$63 Million Medicare Fraud Scheme

Tariq Hafeez, Esq

An Asheville, N.C., resident pleaded guilty today in U.S. District Court in Miami for her role in a health care fraud scheme that resulted in the submission of more than $63 million in fraudulent claims to Medicare and Medicaid in Miami and Hendersonville, N.C., announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Serena Joslin, 31, a Licensed Psychological Associate, pleaded guilty before U.S. District Judge Cecilia M. Altonaga in Miami to one count of conspiracy to commit health care fraud.  Joslin admitted to participating in a fraud scheme that was orchestrated through an entity called Health Care Solutions Network (HCSN).  HCSN operated purported partial hospitalization programs (PHPs), a form of intensive mental health treatment for severe mental illness, in both Miami and Hendersonville.

According to an indictment unsealed on May 2, 2012, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not provided.  HCSN obtained those beneficiaries by paying kickbacks to owners and operators of assisted living facilities (ALFs) or by otherwise recruiting them from ALFs and nursing homes.  According to court documents, Joslin admitted that she was aware that HCSN recruited patients who were inappropriate for PHP treatment.  Nevertheless, Joslin agreed with other HCSN employees to, among other things, fabricate therapy notes and other medical records, and to direct therapists to fabricate therapy notes and other medical records, all to make it appear as if HCSN patients received appropriate PHP services.  Joslin was aware that fraudulent claims to Medicare would be submitted on behalf of these patients.

At sentencing, scheduled for Jan. 11, 2013, Joslin faces a maximum of 10 years in prison and a $250,000 fine.

Eight other charged defendants, including the owner and operators of HCSN, await trial before Judge Altonaga. 

Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

If you have any questions relating to health care fraud law contact Tariq Hafeez at (248) 380-0000.

Massive Medicaid Fraud Uncovered in New York

Tariq Hafeez, Esq.

Federal prosecutors charged 48 people in a massive fraud that allegedly bought HIV medications and other prescription drugs from Medicaid recipients and sold them to unsuspecting buyers.

The scheme cost tax payers $500 million, prosecutors said Tuesday.

According to prosecutors, the fraud was perpetuated as follows: Medicaid beneficiaries in New York, including AIDS patients and others suffering from illnesses requiring expensive drugs, sold their prescriptions to some of the defendants for cash instead of using them for treatment. Once Medicaid beneficiaries sold the drugs to other buyers, the buyers marketed the pills to pharmacies and other wholesale prescription drug companies in New York, New Jersey, Pennsylvania, Florida, Texas, Massachusetts, Utah, Nevada, Louisiana and Alabama, according to authorities.

 

The scheme targeted expensive medications — some at a cost of more than $1,000 a bottle — for illnesses such as asthma and HIV, authorities said. According to prosecutors, the defendants ran a black market in prescription pills involving a  gigantic double-dip fraud. In other words, the defendants defrauded Medicaid, in some cases, two times over- a fraud on pharmaceutical companies, a fraud on legitimate pharmacies, and a fraud on patients who unwittingly bought second-hand drugs.

If you have any questions relating to health care fraud law contact Tariq Hafeez at (248) 380-0000.

Camp Lejeune Water

Jim Fausone
Veteran Disability Lawyer

Decades after one of the worst drinking water contaminations in U.S. history, affected Marines and their families may finally receive the health care they need.

Camp Lejeune is a Marine base located in North Carolina.  Over the course of 30 years, up to one million Marines and family members were exposed to drinking water contaminated with human carcinogens.

The U.S. Senate recently passed, by unanimous vote, a bill that provides these soldiers with health care for diseases and conditions resulting from exposure to the contaminated water.  This care will be available to those who lived or worked at the base from 1957 to 1987.

The passage of the bill was not without some apprehension.  Senator Jim DeMint of South Carolina initially blocked the bill due to his concerns about opportunities for fraud.  However, after amending the bill to address this, the bill passed unanimously.

