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<title>Medicare Fraud - Whistleblower Law Blog</title>
<link>http://whistleblower.labovick.com/articles/whistleblower-articles/health-care-fraud/medicare-fraud/</link>
<description></description>
<language>en-us</language>
<copyright>Copyright 2010</copyright>
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<pubDate>Tue, 02 Mar 2010 15:36:37 -0500</pubDate>
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<title>HHS-DOJ Healthcare Fraud Summit - a step in the right direction</title>
<description><![CDATA[<p><br />
<img border="5" hspace="5" alt="Secretary Kathleen Sebelius  and Attorney General Eric Holder" vspace="5" align="left" width="150" height="100" src="http://whistleblower.labovick.com/uploads/image/Sectary and Attorney General.jpg" />This week on January 28, &nbsp;the Department of Healthand Human Services and the Department of Justice held an invitation only &nbsp;Summit on Health Card Fraud. Key Speakers included Secretary Kathleen Sebelius and&nbsp;U.S. Department of Justice Attorney General Eric Holder.</p>
<p>The summit was an unprecedented event on&nbsp;health care fraud where&nbsp;law enforcement and the private and public sectors come together as a&nbsp;part of the Obama Administration&rsquo;s coordinated effort to fight health care fraud. The seminar covered such topics as&nbsp;</p>
<ul>
    <li>&nbsp;Use of technology to prevent and detect health care fraud and improper payments.</li>
    <li>Role of states in preventing health care fraud.</li>
    <li>Development of effective prevention policies and methods for insurers, providers and beneficiaries.</li>
    <li>Effective law enforcement strategies.</li>
    <li>Measuring health care fraud, assessing recoveries and determining resource needs.&nbsp;</li>
</ul>
<p>Highlights from some of the key speakers include the following:</p>
<p><a href="http://www.hhs.gov/secretary/">Secretary Kathleen Sebelius</a> gave a moving introduction of the significance of the summit. She reinforced the Obama Administration's stance on&nbsp;&quot;zero&nbsp;tolerance&quot; for criminals who cheat&nbsp; taxpayers, endanger patients, and jeopardize the future of &nbsp;Medicare. A few highlights from her speach include the following remarks:</p>
<blockquote>
<p>&quot;Today, the President has asked us to put these criminals on notic. The problem of health care fraud is bigger than either government, law enforcement or the private industry can handle alone. We will need all of us working together to solve it. In the fight to prevent, find, catch, and prosecute these crooks, we want every good idea we can get.</p>
</blockquote><blockquote>
<p>Health care fraud is a national problem. It affects federal programs like Medicare, state programs like Medicaid, and private insurance companies. We&rsquo;re all part of a health care system that has been undergoing rapid growth.</p>
<p>Between 1970 and today, America&rsquo;s annual health care spending has gone from $75 million to over $2.5 billion. That has produced significant benefits for patients. But it&rsquo;s also created a much bigger target for criminals. And a much bigger challenge for investigators. The difference between catching fraud then and now is the difference between trying to find a penny in a bathtub and trying to find a penny in a swimming pool.&quot;</p>
</blockquote>
<p><a href="http://www.justice.gov/ag/">Attorney General Eric Holder </a>stated in his opening remarks that the HHS-DOJ Healthcaree Fraud&nbsp;summit marks a critical step forward in the work being done by HEAT, our Health Care Fraud Prevention and Enforcement Action Team that was established last May.&nbsp;He gave several insightful comments after addressing the fact that we have a serious problem on our hands with healthcare fraud. If the agencies, concerned advocuates and citizens work together,&nbsp;combined forces, more progress will be made.</p>]]><![CDATA[<p>Comments from Attoney General Holder on&nbsp;the next steps that should be taken in the fight aganst healthcare fraud.</p>
<blockquote>First, we must strengthen HEAT (&nbsp;We will continue to combine and leverage our agencies&rsquo; resources and expertise, including the FBI,the Office of Inspector General at HHS,&nbsp;and&nbsp;the local U.S. Attorneys Offices to pursue both civil and criminal cases. </blockquote><blockquote>
<p>Second, we&rsquo;ll continue to support our Medicare Fraud Strike Forces and work to expand these teams to areas of the country where our efforts are most needed. These teams have changed the enforcement landscape.</p>
</blockquote><blockquote>
<p>Third, we will continue to push for the investments necessary to meet our duties and do our jobs. I&rsquo;m pleased that Congress and the Administration have provided strong support.</p>
<p>Fourth, our agencies will continue to work with Congress to identify and pursue the legislative and regulatory reforms necessary to prevent, deter and prosecute health care fraud.&quot;</p>
</blockquote>
<p>Incoming <a href="http://www.justice.gov/opa/pr/2009/December/09-ag-1378.html">Acting Deputy Attorney General Gary Grindler</a> stated the followng in his remarks:</p>
<blockquote>
<p>&quot;Every year, hundreds of billions of dollars are spent to provide health care for millions of American seniors, children, and the disabled. And each year billions of these dollars are stolen through fraudulent schemes that cheat taxpayers and contribute to the increasing cost of health care for all Americans. <br />
<br />
We are here today because we know we need to do more. Not only does health care fraud harm the stability of public health care programs, it harms everyone - it drives up the cost of health care, insurance premiums, and taxes for all Americans.&quot;</p>
</blockquote>
<p>We applaud the efforts of the Obama Administration and the agencies that have come together to address&nbsp; this critical issue of fighting healthcare fraud.&nbsp; As <a href="http://www.labovick.com/lawyer-attorney-1237341.html">Civil Justice Prosecutors</a>, we are vigilant in the prosecution of fighting corruption, especially fraud against the government and taxpayers.&nbsp;The crime and corruption will only stop if the protocols and measures are put in place to uncover the fraud, and prosecutte the criminals that are found guilty.&nbsp; This will only stop, if criminals, including corporations, understand the significance with huge fines and jail time,where appropriate.</p>
<p>For more information on the fight against Healthcare visit the following sites:<br />
<br />
<a href="http://www.justice.gov/oig/FOIA/hotline.htm">DOJ website on reporting fraud</a><br />
<br />
<a href="http://www.stopmedicarefraud.gov/">Stop Medicare Fraud - Government site</a></p>
<p>&nbsp;I</p>
<p>&nbsp;</p>]]></description>
<link>http://whistleblower.labovick.com/2010/01/articles/whistleblower-articles/health-care-fraud/hhsdoj-healthcare-fraud-summit-a-step-in-the-right-direction/</link>
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<category>Acting Deputy Attorney General Gary Grindler</category><category>Attorney General Eric Holder</category><category>HEAT</category><category>Health Care Fraud</category><category>Medicaid Fraud</category><category>Medicare Fraud</category><category>Secretary Kathleen Sebelius</category><category>healthcare fraud summit</category>
<pubDate>Sat, 30 Jan 2010 06:06:50 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

</item>
<item>
<title>Qui tam suit charges stent device makers of off-label use</title>
<description><![CDATA[<p>A qui tam law suit&nbsp;that&nbsp;accuses Boston Scientific Corp. (NYSE:BSX), Johnson &amp; Johnson (NYSE:JNJ) and its Cordis Corp. subsidiary and Abbott (NYSE:ABT) of&nbsp;promoting the off-label use of biliary stents to treat cardiovascular disease in hundreds of thousands of patients has been unsealed.</p>
