Whistleblower Lawyer & Attorney : LaBovick Law Firm, Florida : Federal False Claims Act, Qui Tam

The Baptist Health South Florida Inc., will pay the United States $7,775,000 to settle False Claims Act and the Stark Statute violations that allegedly occurred between 2003 and 2005. According to the Department of Justice this probe involved Baptist Health South Florida,  over compensating an oncology group for patient referrals to Baptist's hospitals. The payments were made pursuant to a contract under which the oncology group provided physics and dosimetry services to the two hospitals.

The Stark Statute prevents Medicare providers like Baptist from billing the federal health care program for referrals from doctors that have a financial relationship with the provider. There are a few exceptions for the Stark Statute.

Click here to read more from the Department of Justice and the Sun Herald on this False Claims Act settlement.

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A New Orleans Hospital, Touro Infirmary, recently settled a qui tam suit for $1.75 million. According to the Department of Justice, the suit alleged that Touro Infirmary, submitted false claims to the Medicare program.

Involved in the Medicare scheme with the New Orleans Hospital, was Dr. Maria Carmen Palazzo. In previous a Whistleblower Blog post, we mentioned Dr. Palazzo's involvement with fraud in Paxil trials.  According to the recent qui tam case involving Touro Infirmary, Dr. Carmen Palazzo received unlawful payments of $144,000 per year from 2000 to 2004. This was a part of the scheme to get patient referrals to the hospital from Dr. Maria Carmen Palazzo to refer patients to the hospital. According to recent reports,  Dr. Palazzo, was found guilty on 39 counts of health care fraud, including 13 counts arising from her contractual relationship with Touro.

Click here to read more from the Department of Justice, on the False Claims Act settlement from Touro Infirmary.

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Medicare fraud can happen anywhere and can be detected by the most least suspecting individual in a company.  Recently, Fred Steinberg, M.D, a radiologist and owner of the chain, of  University MRI and Diagnostic Imaging Centers, located in Florida settled a qui tam suit for $7 million.  The  Florida firm denied all charges and agreed to settle the qui tam suit according to a quote in the Sun Sentinel  "to end the uncertainty of protracted litigation."

The company was accused of overcharging Medicare for Medical scans and billing the federal government for some tests that were not medically necessary. There were also allegations that that the Florida company paid doctors under the table for sending them imaging patients for tests that could cost as much as $2,500 apiece.

Why is it that when an employee reports questionable government billing practices to management, in this case Medicare bills, the company  takes the defensive and fires the employee.

In the case of the Florida Diagnostic Imaging Centers, David Clayman, M.D, a former radiologist for the imaging centers, was fired after questioning the Medicare billing practices. According to a recent DOJ release, Dr. Clayman will receive $1.75 million as his share of the $7 Million recovery.

According to the American College of Radiology, a doctors' association, in a Sun Sentinel article, the cost for Medicare and insurers is about $16 billion a year for unnecessary imaging tests ordered by doctors who made money from them. These tests not only cost the government and taxpayers, but also expose patients to radiation and and raise medical costs.

One of our favorite crusaders in the Medicare fraud fight, R. Alexander Acosta, U.S. Attorney for the Southern District of Florida, stated that  “We will aggressively prosecute any physicians, including board-certified specialists, who abuse and steal from the Medicare system to line their own pockets.”  Attorney Brian F. LaBovick mentions in an article on health care fraud for a  Thomson West Litigation Reporter, that "We must continue to prosecute fraud on all levels. New amendments are needed to continue to foster the cottage industry of civil attorneys assisting U.S. attorneys' offices around the country with their qui tam investigations. Each state must enact its own qui tam statutes (there are now 22 states with qui tam laws). This will give states the ability to potentially capture additional funds for Medicare fraud prosecution at a local level, pursuant to the Deficit reduction Act of 2005."

The Florida qui tam case discussed in this post is: U.S. ex rel. David Clayman v. University MRI and Fred Steinberg, M.D. et al. Civil Action No. 02-81143 (S.D. Fla.). 

 

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Florida based, Acculab Laboratories has agreed to settle a qui tam suit alleging false claims and fraudulent billing to Medicare. The company has agreed to pay the United States $461,000 according to the Justice Department. The allegations surrounding the Sarasota based company included included billing Medicare for laboratory services that were not ordered, were not provided, were not medically necessary or were improperly unbundled.

The whistleblower will receive $92,200 of the settlement. The whistleblower provisions of the False Claims Act, allows private parties, called "relators," to file an action on behalf of the United States and receive a portion of the proceeds of a settlement or judgment awarded against a defendant.

It is the American taxpayer who is victimized when a provider submits false claims to Medicare," said acting Assistant Attorney General Jeffrey S. Bucholtz.

