The owner of a durable medical equipment (DME) supply company was sentenced to serve 24 months in prison for conspiring to submit nearly $1 million in fraudulent claims to Medicare. In addition to his prison term, the DME supply company owner will serve three years of supervised release and was ordered to pay $653,461 in restitution. The owner of the company pleaded guilty to conspiring with others to bill Medicare for medically unnecessary power wheelchairs. He also admitted that he paid kickbacks to medical clinics for fraudulent prescriptions and other medical documentation to support the power wheelchair claims that he billed to Medicare. If you are under investigation or have been charged with Medicare or Medicaid fraud, then you should consult with an experienced criminal defense lawyer who understands these complex programs. Call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. The initial consultation is free and completely confidential. 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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The owners of hyperbaric oxygen therapy companies pleaded guilty to submitting false claims for physician supervision of hyperbaric oxygen therapy (HBOT) services. HBOT is an outpatient therapy used to assist in healing diabetic sores or amputations. The HBOT process is administered by placing the patient in a hyperbaric oxygen chamber to receive increased levels of oxygen. Physicians were employed by the defendants’ companies to supervise HBOT sessions, ensure that HBOT was medically appropriate for the patients, and handle any medical emergency that may arise during treatment. The defendants admitted that they submitted false claims to Medicare by billing multiple times for physician supervision on days when the physician supervised only one HBOT session. Each of the defendants faces up to five years in federal prison and fines up to $250,000, plus restitution of the amounts paid by Medicare. Medicare fraud can result in very harsh penalties. If you are under investigation or charged with a crime, you should consult a criminal defense attorney who has experience with Medicare and Medicaid fraud charges. Call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. The initial consultation is free and completely confidential. 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. Government Alleges PharMerica Billed Medicare for Controlled Substances That Were Dispensed Without a Valid Prescription The United States Government has joined a whistleblower lawsuit against PharMerica Corp. That alleges the company caused flase claims to be submitted to Medicare. If the government wins the lawsuit, the whistleblower will be entitled to a reward of between 15% and 25% of the amount the government recovers. The complaint alleges that PharMerica violated the Controlled Substances Act by dispensing narcotics without valid prescriptions. The complaint also alleges that PharMerica violated the False Claims Act by causing claims for illegally dispensed drugs to be submitted to the Medicare program. PharMerica is a pharmacy that dispenses drugs to residents of nursing homes, skilled nursing facilities, and other long-term care facilities. The company fills approximately 40 million prescriptions every year. Many of the prescriptions are for controlled substances listed in Schedule II under the Controlled Substances Act, such as oxycodone and fentanyl. Pharmacies are prohibited from dispensing oxycodone, fentanyl, and other Schedule II narcotics without a valid prescription from a physician. According to the complaint, PharMerica allowed nursing home staff to order narcotics, and allowed pharmacists to dispense narcotics without confirming that a physician had issues a valid prescription based on medical necessity. The lawsuit was started by a former PharMerica employee named Jennifer Denk. Ms. Denk filed a whistleblower complaint against PharMerica “under seal” (in secret) and presented her evidence to the government, also in secret. After conducting an investigation, the government decided to join the lawsuit. Only then was the case “unsealed” and made public. This is the standard procedure for filing a whistleblower lawsuit under the False Claims Act. In return for helping the government stop Medicare fraud, the whistleblower is entitled to protection from retaliation and a monetary reward of between 15% and 25% of the amount the government recovers. If you are aware of false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney. You may be entitled to a substantial reward and legal protections as a whistleblower. To arrange a free and completely confidential consultation, call John Howley, Esq. at (212) 601-2728, or click here to reach our law 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. An internist on Long Island was arrested for illegally selling prescriptions for the narcotic medication oxycodone. The government alleges that the doctor had both a legitimate and illegal practice in his medical offices: Real patients were charged $110 for an office visit. Drug users and addicts were charged $250 or more for an office visit that included a prescription for a controlled substance such as oxycodone. Two patients who cooperated with the government’s investigation were charged $250 by the doctor to receive prescriptions for oxycodone. The doctor allegedly did not conduct physical examinations of these patients or even question them about their need for the medication. After learning of the allegedly false prescriptions, investigators from the New York State Attorney General’s Medicaid Fraud Control Unit (MFCU) executed a search warrant at the doctor’s offices. The doctor was arrested and charged with two counts of Criminal Sale of a Prescription for a Controlled Substance in violation of New York Penal Law § 220.65. These are Class C felony charges. If convicted, the doctor faces up to 15 years in prison on each count. He also faces loss of his medical license, exclusion from the Medicare and Medicaid program, and other consequences. If you are under investigation or have been charged with diversion of a controlled substance, then you need to consult with an experienced criminal defense lawyer immediately. Call John Howley, Esq. at (212) 601-2728 or click here to reach our office by email. The initial consultation is free and completely confidential. 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 woman was charged with Medicaid fraud and theft of services after receiving Medicaid benefits for which she was not eligible. The woman is accused of concealing material facts and failing to disclose information on her application in order to obtain Medicaid benefits. She is also charged with theft of services for knowingly obtaining services by deception, fraud, and false pretenses. These charges are felonies, which can result in prison sentences of more than one year on each count. State and federal governments have made Medicaid fraud investigations a top priority. In New York City alone, more than 5,000 individuals are investigated every year for receiving Medicaid benefits they were not eligible to receive. Some of the more common types of Medicaid fraud include failing to report your actual income on an application or recertification, failing to include income from a spouse or rent received from a tenant, and failing to disclose your actual place of residence. In many cases, the fraud investigation can be settled without criminal charges being filed. You must act promptly, however, to avoid serious consequences. If you receive a letter or phone call from the Bureau of Fraud Investigation asking you to provide documents or to meet with an investigator for an interview, you should consult with an experienced Medicaid fraud attorney to protect your rights. To arrange a free and confidential consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A woman was arrested and charged with Medicaid fraud for failing to notify the government that her circumstances had changed. Based on the changed circumstances, the woman was no longer entitled to receive Medicaid benefits. The woman was indicted for Medicaid fraud and theft of services. According to the government, she failed to disclose that certain facts about her situation had changed, making her ineligible for Medicaid benefits. She is accused of making false statements and concealing material facts in order to continue her access to Medicaid benefits. Medicaid fraud is a felony that can result in a prison sentence of more than one year, plus restitution and fines. Many people get an early warning that their eligibility for Medicaid is under investigation. In New York City, you may receive a phone call or a letter from the Bureau of Fraud Investigation asking you to come in for an “interview” and to bring in your tax returns and other documents. If you receive such a letter, then you should consult with an experienced Medicaid fraud attorney immediately to protect yourself. Your lawyer can review your situation to determine whether or not you have a problem. Sometimes the investigation is based on a misunderstanding or a mistake. Other times, you may have a serious problem. Your lawyer will help you understand whether you have a problem and what your options are. By acting promptly and getting legal advice, you may be able to resolve the investigation without any criminal charges or civil lawsuits. Each case is different, and an experienced Medicaid fraud lawyer can advise you only after reviewing your particular facts and circumstances. Do not delay. To arrange a free and confidential consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A dentist 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. 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 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.
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