Increased Police Patrolling During the Holidays

Mark Mandell, Esq.

According to the Michigan State Police, law enforcement officers in 26 counties will be conducting extra patrols through the New Year to ensure motorists are driving safe and sober this holiday season. According to the Michigan State Police website, 11 people were killed in crashes on Michigan roadways; four of those crashes involved alcohol.

The holidays are a very busy time for travel and officers will be making sure that everyone gets to their family gatherings safely. According to OHSP Director Michael L. Prince, "Extra officers will be out strictly enforcing drunk driving laws. Motorists need to designate a sober driver before drinking or take a cab or bus home."

Not only is drunk driving extremely dangerous, but there are hefty consequences associated with drunk driving. A person is considered “over the limit” if they are operating a vehicle with a BAC of .08 or greater. There are enhanced penalties if an individual’s BAC is 0.17 or higher. The severity of the penalties depends on what number offense it is and the level of intoxication. The penalties include the following:

·         If BAC is below .17 and it is a first offense the penalties includes up to a $500 fine and Up to 93 days in jail;

·         If BAC is above .17 and it is a first offense the penalties includes up to a $700 fine and 180 days in jail;

·         If  it is a second offense within 7 years the penalties include one or more of the following: a $200 to $1000 fine and/or 5 days to 1 year in jail;

·         If it is a third offense within a lifetime the offense is considered a felony and the penalties include one or more of the following: a $500 to $5000 fine, 1 to 5 years imprisonment and/or probation with 30 days to 1 year in jail;

·         Additionally, convicted drunk drivers are subject to a $1,000 penalty for two consecutive years under the Driver Responsibility Act, for a total of $2,000 in additional costs.

There are a number of safer alternatives to drunk driving. Safer alternatives include: designating a sober driver; calling a friend; taking a cab; walking or staying over the night at a family or friend’s home. If you are facing drunk driving charges, or have questions regarding the law, contact experienced criminal defense attorney Mark Mandell at 888-674-1189 or online at www.MichiganFraudLawyer.com.

‘Tis the Season for Retail Fraud

Mark Mandell, Esq.

 

As the holiday season nears, retail fraud is expected to skyrocket. Last December, the National Retail Federation estimated retail fraud’s annual cost at $8.9 billion, according to a survey of 60 retail firms. Of that amount, $2.9 billion will come during the holiday season. The holiday season can be difficult on families who may not be able to afford the types of gifts they would like to give their loved ones. For this reason, individuals in this predicament may feel the need to commit retail fraud. Although, this may be a difficult time for many families, the penalty of retail fraud is too severe and the risk is too high. Since the consequences of retail fraud are hefty, quality legal representation is a necessity.

There are three degrees of retail fraud: first degree, second degree and third degree. The difference in degrees of retail fraud depends on the benefit wrongfully received. If the benefit wrongfully received is $200.00 or less, the crime would be considered retail fraud in the third degree, a misdemeanor. If the benefit wrongfully received is more than $200.00 but less than $1000.00, the crime would be considered retail fraud in the second degree, a misdemeanor. If the benefit wrongfully received exceeds $1000.00, the crime would be considered retail fraud in the first degree, which is a felony.

Retail fraud can take a variety of forms such as taking property from the store that has not been paid for; returning items to the store as a refund or exchange for property that was not paid for and misrepresenting the price of an item with intent not to pay for the item or pay less than the price at which the property is offered for sale.

Retail fraud is governed by statute-MCL §750.356. MCL §750.356c provides that any person who commits retail fraud in the first degree is punishable by imprisonment for not more than 5 years or a fine of not more than $10,000.00 or 3 times the value of the difference in price, property stolen, or money or property obtained or attempted to be obtained, whichever is greater, or both imprisonment and a fine. MCL §750.356d provides that any person who commits retail fraud in the second degree is punishable by imprisonment for not more than 1 year or a fine of not more than $2,000.00 or 3 times the value of the difference in price, property stolen, or money or property obtained or attempted to be obtained, whichever is greater, or both imprisonment and a fine. MCL §750.356d provides that any person who commits retail fraud in the third degree is punishable by imprisonment for not more than 93 days or a fine of not more than $500.00 or 3 times the value of the difference in price, property stolen, or money or property obtained or attempted to be obtained, whichever is greater, or both imprisonment and a fine.

