Medicare Fraud Sweep leads to Sixteen Arrests in the Metro Detroit Area

In the event that anyone needed more evidence that the Federal and State government is taking a serious look at persons who are out to take advantage of the Medicare System by exploiting the elderly and vulnerable, the recent arrests in the Metro Area are significant evidence of that proposition. The wide-sweeping arrests that were reported here, also show an increasing trend; namely, that there are those who are seeking to take financial advantage of the elderly and those who are vulnerable and sick.

Unfortunately, the news in this case is only a symptom of a greater problem. There are a lot of individuals who are looking to take advantage of the elderly and vulnerable, and who will try and exploit them financially, either by improperly subjecting them to medical treatment they do not need to try and obtain money from the government illegally, or by simply going into the eider's pocket book and getting ahold of their funds. Many times, it is the persons that the vulnerable trust most that take advantage of their situation; their children, their families, their doctors and their friends.

Sadly, the reports of arrest are not novel, and these are not likely to be the last. Hopefully, with arrests in cases like this, particularly where the thefts are connected with the financial exploitation of those who are most vulnerable, families and law enforcement will become more alert and sensitive to this type of activity, and become more likely to prosecute it, either criminally, or through civil actions.

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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

New Harper Lee Novel Sparks Elder Abuse Investigation

Elder abuse is a serious matter, and no one is immune to it. Not even a famous, award-winning novelist like Harper Lee, who authored To Kill a Mockingbird.

Lee, who is now 88 years old, is set to release her second novel, Go Set a Watchman, which she actually wrote over 50 years ago. While the news of a second novel set-off a buzz on social media, many Mockingbird fans expressed skepticism on the reasons behind the release.

Lee currently resides in an assisted living facility and is said to be in declining health – is it possible that she could have not knowingly consented to the release of the second novel? The New York Times recently reported that there is at least one complaint of elder abuse at Lee’s assisted living facility connected to the book’s release, and Alabama state officials are now investigating the claims.

Officials interviewed Lee in February, as well as employees of her assisted living facility and some of her friends following the unspecified complaint tied it to the publication of Go Set a Watchman.

Allegedly, Lee “appeared capable of understanding questions and provided cogent answers to investigators," according to the Times report. However, writer Marja Mills wrote a book chronicling the 18 months she spent living next to Lee. Alice Lee, Harper Lee’s elder sister, added to Mills’ transcript that Harper, “doesn’t know from one minute to the other what she’s told anybody.”

For her part, Harper Lee has yet to speak directly to reporters about the new novel or about her mental state. The closest she has come to commenting on either is in a two-word statement she gave after receiving a letter from an Alabama reporter: “Go Away!”

Fausone Bohn, LLP Michigan Elder Abuse Attorneys can help you and your family with your elder abuse claim. If you feel that your parents or grandparents have been subject to abuse, coercion, or fraud at a nursing home or an assisted living facility, give us a call today at 248-468-4536.

Read more on the issue here: https://www.yahoo.com/music/s/alabama-investigates-claim-elder-abuse-over-harper-lee-071922680.html

And in the Washington Post:

http://www.washingtonpost.com/news/morning-mix/wp/2015/03/12/report-alabama-investigating-possible-elder-abuse-in-connection-with-harper-lees-new-novel/

Fraudsters Now Impersonating Big Name Stores to Trick Shoppers, Online Retailers

Mark Mandell, Esq.

For everyone that read our last post on avoiding the holiday shopping scams and protecting your financial information, I strongly encourage you to read this Detroit Free Press article on the most recent trend for fraudsters: impersonating big name stores like WalMart, Target, Home Depot, and others.

Here is a link to the article: http://www.freep.com/story/money/personal-finance/susan-tompor/2014/12/18/email-holiday-scams-target-irs-susan-tompor/20554361/

If your credit card was compromised during the recent data breaches at those big name retailers, your credit card number has probably changed by now. However, such cyber-attacks have left consumers emails, and potentially phone numbers, susceptible to hackers.