<p>The Whistleblower, Kevin Colquitt,&nbsp;filed&nbsp;the qui tam lawsuit under 31 U.S.C. 3729 (False Claims Act) and other&nbsp;State&nbsp;False Claims Act Statutes for violations against&nbsp;Medicare, Medicaid, CHAMPUS and TRICARE.&nbsp; The lawsuit allegesthat the companies involved, committed Medicare Fraud and filed fraudulent clearance applications with the FDA.</p>
<p>According to the <a href="http://www.nytimes.com/2010/01/15/business/15stent.html">New York Times</a>,&nbsp;the Justice Department and two of those states, Florida and Tennessee, said in court filings that they were declining for the moment to do so, but added that they were continuing to investigate.</p>
<p>Click on the following link: to view the <a href="http://www.scribd.com/full/25263250?access_key=key-2oh3zz357u610zfe04bs">Colquitt Whistleblower Court Documents</a>&nbsp;</p>
<p>Click on the following links to learn more on this qui tam lawsuit,</p>
<p><a href="http://www.massdevice.com/node/5486">Mass Device</a><br />
<a href="http://www.nytimes.com/2010/01/15/business/15stent.html">The New York Times</a><br />
<br />
<br />
&nbsp;</p>
<p>&nbsp;</p>]]></description>
<link>http://whistleblower.labovick.com/2010/01/articles/qui-tam-legal-news/qui-tam-suit-charges-stent-device-makers-of-offlabel-use/</link>
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<category>Abbott</category><category>Boston Scientific</category><category>Johnson &amp; Johnson</category><category>Kevin Colquitt</category><category>Medicare Fraud</category><category>Qui tam Legal News</category>
<pubDate>Tue, 19 Jan 2010 06:14:05 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<item>
<title>Minnesota Hospital to Pay U.S. nearly $1 Million to Resolve Qui tam Allegations Admissions</title>
<description><![CDATA[<p>The year is starting off on the right tone with qui tam settlements for Medicare fraud. The Minnesota case&nbsp; United States ex rel. Steven Radjenovich v. Stanley Gallagher, et al., Case No.: 04-4538 (D. Minn.) was settled&nbsp;for&nbsp;$846,461 today.&nbsp;</p>
<p>According to the <a href="http://www.justice.gov/opa/pr/2010/January/10-civ-001.html">Department of Justice</a>,&nbsp;Wheaton Community Hospital&nbsp;knowingly made false claims to Medicare for unreasonable and unnecessary hospital admissions. These false claims were made from 1998 to 2004. The hospital&nbsp;billed Medicare for&nbsp;acute patient care that&nbsp;was not medically necessary.</p>
<p>Tony West, Assistant Attorney General for the Justice Department&rsquo;s Civil Division stated the following:</p>
<blockquote>
<p>&nbsp;&quot;Hospitals and doctors have a responsibility to provide patients with reasonable and necessary care. When they neglect those obligations, patients and taxpayers suffer.&quot;</p>
</blockquote>
<p>The whistleblower in this case will be awarded&nbsp;$203,150,&nbsp;as his&nbsp;share of the settlement with Wheaton Community Hospital. In a qui tam&nbsp;case,&nbsp;the <a href="http://www.labovick.com/lawyer-attorney-1237341.html">whistleblower's reward or relator's award can be anywhere from 15% to 30%,</a> depending upon&nbsp;the level of the government's involvement&nbsp;in the case.<br />
<br />
If you are a whistleblower and have pertinent information on Medicare, Medicaid fraud or any other false claims act violations from a company, protect your rights and contact a qualified qui tam attorney to discuss how to protect your rights.</p>]]></description>
<link>http://whistleblower.labovick.com/2010/01/articles/whistleblower-articles/health-care-fraud/medicare-fraud/minnesota-hospital-to-pay-us-nearly-1-million-to-resolve-qui-tam-allegations-admissions/</link>
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<category>Medicaid Fraud</category><category>Medicare Fraud</category><category>Wheaton Community Hospital</category><category>department of justice</category><category>whistleblower reward</category>
<pubDate>Mon, 04 Jan 2010 18:31:09 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Happy New Year 2010 - Justice prevails</title>
<description><![CDATA[<p>Happy New Year 2010!! Today is the first day of the New Year.&nbsp;<img border="3" hspace="5" alt="" align="right" width="180" height="119" src="http://whistleblower.labovick.com/uploads/image/2010 happy new year balloons.jpg" />&nbsp;Last year&nbsp;marked a milestone in record breaking&nbsp;settlements relating to qui tam and false claims act violations.</p>
<p>The year ended&nbsp;with&nbsp;a <a href="http://www.justice.gov/opa/pr/2009/December/09-civ-1384.html">qui tam settlement from&nbsp;Genesys Health System&nbsp;in the amount of&nbsp; $669,413</a>. The lawsuit brought by the Justice&nbsp;Department alleged that&nbsp; the health care provider violated the False Claims Act by submitting false claims to Medicare.</p>
<p>Genesys, a Grand Blanc, Mich.-based Company, provides health care services through a network of medical facilities located in Michigan. The government alleged that between 2001 and 2007, Genesys violated the False Claims Act by billing Medicare for higher levels of service than were actually rendered to patients. Specifically, the government alleged that Genesys overbilled for evaluation and management services provided to cardiology patients.</p>
<p>Assistant Attorney General of the Justice Department&rsquo;s Civil Division, Tony West stated:</p>
<blockquote>
<p>&quot;We are committed to vigorously pursuing those who defraud Medicare.&nbsp;Taxpayer dollars should be spent on health care services for patients, not wasted on fraud and abuse.&quot;</p>
</blockquote>
<p>This case was a success due&nbsp;to the&nbsp;coordinated efforts of the Justice Department&rsquo;s Civil Division, the U.S. Attorney&rsquo;s Office for the Eastern District of Michigan, and the Office of Investigations for the Department of Health and Human Services&rsquo; Office of Inspector General and Office of Counsel to the Inspector General.<br />
&nbsp;</p>]]></description>
<link>http://whistleblower.labovick.com/2010/01/articles/whistleblower-articles/health-care-fraud/medicare-fraud/happy-new-year-2010-justice-prevails/</link>
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<category>False Claims Act</category><category>Genesys Health System</category><category>Medicare Fraud</category><category>Medicare Fraud</category><category>Tony West</category><category>qui tam settlement</category>
<pubDate>Fri, 01 Jan 2010 22:38:55 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

</item>
<item>
<title>Qui tam suit against Healthways settled for $40,000,000</title>
<description><![CDATA[<p>Another successful case in the win column for whistleblowers (relators) bringing qui tam suits, In this most recent instance, whistleblower, Steve Pogue, and his legal team can breathe a sigh of relief, because the litigation against Healthways that took 15 years has finally settled for $40,000,000.</p>
<p>It started back in 1994 when Mr. Pogue was fired from his job as a marketing representative for a company called Diabetes Treatment Centers of America, (owned by parent company Healthways).. The hard work and tireless efforts for bringing justice on behalf of the United States for the Diabetes Treatment Centers for&nbsp;stealing&nbsp;millions of&nbsp;dollars in taxpayer money&nbsp;through Medicare fraud and illegal kickbacks, paid off inthe recent&nbsp;settlement.</p>
<p>Since the government decided not to intervene, whistleblower, Steve Pogue will collect 25% - 30% of the settlement as a reward.&nbsp; That comes out to $10,000,000 - $12,000,000 for him stepping forward and bringing forth the qui tam claim. Hopefully settlements like these will encourage more whistleblowers to report fraud against their employers that are stealing from the government.</p>