The harsh penalties of retail fraud make having experienced and knowledgeable legal counsel invaluable.  If you have been charged with retail fraud, contact attorney Mark Mandell at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

False Claims Act

Mark Mandell, Esq.

 

The False Claims Act has recovered approximately $18.3 billion dollars for the federal government from 2008 through 2012. For every dollar the government invests in fighting healthcare fraud, the government gets $16 dollars in return.

The False Claims Act is a Civil War era law, dating back to 1865. The Act is meant to fight companies who defraud governmental programs. People that are not affiliated with the government are also allowed to file actions on behalf of the government; this is known as “whistleblowing”. Whistleblowers can receive up to 15-25% of recovered damages. 

In the past two years, there has been a tremendous increase in healthcare fraud cases. For example, in 1987-1992, there were only 62 healthcare fraud cases filed by “whistleblowers”. The number of cases in 2011 and 2012 add up to 829 cases.

Supporters of The False Claims Act explain that this revenue actually returns a large amount of money to U.S. tax payers. The report from the Washington based group, D.C.-based Taxpayers Against Fraud, states that this revenue can fund the entire Children's Health Insurance Program, serving more than 5 million people, for approximately four years.

 

Although, there are many supporters of the act, there is also some opposition. For example, the U.S. Chamber of Commerce believes that this act needs a lot of reform to encourage companies to try to fix the fraud issue internally. Penalties for healthcare fraud are actually three times the amount of the actual damages and the Chamber of Commerce explains that these penalties are handed out without any due process. The Chamber of Commerce explains that these penalties are too harsh and this makes companies less likely to come forward and ask for help in solving their issues with internal fraud. For example, the Chamber of Commerce thinks a good idea for reform would be to create benefit incentives for companies who create in house programs against fraud.

Healthcare fraud continues to be a serious problem and initiatives to fight healthcare fraud continue. For more information please read:

http://www.beckershospitalreview.com/legal-regulatory-issues/u-s-recovers-16-for-every-1-it-spends-fighting-civil-healthcare-fraud.html

http://www.mainjustice.com/2013/10/23/u-s-chamber-of-commerce-proposes-false-claims-act-reforms/

Michigan to Receive $42 Million in Nationwide Healthcare Fraud Settlement

Matthew Worley, Esq.

 

Johnson & Johnson and its subsidiaries have agreed to pay more than $2.2 billion to the federal government and 45 states in one of the largest health care fraud settlements in history.

 

The payment is made to settle criminal fines and civil suits alleging the entities offered kickbacks to doctors and pharmacies to promote certain drugs for uses not approved by the FDA – a practice prohibited under U.S. law.

Allegedly, the health care giant promoted the use of schizophrenia drugs for use in elderly dementia patients and for children with AD/HD, autism, and other disorders.  These drugs were not approved for these uses, making it illegal for the manufacturer of the drug to market them.

Michigan’s share of the settlement, which is approximately $42 million, will primarily go to the state’s Medicaid program which initially paid for most of these prescriptions.  According to Michigan Attorney General Bill Schuette, this major settlement makes a statement that the hardworking taxpayers of Michigan deserve better than to be duped into paying more than they should have.

Under a “Corporate Integrity Agreement,” the federal government will be closely monitoring the company’s marketing practices going forward.

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 original article detailing this health care fraud settlement, visit: http://www.mlive.com/business/index.ssf/2013/11/michigan_johnson_johnson_drug.html

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/

Last Call for Alcohol at 4 a.m.?

Mark Mandell, Esq.

 

Many individuals and law enforcement officials are concerned with Senate Bill 247 which would allow bars and restaurants in cities' central business districts to sell alcohol until 4 A.M. with a special permit.

