U.S. Attorney Says Attack on Fraud Has Saved $100 Million in Health Care Funds

Mark J. Mandell, Esq.

If you are a health care professional, Medicare and Medicaid fraud allegations are serious. In addition to heavy fines and penalties, the government often seeks prison time to punish violators.

And that dual strategy of criminal and civil penalties, which are part of ramped-up fraud prevention efforts, has saved over $100 million in federal health care funds for the Western District of Michigan, according to U.S. Attorney Patrick Miles.

In the past few years, the attack on fraud has yielded 20 criminal convictions and health care companies paying over $5 million in fines. Mr. Miles and investigators with the U.S. Department of Health and Human Services said Michigan is experiencing issues with fraudulent activities, in part, because some firms, like home health care companies, do not have to be licensed by the state.

What officials call “mom and pop” pharmacies make up a significant portion of the spike in fraud, while physicians and other professionals have not seen an increase in fraud issues. One of the largest cases federal attorneys recently prosecuted involved six pharmacists with a Kentwood Pharmacy, where pharmacists were accused of illegally restocking and re-prescribing drugs.

The $100 million saved in Medicare and Medicaid costs is a significant amount given the area's relatively low population. In comparison, officials said, focused fraud prevention efforts in Miami, Florida have saved some $500 million in health care costs.

Mr. Miles also stated in a recent Gongwer Michigan Report that, as part of the effort, the U.S. attorney’s office has met with various health care providers, including pharmacists, physician assistants and nurse practitioners to explain what constitutes fraud and its consequences. And, he noted that those meetings, along with the ramped-up enforcement, have deterred individuals from trying to commit fraud.

Fausone Bohn, LLP Medicare and Medicaid Fraud Defense Attorneys have experience defending health care professionals, and, as former prosecutors, we understand the opposition’s mindset and strategy. Our Medicare and Medicaid fraud attorneys can help defend you against allegations of: 

• Billing for services that were never performed.
• Providing services that aren’t medically necessary.
• Upcoding of services.
• Offering and paying kickbacks to doctors or Medicare beneficiaries.
• Submitting fraudulent cost reports.
• Conspiring to commit healthcare fraud. 

Give us a call today at 248-468-4536, or visit us online at www.fb-firm.com and www.Facebook.com/FausoneBohnLLP

VA Health Care Investigations Left in the Dark

The Department of Veterans Affairs picked up another notch on their belt of scandals and mishaps earlier this month. USA Today recently reported that the VA has not publicly released the findings of 140 health care investigations going back to 2006.

And so more problems for our veterans continued to fester without proper oversight, leaving those who have served our country out to dry.

It is unknown how many of the investigations uncovered serious or dangerous problems as the reports have not been read or analyzed yet, but all of them concerned VA medical care provided to veterans or complaints of clinical misconduct.

The VA inspector general said they could not provide specifics for the apparent lack of transparency, as the inspector general has not analyzed the reports in full.

Catherine Gromek, the VA inspector general, advised requesting the reports under the Freedom of Information Act. USA Today submitted a request in January for 23 reports. Her office has maintained that officials are "working diligently" to fulfill the request.

The inspector general’s office noted that, in general, reports may not be released if allegations are unsubstantiated and disclosing them could damage someone's reputation, when there is a pending lawsuit or when subjects of investigations are no longer working at the VA.

Officials from the inspector general's office did review 26 reports withheld from the public since January 2014 and found less than half — 46% — involved unsubstantiated allegations. They said in 42% of the cases, inspectors determined VA officials had already addressed their concerns so a public report was unnecessary. One was the subject of a pending lawsuit.

However, these statistics and reasons for lack of transparency do not satisfy the many veterans and their families who continue to suffer through poor care, long waits, and a bevy of other issues at VA medical centers. And they should not satisfy the public either.

Read USA Today’s full report on the issue here:

http://www.usatoday.com/story/news/politics/2015/03/08/probes-of-veterans-health-care-often-not-released-to-public/24525109/

At Legal Help For Veterans, PLLC, we focus exclusively on veterans’ rights. If you are a veteran looking to get the benefits that you deserve, call us today at 1-800-693-4800. We handle a variety of claims, including PTSD, TBI, and other service-connected injuries. www.LegalHelpForVeterans.com

Camp Lejeune Toxic Water Victims to Receive Financial Relief, VA Announces

The Department of Veterans Affairs (VA) announced that it will begin covering out-of-pocket health care expenses for Marine dependents who fell victim to cancer and other illnesses from toxic water at Camp Lejeune, NC.

The relief is long-overdue, as victims were promised coverage for their health care costs two years ago when Congress passed the landmark Honoring America’s Veterans and Caring for Camp Lejeune Families Act. Not to mention, the toxic water problem stems all the way back to the mid-1950s.

The 2012 law provided health care for Marines and family members who had lived on the base from 1957 to 1987 and who suffered from any of 15 illnesses named in the law. These included cancer related to the lungs, bladder, breasts, kidneys and esophagus, as well leukemia and problems involving female infertility.

Some 750,000 people were exposed to polluted drinking water, which contained harmful chemicals from spills, a dump site on the base, leaking underground storage tanks on base and an off-base dry cleaner.

With the 2012 law, the VA immediately offered full care for veterans who had been stationed at Camp Lejeune, but it also established a waiting period for their dependents who suffered from covered illnesses to be reimbursed.

The most recent announcement from the VA means they will begin reimbursing family members later this year for health care costs incurred since March 26, 2013 – the date which Congress appropriated the funding.

The VA also planned to release a document about health care services to veterans who were on active duty at the base for at least 30 days in the three-decade period.

The news site McClatchy spoke with two individuals who were affected by the toxic water at Camp Lejeune.  Retired Marine Jerry Ensminger’s 9 year old daughter, Janey, died of leukemia in 1985, and Mike Partain, who was born at the base, has suffered from male breast cancer.

The two led the long fight to get the 2012 law passed, and both said they were dismayed by the delay in individuals receiving this financial relief.

“As far as I’m concerned, so many people have already died. They just keep dragging this thing out,” Ensminger said.

Partain said “institutional apathy and incompetence” were the reasons it took two years to write and approve the regulations for how the law would be administered.

For now, at least, the victims of Camp Lejeune can celebrate a step in the right direction.

Read more on this story on McClatchy DC:   

http://www.mcclatchydc.com/2014/09/23/240809/financial-relief-finally-coming.html

Michigan Veterans Not Using Services

Michigan has a significant concentration of resident veterans – around 700,000.  However, in December, it was revealed that Michigan also has the lowest percentage of veterans who utilize benefits and services available to them.

According to a report released by the Michigan Veterans Affairs Agency, only 142,260 veterans use services available to them such as health care and education resources. This number accounts for just 20% of Michigan’s veteran population.

So why aren’t more Michigan veterans taking advantage of these services and opportunities? 

The disparity can be partly attributed to poor information and lack of an organized method for distributing information about these programs.  With no central database for this information, many veterans aren’t even aware of the benefits available to them.  Additionally, the disparity is partly due to a shortage of trained and on-staff service officers necessary to meet the needs of the growing number of veterans leaving the armed forces and taking up residence in Michigan.

In an effort to increase communication and awareness of these available programs, the Veterans Affairs Agency has launched pilot programs in Wayne County and Grand Rapids.  Part of these programs include increasing staff levels to generate demand.

If you are a veteran and have questions about what benefits you are entitled to, contact the experienced professionals at Legal Help For Veterans.  Our team of lawyers and professionals are experts on veteran benefits and can help you get the help you need.  Contact us at 800-693-4800 or online at www.legalhelpforveterans.com.  

One Year Delay in Enforcement of Employer Mandate

Tariq Hafeez, Esq.

The Obama Administration announced on July 2, 2013 that it would delay the implementation of a key provision of the Affordable Care Act--the employer mandate which will require employers with 50 or more workers to provide affordable health coverage to employees or risk tax penalties of up to $2,000 for each full-time employee that did not get health coverage.  The employer mandate was originally to take effect on January 1, 2014 but now will not be implemented until January 1, 2015.

The employer mandate has been a big source of anxiety and criticism in the business community as many business owners feel that the provision would be too costly to implement. Additionally,  confusion remains on which businesses would be subject to the mandate as definitions of “full time” employees and what constitutes “affordable” insurance are complicated and subject to interpretation.

 

The delay in implementation of the employer mandate does not affect the other implementation timelines of the Affordable Care Act, including the opening of the health care exchanges in October 2013 and new tax credits to help individuals buy health insurance.

If you have questions about health care fraud or other legal issues, please contact Mark Mandell or Tariq Hafeez at 248.380.0000 or online at www.MichiganFraudLawyer.com.

 

Michigan Veterans Affairs Agency

Last week, Michigan's Governor, Rick Snyder, signed an executive order that created the Michigan Veterans Affairs Agency.  The goal of the agency is to help connect former service personnel with government departments and service organizations that will help them apply for benefits such as health care, education, and employment assistance.

Michigan has over 650,000 veterans and that number is rapidly rising with the returning troops from Iraq and Afghanistan.  All of the programs for veterans are scattered among various federal and state departments.  As such, it is a confusing maze for Michigan veterans to not only be aware of the benefits available to them, but obtain them.  The hope is that this agency will help Michigan veterans traverse the maze much more easily than by themselves.

PTSD 30% of Treated Troops

James G. Fausone
Veterans Disability Attorney

A report, posted to the VA's website, showed that 247,243 of the 834,463 treated veterans from the two current conflicts were diagnosed with PTSD.  So the question is does VA intend to have the resources necessary both in health care and in disability benefits to meet this reality.  Based on the recent VA report, on post-traumatic stress disorder that nearly 30 percent of veterans who served in conflicts in Iraq and Afghanistan and treated at VA hospitals were diagnosed with PTSD what are you doing to address this situation.  At the law firm we help hundreds of vets with PTSD. The story is often the same VA diagnoses for PTSD but treatment is another challenge and disability benefits are years in waiting. Let’s solve this problem now.

http://www.stripes.com/news/special-reports/post-traumatic-stress-disorder-ptsd/nearly-30-percent-of-recent-combat-vets-treated-by-va-have-ptsd-1.193913