Hospital Pays $41 Million to Settle Claims that “Unreasonably High” Cardiologist Salaries Violated the Physician Self-Referral Law
King’s Daughters Medical Center agreed to pay almost $41 million to settle allegation that it submitted false claims to Medicare and Medicaid for coronary stents and diagnostic catheterizations. The government claimed that the hospital violated the Stark Law, also known as the physician self-referral law, which prohibits certain types of financial relationships between hospitals and physicians. In this case, the government claimed that the hospital paid above-market salaries to cardiologists to induce them to refer patients to the hospital. Once an improper financial relationship exists, all claims for reimbursement from Medicare or Medicaid that arise out of that relationship are considered “false claims,” even if the patient received medically appropriate care. In this case, however, the government alleged that the financial relationship also resulted in medically unnecessary procedures. As a result of the improper financial incentives, the government alleged, Medicare and Medicaid were billed for medically unnecessary diagnostic catheterizations and cardiac stents. The government also alleged that the physicians falsified medical records to justify the unnecessary cardiac procedures. The Stark Law is very complex and contains exceptions to ensure that physicians can be fairly compensated. A related law known as the Anti-Kickback Statute is similarly complex and contains so-called “safe harbors.” Compliance with both laws is strictly enforced and must be properly documented. Violations of the Stark Law or Anti-Kickback Statute can result in civil penalties including treble damages, criminal prosecutions, and disciplinary action against the professionals involved. If you are being investigated for potential Stark Law violations, or if you have evidence that a hospital is engaged in improper financial relationships with physicians, then you should consult with an experienced Medicare and Medicaid fraud lawyer immediately. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. John Howley, Esq.
0 Comments
Former Employees Allege Hospice Submitted False Claims to Medicare for Palliative and Continuous Home Care Services
The United States government has decided to join a lawsuit started by whistleblowers against Home Care Hospice, Inc., a provider of hospice services, and the company’s owners. The lawsuit was started by two former employees who allege that the hospice company submitted false claims to Medicare for palliative and crisis care services. Under the qui tam or whistleblower provisions of the False Claims Act, individual citizens may start a lawsuit on behalf of the government and share in any recovery. The qui tam or whistleblower lawsuit was initially filed “under seal” (in secret). After conducting an investigation, the government decided to join the lawsuit. If the government recovers money from the defendants as a result of the lawsuit, the whistleblowers will be entitled to a reward of between 15% and 25% of the amount recovered. The former employees allege that the hospice company and its owners submitted false claims to Medicare for palliative care to patients who did not qualify. They also allege that the defendants submitted false claims for continuous home care services that were not medically necessary or not actually provided. The Medicare hospice benefit pays for palliative care for patients who have a life expectancy of six months or less. Palliative care is focused on providing the patient with relief from the pain and stress of terminal illnesses. A patient who chooses palliative care no longer receives medical services intended to cure the terminal illness. The whistleblowers allege that the hospice company and its owners created false medical records and submitted false claims to Medicare for patients who were not terminally ill. The whistleblowers also allege that the defendants created false medical records and submitted false claims to Medicare for continuous home care services that were not medically necessary or not actually provided. Continuous home care services, also known as crisis care, are provided to terminally ill patients who experience acute medical symptoms on a temporary basis. The crisis care services usually include skilled-nursing services for a short period to allow the patient to remain at home. Medicare reimburses continuous home care at a much higher rate than the usual palliative care services provided by hospices. If you have evidence that a hospice is submitting false claims to Medicare, then you should consult with an experienced Medicare fraud whistleblower lawyer immediately. You may be entitled to a significant reward and legal protections as a whistleblower. To arrange a free and confidential consultation with an experienced Medicare fraud whistleblower lawyer, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. John Howley, Esq. Company Used Pathology Code to Bill Medicare and Medicaid for Unnecessary Services
Calloway Laboratories, Inc. has agreed to pay $4.7 million to settle allegations that it submitted false claims to Medicare and Medicaid. The company provides clinical laboratory services, including urine drug testing, to physicians and other healthcare providers. According to the government, the company routinely billed Medicare and Medicaid using a code for pathology services in addition to the code for urine drug testing. As a result, the company was paid for both urine tests and pathology services. Government investigators concluded, however, that the healthcare providers who ordered the urine tests did not knowingly order the pathology services and did not consider the pathology services to be medically necessary. The investigators also concluded that the diagnostic labs did not actually provide pathology services when they used the code seeking reimbursement for such services. Instead, the testing labs merely conducted a type of medical review that did not qualify for reimbursement as pathology services. This case presents a