The case was handled by the Justice Department's Civil Division, Commercial Litigation Branch; and the U.S. Attorney's Office for the Middle District of Florida. 

Click here to read more from the Department of Justice

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South Carolina Regional Hospital, Tuomey Regional Medical Center, is accused of Medicare and Medicaid  fraud in a qui tam lawsuit, brought by the U.S. Attorney's Office in South Carolina.  According to a recent article on State.com, the suit involves the Regional Hospital overcharging Medicare for surgeries and “bribing” doctors with “kickbacks” for their business. The case is being handled by U.S. Attorney Norman Acker. The lawsuit alleges that the Toumey Regional Medical Center created a billing scheme from January 2005 to September 2007, in which "it submitted and caused others to submit false and fraudulent claims for payment to Medicare and Medicaid ...”

Judge Matthew Perry ruled yesterday that the Justice Department-backed lawsuit against the South Carolina Regional Hospital can proceed and crucial evidence against the Hospital can be admitted into the f the case. The lawyers for the hospital had been trying to get the case dismissed.

Orthopedic Surgeon, Michael Drakeford, initial qui tam lawsuit  was filed under seal in federal court in Columbia in October 2005. The federal government investigated Drakeford’s claims and before taking over as lead plaintiff in the case. 

Time will tell how much of the behind-the-scenes, big-profits world of doctors and hospitals in the billion-dollar S.C. health care industry will be revealed. The hospital is expected to answer the allegations by March 28.

The case could be worth millions of dollars to the government if the South Carolina Hospital is found guilty of fraudulently over billing the government or if they decide to settle and no admit any guilt or wrong doing. 

Charles Miller, a Department of Justice spokesman is quoted as saying, "The government intervenes only if a case has merit. The department gets involved in less than 25 percent of qui tam actions filed each year. In qui tam cases, the government nearly always gets a settlement or wins in a jury trial."

Click here to read more on this case from the State.com

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HealthSouth Corporation agrees to pay $14.2 million to settle allegations that the company submitted false claims to the government and paid illegal kickbacks to physicians who referred patients for care in some of its hospitals, outpatient rehabilitation clinics, and ambulatory surgery centers, according to reports from the Justice Department. 

HealthSouth, the nation’s largest provider of inpatient rehabilitation services, was also one of the largest providers of outpatient rehabilitation services, ambulatory surgery services, and diagnostic imaging services until it sold those lines of business earlier this year.

The settlement was due to the joint efforts of the U.S. Attorney for the Northern District of Alabama, the U.S. Attorney’s Office for the Central District of California, the Civil Division of the Department of Justice, the Department of Health and Human Services, Office of Inspector General, and the FBI.

U.S. Attorney for the Central District of California, “Thomas P. O’Brien, gave a powerful statement in response to the settlement and kickbacks “We will not be fooled when healthcare providers attempt to disguise kickbacks as cleverly crafted business arrangements. Medicare providers seeking federal funds must play by the rules. Providing sweet deals to physician groups to insure a steady stream of referrals runs afoul of those rules and will not be tolerated.”

HealthSouth Corporation stock closed yesterday at $21.48. Click here to find out more from Health South.

To read more from the Department of Justice, Click here.

 

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Thanks to a brave nurse for uncovering what she saw as fraudulent Medicare billing practices, the government will receive $26 million from Saint Josephs Hospital of Atlanta and Saint Josephs Medical System to resolve the "whistleblower" lawsuit that alleges the hospital violated the federal False Claims Act in regards to Medicare billing practices.  According to the DOJ, the St. Joseph's Hospital employee, Tami Ramsey, will receive $4.94 million for her valiant actions in coming forward and reporting the improper billing practices. She found that the hospital routinely billed Medicare for inpatient rates, when patients were receiving outpatient services, resulting in a higher charge, since inpatient services are more than outpatient services.

 According to United States Attorney, David M. Nahmias, "This significant settlement demonstrates our commitment to protect public funds from fraud and abuse. Every Hospital that submits claims to the Medicare program must ensure that its services are billed appropriately. We will continue to vigorously pursue Medicare provides who disregard billing rules."

This is a strong message to the Medical community, that fraudulent billing practices to the Medicare program will not be tolerated. There will harsh fines and penalties imposed. Rewards will be given to whistleblowers who uncover this fraud.  In a prior  Whistleblower Law Blog post this year, we reported that Medicare and Medicaid fraud in 2007 accounted for $1.54 billion to the government from corporations settling heath care fraud qui tam or false act claims.  Whistleblowers were awarded $177 million for their valiant actions of bringing the corporations to justice. Under the False Claims Act, whistleblowers can sue companies or individuals that they believe have filed fraudulent claims with the federal government. If successful, they can receive up to 30 percent of the proceeds of what the government recovers.

