Articles Tagged with attorney for health care fraud

daan-stevens-282446-copy-300x191California 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.

daniel-frank-201417-copy-300x200The 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

jennifer-burk-118076-unsplash-copy-200x300In 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.

hush-naidoo-382152-copy-300x200In 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:

patrick-tomasso-40279-copy-300x225Jimmy 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.

jonathan-perez-409943-copy-300x200Kmart Corporation, a subsidiary of Sears Holding Corporation, will pay the federal government $32.3 million to settle allegations of violations of the False Claims Act. A whistleblower alleged that Kmart stores did not report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, thereby receiving larger reimbursements than it was entitled to.

Kmart Wrongdoing Exposed by Whistleblower

In 2008, pharmacist James Garbe filed a qui tam suit under the FCA against Kmart. He alleged that Kmart pharmacies offered discounted generic drug prices to customers who paid cash through various programs, yet knowingly failed to disclose those prices to federal health programs. Instead, between 2004 and 2016, it reported to Medicare, Medicaid, and TRICARE its customary prices for drugs, which were then used to establish reimbursement rates. The incorrect claims lead to Kmart receiving higher reimbursements than the business was entitled to.

josh-appel-423804-copy-300x225The operator and two employees of a former medical supply company in Hawthorne and Ventura, California have been arrested by special agents of the U.S. Department of Health and Human Services’ Office of Inspector General and the Federal Bureau of Investigations (FBI) for health care fraud. The allegations state that the three individuals fraudulently charged Medicare for more than $24 million in unnecessary power wheelchairs and repairs.

The Defendants

The three individuals arrested for this healthcare fraud scheme were:

hush-naidoo-382152-copy-300x200In mid-December, a federal jury found Ronald Grusd and two corporations, California Imaging Network Medical Group and Willows Consulting Company, guilty of fraud and bribery related to a health care fraud scheme involving California’s Workers’ Compensation program. More specifically, the jury was found guilty of Conspiracy, Honest Services Mail and Wire Fraud, Health Care Fraud, and violations of the Travel Act. Grusd, the companies, and his administrator, Gonzalo Paredes, were indicted by a federal grand jury in November 2015. Grusd will return for sentencing in March 2018. Paredes is to return to court for a hearing regarding a retrial in January 2018.

Grusd’s Health Care Scheme

Grusd and his two companies paid kickbacks to multiple clinics in San Diego County and Imperial County for patient referrals. The purpose of these illegally obtained patient referrals was to fraudulently bill insurers more than $25 million in medical services.

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.

alex-boyd-260321-copy-300x200Sentencing for four California residents who pleaded guilty to conspiracy to commit health fraud was recently handed down. Geoffrey Ricketts, 49, Marla Ricketts, 38, Samuel Kim, 41, and Sunyup Kim, 40, all pleaded guilty in late 2016 and early 2017 after being indicted in June 2015.

Glucose Meter Fraud Scheme

These individuals created a fraudulent scheme regarding the sale of “talking glucose meters,” which were not medically needed or requested by consumers. They did so through the operation of Care Concepts, LLC and Choice Home Medical Equipment and Supplies (“Care Concepts”). The main corporate business was based out of Louisiana, while Care Concepts had its principal place of business in Chatsworth, California.