Healthcare Fraud Lawyer Blog

There has been growing awareness in recent years about the importance of mental health. More people are seeking help and health professionals are becoming more educated on the importance of a well-rounded definition of health. Sadly, there are also scammers out to take advantage of this trend including the perpetrators of Medicare fraud. As a health care fraud law firm based in California, the Brod Firm partners with whistleblowers to fight mental health benefit fraud, working together to return money to government coffers and ensure that the benefits are available for those who truly need them.

Sentencing in $97 Million Fraud Scheme

The government’s commitment to fighting health care fraud has extended into 2015 as demonstrated by the sentencing of two Houston area physicians who used their ownership in a mental health clinic to perpetrate a $97 million Medicare fraud scheme. As a Department of Justice press release details, Dr. Mansour Sanjar, 81, and Dr. Cyrus Sajadi, 67, were found guilty of conspiracy to commit health care fraud and related counts involving kickbacks via a jury trial last March. This month, they were sentenced to 148 months and 120 months in jail respectively and ordered to pay restitution of approximately $8 million. A group home owner, Chandra Nunn, was also sentenced to a 54 month jail term and ordered to pay over $1.8 million restitution. Several other co-defendants are still awaiting sentencing.

It takes a very special individual to work in the end-of-life care arena. We have the deepest respect for the men and women who support both patients and their loved ones in the hospice care environment. These professionals offer much more than medical care, they offer emotional support to people facing some of life’s hardest moments. It is out of respect for the vast majority of these workers who are honest and good-hearted and a belief in the importance of the services they offer that our San Francisco-based Medicare fraud law firm is committed to uncovering and redressing cases of hospice care fraud.

Hospice Care Generally

The Eldercare Locator, a program operated by the Administration on Aging, U.S. Department of Health and Human Services (“HHS”), helps connect older Americans and their loved ones with a range of senior services. The website offers a Hospice Care Factsheet which explains that hospice programs help the terminally ill and their families with 24-hour care aimed at making the patient’s final days as comfortable and dignified as possible. In addition to medical services, hospice care offers psychosocial support to patients and their loved ones.

Choosing a nursing home or other senior care facility is a difficult and emotional decision. There are many factors to consider, many of which can spark intense family debates, including location, price, and available forms of care. There are also more individualized factors like whether the prospective resident has friends at the facility, whether the facility has a religious affiliation, and the input provided by the resident’s current doctors. That last item, the advice of medical professionals, can be extremely persuasive and a good doctor will assess numerous factors before voicing an opinion. Kickbacks from nursing homes should never cloud a doctor’s professional judgment. While that may sound obvious, payments to doctor for referrals our Northern California Medicare fraud law firm knows illegal kickbacks are more common than most of us would like to think and pose both a financial threat to the Medicare program and a threat to patients’ health and well-being.

Whistleblower Alleges Kickbacks Were Key Part of Medicare Fraud by Senior Care Network

According to the Broward Bulldog, the Plaza Health Network has worked to maintain a top-notch reputation since its founding 64 years ago as a home for Jewish seniors and war veterans who could no longer live alone and/or care for themselves. Plaza is now a non-profit with corporate offices in Aventura, Florida, and runs eight care facilities in the Miami region open to seniors of all denominations. The company’s reputation may, however, change dramatically if a lawsuit alleging health care fraud is successful

Medicare fraud is a topic that is receiving increasing attention from authorities and news media alike. Our California Medicare fraud law office believes this attention is rightly placed and we support efforts to both recover wrongfully diverted funds and prevent future frauds. Two of the ways that the government accomplishes these interrelated goals is through rulemaking and through intervening in whistleblower-led health care fraud claims.

Rulemaking – New Rule Limits Enrollment by Suspect Entities

Last week, the Center for Medicare and Medicaid Services (“CMS”) announced approval of a new rule that will allow the agency to prevent future frauds by identifying persons/entities that pose particular risk to the integrity of our federal health care programs. The rule, as detailed in a CMS Fact Sheet, attempts to prevent suspect groups from enrolling in or remaining part of the system and being permitted to bill Medicare for services provided to beneficiaries. Key elements include: Denying enrollment of providers and others associated with an entity that has an outstanding Medicare debt; Denying or revoking billing privileges of groups that have a managing employee who was previously convicted of certain felonies; and Revoking the billing rights of providers and suppliers that show a pattern of improperly billing for services that fail to meet program requirements.

Sadly, it doesn’t feel unusual for someone accused of a crime to continue suspect behavior. As pending litigation against a surgeon already embroiled in health care fraud litigation became even more complex last week, it also continued to break new legal ground with allegations involving a specific form of business entity known as a physician-owned distributorship. Also known as “PODs,” these entities raise some major red flags that can point to both criminal and civil wrongdoing. While the current case is the first publicly noted health care fraud case involving PODs, our San Francisco health care fraud attorney expects that litigation will continue as long as the suspect devices are used by those who put profit over patient care.

Man Faces Health Care Fraud Charges in Both California and Michigan

A report in the journal Modern Healthcare details expanded claims filed against a doctor in Michigan who has already been stripped of his license here in California. Dr. Aria O. Sabit stands accused of committing fraud, violating naturalization laws, and performing spinal fusion surgeries in which he did not actually implant promised medical devices. When some patients in Michigan who had undergone surgery with Sabit had continued pain and sought second opinions, they were told that medical devices had not actually been placed during the initial surgeries, even though bills for the devices had been filed with government and private insurers. Sabit also, per the recently filed suit, failed to inform citizenship officials of prior felony-level health care fraud charges that would have rendered him ineligible for naturalization.