The amended bill now goes to the U.S. House of Representatives for approval. 

“After decades of denial,” said Sen. Kay Hagan of North Carolina, “this country owes it to them to ensure they are taken care of in their time of need.”  We couldn’t agree more.

To learn more or see the original article, please visit: 

http://hamptonroads.com/2012/07/us-senate-passes-bill-aid-camp-lejeune-marines

Burial at Sea

Jim Fausone

Veteran Disability Lawyer

The tradition of burial at sea is an ancient one.  On a listserv an attorney asked if he could paddle out on Lake Michigan and spread the cremains of his brother.  Only an attorney would worry about the regulations!

Yes, US EPA regulates such activity.  40 CFR 229.1 contains the basic requirements for burials at sea.  Burial of non-cremated remains must take place at least 3 nautical miles from shore in water at least 600 feet deep.  Also, measures must be taken to ensure that the remains sink permanently to the bottom.

Burial of cremated remains must also take place at least 3 nautical miles from land, but the water does not have to be any required depth.

There is no permit requirement by the EPA prior to the burial.  However, the EPA must be notified of the burial within the 30 days following its occurrence.  Additionally, coastal states may have specific guidelines or permit processes that must be followed regarding burials at sea.

The EPA does not regulate burials in inland lakes and rivers; this is supposedly regulated by the states under the Clean Water Act.  However, Michigan does not have any statutes or regulations stating what requirements there are, if any, for the burial of a loved one in Michigan’s lakes or rivers.

My advice is, don’t ask your lawyer relative to undertake this final request.

Burn Pit Registry

Jim Fausone

Veteran Disability Lawyer

It seems like the DOD and VA fight the most obvious and necessary things.  Think about the atomic registry, the Gulf War registry, AO registry, etc.  This time it’s the burn pits our men and women were exposed to in Iraq and Afghanistan.  Over objections from the VA, a House panel voted last week to create a registry of people exposed to toxic fumes and chemicals from open burn pits while deployed to Iraq and Afghanistan.  The registry would be used to monitor the health of service members and veterans to determine if there are any ill effects from being close to or downwind of the open fires used to dispose of solid waste in Iraq and Afghanistan.

As reported in the Army Times: "VA, however, doesn’t see the need for the registry. Officials say there are other ways to identify and track Iraq and Afghanistan veterans exposed to burn pits without a special registry — and they are not convinced burn pits even posed a serious problem.

VA officials told the Senate Veterans’ Affairs Committee, which is considering similar legislation, that an independent report by the Institute of Medicine “identified air pollution, rather than smoke from burn pits, as the most concerning potential environmental hazard.”   

Will it again take 20 years for VA to recognize that serious health concerns exist because of this exposure?

http://www.armytimes.com/news/2012/06/military-lawmakers-vote-to-create-burn-pit-registry-062912w/

Camp Lejeune Help Finally

Jim Fausone
Veteran Disability Lawyer

For years it has been known that the drinking water at Camp Lejuene was contaminated with a soup of chemicals from DOD operations at the site.  Congressional committees are wrapping up negotiations for expanding veterans’ health care by proposing VA treat veterans and dependents exposed to contaminated well water at Camp Lejeune, N.C.  Up to 750,000 people — Navy and Marine Corps members and their families — may have been exposed to water found to be contaminated by carcinogens from the 1950s into the 1980s.   This is one of those embarrassments by DOD that far too long to correct.  We have been hearing about veterans with contaminated water related diseases for over a decade.

VA was never going to wholesale approve disability claims for such exposure without Congressional action because of the cost implications.  Let’s hope that this sordid chapter is now behind us and Congress authorizes the funds and VA gets on with providing care and treatment to those exposed in a compassionate and timely manner.  Read more about this at the Navy Times article below.

http://www.navytimes.com/news/2012/06/military-lawmakers-propose-va-care-for-those-exposed-to-lejeune-water-062212w/

More Health Care Jobs in Michigan than Manufacturing Jobs

By Tariq Hafeez

There are more health care related jobs in Michigan than manufacturing jobs for the first time in the State’s history.  In 2011, health care related employment generated 543,900 payroll jobs while the auto industry and other manufacturers finished second with 506,100 payroll jobs. 