To read more from the Department of Justice on St. Johns Medical Center, Click Here

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Dear Blog Readers,

I write this blog with absolute reverence. What I am about to share is a biblical tale of the Lord's retribution against the evil fraudsters in our midst.  In modern society we often see the hand of the Lord as a simple act of coincidence or an explained scientific event or better yet, a scientific anomaly.  But here, the hand of the Lord is obvious.   He  (this is not intended to be sexist) is against those who defraud Medicare.  That's right, you heard it here first.  The Lord is paying attention to the fraudulent people who are ripping off Medicare.

Ok, let me clarify this beginning.   On Wednesday, December 5, 2007, Mark Potter, an NBC Correspondent, wrote an article for MSNBC.com entitled "Fake Companies Steal Billions from Medicare". What makes this article interesting is that it involves a man from Miami, Florida, literally being eaten by an alligator while running from the police. Another important feature about this man is that he allegedly ran a fraudulent Medical Supply Company in Florida. 

Make no mistake about it.  This is not an unfortunate event.  This is one of those events that gets written down in the Holy Scriptures and retold for centuries to come.  I can hear it now:

And the people cried, for the coins set aside for the sick were stolen by the evil souls amongst the people.  And so the people sent their courageous fighters to find the evil souls, collect their coins and cage the evil to stop the theft of the coins set aside for the ill.  The courageous fighters searched across the swamps and paved lots through a sea of multi-colored automobiles.  Upon finding the evil souls the courageous fighters took flight to capture and cage the evil amongst them.  The evil would not be taken and caged and thus also took flight.  Into the wilderness the evil fled to avoid capture by the courageous fighters.  Through all  this  the Lord was watching.  The Lord was angered by the evil in the land.  The Lord knew the coins set aside for the sick were sacred to the people.  Helping the ill was judged by the Lord as good and proper under his laws and commandments.  Therefore the coins were good and aiding the ill was important to the Lord.  The Lord  decided he would no longer permit the evil to dwell in the land.  The Lord sent a great lizard to rise up from the Earth's midst.  The great lizard heard the voice of the Lord and came forth  to teach the people how to rid the evil from their midst.  The great lizard searched the wilderness until it found the evil souls.  In a quick and merciless moment  the  great lizard tore from limb to limb the evil souls .  The people could hear the gnashing of teeth and the and wrenching of souls.  The intent of the Lord was good and the people understood the evil must dwell in the land no more.

Can we stick that in one of the minor scriptures?

All Jokes aside. It is not my intent to be blasphemous.  Please note: I am just kidding around.   I do think it is unfortunate that the Lord doesn't intervene more often to stop fraudulent people.  But then again, the Lord could be leaving it up to us to take action and bring these corrupt people to justice.  The fraud that is going on in the world around us is astounding.  Medicare is bilked out of an estimated $60+ Billion  (yes "B" billion) dollars a year.  Imagine what we could do with the money, if it was applied to some cause other then fraud.

Potential Whistleblowers: If you know of a significant fraudulent scheme, stand up.  Stop the silence.  The sight of criminals driving luxury cars and living on oceanfront mansions is too much for society to bear.  These people must be brought to Justice.  If the Lord is willing to take one or two out with an alligator now and again, so be it.  But we are being challenged to take out the rest.  We must take a stand.  We must swallow the safety of anonymity and report the fraud.  We must be willing to fight.

Brian

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Stryker Corp and Physiotherapy Associates have agreed to pay $16 million to settle qui tam allegations on submitting false claims to Medicare and other Federal health programs, according to the Department of Justice. Stryker Corp sold its outpatient therapy division, Physiotherapy Associates in June 2007.

The settlement resolves allegations that Physiotherapy,  submitted claims for services to Medicare, state Medicaid programs, and the Department of Defense's TRICARE program that were falsely billed as one-on-one services and that Physiotherapy improperly retained excess or duplicate payments it received from federal health care programs. Under the terms of the settlement, Physiotherapy agreed also to enter into a corporate integrity agreement with the Office of Inspector General for the Department of Health and Human Services.

Stryker Corp stock closed at $70.78 yesterday, with shares being down $.09 or .13% from previously trading.

To read more about this settlement from the Department of Justice, Click here.

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Nelson Valdes, Pharmacy Owner and Durable Medical Equipment owner, was ordered by  U.S. District Judge Cecilia M. Altonaga to pay approximately $3.5 million in connection to Medicare false claims. In July of this year, a federal jury in Miami convicted Mr. Valdes of conspiring to defraud Medicare, taking kickbacks and other related charges. This was the third time, Mr. Valdes has been convicted of Medicare fraud. Hopefully he will learn from his mistakes this time around.

