JOHN HOWLEY, ESQ.
  • Medicare Fraud Defense Attorney
  • For Medicare Providers
  • For Whistleblowers
  • About John Howley
(212) 601-2728

Under-Reporting Income Results in Medicaid Fraud Claims

8/9/2012

1 Comment

 
The United States has joined a whistleblower action against North East Medical Services (NEMS), a federally-qualified health center (FQHC).  The lawsuit alleges that the center under-reported income it received from a managed care organization in order to artificially inflate reimbursements it received from the California Medicaid program.

FQHCs are “safety net” community clinics certified under federal law and licensed under state law to provide medical care to poor and under-served populations.  As such a health center, North East Medical Services is entitled to special payments from the California Medicaid program (Medi-Cal) that are significantly more generous than typical Medicaid payments.


In order to receive these additional payments, NEMS must submit annual reports to Medi-Cal stating the total amount it actually received during the preceding year from any source for treating Medi-Cal enrollees.  Medi-Cal then subtracts that amount from the amount that NEMS is entitled to receive as an FQHC and pays NEMS the difference.

NEMS allegedly under-reported payments it received from a managed care organization for treating Medi-Cal beneficiaries in order to artificially inflate the payments it received from Medi-Cal.

The whistleblower lawsuit was filed by Loi Trinh and Ed Ta-Chiang Hsu under the qui tam provisions of the False Claims Act.  The False Claims Act allows private persons to file actions to provide the government information about wrongdoing.  Under the statute, if it is established that a person has submitted or caused others to submit false or fraudulent claims to the United States, the government can recover treble damages plus $5,500 to $11,000 for each false or fraudulent claim filed.  If the government is successful in resolving or litigating its claims, the whistleblower who initiated the action can receive a share of between 15 percent to 25 percent of the amount recovered.

If you believe that your employer is making false claims to Medicare, Medicaid, or another government health care program, then you should consult with an experienced lawyer immediately.  To schedule a free initial 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


Sources:  Department of Justice press release; modernhealthcare.com


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.
1 Comment
Daily Stock Future Tips link
1/2/2016 12:04:33 am

Excellent and helpful post… I am so glad to left comment on this. This has been a so interesting read,

Reply



Leave a Reply.

    John Howley, Esq.
    350 Fifth Avenue, 59th Floor

    New York, New York  10118
    (212) 601-2728

    Categories

    All
    Criminal Defense
    Dialysis
    False Claims Act
    Government Contract
    Integrity Agreement
    Kickbacks
    Medicaid
    Medicaid Fraud Control Unit
    Medicare
    Nephrology
    Occupational Therapy
    Pharmacy Fraud
    Physical Therapy
    Qui Tam
    Subpoenas
    Upcoding
    Whistleblower

    Disclaimer

    This web site provides general information.  It does not provide legal advice.  You should consult a lawyer to obtain legal advice regarding your personal situation.

Copyright (c) 2012-2018 John Howley, Esq. This web site contains attorney advertising. Prior results do not guarantee a similar outcome.
  • Medicare Fraud Defense Attorney
  • For Medicare Providers
  • For Whistleblowers
  • About John Howley