Cal Graves was a 31 year old physician's assistant at the South Dallas Community Medical Center. The owner of the center, Dr. Daniel K. Leong, is about to go on trial for Medicare and Medicaid Fraud. According to court papers, Dr. Leong signed a blank prescription form and instructed Cal and other staff members to copy and use this pre-signed prescription as needed -- even when Dr. Leong never saw the patient.
Patients had their prescriptions filled at pharmacies, which then submitted claims to Medicare and Medicaid for reimbursement. However, Medicare and Medicaid would not have paid those claims if they had known that Dr. Leong never saw the patient.
When the government discovered the scheme, it arrested Dr. Leong for health care fraud. The government also arrested his physician's assistant, Cal Graves, for conspiracy to commit health care fraud because, by going along with the doctor's instructions, Cal helped execute the fraudulent scheme. Now Cal faces a maximum statutory sentence of five years in prison and a $250,000 fine.
Sadly, good people get into this type of trouble all the time. A physical therapist goes along with her administrator's instructions to extend patient treatments beyond what is medically necessary and ends up charged with conspiracy to commit Medicare Fraud. A billing clerk follows her supervisor's instructions to "upcode" claims (i.e., use a code for a different service that results in a higher reimbursement) and ends up charged with conspiracy to commit Medicaid Fraud. A nurse goes along with the doctor's instructions to refer patients to a particular diagnostic lab that pays the doctor for each referral, and the nurse ends up charged with a felony for violating the Anti-Kickback statute.
If you think no one will find out, think again. The government has very sophisticated computer systems that constantly monitor Medicare and Medicaid claims for suspicious patterns. It also has Medicare Fraud Strike Forces staffed with FBI agents and other experienced investigators around the country. And it pays out hundreds of millions of dollars in bounties every year to whistleblowers -- individuals who help the government uncover false and fraudulent claims in return for a percentage of the amount recovered.
Protect yourself and get expert advice. Do not end up like Cal, facing five years in prison for doing nothing more than following instructions.
If you become aware of false, dishonest or fraudulent conduct at work, then you should consult with an experienced attorney immediately to protect your rights. To schedule a free initial consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me via email. You do not have to face this alone.
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