Physician Blows the Whistle on Ineffective Prostate Treatments
A physician in New Mexico has earned a whistleblower reward for helping the government uncover evidence that another physician was performing ineffective prostate laser ablation procedures on patients. Dr. Arnaldo Trabucco, M.D., presented the government with evidence that another physician was billing Medicare for prostate laser ablation procedures that were too short to generate a therapeutic benefit, failed to meet professionally recognized standards of care, were medically unnecessary, and violated applicable Medicare regulations. The procedure is also known as a Green Light prostatectomy. Dr. Trabucco presented his evidence in a lawsuit under the qui tam, or whistleblower, provisions of the False Claims Act. This whistleblower law allows private citizens to bring lawsuits on behalf of the United States and share in any recovery obtained. The lawsuit was initially filed “under seal” (in secret) to give the government an opportunity to investigate the allegations and evidence. After investigating the allegations and evidence in this case, the government entered into a settlement agreement with the accused physician. The physician agreed to pay $207,988 to resolve claims that he violated the False Claims Act by submitting false bills to Medicare. Dr. Trabucco, the whistleblower, will receive a reward equal to between 15% and 25% of the amount the government actually recovers. He also has the satisfaction of knowing that patients will no longer receive inadequate prostate treatment. If you have evidence that a physician or other healthcare provider is submitting false claims to Medicare, contact an experienced whistleblower lawyer to see if you qualify for a financial reward and legal protections. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Employees Face Prison Because They Went Along with Employer’s Medicare Fraud
The former billing manager and EMT supervisor of an ambulance company in Los Angeles have been found guilty of health care fraud. The defendants were charged with helping the owners of the ambulance company bill Medicare to transport dialysis patients in ambulances, when the patients could have been transported by less expensive means. This case is a warning for any employee who knows that their employer is engaged in Medicare fraud. When the government finds evidence of fraud, it prosecutes everyone who was involved, not just the owners of the company who benefitted from the scheme. You could go to prison for going along with your employer’s fraud. In the recent ambulance fraud case, the government charged two employees – the billing manager and EMT supervisor – with helping the owners bill Medicare for ambulance transportation services for individuals who did not need such services. Their “guilty conduct” included transmitting the owners’ instructions to the EMTs who created trip reports or run sheets. For example, the government introduced evidence that EMTs were instructed to conceal the true medical conditions of patients they were transporting by creating false trip reports to justify the transportation services. By transmitting these instructions from the owners of the ambulance company to the EMTs, the billing manager and the EMT supervisor became part of the conspiracy to defraud Medicare. Now they are facing lengthy prison sentences because they went along with their employer’s fraud. Do not go to prison for your employer’s Medicare fraud. If you know that your employer is submitting false claims to Medicare, then you should consult with an experienced whistleblower lawyer immediately to protect yourself. You may be entitled to a substantial reward and legal protections as a whistleblower. You may also be able to avoid criminal prosecution, even if you had some involvement in the fraud. Do not wait until the FBI comes knocking at your door. Call John Howley, Esq. at (212) 601-2728 to schedule a free and confidential consultation with an experienced whistleblower lawyer. Dr. Jean Moore, a physician, will receive an $825,000 whistleblower reward for reporting that his employer, a hospital and an affiliated medical clinic, submitted false claims to Medicare. The hospital and affiliated clinic have agreed to pay $5.5 million to settle the claims.
Dr. Moore alleged that the hospital and its affiliated clinic were paying bonuses to physicians in return for patient referrals. The bonuses were paid based on a formula that took into account the value of the physicians’ patient referrals. Paying anything of value in return for referrals of Medicare patients violates the anti-kickback statute. It also renders all resulting claims to Medicare “false claims” for purposes of the False Claims Act. Dr. Moore started a qui tam or whistleblower lawsuit under the False Claims Act. That law allows individual citizens to commence a lawsuit on behalf of the government for false claims submitted to Medicare, Medicaid, and other government programs. The lawsuit is filed “under seal” (in secret), and the whistleblower provides all of his evidence to the government. The government then investigates the claims. If the government recovers money as a result of the qui tam lawsuit, then the whistleblower is entitled to a reward of between 15% and 30% of the amount actually recovered. The key to a successful whistleblower lawsuit is having evidence of the false claims. It is not enough that you suspect that false claims are being filed. You must give the government evidence to support your suspicions. If you have evidence that a healthcare provider is paying kickbacks in return for patient referrals, or that it is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower. You may not file a whistleblower lawsuit on your own. The law requires that an attorney file the lawsuit for you. You will also need careful legal advice on gathering and presenting your evidence, especially if HIPAA-protected medical records are part of your evidence. Contact our law office for a free and confidential consultation. If you have a case, we will represent you on a contingency fee basis. You will not owe any legal fees unless you win. John Howley, Esq. (212) 601-2728 A receptionist in a physician’s office is in line to receive a six-figure whistleblower reward after her employer agreed to pay $1.1 million to settle claims that it billed for unnecessary medical testing.
Rosemarie Hennessey, a receptionist at East Islip Family Care, filed a complaint on behalf of the United States government under the qui tam or whistleblower provisions of the False Claims Act. She alleged that her employer and its physicians ordered diagnostic tests on patients that were not medically necessary. The physicians and the practice group then billed Medicare for the unnecessary tests. The tests at issue are called nerve conduction studies or NCVs. NCVs involve the electrical stimulation of a patient’s nerves and muscles to measure the conduction speed of electric impulses and proper nerve and muscle function. Because NCVs involve the administration of low levels of electric current to a patient, the tests can be uncomfortable and even painful. The whistleblower alleged that the physicians ordered NCVs despite the lack of apparent indications in the medical charts. She also alleged that even when NCV studies were indicated, they were not performed properly. For example, patients with arm complaints were given NCVs on their legs. The whistleblower claimed (and the government agreed) that the physicians were billing for tests that were not medically necessary. Under the False Claims Act, an individual with evidence of false claims to Medicare or Medicaid may file a complaint on behalf of the government. The complaint is filed “under seal” (that is, in secret), and the evidence of false claims is provided to government prosecutors. The prosecutors then conduct an investigation to determine whether or not to pursue the lawsuit. If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. After conducting an investigation in this case, the government decided to pursue the claims and negotiated a settlement with the physician and his practice. Dr. Vikas Desai, the principal of East Islip Family Care, and Dr. Robert Maccone, a physician who was previously affiliated with the practice, agreed to pay the United States a total of $1,120,299 to resolve the allegations that they submitted claims to Medicare for NCVs that were not medically necessary. The amount of the whistleblower’s reward has not yet been determined. Based on the statute, she should receive between 15% and 25% of the amount the government actually recovers from the defendants. If you have evidence of false or inflated claims to Medicare or Medicaid, you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a significant reward and legal protections as a whistleblower. John Howley, Esq. (212) 601-2728 Pediatric Services of America Agrees to Pay $6.88 Million to Settle Claims it Failed to Return Overpayments to Medicare and Medicaid
Two former employees of Pediatric Services of America and its affiliates will share a whistleblower reward of $1,121,729 for helping the government pursue claims that their former employer failed to return overpayments to Medicare and Medicaid. This is the first settlement of a whistleblower lawsuit involving a health care provider’s failure to investigate credit balances on its books to determine whether they resulted from overpayments made by Medicare or Medicaid. Under the Affordable Care Act, healthcare providers must report and return any overpayments within 60 days after the overpayment is identified. According to the whistleblowers’ complaint, Pediatric Services of America and related entities failed to disclose and return overpayments that it received from Medicare and Medicaid as required by the Affordable Care Act. The company and its affiliates were also accused of submitting claims for home nursing care without documenting the requisite monthly supervisory visits by a registered nurse, and submitting claims that overstated the length of time their staff had provided services. If you have evidence that a healthcare provider has failed to return overpayments to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower. John Howley, Esq. (212) 601-2728 Whistleblower cases in at least four states accuse dozens of privately-run Medicare Advantage plans of defrauding Medicare by overstating the medical needs of elderly patients and then not providing follow-up medical care.
Medicare Advantage plans are run by private insurance companies as an alternative to Medicare. While Medicare pays doctors on a fee-for-service basis, Medicare Advantage plans receive a monthly capitation payment, which is a set fee each month for each patient. The capitation payment is based on an assessment of patient risk. Patients who are in good health receive a lower risk score, which results in a lower monthly payment to the private insurance company, than patients with existing medical conditions or health risks. The problem arises because privately-run Medicare Advantage plans retain consultants to conduct home health evaluations that assess patient risks. Medicare relies on these evaluations to set the monthly capitation payment to the private insurance companies. The whistleblower lawsuits claim that the consulting firms conducted false health assessments that overstated how ill patients were, which in turn inflated Medicare payments to the privately-run Medicare Advantage plans. One whistleblower lawsuit in Texas was brought by a former employee of a consulting firm that conducts home health assessments for Medicare Advantage plans. The whistleblower claims that the company sent doctors to patients’ homes to gather information, but the doctors did not conduct any physical exams and no lab tests were performed. The doctors simply filled out “evaluation forms” that were nothing more than self-reporting by the patients, the lawsuit claims. The lawsuit also claims that some of the doctors were not licensed, and that some of the evaluations were intentionally falsified. The whistleblower claims that she was fired after she objected to the way assessments were being done. She alleges that her manager told her that the company could no longer trust her. Medicare Advantage plans are very popular and cover almost 17 million people. A Center for Public Integrity investigation concluded that, between 2008 and 2013, Medicare overpaid $70 billion to Medicare Advantage plans based on overbilling, including overbilling caused by exaggerated patient risk scores. In addition to the amount of money involved, some question whether the use of consultants to assess patients risks is doing anything to improve medical care for patients. The Centers for Medicare and Medicaid Services (CMS) has expressed concern that the primary objectives of home evaluation visits is to create inflated risk scores and increase revenues without actually providing any follow up care or treatment to the patients. If you have evidence of overbilling to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney. You may be entitled to a substantial reward and legal protections as a whistleblower. John Howley, Esq. (212) 601-2728 Medical Professionals Face Prison Time for Failing to Report Medicare Fraud
U.S. Attorney General Loretta Lynch has continued her predecessor’s practice of targeting doctors, nurses, and other medical professionals for Medicare fraud. This week 46 doctors, nurses, and other medical professionals were arrested for their involvement in schemes to submit false claims to Medicare. The doctors and nurses are accused of providing false documentation for services that were not medically necessary or not actually provided to patients. Medical professionals who work as employees of healthcare facilities are often under subtle pressure to increase revenues for their employers by providing services or extending treatments that are not medically necessary. A physician feels pressure to order medically unnecessary diagnostic testing or pain medication injections. A physical therapist feels pressure to authorize the maximum amount of therapy that can be reimbursed. A nurse feels pressure to refer patients to a specific ambulance company or medical imaging center that has a financial arrangement with their employer. It all seems very minor until law enforcement agents show up with handcuffs. Then the doctor, nurse, or other medical professional has to deal with the fact that it is their signature, not their employer’s, on the medical records. Attorney General Lynch warned that we can expect more arrests of medical professionals. "In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives," Lynch said. Fortunately, the law helps medical professionals who report Medicare and Medicaid fraud. Under the False Claims Act, an individual who helps the government uncover false claims to Medicare and Medicaid is entitled to a substantial reward and legal protections as a whistleblower. If you have evidence that your employer is submitting false claims to Medicare or Medicaid, do not wait for government agents to show up at your home. Consult with an experienced whistleblower lawyer immediately to protect yourself. You may be entitled to a significant reward and legal protections. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Ambulance Company Accused of Improperly Receiving $28 Million from Medicare and Medicaid by Offering Discounts in Return for Patient Referrals and by Submitting False Claims for Medically Unnecessary Ambulance Transports
The U.S. government has agreed to join a lawsuit that was started by a whistleblower against an ambulance company under the False Claims Act and the Anti-Kickback Statute. The complaint alleges that the ambulance company improperly received $28 million in reimbursements from Medicare and Medicaid as a result of the false claims. The lawsuit was originally filed under the whistleblower or qui tam provisions of the False Claims Act by Shawn Pelletier, a former employee at Liberty Ambulance. Under the False Claims Act, he will be entitled to a whistleblower reward of between 15% and 25% of the amount the government recovers because of his lawsuit. In this case, that could mean a whistleblower reward of as much as $4.2 million to $7 million. The complaint alleges two types of false claims: one that is fairly common under the False Claims Act; and a second that explains the broad reach of the Anti-Kickback Statute. The first set of claims allege that Liberty Ambulance submitted false claims for ambulance transports that were medically unnecessary, predicated on false statements, and should not have been reimbursable. The complaint alleges that the ambulance company trained its employees to falsify records and to make false statements to support claims for medically unnecessary ambulance transports. The second set of claims allege that the ambulance company violated the Anti-Kickback Statute by offering discounts to private healthcare providers – such as hospitals and skilled nursing facilities – in return for referrals of patients who were covered by Medicare and Medicaid. The complaint alleges that the ambulance company failed to offer these same discounts to the government. Under the Anti-Kickback Statute, it is illegal to offer or accept anything of value in return for referrals of patients covered by Medicare or Medicaid. Kickbacks obviously include cash payments, but they may also include non-cash benefits such as discounted rates on services for hospitals and nursing homes, free medical supplies or gift cards for patients, free office space or subsidized office staff for doctors, excessive compensation for medical directorships, or anything else of value. Once a kickback has been paid, any claims submitted to Medicare or Medicaid are considered “false claims,” even if the services were medically necessary and actually provided to the patient. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid – or that a healthcare provider is offering anything of value in return for patient referrals – then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and protections as a whistleblower. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Children's Hospital Allegedly Filed False Cost Reports to Increase Reimbursement Rates from Medicare and Medicaid.
James A. Roark, Sr., a former employee of Children's National Medical Center, will receive a $1.9 million whistleblower reward for coming forward with evidence that his former employer submitted false cost reports to the government in order to increase its reimbursements from Medicare and Medicaid. The whistleblower reward resulted from a settlement agreement in which the hospital agreed to pay $12.9 million in restitution to the government. The whistleblower claimed that the hospital filed false cost reports that misstated its overhead, which resulted in higher reimbursement rates and overpayments from Medicare and Medicaid. According to the settlement agreement, the hospital also misreported its available bed count on an application for the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. The CHGME Payment Program provides federal funds to freestanding children's hospitals to help them maintain their graduate medical education programs that train pediatric and other residents. Under the False Claims Act, an individual citizen may commence a whistleblower or qui tam lawsuit on behalf of the government to recover money for false claims submitted to Medicare, Medicaid, and other government programs. The qui tam lawsuit is filed "under seal" (in secret) and the whistleblower's evidence is given to the government, which then must conduct an investigation. If the government recovers money as a result of the lawsuit, the individual whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. If you have evidence of false claims submitted to Medicare, Medicaid, or other government programs, you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and legal protections as a whistleblower. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. OIG Announces Increased Scrutiny of Compensation for Medical Directorships for Possible Violations of the Anti-Kickback Statute.
The government sent a stern warning to physicians that their compensation for medical directorships will be scrutinized for compliance with the Anti-Kickback Statute. In a recent press release, the Office of Inspector General (OIG) at the Department of Health and Human Services announced that it will be paying careful attention to two aspects of medical directorship compensation. First, the compensation must reflect the fair market value of bona fide services that the physician actually provides. Second, the amount of compensation must not be based, in whole or in part, on the volume or value of patients referred by the physician. Many physician compensation arrangements are legitimate. A compensation arrangement may violate the Anti-Kickback Statute, however, if any part of it is based on the physician's past or future referrals of patients who receive Medicare, Medicaid, or other government healthcare benefits. The compensation arrangements subject to increased scrutiny are not limited to cash payments. Physicians may violate the Anti-Kickback Statute if they accept free services, subsidized office staff, below-market rent for office space, or anything of value in return for patient referrals. Once a kickback has been paid, every resulting claim for reimbursement submitted to Medicare or Medicaid is considered a "false claim" under the False Claims Act, even if the services were medical necessary and actually provided. Individuals responsible for submitting false claims may be required to pay back three times the amount the government paid for the services, plus a penalty of up to $11,000 per claim. If you have evidence that a physician is accepting kickbacks in return for patient referrals to a hospital, diagnostic imaging center, medical lab, or other healthcare provider, then you should consult with an experienced whistleblower lawyer immediately. You may be eligible for a reward of up to 30% of the amount the government recovers. To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. |