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

$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

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

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.