Those opposing the bill are concerned with potential health and safety implications. One of the main concerns with extending the time to sell alcohol is drunk driving. There were several posts made on the MLive Facebook page that show why many people are concerned with this bill. Thomas Donnely, a Michigan citizen, posted "I am against this proposal. People leaving bars at 4:00 AM will endanger those going to work in the early AM." This is only one of many comments posted against Senate Bill 247.

Although there are a lot of individuals against the bill, there are many who support the bill as well. Supporters explain that longer hours would help create jobs for bartenders and create more wages for taxi drivers. A supporter of the bill, Roy Munson, posted on the MLive Facebook page that the hours "should be up to the bars. We don't need the government telling anybody what to drink and when. People need to be responsible."

MLive conducted an informal poll and found that 57 percent of the nearly 800 poll takers would support the bill, including those who want it extended to all areas, not just cities' central business districts, and those who would only support it if the local municipality opts in. 43 percent of poll takers opposed the bill and agreed with the saying that “Mama always said ‘Nothing good happens after midnight.’”

If you have questions about drunk driving laws in Michigan, contact criminal defense attorney Mark Mandell at 248-380-0000 or online at www.MichiganFraudLawyer.com. 

 

For more information please read:

http://www.mlive.com/business/index.ssf/2013/10/4_am_last_call_for_alcohol_som.html

 

New Michigan Anti-Fraud Taskforce

Matthew Worley, Esq.

Michigan Secretary of State Ruth Johnson, in coordination with police, prosecutors, state officials, and industry leaders has launched a new anti-fraud task force.  Fighting Auto Insurance Rip-offs, referred to simply as FAIR, is aimed at combatting a growing trend in Michigan – auto insurance fraud.

The scam involves individuals selling fake auto insurance policies.  The perpetrators then set up fake help desks so when a call is made to verify a policy, a real person answers and vouches for the non-existent policy.  However, as soon as the motorist is in an accident or tries to make a claim, they realize that there is no policy and their premiums having been lining someone’s pocket.

In July, Secretary of State Johnson’s office conducted a one-day review of the 15,000 registration renewals submitted in all the branches.  Of the insurance policies verified that day, an astonishing 16% were found to be invalid or fraudulent.  These fakes turned up in more than half of Michigan’s 83 counties.

The burden of these uninsured motorists is felt by every law-abiding Michigan motorist who follows the law and carries a no-fault policy.  The costs of having these uninsured motorists on the road rise into the hundreds of millions of dollars – which translates to higher insurance premiums.

The FAIR task force will explore new means to combat insurance fraud through procedural changes, new investigative efforts, and potentially new legislation.  It will include representatives from the Secretary of State’s office, the Michigan State Police, Michigan prosecutors, and several insurance industry organizations.

If you have questions about auto insurance fraud, or any other legal matters, contact the experts at Fausone Bohn, LLP at (248) 380-0000 or online at www.fb-firm.com.

 

To learn more about the new fraud task force, visit: http://www.insurancejournal.com/news/midwest/2013/09/19/305718.htm.

Eastern Market Businesses Investigated and Charged With Food-Stamp Fraud

Breeda O’Leary, Esq.

 

A recent sweep of numerous establishments located within the Eastern Market shows that the U.S. Attorney’s Office continues to investigate and pursue fraud throughout the metro Detroit area.

The U.S. Attorney’s Office, together with the U.S. Department of Agriculture Office of Inspector General, Internal Revenue Service, Michigan State Police, and the U.S. Immigration and Customs Enforcement’s Home Security Investigations, executed a search warrant against several businesses suspected of participating in food stamp fraud. 

The alleged fraud included the sale of food stamps for as low as fifty cents on the dollar.  An individual who receives food stamp benefits is provided an EBT card and a pin number for the EBT card.  At a retailer, the recipient scans its EBT Card and enters its four-digit pin at checkout in order to pay for its food-product purchase.  Here, it is alleged that retailers were purchasing a recipient’s EBT Card and pin number, providing fifty cents for every dollar the business charged to the EBT card in food-stamp benefits.  As a result of this fraud, the retailer would be reimbursed $1.00 in cash from the government for a food product it never provided to the EBT Card recipient.  In exchange, the retailer would only provide fifty cents in cash to the EBT Card recipient.

