Report Shows Seniors Abused at 1 in 3 Nursing Homes

Daniel J. Williams, Esq.

The United States has over 15,000 nursing homes, and according to a report, elder abuse occurs at 1 in 3 of them. The study showed that over 5,200 nursing homes were cited for about 9,000 instances of abuse over a two year period.

In over 1,600 cases, nursing home residents experienced serious harm to place the resident in jeopardy of serious injury or death. Yet, despite the horror stories, the nursing home population is only projected to grow significantly.

Some of the most common problems in nursing homes include untreated bedsores, inadequate medical care, malnutrition, dehydration, preventable accidents, and inadequate sanitation and hygiene.

The bottom line is that no one is immune to elder abuse at a nursing home, especially given these numbers. Even the famous novelist Harper Lee, author of To Kill A Mockingbird, has been subject to an alleged case of nursing home abuse – check out our previous blog to learn more on that case: Click Here.

The homes cited by the study for instances of abuse accommodate some 550,000 residents, many of whom live in the 11,000 for-profit nursing homes across the country. Many of those for-profit businesses are receiving federal funds.

The federal government is the biggest contributor of nursing home care, mostly through Medicaid, a joint federal-state health care program for the poor, and Medicare, the federal program for elderly and disabled people. Federal health and safety standards are designed to protect nursing home residents from abuse.

To enforce the standards, the U.S. Department of Health and Human Services contracts with the states to conduct annual inspections of nursing homes. The states also are required to investigate individual abuse complaints. The report's statistics were derived from these state inspections.

The industry has cited money as an issue, in particular in their ability to attract and retain skilled staff. The average hourly wage for nursing assistants ranges from $7 to $9 per hour. Some have argued that non-profit homes, often run by community or religious organizations are better at serving residents and caring for their needs.

However, whether it is a not-for-profit home, a for-profit home, and no matter the age of your loved one, they deserve to be treated with dignity and respect. And while nursing home care has improved over the years, as this report shows, instances of atrocious abuse still occur and are prevalent.

Daniel J. Williams is an Elder Abuse Attorney with Fausone Bohn, LLP. The firm has former prosecutors and experienced attorneys who can help you and your family right the wrongs done to your loved one, whether it be nursing home abuse or financial exploitation. Call the Metro Detroit Elder Abuse attorneys today, at (248) 468-4536, or visit us online at www.fb-firm.com.

Read more at ABC News: http://abcnews.go.com/US/story?id=92689&page=1

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

Free Medical Services for Qualifying Veterans & Family Members

The Michigan Endoscopy Center in Novi, Michigan has a unique offer for free GI procedures.  This free service is made available by rules of the Centers for Medicare & Medicaid Services.  Michigan Endoscopy Center has CMS approval until the end of the year at its new surgery center in Novi to provide these tests free of charge.  These procedures cost around $3,000, so this is a real benefit to veterans that may not have income, insurance or healthcare. 

Colonoscopy’s make a great holiday gift! …one size fits all, they can’t be returned and just might save a life!

To see if you qualify, please contact the Center’s administrator at the number below. 

Brien Fausone, MA, MBA

Administrator

Michigan Endoscopy Center

(248) 865-6555 phone

bfausone@endoctr.com

$4.15M Settlement Evidences Benefit of Reporting

Breeda O’Leary, Esq.

The U.S. Government (“Government”) and the State of Michigan (“State”) have reached an agreement in a False Claims Act case wherein the Defendants have agreed to pay $4.15M to the Government and State for fraudulent billings to Medicare and Medicaid.

   

The qui tam provisions of the False Claims Act allows an individual with knowledge of Medicare or Medicaid Fraud, referred to as the “relator,” to file a lawsuit on behalf of the Government against those committing the fraud.  The Government is then provided notice of the lawsuit and is given the option to intervene as Plaintiff in the suit.  If the Government obtains a judgment or settlement in the suit, the relator is provided a percentage of the amount collected.

      

In the instant case, it was alleged that the Defendants, Dr. Jashu R. Patel and other Jackson Cardiology Associates physicians, performed unnecessary cardiac procedures at Allegiance Health’s W.A. Foote Hospital in Jackson, also a Defendant in the case.  Medicare and Medicaid were billed for these procedures.  Dr. Julie A. Kovich, a former independent contractor at Jackson Cardiology Associates, filed suit as the relator in this case.  While Dr. Kovich faces the possibility of being ostracized by her peers, she will receive approximately $764,700.00 as the relator. 

