Hospital Pays $2.5 Million to Settle Medicare and Medicaid Fraud Claims
A former employee of Baptist Health System Inc. was awarded a $425,000 whistleblower reward for helping the government recover $2.5 million in allegedly false claims submitted to Medicare and Medicaid. The former employee gave the government evidence that the hospital system billed Medicare and Medicaid for services and drugs that were not medically necessary. According to the whistleblower lawsuit, two neurologists at the hospital system misdiagnosed patients with multiple sclerosis and other neurological disorders. As a result of the misdiagnoses, the hospital system billed Medicare and Medicaid for medically unnecessary services and drugs. The hospital system placed one of the neurologists on administrative leave, but it did not disclose the problems to the government until a year later. The government’s investigation began when a former hospital employee brought a qui tam or whistleblower lawsuit. A whistleblower lawsuit is filed with the court “under seal” (in secret). At the same time, the whistleblower gives their evidence to the government, and the government is required to conduct an investigation. If the government recovers money as a result of the evidence provided, then the whistleblower is entitled to a reward of between 15% and 30% of the amount the government recovers. In this case, the whistleblower was awarded 17% of the amount recovered or $425,000. If you have evidence that a hospital or other medical provider is submitting false claims to Medicare or Medicaid, then you should consult with an experienced Medicare fraud whistleblower lawyer immediately to protect your rights. Do not delay. The reward is available only to the first whistleblower who provides evidence to the government. 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
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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 Former Employee Claims Pan de Sal and Grill 21 Cheated Workers Out of the Minimum Wage and Overtime Pay
A federal judge has refused to dismiss claims that two well-known Filipino restaurants in New York City deprived their workers of the minimum wage and overtime pay. Pan de Sal and Grill 21 in Manhattan are facing a class action lawsuit accusing them of violating state and federal minimum wage and overtime laws. The lawsuit was brought by a former employee, Violeta Morales, on behalf of herself and all other hourly workers at the two restaurants and four other companies owned by Marissa Teves Beck. The complaint alleges that Mrs. Beck cheated employees out of their compensation by refusing to report all the hours the employees worked to the payroll companies that prepared their paychecks. The restaurant owner asked a federal judge to dismiss the case, but the judge denied the motion. U.S. District Judge Alvin K. Hellerstein found that “the complaint sufficiently alleges, against all defendants, its claims under the Fair Labor Standards Act and the New York Labor Law.” Judge Hellerstein also found that the claim for a collective action on behalf of all of the current and former employees was sufficiently stated. The complaint points to what it calls Mrs. Beck’s “history of willfully failing to pay employees the wages they are legally entitled to receive.” The complaint states that the U.S. Department of Labor issued a determination letter in 2008 finding that Mrs. Beck cheated employees out of more than $3 million in wages and, in 2009, a federal court entered a permanent injunction against Mrs. Beck. According to Ms. Morales’ complaint, the new lawsuit “has been made necessary by Mrs. Beck’s willful contempt for this Court’s permanent injunction and the rights of her employees.” Ms. Morales also alleges that Mrs. Beck attempted to conceal her illegal activity by creating multiple sets of payroll records, paying employees “off the books,” and moving employees from the books of one corporate entity to another without regard to where they actually worked. Judge Hellerstein ordered the defendants to answer the class action complaint and scheduled a status conference at 10:00 a.m. on May 30, 2014. The plaintiff is represented by John Howley, a New York lawyer who has lived in the Philippines and speaks Tagalog. The defendants are represented by Concepcion Montoya, a Fil-Am lawyer with the firm of Hinshaw & Culbertson LLP. For more information, contact: John Howley, Esq. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728 Astellas Pharma Pays $7.3 million to Settle Qui Tam Lawsuit Alleging Off-Label Promotion of Mycamine for Pediatric Use
A former sales representative for Astellas Pharma US will receive a $700,000 whistleblower reward as part of a settlement of a qui tam or whistleblower lawsuit he brought under the federal False Claims Act. Frank Smith, the former pharmaceutical sales representative, started a qui tam lawsuit under the federal False Claims Act alleging that his employer illegally marketed and promoted the drug Mycamine for a use that was not approved by the federal Food & Drug Administration (FDA). Specifically, the lawsuit alleged that Mycamine was marketed and promoted for pediatric use when the FDA had only approved the drug for use in adults. When a drug is marketed for an off-label use, it results in false claims for reimbursement to Medicare and Medicaid. The drug company that engaged in off-label marketing is liable for those false claims and may be required to pay back three times the amount Medicare and Medicaid paid for the drug, plus a penalty of up to $11,000 per false claim. The pharmaceutical company in this case agreed to settle the whistleblower lawsuit for $7.3 million. The federal government will receive $4.2 million