According to the Department of Justice, Mr. Valdes conspired with Med-Pro Billing and Unimed Pharmacy to refer paid patients in exchange for half of what Medicare paid for “compounded” aerosols. Compounding is the the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer.

Mr. Valdes will receive 12 years in prison for Medicare fraud, according to Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

This verdict marks another win for our diligent medicare fraud strike force. Since March 2007, the strike force team has indicted approximately 80 cases and 120 defendants in Miami-Dade County alone.  The Medicare fraud strike team deserves a big round of applause.  Their hard work helps the government recoup millions of dollars for qui tam or false claims involving medicare fraud.

Click Here to read more on this case from the Department of Justice.

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Florida's Strike Force team has another successful win to celebrate in the fight against Medicare Fraud and qui tam. Marianela Smith, Owner and Operator of a Florida durable medical equipment company and an assisted living facility was convicted by a federal jury in Miami of Medicare fraud and submitting false claims to Medicare among other things, such as kickbacks.

According to reports from the Department of Justice, Marianela Smith conspired with the owners of Lily’s Pharmacy to refer paid patients to the pharmacy in exchange for half of what Medicare paid for “compounded” aerosols. Compounding is the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer. She referred patients and their Medicare billing information to the owners of Lily’s Pharmacy and gave false prescriptions for compounded aerosol medications purchased from local physicians. A patient testified during trial that he was paid $150 per month to use his Medicare card and to obtain false prescriptions in his name that were ultimately provided to the pharmacy. This medicare fraud scheme with Lily’s Pharmacy fraudulently billed Medicare more than $271,000 for the false prescriptions for compounded aerosol medications provided by Smith. In exchange, Smith received more than $81,000 in kickbacks.

Marianella faces up to 30 years in prison for her role in this Medicare Fraud scheme.  What amount of money could be worth this great risk of freedom?

We salute our special force fraud team for all of their hard work and successful efforts, including Assistant Chief John Kelly, Trial Attorney Hank Walther of the Fraud Section of the Criminal Division, Deputy Chief Kirk Ogrosky of the Fraud Section and last but not least U.S. Attorney R. Alexander Acosta of the Southern District of Florida.

Click here to read more from the Department of Justice on the Medicare fraud case against Marianella Smith.

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Earlier this week, the qui tam case of  United States ex. rel.Louanne Boothe v. Sun Healthcare Group, Inc., No. 06-2156 (10th Circuit August 7, 2007) was remanded by the United States Court of Appeals, Tenth Circuit.

This case involves allegations by former finance and accounting employee, Louanne Boothe against Sun Healthcare Group, a U.S. Healthcare provider, claiming that Sun Healthcare Group over-billed the United States in ten distinct ways. The complaint includes allegations of the following: 1)  Sun over-billed the government by abusing the Section 1010 exception in the years 2000-2002;  2) Sun defrauded Medicare by disregarding Medicare’s prudent-buyer guidelines and overcharged for therapy management services for  $2.6 million; 3) overstated its temporary nursing staff’s labor hours in 2001 and 2002 by $500,000; 4) overcharged Medicare by $240,000 in 2002 for pharmacy charges  5) improperly billed Medicare in 2001 for $200,000 worth of stolen medical supplies; 6) overcharged Medicare by $540,000 in 2000-02 by funneling costs between Denver Mediplex and an outpatient clinic; 7) filed Medicare reimbursements for $3.6 million worth of mortgage interests payment; 8) released patients earlier than its prior practice from Ballard Rehabilitation Hospital to inflate its Medicare revenue by $2 million; 9) manipulated patient discharges to impose improper costs on Medicare of $500,000; and 10) signed without the knowledge or consent of its patients admission forms for three years ending January 2003 to receive from Medicare $9 million in reimbursements for accident and injury treatments when liability potentially rested with third parties.

These allegations seem pretty specific, however, the primary issue at hand is whether the allegations are “based upon” information already in the public domain or whether Ms. Louanne Boothe is an “original source” of the information.

The district court held that it lacked subject matter jurisdiction under 31 U.S.C.§ 3730(e)(4) of the False Claims Act, 31 U.S.C. § 3729-33, to hear the case.

According to the Tenth Circuit, the district's assessment was accurate that it lacked jurisdiction in three of the claims Ms. Boothe presented. However, jurisdictional analysis of each of Ms. Boothe’s
remaining seven claims of fraud is necessary. Therefore, the United States Court of Appeals Tenth Circuit remanded the cases for further proceedings. The Court included the following language "Three bad apples does not necessarily warrant discarding the barrel". Interesting choice in words.