<p>Legal Blogger, from Getnick &amp; Getnick on QuitamHelp.com, made a valid point in the&nbsp;blog post <a href="http://www.quitamhelp.com/index.php?/weblog/healthways_pays_40_million_in_15_year_qui_tam_lawsuit/">&quot;Healthways pays $40 million to settle 15 year qui tam suit</a>, when they shared the following statement:</p>
<blockquote>
<p>&quot;This case &ldquo;demonstrates the wisdom of Congress in deciding that the government&rsquo;s decision not to participate does not mean that a case has no merit.&rdquo;</p>
</blockquote>
<p>Although it took 15 years, the reward was great, Unfortunately, it is not always like this and sometimes the whistleblower doesn't win such a large amount of money.&nbsp;&nbsp;Wen working with&nbsp;whistleblowers around the country, most step forth and bring fraud to their employer's attention, because they want to do what is right for the company and the government. Unfortunately, most companies fire the messenger or make their lives miserable,. The whistleblower is forced&nbsp;is forced to seek legal counsel and bring the company's&nbsp;fraudulent behavior to the authorities..</p>
<p>Hopefully, the proposed <a href="http://whistleblower.labovick.com/admin/trackback/138898">False Claims Act Amendment </a>will&nbsp;give protections to more whistleblowers so that we can prevent taxpayer&nbsp;fraud.&nbsp; We all lose, when someone defrauds the government.&nbsp;&nbsp;Let's all be watchful of how companies bill&nbsp;the government and spend government funds.&nbsp;&nbsp;If&nbsp;the public doesn't keep a watchful eye out&nbsp;for the government, who else&nbsp;will? Definitely not the companies stealing and overcharging the government.</p>
<p>To learn more on this qui tam settlement from Healthways, read <a href="http://www.medicalnewstoday.com/articles/152048.php">Medical News Today</a></p>]]></description>
<link>http://whistleblower.labovick.com/2009/06/articles/qui-tam-legal-news/qui-tam-suit-against-healthways-settled-for-40000000/</link>
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<category>False Claims Act Amendment</category><category>Health Care Fraud</category><category>Healthways</category><category>Medicare Fraud</category><category>Qui tam Legal News</category><category>Steve Pogue</category>
<pubDate>Fri, 12 Jun 2009 21:49:23 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<item>
<title>Health System settles Qui tam suit for $1.9 million</title>
<description><![CDATA[<p>Whistleblower Anthony Kite has $1.9 million reasons to be happy this Thanksgiving. The Pennsylvania based, St. Vincent Health System settled a qui tam case pay $1.9 million to the federal government to settle a whistleblower lawsuit that alleged the hospital submitted reimbursement claims to Medicare that greatly exceeded actual costs.&nbsp; <br />
<br />
This is the latest in a string of whistleblower cases settled against hospitals.&nbsp; What makes this cases really interesting is that the whistleblower, Anthony Kite, has been instrumental in bringing several qui tam cases to light.&nbsp; According to Mr. Kite, St. Vincent Health System increased Medicare reimbursement claims from 2001 to 2003 with the hopes of receiving what is commonly referred to as &quot;outlier&quot; or supplemental payments.&nbsp; Surprisingly, other hospitals were doing the same thing according to allegations brought by the whistleblower.</p>
<p>What makes this suit fascinating is that Medicare uses &quot;outlier&quot; payments to hospitals for instances where costs for treating a patient exceed a predetermined reimbursement amount for a particular type of treatment.&nbsp; One can only imagine how many times hospitals have taken advantage of this loophole to try and take advantage of Medicare billing.<br />
<strong><br />
A few other qui tam suits against Hospitals and Health Care Systems include:</strong><br />
Cooper University Hospital in Camden, N. J., $3.85 million&nbsp;settlement.<br />
Warren Hospital in Phillipsburg, N.J.,&nbsp;$7.5 million settlement<br />
Bayonne Medical Center in Bayonne, N.J., $2.5 million settlement<br />
Cathedral Healthcare System in Newark, N. J. $5.3 million settlement<br />
Raritan Bay Medical Center in Perth Amboy, N.J. $7.5 million settlement<br />
Grand Total: <strong>$26,650,000.00 </strong>- In Qui tam/ whistleblower suits against Health Systems</p>
<p>Now, I must caution you to not think that every whistleblower claim produces results like these, because they do not. It takes PROOF and hard FACTS to prove the claim and it takes time.&nbsp; As most whistleblowers can attest to this fact.</p>
<p>Click <a href="http://www.healthcarefinancenews.com/story.cms?id=8993">here </a>to read more on this whistleblower suit against health systems.<br />
<br />
Click <a href="http://www.labovick.com/lawyer-attorney-1237341.html">here </a>to read more on qui tam statutes and how to file a whistleblower claim.</p>
<p>&nbsp;</p>]]></description>
<link>http://whistleblower.labovick.com/2008/11/articles/qui-tam-legal-news/health-system-settles-qui-tam-suit-for-19-million/</link>
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<category>Anthony Kite</category><category>Bayonne Medical Center</category><category>Cathedral Healthcare System</category><category>Cooper University Hospital</category><category>Health Care Fraud</category><category>Medicare Fraud</category><category>Medicare outlier payments</category><category>Qui tam Legal News</category><category>Raritan Bay Medical Center</category><category>St. Vincent Health System</category><category>Warren Hospital</category><category>Whistleblower Legal News</category>
<pubDate>Wed, 26 Nov 2008 14:35:30 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Miami men charged in $110 Million Medicare False Claims Scheme uncovered by the Medicare Fraud Strike Force</title>
<description><![CDATA[<p>Four Miami men have been charged in $110 Million Medicare False Claims&nbsp;Scheme that was uncovered by the Medicare Fraud Strike Force. According to the Department of Justice&rsquo;s Criminal <img height="155" width="160" align="right" alt="" src="http://whistleblower.labovick.com/DOJ SEAL(1).jpg" />Division and the U.S. Attorney&rsquo;s Office for the Southern District of Florida, Carlos and Luis Benitez, Jose Benitez and Thomas McKenzie were all allegedly involved in the Medicare Fraud. The alleged fraud happened&nbsp;from January 2001 through November 2004.&nbsp; <br />
<br />
The four men&nbsp;are accused of conspiring&nbsp;to submit $110 Million in fraudulent false Medicare Claims&nbsp;for HIV infusion services&nbsp;provided at&nbsp; the following 11&nbsp;HIV infusion clinics: AH Medical Office Inc.; Advanced Medical Rehabilitation Center Inc.; Best Medi Corp.; Physician&rsquo;s Health Med-Care; Physician&rsquo;s Med-Care Inc.; Saint Jude Rehab Center Inc.; Global Med-Care Corp.; CNC Medical Corp.; G&amp;S Medical Centers Inc.; Karla Medical Services Inc.; and Best Medicare Inc. </p>
<p>According to the indictment, The Medicare False Claims Scheme involved recruiting Medicare beneficiaries to go to the Clinics under the false pre-tense of needing HIV infusion services.&nbsp; Physicians and medical staff were trained to fraudulently show that medical services were&nbsp;performed and&nbsp;medically necessary. <br />
<br />
Thanks to the valiant efforts of&nbsp;Deputy Chief Kirk Ogrosky's Strike Force Team and&nbsp;U.S. Attorney R. Alexander Acosta's&nbsp;outstanding prosecutors, this&nbsp;Medicare fraud was uncovered. We applaud their efforts and hard work.</p>
<p>Five Ways we can combat&nbsp;Medicare False Claims fraud and prevent new schemes&nbsp;</p>
<ul>
    <li>First,&nbsp;&nbsp;we can prosecute people and companies that are guilty of&nbsp;Medicare False Claims. </li>
    <li>Second, we can ask for Whistleblowers to come forward and report the&nbsp;fraud/ false claims. </li>
