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One of the worst mistakes you can make during a Medicare fraud investigation is failing to respond to the investigators.
Burying your head in the sand will not make the investigators go away. They will simply finish their investigation without your input. They will report to the prosecutor and the court that you refused to cooperate. They will argue that your refusal to cooperate shows that you are guilty and deserving of the harshest punishment. That said, you should never answer the investigators’ questions or turn over any documents before consulting with an experienced lawyer. Anything you say can and will be used against you. So, what should you do when contacted by Medicaid or Medicare fraud investigators? Be polite and professional. Let the investigators know that you want to cooperate, but that you cannot talk right now. Then get professional help and advice right away. If you are contacted by letter, bring the letter to a lawyer and get advice on how to respond. Make sure that you or your lawyer responds by the date in the letter, even if it is only to ask for more time. If you are contacted by telephone or in person, politely tell the investigator that you cannot talk right now. Ask for their name and telephone number. Tell them that you will get back to them. Then bring the investigator’s contact information to a lawyer for advice on how to respond. Responding promptly to fraud investigators and letting them know that you are willing to cooperate with the advice of an attorney are the first steps to preventing a catastrophe. You cannot build a defense or negotiate a resolution of the investigation unless you are in regular contact, through your lawyer, with the investigators. Staying in contact with the investigators will allow give your lawyer insights into the strengths and weaknesses of the case against you. That is critical to building your defenses. For more tips on how to respond to a Medicaid or Medicare fraud investigation, download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations." Just click here to download a free copy. Then call an experienced healthcare fraud defense lawyer to discuss the specifics of your case. To schedule a free and confidential consultation, call us at (212) 601-2728. John Howley, Esq. The Howley Law Firm P.C. 350 Fifth Avenue, 59th Floor New York, New York 10118 (212) 601-2728
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An Early, Proactive Response to a Medicare Fraud Investigation is Your Best Hope for a Good Outcome
The first question a Medicare fraud defense lawyer usually gets from a new client is: Will I go to prison? The answer depends on the nature of the alleged fraud, how early the client retains experienced defense counsel, and how they respond to the fraud investigation. Retaining an experienced Medicare fraud defense lawyer early in an investigation gives you a number of advantages. The government has not yet charged you with a crime or obtained an indictment. Prosecutors and fraud investigators may still be willing to consider alternatives to criminal charges, or may be convinced to limit the charges to less serious offenses without a prison sentence. For example, take the case of the OB/GYN who was accused of stealing more than $8 million from Medicare and Medicaid by billing for treatments provided by an unlicensed and often unsupervised staff. By retaining defense counsel early in the process, this physician was able to enter into a deferred prosecution agreement and avoid criminal prosecution. Under the agreement, the physician will pay back the money at issue and will retain an independent billing monitor for his practice. As long as the physician complies with these conditions for a period of two years, the government agrees not to prosecute him criminally. In another case, a hospital in New York agreed to pay more than $1.5 million in restitution for allegedly billing Medicare and Medicaid for services that were not medically necessary or not properly documented. This case was settled as a purely civil matter with no criminal charges because the hospital retained experienced defense counsel, approached fraud investigators very early in the process, and negotiated a resolution. In contrast, every day the government announces lengthy prison sentences for healthcare providers who are accused of frauds involving much less money. Consider, for example, the chiropractor who was recently sentenced to 44 months (more than three and a half years) in prison and another three years of supervised release for allegedly submitting less than $200,000 in false insurance claims. The outcome in any case, of course, depends on a number of different factors. Prosecutors tend to be more aggressive when the alleged fraud involves risks of harm to the health and safety of patients. Prosecutors tend to be less willing to negotiate when the alleged fraud involves billing for services or products that were never actually provided, or when the alleged fraud is part of a larger criminal scheme. Regardless of the nature of the alleged fraud, however, your best hope for a favorable outcome is retaining an experienced Medicare fraud defense lawyer as soon as you believe that you are under investigation. That is when you and your lawyer have the most options and the best chance of avoiding a personal and professional catastrophe. John Howley, Esq. (212) 601-2728 Former CEO, COO, and CFO Also Ordered to Pay $8.48 Million in Forfeiture
The former Chief Executive Officer, Chief Operating Officer, and Chief Financial Officer of Sacred Heart Hospital in Chicago were sentenced to prison for their roles in a conspiracy to pay kickbacks to doctors in exchange for patient referrals. The three former senior executives were also ordered to pay $8.48 million in forfeiture. The hospital’s former owner and CEO was sentenced to 54 months in prison. The hospital’s former COO was sentenced to 21 months in prison. The hospital’s former CFO was sentenced to 12 months and one day in prison. The three former senior executives and others were found guilty of paying kickbacks and bribes to physicians in return for referrals of Medicare and Medicaid patients. According to the government, the payments were disguised as compensation for consulting work or instructional services. Some kickbacks were paid to doctors in the form of free professional staff and below market lease agreements. Under the anti-kickback statute, providing anything of value in return for referrals of Medicare and Medicaid patients is a crime. It can also result in civil liability under the False Claims Act. If you are under investigation or have been charged with violating the anti-kickback statute or the False Claims Act, you need to consult with an experienced Medicare fraud attorney immediately to protect your rights. How you respond in the early stages of an investigation or prosecution often means the difference between paying civil damages or going to prison. John Howley, Esq. The owner of Biomax Pharmacy Inc. pleaded guilty in federal court to one count of health care fraud.
