$40 million Detroit-area Medicare Fraud Scheme

Tariq Hafeez, Esq.

 

A Detroit-area doctor, Hicham Elhorr, has been charged in federal court for his alleged leading role in a $40 million Medicare fraud scheme.

Dr. Elhorr was the owner and operator of House Calls Physicians (HCP), a physician home visiting service.  Elhorr allegedly submitted claims through HCP for physician home visits for patients that were never seen or visits conducted by doctors who were not licensed.  The complaint further alleges that Elhorr submitted claims to Medicare when he was out of the country, when beneficiaries were hospitalized, or even when the beneficiary was dead.

 
Additionally, Elhorr is charged with accepting kickbacks from home health agencies in exchange for referring patients to those agencies.  According to court documents, HCP has billed Medicare for approximately $9.2 million since January 2008.  In that same time period, the company has allegedly referred Medicare beneficiaries for home health services that resulted in approximately $30.8 million of reimbursements from Medicare.

Of course, these charges mean that Dr. Elhorr is suspected of committing these crimes but is considered innocent until proven guilty beyond a reasonable doubt in a court of law.

Medicare and Medicaid fraud are serious offenses that are harshly prosecuted and carry severe penalties and jail time.  Having quality legal advice is imperative when defending against such allegations.

The experienced fraud team at Fausone Bohn, LLP – Mark Mandell, Tariq Hafeez, and Breeda O’Leary – can provide a top-notch legal defense for those involved in a government investigation or prosecution.  The team can also provide counsel for “whistleblowers” looking to expose the fraud of their employers (or ex-employers).  Whistleblowers may be eligible to receive money from a settlement or verdict and this knowledgeable team has the expertise to obtain these positive results.

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

http://www.examiner.com/article/michigan-doctor-charged-40m-medicare-fraud-scheme

Medicare Fraud Max Sentence

By Matthew Worley

64 year-old George Dalyn Houser of Georgia was sentenced in Federal Court to 20 years in prison for Medicare fraud.  Houser and his wife operated three nursing homes and used them to fraudulently bill Medicare and Medicaid for “worthless services.”

Houser will serve his 20-year sentence followed by 3 years of supervised release.  He will also have to pay $6,742,808 in restitution to the Medicare and Medicaid programs.  Additionally, he must pay $872,515 in restitution to the IRS for failing to pay payroll taxes and personal income taxes.

Houser bought real estate, luxury vehicles, vacations, and planned to build a hotel – all while the residents in his nursing homes allegedly starved and lived in unacceptable conditions.

The nursing homes allegedly suffered from food shortages bordering on starvation, leaking roofs, no nursing or housekeeping supplies, poor sanitary conditions, major staff shortages, and safety concerns.

“Senior citizens in nursing homes are some of our most vulnerable citizens.  Houser stole millions in taxpayer dollars while the residents entrusted to his care went without food or medicine.  Now he’ll spend 20 years in prison,” said US Attorney Sally Quillan Yates.

The Office of the Inspector General is committed to aggressively investigating and prosecuting these taxpayer-funded, worthless service cases.

Medicare and Medicaid fraud are serious offenses and those that commit them face harsh prosecutions and severe penalties or jail time.  Having quality legal advice is imperative when defending such allegations.

The experienced fraud team at Fausone Bohn, LLP – Mark Mandell, Tariq Hafeez, and Breeda O’Leary – can provide a top-notch legal defense for those involved in a government investigation or prosecution.  The team can also provide counsel for “whistleblowers” looking to expose the fraud of their employers (or ex-employers).  Whistleblowers may be eligible to receive money from a settlement or verdict and this knowledgeable team has the expertise to obtain these positive results.

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

http://www.examiner.com/article/rome-nursing-home-owner-receives-maximum-sentence-for-health-care-fraud

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.

Time to Stop Michigan Fraud

Jim Fausone

All you have to do is read the papers or online local news to realize that fraud, waste and abuse in government contracting and programs is running rampant. I will leave it to the psychiatrists to figure out why human nature leads people to take advantage of government programs. But the way to stop it is allow anyone to sue and recover from the wrong doer. This is one state's efforts.

An overhaul of the State of Washington’s Medicaid fraud recovery efforts to cut waste and recover taxpayer dollars was passed by the Legislature. Experts from the National Conference of State Legislatures estimate the cost of Medicaid fraud accounts for 3 and 10 percent of total Medicaid expenditures. Washington spent $8.5 billion on Medicaid last year only to recover less than $20 million in fraud. At its most optimistic, the state’s recovery rate tops out at less than 1 percent so more simply has to be done.

Michigan has a similar statute which is limited to Medicaid fraud. Let’s open it up and let citizens sue on all government programs. You can read more about Washington State's efforts at: http://www.maplevalleyreporter.com/news/142212725.html

Turning Up The Heat

by Paul F. Bohn

In an effort to curb Medicaid and Medicare abuse, the U.S. Attorney’s Office has ramped up its efforts in the Detroit Metropolitan area. Evidence of this is in the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) within the Department of Justice. A HEAT Medicare Strikeforce has recently been sent to the Detroit Metropolitan area and has identified over $120 million in Medicaid and Medicare abuse, charging hundreds of Defendants criminally.

Michigan is one of the few states that allows a private individual to sue and recover a portion of damages when others abuse the Medicaid and Medicare system. Often termed “whistleblower” suits, persons with knowledge of Medicaid and Medicare abuse and who report the same, may be eligible to share in the recovery. If you believe you have information that someone has been abusing Medicaid or Medicare, and want to discuss your options, please contact either Paul Bohn(248.380.0000, ext 243) or Mark Mandell (248.380.9976).

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