A Los Angeles-area doctor has pleaded guilty to accepting kickbacks from the makers of power wheelchairs and other durable medical equipment (DME). He faces up to 10 years in prison and a $250,000 fine. Here’s a critical fact that every physician must understand. It does not matter if the patient actually needed the prescription. Once a prescription is tainted by a kickback, you have violated the law even if the prescription was otherwise legitimate and the patient truly needed it. Penalties for violating the Anti-Kickback statute and the False Claims Act are severe. As a starting point, an individual who requests, offers, pays or accepts a kickback may be liable for three times the amount paid out by Medicare or Medicaid, plus a penalty of $11,000 per claim. A healthcare professional could also lose their professional license and suffer exclusion from government healthcare programs. In some cases, the government seeks criminal sanctions that can include up to five years in prison and a $25,000 fine for each charge. In this case, Dr. Juan Tomas Van Putten is looking at a possible sentence of 10 years in prison and a $250,000 fine because he pleaded guilty to more than merely accepting kickbacks. He also admitted that:
If you have been offered or have accepted payments from DME suppliers, pharmaceutical companies, or other service or equipment suppliers, then you should consult with an experienced False Claims Act attorney immediately. You may have options to protect your rights and avoid a personal catastrophe. And if you are aware of kickbacks or other improper payments being made to medical professionals, you may be entitled to a whistleblower reward for helping the government stop healthcare fraud. To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me 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 registered nurse and an intake specialist at a community mental health center have pleaded guilty to conspiracy to commit health care fraud. They each face up to five years in prison when they are sentenced. Both employees worked at Health Care Solutions Network, which operated community mental health centers in Florida and North Carolina. The company provided partial hospitalization program (PHP) services to individuals suffering from mental illness. A PHP is a form of intensive treatment for severe mental illness. According to the government, the two employees helped their employer bill Medicare and Medicaid for mental health treatment that was unnecessary and, in many instances, not even provided. John Thoen, a registered nurse, was charged with admitting patients who were not eligible for PHP services. He was accused of creating false medical records that were used to support false billing to Medicare and Medicaid. Alexandra Haynes, an intake specialist, was also charged with creating false patient medical records including false group therapy notes. Their employer, Health Care Solutions Network, was accused of a broader Medicare fraud scheme that included paying kickbacks to owners and operators of assisted living facilities who referred Medicare and Medicaid patients for treatment. Paying kickbacks in return for patient referrals is illegal under the Anti-Kickback Statute. Any claim for treatment resulting from kickbacks also constitutes a false claim under the False Claims Act. This is a wakeup call for any doctor, nurse, medical biller, or other healthcare professional who believes their employer may be submitting false claims to Medicare or Medicaid. If you helped to create the patient medical records that are being used in the submission of false claims, you are at serious risk of civil penalties, criminal charges, and even loss of your professional license. Fortunately, you do have options – especially if you take action before the FBI comes knocking on your door. You may be able to avoid prosecution. You may even be entitled to a substantial reward for helping the government stop Medicare fraud. If you are aware that false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me 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. Morton Plant Mease Health Care Inc. and its affiliated hospitals will pay more than $10 million to the federal government to resolve allegations that they submitted false claims to Medicare. Randi Ferrare, a former employee who prompted the government’s investigation, will receive a $1.8 million reward as her share of the settlement. Ms. Ferrare is entitled to the reward under the qui tam or whistleblower provisions of the False Claims Act. The government’s press release announcing the settlement calls the False Claims Act “one of the most powerful tools” in the battle against health care fraud. The settlement resolves allegations that the hospitals billed interventional cardiac and vascular procedures as inpatient care when those services should have been billed as less costly outpatient care. Most interventional cardiology and vascular procedures are classified as minimally invasive because they do not require an instrument to enter the body or large incisions. They usually involve the insertion of a catheter into a small incision in the upper leg. The catheter is guided toward the heart or vascular area through the use of real-time X-ray. The whistleblower in this case is a former Director of Health Management Services at Morton Plant Hospital. She brought her concerns to a lawyer who helped her prepare a complaint and disclosure statement describing the evidence of false claims that were submitted to Medicare. After reviewing these materials and conducting an investigation, the U.S. Attorney decided to pursue the case and ultimately negotiated the settlement. Billing lower cost outpatient procedures as more expensive inpatient procedures is just one of many ways false claims can be submitted to Medicare. Other types of Medicare fraud involves “upcoding” (using a more expensive diagnostic code than the procedure actually justified), billing for services or treatments that were not medically necessary, creating false medical records, and billing for services that involved the payment of kickbacks to referring physicians. If you are aware that false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me 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. Two hospice employees will share a $250,000 reward for blowing the whistle on Medicare fraud. The reward will be paid out of a $1.3 million settlement that Harmony Care Hospice Inc. and its owner, Daniel J. Burton, will pay to settle allegations that they submitted false claims to Medicare for patients at their hospice facilities. Hospices provide palliative care to patients who decline curative care of their illness. Palliative care is medical treatment that concentrates on reducing the severity of pain and other disease symptoms. Medicare beneficiaries are entitled to hospice care if they have a terminal illness with a prognosis that their life expectancy is six months or less. The lawsuit alleged that Harmony Care Hospice and its owner knowingly submitted false claims to Medicare for patients who did not have such a prognosis and thus were not eligible for hospice care reimbursement. The two hospice employees, Mona Singletary and Lynda Fulton, started the government’s investigation by filing a lawsuit under the qui tam, or whistleblower, provisions of the False Claims Act. This law allows private citizens to start lawsuits for false claims on behalf of the United States government and share in any recovery. The individuals who file the lawsuit are called “relators.” The qui tam lawsuit was filed by the relators “under seal” (in secret) so the U.S. Attorney could review the evidence and conduct an investigation without alerting the defendants that they were being investigated. The case became public only after the U.S. Attorney conducted an investigation and decided to join the lawsuit. Under the False Claims Act, qui tam relators are entitled to a reward of between 15% and 25% of the amount recovered when the government joins the lawsuit. In this case, the relators will receive a reward of almost $250,000, or a little more than 19% of the $1.3 million settlement amount. If you have information that false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me 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. Medicare pays more than $30 billion every year for services at skilled nursing facilities. A new study concludes that more than $1 billion of those payments are for inaccurate, medically unnecessary, and fraudulent claims. This study is important for anyone who owns, operates, or is employed by a skilled nursing facility because it will lead to more audits and investigations. Some owners and employees will pay large penalties and may even go to prison. Others will earn six- and seven-figure rewards for helping the government uncover false claims. One of the most common types of false claims at nursing homes is upcoding. Upcoding is the practice of using billing or diagnostic codes that result in a higher reimbursement rate than the codes for the services actually provided. Other false claims involve billing for services that were not actually provided or that did not meet Medicare coverage requirements. Another common type of nursing home fraud involves misreporting information on Minimum Data Sets (MDS). MDS assessment forms are completed for all residents in Medicare- or Medicaid-certified nursing homes to provide a comprehensive assessment of each resident's functional capabilities and help identify health problems. The MDS information also determines the Resource Utilization Group (RUG) category, which ultimately determines the per diem rate paid to the facility for a resident whose stay is covered under Medicare Part A. When a nursing home provides inaccurate or false information on the MDS forms, it makes a “false claim” that can result in overpayments by Medicare. Under the False Claims Act, an individual or company that submits false claims to Medicare must pay the government three times the amount of the improper payments plus a penalty of $11,000 per claim. Individuals and companies can also face criminal fraud charges. The False Claims Act provides an incentive for individuals who help the government uncover false claims. Under the qui tam provisions of the False Claims Act, an individual can start a lawsuit on behalf of the government to recover money paid on false claims. The individual who brings the lawsuit is called a relator. If successful, the relator is entitled to a reward of between 15% and 30% of the amount recovered. In many cases, the reward amounts to millions of dollars. If you work at a skilled nursing facility and have information about false claims submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. You may be entitled to a very large reward for reporting false claims, as well as protection from adverse employment action as a whistleblower. To arrange a free and confidential consultation by phone or in person, call my office today at (917) 652-6504 or click here to contact me 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 registered nurse was sentenced to 30 months in prison for signing false medical records that were used by his employers to submit fraudulent claims to Medicare. Anthony Parkman, RN, will also serve three years of supervised release and must pay $450,988 in restitution. According to court records, the nurse signed false medical documentation for his employers, a group of home health care agencies. Each home health agency used the false medical records to bill Medicare for home health care services that were never actually rendered. The home health care agencies accused of participating in the Medicare fraud are Physicians Choice Home Health Care LLC, First Care Home Health Care LLC, Quantum Home Care Inc., and Moonlite Home Care Inc. Medicare paid the home health companies a total of $13.8 million in false claims. Of that amount, Medicare paid approximately $450,988 for skilled nursing claims based on falsified patient records signed by this particular nurse. Nine other individuals have pleaded guilty and await sentencing. Six more are waiting for trials on the home health fraud charges against them. This is yet another sad story of employees who went along with their employer’s submission of false claims to Medicare. Instead of receiving a reward for reporting the fraud, these employees will spend years in prison and pay hundreds of thousands of dollars to the government in restitution. Nurses, physical therapists, billing and accounting staff, and other healthcare employees are at serious risk if they know that their employer is submitting false claims to Medicare or Medicaid. If you think that you will never get caught, or that you are too low on the organization chart to matter, you should think again. The government goes after everyone who has any involvement in health care fraud. And it has very powerful tools to detect false and fraudulent claims, including sophisticated computer programs to detect suspicious billing patterns. The government also has thousands of investigators and auditors who are constantly looking for evidence of Medicare and Medicaid fraud. They try to find everyone who had any role in the fraud. You do have options. You can choose to do nothing and wait until the FBI shows up to interrogate you. Or you can consult with an experienced False Claims Act lawyer now to protect your rights. Those rights may include a large reward for helping the government stop Medicare and Medicaid fraud. Under the False Claims Act, a whistleblower who helps the government recover money paid on false claims is entitled to between 15% and 30% of the amount recovered. If you are aware of false documents or fraudulent claims involving Medicaid, Medicare, or another federal government healthcare program, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. To schedule a free and confidential consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me 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 federal government audit concludes that the State of New Jersey improperly claimed more than $100 million in "Disproportionate Share Hospital Payments" for five hospitals that did not qualify for such payments. The auditors recommend that New Jersey repay more than $50 million to the federal Medicaid program. Under the Medicaid program, a state is required to make Disproportionate Share Hospital Payments to hospitals that serve a disproportionate share of low-income and/or uninsured patients. To qualify for these special payments, the state must classify a hospital as a Disproportionate Share Hospital. Hospitals qualify for that classification if their Medicaid Inpatient Utilization Rate (MIUR) exceeds 1 percent. A hospital's MIUR, expressed as a percentage, is the number of inpatient days attributable to patients who were Medicaid-eligible, divided by the total of the hospital's inpatient days in a particular year. According to an audit conducted by the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS), New Jersey claimed Disproportionate Share Hospital Payments for five hospitals that did not have MIURs in excess of 1 percent. The audit report states that New Jersey itself had calculated MIURs of less than 1 percent for these hospitals during one or more fiscal years. The state acknowledged that it misinterpreted Disproportionate Share Hospital eligibility regulations, but claimed that two of the five hospitals at issue did qualify for the special payments during the audit period. The OIG auditors have recommended that the State refund $50 million to the federal Medicaid program and take steps to ensure that all Disproportionate Share Hospital designations meet federal eligibility requirements in the future. As this audit demonstrates, mistakes can result in tens of millions of dollars and sometimes hundreds of millions of dollars in Medicaid and Medicare overpayments. In this particular case, the overpayments were caught during a random audit. Another way of uncovering overpayments is by having insiders come forward as whistleblowers under the False Claims Act. Overpayments can result in liability under the False Claims Act if the entity receiving Medicaid or Medicare reimbursement knows that it has been overpaid and fails to refund the overpayment. This is a type of Medicare and Medicaid fraud. An individual who has knowledge of such overpayments may bring a qui tam lawsuit under the False Claims Act on behalf of the federal government to recover the overpayments. The person bringing the lawsuit is called a "relator." If successful, the qui tam relator is entitled to a whistleblower reward of between 15% and 30% of the amount the federal government ultimately recovers. For example, if the New Jersey case had been brought by a qui tam relator and the state refunded the full $50 million to the federal government, then the relator's reward would have been between $7.5 million and $15 million. If you are aware of overpayments or false claims involving Medicaid, Medicare, or another federal government healthcare program, then you should consult with an experienced False Claims Act attorney immediately to protect your rights. To schedule a free and confidential consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me via email. John Howley New York, New York 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 Downtown hospital has agreed to pay $13.4 million to resolve claims that it defrauded Medicare and Medicaid by submitting false claims for an inpatient detoxification program. The settlement is the result of lawsuits brought by two individuals under the qui tam provisions of the False Claims Act. A qui tam lawsuit allows private individuals to sue on behalf of the government to recover money paid out as the result of false claims. The individuals brining the lawsuit are called “relators.” As a reward for blowing the whistle on fraud, the relators will receive between 15% and 25% of the total amount recovered by the government. In this case, that means a reward of between $2 million and $3.35 million. After the whistleblower lawsuit was filed, the government conducted an investigation. The investigation revealed that the hospital and a Missouri-based company, Special Care Hospital Management Corporation, operated an inpatient drug and alcohol detoxification program under the name New Vision without having received a license from the New York State Office of Alcoholism and Substance Abuse Services. Because the program was unlicensed, New York Downtown Hospital was not entitled to bill Medicare and Medicaid for treatment provided by the program. All claims submitted to Medicare and Medicaid, therefore, were considered “false claims.” The government’s investigation also established that the hospital paid Special Care Hospital Management for patient referrals. Payments of kickbacks in return for patient referrals violate federal and state anti-kickback statutes. Any services provided as a result of those kickbacks are ineligible for reimbursement from Medicare and Medicaid. New York Downtown Hospital is a community teaching hospital affiliated with the prestigious New York-Presbyterian Healthcare System and Weill Cornell Medical