of that amount and state governments will share $3.1 million. Under the federal False Claims Act, an individual who has evidence of false claims may start a lawsuit “under seal” (in secret) on behalf of the United States government to recover the money that was paid for the false claims. This is known as a qui tam lawsuit. The government then must investigate the allegations and decide whether to join in the lawsuit or allow the whistleblower to prosecute the lawsuit with his own lawyer. When the government recovers money as a result of the qui tam lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the total amount recovered. In this case, the whistleblower will receive more than $700,000 from the federal portion of the recovery, or approximately 17% of the federal government’s share of the settlement. The whistleblower may also be entitled to rewards from the state governments’ share of the settlement under state false claims acts. If you have evidence that false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. You may be entitled to a significant reward and legal protections. Do not delay. Only the first whistleblower who comes forward with evidence is entitled to the 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 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 Kickbacks Allegedly Were Disguised as “Consulting Agreement” Compensation Teva Pharmaceuticals will pay $27.6 million to settle claims that it violated the False Claims Act by paying kickbacks to induce a physician to write more prescriptions for an anti-psychotic drug. The settlement resolves claims that the pharmaceutical company paid a physician to induce him to write prescriptions for generic clozapine, an anti-psychotic medication. Clozapine is usually considered a drug of last resort because it has serious potential side effects, especially for elderly patients. The side effects include a potentially deadly decrease in white blood cells, seizures, inflammation of the heart muscle, and increased mortality in elderly patients. The complaint alleged that the kickbacks were disguised as compensation under a “consulting agreement.” Under that agreement, the pharmaceutical company allegedly paid the doctor $50,000 per year and other benefits to induce him to switch his patients to generic clozapine. The other benefits included all-expenses paid trips to Miami for the doctor, his wife, and several of his employees. After entering into the “consulting agreement,” the doctor quickly became the largest prescriber of generic clozapine in the United States. The government claims that the payments and other benefits continued for many years, resulting in Medicare and Medicaid paying for thousands of generic clozapine prescriptions. The Anti-Kickback Statute prohibits pharmaceutical companies from offering or paying anything of value to induce prescriptions covered by Medicare or Medicaid. This kickback prohibition is designed to ensure that a physician’s medical judgment is based solely on the best interests of the patient and not compromised by improper financial incentives. Individuals who help the government uncover these types of healthcare frauds are entitled to significant rewards – up to 30% of the amount the government recovers. But you must follow a specific, confidential process to qualify. If you go to the government on your own or give your evidence to the media, you may lose your right to a reward. If you have evidence that a pharmaceutical company, hospital, or other healthcare provider is paying kickbacks in return for prescriptions or patient referrals, then you should consult with an experienced whistleblower attorney immediately to protect your rights. 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 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.
What To Do When The Bureau of Fraud Investigation Asks For Your Tax Returns Every year, more than 5,000 families are investigated by the NYC Bureau of Fraud Investigation. The investigations begin when investigators believe that you provided incorrect or incomplete information on an application for Medicaid or Family Health Plus benefits. If the investigators find that you intentionally provided false or incomplete information, they can send your case to the District Attorney for criminal prosecution. The penalties can be severe. If convicted of a felony, you could be sentenced to between one and seven years in prison. Even if you are convicted of only a misdemeanor, you could be sent to jail for up to one year. However, many cases are settled without any criminal charges at all. The settlement usually involves paying back the value of any benefits you received when you were not eligible. A settlement means no criminal charges, no criminal record, no imprisonment or fines, no impact on your credit report, and no adverse immigration action. Why do some cases settle without any criminal charges, while other cases result in criminal convictions and prison sentences? It all depends on how you handle the investigation. Every situation is different. Just keep in mind that anything you say to the investigator may be used against you. If you are contacted by the Bureau of Fraud Investigation, you should consult with an experienced Medicaid and Family Health Plus fraud attorney. Your lawyer can help you understand whether you have a problem, how severe the problem is, and the best strategy for resolving the investigation without criminal charges. To arrange a free and confidential consultation with an experienced Medicaid and Family Health Plus fraud attorney, 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. 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. |
John Howley, Esq.
350 Fifth Avenue 59FL New York, NY 10118 (212) 601-2728 |