Medicare fraud attorney

August 24, 2015

Hospice Care Fraud: A Wrong Amounting to Theft from the Terminally Ill

Hospice care workers are some of the most amazing people you’ll ever encounter. Not only do they care for people in their final days, they also care for the patient’s families. All forms of Medicare fraud result in theft of taxpayer’s money and endanger the health of beneficiaries, but there’s something particularly insidious about hospice fraud. Our Medicare fraud attorney is honored to work with private individuals who observe these wrongs and step forward to help stop them.

FBI Reports on Case of Hospice Fraud

Last week, the FBI posted a report dealing with a case of hospice care fraud in Oklahoma (note: all assertions in this post regarding the case are per the FBI’s report). P.K. owned a hospice center and, together with certain colleagues, submitted fraudulent claims to Medicare totaling in the millions of dollars. From June 2010 to July 2013, the conspirators did not comply with the rules and regulations governing Medicare-eligible hospice centers. They actively concealed the actual health status of patients and falsely reported the treatment provided, including claiming nurse visits that never actually occurred and altering files to make patients appear sicker than they actually were. While hospice is intended for the terminally ill, specifically patients with a life expectancy of six months or less, many patients remained at the center for five to seven years. When an audit was performed to review services in the state, P.K. provided falsified documents to those conducting the audit.

April 27, 2015

The Role of Compliance Department in Fighting (or Perpetuating) Health Care Fraud

by Gregory J. Brod

Sometimes 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.

April 20, 2015

Provider Medical Identity Theft

by Gregory J. Brod

Identity theft is a common fear and a common problem. Readers of this blog know that identity theft is a problem that reaches beyond the financial sphere. Quite often, health care fraud cases involve an element of medical identity theft. In a previous post, our medical identity theft lawyer discussed the problem of scammers stealing consumers’ medical identities and using the information to submit and collect on false claims. However, consumers are not the only targets of medical identity theft. Provider identity theft is also a component of many health care fraud scams, criminal enterprises that divert critically needed health care dollars and endanger the health and well-being of countless Americans.

Clinic Owner Allegedly Filed Claims Using Former Owner’s Provider Information

In late August 2012, NBC New York reported on the arrest of a man who operated a radiology practice in Queens on charges that he engaged in health care fraud. According to the article, a 34 year-old man by the name of Ting Huan Tai was taken into custody by federal agents who arrested him at his luxury apartment in a Lower Manhattan high- prescription rise. In May 2010, as alleged in court filings, Tai took over operations at United Medical Diagnosis (“UMD”), a radiology clinic in Flushing, New York. From May 2010 through May 2012, Tai and his staff allegedly used the identity of the clinic’s prior owner, a radiologist, to submit more than $30 million in claims to Medicare and Medicaid. The claimed services were not actually performed and the bills were submitted without the knowledge or consent of the former UMD owner. United States Attorney Loretta Lynch explained, “The defendant sought to enrich himself and fund his lifestyle first by stealing a doctor’s identity and then using that stolen identity to steal Medicare and Medicaid funds…While the documentation provided was a sham, the money stolen was very real.”