And those emails and phone numbers probably have not changed since the data breaches. (You don’t have to change your email, but changing your password every once and a while can help avoid hacks).

These hackers may already know where you shop, and if you shop online with a work email, they probably can figure out where you work, too. This information allows the scams to sound more legitimate – the Better Business Bureau has even received reports of fraudulent emails sent by scammers impersonating big names like WalMart Target, Home Depot, Costco, and Amazon.

One recent example from last month was the “pizza scam,” in which hackers sent an email under the guise of Pizza Hut asking consumers to take a survey. However, when the “survey” link was clicked, malware was downloaded that wreaks havoc on unsuspecting customers’ computers.

Businesses should be especially careful. If one employee opens up a malicious email or link in a scam email, the whole computer network can be infiltrated with a virus.

One helpful tip to avoid getting bit by one of these viruses is to ignore the “pay now” and/or “you need to act now” emails. If you have purchased something online from a big name like WalMart or Target, they would not be demanding immediate payment via email – especially when you probably already paid at the online checkout.

In the case of receiving “order update” or “shipping update” emails, if you suspect it could be a scam, call the customer service line first – do not open the email. Talk to a real person, find out where your package is and when it will arrive. If it arrives safely, go and delete the potentially fraudulent email without ever opening it.

In today’s world, cyber-attacks are a rather common occurrence. Sometimes the best way to shield yourself is to do nothing at all, i.e. don’t open the emails or click on the links. But especially in the holiday frenzy of buying gifts, and then returning or exchanging them afterwards, the best advice is to slow down, don’t hurriedly click on anything suspicious, and verify that the emails you are receiving are truly legitimate.

That may entail – and this can be rare these days – actually picking up the phone and speaking with the good ole’ customer service reps.

If you feel that you have been a victim of fraud or you have questions, you can contact Attorney Mark Mandell. Or, have you been convicted of retail or return fraud? Arrested for drunk driving after a holiday party? Give Mark Mandell a call and you will get an attorney who knows how to aggressively protect your rights. Call today at (248) 380-0000.

‘Tis the Season of Fraud and Scams

Mark Mandell, Esq.

As families hurriedly finish up their holiday shopping, shoppers should beware of holiday hoaxes and scams – both online and at brick-and-mortar stores.

Shoppers who are not of the “digital native” generation are especially susceptible to online scams as they search for holiday gifts. Internet fraud is now the sixth most prevalent scam against seniors, according to the National Council on Aging (NCOA) and results in millions of dollars lost each year.

I would like to provide some helpful hints for protecting yourself against such fraud, beyond avoiding the “Nigerian Prince” emails.

Perhaps the most important point to note is that, when checking out a purchase online, ensure that the web address begins with “https” – the “s” stands for “secure,” which means it is safer to provide your credit card information. Conversely, “http” – without the “s” – is less secure for making online purchases.

Many reputable retailers will even open a window to a separate secure check-out page.

If you are purchasing items from an online marketplace like Craiglist or eBay, the best practice is to only deal with sellers who provide a phone number. Do not rely solely on email, which could open you up to viruses or fraudulent requests for money.

Other common-sense steps you can take include:

• Do not open emails from senders you do not recognize. If you receive such emails delete them immediately; if you open them on accident, delete them without clicking on any links.
• Be mindful of email lists and/or reward programs that you have signed-up for. If you receive a “holiday greeting card” email from a sender whose list you have not signed up for, then delete those emails.
• Do your homework on charities that solicit donations. Charitable donation drives are often at their peak during the holidays and present a unique opportunity for scammers to prey on people’s disposition toward giving during the holidays.
• Watch out for phony websites. When searching for gifts online, read the website description before clicking on it. Scammers can buy websites with similar sounding names to reputable retailers to try and trick shoppers. (e.g. macys.com is the reputable site for Macy’s. But, macysstore.com could be a scammer website.)

