Posts Tagged ‘Healthcare Fraud’
Ohio Doctor Sentenced for Illegally Prescribing Pills
The U.S. Attorney’s Office announced Friday that a former Cincinnati, Ohio doctor, who helped facilitate a large prescription pill conspiracy in Eastern Kentucky, was sentenced to 48 months in prison for illegally prescribing thousands of prescription pills.
Lloyd Stanley Naramore, 65, admitted that starting in late 2005 and continuing until approximately June of 2007, he issued prescriptions, primarily for methadone, to more than 100 patients from Pike and Floyd counties without a legitimate medical purpose. Naramore acknowledged that he was aware that the patients were likely distributing the pills he issued in Eastern Kentucky.
“Mr. Naramore helped promote drug trafficking in Eastern Kentucky,” said Assistant United States Attorney Roger West. “I think that his sentence today shows that not only will users and distributors of prescription pills be punished but key sources of supply such as doctors will also be held accountable.”
West added that the U.S. Attorney’s Office and the federal and state authorities are committed to stopping the prescription pipelines that continue to devastate Eastern Kentucky.
Naramore pleaded guilty in November to the charge of conspiracy to distribute methadone and admitted that he distributed approximately 50,000 pills for the duration of the conspiracy.
According to court documents, in 2005 Naramore, a Vermont native, was hired to work at a company called Urgent Care in Cincinnati. The documents also state that the majority of the clinic’s patients were from Eastern Kentucky and each paid Naramore $400 per monthly visit.
Miami Healthcare Operators Indicted for Healthcare Fraud
Six charged in $13 million Miami healthcare fraud
MIAMI (Reuters) – Six Miami-area residents have been charged for their alleged role in a healthcare fraud scheme that cheated the government out of more than $13 million, authorities said on Wednesday.
Florida, where such cases are far from unusual, has long been known as the capital of healthcare fraud since so many elderly Americans have retired to end their days in its famous sunshine.
The U.S. Attorney’s Office for the Southern District of Florida said the six suspects had been charged in connection with a Miami clinic, T & R Rehabilitation, that submitted $13.6 million in false and fraudulent claims to Medicare for infusion therapies for the treatment of HIV and AIDS patients.
The scheme was made possible because beneficiaries of Medicare, the federal health insurer for more than 43 million elderly and disabled Americans, were paid kickbacks to sign records saying they had received HIV infusion therapies when, in fact, they had not, the U.S. Attorney’s Office said.
It said four of the six suspects were arrested on Wednesday while two remained at large and considered fugitives.
One of the suspects, Joaquin Vega, is a doctor who maintained a Medicare provider number at the clinic to submit claims. Others include the owner of the clinic and the operator of its HIV infusion practice.
The FBI estimates that fraud accounts for 3 percent to 10 percent of U.S. healthcare expenditure per year.
New Heath Care Fraud Provisions
From our friends in Atlanta, Kish & Lietz:
Health Care Fraud Provisions in Federal Bill Passed Last Night :: Federal Criminal Lawyer Blog
The Health Care bill that passed last night provides for additional funding to the Health Care Fraud and Abuse Control Program (HCFAC). This program was established as a part of the Heath Insurance Portability and Accountability Act (HIPAA) in 1996 “to combat fraud committed against all health plans, both public and private.” The HCFAC program coordinates federal, state, and local law enforcement actions with respect to health care fraud and abuse.
Section 1304 of the bill passed last night provides additional funding to the tune of $250 million between 2011 and 2016 to the HCFAC program. The HCFAC Account is funded by the Federal Hospital Insurance Trust Fund pursuant to 42 U.S.C. § 1395i(k). It covers the costs of:
(i) prosecuting health care matters (through criminal, civil, and administrative proceedings);
(ii) investigations;
(iii) financial and performance audits of health care programs and operations;
(iv) inspections and other evaluations; and
(v) provider and consumer education regarding compliance.Now is the time to reevaluate compliance programs and prepare for an increase in health care fraud investigations and prosecutions.
If you are looking for a Tennessee Health Care Fraud Attorney, contact Norman D. McKellar today at 865-566-0125 for a FREE consultation.
Health Club Owners Charged with Healthcare Fraud
PHILADELPHIA – Mark Levin, Michael Karp and Raymond Brozek, a chiropractor, were charged today in connection with a $1.9 million scheme to defraud Independence Blue Cross, announced United States Attorney Michael L. Levy.
The charges allege that Levin, 64, and Karp, 39, both of Bala Cynwyd, were the owners of the Hatfield Athletic Club and Rehab One, a chiropractic and rehabilitation facility located inside the club, in Hatfield. It is alleged that Brozek, 57, of Telford, was a chiropractor hired by Levin and Karp to work at Rehab One from approximately 2004 through 2006. In addition to seeing patients at Rehab One, it is alleged that Brozek saw some patients at a gym located in the basement of Levin’s home, known as Rehab Two, and at the homes of Levin’s friends.