It is also important to note that Sun Healthcare Group tried to use the following arguments against Ms. Boothe: (1) Ms. Boothe waived her right to pursue a qui tam complaint in a severance agreement she executed upon her departure from Sun; (2) Sun’s intervening bankruptcy, from which it emerged in 2002, discharged Sun’s obligations to satisfy the claims in Ms. Boothe’s qui
tam complaint; and (3) Ms. Boothe failed to plead her qui tam complaint with sufficient particularity.

Citing lack of jurisdiction, the district court declined to address these arguments for dismissal and the Tenth Circuit did not address them either. It will be interesting to see if they come up again as this saga continues.

Let's all hope that Sun Healthcare Group is operating with the integrity and honesty that they are known for in the healthcare community rather than the over-billing of Medicaid and Medicare as was alleged in the qui tam suit of Luanne Boothe. The company has been around since 1993 and is continuously growing, serving more sick and terminally ill patients, and doing lots of business with the government. In the year, 2006, they took in $1.116 Billion in revenue according to their quarterly reports. Currently they operate 216 skilled nursing, long-term care and assisted living and mental health facilities in 25 states with approximately 23,520 operating beds according to their self published reports. The company closed out the second quarter at $446.7 million, up 73 percent compared to $258.5 million second quarter 2006. The stock price closed on the Nasdaq Friday at $15.30 per share.

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Tenet Healthcare received good news last week, when U.S. District Judge Patricia A. Seitz granted Tenet's request for Summary Judgment and dismissed a Racketeering case.  The case was that of Boca Raton Hospital v. Tenet Healthcare, 05cv80183, U.S. District Court, Southern District of Florida (Miami).  According to Bloomberg News, Judge Seitz is quoted in her ruling as saying " Tenet escapes Boca's grasp not because its conduct is blameless but only because Boca is not the proper entity, and RICO is not the proper legal vehicle, to redress the harm Boca targets". The  Boca Community Hospital brought charges against Tener under the U.S. Racketeer Influenced and Corrupt Organizations Act . Judge Seitz said the charges were insufficient as a matter of law to prevail against Tenet.

Governor Charlie Crist, in 2005, as Florida's Attorney General, was involved in one of two lawsuits against Tenet with 13 hospital plaintiffs.  According to the complaint, Tenet was accused of racketeering that artificially inflated its prices. Allegedly the scheme, took in more than $1 billion. According to the Business Journal,  Florida was the only state, at that time to file that type of charge against Tenet. However, other states and federal agencies have investigated the company for alleged over-billing.  In 2006,  Attorney General Crist resolved his case against Tenet with a $ 7 million settlement, resolving allegations that the company falsely inflated its hospitals' charges from 2000 to 2003 to obtain reimbursements from a Medicare fund. Unfortunate for Boca Raton Community Hospital, they could not have been a part of the group of Plaintiff's Charlie Crist represented

It is also important to mention that in June 2006, Tenet settled its Medicare fraud disputes with the federal government for $900 million, including funds that Tenet returned for overbilling.

In an effort to clean up its reputation, Tenet has taken a lot of progressive steps. They have  installed a new management team, appointed former Florida Governor Jeb Bush to the Tenet Board and implemented stringent corporate governance and compliance policies.

Hopefully with these measures in place, Tenet Healthcare Corporation, one of the nation's largest health care providers can focus on saving lives and providing the best possible healthcare to patients.  The Tenet Stock closed at $4.86 per share on Friday, but ended at $4.98 in after hours trading.

Click here to read more on this story from Bloomberg News, FindLaw, The Business Journal, The Miami Herald.

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Sebastian River Medical Center and Neurosurgeon, Linda Bland settled a qui tam suit in Florida  for $1.275 Million for performing unnecessary surgeries on Medicare patients, thanks to the brave  whistleblower Anesthesiologist Thomas Gayeski.

It is rare for Doctors to blow the whistle on other doctors, usually, out of professional courtesy. Dr. Gayeski, had the courage to stand up and report this fraud after he left the hospital. As a reward for his efforts, he earned a whistleblower's reward of $230,000 and his Attorneys fees were paid by the Hospital. This was not a bad payday for speaking up and telling the truth.

Allegedly, Dr. Linda Bland performed more than 150 unnecessary surgeries from 2000 through 2002, according to the whistle-blower lawsuit .

A word to the wise: Health Care Professionals in Florida, the U.S. Attorney R. Alexander Acosta, is on a mission to fight government fraud. In a recent statement he said: ''We will aggressively prosecute any physician or healthcare professional, including board certified specialists, who order or perform unnecessary medical or surgical procedures that endanger the health and safety of our citizens and steal scarce resources from the Medicare system." 

