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JOHN HOWLEY, ESQ.
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Fighting Back Against Sexual Harassment

4/28/2015

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How to Respond to Sexual Harassment in the Workplace

The first thing you need to know about sexual harassment in the workplace is that you are not alone.  Sexual harassment happens in the workplace every day in the United States.  It is often subtle, and it happens in every industry.

Fortunately, the law is on your side.

Sexual harassment generally falls into two categories:

Qui Pro Quo Sexual Harassment includes situations where a supervisor grants or withholds employment benefits, such as promotions, raises or continued employment, based on your willingness to go along with sexual advances, such as going out on a date or engaging in sexual favors.

Hostile Work Environment Sexual Harassment includes any form of sexual conduct that is so severe and pervasive that it interferes with your job performance or creates an intimidating, hostile or offensive work environment.

Sexual harassment can come in many forms, some of which are subtle.  The types of conduct that constitute sexual harassment include:

Sexual comments or jokes
Pressure to go out on a date
Displaying pornography or other sexual images
Sexual gestures, leering or other suggestive actions
Unwelcome physical touching
Sexual text messages or emails

Minor, isolated incidents usually do not rise to the level of sexual harassment.  But a series of incidents that are frequent or severe can create a hostile work environment, especially if the company's management is aware of the conduct and does not take action to stop it.

If you are experiencing sexual harassment in the workplace, you should take the following steps immediately:

1.  Record what is going on.  Your record can be in the form of notes that you write on your own or a report to your human resources office.  If you are in the State of New York, you can also make secret audio recordings of conversations as long as you are a participant in the conversation.  (In other words, you cannot hide a recording device in someone's office to record conversations while you are not present, but you may put a recording device in your pocket and record your conversation with them.)

2.  Bring your evidence to an experienced sexual harassment lawyer to get advice and guidance.  Sexual harassment cases often come down to he said/she said situations.  An experienced sexual harassment lawyer can help you build your case.

Most of all, do not delay.  The law contains very strict time limits for bringing your claims of sexual harassment and hostile work environment. 

Do not continue to suffer through the harassment alone.  Get an experienced sexual harassment lawyer on your side, and let the law protect you.

John Howley, Esq.
(212) 601-2728
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Selling Prescriptions Results in Prison for Doctor

4/9/2015

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An anesthesiologist has pleaded guilty to selling prescriptions for oxycodone.  He now faces one to three years in prison at sentencing.

Dr. Arnold Roth admitted selling prescriptions made out in the name of three individuals, two of whom he had never met.  The prescriptions allowed the individuals to obtain more than 16,000 oxycodone pills worth $480,000 on the street over a period of 14 months.

The doctor pleaded guilty to Criminal Sale of a Controlled Substance and Conspiracy in the Fourth Degree.

This case highlights the tremendous resources the government has to investigate violations of the controlled substances laws.  The investigator included lawyers, investigators, auditors, and other law enforcement officers from the New York State Attorney General's office and its Medicaid Fraud Control Unit, the New York State Department of Health and its Bureau of Narcotics Enforcement and Office of Medicaid Inspector General, and the Putnam County Sheriff's Office.

If you are under investigation or if you have been charged with violating health laws, you need an experienced criminal defense lawyer who understands the healthcare fraud and controlled substances laws.
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Willful Violation of Health Laws Costs Nurse His License

4/8/2015

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A Licensed Practical Nurse (LPN) was sentenced to 100 hours of community service, a $1,000 fine, and agreed to surrender his nursing license after pleading guilty to one count of Willful Violation of the Health Laws in violation of New York Public Health Law section 12-b.

The LPN was accused of neglecting a blind, 73-year-old nursing home resident who had a gastronomy tube.  The patient was supposed to receive medication directly through the tube.  The LPN was accused of failing to administer a hypertension medication, a protein supplement, and a multivitamin to the patient, who suffered from Alzheimer's disease.

The New York State Attorney General originally charged the LPN with Endangering the Welfare of an Incompetent or Physically Incapable Person (a class E felony), Falsifying Business Records (a class E felony), and Willful Violation of the Health Laws (a misdemeanor).  If convicted on the most serious charge, the LPN would have faced up to four years in prison.