 

If you or anyone you know has specific knowledge of fraudulent billing to Medicare or Medicaid, or is facing criminal or civil liability concerning an alleged fraud, contact the experienced and professional fraud team at Fausone Bohn, LLP for sound legal advice.  Contact us at (248) 380-0000 or online at www.MichiganFraudLawyer.com.

To read the article about the deficiencies in Medicare’s new accounting system, please visit:  http://www.justice.gov/usao/mie/news/2013/2013_7_10_jpatel_HCF.html

Local Oncologist Charged with Medicare Fraud

Mark Mandell, Esq.

Yet another Michigan doctor has been brought up by the FBI on charges of Medicare fraud this past Tuesday. Although this seems like an unfortunate regular occurrence nowadays, this specific case is one of the worst our state has seen.

Dr. Farid Fata, a 48-year-old oncologist from Oakland Township, was arrested Tuesday morning for submitting over $35 million worth of false claims to Medicare. Despite this large fraud, however, the FBI are alleging even worse crimes than cheating Medicare.  In their criminal complaint against Fata, the FBI states he “administered unnecessary chemotherapy to patients in remission.” As shocking as it sounds, not only was Fata fraudulently billing Medicare for his own benefit, but he was abusing the trust and confidence of his cancer patients.

The FBI said that Fata deliberately misdiagnosed patients with cancer so he could bill them for chemotherapy and that he told cancer-free patients who had entered remission that they were still in need of chemotherapy medications. While it is unclear whether Fata’s actions resulted in any severe medical issues or deaths at this point, the FBI is not ruling out the possibilities.

With over $14 million in liquid assets and a house in Lebanon, the FBI considers Fata a flight risk and are holding him until his hearing date arrives. For his current charges he faces up to 20 years behind bars if he is convicted.

If you or someone you know is the target of a fraud investigation, or if you have already been indicted, contact the experienced team of fraud attorneys at Fausone Bohn, LLP, at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

 

To learn more or see the original article, please visit: http://www.wxyz.com/dpp/news/region/oakland_county/doctor-arrested-offices-raided-by-fbi-in-connection-to-healthcare-fraud-charges

Detroit Area Man Pleads Guilty to Health Care Fraud

Mark Mandell, Esq.

 

According to the U.S. Justice Department, a Detroit-area Physical Therapist Assistant, Syed Shah, has pleaded guilty to participating in a $22 million home health care fraud.

Prosecutors say that the 51 year old West Bloomfield man acknowledged that he conspired to bill Medicare for home health services that weren’t performed or were not medically necessary.  These actions occurred between 2008 and 2012.

Mr. Shah will be sentenced on November 19th and he faces a maximum penalty of 10 years in prison. 

Long prison sentences such as this are further evidence of the Federal government’s crackdown on health care fraud.  The Federal government is ramping up its investigation and prosecution efforts in an effort to combat the billions of dollars lost annually to Medicare and Medicaid fraud.

If you or someone you know is the target of a fraud investigation, or if you have already been indicted, contact the experienced team of fraud attorneys at Fausone Bohn, LLP, at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

Medicare’s Disproportionate Fraud Rate

Mark Mandell, Esq.

 

It is difficult to truly understand the enormous fraud problem in the Medicare system.  To put it in perspective, look at the fraud rates of other industries:

             Credit card industry fraud - 0.04%.

            JPMorgan & Chase Co. fraud - 0.6%.

Medicare?  It has a fraud rate of 8.5%.  Incredibly, Medicare and Medicaid fraud totals a whopping $60 billion annually.  That’s $60 billion taxpayer dollars not providing care to seniors but instead lining the pockets of criminals.

U.S. Representative Peter Roskam from Chicago has introduced a bill into Congress (HR 2305) that aims to update the Medicare system to combat fraudulent behavior and improper payments.

Some of the changes introduced in Rep. Roskam’s bill include updating the Medicare payment system.  Currently, the money goes out the door without any rigorous fraud checks.  The proposed change is modeled after the credit card industry – Medicare claims would go through two separate and distinct fraud checks at the beginning and the end of the process.  These checks occur before the money is paid out.

 
Additionally, the bill makes changes to reduce incidents of “dead” doctors prescribing drugs and increasing criminal penalties.  The bill also encourages increased education for seniors to identify and report fraud in the system.  Lastly, the bill increases communication between the Medicare and Medicaid systems to bolster security and fight improper payments.

