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.
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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 Physical Therapy Employees Share $400,000 Whistleblower Reward for Reporting Medicare Fraud4/14/2014 Physical Therapy Clinic Will Pay $2.78 Million to Settle Medicare Fraud Lawsuit
Alliance Rehabilitation, LLC and Active Physical Therapy Services, LLC will pay $2.78 million to settle allegations that they submitted false claims to Medicare and the TRICARE health care program. The companies allegedly billed Medicare for physical therapy services under the name and NPI number of a particular physical therapist when, in fact, that physical therapist was not involved in providing or supervising the services. The settlement resolves similar allegations of false claims involving both Medicare and TRICARE. The false claims for physical therapy services were brought to the attention of the government by two former employees. Under the False Claims Act, individual citizens may bring a lawsuit on behalf of the government and share in any recovery. The whistleblower rewards range from 15% to 30% of the amount recovered. In this case, the two whistleblowers will share more than $400,000 in whistleblower rewards. If you have evidence that false claims are being submitted to Medicare or Medicaid for physical therapy or other medical services, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and legal protections. Do not delay. Only the first whistleblower who comes forward with evidence of Medicare or Medicaid fraud is entitled to the whistleblower reward. 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 Hospital Settles Medicare Fraud Claims Based on Stark Law Violations Halifax Hospital Medical Center and an affiliate will pay $85 million to settle claims that they submitted false claims to Medicare for services that violated the physician self-referral provisions of the Stark Law. The Stark Law prohibits hospitals from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital. The financial relationship may take the form of salaries, benefits, consulting contracts, or below-market office space. The whistleblower complaint in this case alleged that contracts between Halifax and six medical oncologists violated the prohibition on physician self-referrals in the Stark Law. Specifically, the contracts provided an incentive bonus based on the value of prescription drugs and tests that the oncologists ordered and the hospital then billed to Medicare. The complaint also alleged that the hospital violated the Stark Law by paying three neurosurgeons who referred patients to the hospital more than the fair market value of their services. The settlement resolves a whistleblower lawsuit brought by a former hospital employee under the qui tam or whistleblower provisions of the False Claims Act. The qui tam provisions allow an individual citizen to file a lawsuit “under seal” (in secret) on behalf of the government and share in the amount the government recovers. After investigating the claims, the government may choose to take over the lawsuit or allow the whistleblower to proceed on its behalf. The whistleblower in this case, Elin Baklid-Kunz, will receive a $20.8 million reward for helping the government uncover the fraud and prove the allegations. Qui tam or whistleblower lawsuits are different from ordinary lawsuits in several respects. The procedures for filing the lawsuit and disclosing evidence to the government must be followed correctly or the case will be dismissed. In addition, the whistleblower must produce evidence of the false claims, not merely allegations, at the very beginning of the lawsuit. If you have evidence that a hospital is violating the Stark Law or making other types of false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a substantial reward and other whistleblower protections if you prepare your case properly. 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. Whistleblowers Will Share in $2.7 Million Reward Three whistleblowers will share more than $2.7 million in rewards for helping the government uncover false claims for 3D reconstructions of CT scans and other diagnostic tests. The whistleblower lawsuit alleged that Diagnostic Imaging Group submitted claims to Medicare and Medicaid for diagnostic tests that were not performed or not medically necessary. The lawsuit also alleged that the diagnostic testing company paid kickbacks to doctors in return for patient referrals. Diagnostic Imaging Group agreed to settle the lawsuit for $15.5 million. As their reward, the whistleblowers will be paid about 17% of the settlement amount or $2.7 million. Mark Novick, M.D. will receive a $1.5 million reward. Rey Solano will receive a $1.07 million reward. Richard Steinman, M.D. will receive a $209,250 reward. The whistleblowers alleged that the diagnostic testing company paid kickbacks to doctors in return for patient referrals. The kickbacks allegedly were disguised as payments to physicians for supervising patients who underwent nuclear stress testing. The payments, however, allegedly exceeded fair market value of the physician’s services and were, in fact, designed to reward physicians for patient referrals. The Anti-Kickback Statute prohibits a healthcare provider from giving anything of value in return for patient