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Health Care Fraud Blog

Covers fraud in Medicare, Medicaid and insurance benefits.
By Robert David, Esq.

Post Frequency: 0.6/day

Last Entry: March 02, 2011 at 00:22:24

Department of Justice FY 2011 Requests $236.6 M Budget Increase - $60.2 M Increase Sought to Fight Health Care Fraud

Posted on February 03, 2010
The FY 2011 Budget requests a $234.6 million increase, including 708 new positions (143 agents and 157 attorneys), to restore confidence in U.S.markets, protect the federal treasury and defend the interests of the U.S. Government. This includes an additional $96...

Details Emerge in Case Against Operators of Tampa Pain Clinics Arrested

Posted on February 02, 2010
As part of the recent focus of a task force in the Tampa area, a physician and a physician?s assistant who owned and operated 8 clinics were arrested for health care fraud and drug trafficking charges. The clinics, Neurology...

The Government Holds A Summit About Health Care Fraud, Excludes Providers

Posted on February 02, 2010
HHS held a National Summit on Health Care Fraud in late January. The purpose was to bring together "leaders from the public and private sectors to identify and discuss innovative ways to eliminate fraud, waste and abuse in the U.S....

What Is It About Federal Prosecutors and Internet Pharmacy Cases?

Posted on January 27, 2010
SAN DIEGO (January 26) Less than a year after a South Florida internet Pharmacy trial was dismissed in part due to prosecutorial misconduct, (click: here to read more) another large internet pharmacy case may be heading the same way. A...

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Why Losing At Trial Can Be Costly

Posted on January 23, 2010
HOUSTON - Whether it is known as ?courtroom rent? or by some other name, the dangers of going to trial as opposed to pleading guilty requires a careful consideration of the case, the facts, the sentencing guidelines and the judge....

HHS Inspector General Re-Issues Updated Fraud Alert - DME Suppliers Beware!

Posted on January 21, 2010
Health and Human Services Office of Inspector General released an updated fraud alert ?Telemarketing by Durable Medical Equipment Suppliers? originally published in March 2003. The Fraud Alert states in relevant part: Section 1834(a)(17)(A) of the Social Security Act prohibits suppliers...

Home Health is the Medicare Fraud Issue Du Jour; And Finally A Task Force Indictment Not Tied To Miami

Posted on January 14, 2010
As the federal government?s Medicare Fraud Task Force called HEAT (Health Care Fraud Prevention and Enforcement Action Team), left Miami and deployed out across the country in six phases to Houston, Los Angeles, Detroit, Tampa, Baton Rouge and Brooklyn, it...

Arrests Made by Newly Created Central Florida Health Care Fraud Strike Force

Posted on January 13, 2010
Recently state and federal authorities announced a regional health care fraud strike force in the Tampa and Orlando region. In what may be one of the first operations of that strike force, a Lakeland, Florida couple, Lilian Pagkaliwangan, 40, and...

?Pill Mill Operator Convicted? Is The Headline, But Was It a Victory For the State?

Posted on January 10, 2010
Sometimes it takes some knowledge of how prosecutions generally work to see through press releases and newspaper articles touting big victories by the government. The State of Florida issued a press release yesterday regarding the conviction of a so called...

EX-UCLA Health Care System Employee Pleads Guilty to Illegally Reading Patients Medical Records

Posted on January 09, 2010
LOS ANGELES, CA - January 8, 2010 - The U.S. Attorney?s Office for the Central District of California announced that a former UCLA Healthcare System employee pleaded guilty to four counts of illegally reading private and confidential medical records, mostly...

Prison For Failure To Collect Medicare Co-Payments?

Posted on January 07, 2010
Medicare is not supposed to be free medical care. Medicare rules require an annual deductible and a 20% co-payment by patients for services under Medicare Part B. The co-payment is in part to defray costs and to hold down costs...

Does Aggressive and Sometimes Illegal Pharmaceutical Marketing Pay Off?

Posted on December 22, 2009
Early in the last decade the federal government began paying substantial attention to the marketing of drugs by manufacturers. Investigations and eventual settlements with Tap Pharmaceuticals ($875 million) and AstraZeneca ($350 million) paved the way for compliance guidance by CMS...

Does Aggressive and Sometimes Illegal Pharmaceutical Marketing Pay Off?

Posted on December 19, 2009
Early in the last decade the federal government began paying substantial attention to the marketing of drugs by manufacturers. Investigations and eventual settlements with Tap Pharmaceuticals ($875 million) and AstraZeneca ($350 million) paved the way for compliance guidance by CMS...

Three State Medicare Fraud Crackdown Underway Today

Posted on December 15, 2009
According to a report released this earlier this morning, hours ahead of an official announcement scheduled for later today, arrests were made in Miami, Brooklyn and Detroit. Federal agents are expected to take about 30 suspects into custody from...