Between March 2004 and November 2006, it is alleged that Rehab One fraudulently billed Independence Blue Cross for chiropractic treatments that Brozek performed for the owners and employees of Hatfield Athletic Club, Rehab One and Rehab Two that were not medically necessary; that were purportedly supervised by Brozek; or provided directly by Brozek when he, Levin and Karp knew the services were not performed by Brozek or any other licensed medical professional; and for services the defendants knew were not reimbursable, according to a press release from the United States Attorney’s office.
It is alleged that Brozek prepared fraudulent pre-printed forms, known as “superbills,” for Hatfield Athletic Club employees and family members, who signed Rehab One’s patient log for purportedly receiving weekly chiropractic treatment, but did not receive treatment, according to the United States Attorney’s office.
If you need assistance with a health care fraud investigation or defense of federal crimes, contact Norman D. McKellar today at 1-877-482-9767 for a FREE consultation.
There’s a Fine Line Between Criminal and Civil Healthcare Fraud
There’s a fine line that exists between many civil and criminal matters, such as healthcare fraud or Medicare fraud. As the case below discusses, that line is often as simple as whether the alleged wrongdoer was “willful” in his/her actions.
Connecticut Law Tribune: Hospital Settles Claims That It Overcharged Medicare
The U.S. government and Johnson Memorial Hospital in Stafford Springs entered into a civil settlement agreement late last month to resolve allegations that the infirmary violated the False Claims Act.
The U.S. Attorney’s Office in Connecticut alleges that Johnson Memorial Hospital overcharged Medicare for infusion therapy, chemotherapy administration, and blood transfusions between 2000 and 2005.
During this period, Medicare authorized payments for one unit of infusion therapy (in which a drug is administered intravenously) and chemotherapy administration per patient visit. Also, only one unit of blood transfusion service was permitted per day. However, on many occasions, Johnson Memorial Hospital billed Medicare for between two and eight units per patient visit, according to the U.S. Attorney’s Office.
“Billing for inflated charges relating to chemotherapy, infusion, and blood transfusion services siphons critical resources away from the Medicare program, which relies on hospitals to bill Medicare honestly and accurately,” acting U.S. Attorney Nora Dannehy said in a statement. “Health care fraud is a national problem that the United States Attorney’s Office is devoted to combating.”
Johnson Memorial Hospital, which declared bankruptcy in 2008, agreed to settle the civil dispute by reimbursing Medicare $191,193. By settling the case, the hospital does not admit any liability. The hospital will immediately pay $95,596 of the amount and then pay the remainder over a two year period plus interest.
“What happened here is an honest mistake,” Peter J. Betts, the hospital’s interim president and CEO recently told the Hartford Courant. “There are hundreds of billing codes that you use when you bill Medicare, and if you happen to pick the wrong code, you can be overpaid or underpaid. We would not knowingly overbill.”
If you are being accused of willfully violating the law, contact the legal defense team at The McKellar Law Firm, PLLC, today at 865-566-0125 for a free consultation. For a Tennessee Healthcare and Medicare attorney, click here.
Former Hospital Owner Sentenced to 37 Months for Medicare Fraud
Ex-LA hospital owner sentenced for Medicare fraud – washingtonpost.com
LOS ANGELES — A former Los Angeles hospital owner was sentenced Monday to more than three years in federal prison for paying kickbacks to recruit patients from among the homeless on Skid Row, authorities said.
Robert Bourseau, 75, was sentenced to 37 months in prison and ordered to pay $4.1 million in restitution for defrauding Medicare and Medi-Cal, as Medicaid is known in California. He pleaded guilty in June to paying illegal kickbacks to defraud the government health care systems.
U.S. District Judge George H. King said that such schemes “degrade the health care system, all because of greed and money.”
“Society must know that those who abuse the health care system must answer for that conduct in court,” the judge said.
Bourseau, who has homes in downtown Los Angeles and in Rancho Mirage, co-owned the now-defunct City of Angels Medical Center.
Federal prosecutors contended that Bourseau and the hospital’s co-owner, Dr. Rudra Sabaratnum, paid a recruiter $500,000 between 2004 and 2007 to recruit Skid Row denizens to undergo unnecessary hospital stays, then billed the government for their care.
The patients then received a small payment, typically less than $100, according to a statement from the U.S. attorney’s office.
Sabaratnum, 65, of Los Angeles, pleaded guilty in 2008 to paying kickbacks and is scheduled to be sentenced on April 5. Both men agreed last month to pay $10 million to settle a state and federal fraud lawsuit.
Two others who pleaded guilty await sentencing: Dante Nicholson, the hospital’s former senior vice president, and the recruiter, Estill Mitts.
Mitts, who ran a Skid Row assessment center, said he earned about $20,000 a month in kickbacks and was delivering between 30 and 50 patients a month. He pleaded guilty to conspiracy to commit health care fraud, money laundering and tax evasion.