Hospitals and Health Care Professionals,  Be very carefull... Your co-workers/ employees are going to report your fraud and be compensated for their valiant actions. They will receive 15% - 30% of the government's recovery as a relator's or whistleblower's reward.  Also, it can cost you millions of dollars and a lot of aggravation in trying to defend yourself due to your fraud/ or the fraud of your staff.

Read More in the Miami Herald Story.

The Whistleblower Law Blog appears as a courtesy of LaBovick & LaBovick, Civil Justice Prosecutors, A Private Law Firm.

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Arkansas Neurosurgeon, "Patrick Chan was described as " a very energetic, hard working, loyal and moral" surgeon, by a Colleague in a letter of recommendation to the Arkansas medical review board.  The Doctor had a successful medical career, earning a top income and running a successful surgical practice. Unfortunately, everything did not remain so rosy and bright for the doctor. Patrick Chan awaits trial in August for allegedly taking kickbacks from medical suppliers and for allegedly submitting false claims to Medicare and Medicaid.

The whistleblower, in this qui tam case, is John Thomas, a former employee of Nu Med Technologies, that sold medical instruments and devices used in spinal surgery.

No one is immune to being charged with a qui tam false claims lawsuit, if they are breaking the law. The government will prosecute small or large companies that fraudulently submit bills to the government. Regardless of the size, fraud, even on a small scale, cost taxpayers money. As former Federal Prosecutor, Brian LaBovick mentioned in a previous post, on the Whistleblower Law Blog , the false claims act does not discriminate against prosecuting small fish (small companies) when they break the law.

If you have knowledge of fraud against the government, contact an experienced qui tam attorney to discuss your claim. It is essential that you take the necessary steps in protecting your relator's share of the government's recovery, which can be 15 – 30% of the government’s total recovery along with additional civil penalties. Since false claims act cases are often complex, it can take several years to settle or to litigate. Whistleblowers often hire an experienced attorney to help in submitting a qui tam claim. LaBovick and LaBovick are former federal prosecutors experienced in prosecuting cases on behalf of the government.

The Whistleblower Law Blog is presented as a service of the Private Law Firm, LaBovick & LaBovick, Civil Justice Prosecutors. LaBovick & LaBovick is a Plaintiff's firm that represents whistleblowers across the United States in qui tam (False Claims Act) litigation; including Federal and State False Claims Act Cases. They offer free confidential consultations to whistleblowers that need to discuss sensitive matters, including those involving current or a former employers.

 

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The St. Louis Business Journal reports that the United States filed a civil complaint against Renal Care Group, Renal Care Group Supply Co. and Fresenius Medical Care Holdings Inc. alleging that the firms fraudulently billed the Medicare program for supplies and equipment provided to End Stage Renal Disease patients, according to U.S. Attorney Catherine Hanaway, out of Kansas City.

The lawsuit was filed as a qui tam lawsuit, which are usually filed by private individuals on behalf of the government. These type lawsuits are normally sealed and are often associated with whistleblower accusations. Due to the false claims presented to the United States by defendants, the United States has suffered damages and is seeking multiple damages under the False Claims Act, to be determined at trial, plus a civil penalty of $5,500 to $11,000 for each fraudulent claim presented for payment.

Let's hope that the relators or whistleblowers that were involved in the qui tam suit have all their documentation and have sought legal counsel on how to protect their rights for the relator's portion of the government's settlement.  There are so many whistleblowers that are denied relator claims because they did not follow the proper steps to protect themselves before they brought their case to the proper authorities.

As fomer Federal Prosecutor, Brian F. LaBovick, mentioned in a previous post on the Whistle Blower Law Blog, you need to follow a few steps when preparing to file a qui tam whistleblower claim.  Consult with an attorney that understands and handles qui tam claims.  This can make the difference between getting a thank you from the government or a check in the amount of up to 30% of what the government recovers. Unfortunately, the whistleblower has to protect their interest first, and that is not only gathering the documentation and proof. If you have a potential qui tam claim, contact the civil justice prosecutors at LaBovick & LaBovick. They are former Federal Prosecutors and understand how to bring a case on behalf of the government. Consultations are confidential and FREE.  Act quickly, protect your rights.

The Whistleblower Law Blog is presented as a service of the Private Law Firm, LaBovick & LaBovick, P.A., Civil Justice Prosecutors. LaBovick & LaBovick is a Plaintiff's firm that represents whistleblowers in Florida and throughout the nation in qui tam (False Claims Act) litigation.

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Federal authorities have filed a qui tam suit  seeking $1 million in fraudulent claims plus civil penalties against a company that operated five nursing homes in the St. Louis area, saying that the facilities provided what amounted to "worthless" health care.

The suit claims that Cathedral Rock Corp., based in Fort Worth, Texas, committed Medicaid and Medicare fraud when it billed the government for care it didn't provide, U.S. Attorney Catherine Hanaway said in a statement to the press.

