counts of conspiracy to commit health fraud and one count of conspiracy to launder monetary instruments in March 2017. This came after Oriakhi admitted that he and his daughter, a co-defendant in the case, and other members of his family obtained patients for his home health agencies through illegal kickbacks to patient recruiters, his office employees, and physicians. His five facilities receive hundreds of patient referrals this way.

When qui tam cases under the False Claims Act (FCA) are first filed, they are to remain under seal for 60 days. During this time, the case is secret. The defendant is not even served yet, so it likely does not know there is a suit filed against it unless there are quiet rumblings or leaks. During this 60-day period, the government is given an opportunity to investigate the allegations and decide whether to join the suit or not. Once the government makes its decision, the case is unsealed. In certain instances, this is when the defendant is served. However, in many cases, the seal is partially lifted and the defendant is served prior to the whistleblower case being made public.

The truth of the matter, though, is that a qui tam case is never under seal for just 60 days. The FCA, the government can ask for extensions of the seal period if they can show it is for good cause. This happens regularly and continuously to the point where many qui tam cases remain confidential for years.

How Long Do Qui Tam Cases Remain Under Seal?