    <li>Third, we can support the Medicare Fraud Strike Force team by ensuring they are adequately funded and staffed to handle the investigations and prosecution. </li>
    <li>Fourth, we can pass stringent legislation that helps prosecute those found guilty of fraud/false claims. </li>
    <li>Fifth, we can make it easier to reward&nbsp;whistleblowers for coming forward and reporting Medicare fraud and Medicare false claims schemes and simplify the&nbsp;process. </li>
</ul>
<p>&nbsp;&nbsp;</p>
<p>&nbsp;<br />
</p>
<p><br />
<br />
<br />
</p>]]><![CDATA[If you, or someone you know, has information on government fraud or false claims to the government, we encourage you to step forward and report this information. To learn more about qui tam and the false claims act, we invite you to read our firm website on the topic area <a href="http://www.labovick.com/lawyer-attorney-1237341.html">qui tam.</a> <br />
<br />
If you have any questions on the subject of qui tam or Federal/State False Claims, Former U.S. DOJ Attorney, <a href="http://www.labovick.com/lawyer-attorney-1237397.html">Brian F. LaBovick</a>, is available to answer your questions, via email or phone. <br />
<br />
Click here to read more from the <a href="http://www.usdoj.gov/usao/fls/PressReleases/080611-02.html">United States Attorney Office, Southern District of Florida</a>. <br />
<br />
<br />
<br />]]></description>
<link>http://whistleblower.labovick.com/2008/06/articles/whistleblower-articles/health-care-fraud/medicare-fraud/miami-men-charged-in-110-million-medicare-false-claims-scheme-uncovered-by-the-medicare-fraud-strike-force/</link>
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<category>Deputy Chief Kirk Ogrosky</category><category>Healthcare false claims</category><category>Healthcare fraud</category><category>Medicare False Claims</category><category>Medicare Fraud</category><category>Medicare Fraud Strikeforce</category><category>U.S. Attorney R. Alexander Acosta</category>
<pubDate>Sat, 14 Jun 2008 08:04:00 -0500</pubDate>
<dc:creator>Juliet Sallette</dc:creator>

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<title>Florida Hospital pays over $7 million to settle False Claims Act violations due to doctor referrals</title>
<description><![CDATA[<p>The <a href="http://www.baptisthealth.net/">Baptist Health South Florida Inc.,</a>&nbsp;will&nbsp;pay the United States $7,775,000 to settle&nbsp;False Claims Act and the Stark Statute violations that allegedly occurred between 2003 and 2005. According to the Department of Justice this&nbsp;probe involved Baptist Health South Florida,&nbsp;&nbsp;over compensating an&nbsp;oncology group for patient referrals&nbsp;to&nbsp;Baptist's hospitals.&nbsp;The payments were made pursuant to a contract under which the oncology group provided physics and dosimetry services to the two hospitals. </p>
<p>The Stark Statute prevents Medicare providers like Baptist from&nbsp;billing the federal health care program for referrals from doctors that have&nbsp;a financial relationship with the provider. There are a few exceptions for the Stark Statute.<br />
<br />
Click <a href="http://www.sunherald.com/447/story/554773.html">here </a>to read more from the Department of Justice and the Sun Herald on this False Claims Act settlement.<br />
</p>]]></description>
<link>http://whistleblower.labovick.com/2008/05/articles/whistleblower-articles/health-care-fraud/florida-hospital-pays-over-7-million-to-settle-false-claims-act-violations-due-to-doctor-referrals/</link>
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<category>Baptist Health South Florida</category><category>Baptist Hospital</category><category>Health Care Fraud</category><category>Medicare Fraud</category>
<pubDate>Fri, 16 May 2008 07:17:42 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Touro Infirmary settles Qui Tam suit for $1.75 Million</title>
<description><![CDATA[<p>A&nbsp;New Orleans Hospital, <a href="http://www.touro.com/content/">Touro Infirmary</a>, recently settled a qui tam suit for $1.75 million. According to the <a href="http://www.usdoj.gov/opa/pr/2008/April/08_civ_316.html">Department of Justice</a>, the&nbsp;suit alleged that Touro Infirmary,&nbsp;submitted false claims to the Medicare program.</p>
<p>Involved in the Medicare scheme with the New Orleans Hospital, was Dr. Maria Carmen Palazzo. In previous a <a href="http://whistleblower.labovick.com/admin/trackback/32421">Whistleblower Blog post,</a> we mentioned&nbsp;Dr. Palazzo's involvement with fraud in Paxil&nbsp;trials. &nbsp;According to the recent qui tam case involving Touro Infirmary, Dr. Carmen Palazzo received&nbsp;unlawful payments of $144,000 per year from 2000 to 2004. This was a part of the scheme to&nbsp;get patient referrals to the hospital from Dr. Maria Carmen Palazzo to refer patients to the hospital.&nbsp;According to recent reports,&nbsp; Dr. Palazzo, was found guilty on&nbsp;39 counts of health care fraud, including 13 counts arising from her contractual relationship with Touro.</p>
<p>Click here to read more from the <a href="http://www.usdoj.gov/opa/pr/2008/April/08_civ_316.html">Department of Justice,</a>&nbsp;on the False Claims Act&nbsp;settlement from Touro Infirmary.</p>]]></description>
<link>http://whistleblower.labovick.com/2008/04/articles/whistleblower-articles/health-care-fraud/medicare-fraud/touro-infirmary-settles-qui-tam-suit-for-175-million/</link>
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<category>Dr. Carmen Maria Palazzo</category><category>Medicare Fraud</category><category>Qui</category><category>Touro Infirmary FCA settlement</category><category>Tuoro</category><category>medicare false claims settlement</category><category>settlement&quot;</category><category>tam</category>
<pubDate>Thu, 24 Apr 2008 21:40:25 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Florida doctor settles Medicare qui tam suit for $7 million</title>
<description><![CDATA[<p>Medicare&nbsp;fraud can happen anywhere and can be detected by the most least suspecting individual in a company.&nbsp; Recently, Fred Steinberg, M.D, a radiologist and&nbsp;owner of the&nbsp;chain, of&nbsp; University MRI and Diagnostic Imaging Centers, located in Florida settled a qui tam suit for $7 million.&nbsp; The&nbsp; Florida firm denied all charges and agreed to settle the qui tam suit according to a quote in the Sun Sentinel&nbsp; &quot;to end the uncertainty of protracted litigation.&quot;</p>
<p>The company was accused of&nbsp;overcharging Medicare for&nbsp;Medical scans and billing the federal government for some&nbsp;tests that were not medically necessary. There were also allegations that that the Florida company&nbsp;paid doctors under the table for sending them imaging patients for tests that&nbsp;could cost&nbsp;as much as&nbsp;$2,500 apiece. </p>
<p>Why is it that&nbsp;when an employee&nbsp;reports questionable government billing practices to management, in this case Medicare bills, the company&nbsp; takes the defensive and fires the&nbsp;employee. </p>
<p>In the case of the Florida Diagnostic Imaging Centers, David Clayman, M.D,&nbsp;a former radiologist for&nbsp;the imaging centers, was fired after questioning the Medicare billing practices. According to a recent <a href="http://www.usdoj.gov/opa/pr/2008/April/08_civ_292.html">DOJ release,</a> Dr. Clayman will receive $1.75 million as his share of the $7 Million recovery. </p>
<p>According to the American College of Radiology, a doctors' association, in a <a href="http://www.sun-sentinel.com/news/local/palmbeach/sfl-flpfraud0415pnapr15,0,1676635.story">Sun Sentinel article</a>, the cost for&nbsp;Medicare and insurers&nbsp;is about&nbsp;$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&nbsp;expose patients to&nbsp;radiation and&nbsp;and raise medical costs. </p>