Nearly 47 million people nationwide receive food assistance, making food-stamp fraud a serious concern for the government.  The sale and purchase of food-stamp benefits, also known as “trafficking” is a common form of fraud within the program.

  
If you are a business or individual that has been charged with fraud, or if you think you may be the target of an investigation concerning fraud, contact the experienced and professional fraud team at Fausone Bohn, LLP for sound legal advice.  Contact Breeda O’Leary-Holder at (248) 380-0000 or online at www.MichiganFraudLawyer.com.

To read the article about the recent food-stamp fraud sweep of businesses in Eastern Market, please visit:

 http://www.detroitnews.com/article/20130919/METRO08/309190087/1361/9-accused-of-food-stamp-fraud-after-feds-sweep-Eastern-Market-businesses

 

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.

$4.15M Settlement Evidences Benefit of Reporting

Breeda O’Leary, Esq.

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

   
The qui tam provisions of the False Claims Act allows an individual with knowledge of Medicare or Medicaid Fraud, referred to as the “relator,” to file a lawsuit on behalf of the Government against those committing the fraud.  The Government is then provided notice of the lawsuit and is given the option to intervene as Plaintiff in the suit.  If the Government obtains a judgment or settlement in the suit, the relator is provided a percentage of the amount collected.
      
In the instant case, it was alleged that the Defendants, Dr. Jashu R. Patel and other Jackson Cardiology Associates physicians, performed unnecessary cardiac procedures at Allegiance Health’s W.A. Foote Hospital in Jackson, also a Defendant in the case.  Medicare and Medicaid were billed for these procedures.  Dr. Julie A. Kovich, a former independent contractor at Jackson Cardiology Associates, filed suit as the relator in this case.  While Dr. Kovich faces the possibility of being ostracized by her peers, she will receive approximately $764,700.00 as the relator. 
 
If you or anyone you know has specific knowledge of fraudulent billing to Medicare or Medicaid, or is facing criminal or civil liability concerning an alleged fraud, contact the experienced and professional fraud team at Fausone Bohn, LLP for sound legal advice.  Contact us at (248) 380-0000 or online at www.MichiganFraudLawyer.com.

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

Local Oncologist Charged with Medicare Fraud

Mark Mandell, Esq.

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

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

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

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

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

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

 

Detroit Area Man Pleads Guilty to Health Care Fraud

Mark Mandell, Esq.

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

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

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

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

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

Lower BAC for drunk driving on the way?

Mark Mandell, Esq

 

According to the release of the Michigan Annual Drunk Driving Audit, the number of drunk driving arrests in Michigan increased in 2012, as did the number of fatalities and injuries. 

 

Last year, the state made 37,182 alcohol- and drug-related driving arrests.  Deaths resulting from drug and alcohol induced crashes increased 7.2%, from 319 in 2011 to 342 in 2012.  Non-fatal injuries also increased.

While there was an increase last year, the overall trend in Michigan is positive – over the past 5 years, the number of traffic deaths involving alcohol has decreased 11.4%.

However, many believe Michigan’s drunk driving numbers are still too high and more needs to be done to deter this conduct.  For instance, the National Transportation Safety Board (NTSB) released its May 2013 Safety Report and advocates for decreasing the per se Blood Alcohol Content (BAC) limit from 0.08 to 0.05.

According to the report, studies have shown that a decrease in the BAC limit down to 0.05 reduces traffic fatalities by 8-12% for people ages 18-49.  In fact, more than 100 countries have established maximum per se BAC limits at or below 0.05 – including 25 of the 27 EU member countries.  Many traffic safety and public health organizations view BAC levels higher than 0.05 as posing an unacceptable risk for driving.

