california healthcare fraud attorney Tag Archives

November 30, 2019

Five Things You Should Know About Stark Law

hush-naidoo-382152-copy-300x200 There are many different types of whistleblower claims that involve physicians and other medical providers defrauding the government. Some of the most common involve Stark Law violations. Stark Law was enacted over two decades ago and was meant to ensure that patients receive the best care possible, and that physicians always work in their best interests. Today, Stark Law has become complicated, and it seems the laws are changing all the time. If you work in the medical industry, below are five things you should know about Stark Law to ensure your employer operates honestly and within the confines of the law.

Stark Law Bans Self-Referrals

When it was enacted in 1989, the concept behind Stark Law was relatively simple. The law was intended to ban self-referrals made by doctors for certain services when a patient was covered through Medicare or another government program. The law was named after Representative Pete Stark, the Democrat from California that sponsored the bill.

December 19, 2018

The Scope of Health Care Fraud’s Contribution to the Opioid Epidemic

by Gregory J. Brod

jonathan-perez-409943-copy-300x200 Every day we hear shocking news about the opioid epidemic, from the number of deaths from overdoses to the sheer amount of distribution arrests to the amount of money government is spending to combat the problem. One of the areas that the public may not know about, however, is how much of the problem is being created by dishonest health care professionals across the country through fraud and illegal practices.

The Opioid Epidemic

We are bombarded with statistics about the enormity of scope of opioid use in our country. For example, in FY2016, the Centers for Disease Control and Prevention (CDC) estimated that 42,249 Americans died from opioid overdose in our country. The Substance Abuse and Mental Health and Services Administration (SAMSHA) estimates that 11.8 million Americans over the age of 12 have abused prescription opioids and heroin in the last year. The federal Department of Health and Human Services announced in September of this year that they have awarded over $1 billion in grants to “help combat the crisis ravaging our country.” Obviously, the problem is incredibly dangerous, incredibly real, and at the forefront of discussion in the US. What is not as obvious is what role healthcare fraud plays in fueling this problem.

September 17, 2018

Six Ways Predictive Analysis can be Used to Identify and Combat Healthcare Fraud

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 With the development of big data and predictive analytics, it is easier today than ever before to detect and prevent healthcare fraud. Gone are the days of lengthy, old-fashioned investigation, and here to stay are new technologies that can identify fraudulent activities automatically and instantly. By parsing through big data and analyzing payment trends, predictive analytics softwares can identify inconsistencies in payment and seemingly fraudulent activity. This article delves deeper into the system that mines data and predicts fraud by explaining the many components that make up a fraud detection software. If you are interested in learning more about how you can use technology to detect healthcare fraud, contact our attorneys today to learn more.

Link Analysis

Link analysis focuses on measuring relationships. It mines and analyzes data relating to how individuals, healthcare providers, healthcare employees, and healthcare suppliers are related to and interact with one another. It can identify unusual interactions and even unusual identities, such as multiple or fake addresses and phone numbers.

April 27, 2018

Ambulance Company Employee Sentenced for Medicare Fraud

by Gregory J. Brod

osman-rana-193633-copy-300x169 In mid-April, Aharon Aron Krkasharyan, 54, a former employee of Mauran Ambulance Inc. (Mauran) of San Fernando, was sentenced for his part in a health care fraud scheme. He pleaded guilty to one count of conspiracy to commit health care fraud in November 2017. U.S. District Judge George H. Wu sentenced Krkasharyan to 36 months in prison and to jointly and severally pay $484,556 in restitution to Medicare.

If you know of any type of a fraudulent scheme against a federal or state health care program, do not hesitate to seek legal advice. An experience San Francisco qui tam lawyer from Brod Law Firm can help.

The Medicare Fraud Scheme

April 13, 2018

Executives of California Counseling Facility Arrested for Fraud

by Gregory J. Brod

andres-de-armas-103880-copy-300x200 In early April, two executives for a business offering alcohol and drug abuse treatment services were arrested for healthcare fraud. Mesbel Mohamoud, 45, and Erlinda Abella, 63, both of Inglewood, are accused of submitting bills to Medi-Cal for services that were either not provided or were not eligible for reimbursement. Authorities allege Mohamoud and Abelle fraudulently sought more than $2 million in reimbursements.

If you have any information regarding a healthcare business fraudulently billing a federal or state medical program, contact a San Francisco health care fraud lawyer at Brod Law Firm right away.

Further Details of Alleged Healthcare Fraud

March 23, 2018

Owner of Riverside Regional Surgery Center Charged With Healthcare Fraud

by Gregory J. Brod

vladimir-kudinov-71455-copy-300x241 On 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.

January 25, 2018

Scripps Health to Pay $1.5 Million Settlement for Alleged FCA Violatoins

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 Scripps 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

January 19, 2018

Former California Hospital Owner Sentenced to Prison

by Gregory J. Brod

vladimir-kudinov-71455-copy-300x241 On 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.

December 22, 2017

Two Saratoga Doctors Convicted of Health Care Fraud

by Gregory J. Brod

vladimir-kudinov-71455-copy-300x241 Physicians 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.

October 20, 2017

California Workers’ Comp Suspends 11 Medical Providers in October

by Gregory J. Brod

hush-naidoo-382152-copy-300x200 The 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