Recently in Billing Fraud Category

Florida Sleep Clinics Charged with Violating the False Claims Act

June 16, 2011, by The McKellar Law Firm, PLLC

Earlier this week, a federal criminal Complaint was filed against a Florida sleep clinic and its owner. According to an article in Forbes online magazine, Bay Area Sleep Associates LLC, a Florida-based group, and its owner are facing charges related to violation of the False Claims Act ("FCA") for knowingly making false claims for reimbursement from Medicare and other federal programs. Medicare regulations require that diagnostic testing services, like those available from Bay Area Sleep Associates, be performed by licensed or certified technicians for reimbursement to be available.

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The Complaint specifically alleges that unlicensed sleep technicians were performing sleep tests on patients, that the defendants knew that this unlicensed work violated the reimbursement regulations, yet submitted claims for reimbursement anyway.

The FCA (31 U.S.C § 3729 et seq.) penalizes companies, contractors, and individuals who defraud the government. The FCA provides civil penalties for those who (among other things) make false claims for payments to the government, those who make or use false records relating to a false claim, or receive money or property from the government and deliver less than the full amount to its intended recipient.

The penalties under the FCA can be severe. A civil penalty up to $11,000 may be assessed for each false claim. Treble damages are available to the government as well. The Justice Department has used the FCA to recover an estimated $7.4 billion since January 2009 with approximately $5.8 million of that from cases involving health care fraud. Additionally, a judgment or settlement under the FCA can cause a business or individual to be excluded altogether from federal health care programs such as Medicare and Medicaid. (42 U.S.C. § 1320a-7(b)).

The FCA also provides a tremendous incentive to potential whistleblowers. It permits a whistleblower, referred to as a "Relator," to bring a civil action under the FCA on behalf of the United States. The Relator can receive between 15 and 30 percent of the amount recovered, plus attorney fees and expenses. This case involving Bay Area Sleep Associates case was allegedly initiated by a whistleblower.

Atlanta Doctor Indicted for Healthcare Fraud for Allegedly Treating Dead Patients

March 5, 2011, by The McKellar Law Firm, PLLC

An Atlanta, Georgia doctor has been indicted for filing false Medicare and Medicaid claims for patients which he never saw, including some patients who were already dead at the time he claimed to have administered treatment to them. The Atlanta Journal Constitution reports that Dr. Robert Williams was indicted in Atlanta for healthcare fraud and was arraigned yesterday in federal district court.

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According to a press release from the U.S. Attorney's Office in Atlanta, the prosecution alleges that Dr. Williams, during 2007 to 2009, contracted with a medical services company to provide group psychological therapy to nursing home patients. Per the doctor's signature, thousands of claims were submitted to Medicare and Georgia Medicaid seeking reimbursement for group psychological therapy that Dr. Williams claimed to provide to beneficiaries at nursing homes in the Atlanta area. Allegedly, in many instances, the doctor did not actually provide the therapy claimed.

Doctors are typically held to a high standard of conduct due to their position in society. In the aforementioned press release, prosecution representatives claim:

"As a physician, this defendant had a duty to protect his patients and look out for their interests first. He has been charged with crimes that reflect his misuse of his position and the trust placed in him, all at the expense of his elderly patients, Medicare and Medicaid. Dr. Williams allegedly stole Medicaid funds that were specifically allocated for the care of some of Georgia's most vulnerable citizens: the elderly."

If convicted of these healthcare fraud allegations, Dr. Williams is looking at a maximum 10-year sentence, a fine up to $250,000, and likely restitution of amounts improperly taken.

Healthcare Fraud Investigations to Increase Due to Affordable Care Act

October 25, 2010, by The McKellar Law Firm, PLLC

Healthcare fraud attorneys spend much of their time dealing with investigations and pre-charge or pre-indictment activities of violation of 18 U.S.C. Section 1347, which says:

Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice-- (1) to defraud any health care benefit program; or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury (as defined in section 1365 of this title), such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.

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In an article written by Bob Gatty with Modern Medicine, he writes about the statements of Daniel R. Levinson, inspector general at the Department of Health and Human Services, who claims that "the new Affordable Care Act (ACA) provides additional resources and authority designed to crush healthcare fraud schemes that contribute to the skyrocketing cost of healthcare in the United States. Gatty writes that in the last year, the Office of Inspector General has opened more than 1,300 healthcare fraud investigations and obtained more than 500 convictions, resulting in nearly $3 billion in expected civil and criminal recoveries. While these numbers are staggering, those in the medical field should anticipate increased investigation, litigation, and financial and criminal penalties.

Medical providers need to a) be vigilant in complying with all federal regulations, especially those providers who provide Medicare / Medicaid services, and b) employ the services of an experienced healthcare criminal defense lawyer immediately upon receipt of a summons or upon learning of a potential investigation. Oftentimes, clients mistakenly wait until a government investigation is well under way before beginning the process of obtaining a healthcare attorney to prepare his/her defense.