Investigators, who intervened after two nurses filed a "whistle-blower" lawsuit in 2003, found numerous residents at the facilities suffered from dehydration, weight loss, and preventable bed sores that eventually led to amputations. 

The two nurses, Michele Kimball and Anna Juelfs, who filed the original suit, "qui tam action" could receive 15 percent to 25 percent of the damages recovered in the action, according to U.S. Attorney Hanaway.

Click Here to read more about the case in the St. Louis Post Dispatch.

 

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The United States and the State of Texas have settled a qui tam lawsuit against the Harris County Hospital District (Hospital District) for more than $15 million, according to United States Attorney Don DeGabrielle. The terms of the settlement, calls for the Hospital District to pay to the United States and the State of Texas $15,449,126. This is one of the largest settlements for cases brought under the False Claims Act in the Southern District of Texas.

The whistleblower/ relator, Robert E. McCaslin, Jr., an employee in Patient Billing Services for the Hospital, filed a lawsuit under the qui tam provisions of the False Claims Act alleging that the Hospital District was making false claims and false statements with reimbursement claims being submitted to the Medicare and Medicaid programs for the treatment of patients. The Hospital District was accused of submitting claims to the Medicare and Medicaid programs without first seeking reimbursement from primary carriers as required by each program’s rules and regulations. The end result of this practice was that Medicare and Medicaid paid claims that should have been paid by other responsible third party insurers.

The Federal and State False Claims Acts allow private citizens, often known as whistleblowers or relators, with knowledge of fraud against the government to present those claims by bringing a lawsuit on behalf of the government. If the allegations are proven to be true, the private citizen, whistleblower/ relator, may be entitled to share in the recovery.  The whistleblower/ relator can receive as much as 30% of what the the government recovers, depending upon the case.

Congratulations to Assistant United States Attorney Andrew A. Bobb and Texas Assistant Attorney General Lara Silva for a job well done in conducting an excellent  an investigation and settlement negotiations.

Click Here to read more from the U.S.State Attorneys Office in Texas

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The United States Department of Justice celebrates another win in the fight against Medicare Fraud by corporations. This time, it stemmed from a case against The SCOOTER Store Inc. based out of San Antonio. The SCOOTER Store Inc. will pay the United States $4 million, and give up many millions more in pending claims for reimbursement to Medicare.

This settlement is part of our ongoing commitment to fighting abuse of Medicare's durable medical equipment benefit," said Assistant Attorney General Peter D. Keisler.

The Scooter Store Inc. was accused of fraudulent medicare claims for their motorized scooter. The company ran a savvy tv and print advertising campaign that enticed seniors to call them regarding a mobilized scooter.  The ads were very effective in getting the seniors to sign up and purchase the scooters.  How could anyone refuse, when they were told that medicare and insurance would pick up the cost?  The real problem began when the company coerced doctors into prescribing the mobile scooter as a medically necessary item. It does not stop there, The company  would then bill Medicare for power wheelchairs which cost about $5000 to $7000. This was considerably more than the $1,000 to $2,000 advertised motorized scooter. If it could not get any worse, The Scooter Store Inc., sold used equipment as new and unnecessary additional accessories. 

Thankfully, the brave whistleblower, a former Scooter Store, Inc., employee came forward with this information.  As a result of this bravery, the whistleblower will be awarded the statutory amount of $3,228,251, according to the Department of Justice.

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The federal government has accused southwest Oklahoma City hand surgeon Houshang Seradge of Medicaid and Medicare fraud and is seeking more than $40 million in damages from the surgeon, his associates and family members.

The government's civil lawsuit accuses Seradge and his associates of filing more than 6,400 false Medicare, Medicaid and TRICARE/CHAMPUS claims totaling more than $2.6 million.

The Whistleblowers/relators are being accused of being former disgruntled employees. The suit became public on April 19th after the federal government decided to intervene in the case.

Click Here to read more in The Oklahoman Newspaper  

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The United States has intervened in three qui tam suits accusing Health Essentials Solutions Inc. (HES) of false claims billings to Medicare, the Justice Department announced today. Specifically, HES is accused of upcoding – the practice of improperly assigning a diagnosis code to a patient discharge that is not supported by the medical record for the purpose of obtaining a higher level of reimbursement. Additionally, it is alleged that the Kentucky-based provider of geriatric care knowingly charged Medicare for medically unnecessary services.

The investigation of the allegations in the qui tam complaints was conducted by the U.S. Attorney's Office in Louisville, Ky., the Department's Civil Division, and the Office of Inspector General of the Department of Health and Human Services.