<p>One of our favorite crusaders in the Medicare fraud fight, R. Alexander Acosta, U.S. Attorney for the Southern District of Florida, stated that&nbsp; &ldquo;We will aggressively prosecute any physicians, including board-certified specialists, who abuse and steal from the Medicare system to line their own pockets.&rdquo;&nbsp;&nbsp;Attorney Brian F. LaBovick mentions in an article&nbsp;on health care fraud for a&nbsp; <a href="http://whistleblower.labovick.com/Brian%20Health%20Care%20Fraud%20Article_Andrews%20Litigation%20Reporter.pdf">Thomson West Litigation Reporter</a>, that &quot;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.&quot;</p>
<p>The Florida qui tam case discussed in this post is:&nbsp;U.S. ex rel. David Clayman v. University MRI and Fred Steinberg, M.D. et al. Civil Action No. 02-81143 (S.D. Fla.).&nbsp;<br />
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<link>http://whistleblower.labovick.com/2008/04/articles/whistleblower-legal-news/florida-doctor-settles-medicare-qui-tam-suit-for-7-million/</link>
<guid isPermaLink="false">http://whistleblower.labovick.com/2008/04/articles/whistleblower-legal-news/florida-doctor-settles-medicare-qui-tam-suit-for-7-million/</guid>
<category>American College of Radiology</category><category>Medicare Fraud</category><category>Qui tam Legal News</category><category>R. Alexander Acosta</category><category>U.S. ex rel. David Clayman v. University MRI and Fred Steinberg, M.D</category><category>Whistleblower Legal News</category>
<pubDate>Tue, 15 Apr 2008 20:29:31 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Florida-based AccuLab settles Medicare false claims allegations for $461,000</title>
<description><![CDATA[<p>Florida based, Acculab Laboratories&nbsp;has&nbsp;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&nbsp;Justice Department. The allegations surrounding the Sarasota based company included included billing Medicare&nbsp;for laboratory services that were not ordered, were not provided, were not medically necessary or were improperly unbundled. <br />
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The&nbsp;whistleblower will receive $92,200 of the settlement. The&nbsp;whistleblower provisions of the False Claims Act, allows private parties, called &quot;relators,&quot;&nbsp;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. </p>
<p>It is the American taxpayer who is victimized when a provider submits false claims to Medicare,&quot; said acting Assistant Attorney General Jeffrey S. Bucholtz. </p>
<p>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.&nbsp;</p>
<p>Click here to read more from the <a href="http://www.usdoj.gov/opa/pr/2008/March/08_civ_212.html">Department of Justice</a></p>]]></description>
<link>http://whistleblower.labovick.com/2008/03/articles/whistleblower-articles/health-care-fraud/medicare-fraud/floridabased-acculab-settles-medicare-false-claims-allegations-for-461000/</link>
<guid isPermaLink="false">http://whistleblower.labovick.com/2008/03/articles/whistleblower-articles/health-care-fraud/medicare-fraud/floridabased-acculab-settles-medicare-false-claims-allegations-for-461000/</guid>
<category>Jeffrey S. Bucholtz</category><category>Medicare Fraud</category><category>acculab</category><category>false claims act</category>
<pubDate>Tue, 18 Mar 2008 10:27:53 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Regional Hospital accused of Medicare fraud by U.S. Attorney</title>
<description><![CDATA[<p>South Carolina Regional Hospital, Tuomey Regional Medical Center, is accused of Medicare and Medicaid &nbsp;fraud in a qui tam lawsuit, brought by the U.S. Attorney's Office in South Carolina.&nbsp; According to a recent article on <a href="http://www.thestate.com/154/story/330472.html">State.com</a>, the suit involves the Regional Hospital&nbsp;overcharging Medicare for surgeries and &ldquo;bribing&rdquo;&nbsp;doctors with&nbsp;&ldquo;kickbacks&rdquo;&nbsp;for their&nbsp;business. The case is being handled by&nbsp;U.S. Attorney Norman Acker. The lawsuit&nbsp;alleges that the Toumey Regional Medical Center&nbsp;created&nbsp;a billing scheme from January 2005 to September 2007,&nbsp;in which&nbsp;&quot;it submitted and caused others to submit false and fraudulent claims for payment to Medicare and Medicaid ...&rdquo;</p>
<p>Judge Matthew Perry&nbsp;ruled yesterday that the&nbsp;Justice Department-backed lawsuit against the South Carolina Regional Hospital&nbsp;can proceed and&nbsp;crucial evidence against the Hospital can be admitted into the&nbsp;f the case. The lawyers for the hospital had been trying to get the case dismissed. </p>
<p>Orthopedic Surgeon, Michael Drakeford,&nbsp;initial&nbsp;qui tam lawsuit&nbsp; was filed under seal in federal court in Columbia in October 2005. The&nbsp;federal government&nbsp;investigated Drakeford&rsquo;s claims and before taking over as lead plaintiff in the case.&nbsp;</p>
<p>Time will tell how much of the&nbsp;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.</p>
<p>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.&nbsp;<br />
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Charles Miller, a Department of Justice spokesman is quoted as saying, &quot;The government intervenes only if a case has merit.&nbsp;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.&quot;<br />
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Click here to read more on this case from the <a href="http://www.thestate.com/154/story/330472.html">State.com</a><br />
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<link>http://whistleblower.labovick.com/2008/02/articles/whistleblower-articles/health-care-fraud/medicare-fraud/regional-hospital-accused-of-medicare-fraud-by-us-attorney/</link>
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<category>Health Care Fraud</category><category>Judge Matthew Perry</category><category>Medicaid Fraud</category><category>Medicare Fraud</category><category>Michael Drakeford</category><category>Norman Acker</category><category>Toumey Regional Medical Center</category>
<pubDate>Thu, 28 Feb 2008 02:25:04 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Kickback scheme costs Health South $14.2 Million to settle Health Care Fraud Claims</title>
<description><![CDATA[<p><a href="http://www.usdoj.gov/opa/pr/2007/December/07_civ_1007.html">HealthSouth Corporation</a>&nbsp;agrees to pay&nbsp;$14.2&nbsp;million to settle allegations that the&nbsp;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&nbsp;Justice Department.&nbsp;<br />
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HealthSouth,&nbsp;the nation&rsquo;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. <br />
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The settlement&nbsp;was due to the joint efforts of&nbsp;the U.S. Attorney for the Northern District of Alabama,&nbsp;the U.S. Attorney&rsquo;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. <br />
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U.S. Attorney for the Central District of California, &ldquo;<a href="http://www.whitehouse.gov/news/nominations/1149.html">Thomas P. O&rsquo;Brien</a>,&nbsp;gave a powerful statement in response to the settlement and&nbsp;kickbacks&nbsp;&ldquo;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.&rdquo;</p>
<p>HealthSouth Corporation stock closed yesterday at <a href="http://www.healthsouth.com/who_we_are/investor_information.asp">$21.48.</a>&nbsp;Click <a href="http://www.healthsouth.com/who_we_are/investor_information.asp">here</a> to find out more from Health South.</p>
<p>To read more from the Department of Justice, Click <a href="http://www.usdoj.gov/opa/pr/2007/December/07_civ_1007.html">here</a>.</p>
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<link>http://whistleblower.labovick.com/2007/12/articles/whistleblower-articles/health-care-fraud/kickback-scheme-costs-health-south-142-million-to-settle-health-care-fraud-claims/</link>