classic example of why the government relies on whistleblowers to stop Medicare and Medicaid fraud. People who work inside the diagnostic lab are often the only ones who actually know which tests are actually ordered and performed. Diagnostic lab billing staff are usually the only ones who know how claims to Medicare and Medicaid are being coded. As a result, this type of fraud can often go undetected unless an honest employee is willing to blow the whistle. In return, the government pays very substantial rewards and provides legal protection for those who report healthcare fraud. Under the False Claims Act, a whistleblower is entitled to a reward of between 15% and 30% of the amount the government recovers. In a case such as this one – where the government recovered $4.7 million – the whistleblower reward could be as high as $1.4 million. If you have evidence that a diagnostic lab or other healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You could be entitled to a substantial reward and legal protections. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. John Howley, Esq. Ambulance Company Owners Directed Employees to Create False Trip Reports
The owner of an ambulance company and her son were sentenced to 6 years and 4 years in prison, respectively, for their roles in an ambulance fraud scheme. Each of them was also ordered to pay more than $1.5 million in restitution to Medicare and Medicaid. According to the government, the defendants transported patients in wheelchair vans for routine and non-emergency trips, but then billed Medicare and Medicaid for much more expensive ambulance transports. The defendants also created false medical records to make it appear that the patients had traveled by ambulances instead of in wheelchair vans. A critical part of the fraudulent scheme was getting employees of the ambulance company to omit information from trip reports and other medical records. For example, the government alleged that the defendants instructed their employees to omit information concerning the ability of patients to walk and ride in wheelchairs. As a general rule, Medicare and Medicaid do not reimburse for non-emergency ambulance transports if the patient is able to walk or ride in a wheelchair. Most Medicare and Medicaid fraud schemes require the cooperation of the provider’s employees. Often, the employees are asked to modify trip reports, treatment notes, and other records so that more services, or more expensive services, can be billed to Medicare and Medicaid. This puts the employee in a very dangerous situation. If the government discovers that fraudulent claims were submitted to Medicare or Medicaid based on false records created by an employee, then the employee could find themselves in handcuffs and facing a long prison sentence. If your employer has asked you to falsify trip reports, treatment notes, or any other type of medical record, then you should consult with an experienced Medicare and Medicaid fraud lawyer immediately to protect yourself. You may be entitled to legal protections and even a substantial reward for helping the government stop fraud. To arrange a free and confidential consultation with an experienced healthcare fraud attorney, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 False Statements in Patient Medical Records Resulted in Medicare Fraud Charges
A nurse who worked as a home health agency manager has been convicted of conspiracy to commit healthcare fraud. He faces up to five years in prison. The nurse worked as the director of nursing for PTN Healthcare Services Inc. He was convicted of helping his employer create medical records that made it appear that patients required home health services when they did not. The false records were used as part of a larger scheme that included a doctor who falsely certified that the patients required home health services and that the services qualified for Medicare reimbursement. According to the government, the scheme resulted in Medicare paying $3 million for services that were not medically necessary. This is a common tragedy in healthcare. An employer asks a nurse or physical therapist to create records that will allow the patients to continue receiving home healthcare services or therapy. The nurse or physical therapist does not want to challenge their employer or lose their job. So they write treatment notes to justify more home healthcare services or therapy. All too often, this results in the nurse or physical therapist being arrested at home, put in handcuffs, and taken to the FBI offices for an interrogation. It does not have to end this way. If you have been asked to create false medical records, then you should consult with an experienced Medicare fraud and healthcare employment lawyer immediately to protect yourself. You have rights and legal protections. You may even be entitled a substantial reward if you help the government recover money spent on false claims. Do not delay. You never know when the FBI will come knocking at your door. To arrange a free and confidential consultation with an experienced Medicare fraud and healthcare employment lawyer, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email. The initial consultation is free and completely confidential. John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 Hospital Pays $2.5 Million to Settle Medicare and Medicaid Fraud Claims