Outside the online world, shoppers should also be mindful of the security of their financial information and data. In the heat of holiday shopping, it is tempting to constantly use your debit card. However, as many reports have shown recently, your information could get hacked.

Using a credit card, which is not linked to your bank account, is a better alternative. It is much easier to simply cancel a hacked credit card than to try and recover additional lost funds from your checking or savings account that is linked to your debit card. Keep in mind, too, that paying in cash, when possible, is the best method of keeping your financial information safe – and to tame your buying habits amid all the deals.

Here’s to wishing everyone a safe and happy fraud-free holiday season!

If you feel that you have been a victim of fraud or you have questions, you can contact Attorney Mark Mandell. Or, have you been convicted of retail or return fraud? Arrested for drunk driving after a holiday party? Give Mark Mandell a call and you will get an attorney who knows how to aggressively protect your rights. Call today at (248) 380-0000.

Veteran Charities – Not All Exist to Benefit Veterans

Matt Worley, Esq.


There are around 1.6 million non-profit organizations in this country.  Of those, upwards of 65,000 include the word “veterans” in their title.  With so many seeking donations, it is more important than ever to be confident that when you give to a veteran charity your donation will actually be used to help our veterans.


Many people assume that if an organization has been granted 501(c)(3) status by the IRS, it went through a stringent application and review process and must therefore be legitimate.  However, the truth is that there is minimal oversight of the process of creating a non-profit organization.  In fact, the IRS recently simplified the application for 501(c)(3) tax exemption from 12 pages (plus schedules) down to only 3 pages.


With almost no ongoing oversight, many of these groups use only a very small portion of donation money to fund products and services for veterans.  Worse still, there are fraudulent organizations that are used only to line the pockets of their creators.


For example, the United States Navy Veterans Association (USNVA) was a registered 501(c)(3) charity.  It had many markings of a legitimate non-profit – a quality website, supposedly in operation since 1927 and dozens of purported chapters across the country with thousands of members nationwide.  In reality, USNVA was run by one man out of his duplex in Florida.  This sham charity bilked donors out of nearly $100 million over a seven-year period.  The ringleader was arrested in 2012 and sentenced to 28 years in prison and $6 million in fines, but sadly most of these donations will never be recovered.


Fortunately, there are resources available to assist potential donors in verifying the legitimacy of a charity before donating.  First off, the charity’s website can provide a first step – most legitimate charities post their financial statements and annual reports on their website so that the public may view them.  Additionally, www.guidestar.org is a non-profit that provides detailed information about 501(c)(3) registered charities.  Further, legitimate charities should be completely transparent.  If an organization is not forthcoming about providing financial/audit statements, copies of their conflict of interest policy, or information about the board of directors and employees, there is cause for concern.


If you have questions about the authenticity of a veteran charity, or believe that you have been taken advantage of by a fraudulent charity, contact the experienced attorneys at Fausone Bohn, LLP.  We can provide you the sound legal advice that you need.  You can reach us at (248) 380-0000 or online at www.fb-firm.com. 

Fausone Bohn Scores a Win at Michigan Court of Appeals

Two years ago, then-Congressman Thaddeus McCotter of Michigan’s 11^th District got caught up in a petition fraud scandal that threw him off the ballot and led him to resign from Congress.

It also led to two of his staffers being charged with “conspiracy to commit a legal act in an illegal manner” – a felony. A team of lawyers at Fausone Bohn handled the matter successfully from the trial court all the way to the Michigan Court of Appeals.

The trial judge agreed that the Michigan Attorney General over charged in the case, and dismissed the conspiracy charges. The decision was upheld by the Court of Appeals.

A job well-done by attorneys Mark Mandell, Keith Madden, and Jim Pelland!

Read more on the case here: http://www.hometownlife.com/apps/pbcs.dll/article?AID=%2F201408061723%2FNEWS10%2F308060029

Are you in need of legal help? Our firm has a breadth of experience, from criminal law and family law, to business and corporate matters. Check out our website, www.fb-firm.com, to see if we can be of assistance to you. Or give us a call at 248-468-4536.

Breach of Honor by National Guard General

A recent report that a one-star general and former commander of the Michigan Air National Guard scammed nearly $200,000 represents a stain on the reputation of military officers in positions of power.

Brigadier General Richard G. Elliot, Michigan’s former Air adjutant general, is reported by the inspector general (IG) to have used his public office for private gain. Once a federal military technician, Elliot received a federal paycheck. However, in December 2005 he was appointed to serve as the Air adjutant general and commander of the Michigan Air National Guard, making him a full-time employee of the state.

In an effort to quality for retirement benefits, Elliot failed to terminate his federal position as required by law and instead continued to approve his own time and attendance records. As a result, he received more than $194,000, the IG found. The IG further found nearly $20,000 of unwarranted temporary duty travel money.

Perhaps more unfortunate, however, is that we are in 2014: almost ten years from when these abuses of power transpired. Not only did Brig. Gen. Elliot break the law and scam taxpayers, but the investigation to uncover it took nearly five years. Adding more fuel to the flame, Elliot’s boss, Maj. Gen. Thomas Cutler, then Michigan’s adjutant general, knew that Elliot was trying to reach his retirement date and helped Elliot remain on the books as a military technician.

This behavior is symptomatic of the “old boys club” present in the military, and the slow walking of the investigation allowed those implicated to retire without facing charges for what they had done. It should be noted, though, that this lapse of integrity by a few is not representative of the good men and women who serve our country, and our state.

Still, the case does represent a strand of military officers who have a, “boys will be boys” mentality. One way to rout out this thinking is to hasten investigations of such abuses of power and take the possibility of fraud more seriously. There are many who serve as appointed officials with great integrity, and many others who deserve high-level appointments. Cases like this provide an example of how the current system is not working.

Those officials who pull their weight and serve with integrity deserve better. More importantly, the people these officials serve deserve better – not only from those who abuse their power, but those who investigate the abuses.

To read more on the IG’s report and finding, read the Free Press article here: http://www.freep.com/apps/pbcs.dll/article?AID=/201401131511/NEWS06/301130142

Seniors Beware of Telemarketing Fraud

Mark Mandell, Esq.

Senior citizens and grandparents have been a major target for telemarketing and telephone scams in Michigan. Unfortunately, as Glenn Clark, a repre­sentative of the Michigan Attorney General Bill Schuette’s Consumer Protection Division explains, “if you’re a senior, God bless you, but you have a bull’s-eye on your back for these telemarketing frauds.”

Mr. Clark, keynote speaker at the annual Monroe County Elder Justice Sum­mit held Thursday, said 56 to 80 percent of all telemarketing fraud is aimed at seniors but telemarketing fraud is not the only type of fraud that takes place over the phone. Another common scam aimed at senior citizens is the “emergency situation” scam.

Unfortunately, scammers find the names of their victims from public documents or other sorts of data mining. When the scammers locate their victims, they call the senior citizen pretending to be a relative in distress. The scammers explain to the targeted senior citizen that they are in a medical, legal, or any other type of emergency to acquire funds. The scammer makes sure the senior believes that they are, for example, a grandchild that needs immediate help.

Because senior citizens and grandparents are older in age, may have a hard time hearing over the phone, and are not used to telephone calls, they often do not realize that the person on the line is not their family member.

Mr. Clark further explains that the scammers try to appeal to some kind of emotional bond and “they want you to act emotionally and not logically.”

In order to prevent these types of situations Mr. Clark advises to try to verify who that individual is through quizzing them on personal details or calling relatives to verify that the individual is really in trouble.

If you have faced this type of situation or have any questions regarding these types of issues contact Michigan fraud attorney, Mark Mandell at 888-674-1189 or online at www.MichiganFraudLawyer.com

Read more at: http://www.monroenews.com/news/2013/oct/15/scammers-target-grandparents/

Navy Charity Scam

Jim Fausone
Veteran Advocate
 

A 67-year-old Harvard-trained lawyer and former military intelligence officer, John Donald Cody, is on trial in Cleveland after masterminding a $100 million multi-state fraud scheme. Cody was in court this Monday after two years on the run. He is charged with defrauding people who donated to the reputed United States Navy Veterans Association, based in Tampa, FL.

During his scheme, Cody used his many political connections to encourage donations to the charity. However, according to authorities, little to none of the money collected by Cody was actually used to aid Navy Veterans. In fact, most of the money collected went to republican politicians, including Mitt Romney, John McCain, Rudy Giuliani, and former President George W. Bush.

Joseph Patituce, Cody’s defense attorney, hinted at a defense strategy focused on CIA and government secrets involving a secretive operation decades ago in Arizona. Brad Tammaro, an assistant attorney general who is handling the trial, said that even if “by some fantasy” there was government involvement, it did not vindicate the defendant of his actions.

People ask all the time to which veteran charities they should donate.  I tell them to be careful.  You have to know the person asking and the work being done.

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

http://www.foxnews.com/us/2013/09/30/man-accused-in-100m-navy-charity-scam-headed-to-trial/

Scheme to Defraud the W.K. Kellogg Foundation

Mark Mandell, Esq.

In 2008 an $800,000 scheme targeting funds from a children’s charity was unearthed. The charity was an organization that is devoted to helping children in Africa.

Nehemiah Muzamhindo, a 48-year-old political refugee from Zimbabwe, was sentenced to six years in federal prison for his role in the scheme targeting funds from the foundation. In addition to his sentence Muzamhindo was also ordered to pay $709,000 in restitution fees.

Muzamhindo had taken $629,000 from the foundation before he was cut out of the scheme. In order to claim funds from the children’s charity Muzamhindo set up bank accounts and shell companies to accept fraudulent claims. Then, he would go on to send half of the money he collected to foundation worker, Sabina Brand, in South Africa. Sabina Brand is currently serving 15 years in a South African prison for her role in the scheme.

During the trial Assistant U.S. Attorney Timothy VerHey attacked the “bad character” of Muzamhindo. VerHey wrote in court documents that; “…His crime had a far-reaching impact, because it led the WKKF to withdraw from its charitable activities in Africa.”

Scott Mertens, Muzamhindo’s defense attorney, argued for Muzamhindo’s character saying that, “Mr. Muzamhindo had been involved in charitable works and has assisted others who have emigrated from Zimbabwe.”

To learn more or to see the original article, please visit: http://www.mlive.com/news/grand-rapids/index.ssf/2013/09/kentwood_man_sent_to_prison_in.html

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. 

Embezzlement Law in Michigan

Mark Mandell, Esq.

 

Recently, a Portage, Michigan man was sentenced to 87 months in prison for embezzling $6.5 million from the company where he worked as a comptroller.  In addition to his prison time and supervised release thereafter, he is required to pay restitution of $6.5 million to his former employer.  This shows just how serious the consequences of an embezzlement conviction can be.
 

Embezzlement in Michigan is governed by statute – MCL §750.174.  In essence, a person is guilty of embezzlement when they are in a relationship of trust to the principal (generally an employer-employee situation); in lawful possession or control of the funds of the principal; and wrongfully take or convert those funds to his own use, with the intent to defraud.

The key element to a charge of embezzlement is that the person takes the money, which belongs to the principal, with the intent to convert it to his own use.  In other words, the person has the fraudulent intent to deprive the owner of his property and take it for himself.  Without this intent to defraud, a taking cannot be embezzlement (though it may constitute another offense.)

The severity of an embezzlement charge depends on the amount of money or personal property taken by the agent or employee.  The charges include the following: 

·        If the money or property taken is valued at less than $200, the charge is a 93-day  misdemeanor with a possible fine up to $500; 

·        If the value is up to $1,000, the crime is a 1-year misdemeanor subject to a fine of up to $2,000.

·         $1,000 to $20,000 is a 5-year felony with a fine of up to $10,000. 

·         $20,000 to $50,000 is a 10-year felony with a fine up to $15,000. 

·         $50,000 to $100,000 is a 15-year felony with a fine up to $25,000. 

·         $100,000 and above is a 20-year felony with a fine up to $50,000.

Additionally, a person convicted of embezzlement will likely be required to pay restitution to the owner of the amount illegally taken, in addition to the statutory fines and jail time.  Charges may also be enhanced if the defendant has any prior embezzlement convictions on his record.

If you are facing embezzlement charges, or if you need more information about this area of the law, contact Michigan Fraud Lawyer Mark Mandell at (248) 380-0000 or online at www.MichiganFraudLawyer.com.  Mr. Mandell can provide you the experienced and knowledgeable legal counsel that is absolutely imperative when facing all manners of criminal charges.

 

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

 

Prescription Drug Fraud in Livonia

Mark Mandell, Esq.

 

A Livonia doctor and five accomplices were charged last week with running a prescription pain pill fraud scheme.

The indictment alleges that the scheme involved recruiters who would bring patients to Dr. Mohammad Batahney’s office for a “cursory examination or no examination at all.”  Allegedly, the doctor would then write a prescription for Roxicodone, a highly addictive pain pill, and give it to the recruiter. 

The indictment states that the recruiter would then pay the doctor and get the prescriptions filled at a cooperating pharmacy.  After being filled, the recruiter is alleged to have sold the drugs to street dealers in Detroit.

Dr. Batahney is believed to have unlawfully prescribed more than 300,000 doses of Roxicodone from 2011 to April 2013. 

Dr. Batahney and the other five defendants have been charged with conspiracy to possess with intent to distribute controlled substances – a felony punishable by up to 20 years in prison.

With prescription drug fraud rising to epidemic levels, Federal prosecutions have dramatically increased.  The crimes charged are severe and the sentences are long.  Having knowledgeable and experienced counsel on your side is a necessity.

If you or someone you know has been charged with fraud, or are concerned that you may be involved in fraudulent behavior, contact experienced fraud attorney Mark Mandell at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

To read about this latest indictment, please visit:

http://www.freep.com/article/20130422/NEWS02/304220150/Pills-prescription-fraud-Livonia-doctor

Michigan Chooses New System to Fight Statewide Fraud

Mark Mandell, Esq.

In order to help combat fraud, waste and abuse in the state’s unemployment insurance and food stamp programs, Michigan’s Enterprise Fraud Detection System has selected SAS Analytics as its program of choice. While unemployment insurance helps to provide a safety net for workers who have lost their jobs, it is easily abused. Just last year alone, $10.3 billion in fraudulent insurance payments were made across the country.

The use of the SAS Fraud Framework for Government allows state officials to not only detect where fraud occurs, but also to help uncover fraudulent claims before they are paid. The system will initially be used to fight fraud and abuse in Michigan’s unemployment insurance and food stamp programs. Over time, it will be integrated and used to spot fraud across all executive branch departments and programs as well.

Instead of simply measuring how much fraud occurs, the system will help experts to examine the different factors that caused the fraud to occur in the first place. The SAS Fraud Framework for Government is specifically tailored to help governmental agencies in multiple ways: from detecting suspicious patterns in social programs, to uncovering tax evasion and even identifying sophisticated fraud rings.

Greg Henderson, Government Practice Lead for SAS Fraud and Financial Crimes Global Practice calls Michigan “a national leader in the fight against fraud.” By utilizing SAS, Henderson says, “it supports Gov. Snyder’s commitment to curtail fraud, waste and abuse, and to get assistance to the people who truly need it.”

