Articles Posted in Healthcare Fraud

Medicaid fraudWaveney Blackman, the owner of durable medical equipment company WaveCare Health services, has been charged with one act of healthcare fraud for filing claims to Medicaid for products that were never purchased through her business. Blackman pleaded guilty to these charges after one month and has been sentenced to 42 months in prison and ordered to forfeit $9.4 million, the sum of WaveCare’s proceeds from fraudulent claims.

During the years of 2010 to 2016, Blackman filed multiple claims to Medicaid for incontinence products, wound care supplies, and other pieces of durable medical equipment that resulted in revenue of $9.4 million. None of these products were ever given to Medicaid clients or even requested by one. These fraudulent claims were filed by Blackman herself, along with the assistance of her employees through a WaveCare biller.

Within one month of being charged, Blackman signed a plea agreement that detailed the illegal actions taken, as well as the proceeds she received from them. The government has seized a Mercedes, seven properties, and money traced to two separate bank accounts, and the judge ordered Blackman to pay the total of $9.4 million WaveCare reportedly received in fraudulent claims. She will also be sentenced to 42 months in prison.

NC-health-care-fraud-300x199Mental health company owner, Catinia Denise Farrington of Cyprus, Texas, pleaded guilty to health care fraud and tax evasion in September of 2018. As of March 1st, 2019, she has been sentenced to 60 months in prison after profiting $4 million from Medicaid and just under $400,000 from her tax evasion scheme.

Health Care Fraud Conspiracy

According to prosecutors, Farrington owned a mental health care company out of North Carolina, Durham County Mental Health and Behavioral Health Services, LLC. Through this company, she submitted thousands of fraudulent claims to Medicaid for services that were never performed. These incidents occurred between 2011 and 2015, but this is not the only fraudulent activity that Farrington participated in during this time.

Australia whistleblower lawsThose looking to report corruption, fraud, tax evasion, and other forms of misconduct in the corporate world can finally get the protection they deserve as new whistleblower laws in Australia clear federal parliament.

Corporate whistleblower laws introduced in late 2017 have managed to pass the lower house in early 2019. These laws put into place offer greater protection for anyone wishing to voice concerns about fraudulent activities within a division of the corporate world.

Corporate crime is an illegal act that is committed by a company or business with the goal of giving the company a boost or advantage they normally would be unable to receive. Examples of this are all over the world and are committed by even some of the best-known brands. Many in the U.S. may even recall back in 2014 when Rite Aid, one of the largest drug stores, was required to pay almost 3 billion for violating the False Claims Act by allegedly using gift cards to sway those on Medicare and Medicaid to switch their prescriptions to their pharmacies. This would be considered an act of bribery, and one of the many types of corporate crime. Corporate crime has cost many countries a considerable amount, and so whistleblowers, those who have set out to inform others about illicit activity, are one of the best defenses we have to fight against this type of crime.

Medicare-fraud-300x200Rossana Ramirez, a once certified nursing assistant, was discovered to be helping run a business in West Miami-Dade that is responsible for $7 million in health care fraud. After pleading guilty Ramirez was stripped of her license permanently through an Emergency Suspension Order and is now serving time at a federal detention center with a release date of June 2022.

Rossana Ramirez was registered in the state corporation registration as the vice president of a company titled F&E Home Health Care. While Rossana Ramirez is currently taking the heat from the Florida Department of Health, her husband Evelio Ramirez Jr. is also involved as the president of F&E. He will soon be starting his sentence of three years and ten months in federal prison himself. Both husband and wife are 59 and will both serve their time. Their pleas of guiltily were fairly straightforward and show that this act of fraud is not very uncommon from what has already been seen from healthcare fraud schemes in South Florida.

F&E is accused of paying kickbacks, a form of negotiated bribery in which a commission of sorts is given in return for services rendered, to those who receive Medicare and Medicaid to become F&E patients. Additionally, some of these patients did not even require home healthcare and the services promised were not often necessary or even provided at times. F&E is also accused of paying recruiters of Medicare and Medicaid recipients to promote their health services for them.

pharmacy-fraud-300x199The pharmaceutical industry in Pasadena is much like the rest of the United States. There are certainly an influx of individuals who receive Medicare using these services for particular ailments and diseases that accompany being older than 65 years old. However, a local Pasadena pharmacy, Akhtamar Pharmacy, was abusing the Medicare funds provided for those particular individuals. Although the pharmacy owner did not act alone, she was able to steal $1.3 million dollars from the Medicare system.