A former employee of Baptist Health System Inc. was awarded a $425,000 whistleblower reward for helping the government recover $2.5 million in allegedly false claims submitted to Medicare and Medicaid. The former employee gave the government evidence that the hospital system billed Medicare and Medicaid for services and drugs that were not medically necessary. According to the whistleblower lawsuit, two neurologists at the hospital system misdiagnosed patients with multiple sclerosis and other neurological disorders. As a result of the misdiagnoses, the hospital system billed Medicare and Medicaid for medically unnecessary services and drugs. The hospital system placed one of the neurologists on administrative leave, but it did not disclose the problems to the government until a year later. The government’s investigation began when a former hospital employee brought a qui tam or whistleblower lawsuit. A whistleblower lawsuit is filed with the court “under seal” (in secret). At the same time, the whistleblower gives their evidence to the government, and the government is required to conduct an investigation. If the government recovers money as a result of the evidence provided, then the whistleblower is entitled to a reward of between 15% and 30% of the amount the government recovers. In this case, the whistleblower was awarded 17% of the amount recovered or $425,000. If you have evidence that a hospital or other medical provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced Medicare fraud whistleblower lawyer immediately to protect your rights. Do not delay. The reward is available only to the first whistleblower who provides evidence to the government. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our law offices via email. John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 False Claims for Transporting Dialysis Patients in Ambulances Results in 9-Year Prison Sentence for Ambulance Company Owner
The owners of Alpha Ambulance Inc. are going to prison for Medicare fraud. One of the owners was sentenced to 108 months (9 years) in prison, while the other received 75 months (more than 6 years) after both pleaded guilty to a conspiracy to commit healthcare fraud. Their company focused on non-emergency ambulance transports. Most of their patients were transported to and from dialysis treatments on a regular basis. The government accused the company and its owners of billing Medicare for ambulance transports that were not medically necessary. Under the Medicare rules, a dialysis patient should not be transported in an ambulance if they can be transported in a less expensive form of transportation such as a wheelchair van. An ambulance is usually not considered medically necessary unless the patient is confined to a bed or has a medical condition that requires transportation by ambulance. Most patients who can sit in a wheelchair or walk with a walker do not qualify for ambulance transports under the Medicare rules. In this case, the defendants were accused of instructing their employees to conceal the Medicare beneficiaries’ true medical conditions and to create false justifications for the transportation. Ambulance fraud is widespread because it all seems so easy and innocent. An EMT is instructed to check a box on a trip report or make a note that the patient is bed-confined. A doctor is asked to sign a Physician Certification Statement (PCS) stating that the patient requires an ambulance, even though the patient can walk, but he goes along with it because it will make the patient more comfortable. These little lies add up. In this case alone, the defendants were accused of submitting more than $49 million in claims for ambulance transports. If you have evidence that an ambulance company is submitting false claims to Medicare, or if you have been asked to provide false information on trip reports or other documents, then you should consult with an experienced Medicare fraud attorney immediately to protect yourself. Going along with an employer who is submitting false claims to Medicare could make you, personally, a target of a criminal investigation. On the other hand, you may be entitled to a very substantial whistleblower reward if you help the government stop the fraud and recover overpayments. To arrange and free and confidential consultation with an experienced Medicare fraud lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our law offices via email. John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 Home Healthcare Provider Pays $150 Million to Settle Medicare Fraud Claims
Amedisys Inc. has agreed to pay $150 million to settle a qui tam or whistleblower lawsuit alleging that the company submitted false claims to Medicare for home healthcare services. Nurses, therapists, and other former employees brought the lawsuits on behalf of the federal government alleging that the home healthcare provider billed Medicare for patients and services that were not eligible for reimbursement. Under the False Claims Act, individuals who help stop Medicare fraud are entitled to a whistleblower reward of between 15% and 30% of the amount the government recovers. To earn the whistleblower reward, the individuals bring the lawsuit “under seal” (in secret) and give their evidence to the government. The government then decides whether to pursue the claims. In this case, the former employees claimed that the home healthcare provider billed Medicare for therapy and nursing services that were medically unnecessary. The former employees claimed that their employer misrepresented that patients were homebound, when they were not, and misrepresented the patients’ medical conditions to increase payments from Medicare. The whistleblowers alleged that company management pressured therapists and nurses to provide care based on the ability to get reimbursed from Medicare instead of the best interests of the patients. The whistleblowers also alleged that the home healthcare company provided services to an oncology practice at below-market prices in return for patient referrals. Providing anything of value in return for referrals of Medicare patients violates the Anti-Kickback statute. In return for helping the federal government win the lawsuit, the whistleblowers will share a $26 million whistleblower reward. If you have evidence that a home healthcare provider is overbilling Medicare or otherwise engaged in fraud, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial whistleblower reward and legal protections. The consultation is free and confidential. No attorneys’ fees are charged unless your case is successful. To arrange a free consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our law offices via email. John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 |
John Howley, Esq.
350 Fifth Avenue 59FL New York, NY 10118 (212) 601-2728 |