College. The hospital denied the government’s allegations but agreed to settle the lawsuits by paying $13.4 million to the state and federal governments. The false claims were brought to the government’s attention by two whistleblowers at the hospital, Dr. Mathew I. Gelfand and Enrico Montaperto, when they filed qui tam actions under the False Claims Act. Dr. Gelfand and Mr. Montaperto will now share in the whistleblower’s reward. If you are aware of questionable payments for referrals or false claims submitted to Medicare or Medicaid, then you should consult with an experienced healthcare attorney immediately to protect your rights. To schedule a free and confidential consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me via email. John Howley New York, New York 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. HCA Inc., one of the nation’s largest for-profit hospital chains, has agreed to pay $16.5 million to settle claims that it violated the False Claims Act and the Stark Statute by entering into favorable leasing arrangements with doctors who referred patients to the hospital. The whistleblower who brought the case will receive 18.5% of the settlement as a reward, or more than $3 million. The settlement resolves allegations that HCA subsidiaries Parkridge Medical Center and HCA Physician Services (HCAPS) provided financial benefits to a physician group, Diagnostic Associates of Chattanooga, as an incentive for physicians to refer patients to HCA facilities. The financial incentives included leasing office space from the physician group at a rate well in excess of fair market value, and releasing the physician group from a separate lease obligation. The whistleblower was an appraiser who had been hired by the hospital to provide a fair market appraisal of the physician group's property. When he saw that the hospital was renting the property from the physician group at a rate far above his fair market appraisal, he brought this lawsuit on behalf of the government to recover for violations of the Stark Law and the False Claims Act. The Stark Law limits the types of financial relationships that may exist between hospitals and physicians who potentially may refer patients to them. The theory behind the law is that physicians should should make decisions regarding referrals to health care facilities based on what is in the best interest of patients without being induced by payments from hospitals competing for their business. When the Stark Law is violated, then any resulting Medicare or Medicaid claims are considered “false claims” under the False Claims Act. The lawsuit was brought under the qui tam, or whistleblower, provisions of the False Claims Act. The qui tam provisions allow a private citizen to bring a lawsuit on behalf of the United States and share in any recovery. In this case, the whistleblower will receive 18.5% of the $16.5 million settlement, or more than $3 million, as his reward. If you are aware of questionable financial relationships or false claims submitted to Medicare or Medicaid, then you should consult with an experienced healthcare attorney immediately to protect your rights. To schedule a free and confidential consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me via email. John Howley New York, New York 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. Two elderly Medicare recipients will share almost one million dollars as a reward for bringing a False Claims Act case against RxAmerica, a subsidiary of retail pharmacy chain CVS Caremark Corporation. The reward is part of a $5.25 million settlement the company will pay to resolve allegations that gave the government false prices for the Medicare Prescription Drug Program, known as Medicare Part D. Part D of Medicare provides prescription drug coverage for individuals who join a Medicare-approved plan. The approved plans are run by private companies and vary in terms of drugs that they cover, the amount they reimburse for those drugs, and the deductibles and co-pays participants must pay. To assist Medicare beneficiaries when choosing a Part D plan, the Centers for Medicare & Medicaid Services (CMS) offered a web-based tool called Plan Finder. The Plan Finder allowed Medicare beneficiaries to see estimated prescription drug prices under different Part D plans. CMS obtained the pricing information from the private companies such as RxAmerica that offered Part D plans. Max and Jan Hauser enrolled in RxAmerica’s Medicare Part D plan after using the Plan Finder. The actual drug prices, however, were higher than the prices that had been shown by RxAmerica on the Plan Finder. This meant that the Hausers' Part D benefits were consumed quicker, and Mr. Hauser was forced into the Medicare Part D "donut hole." When thrown into the Medicare Part D donut hole, seniors are forced to pay for their prescriptions out of pocket. After reviewing their Explanation of Benefits form, the Hausers realized that RxAmerica was charging higher prices for the prescription drugs than the prices that were listed on the Plan Finder tool. They decided to do something about it. After consulting a lawyer, they filed a qui tam lawsuit under the False Claims Act. Under this law, individual citizens with evidence of false claims may bring an action on behalf of the government. As a reward, the individuals who bring the lawsuit are entitled to a percentage of the money recovered by the government, usually between 15% and 30% of the total recovery. In this case, the government decided to take over prosecution of the case because, in addition to giving false information to individuals, the false information was also given to Medicare. After the government became involved, RxAmerica agreed to settle the case for $5.25 million. Almost $1 million of that amount will be paid to the whistleblowers who brought the case in the first place. If you have information that a pharmacy or pharmaceutical company is engaged in deceptive marketing, promoting drugs for off-label uses, or paying kickbacks to health care professionals, then you should consult with an experienced whistleblower lawyer immediately. To schedule a free and confidential consultation by telephone or in person, call my office today at (917) 652-6504 or click here to communicate with me via email. John Howley New York, New York 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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