With so many Americans paying into the Medicare system and the prospect of that system going bankrupt as early as 2026, we can’t afford to needlessly pay out $60 billion per year to criminals.  Changes, like those introduced by Rep. Roskam, need to be made to bring Medicare back on track.

If you have questions about Medicare or other types of fraud, contact the experienced team of fraud experts at Fausone Bohn, LLP at (248) 380-0000 or online at www.MichiganFraudLawyer.com.

To read about Rep. Roskam’s bill, visit: http://www.chicagobusiness.com/article/20130621/OPINION/130629969/how-to-cut-medicares-whopping-fraud-rate

 

Pharmacist Pays Big for Healthcare Fraud

Mark J. Mandell, Esq.

 

A medical professional convicted of health care fraud stands to lose nearly everything.

On June 10, Northville pharmacist Lokesh Tayal was convicted of one count of health care fraud conspiracy and one count of conspiracy to distribute controlled substances – both of which are felonies.  Mr. Tayal was sentenced to 5 years and 8 months of imprisonment and ordered to pay restitution of more than $3.6 million.

In addition, the Michigan Department of Licensing and Regulatory Affairs (LARA) has suspended Mr. Tayal’s pharmacy license. 

The conviction and license suspension stem from a case involving multiple area pharmacists.  According to the U.S. Attorneys on the case, the pharmacists participated in an elaborate scheme to defraud Medicare, Medicaid, and Blue Cross Blue Shield.  The pharmacists paid cash kickbacks and other illegal remuneration to physicians to get them to write prescriptions that were medically unnecessary.

 

The pharmacists then billed for expensive medication that was never disbursed or was not medically necessary, according to the U.S. Attorney’s office.

The U.S. Attorney summarized the Federal government’s current stance on health care fraud when she said “these defendants stole money from the Medicare and Medicaid programs, which are designed to provide health care and medicine to some of our most vulnerable citizens.” 

With the recent crackdown on fraud, medical professionals are facing not only hefty prison time and fines, but also the loss of their livelihood – revocation of their professional licenses.  If you have been indicted or are concerned about health care fraud, contact the experienced and professional fraud team at Fausone Bohn, LLP for sound legal advice.  Contact us at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

To read the article about these fraud convictions, please visit: http://www.hometownlife.com/apps/pbcs.dll/article?AID=2013306280006

 

Health Care Fraud Indictments

Tariq Hafeez, Esq.

Thirteen individuals from the metro Detroit area have been charged in a large-scale health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today.

The superseding indictment, adds 13 new defendants and new charges to a 2011 indictment, which charged Canton Pharmacist Babubhai ‘Bob” Patel with overseeing a massive health care fraud and drug distribution ring at more than 20 pharmacies that he owned and controlled in metro Detroit.

The 21-count superseding indictment charges with prescription fraud involving 26 Michigan pharmacies. The indictment alleges that the defendants participated in a scheme whereby the owners/controllers of the pharmacies provided kickbacks, bribes, and other illegal benefits to physicians to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance. The prescriptions be presented to one of the defendants’ pharmacies for billing. In exchange for their kickbacks and inducements, the physicians would write prescriptions for the patients and bill the relevant insurers for services supposedly provided to the patients without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of the defendant owned pharmacies, where defendants would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and, in many cases, never provided. Patients were recruited into the scheme by patient recruiters or “marketers,” who would pay kickbacks and bribes to patients in exchange for the patients’ permitting the defendants’ pharmacies and the defendant physicians to bill their insurance for medications and services that were medically unnecessary and/or never provided.

The indictment further alleges a conspiracy to distribute controlled substances at the defendants’  pharmacies to facilitate the submission of false and fraudulent claims to Medicare, Medicaid, and private insurers. According to the indictment, defendants paid physicians kickbacks for prescriptions for controlled substances for their patients and directed those patients to fill the prescriptions at defendants owned/controlled pharmacies. The controlled substances included the Schedule II drug oxycodone (Oxycontin), the Schedule III drug hydrocodone (Vicodin, Lortab), the Schedule IV drug alprazolam (Xanax), and the Schedule V drug cough syrup with codeine. According to the indictment, prescriptions for these drugs were written outside the course of legitimate medical practice. 