Pasadena Pharmacy Owner Convicted for Medicare Fraud

Although the pharmaceutical industry is driven by a purpose to help those who need medication, it can also be a place for fraudulent acts to occur. With so much paperwork to be completed, many individuals find themselves taking advantage of the system by falsifying numbers or providing inaccurate invoices. Unfortunately, this was the case in a Pasadena pharmacy. A 39-year-old pharmacy owner, Tamar Tatarian, was convicted on one count of healthcare fraud and two counts of wire fraud at Akhtamar Pharmacy in Pasadena. It is believed that she committed the fraudulent acts which amounted to $1.3 million dollars in total.

new-brestmilk-device-300x200As matured human beings, we generally have a plethora of options when it comes to where we receive our nutrients, but for those in the fragile first 12 months of life, the choices are severely limited. Basically, the choices come down to either the less nutrient sufficient formula, or the more nutrient complex breast milk. So those who desire a more nutrient-rich diet for their infant will generally have to choose breast milk.

Recently the U.S. Food and Drug Administration permitted marketing of the Miris Human Milk Analyzer after reviewing it through the De Novo premarket review pathway, a regulatory pathway for new low-to-moderate-risk devices. This device and diagnostic test is designed to examine breast milk in order to accurately measure its nutrient composition. Breast milk composition will often vary depending on the individual, and so a test which can examine their nutritional value can be a valuable guide. The findings from this test can include concentrations of fat, carbohydrate, protein, total solids, and energy; providing healthcare professionals and parents of newborns with vital information.

The Miris Human Milk Analyzer is a prescription device used by professionals that operates by analyzing samples of human milk through an infrared spectroscopy system. This system will produce quantitative measurements of the contents contained in the milk. There are conditions that limit the information taken by the machine though, such as an interference from medication that is generally used by nursing mothers.

https://www.whistleblowerlawyernews.com/files/2018/07/Jeffrey-A.-Newman-240x300.jpg                                                             Contact: Jeffrey A. Newman Esq.

                                                            www.JeffreyNewmanLaw.com

                                                            jeffrey@jeffreynewmanlaw.com

Medicare fraudFederal prosecutors say CityMD, a New York based urgent care, admitted that it overcharged Medicare. They will pay millions for ordering more expensive procedures, and billing for services provided by physicians who were not properly credentialed.

The Whistleblower Lawsuit

The federal government joined a private whistleblower lawsuit. The lawsuit had been filed under seal but made severe allegations that CityMD has now admitted to committing.

Medicare-fraud-300x200Fake Treatments and Paperwork Lead to Arrest in Medicare Fraud Case

A physician has been indicted for stealing nearly $1 million in Medicare fraud scheme that also included private insurance. Dr. Pranav Patel, of the Chicago area, allegedly submitted fake insurance claims for medical tests and exams that were never conducted.

The Scam

SightLine Health LLC (SightLine), which operates radiation therapy centers throughout the United States, will pay $11.5 million to settle a False Claims Act lawsuit alleging that it knowingly submitted claims to the Medicare program that violated the Anti‑Kickback Statute.  Together with Integrated Oncology Network Holdings LLC (ION), which acquired SightLine in 2011, SightLine has agreed to pay the government up to $11.5 million. The Anti-Kickback Statute is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and instead is based on the best interests of the patient.  It prohibits anyone from offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded programs.  Claims submitted in violation of the Anti-Kickback Statute may subject the claimant to liability under the False Claims Act.

The settlement  resolves allegations that SightLine violated the Anti-Kickback Statute and the False Claims Act by targeting physicians that were able to refer patients to its cancer treatment centers, and paid those physicians a share of its profits pursuant to investment arrangements that were set up to allow physicians to profit from their referrals.  Specifically, the United States alleged that SightLine formed a series of leasing companies in which referring physicians were permitted to invest, and through which SightLine allegedly distributed the profits that its physician-investors generated by referring cancer patients for radiation therapy.The allegations resolved by the settlement were brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act. The whistleblower was represented by the firm Morgan Verkamp. The act permits private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to share in any recovery.  The act also allows the Government to take over the case, as it did here in part.  The whistleblower will receive up to $1.725 million.   “Investment arrangements that are structured to improperly compensate physicians for referrals can encourage physicians to make decisions based on financial gain rather than the best interest of their patients,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division.  “The Department of Justice is committed to preventing illegal inducements, in whatever form, that undermine the integrity of our public health programs.”

“As the professionals charged with recommending and referring medical procedures for our community, physicians’ primary motivation must remain the well-being of their patients,” said U.S. Attorney Erin Nealy Cox.  “Today’s settlement demonstrates our determination to eliminate complex business ventures that improperly interpose financial considerations into our physicians’ medical judgment.” In addition to resolving their alleged False Claims Act liability, ION, SightLine, and their related entities have entered into a five-year Corporate Integrity Agreement with the HHS-OIG.  This agreement is intended to increase accountability and transparency and to deter future misconduct.  The Corporate Integrity Agreement includes internal and external monitoring of the relationships between the ION and SightLine entities and referring physician investors.