Opponents to the lower BAC limit point out that the majority of alcohol-impaired drivers in fatal crashes have BAC levels significantly higher than 0.08.  However, according to the NTSB, lowering the per se BAC limit changes the drunk-driving behavior of drivers at all BAC levels.  As a consequence, reducing the limit could reasonably be expected to have a broad deterrent effect on all drivers. 

Whether the per se BAC limit gets lowered is in the hands of the legislature; however, despite NTSB’s recommendation, there are no pending bills taking such action.  If you are facing drunk driving charges, or have questions regarding the law, contact experienced criminal defense attorney Mark Mandell at 888-674-1189 or online at www.MichiganFraudLawyer.com.

 

Amid Fraud Crisis, Medicare’s Accounting System Lacking Basic Information

Breeda O’Leary, Esq.
 

Despite the government’s aggressive approach in criminally prosecuting fraudulent providers, a report from the Department of Health and Human Services inspector general found that Medicare’s new accounting system failed to automatically extract critical data regarding providers.  This failure may lead to the inability to collect more than $543 million in overpayments to Medicare providers.

In 2010, Medicare overpaid providers more than $9.6 billion.  Since that time, Medicare has implemented a new accounting system – a system that failed to automatically extract provider and contractor information from the old accounting system.  As a result, Medicare does not have provider or contractor information critical to collecting from those that were previously overpaid.

In addition, the new Medicare accounting system allows information about providers to remain outdated, with little consequence for providers who fail to update their contact information.  Providers receive payments via direct deposit, thus eliminating the incentive to ensure that Medicare has a correct address in its accounting system.

According to agency spokesman Brian Cook, “Reducing the incidence of overpayments is a high priority for [Medicare].”  However, once a provider has been overpaid, having detailed information regarding the provider, such as a proper contact address, is critical to notifying the provider and collecting any overpayments.

While criminal prosecution of fraudulent providers continues to remain a priority for the government, the inspector general’s report highlights glaring deficiencies in Medicare’s new accounting system.  Medicare should address these deficiencies with the same sense of urgency as the criminal prosecution of fraudulent providers.

If you have been contacted concerning an overpayment or a possible criminal investigation, contact the experienced and professional fraud team at Fausone Bohn, LLP for sound legal advice.  Contact Breeda O’Leary at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

To read the article about the deficiencies in Medicare’s new accounting system, please visit:

http://www.usatoday.com/story/news/politics/2013/07/02/medicare-overpayments-unrecovered/2480429/

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

 

One Year Delay in Enforcement of Employer Mandate

Tariq Hafeez, Esq.

The Obama Administration announced on July 2, 2013 that it would delay the implementation of a key provision of the Affordable Care Act--the employer mandate which will require employers with 50 or more workers to provide affordable health coverage to employees or risk tax penalties of up to $2,000 for each full-time employee that did not get health coverage.  The employer mandate was originally to take effect on January 1, 2014 but now will not be implemented until January 1, 2015.

The employer mandate has been a big source of anxiety and criticism in the business community as many business owners feel that the provision would be too costly to implement. Additionally, confusion remains on which businesses would be subject to the mandate as definitions of “full time” employees and what constitutes “affordable” insurance are complicated and subject to interpretation.

The delay in implementation of the employer mandate does not affect the other implementation timelines of the Affordable Care Act, including the opening of the health care exchanges in October 2013 and new tax credits to help individuals buy health insurance.

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.

Pharmacist Pays Big for Healthcare Fraud

Mark J. Mandell, Esq.

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

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

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

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

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

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

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

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

 

$223 Million Medicare Fraud Bust

Matthew Worley, Esq.

The Medicare Fraud Strike Force has struck again.  The Federal government recently indicted 89 individuals on suspicion of committing Medicare fraud.

The schemes are believed to have resulted in approximately $223 million in false billings submitted to the government.

The 89 individuals charged include doctors, nurses, and other licensed medical professionals.  The defendants reside in eight different cities; 18 of whom (including 2 doctors) are from Detroit.  They are accused of a variety of health care fraud-related crimes, including conspiracy, violations of anti-kickback statutes, money laundering, and submitting claims for medically unnecessary treatments.