This most recent indictment falls in line with the federal government’s increased investigation and prosecution of health care fraud across the country.  In May 2009, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) created the Health Care Fraud Prevention and Enforcement Action Team (HEAT), making the fight against health care fraud a Cabinet-level position. The Heat task force is focused on nine cities including Detroit.

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.

 

Seventeen-Year Sentence Awaits Pharmacist

Mark J. Mandell, Esq.
 

After billing the government for more than $57 million worth of medically unnecessary painkillers, Babubhai (Bob) Patel now faces 17 years in prison.

Owning and operating more than 26 pharmacies across metro Detroit, Patel had a myriad of doctors at his fingertips. He paid such doctors to write orders and had recruiters offer cash to lower-income individuals in exchange for their Medicare or Medicaid numbers. The scheme operated on a business model that paid kickbacks to physicians in exchange for their writing prescriptions for expensive – yet unneeded – medications. As a result, between 2006 and 2011, Patel billed Medicare and Medicaid for over $57 million. At least 25 percent of those billings were for drugs that were never dispensed or were unnecessary to begin with. Not only did Patel take advantage of the government, but he also fraudulently billed to private insurers, such as Blue Cross Blue Shield of Michigan.

In addition to the years Patel will face behind bars, he has also been ordered to pay restitution in the amount of $17.3 million to Medicaid and Medicare, as well an additional $1.5 million to Blue Cross Blue Shield.

“What you have done,” the court told Patel, “is reprehensible.”

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

To learn more and read the original article, please visit: http://www.siliconindia.com/news/usindians/IndianAmerican-Jailed-for-17-Years-For-Healthcare-Fraud-nid-140144-cid-49.html

 

Alleged $22 Million Home Health Care Fraud Scheme

Tariq Hafeez, Esq.

Detroit-area and Chicago-area residents were arrested on Thursday, January 18, 2013 by federal agents on charges arising from the ongoing investigation into an alleged $22 million home health care fraud scheme. The indictment was announced by the US Attorney’s Office, the FBI Detroit Field Office, and the Health and Human Services Office of Inspector General (HHS-OIG).

The 18-count indictment names seven individuals who allegedly participated in a Medicare fraud scheme operating out of four Oakland County, Michigan, home health agencies claiming to provide in-home health services. Defendants are charged with conspiracy to commit health care fraud, health care fraud, conspiracy to violate the Anti-Kickback Statute, and money laundering allegedly defrauding Medicare/Medicaid of $22 million.

 

The charges of health care fraud conspiracy and health care fraud each carry a maximum potential penalty of 10 years in prison and a $250,000 fine. The charge of conspiracy to violate the Anti-Kickback Statute carries a maximum potential penalty of five years in prison and a $25,000 fine. The charge of conspiracy to commit money laundering carries a maximum potential penalty of 20 years in prison and a $500,000 fine.

Fausone Bohn LLP attorneys have provided aggressive legal defense counsel to individuals and companies charged with federal health care fraud the firm has been retained by one of the defendants in the above matter.

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

Detroit Health Care Fraud

Matt Worley, Esq.

Despite regular indictments and convictions of home health care agency owners, Medicare and Medicaid fraud remains prevalent in metro Detroit, according to a new report by the Office of the Inspector General (OIG).

The US Department of Health and Human Services (HHS) found high fraud, waste, and abuse in Detroit.  Other cities found to have high fraud include Chicago, Miami, Tampa, Los Angeles, Dallas, Houston, and Baton Rouge.

Fraud is a major problem in the Medicare system.  Most experts believe that up to ten percent of the annual $1 trillion cost of Medicare and Medicaid can be attributed to fraud, waste, and abuse.  In 2009 HHS created HEAT – a task force whose aim is to reduce fraud in these programs.

According to this report, as much as 22 percent of claims inspected were filed in error because the services were unnecessary or were coded inaccurately.  This resulted in $432 million in unnecessary payments to home health agencies.  Part of the problem lies in poor record-keeping by the agencies.

The OIG report made three recommendations to home health agencies to reduce fraud.  These providers should (1) increase Medicare contractor standards to identify high risk providers; (2) track license revocation recommendations; and (3) take measures to prevent inappropriate payments to agencies with suspended or revoked licenses.

In response to the report, the Centers for Medicare and Medicaid Services (CMS) said it would implement all three of these recommendations.

To read the original article in Crain’s Detroit Business, please visit: http://www.crainsdetroit.com/article/20121220/BLOG010/121229986/report-home-health-agencies-still-target-of-fraud-investigators-in

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