Temple University agreed to pay $100,000 to settle claims that it overbilled Medicare and Medicaid for neurology services. The settlement agreement covers alleged overbilling for services provided by Temple University physicians at the university’s own facilities and at Frankford Hospital. According to the government, the university submitted claims to Medicare and Medicaid using codes that resulted in higher payments for services than the codes that should have been used based on the medical documentation supporting the services. Using a higher billing code than the documentation supports is known as “upcoding.” After reviewing the government’s allegations and the underlying documentation, the university agreed that the coding was not accurate. Upcoding is just one type of billing practice that results in Medicare and Medicaid paying more for services than they should. Healthcare providers can be charged with upcoding when they use the wrong code or when the documentation supporting the claim for reimbursement is inadequate to justify the code that was used. Other improper billing practices include “unbundling” and “double billing.” Unbundling involves charging separately for services and procedures that should be billed under a single billing code. Double-billing occurs when a healthcare provider bills both government programs and either private insurers or patients. Upcoding, unbundling, and other types of improper billing practices are serious violations of the federal False Claims Act. They can result in treble damages and penalties of $11,000 for each claim submitted to the government. But these billing practices are often difficult to detect. That is why the government pays whistleblower rewards to individuals who come forward with evidence of improper, false or fraudulent claims. Under the federal False Claims Act, an individual who helps the government stop Medicare and Medicaid fraud and abuse is entitled to a whistleblower reward of between 15% and 30% of the amount the government recovers. These whistleblower rewards can amount to tens of thousands of dollars, hundreds of thousands of dollars, and in some cases millions of dollars. If you are aware of false or improper claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney. You may be entitled to a substantial whistleblower reward and legal protections under the False Claims Act. To arrange a free and confidential consultation with an experienced whistleblower attorney, 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.
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One of the great tragedies of Medicare fraud is when the corporation that received millions of dollars settles the fraud case by paying back money, while the employees who were asked to sign false documents end up in prison. It happens all the time. A physical therapist is asked to authorize more therapy than the patient really needs. An EMT who transports patients in ambulances to dialysis treatment is asked not to indicate on the trip report that the patient was in a wheelchair or able to walk. A visiting nurse is asked to submit time sheets for more time than was actually spent with the patient. The employer uses these documents to submit millions of dollars in false claims to Medicare. When they get caught – and at some point they always get caught – the employer pays back the money, and the employees go to prison. In a recent case, a registered nurse pleaded guilty to home health fraud after government investigators discovered that she had signed false documents for a home health care company. The nurse admitted that she created nursing visit notes to justify home health care services that the patients did not really require. She also admitted that she signed nursing visit notes for home visits, when the visits were actually made by other individuals who were not licensed. The employer used these types of false records from this nurse and others to submit $24 million in false claims to Medicare for home health care services. The nurse now faces up to ten years in prison and a fine of up to a $250,000. If the nurse had contacted an experienced whistleblower attorney, she could have protected herself and earned a substantial reward. Under the federal False Claims Act, individuals who help the government stop Medicare fraud are entitled to a whistleblower reward of between 15% and 30% of the amount the government recovers. For example, if this nurse had helped the government collect $24 million from the home health care company, she would have been entitled to a whistleblower reward of between $3.6 million and $7.2 million. Instead, she is facing the possibility of a very long prison sentence. Do not go to prison for your employer’s fraud. If you are aware that your employer is creating false documents, then you should consult with an experienced whistleblower attorney immediately. You may be entitled to legal protections and a substantial reward under the False Claims Act. To arrange a free and confidential consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office by 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. One of the most common forms of ambulance fraud is billing Medicare for non-emergency transportation of patients who are not bed-confined or who are able to travel in another form of transportation. This type of ambulance fraud often occurs when transporting patients to dialysis centers. Individuals who help the government stop this type of fraud are entitled to very substantial whistleblower rewards under the federal False Claims Act. Recently, the president of a local rescue squad in Virginia was caught submitting false claims to Medicare for medically unnecessary, non-emergency ambulance transports. Over a five-year period, the false claims added up to more than $1.6 million. Under the false claims act, the government may recover three times the amount it paid plus $11,000 per claim. In a case involving $1.6 million in false claims, the government can recover more than $5 million. The potential whistleblower reward in this type of case is between 15% and 30% of the amount recovered by the government. In a case involving $1.6 million in false claims, that means a potential whistleblower reward of between $750,000 and $1.5 million. In order to receive Medicare reimbursement