referrals. In addition, when kickbacks are paid, all resulting claims for reimbursement from Medicare and Medicaid are considered false claims. The whistlebowers also alleged that the diagnostic testing company submitted false claims to Medicare and Medicaid for tests that were not performed or not medically necessary. According to the complaint, the diagnostic testing company bundled certain tests on its order forms so that physicians could not order other tests without ordering the additional bundled tests, which were not medically necessary. The complaint also alleged that the diagnostic testing company submitted false claims to Medicare and Medicaid for 3D reconstructions of CT scans that were never performed or interpreted. The lawsuit was brought under the qui tam provisions of the False Claims Act. In a qui tam lawsuit, individual citizens can file a lawsuit on behalf of the government and then share in any recovery. Whistleblower rewards can range from 15% to 30% of the total amount recovered by the government. If you are aware of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and other whistleblower 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 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. ILLEGAL KICKBACKS, OFF-LABEL MARKETING, AND SUBSTANDARD MANUFACTURING The federal government recovered more than $4.3 billion from companies and individuals who were accused of healthcare fraud last year. Of that amount, $3.75 billion – or 87% of the total – was recovered from pharmaceutical companies. Several pharmaceutical companies paid hundreds of millions of dollars to settle claims that they paid kickbacks to doctors and pharmacists in exchange for prescribing the companies’ drugs. For example, Amgen paid $762 million to settle claims that it paid kickbacks and engaged in other illegal marketing tactics to promote three of its drugs for off-label uses. Sanofi paid $109 million to settle allegations that it gave doctors free units of the knee injection drug Hyalagan to persuade them to prescribe more of the drug. The Anti-Kickback Statute prohibits paying anything of value in return for patient referrals or prescriptions. The law is designed to ensure that patients are prescribed drugs based solely on their medical needs, not because the doctor or pharmacist is being paid by the pharmaceutical company to prescribe a particular drug. In addition, the law seeks to prevent claims for reimbursement from Medicare and Medicaid for prescriptions that are not medically necessary. Other healthcare frauds by pharmaceutical companies involved the sale of drugs that did not comply with FDA manufacturing standards. Ranbaxy Laboratories paid $500 million for violating manufacturing standards and attempting to cover up its substandard products by making false statements in its manufacturing reports to the FDA. According to the government, Ranbaxy made and sold drugs whose potency, purity, or quality were not within FDA requirements. Other cases against pharmaceutical companies involved off-label marketing of pharmaceuticals for uses not approved by the FDA. An off-label use is one that is not approved by the FDA. While a physician may prescribe a drug for an off-label use based on her or his professional judgment, the pharmaceutical companies are not permitted to promote their drugs for any use not approved by the FDA. Abbott paid $1.5 billion to settle claims that it promoted Depakote, a seizure drug also used to treat bipolar disorder, for off-label uses such as controlling agitation and aggression in elderly dementia patients. Wyeth Pharmaceuticals, a subsidiary of Pfizer, paid more than $490 million for marketing the kidney transplant drug Rapamune for unapproved uses and for engaging in a campaign to switch patients to Rapamune from other drugs. Many of the healthcare fraud cases against the pharmaceutical companies were brought by whistleblowers – current or former employees who came forward with evidence of substandard drugs, improper marketing activities, or illegal kickbacks. Under the False Claims Act, these whistleblowers are entitled to receive large rewards of between 15% and 30% of the amount recovered by the government. If you have evidence that a pharmaceutical company is engaged in off-label promotion, kickbacks, or other improper or illegal conduct, you should consult with an experienced whistleblower lawyer to protect your rights. You may be entitled to a large reward and other 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 35 year old Emergency Medical Technician (EMT) is facing up to 10 years in prison, a $250,000 fine, and other penalties for creating false run sheets or trip reports that were used to bill Medicare and Medicaid for ambulance services. The EMT pleaded guilty to health care fraud after government investigators discovered a scheme by his employer, Brotherly Love Ambulance, Inc., to submit false claims to Medicare and Medicaid. The EMT was accused of creating run sheets or trip reports indicating that patients needed ambulance services, when he knew that they were able to walk or to be transported by less expensive wheelchair vans. The false run sheets resulted in Medicare and Medicaid paying his employer for ambulance transports that were not medically necessary. Unfortunately, this EMT went along with the scheme. If he had sought legal advice, he would have learned not only that he was putting himself at risk, but also that he could earn a large reward for reporting the fraud. Under the False Claims Act, an individual who helps the government prevent Medicare or Medicaid fraud is entitled to a reward of up to 30% of the amount the government recovers. In this case, the EMT could have earned a reward of as much as $600,000. Instead, he is now facing the possibility of spending the next 10 years in prison. Do not go to prison for your employer’s fraud. If you suspect that your employer is submitting false claims to government healthcare programs, then you should consult with an experienced Medicare and Medicaid fraud attorney immediately. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A jury has found that Tuomey Healthcare System in Sumter, S.C., violated the Stark Law by paying doctors in ways that rewarded them financially for referring patients to the hospital. The jury found that more than 20,000 Medicare claims were tainted by the illegal compensation arrangements. The hospital was accused of offering doctors lucrative part-time contracts that paid above fair market value and were not commercially reasonable. The contracts contained “non-compete” provisions requiring that the doctors perform their outpatient procedures at the hospital. The doctors who accepted the contracts were paid an annual base salary plus a “productivity bonus,” which varied based on how much the hospital earned from outpatient procedures. The trial focused on dueling experts: The hospital had an appraiser’s opinion that its compensation arrangements with the physicians were consistent with fair market value; the government’s expert disagreed. The jury agreed with the government’s expert. The hospital faces up to $357 million in potential False Claims Act liabilities. Federal law requires repayment of all of the money paid under illegal Medicare claims, and the False Claims Act allows an award of up to three times the amount of total damages, plus as much as $11,000 per claim. The government’s lawsuit was commenced by a whistleblower, Dr. Michael Drakeford, under the qui tam provisions of the False Claims Act. Dr. Drakeford filed his whistleblower lawsuit after he declined to enter into one of the agreements that the hospital was offering. The whistleblower reward in this case will be between 15% and 25% of the amount collected by the government. Even if the hospital avoids treble damages and penalties by settling the case, the whistleblower reward could be in the range of $7 million to $10 million. If you have evidence that a hospital, nursing home, or other healthcare facility has agreed to pay physicians in return for referrals, then you should consult with an experienced whistleblower attorney immediately. You may be entitled to a whistleblower reward. John Howley, Esq. is an experienced Medicare and Medicaid fraud whistleblower attorney. Call our office today at (212) 601-2728 or click here to arrange a free and confidential consultation. 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. An ambulance company in Pennsylvania and its owners and operators were indicted for ambulance fraud. The charges include conspiracy to commit health care fraud, making false statements in connection with health care matters, aggravated identity theft, paying kickbacks to patients, and money laundering. Non-emergency ambulance transportation may be reimbursed by Medicare only if an ambulance is medically necessary. This means that the patient must be bed confined or have a medical condition that otherwise requires transportation by ambulance. A patient who is able to sit in a wheelchair or walk is considered “ambulatory” and generally must be transported in a less expensive wheelchair van. The defendants are accused of defrauding Medicare by recruiting patients who were able to walk and could travel safely by means other than ambulance. The government alleges that the defendants falsified reports to make it appear that the patients needed to be transported by ambulance when the defendants knew that the patients could be transported safely by other means. Many of the patients, the government says, walked to the ambulance for transport. In addition to filing false claims for ambulance transports that were not medically necessary, the government alleges that the defendants paid illegal kickbacks to the patients as part of the fraudulent scheme. The government alleges that the scheme cost Medicare more than $1.5 million. Under the federal False Claims Act, the government may recover three times the amount of its losses plus $11,000 per false claim. The government is serious about cracking down on ambulance fraud, and it pays significant rewards to individuals who come forward with evidence of false claims. Under the False Claims Act, whistleblowers are entitled to a reward of up to 30% of the amount recovered by the government. In a case such as this one, the whistleblower reward could exceed $1.5 million. If you are aware that an ambulance company is billing Medicare or Medicaid for transporting patients who are not bed confined, then you should consult with an experienced whistleblower attorney immediately. You may be entitled to a significant 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 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 |