Articles Posted in Whistleblowers and Qui Tam Lawsuits

vladimir-kudinov-71455-copy-300x241On 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.

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-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

piron-guillaume-96228-copy-300x200On November 28, the U.S. Department of Justice (DOJ) announced a $1.2 million settlement with Cardiovascular Consultants Heart Center, known as CVC Heart Center, and its shareholder physicians. CVC Health Center is a cardiology clinic with offices in Fresno and Clovis, California.

The CVC Heart Center along with Dr. Kevin Boran, Dr. Michael Gen, Dr. Rohit Sundrani, Dr. Donald Gregory, and Dr. William Hanks resolved state and federal False Claims Act (FCA) allegations based on their allegedly performing medically unnecessary tests and billing state and federal health care programs for them.

If you are aware of any medical false billing to a California or federal health care program like Medicare or Medi-Cal, contact the San Francisco health care fraud lawyers of Brod Law Firm right away. You may have information that would be important to the authorities. You may also have standing to bring a qui tam suit on behalf of a state and/or federal government.

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.