for non-emergency ambulance transports, the patient must be bed-confined or have a medical condition that renders ambulance transport necessary. The ambulance company must obtain a Physician Certification Statement (PCS) stating that the patient requires ambulance transportation. But the existence of a signed PCS does not automatically qualify the patient for non-emergency ambulance transportation reimbursement from Medicare. If the PCS is false – that is, if the patient is not bed-confined and their medical condition would allow them to be transported in a wheelchair van – then any claims submitted to Medicare for non-emergency ambulance transport services are considered false claims. The government has a hard time identifying this type of fraud, because it cannot see the condition of the patients when they are picked up for transport. That is why most whistleblower rewards for ambulance fraud go to EMTs, drivers, medical billers, and other individuals who work for the ambulance companies. For example, an EMT may notice that most of the patients transported by his or her ambulance company are able to walk or sit in a wheelchair when they are picked up for scheduled ambulance transportation. Or a medical biller may notice that patients transported by ambulance do not have current or valid Physician Certification Statements (PCS) in their files. In some ambulance companies, employees are asked not to note the patient’s condition on trip reports. Or medical billers are asked to disregard the dates on Physician Certification Statements when submitting claims. And in some cases, employees are asked to create false documents to support their employer’s Medicare claims. This puts the employee in a very dangerous position. When the government discovers the false claims (and, at some point, it will), anyone who participated in submitting the false claims could end up in prison. Remember the president of the local rescue squad in Virginia who submitted $1.6 million in false claims to Medicare for ambulance transport services? He was not the only one targeted by prosecutors. An employee of the rescue squad who went along with the fraud was sentenced to two years of probation and ordered to pay more than $750,000 in restitution to Medicare. Do not risk criminal charges by turning a blind eye to your employer’s ambulance fraud. If you are aware of false claims submitted to Medicare for ambulance transport services, then you should consult with a whistleblower attorney immediately. You may be entitled to a significant whistleblower reward and legal protections. The consultation is free and completely confidential. An experienced whistleblower attorney will listen to you and answer your questions. If you have a case, you will be represented on a contingency fee basis -- no attorneys’ fees are charged unless you win. To arrange a free and confidential consultation with an experienced whistleblower attorney, 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. The New York Medicaid program paid dentists for fillings and root canals supposedly performed on 465 patients who had no teeth. This is just one of three types of dental fraud identified by the New York State Office of Medicaid Inspector General in a recent report. The New York Medicaid fraud investigation also uncovered double billing for dental services provided to patients who live in skilled nursing facilities. Medicaid pays nursing homes a set fee for the dental care of patients in skilled nursing facilities, and the nursing homes are supposed to pay the dentists. The report found, however, that dentists had billed Medicaid directly for services provided to almost 2,000 residents of skilled nursing facilities. This resulted in Medicaid paying twice for the same services – once when the nursing home was paid, and again when the dentist was paid directly. The third type of dental fraud identified in the report involved referrals. All patient referrals must be documented properly to avoid situations where dentists are referring patients to themselves. The investigation found, however, that 75,392 patient referrals took place without the necessary documentation. New York and other states are becoming increasingly sophisticated when it comes to identifying and prosecuting dental fraud. For example, the New York Medicaid Inspector General is now using a sophisticated data matching review across data sets to identify possible instances of fraud. In other words, claims submitted by dentists are being compared to beneficiary and other records. The Medicaid Inspector General also coordinates with two other agencies devoted to investigating and prosecuting Medicaid fraud. The Medicaid Fraud Control Unit in the Attorney General’s office has teams of auditors, investigators, and lawyers in offices throughout the state. New York City has its own Office of Medicaid Provider Fraud and Abuse Investigations at 250 Church Street in Manhattan. If you are contacted by any of these offices, then you should consult an experienced Medicaid fraud attorney immediately. Medicaid fraud penalties can be severe. You could be ordered to pay three times the amount Medicaid paid plus a penalty of up to $11,000 for each claim. You could be excluded from participating in Medicare and Medicaid. You could even lose your license and go to prison. When you receive a call, letter, or visit from one of these investigative agencies, it means that the investigators have already gathered evidence against you. Anything you say or do will be used against you in their investigation and, possibly, in court. Do not try to handle this on your own. Get an experienced Medicaid fraud attorney on your side. To arrange a consultation with an experienced 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. A dentist was sentenced to three years probation and a $1,000 fine after pleading guilty to submitting false claims to Medicaid. He was also ordered to pay $7,300 in restitution to Medicaid and $2,700 to reimburse the Attorney General’s office for investigative costs. The Medicaid fraud investigation began when an employee in the dentist’s office contacted the Medicaid Fraud Control Unit at the Attorney General’s office. According to the government, the investigation revealed that the dentist was engaged in dental fraud by submitting several different types of false claims to Medicaid, including:
The dentist agreed to settle the charges of dental fraud by pleading guilty to one felony count of billing Medicaid for services not provided. In his plea, the dentist admitted that he billed Medicaid claims for surgical extractions or post-surgical complications when the procedure was only a simple tooth removal with no complications. Medicaid fraud penalties can be harsh. While this dentist was sentenced only to probation, a small fine, and restitution, his ability to practice as a dentist is now at risk. Because he pleaded guilty to a felony, he faces exclusion from Medicare and Medicaid programs, as well as professional disciplinary charges that could include suspension or revocation of his professional license. New York Medicaid fraud investigations often begin with a request for records or other documents from an investigator. If you practice in New York City, that request often comes from an investigator located at 250 Church Street in Manhattan. A request for records means that the government has already commenced its investigation, gathered evidence against you, and suspects that you have done something wrong. Anything you say or do at this point will be used against you. If you are under investigation or have been charged with Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately. How you handle the investigation can mean the difference between retaining or losing your rights, your livelihood, and your professional license. To arrange a consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach us 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. New York City has a new law prohibiting employers from discriminating against job applicants because they are not currently employed. The new law gives rejected job applicants the right to sue for damages if they were denied employment based on their current employment (or, more accurately, unemployment) status. The new provision in the New York City Human Rights Law goes into effect on June 11, 2013. It allows rejected job applicants to seek damages by filing a complaint in court or with the New York City Commission on Human Rights. The new unemployment discrimination law makes it illegal to base an employment decision with regard to hiring, compensation or the terms, conditions or privileges of employment on an applicant’s unemployment status. The new law also prohibits advertisements for any job vacancy from stating that: (i) current employment is a requirement or qualification for the job; or (ii) they will not consider an individual for employment based on his or her unemployment. Employers may ask job applicants why they left their prior employer, including the “circumstances surrounding an applicant’s separation from prior employment.” This means employers may still consider whether a job applicant was fired from a prior job due to poor performance or misconduct. The law also gives employer’s a defense to a claim of unemployment discrimination when the employer’s decision was based on "substantially job-related qualifications.” Some examples of “substantially job-related qualifications” include, where required for the particular job, “a current and valid professional or occupational license; a certificate, registration, permit or other credential; a minimum level of education or training; or a minimum level of professional, occupational or field experience.” Applicants who have all the necessary qualifications, however, may not be denied employment simply because they are currently unemployed. If you believe that you have been denied employment because you are currently unemployed, then you should consult with an experienced employment discrimination lawyer immediately to protect your rights. There are strict time limits on when you must file your claim. To arrange a free and confidential initial consultation with an experienced employment discrimination lawyer, 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 physician is facing up to 60 years in prison after a jury convicted him of Medicare fraud. Dr. Augustus Ohemeng was found guilty of six counts health care fraud based on evidence that he wrote unnecessary prescriptions for medical equipment and nutritional supplies that were never provided to patients. According to the government, the doctor’s prescription fraud caused Medicare to pay $3 million in false and fraudulent claims for durable medical equipment (DME) and nutritional supplies. As medical director of a clinic, the doctor allegedly recruited Medicare patients and billed Medicare for unnecessary tests and procedures. He also wrote prescriptions for enteral nutritional supplies and durable medical equipment such as expensive power wheel chairs that patents did not require. Those prescriptions were sold to medical supply companies, which used the fraudulent prescriptions to bill Medicare for medical supplies that were not necessary and not actually delivered to patients. According to the government, nearly all the prescriptions for power wheelchairs were written for patients who could walk. In many instances, the doctor signed blank prescription forms and his office manager filled in the details. Over the course of four years, the doctor wrote hundreds of unnecessary prescriptions, resulting $5.6 million worth of false and fraudulent Medicare claims. Medicare paid out $2.97 million on those claims. Medicare and Medicaid fraud penalties can be severe, especially in DME fraud and prescription fraud cases. In this case, the doctor faces a possible sentence of up to 60 years in federal prison. Dr. Ohemeng is the last of 10 defendants who were charged in this Medicare fraud scheme. The other nine -- including two other doctors, a nurse, and the owner of a medical supply company -- have been convicted of crimes either by pleading guilty or as the result of a jury verdict after trial. If you are facing a Medicare fraud investigation, or if you have been charged with a crime, then you should consult with an experienced Medicaid and Medicare fraud lawyer to protect yourself. Do not try to handle this on your own or with a lawyer who does not understand the complex laws and regulations governing Medicare and Medicaid. The government will have tremendous resources on its side – including the FBI, the