These indictments are the latest step forward in the Federal government’s comprehensive efforts combatting healthcare fraud and abuse.  The Medicare Fraud Strike Force team is a division of the Health Care Fraud Prevention & Enforcement Action Team (also known as HEAT).  Since 2007, the Strike Force team has charged more than 1,500 defendants who collectively have falsely billed the Medicare program more than $5 billion.

With the Federal government’s recent crackdown on Medicare fraud, knowledgeable legal counsel is essential to effectively defend these charges.  If you or someone you know needs sound advice regarding fraud, contact the experienced team at Fausone Bohn, LLP at (248) 380-0000 or online at www.MichiganFraudLawyer.com. 

To read the Department of Health & Human Services press release, please visit: http://www.hhs.gov/news/press/2013pres/05/20130514a.html.

The Evolution of Drunk Driving

Mark J. Mandell, Esq.

Recently, a principle of one of Michigan’s elementary schools was arrested with charges of Super Drunk Driving. Passed in 2010, the new ‘Super Drunk’ law has created harsher penalties for those driving with a BAC of .17% or higher.

In comparison to a regular drunk driving charge, those convicted of being “super drunk drivers” can face up to 180 days in jail, are required to complete an alcohol treatment program, pay up to $700 in fines and are not allowed to drive for 45 days following the incident. On top of all of that, their driving is further restricted for 320 days with the implementation of an ignition interlock device that prevents the vehicle from starting if alcohol is detected on the breath.

While these penalties may seem harsh, alcohol-related traffic accidents account for nearly one-third of all traffic-related deaths in the United States. Each year, tens of thousands of people are killed in such crashes – despite their preventability.

In recent years, Michigan has seen a fall in the rates of alcohol-related arrests; however, it is hard to say whether this trend is a direct result of the new laws and associated penalties or the police force’s loss in manpower due to budget cuts. The Michigan Office of Highway Safety Planning has stated that by advertising and warning the public about the dangers and costs of drunk driving, people are thinking twice before getting behind the wheel while drunk.

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 at (248) 380-9976.

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

Award under Michigan Whistleblower Act Reversed

Matthew Worley, Esq.

The Michigan Court of Appeals has reversed a jury verdict awarding more than $147,000 to a woman who claimed she was fired for reporting illegal activity.

Barbara Hays was a home care worker for Lutheran Social Services of Michigan.  One of her clients smoked marijuana in his house, including when she was present.  Ms. Hays informed her supervisor and, at one point, contacted the Bay Area Narcotics Enforcement Team (BAYANET) to find out if there were any legal consequences to her.  At the end of the phone call, she was asked if she wanted to take any further action but she declined.

When her supervisor later found out that she disclosed this patient information to an outside party, which was a violation of her confidentiality agreement, Ms. Hays was terminated.

Ms. Hays then filed a lawsuit under Michigan’s Whistleblower Act which provides a remedy to people who are fired for reporting a violation of law.

In order to provide relief, the Act requires the person to make a “report” of illegal activity; however, the Act does not actually define what constitutes a “report.” 

The Court of Appeals determined that Ms. Hays did not make a “report” of the incident to anyone because when she called law enforcement, she didn’t give any names, locations, or even the type of drug used.  She was merely seeking information and advice.  To provide her relief, the court said, would not further the purpose of the Whistleblower Act which is protecting the public by encouraging the reporting of illegal activity.

Because she failed to meet the requirements under the Act, the Court of Appeals reversed her jury award and dismissed her case.

If you have been retaliated against for reporting illegal activity, or have questions about this or other legal topics, contact the experienced legal team at Fausone Bohn, LLP at (248) 380-0000 or online at www.fb-firm.com.

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

New State Law Could Leave Shoplifters with Five-Year Sentence

Mark Mandell, Esq.