The pharmacy owner admitted that she submitted almost $1.6 million in fraudulent claims to Medicare for prescription drugs that were not prescribed by physicians, not medically necessary, not purchased by her pharmacy, and not provided to Medicare beneficiaries. Medicare paid 100 percent of the claims. The government accused the pharmacy owner of stealing and paying for unique identifying information of Medicare beneficiaries. The pharmacy owner used that information to submit the fraudulent claims to Medicare. The case was investigated by the FBI and the Office of Inspector General at the U.S. Department of Health and Human Services. Typically in these cases, government agents contact drug wholesalers to determine if the pharmacy’s purchases of pharmaceuticals match the quantity of pharmaceuticals that were billed to Medicare. The government agents also contact physicians and patients to determine whether prescriptions were actually written and filled. If you are under investigation for Medicare fraud, you need to contact an experienced Medicare fraud defense attorney immediately to protect your rights. If your lawyer gets involved during the investigation stage, he can often work with investigators and prosecutors to avoid criminal charges or reduce their severity. John Howley, Esq. (212) 601-2728  The government issues press releases all the time announcing that a physical therapy business has been caught submitting false claims to Medicare. The government uncovers these false claims in two ways: (1) by offering very large rewards to patients, employees, and others who report the fraud and help recover over-payments; and (2) by using computer software tools to identify suspicious billing patterns. False claims for physical therapy services take many forms. In the most recent case, the owner of a physical therapy service (who was not herself a physical therapist) was caught billing Medicare for physical therapy services under the name and provider number of a physical therapist who no longer worked at her company. The services were actually provided by unsupervised non-physical therapist employees such as physical therapist assistants, massage therapists, and massage therapy students. Those “physical therapy” services billed to Medicare did not qualify for reimbursement, because they were not rendered by, or under the supervision, of a licensed physical therapist. When a whistleblower helps the government uncover this type of false claim through something called a qui tam action, the government pays the whistleblower a reward of between 15% and 30% of the amount the government recovers. Since the government can go back several years -- and can recover three times the amount of the overpayment plus penalties -- those rewards can add up to hundreds of thousands and sometimes millions of dollars. If you are aware of false claims being submitted to Medicare or Medicaid, then you should consult with an experienced lawyer immediately to protect your rights. To schedule a free and confidential consultation by telephone or in person, call my office today at (212) 601-2728 or click here to communicate with me via email. John Howley New York, New York The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.  Cassandra Faye Thomas was sentenced to 14 years in federal prison for healthcare fraud, and ordered to pay $6,924,958.60 in restitution and to forfeit $6,924,988.60 to the United States. According to the government, Thomas engaged in simple, outright fraud. She owned a “physical medicine” group that claimed to provide physical therapy services to Medicare and Medicaid beneficiaries in their homes, free of charge to the beneficiary. She then submitted claims to Medicare and Medicaid, representing that the therapy services had either been provided by a doctor, provided under the doctor’s direct supervision, or provided by a licensed physical therapist. In fact, the government claimed, none of the services were provided or supervised by a doctor or a licensed physical therapist. Instead, the therapy services were provided by employees who were not trained or licensed physical therapists. Most of the employees, according to the government, had little or no medical training at all. Despite being an outright fraud, Medicare and Medicaid paid Thomas’ company more than $6,900,000.00 during a period of only six months, from March, 2002, until September, 2004. How could a fraudulent physical therapy service collect almost $7 million in false claims over a six-month period? The answer is: Medicare and Medicaid have become so massive that the government simply cannot check up on all the beneficiaries and providers receiving payments. The only way the government can uncover even blatant frauds is if someone on the inside comes forward with evidence. That is why the government pays substantial rewards to whistleblowers – anywhere from 15% to 30% of the amount the government ultimately recovers. In the case of a $7 million fraud, that means a reward of between $1 million and $2 million for the whistleblower. If you have personal knowledge or evidence of Medicare or Medicaid fraud, then you should consult with an experienced lawyer immediately to protect your rights.To schedule a free and confidential consultation by telephone or in person, call my office today at (212) 601-2728 or click here to communicate with me via email. John Howley New York, New York The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.  