As part of a plea agreement, the LPN agreed to surrender his license and plead guilty to the misdemeanor charge of Willful Violation of the Health Laws.  The court sentenced him to 100 of community service and a $1,000 fine.
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Doctor and Nurse Charged with Billing Medicare and Medicaid for Physician Services Provided by Nurse

4/7/2015

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A medical doctor and registered nurse have been charged with billing Medicare and Medicaid for physician services that were actually provided by the nurse.  If convicted on the most serious charges, the doctor faces up to 15 years and the nurse faces up to 4 years in prison.

Jeanine Santiago, the medical doctor, and Wendy Potter, the registered nurse, are accused of conspiring to have Potter provide physician services to homebound patients and then billing Medicare and Medicaid as if the services had been provided by Santiago. 

Physician services are reimbursed at a higher rate than services provided by a nurse.  In this case, the doctor is charged with billing Medicare and Medicaid for more than $50,000 in physician services that were actually provided by the nurse.

The criminal complaint also alleges that the doctor gave the nurse blank, pre-signed prescription forms, and that the nurse filled out the prescriptions at her discretion for narcotics such as morphine and oxycodone.

The doctor is charged with Grand Larceny in the Second Degree, a class C felony.  She is also charged with Grand Larceny in the Fourth Degree, Offering a False Instrument for Filing in the First Degree, and Unauthorized Practice of a Profession, all of which are class E felonies.  The nurse is charged with Unauthorized Practice of a Profession.
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Hyperbaric Oxygen Therapy (HBOT) and Medicare Fraud

6/9/2014

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Medicare Investigates and Prosecutes False Claims for Physician Supervision of Hyperbaric Oxygen Therapy

The federal government has targeted Hyperbaric Oxygen Therapy companies that submit false and fraudulent claims for reimbursement to Medicare.

In a recent case under the False Claims Act, the owners of HBOT companies were sentenced to five years in prison and ordered to pay restitution of more than $1.5 million for submitting false claims to Medicare for physician supervision of HBOT sessions or dives. 

Hyperbaric Oxygen Therapy (also known as HBOT or HBO2) involves giving a patient high concentrations of oxygen within a pressurized chamber.  Originally developed for treatment of decompression sickness, HBOT is primarily an adjunctive treatment for the management of select non-healing wounds.   Some studies suggest that HBOT may also relieve symptoms associated with traumatic brain injury, but other studies suggest that the evidence is inconclusive.

An HBOT session is called a “dive.”  Each dive begins when the patient enters the chamber and concludes when the patient exits the chamber.  Physician supervision of the dive usually involves ensuring that the patient’s condition is medically appropriate for the dive and to treat any medical emergency that might arise during the dive, such as a stroke or heart attack. 

Medicare reimburses for HBOT dives only if the patient suffers from specific conditions, most of which are related to decompression illness, acute carbon monoxide intoxication, crush injuries, severed limbs, and diabetic-related wounds or other wounds that are not healing.

If the HBOT dive takes place in a hospital, then Medicare reimburses for both hospital charges and physician supervision of the dives. 

Two of the most common types of false claims involving HBOT are billing for medically unnecessary treatments and improperly billing for physician supervision.

For purposes of Medicare reimbursement, medical necessity means that the patient suffers from one or more of the conditions for which Medicare will reimburse the service.  HBOT companies can get into trouble by billing for HBOT dives ordered by a physician that do not fall within the Medicare reimbursement guidelines, by billing for HBOT dives without proper documentation of the medical necessity, and by creating false or fraudulent documentation. 

Physician supervision of HBOT dives is usually billed using Current Procedural Terminology (CPT) code 99183.  This CPT code applies only when the physician provided “direct supervision” of the HBOT session.  “Direct supervision” usually does not require that the physician be physically present in the same room as the chamber.  The physician, however, must be physically present at the site and immediately available to furnish assistance and direction throughout the performance of the procedure.