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<category>Health Care Fraud</category><category>HealthSouth Corporation</category><category>Medicaid Fraud</category><category>Medicare Fraud</category><category>Thomas P. O&apos;Brien</category>
<pubDate>Mon, 31 Dec 2007 15:00:33 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>St. Josephs Hospital settles Whistleblower Suit for $26 Million</title>
<description><![CDATA[<p>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 &quot;whistleblower&quot; lawsuit that alleges the hospital violated the federal False Claims Act in regards to Medicare billing practices.&nbsp; According to the <a href="http://www.usdoj.gov/usao/gan/press/2007/12-21-07.pdf">DOJ</a>, 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&nbsp;inpatient&nbsp;services are more than outpatient&nbsp;services.</p>
<p>&nbsp;According to United States Attorney, David M. Nahmias, &quot;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.&quot;</p>
<p>This is a strong message to the&nbsp;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.&nbsp; In a prior&nbsp; <a href="http://whistleblower.labovick.com/2007/11/articles/whistleblower-legal-news/whistleblower-legislation-pays-2007-government-recovered-2-billion-in-fraud-cases/">Whistleblower Law Blog</a> post this year, we reported that&nbsp;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.&nbsp; 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. <br />
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To read more from the Department of Justice on St. Johns Medical Center, Click <a href="http://www.usdoj.gov/usao/gan/press/2007/12-21-07.pdf">Here</a></p>]]></description>
<link>http://whistleblower.labovick.com/2007/12/articles/whistleblower-articles/health-care-fraud/medicare-fraud/st-josephs-hospital-settles-whistleblower-suit-for-26-million/</link>
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<category>David M. Nahmias</category><category>Medicare Fraud</category><category>St. Joseph&apos;s Hospital</category><category>Tami Ramsey</category>
<pubDate>Fri, 28 Dec 2007 13:27:52 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Alligator takes bite out of fraud</title>
<description><![CDATA[<p>Dear Blog Readers,</p>
<p>I write this&nbsp;blog&nbsp;with absolute reverence. What I am about to share&nbsp;is a biblical tale of the Lord's retribution against the evil fraudsters in our midst.&nbsp; In&nbsp;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.&nbsp;&nbsp;But here,&nbsp;the hand of the Lord is obvious.&nbsp;&nbsp;&nbsp;He&nbsp;&nbsp;(this is not intended to be sexist)&nbsp;is against those who defraud&nbsp;Medicare.&nbsp; That's right, you heard&nbsp;it here first.&nbsp; The&nbsp;Lord&nbsp;is paying attention to&nbsp;the&nbsp;fraudulent people who are ripping off Medicare.</p>
<p>Ok, let me clarify this&nbsp;beginning.&nbsp;&nbsp;&nbsp;On Wednesday, December 5, 2007, Mark Potter,&nbsp;an&nbsp;NBC Correspondent, wrote an article for MSNBC.com entitled<a href="http://fieldnotes.msnbc.msn.com/archive/2007/12/05/495910.aspx">&nbsp;&quot;Fake Companies Steal Billions from Medicare&quot;.</a> What makes this article interesting is that it involves a&nbsp;man from Miami, Florida, literally being eaten by an alligator while running from the police.&nbsp;Another important feature about this man is that he allegedly ran a fraudulent Medical Supply Company in Florida.&nbsp;</p>
<p>Make no mistake about it.&nbsp; This is not an unfortunate event.&nbsp; This is one of those events that gets written down in the&nbsp;Holy Scriptures and retold for centuries to come.&nbsp; I can hear it now:</p>
<p><em><strong>And the people cried, for the coins set aside&nbsp;for the sick were&nbsp;stolen by the evil souls amongst the people.&nbsp; And so the people sent their courageous fighters to find the evil souls, collect their coins&nbsp;and cage the evil to&nbsp;stop the theft of&nbsp;the coins set aside for the ill.&nbsp; The courageous fighters searched across the swamps and paved lots through&nbsp;a sea of multi-colored&nbsp;automobiles.&nbsp; Upon finding the evil souls the courageous fighters took flight&nbsp;to capture and cage&nbsp;the evil amongst them.&nbsp; The evil&nbsp;would not be taken and caged and thus also took&nbsp;flight.&nbsp; Into the wilderness the evil fled to avoid capture by the courageous fighters.&nbsp; Through all&nbsp;</strong></em>&nbsp;<em><strong>this </strong></em>&nbsp;<em><strong>the&nbsp;Lord&nbsp;was watching.&nbsp; The Lord was angered by the evil in the land.&nbsp; The Lord knew the coins set aside for the sick were sacred to the people.&nbsp; Helping the ill was judged by the Lord as good and proper under his laws and commandments.&nbsp; Therefore the coins were good and&nbsp;aiding&nbsp;the ill was important to the Lord.&nbsp; The Lord&nbsp;</strong></em>&nbsp;<em><strong>decided&nbsp;he</strong></em>&nbsp;<em><strong>would no longer permit&nbsp;the evil to dwell in the land.&nbsp; The Lord&nbsp;sent a great&nbsp;lizard to rise up from the Earth's midst.&nbsp; The great lizard heard the voice of the Lord and came forth</strong></em>&nbsp;<em><strong> to teach the people how to rid the evil from their midst.&nbsp; The great lizard searched the wilderness until it</strong></em><em><strong>&nbsp;found the&nbsp;evil souls.&nbsp; In a quick and merciless moment</strong></em>&nbsp;&nbsp;<em><strong>t</strong></em><em><strong>he&nbsp;</strong></em>&nbsp;<em><strong>great</strong></em>&nbsp;<em><strong>lizard&nbsp;tore from limb to&nbsp;limb the evil souls</strong></em>&nbsp;<em><strong>.&nbsp; The people&nbsp;could hear the gnashing of teeth and the and wrenching of souls.&nbsp;&nbsp;The intent of the Lord&nbsp;was good and the people understood&nbsp;the</strong></em><em><strong> evil</strong></em>&nbsp;<em><strong>must </strong></em><em><strong>dwell in the&nbsp;land no more.</strong></em></p>
<p>Can we stick that in one of the minor scriptures? </p>
<p>All Jokes aside. It is not my intent to be blasphemous.&nbsp; <strong>Please note: I am just kidding around</strong>.&nbsp;&nbsp;&nbsp;I do think it is unfortunate that the Lord doesn't&nbsp;intervene more often&nbsp;to stop fraudulent&nbsp;people.&nbsp; But then again, the Lord could be leaving&nbsp;it up to us to&nbsp;take action and bring&nbsp;these corrupt people to justice.&nbsp;&nbsp;The fraud that is going on in the world around us is astounding.&nbsp; Medicare is bilked out of an estimated $60+ Billion&nbsp;&nbsp;(yes &quot;B&quot; billion)&nbsp;dollars a year.&nbsp; Imagine what we could do with the&nbsp;money, if it&nbsp;was applied to some&nbsp;cause other then fraud.</p>
<p>Potential Whistleblowers: If you know of a significant fraudulent scheme, stand up.&nbsp; Stop the silence.&nbsp; The sight of criminals driving luxury cars and living on oceanfront mansions is too much for society to bear.&nbsp; These people must be brought to Justice.&nbsp; If the Lord is willing to take one or two out with an alligator now and again, so be it.&nbsp; But we are being challenged&nbsp;to take out the rest.&nbsp; We must take a stand.&nbsp;&nbsp;We must swallow the safety of anonymity and report the fraud.&nbsp; We must be willing to fight.</p>
<p>Brian</p>]]></description>
<link>http://whistleblower.labovick.com/2007/12/articles/whistleblower-articles/health-care-fraud/medicare-fraud/alligator-takes-bite-out-of-fraud/</link>
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<category>Mark Potter</category><category>Medicare Fraud</category>
<pubDate>Tue, 11 Dec 2007 14:30:57 -0500</pubDate>
<dc:creator>Brian F. LaBovick, Esq.</dc:creator>

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<title>Stryker Corp and Physiotheray Associates pay $16 million to settle qui tam claims</title>
