Articles Tagged with health care fraud lawyer

Is Medicare fraud really that bhealthcashig of a problem?  After all, doesn’t fraud exist in almost every sector of the economy?  Why focus so much energy on one issue?  As recently filed charges in one case show, Medicare fraud is an enormous problem that costs our government billions of dollars every year.  Stealing from the government is, in essence, stealing from every single taxpayer.  Medicare fraud diverts money from those who truly need and deserve health care services and puts the money in the pockets of wrongdoers.  At the same time, there is also very specific, personal harm to patients whose providers are involved in fraudulent schemes, patients whose health is put in jeopardy because a provider puts profit over care.

DOJ Announces Allegations of Fraudulent Medicare Billing in Excess of $1 Billion

Late last month, Assistant Attorney General Leslie R. Caldwell publicly announced the unsealing of charges in what she called “the largest single criminal health care fraud case ever brought against individuals by the Department of Justice.”  The case involves allegations of fraudulent billing that total over $1 billion.  The allegations are focused on a group in South Florida, a region particularly hard hit by Medicare fraud.

dentistHealth care fraud touches almost every part of the American health care system and dental care is no exception.  While dental services are typically not covered by Medicare, Medicaid requires states to include dental care for covered children and states can elect whether or not to cover dental care for Medicaid-covered adults.  When dental fraud targets Medicaid dollars (or other government programs such as Tricare), children and adults can be deprived of an important aspect of overall health and taxpayer money is diverted from its intended purpose.  Our dental fraud law firm works with whistleblowers using both state and federal False Claims Acts to bring the perpetrators to justice.

Two Examples of Medicaid Fraud Allegations Involving Dental Services

In February, according to a press release from the Department of Justice, a Missouri dentist entered a guilty plea to allegations he conspired to commit Medicaid fraud and to collect over $167,000 in connection with claims for orthodontic devices purchased for child patients in his dental clinics.  In his plea, the dentist admitted he and his co-conspirators billed Medicaid claiming the devices were intended as a form of speech aid prosthesis when they were actually a method of straightening teeth without the use of braces.  Although the Medicaid code used meant the claims were pre-certified, they should have been filed under a different code which would have required pre-authorization.  In his plea, the dentist admitted the patients had not received and did not qualify for orthodontic treatment so Medicaid would not have covered the claims.  The defendant further admitted that the co-conspirators paid around $50 per device, but billed Medicaid for approximately $695 per device (the maximum allowed for a speech prosthesis).

In Fiscal Year 2015, the government, often with the assistance of private whistleblowers, recovered more than $3.5 billion using the False Claims Act to target companies and individuals who attempted to commit fraud and steal money from federal government programs.  We took a broad look at these recoveries a couple of weeks back, today we take a narrower focus: health care fraud.  We believe that looking at these cases can help people understand what sort of actions violate the FCA and encourage them to contact our whistleblowers’ law firm.  As the 2015 numbers show, the FCA works and individuals can play a major role in the fight against fraud targeting Medicare, Medicaid, and other vital government health care programs.

$1.9 Billion Recovered in Health Care Fraud False Claims Act Cases in 2015

According to the Department of Justice’s press release announcing the successes under the FCA in FY2015, $1.9 billion of the $3.5 billion recovered on behalf of the federal government last year came from the health care industry.  This makes the total health care fraud dollars recovered via the FCA since January 2009 nearly $16.5 billion.  Importantly, these numbers are limited to federal dollars returned to federal programs.  Quite often, health care fraud prosecutions include additional charges involving state programs and can include recoveries on behalf of these programs as well, especially when cases involve Medicaid which is a joint federal/state venture.

We spend a lot of time talking about the federal False Claims Act and for good reason; it is an important tool for fighting frauds that steal taxpayer money and leave some of our nation’s most vulnerable and worthy individuals unable to get the services they need or even directly endangered by the fraud.  It is important to remember, however, that there are also powerful state laws that cover similar cases of fraud on state government.  As a recent case shows, these laws not only allow for the potential return of money to already-underfunded state programs, but they can also prove powerful incentives for change.

