Articles Tagged with law firm for Medicare whistleblower

Among the lessons we’ve learned as a Medicare fraud law firm is that fraud doesn’t always look like you think it does or involve the type of services you’d typically expect.  Most people would presume a case of Medicare fraud would involve a geriatric doctor, senior care facility, provider of age-related medical devices, or maybe a general practitioner.  However, as the case discussed below reminds us, Medicare fraud extends into every facet of the health care industry.  It is only with the help of honest whistleblowers that we can hope to tame this growing beast.

Indictment Filed in Medicare Fraud Case Against Florida Ophthalmologist

eyedocIn April, the Justice Department announced the filing of a seventy-six count indictment charging South Florida Doctor Salamon Melgen with assorted counts tied to his alleged participation in a Medicare fraud scheme.  The charges include 46 counts of health care fraud, 19 counts involving filing false claims, and 11 counts of making false statements involving health care.  From January 2008 through December 2013, Melgen billed Medicare for more than $190 million and his practice received reimbursements in excess of $105 million.  Officials believe much of this money was received as the result of fraudulent actions.

scalesSometimes health care fraud is a well-known secret, something many in a company’s leadership know about and either passively or actively conceal.  Likewise, a number of lower-level employees may know about and be asked to help perpetuate the fraud.  Fraud takes cooperation.  How does this happen when almost everyone we meet agrees that it a blatant violation of both law and their moral codes?  Often, especially in cases involving larger organization, our Medicare fraud law firm finds health care fraud continues because the company’s structure allows it.

How Corporate Structure Can Contribute to Fraud

Earlier this year, Atlantic Information Services Inc. (“AIS”), a health care publishing and information organization, published a report on how corporate structures can contribute to health care fraud.  The Affordable Care Act mandates that Medicare/Medicaid providers have compliance programs (for an overview of this mandate, see the Medicare and Medicaid Services’ Webinar “The Affordable Care Act Provider Compliance Programs: Getting Started”).    The AIS report suggests that the compliance mission is hindered when compliance officers report to a company’s general counsel (“GC”) rather than reporting directly to the CEO or the board of directors.  According to the author, the mindset of the GC differs from that of the compliance team.  Ultimately, the article suggests legislators pass a new regulation forbidding a structure that makes the compliance department subordinate to the general counsel.

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