Under some circumstances, Medicare regulations require that the physician be physically present in the treatment room continuously for the duration of the HBOT session.  The supervising physician must be continuously present next to the chamber when the patient has been diagnosed with acute peripheral arterial insufficiency; acute carbon monoxide intoxication; decompression illness; gas embolism; gas gangrene; crush injuries and suturing of severed limbs; progressive necrotizing infections; and cyanide poisoning. 

Billing Medicare for HBOT dives that are not medically necessary or for physician supervision that does not comply with the direct supervision requirements is a serious matter.  You can be sued civilly for three times the amount Medicare paid plus a penalty of up to $11,000 per false claim.  You can also face criminal charges and long prison sentences.

If you have evidence that a hospital or other healthcare provider is improperly billing Medicare for HBOT sessions, then you should consult with an experienced Medicare fraud attorney immediately to protect yourself. 

By getting legal advice early, you may be able to avoid criminal investigations and charges.  If you help the government uncover the fraud, you may also be entitled to a substantial whistleblower reward and legal protections.

To arrange a 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.

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Above-Market Cardiologist Salaries Result in $41 Million Stark Law Settlement

5/30/2014

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Hospital Pays $41 Million to Settle Claims that “Unreasonably High” Cardiologist Salaries Violated the Physician Self-Referral Law

King’s Daughters Medical Center agreed to pay almost $41 million to settle allegation that it submitted false claims to Medicare and Medicaid for coronary stents and diagnostic catheterizations.

The government claimed that the hospital violated the Stark Law, also known as the physician self-referral law, which prohibits certain types of financial relationships between hospitals and physicians.  In this case, the government claimed that the hospital paid above-market salaries to cardiologists to induce them to refer patients to the hospital.

Once an improper financial relationship exists, all claims for reimbursement from Medicare or Medicaid that arise out of that relationship are considered “false claims,” even if the patient received medically appropriate care.  In this case, however, the government alleged that the financial relationship also resulted in medically unnecessary procedures.

As a result of the improper financial incentives, the government alleged, Medicare and Medicaid were billed for medically unnecessary diagnostic catheterizations and cardiac stents.  The government also alleged that the physicians falsified medical records to justify the unnecessary cardiac procedures.

The Stark Law is very complex and contains exceptions to ensure that physicians can be fairly compensated.  A related law known as the Anti-Kickback Statute is similarly complex and contains so-called “safe harbors.”  Compliance with both laws is strictly enforced and must be properly documented.

Violations of the Stark Law or Anti-Kickback Statute can result in civil penalties including treble damages, criminal prosecutions, and disciplinary action against the professionals involved.

If you are being investigated for potential Stark Law violations, or if you have evidence that a hospital is engaged in improper financial relationships with physicians, then you should consult with an experienced Medicare and Medicaid fraud lawyer immediately.

To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email.

John Howley, Esq.

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US Government Joins Hospice Fraud Whistleblower Lawsuit

5/27/2014

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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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Diagnostic Labs Pay $4.7 Million to Settle Medicare and Medicaid Fraud Claims

5/22/2014

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Company Used Pathology Code to Bill Medicare and Medicaid for Unnecessary Services

Calloway Laboratories, Inc. has agreed to pay $4.7 million to settle allegations that it submitted false claims to Medicare and Medicaid.

The company provides clinical laboratory services, including urine drug testing, to physicians and other healthcare providers.  According to the government, the company routinely billed Medicare and Medicaid using a code for pathology services in addition to the code for urine drug testing.  As a result, the company was paid for both urine tests and pathology services.

Government investigators concluded, however, that the healthcare providers who ordered the urine tests did not knowingly order the pathology services and did not consider the pathology services to be medically necessary. 

The investigators also concluded that the diagnostic labs did not actually provide pathology services when they used the code seeking reimbursement for such services.  Instead, the testing labs merely conducted a type of medical review that did not qualify for reimbursement as pathology services.

This case presents a classic example of why the government relies on whistleblowers to stop Medicare and Medicaid fraud.  People who work inside the diagnostic lab are often the only ones who actually know which tests are actually ordered and performed.  Diagnostic lab billing staff are usually the only ones who know how claims to Medicare and Medicaid are being coded.  As a result, this type of fraud can often go undetected unless an honest employee is willing to blow the whistle.