Manufacturing still generates more economic activity than any other industry in Michigan, generating $61 billion in gross domestic product in 2011. The recession of 2009 and the bankruptcy and subsequent layoffs by General Motors and Chrysler contributed to the health care sector quietly overtaking manufacturing as the state’s employment leader. 

Among the largest job gainers in the health care field will be registered nurses, physical and occupational therapists and medical assistants.

Health care in Michigan is forecasted to continue to grow as Metro Detroit senior are expected to increase 86% by 2040, according to an April forecast by the Southeast Michigan Council of Governments. With the increase of senior population, demand for additional medical services, including outpatient and hospital care is forecasted to continue to grow.

If you have any questions relating to health care, corporate law, licensure, or health care fraud, contact Tariq Hafeez at (248) 380-0000.

Confusing Website

James G. Fausone
Veteran Disability Attorney

GIBill.com looked like an official government website intended to provide information to veterans about their GI Bill benefits.  But looks can be deceiving.

The website was actually owned by QuinStreet Inc., an internet marketing and media company.  The Attorneys General of several states sued QuinStreet alleging violation of consumer protection laws.  They contended that the website purposely and deceptively gave the appearance that it was owned or operated by the U.S. government.

The GI Bill is an extensive educational assistance program provided to veterans.  The bill gives the veterans the flexibility to pursue education how they see fit – at public, private non-profit, or private for-profit schools.

However, GIBill.com deceived veterans into thinking they were making an informed decision about their education choices.  In reality, the veterans were being deceived and receiving information exclusively about for-profit institutions that were clients of QuinStreet.

QuinStreet has settled the suit by agreeing to pay $2.5 million and, more importantly, turning over its GIBill.com website to the U.S. Department of Veteran Affairs to prevent further fraud by QuinStreet.

The post-9/11 GI Bill was authorized by Congress in 2008.  Through the program, the VA has disbursed nearly $20 billion in payments to 759,000 people and their educational institutions.

Providing education to our veterans via the GI Bill is just a small token of appreciation for the sacrifice and service of these brave men and women.  Hopefully this action by these attorneys general will send a message to others like QuinStreet that such deceptive practices will not be tolerated.

To learn more or read the VA press release, please visit:  http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2345

Largest Healthcare Fraud Settlement in US History

By Tariq Hafeez

British drug maker GlaxoSmithKline (GSK) has agreed to pay $3 billion US in criminal and civil fines and plead guilty to misdemeanor criminal charges related to the sale and marketing of its antidepressants Paxil and Wellbutrin and the diabetes drug Avandia in the largest health-care fraud settlement in U.S. history.

The case was brought against GSK under the federal government’s whistle-blower law, known as the False Claims Act.  Whistle-blowers get a share of any money received by the federal government.  The case stems from claims made by four employees of GSK, including a former senior marketing development manager for the company and a regional vice president, who informed the government about a range of improper practices from the late 1990s to the mid 2000s. 

The British drug maker admitted, as part of its settlement, that it misbranded antidepressants Paxil and Wellbutrin. It also admitted to marketing them for uses not approved by the FDA including treatment of children for depression and treatment for obesity, addition, ADHD and anxiety. The company also admitted that it failed to inform the FDA that its diabetes drug Avandia might cause heart problems.

GlaxoSmithKline will pay $1 billion in criminal fines and forfeitures and the remaining $2 billion will go to settle state and federal civil allegations regarding false claims that it submitted to the federal health care programs. According to the Michigan Attorney General Bill Schuette, Michigan is in line to get $23.8 million as part of the settlement, as Michigan was among the states that sued GSK.

If you have any questions relating to health care fraud, contact Mark Mandell or Tariq Hafeez at (248) 380-0000.