Articles Tagged with attorney for health care whistleblowers

vladimir-kudinov-71455-copy-300x241Physicians Vilasini Ganesh, 47, and Gregory Belcher, 56, were convicted in December of committing health care fraud and making false statements to health care programs. A federal jury found Ganesh guilty of five counts of health care fraud and five counts of making false statements relating to fraudulently submitted claims. Belcher was found guilty of one count of making a false statement regarding a health care benefit program. Both were acquitted of conspiracy and money laundering charges.

Health Care Fraud and False Statements

Evidence presented at trial showed Ganesh, who was the head of Campbell Medical Group, submitted false and fraudulent claims to several health benefit programs for services. She submitted claims for days when patients had not seen a health care provider and claims that patients had been seen by another physician who was no longer with her practice.

osman-rana-193633-copy-300x169The U.S. Department of Justice announced on November 28 that two former health care employees pleaded guilty to Medicare fraud. Aharon Aron Krkasharyan, 53, was employed as a quality improvement coordinator at Mauran Ambulance Inc., a Los Angeles area ambulance company that provided non-emergency services to Medicare patients. Maria Espinoza, 47, was an administrative assistant at DaVita Doctors Dialysis of East Los Angeles.

Both pleaded guilty to fraud charges for a scheme that caused $6.6 million in fraudulent claims to be submitted to Medicare. They are scheduled to be sentenced in the spring of 2018.

If you have any information regarding a similar Medicare or Medi-Cal kickback or fraudulent claim scheme, you should contact a San Francisco health care fraud attorney from Brod Law Firm right away. You may be able to bring this illegal activity to state and federal authorities’ attention or to file a False Claims Act (FCA) qui tam suit yourself, potentially benefiting from a jury award or settlement.

alex-boyd-260321-copy-300x200Four San Diego nursing homes owned by Brius Management Co. have agreed with the federal and state governments to resolve civil allegations regarding illegal kickbacks and health care fraud by paying a $6.9 million settlement.

The investigation into the Point Loma Convalescent Hospital, Brighton Place located in San Diego, Brighton Place located in Spring Valley, and Amaya Springs Health Care Center in Spring Valley began through a qui tam lawsuit regarding false claims submitted to Medicare and Medi-Cal. The whistleblower’s allegations enabled the government to investigate the claim and eventually enter into Deferred Prosecution Agreements (DPAs) and a Corporate Integrity Agreement with these four facilities.

If you work for a nursing home, hospital, or other medical facility and you aware of an illegal kickback scheme or false claims being made to Medicare or Medi-Cal, contact a San Francisco health care fraud lawyer from Brod Law Firm right away.

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.

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.

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.

david-everett-strickler-196946-copy-300x195On July 13, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced the Department of Justice’s largest ever health care fraud enforcement action. The work of the Medicare Fraud Strike Force, established in 2007, led to 412 defendants being charged with health care fraud offenses based on information they all participated in fraudulent schemes to obtain about $1.3 billion in false billings to Medicare, Medicaid, and TRICARE. Additionally, HHS has begun the suspension process against 295 health care providers’ licenses.

Hundreds of Individuals Charged With Health Care Fraud

Of the 412 defendants, 115 are physicians, nurses, and other licensed medical professionals. Many of these defendants were charged with federal crimes for prescribing medically unnecessary drugs and compound medications, many of which were not actually distributed to the patients or purchased. Providers could then bill for these unnecessary or unpurchased medications and receive a greater amount of reimbursements from state and federal health services.

jimi-filipovski-189724-copy-300x176There are currently two False Claims Act (FCA) qui tam cases against United Health Group (UHG) pending in the Central District of California. The cases are: U.S. ex rel. Benjamin Poehling v. UnitedHealth Group, Inc. and U.S. ex rel. Swoben v. Secure Horizons, et al. The cases were brought by James Swoben, who was previously an employee of Senior Care Action Network Health Plan and a consultant within the risk adjustment industry, and Benjamin Poehling, who was the former finance director of a UHG group that managed the insurer’s Medicare Advantage Plans.

The Qui Tam Cases Against UHG

On May 2, the U.S. intervened in the Swoben False Claims Act suit against UHG based on the allegations the insurer overcharged Medicare Advantage and prescription drug programs. In the DOJ’s complaint, it alleges the insurer knowingly ignored patients’ medical conditions to increase payments it received from Medicare and funded chart reviews to increase the risk adjustment payments it reviewed. However, any information the reviews uncovered regarding misdiagnoses were disregarded to avoid repaying Medicare.