The Militaristic Sound of Medicare Fraud Enforcement

Posted on December 14, 2009
Increasingly the manner in which the government promotes its law enforcement efforts in the Medicare arena sound more and more like military operations or even Saturday morning cartoons. The creation of the ?Strike Force? known as HEAT, Health Care Fraud...

Physical Therapist Charges $50 Per Fake File in $5M+ Detroit Area Medicare Fraud Scheme

Posted on December 13, 2009
In one of the recent pleas related to the government?s new focus on Medicare fraud in Detroit, a physical therapist and two others pleaded guilty to approximately $2.5 million in Medicare Fraud related to physical and occupational therapy services. Click...

Doctor Pleads Guilty To Fraud Altering Records For Ambulance Transportation

Posted on December 11, 2009
A Jacksonville physician, Janet Johnson-Hunter, pleaded guilty to altering medical records to justify ambulance transportation of patients. Rather than have the case presented to a grand jury and require the government obtain an indictment, Dr. Hunter-Johnson waived that right and...

Whistleblower Alleges Drug Salespeople, not Doctors Dictated Dosages of Medicine

Posted on December 01, 2009
In an interesting suit filed against Amgen, the maker of Epogen, as well as two large dialysis clinic chains, Fresenius and Davita, a whistleblower alleges that salespeople for the drug company told clinic operators and physicians working there to prescribe...

The Political Debate Over Health Reform And Florida , ?The Health Care Fraud Capital Of The World?

Posted on November 29, 2009
According to Senator LeMieux of Florida, Florida is the health care fraud capital of the world and instead of reforming health care, the government should be focusing on fixing the current system, particularly targeting fraud waste and abuse. Meanwhile, federal...

By The Time You Read This You May Have Already Committed Three Crimes

Posted on November 24, 2009
The growing issue of the number and vagueness of federal criminal statutes has led to a push back from even conservative groups, disdaining the over criminalization of federal law, leading one author to write a book arguing that each person...

South Florida Remains the Oxycontin Capital

Posted on November 23, 2009
The federal agents arrested 20 people for a Palm Beach operation that engaged in buying up oxycontin from Broward County pain clinics and pharmacies and shipping those drugs to Tennessee, Kentucky, West Virginia, Virginia and North Carolina . The operation...

FDA Targets Internet Pharmacy Websites

Posted on November 23, 2009
The FDA recently moved to shut down internet pharmacy ?affiliate? websites in the United States . The Ryan Haight Act, passed in 2008 was the first effort to define the lawful and unlawful practice of telemedicine with respect to controlled...

W Administration Ignored Warning About Organized Crime Committing Medicare Fraud

Posted on November 20, 2009
Federal officials in charge of preventing fraud in the billion-dollar Medicare program ignored dozens of warnings of criminal activity during the Bush administration, according to investigations by the Associated Press and U.S. Senator Charles Grassley?s (R-IA) office...

President Establishes Interagency Financial Fraud Enforcement Task Force

Posted on November 17, 2009
WASHINGTON (November 17, 2009) ? Today President Barack Obama established by Executive Order an interagency Financial Fraud Enforcement Task Force (FFETF) to strengthen efforts to combat financial crime. According to a press release, the Department of Justice will lead the...

CMS Efforts To Use Software to Detect Fraud

Posted on November 17, 2009
CMS uses contractors to process claims, but also to use sophisticated software to detect fraud patterns and make referrals for claims denials, audits and criminal investigations. At one time the system was somewhat fragmented, given that there are different contractors...

FBI, OIG, HEAT How About SFO - ?Serious Fraud Office??

Posted on November 16, 2009
We have done posts on the various monikers given to task forces, including the most recent in healthcare fraud, HEAT (Healthcare Fraud Prevention and Enforcement Team) and the agencies in involved in those investigations; the FBI (Federal Bureau of Investigation),...

Are Large Corporations Treated Differently? Pfizer $2 Billion False Claims Act Settlement Is Its Second In Six Years

Posted on November 13, 2009
Often, we hear that white collar crime is treated differently than other types of crime. However, it is often who commits white collar crime that brings about different treatment. I had a client indicted for fraud related to a DME....

Increased Penalties for Health Care Fraud Likely

Posted on November 10, 2009
Proposals to increase the criminal penalties for health care fraud are making their way into the Senate?s health care reform bill. The proposal, The Health Care Fraud Enforcement Act, involves significant increases in potential jail time through modifications of the...

Medicare Fraud Bumps Workers Comp Fraud Off The Radar?

Posted on November 09, 2009
Budget priorities and redirection of investigations at the state level, has led to a drop off in investigations of workers compensation fraud at a time when such fraud is increasing, according to investigators. The focus on Medicare and Medicaid fraud...

Whistleblower Lawsuit Alleges Medicare Fraud by Fresenius North America

Posted on November 07, 2009
A Federal False Claims Act Case filed by an employee of a dialysis center owned by Fresenius North America, which has over 1500 clinics serving dialysis patients, alleges that a clinics in El Paso and elsewhere used unlicensed employees...

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