Minnesota Group Accused of Fraud in Mental Health Arena

Earlier this month, The Star Tribune wrote about allegations of fraud in the provision of mental health services filed at both the state and federal level.  According to the report, Complementary Support Services (“CSS”), a nonprofit organization based in Richfield, Minnesota, stands accused of improperly billing government assistance programs for mental health services.  Specifically, the pending lawsuit alleges CSS billed for services provided to hundreds of patients without the supervision by a licensed mental health professional that the programs require.  Additionally, the suit accuses the organization of padding bills by including time spent on paperwork, a lonelyseniorpractice prohibited under state law.  Prosecutors further allege that CSS’s president, herself a licensed social worker, “batch signed” large numbers of documents and directed the practice be continued while she was out on leave, rather than giving the files the personal review required by law.  The suit also accuses the company of encouraging fraudulent practices tying employees commissions to regional billings.

As a law firm for beneficiary whistleblowers in health care fraud cases, we are committed to staying informed about developments involving fraud and related wrongs across the country.  When a beneficiary reporting health care fraud (or a beneficiary who simply feels something is amiss) calls our office, we can evaluate the facts and discuss the law, including the very latest cases involving federal and state anti-fraud statutes.  This week, a case from Illinois caught our eye.  It involves alleged fraud by a chiropractor, a field many view as new and/or alternative despite having roots in Ancient Greece and practitioners being recognized in all 50 states (American Chiropractic Association).  Notably, the allegations suggest some beneficiaries were complicit in the scam.  While patients probably didn’t know the extent of the fraud, perhaps accepting a dubious explanation, the clinic’s fishy behavior likely set off alarm bells; alarm bells we hope lead others to contact our team rather than assent to wrongful acts.

The Allegations: Chiropractor’s Fraudulent Billing Scheme Supported by Beneficiary Cooperation

chiropractorAccording to the Journal & Topics Newspapers, a Wheeling, Illinois chiropractor and members of his family are facing charges they fabricated medical records and billed insurance carriers for services that were medically unnecessary or never rendered at all (indictment available via the FBI).  The charges include health care fraud and aggravated identity theft.  In all, the defendants are accused of filing $28,775,000 in insurance claims from 2006 through November 2012 and receiving $10,47,000 in insurance payments.

One of the reasons we write about health care fraud is to make people aware of the true cost of these schemes.  These crimes are ultimately financial in nature, with scammers stealing billions (not a typo!) each year from government programs that are already operating on strained budgets.  As if stealing money that is supposed to go towards ensuring the health of some of our nation’s most deserving (including military families and seniors) isn’t bad enough, these crimes also have a direct impact on individual beneficiaries.  The broad, sometimes life-threatening impact of these crimes is why we urge private citizens to join the fight against health care fraud and why we are proud to serve as a law firm for health care fraud whistleblowers.

A Scheme Founded Upon False Cancer Diagnoses and Other Lies Told by a Michigan Doctor

A case from 2014 stands out as a particularly egregious example of how scammers put individuals at risk, ignoring the duties of the health care profession and risking people’s lives for profit.  The FBI’s news article paints the picture:

Who are the victims of Medicare fraud?  As a law firm specializing in health care fraud matters, we understand that question requires a multi-part answer.  At the broadest level, Medicare fraud is theft and the target is a taxpayer-funded government program, meaning every U.S. taxpayer is a victim.  Narrowing the focus a bit, Medicare fraud depletes an already strained budget and thus it jeopardizes the health and well-being of all Medicare beneficiaries.  Medicare fraud also has more specific victims, individuals who are treated as mere pawns by the scammers.  A recent case involving mental health benefit fraud in Texas brings these individual victims to the forefront of our minds.

Medicare and Mental Health

Medicare recognizes that true health involves both physical and mental well-being.  In order to understand the Texas case, it is helpful to understand a bit about Medicare’s mental health coverage.  Medicare Part B includes outpatient mental health services holdinghandfor all program beneficiaries.  This coverage includes an annual depression screening and necessary outpatient mental health treatment such psychotherapy and medication management.   If a beneficiary requires inpatient mental health treatment, coverage is provided via Medicare Part A, the hospital insurance arm of the program.

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