In return, the government pays very substantial rewards and provides legal protection for those who report healthcare fraud.  Under the False Claims Act, a whistleblower is entitled to a reward of between 15% and 30% of the amount the government recovers.  In a case such as this one – where the government recovered $4.7 million – the whistleblower reward could be as high as $1.4 million.

If you have evidence that a diagnostic lab or other healthcare provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced whistleblower attorney immediately to protect your rights.  You could be entitled to a substantial reward and legal protections.

To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email.

John Howley, Esq.

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Long Prison Sentences for Ambulance Fraud

5/21/2014

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Ambulance Company Owners Directed Employees to Create False Trip Reports

The owner of an ambulance company and her son were sentenced to 6 years and 4 years in prison, respectively, for their roles in an ambulance fraud scheme.  Each of them was also ordered to pay more than $1.5 million in restitution to Medicare and Medicaid.

According to the government, the defendants transported patients in wheelchair vans for routine and non-emergency trips, but then billed Medicare and Medicaid for much more expensive ambulance transports.  The defendants also created false medical records to make it appear that the patients had traveled by ambulances instead of in wheelchair vans.

A critical part of the fraudulent scheme was getting employees of the ambulance company to omit information from trip reports and other medical records.  For example, the government alleged that the defendants instructed their employees to omit information concerning the ability of patients to walk and ride in wheelchairs.  As a general rule, Medicare and Medicaid do not reimburse for non-emergency ambulance transports if the patient is able to walk or ride in a wheelchair.

Most Medicare and Medicaid fraud schemes require the cooperation of the provider’s employees.  Often, the employees are asked to modify trip reports, treatment notes, and other records so that more services, or more expensive services, can be billed to Medicare and Medicaid. 

This puts the employee in a very dangerous situation.  If the government discovers that fraudulent claims were submitted to Medicare or Medicaid based on false records created by an employee, then the employee could find themselves in handcuffs and facing a long prison sentence.

If your employer has asked you to falsify trip reports, treatment notes, or any other type of medical record, then you should consult with an experienced Medicare and Medicaid fraud lawyer immediately to protect yourself.  You may be entitled to legal protections and even a substantial reward for helping the government stop fraud.

To arrange a free and confidential consultation with an experienced healthcare fraud attorney, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email.

John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York  10118
(212) 601-2728


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Nurse Faces Prison for Helping Employer Create False Records

5/19/2014

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False Statements in Patient Medical Records Resulted in Medicare Fraud Charges

A nurse who worked as a home health agency manager has been convicted of conspiracy to commit healthcare fraud.  He faces up to five years in prison.

The nurse worked as the director of nursing for PTN Healthcare Services Inc.  He was convicted of helping his employer create medical records that made it appear that patients required home health services when they did not. 

The false records were used as part of a larger scheme that included a doctor who falsely certified that the patients required home health services and that the services qualified for Medicare reimbursement.  According to the government, the scheme resulted in Medicare paying $3 million for services that were not medically necessary.

This is a common tragedy in healthcare.  An employer asks a nurse or physical therapist to create records that will allow the patients to continue receiving home healthcare services or therapy.  The nurse or physical therapist does not want to challenge their employer or lose their job.  So they write treatment notes to justify more home healthcare services or therapy.

All too often, this results in the nurse or physical therapist being arrested at home, put in handcuffs, and taken to the FBI offices for an interrogation.

It does not have to end this way.

If you have been asked to create false medical records, then you should consult with an experienced Medicare fraud and healthcare employment lawyer immediately to protect yourself.  You have rights and legal protections.  You may even be entitled a substantial reward if you help the government recover money spent on false claims.

Do not delay.  You never know when the FBI will come knocking at your door.

To arrange a free and confidential consultation with an experienced Medicare fraud and healthcare employment lawyer, call John Howley, Esq. at (212) 601-2728, or click here to reach our law offices via email.

The initial consultation is free and completely confidential.

John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York  10118
(212) 601-2728


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    John Howley, Esq.
    350 Fifth Avenue 59FL
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  • About John Howley