A dentist who was previously excluded from Medicaid has pleaded guilty in federal court to health care fraud allegedly involving $20 million in false claims submitted to Medicaid. The dentist was excluded from Medicaid and Medicare after a 1997 conviction for submitting false claims. Despite his exclusion from Medicaid, the government alleged that the dentist owned and operated several dental clinics in Connecticut by using a licensed dentist to act as the nominal head of the clinics. The clinics included Landmark Dental, Dental Group of Connecticut, and Dental Group of Stamford. When applying to enroll as Medicaid providers, the excluded dentist and the nominal head of the clinics did not disclose the excluded dentist’s controlling interest in the clinics. An individual who is excluded from Medicaid may not participate directly or indirectly in any services provided to Medicaid beneficiaries. The involvement of an excluded individual as an owner of the clinics meant that all claims for reimbursement to Medicaid submitted by the clinics were considered false claims. The excluded dentist pleaded guilty in federal court to one count of health care fraud, which carries a maximum term of imprisonment of 10 years, and one count of tax evasion, which carries a maximum term of imprisonment of five years. He also agreed to pay $9.9 million to the State of Connecticut to settle related state law false claims allegations. If you have questions about exclusion or the employment of an individual who is excluded from Medicare or Medicaid, then you should consult with an experienced Medicare and medicaid fraud attorney. Contact 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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Exclusion from Medicare and Medicaid can have devastating consequences for doctors, nurses, pharmacists, and other healthcare professionals. Exclusion results in the inability to submit claims to federal healthcare programs. It also means that you cannot work for any healthcare providers that accept payment from such programs. In addition, many private insurance companies, providers, and suppliers will not do business with an excluded professional. Unfortunately, too many medical professionals and their lawyers do not think about exclusion and its career-destroying potential until it is too late. When faced with a billing dispute or a fraud investigation, they tend to focus exclusively on avoiding criminal charges or reducing the financial exposure. Even if they avoid criminal charges, however, they still may face exclusion from Medicare, Medicaid, and other federal healthcare programs. Under federal law, there are two types of exclusion: mandatory and permissive. Mandatory exclusions: The Office of Inspector General (OIG) at the Department of Health and Human Services (HHS) must exclude individuals and entities from participation in all federal health care programs if they are convicted of certain criminal offenses. The types of criminal offenses that result in mandatory exclusion from Medicare and Medicaid are:
Permissive exclusions: The OIG may, but is not required to exclude individuals and entities that engage in other conduct, including conduct that does not involve Medicare or Medicaid. For example, a misdemeanor conviction for submitting false claims to a private insurance company may result in exclusion from federal healthcare programs. Even defaulting on student loans may result in exclusion. The grounds for permissive exclusion include:
If you are facing a dispute over claims submitted to Medicare, Medicaid, or even a private insurance company, then you should consult with an experienced Medicare and Medicaid fraud attorney who understands all the implications, including the possibility of exclusion and the potential impacts on your professional license. 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. 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. 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. The owners and operators of two home health agencies pleaded guilty to participating in a $48 million home health Medicare fraud scheme. Rogelio Rodriguez and Raymond Aday operated Caring Nurse Home Health Corp. and Good Quality Home Health Inc. in Miami, Florida. According to the government, the two defendants submitted claims to Medicare for home health care and therapy services that were not medically necessary. They also engaged in phantom billing or billing for services not provided. The fraudulent scheme involved paying kickbacks to patient recruiters who supplied the home health care agencies with patients, prescriptions, plans of care, and certifications for therapy and home health services. The owners used these documents to submit false claims to Medicare. In addition, nurses and office staff at the home health agencies created false medical records to make it appear that Medicare beneficiaries qualified for home health care and therapy services when, in fact, the beneficiaries did not qualify for and did not receive such services. Between 2006 and 2011, the two home health care agencies submitted approximately $48 million in claims for home health services that were not medically necessary and/or not provided. The two defendants each pleaded guilty to one count of conspiracy to commit health care fraud. They each face up to 10 years in prison and exclusion from Medicare in the future. Home healthcare fraud is a top priority for government investigators and prosecutors. They are constantly monitoring Medicare and Medicaid claims data to identify suspicious billing patterns. And when government investigators find evidence of Medicare or Medicaid fraud, they go after everyone involved – not just the owners and managers, but every single employee who was aware of the fraud or signed false medical records. Do not go to prison for your employer’s fraud. Consult with a Medicare and Medicaid fraud attorney to protect yourself before the FBI shows up at your door. An experienced defense lawyer can help you avoid prosecution or minimize the charges. You may even be entitled to legal protections and a substantial reward as a whistleblower by bringing a qui tam case under the False Claims Act. You should also consult with a Medicaid and Medicare fraud lawyer immediately if you are under investigation or have been charged with a crime. You may have options and defenses, but only an experienced defense lawyer can help you assert them. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 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 owner of adult day care centers pleaded guilty to submitting false claims to Medicare for psychotherapy services that were not provided. He faces a possible sentence of 60 years in prison, a $1.5 million fine, and mandatory exclusion from Medicare and other government healthcare programs. Marcus Jenkins owned and operated two adult day care centers and several adult foster care homes (AFCs) that housed severely mentally-disabled Medicare recipients. The government alleges that Jenkins and his wife used the Medicare identification information of more than 100 residents to bill Medicare for individual and group psychotherapy services that were never provided. The government alleged that Jenkins and others submitted more than 185,000 false Medicare claims totaling more than $13.2 million for group and individual psychotherapy sessions that were not provided. The phantom billing scheme allegedly included billing for services provided to a patient who was deceased on the dates of claimed service. Jenkins admitted that he and others conspired to defraud Medicare by billing for services not rendered. He pleaded guilty to one count of conspiracy to commit health care fraud and five counts of health care fraud. The government aggressively investigates and prosecutes allegations healthcare providers billing for services not provided. If you are under investigation or have been charged with a crime, then you should consult with an experienced Medicaid and Medicare fraud lawyer immediately. Do not try to handle this on your own. The government also goes after everyone connected with the fraud. In this case, Jenkins’ wife and a physician who worked for their companies are also facing criminal prosecution. If you are aware that your employer is submitting false claims to Medicare or Medicaid, then you are at serious risk of criminal prosecution. You need to consult with an experienced Medicare and Medicaid fraud attorney immediately to protect yourself. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to contact 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 pharmaceutical sales representative has earned a $1.7 million reward for blowing the whistle on Medicare fraud. The reward will be paid out of an $11.4 million settlement by Victory Pharma Inc., a specialty pharmaceutical company, to resolve allegations that it paid kickbacks to doctors to induce them to write prescriptions for Victory’s products. Chad Miller, the former sales representative, brought the lawsuit under the whistleblower or qui tam provisions of the False Claims Act. He alleged that his former employer paid doctors kickbacks to induce them to write prescriptions for Naprelan, Xodol, Fexmid and Dolgic. The kickbacks included tickets to sporting events, concerts and plays; spa, golf and ski outings; dinners at expensive restaurants; and numerous other out-of-office events. Victory also promoted a program of paid “preceptorships,” which involved sales representatives “shadowing” doctors in their offices. The settlement resolves allegations that Victory improperly used these preceptorships to induce doctors to prescribe Victory’s products. The Anti-Kickback Statute makes it a crime for anyone to give, receive, solicit or help arrange anything of value to induce a doctor to prescribe products that will be paid for, in whole or in part, by Medicare, Medicaid or other government healthcare programs. The underlying rational is that physicians should make treatment decisions based solely on their own independent medical judgment, without being influenced by kickbacks or other improper benefits. A conviction for violating the anti-kickback law can result in jail time, monetary penalties, and exclusion from Medicare, Medicaid and other federal healthcare programs. Violation of the anti-kickback statute can also result in violation of the False Claims Act. Once a prescription is tainted by a kickback, any claim for reimbursement from Medicare or Medicaid is considered a “false claim” under the False Claims Act. This pharmaceutical kickbacks case was settled when Victory agreed to pay $1.4 million to resolve federal Ant-Kickback Statute allegations and $9,938,310 to resolve False Claims Act allegations. The whistleblower in this case will receive a reward of $1.7 million or approximately 17% of the False Claims Act portion of the settlement. If you are aware of kickbacks or false claims being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately. You may be entitled to a very substantial reward. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 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. A dentist entered into a consent order agreeing to pay $30,000 to Medicaid after investigators discovered billing irregularities and documentation problems. According to the consent order, Peter J. D'Allessandro "failed to maintain adequate records to support and justify treatments." The consent order also provides for a public reprimand and a two-year probation period. During the probation period, Medicaid officials will randomly examine patient charts during unannounced visits to the dentist's practice to "insure compliance with minimum requirements for record-keeping and billing." Failing to maintain adequate records to support and justify treatments creates serious problems. Any claim that is not adequately supported by contemporaneous records may be considered a "false claim." Submitting false claims to Medicaid can result in heavy financial penalties, exclusion from Medicare, Medicaid and other government healthcare programs, and even a criminal conviction resulting in the suspension or loss of a professional license. By cooperating with the investigation and agreeing to the terms of the consent order, the dentist avoided the possibility of more serious proceedings and consequences. The government aggressively investigates and prosecutes cases of dental Medicaid fraud. If you are contacted by a Medicaid investigator, then you should consult with an experienced Medicaid fraud attorney immediately to protect your rights. How you respond to the investigation can mean the difference between an inconvenience and a career-destroying catastrophe. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 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 husband and wife who operated a medical transportation company have both been convicted of Medicaid fraud because the husband was excluded from participating in federal healthcare programs due to a prior conviction for Medicaid fraud. Tracy Roberts is listed as the owner of Community Transportation LLC, a specialized medical vehicle (SMV) company, and is a certified Medicaid provider of medical transportation services. As part of the certification process, she agreed to comply with all state and federal regulations governing the Medicaid program. Her husband, Joseph Roberts, was convicted of felony Medicaid fraud in 2007 and was sentenced to four years of probation. As a result of his conviction, Mr. Roberts was placed on the federal exclusion list, which prohibited him from working for any certified Medicaid provider. Exclusion means that Medicare, Medicaid, and other federal government health care programs will not pay the provider for services performed or ordered by the excluded party. The law precludes not only direct payments to an excluded individual, but also indirect payments such as the payment of wages to an excluded individual who works with Medicare or Medicaid patients. According to the government, Mr. Roberts provided transportation services on multiple occasions for Community Transportation, LLC, and Mrs. Roberts filed claims with Medicaid for reimbursement for those services. Because services provided by an excluded individual are not eligible for reimbursement, these were considered false or fraudulent claims. If you own or operate a healthcare business that submits claims to Medicare, Medicaid, or other government programs, you should check to ensure that your employees are not excluded from participating in those programs. If you have inadvertently hired someone who is excluded, then you should consult an experienced Medicaid fraud attorney immediately to protect yourself. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to contact 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 words “Medicare Fraud” evoke images of hardened criminals creating false medical records to steal money from government healthcare programs. In fact, most “Medicare fraud” cases involve complicated allegations against large, legitimate institutions such as well-known hospitals and pharmaceutical companies. A good example is the recent $900,000 settlement by Baylor University to resolve allegations that its hospitals submitted false claims to Medicare, the Civilian Health and Medical Program of the Uniformed Services (TRICARE), and the Federal Employees Health Benefit Program (FEHBP). At issue were claims for intensity modulated radiation therapy (IMRT), a type of high-precision radiotherapy that uses computers to deliver precise doses of radiation to a malignant tumor or specific areas within the tumor. IMRT is used when extreme precision is required to avoid harming surrounding organs or healthy tissue. The government alleged that Baylor submitted improper claims for IMRT (an expensive procedure) when a different, less expensive procedure should have been billed. The government also alleged that Baylor failed to maintain supporting documentation in the medical records and did not provide corroboration of physician supervision. In other words, this was a dispute over professional medical judgments and record keeping. And it cost Baylor more than $1 million when its attorney’s fees are included in the settlement costs. Under the False Claims Act, the government is not required to prove that the hospital or other healthcare provider intended to defraud Medicare or another government program. Very severe penalties may be imposed if a court finds that the healthcare provider knew that a claim for reimbursement was not justified by medical necessity or was not supported by complete documentation. If a healthcare provider is found to have violated the False Claims Act, it must pay three times the amount the government paid on the allegedly false claims, plus a penalty of $11,000 per claim. The heathcare provider may also be excluded from future participation in government healthcare programs. Healthcare providers often choose to settle False Claims Act cases and refund some money instead of spending hundreds of thousands of dollars or more on legal fees to defend themselves at trial where a loss could mean a multi-million dollar judgment, exclusion from government healthcare programs, and adverse publicity. The key to resolving these types of disputes is getting expert advice from an experienced healthcare lawyer at the earliest possible stage of a government audit or investigation. A lawyer with intimate knowledge of reimbursement rules and regulations can help you work with auditors and investigators to explain your actions, answer their questions, and often resolve disputes before they become a federal case with the local prosecutor. If you are facing a government audit, investigation, or healthcare fraud charges, 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. |
John Howley, Esq.
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