Click Here to Read more about the case from the DOJ

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Cell Therapeutics, Inc. (CTI) settled all government claims arising out of a Department of Justice investigation into allegations regarding alleged overpayments by Medicare to doctors who prescribed the anti-cancer drug, TRISENOX. As part of the settlement, CTI will pay $10.5 million plus interest and the Department of Justice has agreed to fully release CTI from all liability for the issues under investigation, including claims asserted in a qui tam lawsuit. The terms of the settlement contain no admission of wrongdoing by CTI.

According to a recent Seattle Times Article, Peter Kessler,  Assistant Attorney General for the Justice Department's Civil Division, stated "They misled a lot of doctors by telling them that the drug was medically accepted."  Cell Therapeutics blamed Medicare billing issues on consulting firm, Lash Group, a unit of pharmaceuticals distributor AmerisourceBergen. Lash denies the company's allegations.

Click Here to read more on the Seattle Times Article

 

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Does anyone watch TV out there? I can’t believe what is going on. Since I started prosecuting whistleblower cases I see the entire world through big Qui Tam colored glasses. If not looking at an actual Qui Tam case, then judging by TVs latest content, the world is very aware of the huge number of fraud claims which are being made on our government and which are tax dollars are actually paying.

What am I talking about? The Sopranos on HBO. The lead character,  Tony Soprano  is taking on a new and burgeoning criminal enterprise called Medicaid/Medicare fraud. In the first episode of The Soprano’s last season Tony Soprano is making plans to use a doctor to defraud Medicaid and Medicare for ghost MRIs. In other words, he is trying to conspire with a doctor to bill Medicare and Medicaid for MRI tests that are never actually completed. Now that is good business and it doesn’t take Tony Soprano to think it up. Anyone who pays any attention to fraud cases can see that 80% of the claims now being prosecuted are for health care related fraud. Ghost MRIs are real, not spooky, but real none the less.

But Tony is an enterprising man. He isn’t going to stop at some low level Medicare fraud. He is also jumping into the prescription drug fraud mess that our country refuses to face head on. Tony is creating a prescription drug ring by importing Fosamax in from Canada. Importing may be a bit euphemistic; we could say smuggling for clarity’s sake. Fortunately the people who are buying the Fosamax are not getting very effective dosages of Fosamax because the drugs Tony chooses to import are expired.

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The owner of three Miami durable medical equipment companies, Ricardo R. Aguera, was recently convicted by a jury of Medicare fraud - part of a larger kickback conspiracy. Federal prosecutors have launched new efforts to combat the growing problem of medicare Fraud in South Florida. The government is seeking to recoup an additional $30 million from 23 clinics and durable medical equipment companies. Four other defendants - Ivan Aguera, Robert Berenguer, Aristides Berenguer and Carlos Berenguer - entered guilty pleas to all counts in the indictment without plea agreements prior to trial. All five defendants are related and run health care companies that were involved in the fraud scheme. 

The medicare fraud scheme involved, pharmacy owners billing the Medicare program over $20 million. Half the money paid was kicked-back to the six defendants in exchange for bringing patients to the pharmacies.

Click here to read more on this medicare fraud case in South Florida Business Journal.

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Universal Health Services is being investigated for possible Medicare fraud. This case is regarding an investigation under the False Claims Act of compliance with Medicare and Medicaid rules and regulations pertaining to the employment of physicians and the solicitation of patient referrals from physicians.

The company was downgraded by Bear Stearns after an announcement that United Health Services received a search warrant in a criminal investigation of its South Texas affiliates.

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Medicare is a lifeline to millions of Americans. For the elderly it is often the only source of medical care, treatment, and nursing facility options. Medicare also creates jobs for thousands of doctors, nurses, technicians and other health care workers, whose livelihoods are funded by Medicare programs. The program is massive, and like many large government programs, opportunities for fraud frequently arise. The Medicare Ombudsman's Office is devoted to controlling waste and fraud, but can only do so much with limited resources. Thus the bulk of the responsibility for identifying unscrupulous medical billing practices is placed upon front line health care workers including caregivers, specialists, and medical billing and office staff.  

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Department of Justice (DOJ) -  False Claims Act Compliance and National Initiatives 

In fiscal year 2001, the Department of Justice (DOJ) reported recoveries over $1.2 billion related to civil health care fraud. The DOJ’s use of its False Claims Act authority has included several nationwide investigations of hospitals—projects known as national initiatives. These investigations resulted in significant concerns from hospital industry representatives.

The DOJ issued guidance on the appropriate use of the act in civil health care matters, including national initiatives to emphasize the importance of using the act in a fair and even-handed manner and to implement new procedures regarding national initiatives.

whistleblower.labovick.com/GAO_Med Fraud_DOJ_FCA_compliance_2002.pdf

 

 

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