Articles Tagged with Medicare fraud whistleblower’s law firm

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.

Anyone who hhospicehandsas ever watched a loved one fight through the final stages of a terminal illness knows how important kindness is during these times.  Some of the kindest and most caring people in the world work with terminal patients and their families in hospice care settings.  On behalf of everyone these people touch, we want to say thank you.  It is because we respect these workers so much and understand the importance of their work that we are particularly angered by the allegations in a recent false claims act case accusing a health care provider of hospice care fraud.  This case is a reminder of the very profound real world impact of health care fraud and it is one example of why we choose to serve as a health care fraud whistleblowers’ law firm.

Hospice Provider to Pay $18 Million to Settle Medicare Fraud Allegations

On July 13, the Department of Justice (“DOJ”) issued a press release announcing that a hospice care provider has agreed to pay $18 million to settle pending allegations of False Claims Act violations.  The defendant, Evercare Hospice and Palliative Care (“Evercare”), now known as Optum Palliative and Hospice Care, is based in Minnesota and provides hospice care in several different states.  As the DOJ explains, hospice care is a special form of care aimed at providing comfort to the terminally ill.  Hospice care patients receive palliative care only and do not receive medical care aimed at treating their illnesses.  Medicare only allows patients with a life expectancy of six months or less to receive coverage for hospice care.

There are few topics that will get people talking (and, inevitably, complaining) like health insurance.  The truth of the matter is that, in order to function efficiently and provide the best possible care to the largest possible audience, health insurance companies must have rules and guidelines.  Perhaps the context where this principle is most important is when the insurer is Medicare.  According to a government memo published in July marking the program’s 50th year, Medicare currently covers 55 million beneficiaries, an increase of 3 million beneficiaries from just three years ago.  While coverage rules are sometimes unpopular, they exist for a reason and organizations that repeatedly bill and collect money in violation of Medicare coverage rules put the system and all who rely on it in jeopardy.  The government cannot examine every claim in depth making health care fraud whistleblowers critical to protecting the system, one of the many reasons we are proud to serve as a Medicare fraud whistleblower’s law firm.

Settlement Resolves Allegations 450+ Hospitals Violated Medicare Guidelines for Cardiac Devices

On October 30, the Department of Justice (“DOJ”) announced that it had reached 70 related settlements totaling over $250 million dollars resolving allegations that 457 hospitals (listed in a separate document) in 43 states violated Medicare rules related to implantable cardiac devices.  Most of the hospitals were named as defendants in a lawsuit filed under the False Claims Act (“FCA”) which contains a special qui tam provision allowing private whistleblowers to file claims on the government’s behalf.  In this case, the original suit was filed by a cardiac nurse and a health care reimbursement consultant.  Pursuant to the FCA, the whistleblowers received over $38 million from the settlement.  While some might suggest that amount seems excessive, as the legal news website Lawyers and Settlements notes, “when the depth and breadth of the alleged healthcare fraud is factored in, it soon becomes clear the contributions of the two lead plaintiffs were integral in what has been described as one of the largest examples of alleged healthcare fraud, in terms of the number of defendants, in the history of the False Claims Act (FCA).”

cash2When it comes to the world of health care fraud, there’s one truth we cannot emphasize enough – Honest individuals are the key to winning the fight against fraud.  It is a truth we see again and again in our work as a whistleblower’s law firm.  The False Claims Act (“FCA” or “the Act”) provides a financial incentive for people to elect the morally right path and report suspected cases of health care fraud and other forms of government claims fraud.  The importance of health care fraud whistleblowers in the fight for right is emphasized by the emerging story of a record-breaking case against one the nation’s largest kidney dialysis companies.

DaVita Settles False Claims Act Case for $495 Million

syringeIn 2007, according to last week’s Denver Post, Dr. Alon J. Vainer and nurse Daniel D. Barbir filed a whistleblower lawsuit against Denver’s DaVita HealthCare Partners.  The pair had been working for DaVita when they noticed the company was throwing out good medicine and dividing single use doses into multiple vials.  They only filed suit after internal questions/complaints went unanswered.  DaVita was, per the allegations, overbilling Medicare and Medicaid.  For example, the lawsuit suggests a physician would use part of a 100mg vial of Zemplar (vitamin D) or Venofer (an iron supplement), charging for the whole dosage despite the fact that the patient only needed 25mg.  In other cases, doctors were told to treat a patient who needed 8mg of medicine with a 10mg vial instead of a cheaper option of four 2mg vials.

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.

Often, Medicare fraud is brought to light because a brave employee saw a wrong and spoke up.  Notably, however, insiders are not the only ones who can bring a Medicare fraud whistleblower lawsuit (aka a qui tam action).  Medicare beneficiaries can also witness and report Medicare fraud.  We are proud to partner with Medicare beneficiary whistleblowers  in addition to working with current/former employees on health care fraud matters.  We investigate the whistleblower’s concerns and, when appropriate, file suit.  Our mutual goal is recovering wrongfully diverted funds and preventing on-going/future frauds.  As a Medicare fraud whistleblower’s law firm, we also vigilantly work to protect the whistleblower from retaliation and ensure s/he receives fair compensation should the information leads to a recovery.

Example 1: Over $5 Million Recovered in Action Initiated by Medicare Beneficiary Whistleblowers

healthcashIn Fall 2012, RxAmerica (a subsidiary of CVS) agreed to pay $5.25 million to settle a Medicare fraud action that consolidated two suits brought by Medicare beneficiaries.  According to Law360, Robert Fischer filed suit against RxAmerica in a New York federal court after noticing suspiciously large payments on an Explanation of Benefits (“EOB”) report sent to him by Medicare.  As explained in a Business Wire report, Jan and Max Hauser also filed suit against RxAmerica bringing their claim in a North Carolina federal court.  The Hausers also carefully reviewed an EOB statement and they noticed that RxAmerica was charging the government more money for prescription drugs than had listed in the Plan Finder tool they had used when selecting their Medicare Part D plan.  This discrepancy meant the Hausers consumed their allowed benefits faster than expected/promised and had to pay out-of-pocket for their prescription medications.