<description><![CDATA[<p><a href="http://www.stryker.com/myhsp/corporate/AboutUs/index.htm">Stryker Corp</a> and <a href="http://www.myphysio.com/index.cfm?fuseaction=goHome">Physiotherapy Associates</a> 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 <a href="http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&amp;STORY=/www/story/11-14-2007/0004705969&amp;EDATE=">Department of Justice</a>. Stryker Corp sold its outpatient therapy division, Physiotherapy Associates in June 2007. </p>
<p>The settlement resolves allegations that Physiotherapy,&nbsp; 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. </p>
<p>Stryker Corp stock closed at $70.78 yesterday, with shares being down $.09 or .13% from previously trading.</p>
<p>To read more about this settlement from the Department of Justice, <a href="http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&amp;STORY=/www/story/11-14-2007/0004705969&amp;EDATE=">Click here.</a><br />
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<link>http://whistleblower.labovick.com/2007/11/articles/whistleblower-articles/health-care-fraud/medicare-fraud/stryker-corp-and-physiotheray-associates-pay-16-million-to-settle-qui-tam-claims/</link>
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<category>Associates&quot;</category><category>Medicare Fraud</category><category>Physiotherapy</category><category>Qui tam Legal News</category><category>Stryker</category>
<pubDate>Thu, 15 Nov 2007 05:53:43 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Medicare Fraud lands Florida Pharmacy Owner 12 years in Prison and $3.5 Million in Fines</title>
<description><![CDATA[<p>Nelson Valdes,&nbsp;Pharmacy Owner and Durable Medical&nbsp;Equipment owner,&nbsp;was ordered by&nbsp; U.S. District Judge Cecilia M. Altonaga to pay approximately $3.5 million&nbsp;in connection to Medicare false claims.&nbsp;In <a href="http://www.usdoj.gov/criminal/pr/press_releases/2007/07/07-18-07nvaldes-convict.pdf">July of this year</a>,&nbsp;a federal jury in Miami convicted Mr. Valdes of conspiring to defraud Medicare, taking kickbacks and other related charges. This was the third time,&nbsp;Mr. Valdes has been convicted of Medicare fraud. Hopefully he will learn from his mistakes this time around.</p>
<p>According to the <a href="http://www.usdoj.gov/opa/pr/2007/September/07_crm_773.html">Department of Justice</a>, Mr. Valdes conspired with&nbsp;Med-Pro Billing and Unimed Pharmacy to refer paid patients in exchange for half of what Medicare paid for &ldquo;compounded&rdquo; aerosols. Compounding is the&nbsp;the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer. </p>
<p>Mr. Valdes will receive&nbsp;12 years&nbsp;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.</p>
<p>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.&nbsp; The Medicare fraud strike team deserves a big round of applause.&nbsp; Their hard work helps the&nbsp;government&nbsp;recoup&nbsp;millions of dollars for qui tam or false claims involving medicare fraud.<br />
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<p>Click Here to read more on this case from the <a href="http://www.usdoj.gov/opa/pr/2007/September/07_crm_773.html">Department of Justice</a>.<br />
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<link>http://whistleblower.labovick.com/2007/10/articles/whistleblower-articles/health-care-fraud/medicare-fraud/medicare-fraud-lands-florida-pharmacy-owner-12-years-in-prison-and-35-million-in-fines/</link>
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<category>Alexander Acosta</category><category>Alice S. Fisher</category><category>Cecilia M. Altonaga</category><category>Medicare Fraud</category><category>Nelson Valdes</category><category>department of justice</category>
<pubDate>Thu, 04 Oct 2007 12:01:12 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Florida Strike Force has another win in the fight against Medicare Fraud with Medical Equipment Company</title>
<description><![CDATA[<p>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&nbsp;convicted by a federal jury in Miami of Medicare fraud and submitting false claims to&nbsp;Medicare among other things, such as kickbacks. </p>
<p>According to reports from the Department of Justice, Marianela&nbsp;Smith conspired with the owners of Lily&rsquo;s Pharmacy to refer paid patients to the pharmacy in exchange for half of what Medicare paid for &ldquo;compounded&rdquo; aerosols. Compounding is the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer. She&nbsp;referred&nbsp;patients and their Medicare billing information to the owners of Lily&rsquo;s Pharmacy&nbsp;and gave&nbsp;false&nbsp;prescriptions for compounded aerosol medications purchased from local physicians. A patient&nbsp;testified during trial that he was&nbsp;paid&nbsp;$150 per month to use his Medicare card and to obtain false&nbsp;prescriptions in his name that were ultimately provided to the pharmacy. This medicare fraud scheme with Lily&rsquo;s Pharmacy fraudulently billed Medicare more than $271,000 for the&nbsp;false prescriptions for compounded aerosol medications provided by Smith. In exchange, Smith received more than $81,000 in kickbacks. <br />
<br />
Marianella faces up to 30 years in prison for her role in this Medicare Fraud scheme.&nbsp; What amount of money could be worth this great risk of freedom?<br />
<br />
We salute our special force fraud team for all of their hard work and successful efforts,&nbsp;including Assistant Chief John Kelly,&nbsp;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.<br />
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<br />
Click here to read more from the <a href="http://www.usdoj.gov/opa/pr/2007/August/07_crm_678.html">Department of Justice</a> on the Medicare fraud case against Marianella Smith.</p>]]></description>
<link>http://whistleblower.labovick.com/2007/09/articles/whistleblower-articles/health-care-fraud/medicare-fraud/florida-strike-force-has-another-win-in-the-fight-against-medicare-fraud-with-medical-equipment-company/</link>
<guid isPermaLink="false">http://whistleblower.labovick.com/2007/09/articles/whistleblower-articles/health-care-fraud/medicare-fraud/florida-strike-force-has-another-win-in-the-fight-against-medicare-fraud-with-medical-equipment-company/</guid>
<category>Lily&apos;s Pharmacy</category><category>Marianela Smith</category><category>Medicare Fraud</category><category>U.S. Attorney R. Alexander Acosta</category>
<pubDate>Thu, 06 Sep 2007 19:13:47 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Qui Tam claim in Boothe v. Sun Healthcare Group, Inc. remanded by the 10th Circuit</title>
<description><![CDATA[<p>Earlier this week, the qui tam case of&nbsp; <a href="http://www.ca10.uscourts.gov/opinions/06/06-2156.pdf">United States ex. rel.Louanne Boothe v. Sun Healthcare Group, Inc</a>., No. 06-2156 (10th Circuit August 7, 2007) was remanded by the United States Court of Appeals, Tenth Circuit. </p>
<p>This case involves&nbsp;allegations by former&nbsp;finance and accounting employee, Louanne Boothe against <a href="http://www.sunh.com/Production/SHG/index.asp">Sun Healthcare Group</a>, a U.S. Healthcare provider, claiming that&nbsp;Sun Healthcare Group over-billed the United States in ten distinct&nbsp;ways. The complaint includes allegations of the following: 1)&nbsp; Sun over-billed the government by abusing the&nbsp;Section 1010 exception in the years 2000-2002;&nbsp; 2) Sun defrauded Medicare by disregarding Medicare&rsquo;s prudent-buyer guidelines and overcharged&nbsp;for therapy management services for&nbsp; $2.6 million; 3) overstated its temporary nursing staff&rsquo;s labor hours in 2001 and 2002&nbsp;by $500,000; 4) overcharged Medicare by $240,000 in 2002 for pharmacy charges&nbsp; 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&nbsp;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&nbsp;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.</p>