Shoplifting, to many, appears as a lapse in self-restraint: kleptomania, psychologists have deemed it. Currently, shoplifters spend 90 days in jail and pay about $200 in fines. Recently, shoplifting has begun to evolve into organized retail crime with farther reaching consequences. A new Michigan state has gone into effect with stiffer penalties aimed to combat this growing problem. Individuals participating in this more sophisticated version of retail fraud could face a five-year felony sentence.

Over the past fives years, rates of shoplifting have risen between 3% and 4%. While the effects of shoplifting aren’t always readily apparent, the average American household pays for the crime: $500 a year to cover losses. And while the ordinary shoplifter is easily deterred by retailers, those involved in organized theft are much more brazen in their actions, often crossing state lines with their stolen merchandise in order to sell it for a profit. As a result, more than 15 states have passed new laws targeting retail fraud; however, legislators are still pushing to make it a federal law.

The penalties perpetrators will face as a result of the new law are meant to deter these individuals. For example, a Clinton Township man stole a shopping cart full of Red Bull energy drinks from a Kroger store in December, planning to sell the drinks to party stores. Under Michigan’s existing retail fraud laws, the most the man would face was 93 days in jail. However, under the new law, he could face five years in prison and a hefty $2,000 fine.

To learn more and read the original article, please visit: http://www.freep.com/apps/pbcs.dll/article?AID=2013303300100

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

After Outrage, the Michigan Unemployment Agency Reverses Controversial Directive

Mark Mandell, Esq.

After a harsh grilling of the Michigan Unemployment Agency’s director by a Senate committee last week, the agency has rescinded a controversial directive made in October regarding the handling of fraud cases.

The October directive at issue told agency officials not to show up for administrative hearings for unemployment insurance fraud cases unless the amount of fraudulently claimed benefits was at least $15,000. However, the directive ran contrary to the 2011 law passed by the legislature that makes unemployment insurance fraud above $3,500 a potential felony. As a result, lawmakers were outraged.

“Do you make it a habit of interpreting legislation for your own convenience?” Sen. Jack Brandenburg, R-Harrison Township, asked UI Agency Director Steve Arwood. “You changed the legislation’s intent; don’t tell me you didn’t.”

Arwood stated that he only signed off on the directive as a “temporary measure” due to staff shortages after the UI Agency laid off 400 of its 1,200 employees at the beginning of October.

When agency officials do not appear for the fraud hearing, the judge finds that the state has abandoned its fraud claim and tosses out the case. While it may be convenient for the UI Agency to ignore smaller claims, such fraudulent claims cost both employers and workers through higher insurance rates.

A new directive was sent out last Friday that referred agency officials to the fraud manual, which specifically states that attendance at civil fraud hearings before administrative law judges is necessary if the amount in question is $3,500 or more.

It seems the UI Agency is back in line with the law.

To learn more and read the original article, please visit: http://www.freep.com/article/20130417/NEWS06/304160180/Unemployment-Insurance-Agency-pivots-controversial-fraud-policy

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.

New Bill Introduced in an Attempt to Fight Bridge Card Fraud

Mark Mandell, Esq.
 

State Representatives Roger Victory and Gail Haines announced new legislation that will penalize retailers committing Bridge Card Fraud.

 

“It is my job to protect hard-working Michigan taxpayers from waste and abuse of our welfare system, as well as protect our retailers from unfair competition,” said Victory.

The bills are meant to punish those retailers who abuse the state’s welfare system by allowing Bridge Card holders to purchase liquor and lottery tickets with their Bridge Card funds. By overcharging a customer on another item, retailers allow Bridge Card holders to purchase items the Bridge Card funds do not in fact cover.

Victory says the legislation is an attempt not only to penalize those retailers who abuse the system, but it is also an attempt to discourage future Bridge Card fraud.

If passed, the bills would provide consequences for those retailers abusing the system. With the first offense, the business would have its liquor or lotto license suspended for 60 days. With the second offense, the license would be revoked. Haines says it is these steep penalties that will help to prevent Bridge Card fraud. 

To learn more and read the original article, please visit: http://detroit.cbslocal.com/2013/03/04/new-bill-targets-bridge-card-fraud/

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.