Department of Justice, the Office of Inspector General for the U.S. Department of Health and Human Services, and other state and federal agencies. You need an experienced Medicare fraud lawyer on your side. To arrange a free and confidential consultation with an experienced Medicaid and Medicare fraud lawyer, 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 pharmacist who owned and operated a Medicine Shoppe pleaded guilty to billing Medicaid for drugs and supplies that were never dispensed to patients. She was accused of stealing more than $93,000 from the New York Medicaid program. The pharmacist and pharmacy owner pleaded guilty to larcency in state court. She will be sentenced to three years of probation. She will also be required to pay restitution of $93,406.02 to the Medicaid program. This case is typical of many Medicaid fraud cases involving pharmacists and their pharmacies. This pharmacist was caught because she allegedly billed the Medicaid program for approximately 18 different drugs, treatments and supplies that she did not purchase. Other pharmacists have been caught and convicted of Medicaid fraud because their claims for drugs allegedly dispensed to patients far exceeded their purchases. New York Medicaid fraud investigations are usually conducted by lawyers, investigators, and auditors assigned to the state’s Medicaid Fraud Control Unit (MFCU). It is a very large, active and aggressive unit within the New York State Attorney General’s office. In 2012, MFCU investigations and prosecutions resulted in more than $335 million in restitution to the state from individuals and companies engaged in Medicaid fraud and abuse. If you are under investigation or have been charged with Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately to protect yourself. The penalties for Medicaid fraud can be severe. Failing to handle the investigation properly could result in the loss of your livelihood, your license, and your freedom. 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. A former revenue manager and coding compliance officer for a radiology practice will receive a whistleblower reward of between $345,000 and $575,000 for helping the government uncover double billing of Medicare and Medicaid by his former employer and one of its clients. The whistleblower went to the government with evidence that Children’s Physician Services of South Texas had billed and received payment for professional services provided by a radiology practice and, without disclosing the payments, directed the radiology practice to bill and receive payment for the same professional services. Here’s how the fraud worked. Technicians working for Children’s Physician Services took genetic ultrasounds of patients and sent the resulting images to Radiology Associates for reading and interpretation by a physician. Children’s Physician Services then billed Medicare and Medicaid for both the taking of the ultrasound and the reading and interpretation of the ultrasound image. When Radiology Associates billed for its professional services, that resulted in double billing of Medicare and Medicaid for the reading and interpretation of the ultrasound image. At some point, the government alleged, Radiology Associates learned of the double billing but continued to bill Medicare and Medicaid anyway. A former coding manager at Radiology Associates ended the fraud – which involved thousands of ultrasound images over a five-year period – by commencing a qui tam or whistleblower lawsuit under the False Claims Act. The lawsuit was filed “under seal” and disclosed only to local prosecutors. The prosecutors then conducted an investigation and decided to join in the lawsuit. Children’s Physician Services and Radiology Associates agreed to settle the lawsuit by paying a total of $2.3 million. Under the False Claims Act, the former coding manager will receive between 15% and 25% of that amount as his whistleblower reward, for a total reward of between $345,000 and $575,000. If you are aware of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney to find out if you may be entitled to a whistleblower reward and legal protections. To arrange a free and confidential consultation with an experienced whistleblower 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. A former nursing home employee will receive a $405,000 whistleblower reward for helping the government uncover false claims submitted to Medicare and Medicaid for physical, occupational, and speech therapy services. Doug Ottinger, a former administrative assistant at Grace Healthcare, went to the government with evidence that his former employer had billed Medicare and Medicaid for physical, occupational, and speech therapy services that were not medically necessary. The government investigated the allegations and decided to join in a lawsuit against the nursing home management company. The lawsuit alleged that Grace pressured therapists to increase the amount of therapy provided to patients in order to meet targets for Medicare revenue. Those revenue targets, the government alleged, were established without regard to an individual patient’s need for therapy. The company agreed to settle the case by paying $2.7 million. Mr. Ottinger will receive $405,000 of that amount as his whistleblower reward. The lawsuit was filed under the qui tam or whistleblower provisions of the federal False Claims Act. The qui tam provisions allow an individual citizen to bring a whistleblower lawsuit on behalf of the government and share in any recovery. In this case, the former employee’s lawsuit was filed “under seal” (in secret) and disclosed only to the government. After investigating his allegations, the government decided to intervene or join in the lawsuit. The government then took the lead in the lawsuit against his former employer and negotiated the settlement. If you are aware that your current or former employer has submitted claims to Medicare or Medicaid for products or services that were not necessary or not actually provided, then you should consult with an experienced Medicare whistleblower attorney immediately. You may be entitled to a substantial whistleblower reward and legal protections. To arrange for 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.
350 Fifth Avenue 59FL New York, NY 10118 (212) 601-2728 |