A 37 year old Louisiana man is going to prison for 15 years after being convicted of Medicare fraud involving false claims and illegal kickbacks for durable medical equipment (DME). He was also ordered to pay $13,397,759 in restitution and will serve three years of supervised release after his prison term. The government charged that companies owned by the defendant fraudulently billed Medicare for medical equipment that either was not medically necessary or not provided. The government also charged that he hired patient recruiters to obtain Medicare beneficiary information and prescriptions for medical equipment such as leg braces, arm braces, power wheel chairs and wheel chair accessories. These prescriptions were then used to submit fraudulent claims to the Medicare program. The investigation was led by the government's Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,330 defendants who have collectively billed the Medicare program for more than $4 billion. If you are under investigation, or if you have information that your employer is submitting false claims to Medicare or Medicaid, then you should consult with an experienced lawyer immediately. To schedule a free and confidential consultation by telephone or in person, call my office today at (212) 601-2728 or click here to communicate with me via email. John Howley New York, New York The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. At a time when our attention is drawn to massive Medicare fraud investigations involving hundreds of defendants, it is important to remember that the government brings out its full firepower to investigate and prosecute individuals as well. This week a United States District Judge in Florida sentenced an individual Occupational Therapy Assistant to 30 months in federal prison for defrauding Medicare and Medicaid. The court also ordered the defendant to forfeit $455,537.30 in overpayments. According to a press release from the local U.S. Attorney's office, the defendant owned Active Life Rehab, Inc. He was charged with health care fraud and aggravated identity theft for submitting fraudulent claims of more than $1 million to the Medicaid program. The claims submitted were for occupational therapy services that were either not provided at all, or not provided as billed to Medicaid. The fraud allegedly was carried out by falsifying patient records, "upcoding," and using unauthorized Medical Provider Numbers of other licensed occupational therapists to submit claims to Medicaid for payment to Active Life Rehab. False claims were also submitted to Medicare. In total, Medicaid and Medicare were billed approximately $1.5 million of which $455,537.30 was unwarranted. This case was investigated by the Tampa Bay Medicare Fraud Strike Force, which comprises agents from the Tampa Regional Office of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), the Federal Bureau of Investigation (FBI), the Florida Attorney General’s Medicaid Fraud Control Unit (MFCU), Florida Department of Law Enforcement (FDLE), and the Defense Criminal Investigative Service Office of Investigations. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. Nephrology Physician Practice Group and Dialysis Centers Accused of Overbilling Medicare Apex Medical Group, P.C., d.b.a. Nephrology Consultants, a Tennsessee-based nephrology physician practice group, has agreed to pay $4.36 million to settle alleged violations of the federal False Claims Act, the Tennessee Medicaid False Claims Act, and other federal and state laws and regulations. The U.S. Attorney for the Eastern District of Tennessee asserted that the group submitted numerous false and fraudulent claims to government health programs, including Medicare and TennCare, for payment through a pattern of upcoding for various physician services. “Upcoding” refers to using billing codes that reflect a more severe illness than actually existed or a more expensive treatment than was provided. The government also contended that six dialysis clinics owned by Extracorporeal Technologies, Inc., and Fort Sanders Kidney Center, Inc., improperly submitted inaccurate claims to the same government health programs for a variety of dialysis services. As part of the overall settlement, Apex and Dr. Naseemul Siddiqi entered into a comprehensive five-year Integrity Agreement with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS). The OIG negotiates integrity agreements with health care providers to ensure future compliance with federal health care benefit program requirements. In exchange, the OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other Federal health care programs. Click here to see the government's press release on the settlement. John Howley, Esq. New York, New York The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |