Medicare Fraud: Who’s in on it and how they’re getting away with it

Mark Mandell, Esq.

Imagine a single mom with five kids with no income on record and struggling to make ends meet – sounds like an eligible candidate for government subsidy programs. She signs up for the SNAP (Supplemental Nutrition Assistance Program) and Medicaid for herself and her children and gets government assistance to help cover her rent.

But in reality, she’s married, her husband has an all-cash business, which allows her to rake in thousands of dollars a month via welfare programs and remain undetected by the government.

This situation is all too common throughout the US. Savvy individuals are able to game the healthcare system through tricks such as getting married under religious law but not state law. These individuals scam taxpayers time and time again.

The amount of taxpayer money down the drain from fraud and spent on curbing fraud are jaw-dropping.

The federal government is projected to lose $19.6 billion in “improper payments” under the Medicaid program. Accurate fraud figures can be hard to calculate since improper payments aren’t necessarily fraudulent--they could be due to an error either by the government or recipient. Fraud estimates for fiscal year 2014 are up from last year’s $17.4 billion, but down from 2010’s $22.5 billion estimation of improper payments.

Federal Medicaid Spending is projected to be $298 billion in 2014, and Medicare is projected to be $603 billion. The SNAP program cost $79.9 billion in 2013. The White House requested $389 million to fund the Department of Health and Human Services’ Office of the Inspector General in an attempt to better curb waste in the 2104 budget.

In February of this year, the D.C. U.S. attorney’s office announced the largest health-care fraud takedown in the history of the District. The multi-year effort led to more than 20 arrests and schemes involving millions of dollars in fraud, kickbacks and false billings in the home health-care services field throughout the nation’s capital.

Ron Machen was the U.S. attorney for Washington, D.C. on the case. He said his office was tipped off to the scheme when certain agencies were requesting 300% more than other Medicaid beneficiaries over the past several years.

“We were wondering what the reason was for such a skyrocket in growth,” Machen says in a recent Fox News report. “We used wires, cover agents and beneficiaries to uncover them.”

What they uncovered was eye opening. The investigation busted personal care assistants misrepresenting the amount of time they spent with beneficiaries. These beneficiaries would fill out inaccurate time sheets and submit them to home care agencies. While the sheets listed them as being seen by assistants for up to eight hours, in reality the personal care assistants never saw the patients.

The beneficiaries were elderly, disabled and low-income, said Machen, and recruiters would offer them kickbacks of $200 a week and coach the patients on what to say if someone asked about their work.

Healthcare fraud is also an increasing concern with the Obamacare overhaul.

If you have questions about health care fraud, or are afraid that you may have been the victim of a fraud, contact the experienced attorneys at Fausone Bohn, LLP, by calling (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

To read the Fox News story on this fraud bust, click here: http://www.foxbusiness.com/personal-finance/2014/02/28/medicaid-fraud-whos-in-on-act-and-how-theyre-getting-away-with-it/

Detroit Man Pleads Guilty to $29.1 Fraudulent Medicare Fraud Scheme

Mark J. Mandell, Esq.

For five years, Sachin Sharma of Detroit, 37, oversaw and directed the operations of a broad network of home health, psychotherapy, and medical clinics. As the ringleader of the operation, Sharma – with the help of many – fraudulently billed Medicare for $29.1 million in medically unnecessary claims. Now, Sharma has pleaded guilty to one count of conspiracy to commit health care fraud and one count of tax evasion this month.

Apart from the fraudulent kickbacks, Sharma also trained others in techniques used to both defraud the system as well as conceal the fraud. By directing employees to fabricate and alter medical documents, the broad network of home health, psychotherapy, and medical clinics involved gave the impression that medical services were provided.

As a result of the scheme, Sharma admitted to receiving substantial proceeds of the fraud from these companies, however, he failed to report these proceeds on his individual federal income tax returns. Moreover, Sharma failed to file tax returns from 2007 to 2011.

At sentencing, Sharma faces up to 10 years in prison and a $250,000 fine. Several of Sharma’s co-defendants have already pleaded guilty to conspiracy to commit health care fraud for their roles in the scheme, and one remains a fugitive.

To learn more about Michigan’s drunk driving laws, or if you yourself have been charged, please visit: www.michiganfraudlawyer.com or contact Mark Mandell or Tariq Hafeez at (248) 380-9976.

To read the original article, please visit: http://www.fbi.gov/detroit/press-releases/2013/leader-of-29.1-million-medicare-fraud-scheme-pleads-guilty-in-detroit

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.

 

Penalties Severe for Pharmacy and Medicare Fraud

Mark Mandell, Esq.

In Detroit on Wednesday, 43 individuals were indicted by the Federal government on allegations of a widespread conspiracy of pharmacy and Medicare fraud.  The indictment alleges that conspiring doctors, pharmacists, and health care workers wrote fraudulent prescriptions for pills such as OxyContin, Vicodin, and Xanax.  These pills were then sold on the streets of Detroit and elsewhere at a significant profit.

This conspiracy is believed to have defrauded Medicare for more than $21.5 million.

Defendants were charged with a variety of crimes, the main charges including Conspiracy to Distribute and Possess with Intent to Distribute Controlled Substances; and Health Care Fraud Conspiracy.  Also charged were various unlawful monetary transactions and weapons-related offenses.

If convicted of conspiracy to distribute a Schedule II controlled substance, such as OxyContin, Defendants are looking at up to 20 years in prison and more if death or injury resulted from the use of the controlled substances.  This is on top of fines up to $1 million for individual defendants.  If a convicted Defendant has any prior felony drug convictions, the minimum term of imprisonment and fines are increased.

If convicted of a Health Care Fraud Conspiracy, Defendants are looking at up to 10 years in prison, more if injury or death occurs as a result of the fraud.

These fines and imprisonment are in addition to restitution that Defendants may be required to pay to the Medicare System for the fraud.

With the Federal government’s crackdown on all types of health care fraud, these indictments are becoming more and more common.  If you are caught up in fraud or other criminal charges, having experienced and knowledgeable defense attorneys isn’t just helpful – it’s imperative.  Mark Mandell and the fraud team at Fausone Bohn, LLP, have years of experience and are especially suited to negotiate charges with prosecutors and, if necessary, take these cases to trial.

If you need a top-notch legal defense, contact Mark Mandell at 248-380-0000 or online at www.MichiganFraudLawyer.com. 

43 Indicted in Michigan on Federal Prescription Drug Fraud Charges

Mark Mandell, Esq.

Yesterday, the Federal government indicted 43 people on charges of running a massive prescription drug scheme.  Those charged include doctors, pharmacists, and home health care workers.

According to the indictment, five of the doctors charged prescribed more than half a million doses of OxyContin – pills with a street value of $10 million.  In addition, those doctors are alleged to have prescribed 2 million doses of Vicodin, 2 million doses of Xanax, and more than 1,000 liters of cough syrup.  All of this occurred over a 21-month period, the indictment said.

The indictment alleges that the defendants held “patient parties” and hired recruiters to obtain new beneficiaries for the scheme.

It is believed that the fraud bilked Medicare for more than $21.5 million.  Also included in the indictment are charges for bribery, money laundering, kickbacks, and weapons-related offenses.

If you have questions regarding fraud or any other legal issues, contact Mark Mandell at 248.380.0000 or online at www.MichiganFraudLawyer.com.

To read the original Free Press article detailing the indictment, please visit:  http://www.freep.com/apps/pbcs.dll/article?AID=2013303210180

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-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.

Gynecologist Medicare Fraud

Tariq Hafeez, Esq.
 

A five year sentence and $3 million in restitution awaits Jonathan Agbebiyi, the Michigan gynecologist behind a $5.4 million Medicare fraud scheme. Between 2007 and 2010, Agbebiyi practiced at three different clinics in Livonia, running a Medicare fraud scheme from each.

However, it is not just Agbebiyi’s fraudulent use of the Medicare system that draws concern, but his recruitment practices raise alarms as well. Rather than being referred to the clinic by a primary care physician, Agbebiyi recruited patients with promises of cash, fast food, and prescriptions for illicit substances.

Once recruited, patients underwent medically unnecessary neurological tests during which they received electrical impulses through their arms and legs. Agbebiyi then billed Medicare for these tests, while patients never received any type of neurological follow-up.  Clearly, any legitimate purpose for the tests was non-existent.

 

After the FBI investigated the scheme, Agbebiyi was charged with one count of conspiracy to commit health care fraud and six counts of health care fraud. U.S. Attorney Barbara McQuade hopes that cases such as Agbebiyi’s will “deter other doctors from using patients as commodities for personal gain.”

Cases such as these are common. The prosecution of Agbebiyi was a direct result of the federal government’s Medicare Fraud Strike Force operations, which is responsible for charging over 1,330 defendants since 2007, reigning in over $4 billion in fraudulent Medicare billing practices.

If you need to discuss Medicare or fraud issues with an attorney, please contact Mark Mandell or Tariq Hafeez at (248) 380-0000.

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

http://www.thirdage.com/news/gynecologist-sentenced-to-prison-in-medicare-scheme_11-07-2012

Michigan Medicare Fraud Strike Force

By Mark Mandell

Recently, in the Eastern District of Michigan, five more individuals were charged for their participation in yet another Medicare fraud scheme. The Department of Justice, FBI and the Department of Health and Human Services (HHS) announced the charges in late September, stating the individuals were involved in fraudulent health and psychotherapy services.

Defendants charged in the documents include: Mohammed Sadiq, 65, Troy, Mich.; Jamella Al-Jumail, 23, of Brownstown, Mich.; Firas Alky, 40, of Shelby Township, Mich.; Clarence Cooper, 53, of Detroit; and Beverly Cooper, 58, of Detroit.

According to court documents the scheme involved a total of more than $24.7 million in fraudulent claims submitted to Medicare. The majority of this total was billed as home health care and psychotherapy services that were either medically unnecessary or had never really occurred.

The investigation was triggered by the Medicare Fraud Strike Force. Since its inception in March 2007, the strike force has charged more than 1,330 defendants who collectively have fraudulently billed Medicare for more than $4 billion. Working in conjuncture with the FBI and HHS, the strike force hopes to increase accountability and decrease the presence of fraudulent providers.

Fausone Bohn’s team working on Medicare fraud cases include Mark Mandell, Tariq Hafeez, Breeda O’Leary and Matt Worley.

To learn more or see the original article, please visit: http://www.enewspf.com/latest-news/police-reports/36682-five-individuals-charged-in-detroit-for-alleged-roles-in-247-million-medicare-fraud-scheme.html

Multimillion Fraud Award

Mark Mandell, Esq.

 

In this era of increasing health care costs and budget constraints, allegations of Medicare fraud need to be aggressively pursued to maintain the integrity of the system.  On October 15, 2007, Gale Bryden filed a lawsuit against her former employer, Wyoming Medical Center (WMC), under the whistleblower provisions of the False Claims Act.  Ms. Bryden alleged that WMC had committed Medicare Fraud.

Specifically, Ms. Bryden stated that WMC submitted requests to Medicare for reimbursement that were inconsistent with patient records, changed the admission status of patients without a physician order, and billed Medicare for unnecessary inpatient admissions.

The United States conducted an extensive investigation and found evidence to support the allegations of fraud.

The WMC settled this case with the United States and must pay $2.7 million in damages arising from the alleged fraud.  Ms. Bryden, as compensation for filing the case and assisting the United States in its investigation, will receive a share of this settlement.  The assistance of citizens like Ms. Bryden is essential to combat this abuse of the system.  Corporations allegedly seeking to increase profits at the expense of taxpayers can expect aggressive investigation.

If you have questions or have witnessed Medicare fraud, contact the experienced fraud team at Fausone Bohn, LLP.  Call us at (248) 380-0000 or visit our website at www.MichiganFraudLawyer.com.

To read the original article, please visit:

http://www.kgwn.tv/story/19689697/settlement-reached-over-medicaid-fraud

$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

Busted! Another Medicare Crook Gets Taken Down

By Matthew Worley

27 year old Alejandro Haber was busy running a Detroit-area health clinic.  But that’s not all he was running.

Haber was also running a multi-million dollar Medicare fraud scheme.

Haber conceived and oversaw his fraud schemes at a clinic he operated called Ritecare, LLC.  Along with his co-conspirators, he obtained patients by paying illegal kickbacks to recruiters and directly to Medicare recipients. 

Haber instructed these patients to feign certain symptoms.  These fake symptoms were used to create false and fraudulent medical records.  The conspirators then billed Medicare for medically unnecessary services such as expensive nerve conduction studies.

From 2007 to 2009, Haber submitted approximately $7.42 million in fraudulent claims through Ritecare to the Medicare program for reimbursement.  Out of this amount, Medicare actually paid $5.33 million to Ritecare.

Haber has since pleaded guilty in federal court to one count of conspiracy to commit health care fraud.  He was sentenced to serve 40 months in federal prison followed by three years of supervised release.  Additionally, he must pay restitution of $5,333,906 – the amount he fraudulently received.  $99,000 has already been seized from his bank accounts – although this hardly makes a dent in the amount he owes.

Medicare fraud must run in the family – Alejandro’s father was also sentenced in July to 60 months in prison for his role in an $8.5 million Medicare fraud scheme.

To learn more or to read the original press release, please visit:

http://www.justice.gov/opa/pr/2012/July/12-crm-932.html

Medicare Fraud –Troy, Michigan

Mark Mandell, Esq.

Three laboratory companies in Troy, Michigan are merely another example of our Country’s Medicare system being thoroughly abused.

Coventry Diagnostics LLC and Western Slope Laboratory LLC were both owned by an umbrella company Accela Medical LLC. Through an investigation, the U.S. Attorney’s Office found that Accela had billed for over $6 million in Medicare funds, using a specific billing code more than any other provider in the Nation. Accela turned out to be owned by Thomas McCormick of Troy, Michigan, who was using the company as a front to circumvent his previous Medicare fraud related disbarment.

The investigation turned up $900 worth of urine tests (billed for every patient despite the need) and falsified documents to the government about the ownership of all three laboratories. The $6 million will be repaid as U.S. District Judge Stephen J. Murphy III froze assets including $400,000 in cash, transfer of a North Carolina beach home, $500,000 transferred to a shareholder in Singapore and much more.

U.S. Attorney Barbara L. McQuade commented on the issue.

 “This fraud was discovered by analyzing data to flag billing anomalies….Providers should be aware that law enforcement is scrutinizing billing records to identify providers who are stealing from taxpayers."

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

 http://www.dailytribune.com/article/20120210/NEWS/302109937/troy-labs-to-pay-6m-in-fraud-fines

If you have questions in this area of law contact Mark Mandell at 248-380-9976.

Medicare Fraud

Mark Mandell

It takes nothing more than Googling the words “Medicare Fraud Strike Force” to realize our country has a growing problem; Medicare fraud.

Since their creation in early 2007, the Medicare Fraud Strike Force (MFSF) has placed charges on over 1,190 individuals who falsely billed the Medicare program for over $3.6 billion. MFSF operates in over nine districts, including Michigan where instances of Medicare fraud are far from rare.

In January, the U.S. Attorney’s Office filed a complaint against Universal Imaging, Inc., a Michigan company that fraudulently received over $1.56 million in Medicare kickbacks (accounting for over 90% of their business).

More recently in March, three Detroit-area clinic owners pleaded guilty to conspiracy to commit health care fraud. Estimates based off court documents suggest the three clinics billed Medicare for over $5.4 million during the course of their scheme. Each defendant faces a maximum penalty of 10 years in prison and a $250,000 fine.

With dollar amounts easily climbing into the millions and no end in sight, Medicare fraud certainly deserves our attention.

To learn more please visit:

http://www.justice.gov/opa/pr/2012/March/12-crm-323.html

http://www.justice.gov/usao/mie/news/2012/2012_01_06_universal_image.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).

If is our desire to be the firm that helps your business grow and stands with you through the rough spots. When you need steady, professional advice, give us a call.