Recently in Georgia Health Care Fraud Category

Georgia Doctor's Health Care Fraud Conviction Reversed on Appeal

August 10, 2011, by The McKellar Law Firm, PLLC

In United States v. Ly, No. 09-12515, 2011 WL 2848477, at *1 (11th Cir. July 20, 2011), the United States Court of Appeals for the 11th Circuit reversed a pro se defendant's conviction when it was apparent that the defendant misunderstood his right to give a narrative testimony without having to be cross-examined by the prosecution.

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Defendant Hung Thien Ly was a medical practitioner who was indicted on 129 counts of writing prescriptions for certain medications "outside the usual course of professional practice and without legitimate medical purpose" under 21 U.S.C. § 841(a)(1) an 21 C.F.R. § 1306.04. Ly claimed that he was indigent and therefore requested court-appointed counsel. The Government opposed the motion, arguing that Ly moved all his assets into his wife's name and was therefore not indigent. The magistrate judge accordingly denied Ly's request. Ly subsequently pled not guilty and, after the magistrate warned Ly of the dangers that came with representing himself at trial, decided that he would still defend his charges pro se.

Ly had no prior legal training or experience in a courtroom. After the prosecution presented their arguments, the court explained that Ly could testify as to what kind of practice he had and how he handled his patients. Ly was unaware that he could testify in narrative form and therefore did not need to be questioned by opposing counsel. After Ly revealed his confusion to the court, the judge did nothing to correct Ly's misunderstanding. Ly therefore chose not to testify on his own behalf and was subsequently found guilty on all 129 counts of health care fraud. Ly then appealed his case, arguing that the district court denied him his right to testify by failing to correct his misunderstanding regarding the availability of narrative testimony.

On appeal, the Government argued that a district court has no duty to act as a pro se defendant's lawyer and therefore had no duty to correct Ly's misunderstanding. The 11th Circuit held, however, that a court has an obligation to protect pro se defendants from inadvertent forfeiture of the right to testify if the court has already engaged in a conversation with the defendant regarding that right. Since Ly had no legal training or courtroom experience, it was reasonable for Ly to believe that direct testimony only allows for a question-and-answer dialogue between an attorney and a witness. Once it was apparent that Ly misunderstood this right, the district court should have corrected Ly. The 11th Circuit also stressed that their holding only applies in situations like Ly's where a court has already discussed with the defendant their right to testify and it is apparent that this right is misunderstood by the defendant.

Atlanta Chiropractor Sentenced to 57 Months Imprisonment and $6.5 Million in Restitution for Health Care Fraud

July 11, 2011, by The McKellar Law Firm, PLLC

An Atlanta, Gerogia chiropractor was sentenced to nearly five years in prison for conspiracy to commit health care fraud, according to a press release from the United States Attorneys' Office. Andrew Sokol pleaded guilty to charges that he fraudulently billed several private insurance companies for millions of dollars in physical therapy services that he never actually provided his patients. In addition to his prison sentence, Sokol was also ordered to pay restitution of over $6.5 million.

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According to the Government's press release, Sokol defrauded insurance companies by offering services like chiropractic care, personal training, and massages to the patients at his "WellnessOne" clinics in the Atlanta area. He would then bill insurance companies for the services, claiming he provided patients with physical therapy. Sokol specifically targeted employees at companies that offered Blue Cross Blue Shield policies because their plans provided generous physical therapy benefits. Sokol would offer promotional incentives to these employees such as massage gift cards, restaurant and gas cards, gift bags, and free lunches to entice them to use the clinic's services. He also waived deductibles and co-payments, so his patients were actually compensated for the services they received. Sokol did employ doctors and physical therapists, but they saw very few WellnessOne patients. These professionals were merely on the payroll so that Sokol could bill the insurance companies for their higher rates, while massage therapists were actually providing the massages. The scheme allowed Sokol to pocket millions of dollars by billing personal training sessions and massages as physical therapy.

Sokol's case is another example of the Government's crackdown on health care fraud as a means to help control skyrocketing health care costs. According to the FBI, fraudulent billing to private insurance companies and public health care programs such as Medicare and Medicaid account for an estimated 3 to 10 percent of total health care expenditures in the U.S., a potential cost of over $200 billion annually. Because of these enormous costs, federal law enforcement agencies are increasing their efforts to detect these schemes. In 2010, the government recovered $4 billion from health care fraud enforcement and prevention efforts relating to public programs alone. There are huge sums of money at stake for both public health programs and private insurers, so cases like Andrew Sokol's are likely to be prosecuted vigorously well into the future.

Atlanta Pain Clinic Operators Arrested for Illegal Distribution of Prescription Medication and Wire Fraud

According to a press release from the U.S. Attorney's Office for the Northern District of Georgia, federal law enforcement officers arrested five people last week connected to an alleged "pill mill" in the Atlanta, Georgia area. The five defendants are the owners, manager, and doctor at the Atlanta Medical Group, a pain clinic that prosecutors allege was illegally distributing Oxycodone. According to the indictment, Jason Cole Votrobek, Jesse Violante, and Roland Rafael Castellanos provided the financing and were responsible for operating the clinic; Tara Atkins worked as the office manager; and Dr. James Chapman was the primary physician on staff.

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The investigation suggests that Dr. Chapman was seeing as many patients as possible in order to maximize profits since most of the Oxycodone was dispensed on site. The indictment further alleges that patients were not given proper medical examinations prior to receiving their prescriptions and that non-medical staff helped with medical procedures so that the clinic could see even more patients. The defendants may have pocketed millions of dollars in just one year. The five defendants are now facing drug and money laundering charges in federal court.

These arrests illustrate how law enforcement and prosecutors are increasing their focus on stopping the illegal distribution of prescription drugs. As John S. Comer of the DEA stated in discussing the investigation, "those involved in 'pill mill' activity are in fact drug dealers." Law enforcement is also focusing on illegal prescription drugs because of the consequences of abuse of pain medications. Overdose deaths caused by prescription pain killers have increased four-fold from 1999 and now account for more overdose deaths in the U.S. than heroin and cocaine combined.

Investigations into these "pill mills" frequently involve many different law enforcement organizations. For example, in the Atlanta Medical Group case, the FBI, the Georgia Bureau of Investigation, Drug Enforcement Administration, Bartow County Sheriff's Office, and the IRS all participated in the investigation.

The penalties these defendants are facing are severe, and this case illustrates that not only are the doctors and clinic owners exposed to potential criminal action, but the staff can be exposed to criminal action as well. Federal law provides a maximum sentence of 20 years in prison for illegal distribution of a controlled substance such as Oxycodone, and even more time could be warranted if the medicine distributed results in someone's death. Additionally, the charges for money laundering also carry fines and a maximum penalty of 20 years imprisonment. As the government continues to crack down on suspected pill mills, many more people could be facing these serious charges.

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.