A physician in Illinois has demonstrated how not to respond to a healthcare fraud investigation. He now faces up to 10 years in federal prison after pleading guilty to obstructing the fraud investigation. Dr. Mahmoud Yassin was being investigated on suspicions that he had submitted insurance claims for medical procedures that were never performed. The FBI served a subpoena on the doctor seeking patient medical records. In response to that subpoena, the doctor allegedly gave an FBI agent a patient progress note that had been altered. The government claims that this single patient progress note was altered by the doctor to show an in-office examination previously claimed to an insurance carrier, but which had not taken place. A single falsification in a single patient medical record, and now the doctor faces up to ten years in prison plus the loss of his professional license. Does no one remember what happened to Martha Stewart? Martha Stewart, you may recall, was being investigated for insider trading in violation of the securities laws. At the conclusion of that investigation, she was not charged with any securities law violations. So, why did she go to prison? Because, instead of exercising her right to remain silent, Ms. Stewart decided to accept the government’s invitation to be interviewed. The government alleged that she made false statements to them during that interview, which is a federal crime. Dr. Yassin made a huge mistake by falsifying evidence. While healthcare fraud is a serious crime and can result in substantial penalties, physicians can often avoid criminal charges and preserve their professional license if they retain capable counsel and respond properly to the investigation. An experienced Medicare and Medicaid fraud attorney will advise their client on how to respond to the investigation, including how to respond to subpoenas and whether to speak with investigators or exercise their constitutional right to remain silent. The attorney can help the client identify possible defenses and weaknesses in the evidence that will make it difficult for the government to prove any crime, and can make motions to limit or exclude evidence. Retaining an experienced Medicare and Medicaid fraud attorney also means that the physician does not have to speak directly to investigators or prosecutors, unless he and his attorney decide that it is in his best interests to do so. The attorney can negotiate with the government in an effort to avoid or reduce any possible charges. If you are under investigation or have been charged with healthcare fraud, do not try the do-it-yourself approach. Get an experienced Medicare and Medicaid fraud attorney on your side. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
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A dentist has been charged with Medicaid fraud and grand theft for allegedly billing Medicaid for services provided by an unlicensed dental hygienist. The government’s Medicaid Fraud Control Unit (MFCU) investigated the dentist after parents of young patients complained that he mistreated them. The investigation allegedly uncovered evidence that the dentist employed an unlicensed dental hygienist to perform periodontal root cleaning and scaling on dozens of children. Under state law, only a licensed dentist or licensed dental hygienist may perform this procedure. Employing an unlicensed individual to perform services that can only be performed by a licensed professional is, by itself, a crime under state licensing laws. When claims for reimbursement are submitted to Medicaid for those services, the conduct becomes Medicaid fraud as well. The penalties for dental fraud can be severe. If convicted, this dentist faces up to 15 years in prison and more than $30,000 in fines. He may be excluded from participating in Medicare, Medicaid, or other government programs. He could also lose his professional license. If you are under investigation or have been charged with dental Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A woman who owns a home health care agency in Jacksonville, Florida, was arrested on charges of stealing more than $400,000 from Medicaid. Edna Lorraine Watkins allegedly filed false claims with Medicaid for services provided under Florida’s Aged and Disabled Adult Waiver Program. The program provides home and community-based services to elderly and permanently disabled adults who would otherwise require nursing home care. The services are designed to help the recipient remain in the community for as long as possible. Services that may be provided include: personal care, case management, adult day health care, counseling, physical therapy, caregiver training and support, emergency alert response, home-delivered meals, environmental modification, health risk management, speech therapy, and occupational therapy. Ms. Watkins is accused of phantom billing, or billing Medicaid for services that were not provided, and billing for services to recipients who were not eligible for Medicaid. The government claims that some of the alleged recipients of her services were in jail at the time she claims to have provided them services in their homes or communities. She is also accused of falsifying her application to become a Medicaid provider by concealing prior felony convictions and using a false social security number. The penalties for this type of home health fraud are harsh. She faces up to 90 years in prison. If you are under investigation or have been charged with Medicaid fraud or abuse, then you should consult with an experienced Medicaid fraud attorney immediately. An experienced Medicaid fraud attorney can help you understand the charges, develop your defenses, and negotiate with the government. Often, criminal charges can be avoided or minimized, but only if you act immediately. Do not speak with investigators until you have consulted an experienced Medicaid fraud attorney. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. Therapists who once worked at a Virginia nursing home will receive a whistleblower reward of $122,500 for helping the government recover $700,000 in a Medicare fraud case against their former employer. The therapists went to the government with evidence that their former employer, Fairfax Nursing Center, billed Medicare for physical, occupational, and speech therapy services that were excessive or medically unnecessary. Their claims were filed in a qui tam lawsuit under the whistleblower provisions of the False Claims Act. Under the federal False Claims Act, individual citizens may bring claims on behalf of the government and share in any recovery. The qui tam lawsuit was initially filed “under seal” (in secret), while the government conducted an investigation. After investigating the claims, the government joined the lawsuit and accused the nursing home of billing Medicare for excessive, medically unnecessary, and otherwise non-reimbursable physical, occupational, and speech therapy services. The government alleged that services billed to Medicare were not necessary for treatment of the patients’ conditions. In some instances, treatment was provided or extended solely for the purpose of billing Medicare. The nursing home agreed to settle the allegations of Medicare fraud by paying $700,000. Under the False Claims Act, the therapists who brought the qui tam lawsuit are entitled to a whistleblower reward of between 15% and 25% of the amount the government actually collects. In this case, the therapists will receive a whistleblower reward of $122,500. Is your current or former employer creating false treatment records or submitting false claims to Medicare? If so, then you should consult with an experienced whistleblower attorney. You may be entitled to legal protections and a whistleblower reward. To find out if you may be entitled to a whistleblower reward, contact John Howley, Esq. at (212) 601-2728 or click here to reach us via email. The consultation is completely free and confidential. No attorneys’ fees are charged unless your case is successful. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. When prosecutors indicted the owner of a dental practice for Medicaid fraud, they also indicted his office manager, billing manager, and four dentists employed by the practice as co-conspirators in the fraud. Stephen Beukas is a dentist and former owner of New Jersey Mobile Dental Practice, P.A. (”NJ Mobile”). Dentists working for NJ Mobile provided on-site dental treatment to patients at nursing homes, assisted living facilities, adult day care facilities, and private homes. The government alleges that NJ Mobile submitted more than $5 million in false claims to Medicaid by:
As is typical in dental fraud cases, the government did not just arrest the dentist who owned the practice. The government also indicted the office manager, billing manager, and other employees as co-conspirators for going along with the fraud. These employees now face felony fraud charges that could result in long prison sentences and hefty financial penalties. It is too early to tell whether the dental office employees were innocent rubes or willing co-conspirators. But if they knew that false claims were being submitted to Medicaid, they had a number of options that might have avoided the criminal charges they now face. One option was to consult with an experienced whistleblower attorney about the rewards and legal protections available under the state and federal False Claims Acts. Under the federal False Claims Act, an individual citizen may bring a qui tam lawsuit on behalf of the government and share in any recovery. The lawsuit is initially filed “under seal” (in secret), and the evidence is provided only to the prosecutor. The prosecutor then investigates the case and decides whether to take it on. The whistleblower who brings the case is entitled to a reward of between 15% and 30% of the amount recovered. They are also entitled to legal protections against retaliation. The amount of the whistleblower reward depends on the amount actually recovered by the government. In this case, if the government recovered $5 million, then the whistleblower reward would be between $750,000 and $1.5 million. Do not go to prison for your employer’s fraud. If you know that false claims are being submitted to Medicare or Medicaid, consult with an experienced whistleblower attorney immediately to protect your rights, your livelihood, and your freedom. The consultation is free and confidential. No attorneys’ fees are charged unless you win. To arrange a free consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach us via email. We will listen to you, explain how whistleblower rewards work, advise you on your rights, and explain your options. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A physician and his professional corporation agreed to pay $700,000 to settle allegations that false claims were submitted to Medicare for physician services at nursing homes. The government alleged that the physician’s medical records did not support his claims for Medicare reimbursement. The patient records did not contain the detailed history, examination, and medical decision-making documentation necessary to justify reimbursement. In some instances, there was no documentation at all. The government also alleged that the patient records did not accurately describe where the treatment was rendered. In some instances, the physician's records indicated that services were provided to patients in nursing homes, while other records indicated that the patients had been transferred to local hospitals for treatment. Claims submitted to Medicare or Medicaid must be supported with proper documentation. The patient records must establish that the treatment met the Medicare "medical necessity" requirements and was actually provided by the appropriate medical professional. Absent that documentation, the claims may be considered “false claims” under the federal False Claims Act, even if the services were actually provided and medically necessary. False Claims Act penalties include liability for three times the amount the government paid, plus $11,000 per claim. If the government can prove that the submission of false claims was intentional, it may pursue criminal charges that can result in up to five years in prison, hefty fines, exclusion from Medicare and Medicaid, and loss of professional licenses. If you are being investigated or have been charged with filing false claims to Medicare or Medicaid, then you should consult with an experienced Medicare and Medicaid fraud attorney immediately to protect your rights, your license, and your livelihood. Do not speak with the government until you have retained an experienced lawyer on your side. To arrange a free and confidential consultation with an experienced Medicare and Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. The Cooper Health System will pay $12.6 million to settle a whistleblower lawsuit brought by one of its doctors. The suit alleged that the hospital system made improper payments to physicians for “consulting” and “advisory board” compensation in return for referrals to the hospital’s cardiology program. The physician who filed the lawsuit will receive a whistleblower reward that should be between $1.89 million and $3.15 million. The lawsuit alleged that outside physicians were paid $18,000 per year to serve on the Cooper Heart Institute Advisory Board, and that at least one purpose of these payments was to induce the physicians to refer patients to the hospital’s cardiology program. Payments by hospitals to outside physicians violate the Anti-Kickback statute and the Stark law if they are based on patient referrals. The rationale is that payments for referrals interfere with the physician-patient relationship and can lead to over-utilization and inflated costs. The law punishes both those who make the payments for referrals and those who receive the payments. A violation of the Anti-Kickback statute or Stark law also renders the resulting treatment ineligible for reimbursement from Medicare or Medicaid. Any claim for reimbursement is therefore considered a false claim. Submission of false claims to Medicare or Medicaid results in liability for treble damages, a penalty of $11,000 per claim, and in some cases criminal prosecution. In this case, a physician who was recruited to serve on the Advisory Board recognized the potential illegality and decided not to join. Instead, he filed a qui tam or whistleblower lawsuit and alerted the authorities. The qui tam provisions of state and federal False Claims Acts allow an individual to file a lawsuit on behalf of the government and share in any recovery. A qui tam lawsuit is filed initially “under seal” (in secret) and the evidence is presented only to the government. The government investigates the allegations and decides whether or not to join in the lawsuit. In this case, both the federal and state governments decided to join in the lawsuit. Cooper Health System agreed to pay $10.2 million to the United States and $2.3 million to the State of New Jersey to resolve the physician kickback and Stark law allegations without admitting wrongdoing. Under the False Claims Act, the doctor who brought the qui tam suit is entitled to a whistleblower reward of up to 25% of the amount recovered. If you are aware of hospitals, nursing homes, or other facilities that are paying physicians to serve on boards or as consultants, or providing them with low-cost office space or other benefits in return for patient referrals, then you should consult with an experienced whistleblower attorney to find out if you may qualify for a significant whistleblower reward and legal protections. The consultation is completely free and confidential. If you have a viable case, there are no attorney’s fees unless you win, in which case your whistleblower attorney will be paid out of the winnings. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our offices via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
John Howley, Esq.
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