The new system will bring transparency to both the unemployment and food stamp programs, helping Michigan to deliver benefits and services to those in need while avoiding costly, fraudulent pay-outs.

To learn more and read the original article, please visit: http://gcn.com/articles/2013/03/05/michigan-analytics-stop-fraud-waste-abuse.aspx

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.

Worry over Healthcare Leaves Elderly Vulnerable to Medicare Scam

Mark Mandell, Esq.           

Scammers are now targeting the elderly, a population who are increasingly concerned over their health care, especially in light of the Affordable Care Act’s ensuing changes. A Medicare-card related scam has left a trail of elderly victims across at least 15 states, including Michigan, West Virginia, Tennessee, Illinois, New Jersey and California.

Individuals fall prey to such a scam after receiving a phone call informing them of the need to verify information in order to receive a new Medicare card. Despite being warned to never give out personal information over the phone, when the caller on the other end of the line seems legitimate, it is hard to pick out a fraudulent call.

"Medicare is my lifeline,” says Bessie Bell, 72, just one of many senior citizens who has received a fraudulent call within the last year.

When fraudulent callers pick up on these worries and focus on current issues such as Medicare changes and the cost of prescription drugs, it is easy for concerned individuals to believe the newest pitch. Lately, Medicare beneficiaries are being told they must verify their account information by giving out their bank account or Social Security numbers in order to receive a new Medicare card. Others have been lured into believing in a new, “Preferred Medicare” card that would somehow be used alongside the current card.

The public is concerned with how to spot the scammers as they grow more convincing. Before giving out any personal information, individuals are warned to stop and think: would the government call each individual if changes were made to the Medicare program? Senior citizens have been advised to first call their doctor, the drugstore, or the AARP before taking any action. While a call may seem legitimate, it is important to remember that bank routing numbers are public information, and while a caller’s knowledge of such information may make the call seem more legitimate, it is better to be safe than sorry.

 

While this Medicare-card related scam may be one of the newer fraudulent schemes occurring across the nation, these scammers are not alone. Just last year, millions were called to verify their personal information in order to receive diabetic test strips; fraudulent online pharmacies lure in many each year by offering prescription drugs at prices too good to be true.

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 visit the original article, please visit: http://www.livingstondaily.com/article/20130210/OPINION01/302100310/Susan-Tompor-Scammers-target-seniors-fake-Medicare-card

$350,000 Whistleblower Verdict Reinstated

Mark Mandell, Esq.

 

The Michigan Supreme Court has recently reinstated a $350,000 verdict in a whistle-blower lawsuit brought against Lake County by a former employee.

 

Former Lake County 911 department director Cheryl Debano-Griffin sued the county in 2005 under the Whistleblowers Protection Act. Cheryl complained about the handling of emergency funds when property tax money for ambulance services was being funneled into another county account. As a result, Cheryl lost her job.

While Cheryl originally won her case at trial in Lake County Circuit Court, the case has been sent to the state Court of Appeals twice, as well as to the Supreme Court. Most recently however, in a 4-0 opinion authored by Justice Michael Cavanagh, the court did in fact find a causal link between Cheryl’s termination and the complaints she made to the county board.

Cheryl’s objections included opposition towards the use of a Lake County EMS ambulance for the transportation of residents from other counties in non-emergency situations, as well as the county board’s authorization to transfer $50,000 from the ambulance account to a “mapping project account.” However, the board voted to return the funds to the ambulance account two days after voting to merge two county positions, which eliminated Cheryl’s job due to “budgetary problems.”

The court determined that although there may have been financial issues at the time, it did not appear that these difficulties were the board’s motivating factor when it eliminated Cheryl’s position. As a result, the original $350,000 verdict to Cheryl was reinstated.

