Medicare Fraud 101 » kickbacks

Medicare Fraud Strike Force Charges 30 Individuals with Medicare Fraud and Expands Operations

Nolan and Auerbach — Wed, 13 Jan 2010 01:21:16 +0000

Thanks to the Medicare Fraud Strike Force, 30 people have been charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims, according to a Dec. 15, 2009 press release by the Federal Bureau of Investigation (FBI). These individuals who were charged are accused of various Medicare fraud crimes, including conspiracy to defraud the Medicare program, conspiracy to launder money, money laundering, criminal false claims, making false statements, and receiving kickbacks, according to the release.

On the same day of the release, the Department of Justice and U.S. Department of Health and Human Services announced the expansion of Strike Force operations into Brooklyn, Tampa, and Baton Rouge. Strike Force teams are operating in seven cities: Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa, and Baton Rouge.

The Strike Force has obtained indictments of more than 460 individuals and organizations that collectively have falsely billed the Medicare program for more than one billion dollars, according to the release.

For the full release, go to: http://www.fbi.gov/pressrel/pressrel09/medicare_121509.htm.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

Nation’s Largest Inpatient Rehab Services Provider Allegedly Paid Illegal Kickbacks to L.A. Orthopedic Clinic

Nolan and Auerbach — Fri, 04 Dec 2009 23:06:50 +0000

HealthSouth Corporation, the nation’s largest provider inpatient rehabilitative healthcare services, allegedly paid illegal kickbacks to the Kerlan Jobe Orthopedic Clinic, a sports medicine clinic in Los Angeles. As a result, the Kerlan Jobe Orthopedic Clinic has agreed to pay the United States $3 million to settle these allegations, the United States Department of Justice announced December 1, 2009.

The settlement resolves allegations that HealthSouth paid kickbacks to Kerlan Jobe in the form of stock option grants, donations to the Kerlan Jobe Foundation, loan forgiveness on an equipment lease, and a disproportionately high ownership interest in a jointly owned ambulatory surgery center. In exchange for the illegal kickbacks, Kerlan Jobe allegedly referred patients to HealthSouth facilities. As a condition of continued participation in government healthcare programs, Kerlan Jobe was required to enter into a Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services to address Kerlan Jobe’s financial relationships with referral recipients.

For the full release, go to: http://www.justice.gov/opa/pr/2009/December/09-civ-1294.html.

For more information about qui tam and health care fraud, contact Nolan and Auerbach, PA.

Medicare Fraud Boosts Home Health Spending, According to New GAO Report

Nolan and Auerbach — Fri, 13 Mar 2009 18:28:48 +0000

Medicare spending on home health was $12.9 billion in 2006—that’s up 44% since 2002, according to Government Accountability Office (GAO) report released March 13, 2009. Upcoding, by home health agencies, as well as other fraudulent and abusive practices, such as kickbacks and billing for services not rendered, contributed to the rise in Medicare spending for homebound enrollees, the report says.

GAO found that inadequate administration of the Medicare home health benefit is making it vulnerable to improper payments, and, as a result, GAO made four recommendations to the Centers for Medicare and Medicaid Services (CMS).

For a copy of the report, including GAO’s recommendations, go to http://grassley.senate.gov/private/upload/03132009.pdf.

For more about Medicare fraud, contact Nolan and Auerbach, PA.

Medicare Scam Results in Indictment of California Doctor and Employee

Nolan and Auerbach — Mon, 24 Sep 2007 15:53:48 +0000

Dr. Kenneth Ferguson, a physician of record at Huntington Beach Medical Center which operated from July through October 2004 was indicted by a federal grand jury in Santa Ana, California along with his employee Olena Kulakova for health care fraud. According to the allegations, Dr. Ferguson and his employee Kulakova would bill Medicare for physician services for care rendered to patients by Kulakova. Kulakova had no medical license in the State of California even though she held herself out to be either a doctor or a physician’s assistant. Both Dr. Ferguson and Kulakova caused Medicare to be billed for comprehensive evaluation and management visits for patients even though face time with patients lasted only 5 to 10 minutes as opposed to the usual 25 to 45 face to face time with a patient. In addition, it is alleged that both Dr. Ferguson and Kulakova directed and caused kickbacks to be paid to patients to come to the Huntington Beach Medical Center for Services.

Both defendants face a maximum of 100 years in federal prison and fines in excess of $2,000,000 if convicted.

To read more about this case click here; or read more about medicare fraud and qui tam actions.

Medical Biller Nabbed in Medicare Fraud Scheme

Nolan and Auerbach — Tue, 20 Mar 2007 17:52:16 +0000

An owner of All Medical Billing Solutions, Inc (All Medical Billing) located in Miami, Florida, was sentenced to 10 years imprisonment after being convicted of conspiracy to defraud Medicare, pay health care kickbacks and laundering health care fraud proceeds. Sotto’s company submitted fraudulent Project New Hope (a Miami HIV medical clinic) claims to Medicare in excess of $2.8 million and Sotto received more than $600,000 in fraud proceeds. Five co-defendants previously plead guilty before trial and received sentences from probation to over seven years incarceration.

To read more on this article click here, or to learn more about healthcare fraud qui tam click here.

New York Hospital Appears to be Under Investigation for Possible Health Care Fraud and Kickbacks

Nolan and Auerbach — Wed, 14 Mar 2007 19:11:55 +0000

Westchester Medical Center received a subpoena on January 31, 2007 from Office of Inspector General of the U.S. Department of Health and Human Services, asking for information going back to 1997, primarily related to the hospital’s relationships with its doctors. Under Stark and anti-kickback laws, hospitals are not permitted to give physicians inducements for patient referrals.

To see the full story click here or to learn more click here.

Medicare Fraud – Motorized Wheelchairs

Nolan and Auerbach — Tue, 08 Aug 2006 18:12:57 +0000

An Arkansas physician was sentenced to prison for his role in a Medicare fraud case involving motorized wheelchairs. The physician convinced his elderly patients to seek motorized wheelchairs which were paid for with Government funds. The wheelchair supplier was allegedly paid kickbacks as part of the scheme.

For more information, click here.

Big Fines Levied For Violations of False Claims Act

Nolan and Auerbach — Wed, 10 May 2006 15:57:10 +0000

In an article that appeared in The Baltimore Sun (Jonathan D. Rockoff, Improper sales of medicines targeted; Drug firms have paid fines of $3.5 billion since 2001 for wrongful promotions, The Baltimore Sun, May 7, 2006 at 1A), it is reported that since 2001, pharmaceutical companies prosecuted under the False Claims Act have paid nearly $3.5 billion in penalties. These penalties have resulted from the improper promotion by pharmaceutical companies, which include improper promotions and kickbacks. “…One reason the law has been effective is its reward to tipsters who can receive 15 percent to 30 percent of the penalties against a company …”

To read more, see The Baltimore Sun.