Articles Tagged with bay area healthcare fraud lawyer

piron-guillaume-96228-copy-300x200Federal authorities arrested five individuals connected to San Fernando Valley clinics and a significant health care fraud scheme. On May 22, a federal grand jury indictment was unsealed. The indictment alleges that the five individuals engaged in a health care fraud conspiracy over multiple years and targeted at least eight health insurance companies and the International Longshore and Warehouse Union, the Pacific Maritime Association Benefit Plan, and the Federal Employees Health Benefits Program.

The Conspirators

According to the Department of Justice (DOJ) press release, the co-conspirators included:

aidan-bartos-313782-copy-300x200One of the ways in which physicians and other health care professionals commit fraud against the federal government is through accepting or providing illegal payments or gifts to generate certain business. This type of scheme is also known as kickbacks.

One of the most common kickback schemes associated with this field is paying a health care professional for referrals to a certain physician, facility, or medical device provider. The person or place that receives the referral is then able to use the new business to grow their claims to a federal health care program and unlawfully increase their reimbursements. In many cases, the services or products they bill for are medically unnecessary or fraudulent in another way. However, not all kickback schemes involve referrals. Payments or gifts intended to generate any health care business, which is then unlawfully invoiced to Medicare or Medicaid for reimbursement, is illegal.

If you know of a physician or other health care professional who is paying or accepting kickbacks that lead to false claims against Medicare or Medicaid, contact a San Francisco anti-kickback lawyer from Brod Law Firm today. The information and evidence you have may be enough for you to file a qui tam case under the False Claims Act against those participating in the fraudulent scheme.

jonathan-perez-409943-copy-300x200On April 13, the U.S. intervened in five lawsuits against Insys Therapeutics Inc., which all accuse the company of violating the False Claims Act in regard to its opioid painkiller, Subsys. The painkiller is a sublingual spray form of fentanyl, an extremely potent and addictive drug.

Fentanyl has made the news in recent years as a replacement for heroin and other illegal street drugs, which has led to an increase in drug overdoses. Fentanyl analogues are hundreds of times more potent than heroin, and thousands of times stronger than morphine. Considering the risk of addiction and dependence on opioid painkillers, and the risk of death, the government takes accusations of improper marketing and prescribing of the drug seriously.

If you are aware of illegal activity regarding opioid drugs at a doctor’s office or medical facility, contact an experienced San Francisco health care fraud lawyer at Brod Law Firm today. Not only may the activity be a crime under California or federal law, it may also give rise to a civil claim.

jonathan-perez-409943-copy-300x200The sentencing of a physician convicted of health care fraud was continued in March. Paul Matthew Bolger, 46, will not be sentenced until May 22 for committing health care fraud. In August 2017, he pleaded guilty to 18 counts of making false claims related to health care and five counts for crimes related to misbranded drugs. While Bolger’s case took place in Bettendorf, Iowa, one count of false statements began in California and was transferred from the Central District of California, demonstrating that many health care fraud schemes cross state lines.

Intentional False Statements Regarding Prescriptions

Bolger pleaded guilty to knowingly and willfully making false statements by signing numerous prescription forms that authorized prescription drugs and indicated they were necessary. However, he did not know that to be true. He signed and supported the validity of each prescription based on an intake form created by non-medical staff at a call center located outside of the U.S. He did not talk with any of the patients personally, he did not conduct any physical exams, and he did not review any of the patient’s medical records.

vladimir-kudinov-71455-copy-300x241On January 12, the former owner of Pacific Hospital in Long Beach, California was sentenced to 63 months in prison. The owner, Michael D. Drobot, 73, was charged with crimes related to running a 15-year health care fraud scheme. In 2014, he pleaded guilty to conspiracy and paying illegal kickbacks to physicians. In addition to the prison sentence, Drobot has been ordered to liquidate numerous assets in order to forfeit $10 million to the government and pay a $500,000 criminal fine. A restitution hearing is scheduled for May 11, which may result in additional financial consequences for Drobot.

Owner Created Massive Kickback Scheme

Between 1997 and 2013, Drobot created a scheme in which he would bill workers’ compensation insurers for spinal surgeries performed on patients who had been referred by physicians who received illegal kickbacks from Drobot for sending patients to his facility. Drobot had dozens of physicians, chiropractors, and others involved in sending patients to his hospital for services in exchange for illegal payments.

hospitalOne of the many ways that patients are at the mercy of their health care providers and insurers is through pharmaceuticals and prescriptions. Doctors write specific prescriptions, sometimes based on pharmaceutical advertisements, that may require that patients receive name brand drugs. Insurers place limitations on the types of drugs that insureds can access. Another way that insurers and pharmaceutical companies have been limiting patient options is by engaging in health care fraud in order to increase profits at the expense of patient choice. Luckily, False Claims Act lawsuits have exposed pharmaceutical fraud, and actions have been taken against some major perpetrators.

Medco Fraud Settlement

According to the Corporate Crime Reporter, former AstraZeneca employees filed a qui tam lawsuit against AstraZeneca, a pharmaceutical manufacturer, and Medco, a company that manages pharmacy benefits. The lawsuit alleged that Medco and AstraZeneca entered into hidden financial agreements based on which Medco received lower prices on three AstraZeneca drugs in exchange for including one of AstraZeneca’s medications as the only one of its kind on some of Medco’s list of covered prescriptions.