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.mlive.com/news/index.ssf/2013/02/former_911_directors_350000_wh.html?utm_source=WhatCounts+Publicaster+Edition&utm_medium=email&utm_campaign=MiLW+Daily+Alert%3a+Lawyering%2c+24-7%3a+Setting+degree+of+access+by+clients+a+personal+choice&utm_content=Lake+Co.+whistleblower%e2%80%99s+%24350%2c000+verdict+reinstated+%0dby+MSC

 

 

Pell Jumpers Cost Taxpayers Millions

Mark Mandell, Esq.

Pell Grants, maxing out around $5,500 per year, are available to college students for tuition payment, as well as living costs such as rent, groceries, and transportation. However, when a student who receives a Pell Grant never shows up to class and disappears with the money, the college is left high and dry.

Because of their lower tuition rates, community colleges are victimized more so than costly universities. When a student signs up for a full semester of classes for $700 to $900, he can choose to pocket the leftover cash, received as a check from the school. While a thousand dollars may not seem like much for a college collecting thousands in tuition money from students every semester, the money lost to these Pell Jumpers adds up. Mark Kantrowitz, a leading expert on financial aid issues, estimates that 3.6 percent of Pell Grant recipients collect the money fraudulently. As a result, taxpayers lose $1.2 billion per school year. In context, it seems, Pell Grant fraud can be incredibly costly.

While colleges can attempt to go after these scammers, it’s an uphill battle to track down students after they leave the school with their check in hand. As a result, the U.S. Department of Education has proposed ways to put a stop to the fraud before it begins: by delaying payments to students until a few weeks into the semester and requiring professors to take attendance, schools hope to differentiate the students who are committed to their education from those who are interested in the money but not necessarily an education. Other suggestions include requiring financial-aid recipients to put a bank account or credit card on file in order to make them more easily traceable if they disappear with their Pell Grant check. However, such tactics may be potentially harmful for those who truly need the money – the delay in receiving a necessary check may prevent students from purchasing text books or paying rent.

One such college, Kellogg Community College in Battle Creek, has implemented such procedures and, and a result, cut its financial-aid losses in half in recent years. While Kellogg Community College represents one success story, there is yet to be an ideal remedy for preventing Pell Jumpers from running away with taxpayer dollars.

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.livingstondaily.com/article/20130218/NEWS01/302180313/Pell-Grant-scammers-cheating-Michigan-colleges-out-millions?odyssey=tab%7Ctopnews%7Ctext%7CFrontpage

Detroit-Area Physical Therapy Clinics Involved in Medicare Fraud

Mark Mandell, Esq.

It seems Medicare fraud permeates all areas of the health care field as yet another case has come to light in the metro-Detroit area, this time involving a physical therapy clinic. The clinic was involved in a $13.8 million home health care fraud scheme. Physical therapy assistant Ankit Patel of Westland, Michigan pleaded guilty to his involvement in the scheme, admitting to conspiracy to commit health care fraud.

Beginning in June 2009, Patel falsified medical documents for a number of different home health care agencies in the Detroit-area. Patel created evaluations, falsified therapy revisit notes and other medical documentation, and signed such documents, validating treatment for physical therapy patients that did not exist. Patel later admitted that he was in fact aware that the false documents he created would be used to support false claims to Medicare.

Over the past few years, Medicare paid out almost $1.5 million to Physicians Choice Home Health Care LLC, Quantum Home Care Inc., and Moonlite Home Care Inc. – three companies that benefited from Patel’s involvement.

As a result of his involvement in the fraudulent scheme, Patel faces a maximum of 10 years in prison as well as a $250,000 fine. However, Patel is not alone in these charges. Ten others have pleaded guilty to involvement. One has already been sentenced: Hetal Barot was sentenced to 30 months in prison for her involvement for the same criminal charge. Patel is scheduled to be sentenced in March.

These charges were brought about by the Medicare Fraud Strike Force, an agency that has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.

To learn more and read the original article, please visit: http://7thspace.com/headlines/428595/usdoj_physical_therapy_assistant_pleads_guilty_in connection_with_detroit_medicare_fraud_scheme.html

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.