<p>These allegations seem pretty specific, however, the primary issue at&nbsp;hand is whether the allegations are &ldquo;based upon&rdquo; information already in the public domain or whether Ms. Louanne Boothe&nbsp;is an &ldquo;original source&rdquo; of the&nbsp;information.</p>
<p>The&nbsp;<a href="http://www.ca10.uscourts.gov/opinions/06/06-2156.pdf">district court</a> held that it lacked subject matter jurisdiction under 31 U.S.C.&sect; 3730(e)(4) of the False Claims Act, 31 U.S.C. &sect; 3729-33, to hear the case.</p>
<p>According to the <a href="http://www.ca10.uscourts.gov/opinions/06/06-2156.pdf">Tenth Circuit</a>, the district's assessment was accurate that it lacked jurisdiction&nbsp;in three of the claims Ms. Boothe presented. However, jurisdictional analysis of each of Ms. Boothe&rsquo;s <br />
remaining seven claims of fraud is necessary. Therefore, the&nbsp;United States Court of Appeals Tenth Circuit&nbsp;remanded the cases for further proceedings. The Court included&nbsp;the following language &quot;Three&nbsp;bad apples does not necessarily warrant discarding the barrel&quot;. Interesting choice in words.</p>
<p>It is also important to note that <a href="http://www.sunh.com/Production/AboutSHG/sun_pressrel.asp">Sun Healthcare Group</a> 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&rsquo;s intervening bankruptcy, from which it emerged in 2002, discharged Sun&rsquo;s obligations to satisfy the claims in Ms. Boothe&rsquo;s qui <br />
tam complaint; and (3) Ms. Boothe failed to plead her qui tam complaint with sufficient particularity. </p>
<p>Citing lack of&nbsp;jurisdiction, the district court declined to address these arguments for dismissal and the&nbsp;Tenth Circuit did not address them either. It will be interesting to see if they come up again as this saga continues.</p>
<p>Let's all hope that <a href="http://www.sunh.com/Production/AboutSHG/sun_mission_values.asp">Sun Healthcare Group</a> is&nbsp;operating with the integrity and honesty that they are known for in the healthcare community&nbsp;rather than the&nbsp;over-billing of Medicaid and Medicare as was alleged in the qui tam suit of Luanne Boothe.&nbsp;The company has been around since 1993 and is continuously growing, serving more&nbsp;sick and terminally ill patients, and doing&nbsp;lots of business with the government. In the year, 2006, they took in $1.116 Billion in revenue according to their&nbsp;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&nbsp;according to their self published reports. The company&nbsp;closed out the second quarter at<a href="http://www.sunh.com/Production/AboutSHG/sun_pressrel.asp">&nbsp;$446.7</a> million, up 73 percent compared to $258.5 million second quarter 2006. The stock price closed on the Nasdaq Friday at&nbsp;<a href="http://finance.google.com/finance?client=ob&amp;q=SUNH">$15.30</a>&nbsp;per share. </p>]]></description>
<link>http://whistleblower.labovick.com/2007/08/articles/whistleblower-articles/health-care-fraud/medicare-fraud/qui-tam-claim-in-boothe-v-sun-healthcare-group-inc-remanded-by-the-10th-circuit/</link>
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<category>Boothe v. Sun Healthcare Group, Inc</category><category>Louanne Boothe</category><category>Medicaid Fraud</category><category>Medicare Fraud</category><category>Qui tam Legal News</category><category>Sun Healthcare Group</category>
<pubDate>Sat, 11 Aug 2007 10:02:48 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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<title>Tenet puts racketeering charges and alleged Medicare fraud behind them</title>
<description><![CDATA[<p><a href="http://whistleblower.labovick.com/2007/06/articles/legal-news-breaking-stories/jeb-bush-earns-474500-as-a-new-board-member-for-tenet-healthcare/">Tenet Healthcare</a> received good news last week, when U.S. District Judge Patricia A. Seitz granted Tenet's request for Summary Judgment and dismissed a&nbsp;Racketeering case.&nbsp; The case was that of Boca Raton Hospital v. Tenet Healthcare, 05cv80183, U.S. District Court, Southern District of Florida (Miami).&nbsp; According to <a href="http://www.bloomberg.com/apps/news?pid=20601202&amp;sid=aXyMRajt9v38&amp;refer=healthcare">Bloomberg&nbsp;News</a>, Judge Seitz is quoted in her ruling as saying &quot;&nbsp;Tenet escapes Boca's grasp not because its conduct is blameless&nbsp;but only because Boca is not the proper entity, and RICO is not the proper legal vehicle, to redress the harm Boca targets&quot;. The&nbsp; Boca Community Hospital&nbsp;brought charges against Tener&nbsp;under the U.S. Racketeer Influenced and Corrupt Organizations Act . Judge Seitz said the charges&nbsp;were insufficient as a matter of law to prevail against Tenet.</p>
<p>Governor Charlie Crist, in 2005,&nbsp;as Florida's Attorney General,&nbsp;was involved in one of two lawsuits against Tenet&nbsp;with&nbsp;13 hospital plaintiffs.&nbsp;&nbsp;According to <a href="http://myfloridalegal.com/webfiles.nsf/WF/JFAO-6M7RAH/$file/Tenet+Complaint.pdf">the complaint,</a> Tenet was accused of&nbsp;racketeering&nbsp;that artificially inflated its prices.&nbsp;Allegedly the scheme,&nbsp;took in more than $1 billion. According to <a href="http://www.bizjournals.com/losangeles/stories/2005/03/07/daily43.html">the Business Journal</a>,&nbsp; Florida was&nbsp;the only state, at that time&nbsp;to file that type of charge against Tenet. However, other states and federal agencies have investigated the company for alleged over-billing.&nbsp;&nbsp;In 2006,&nbsp; Attorney General&nbsp;Crist resolved his case against Tenet with <a href="http://myfloridalegal.com/webfiles.nsf/WF/JFAO-6M7RBW/$file/Tenet+Settlement.pdf">a $ 7 million settlement</a>,&nbsp;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</p>
<p>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&nbsp;that Tenet returned for&nbsp;overbilling. <br />
<br />
In an effort to clean up its reputation, Tenet has taken a lot of progressive steps. They have&nbsp; installed a new management team, appointed <a href="http://whistleblower.labovick.com/2007/06/articles/legal-news-breaking-stories/jeb-bush-earns-474500-as-a-new-board-member-for-tenet-healthcare/">former Florida Governor Jeb Bush to the Tenet Board </a>and implemented&nbsp;stringent corporate governance and compliance policies.</p>
<p>Hopefully with these measures in place, <a href="http://www.tenethealth.com/TenetHealth">Tenet Healthcare Corporation</a>, one of the&nbsp;nation's&nbsp;largest health care providers can&nbsp;focus on saving lives and providing the best possible&nbsp;healthcare to patients.&nbsp; The Tenet Stock closed at $4.86 per share on Friday, but ended at&nbsp;$4.98&nbsp;in after hours trading.<br />
<br />
Click here to read more on this story from Bloomberg News, <a href="http://news.findlaw.com/andrews/h/hcf/20050406/20050406tenet.html">FindLaw</a>, <a href="http://www.bizjournals.com/losangeles/stories/2005/03/07/daily43.html">The Business Journal</a>, <a href="http://www.miamiherald.com/breaking_business/story/191800.html">The Miami Herald</a>.</p>]]></description>
<link>http://whistleblower.labovick.com/2007/08/articles/whistleblower-articles/health-care-fraud/tenet-puts-racketeering-charges-and-alleged-medicare-fraud-behind-them/</link>
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<category>Boca Raton Hospital</category><category>Charlie</category><category>Crist&quot;</category><category>Health Care Fraud</category><category>Medicare Fraud</category><category>Patricia A. Seitz</category><category>Tenet</category>
<pubDate>Sun, 05 Aug 2007 19:00:40 -0500</pubDate>
<dc:creator>LaBovick Law</dc:creator>

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