Jury Finds Four New Orleans Doctors and Others Guilty for Participation in $13.6 Million Medicare Fraud Scheme

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On May 9, 2017, a federal jury found four New Orleans doctors and two others guilty for their participation in a Medicare fraud scheme. According to prosecutors the defendants netted more than $13.6 million in fraudulent Medicare reimbursements.

Details of the Scheme.

The six defendants worked for or with Abide Home Care Services (Abide) in New Orleans. Federal prosecutors said Abide routinely falsified diagnoses so Medicare reimbursements were inflated. Abide also falsified medical records that supported medically unnecessary home health services, prosecutors said. Abide was owned by Lisa Crinel, who pleaded guilty to her role in the scheme in 2015.

In exchange for their role in the scheme, Abide made monthly payments to the doctors that were falsely characterized as medical consultant or director fees. Abide also hired Dr. Michael Jones’ wife Paula Jones and inflated her salary payments to pay for fraudulently certifying documents. Additionally, Jonathan Nora scheduled doctor visits with Abide “well knowing” that the referral did not come from the beneficiary’s own health care professional.

The Trial.

After a month long trial, a federal jury returned guilty verdicts against the six individuals charged with committing Medicare fraud. Found guilty were Dr. Henry Evans, Dr. Michael Jones and his wife Paula Jones, Dr. Shelton Barnes, Dr. Gregory Molden and Jonathon Nora. Click here to read the press release issued by Acting U.S. Attorney Duane Evans’s Office in Eastern District of Louisiana.

The Consequences.

Dr. Evans was found guilty of five counts of health care fraud. Dr. Michael Jones, Paula Jones, Dr. Barnes, Dr. Molden and Jonathan Nora each were found guilty of conspiracies to commit health care fraud, defrauding the United States, receiving and paying kickbacks and health care fraud, according to the U.S. Attorneys Office. The four doctors and Nora were convicted of additional individual counts of health care fraud. Dr. Shelton Barnes was additionally convicted of obstruction of a federal audit.

Dr. Barnes faces a maximum penalty of up to 170 years in federal prison; Dr. Molden faces up to 115 years; Dr. Michael Jones faces up to 95 years; Dr. Evans faces up to 50 years in federal prison; Paula Jones faces up to 15 years; and Nora faces up to 25 years. Each also faces a maximum fine of up to $250,000 for each count.

Doctors Beware.

In our practice we have represented a number of doctors who have been exploited by nonphysicians intent on committing fraud. They will often target older and semi-retired physicians. The goal is merely to get their name and identification number to use in falsifying medical records and claims. If the deal you are being offered seems like too good of a deal, involves little or no work on your part to receive a large check each month or involves working for nonphysicians or individuals you do not know, you should beware. Always know who you are working for, the location of their actual place of business and residence, and with whom (physician-wise) they have done business before. You do not want to spend the later years of your life in prison, after pursuing an honorable career for decades.
Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many cases, those subject to Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of Medicare fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of Medicare fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

To read further about the seriousness of Medicare fraud, click here to read one of my prior blogs.

Additionally, you can watch our informational video blog on Medicare fraud, here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.
Sources:

Lane, Emily. “4 New Orleans doctors, 2 others convicted in $13.6 million Medicare fraud scheme.” The Times-Picayune. (May 10, 2017). Web.

“4 New Orleans doctors, 2 others convicted in $13.6 million Medicare fraud scheme.” Health Leaders Media. (May 11. 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Keywords: Legal representation for Medicare fraud, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegations of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for illegal kickbacks, Medicare false claims defense attorney, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Florida Federal Judge Triples Award to $347 Million in Rare Whistleblower Case

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 1, 2017, a Florida federal judge tripled a $115 million damages award for the government to $347 million after a jury found that the operators of 53 nursing facilities submitted false claims to Medicare and Medicaid. U.S. District Judge, Steven D. Merryday, upheld the jury’s $115 award affirming that the operators of the 53 nursing facilities had violated the False Claims Act (FCA). The case is U.S. ex rel. Ruckh v. CMC II LLC et al., case number 8:11-cv-01303, in the U.S. District Court for the Middle District of Florida.

The whistleblower in the case, Angela Ruckh, a former nurse at two of the facilities, brought the allegations against four defendants that they had submitted false claims and fraudulent records to the government. The four defendants in the case are CMC II LLC, Salus Rehabilitation LLC, 207 Marshall Drive Operations LLC and 803 Oak Street Operations LLC.

Details of the Case.

On February 15, 2017, the jury found that the four defendants had falsely increased the amount of resources needed for their patients needed, in order to get more money from Medicare and Medicaid. In the jury’s verdict, the four defendants were ordered to pay $115 million in damages for violating the FCA. Click here to read the jury’s verdict in full.

Treble Damages for FCA.

This rare FCA case that both went to trial and received a jury verdict, called for treble damages. The four defendants received penalties proportionate to the jury’s allocated findings. Sea Crest Health Care Management, L.L.C. and CMC II, LLC were ordered to pay $291,160,608 to the U.S. government and $39,897,291 to the Florida government. Salus Rehabilitation LLC was required to pay $484,000 to the U.S. government. 207 Marshall Drive Operations L.L.C. incurred $6,266,424 of damages owed to the federal government and 803 Oak Street Operations, LLC was penalized $10,055,961 to be paid back to the U.S. government. Click here to read the order from this case in full.

To learn more about FCA violations and cases of fraud involving a relator or whistleblower, click here to read one of our prior blogs.

Nurses and Other Employees Are Often Whistle Blowers in These Big Cases.

It is often a nurse or other health professional employed by the facility that is the whistle blower in such cases. They are in a position to know whether or not services are being provided and whether or not they are medically necessary. They are often in a position to see if false bills are being submitted for the patients.

In a case such as this one, where the U.S. did not intervene to take the case forward and the whistleblower and her attorneys did, she can receive an award of up to thirty percent (30%) of the recovery or $104,100,000.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Smith, Mara. “Florida Judge Trebles Award to $347 Million in Whistleblower Case.” AHCA. (March 1, 2017). Web.

Bolado, Carolina. “Judge Triples Nursing Home Cos.’ Fraud Penalty To $347M.” Law360. (March 6, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) violations, FCA defense attorney, Medicare and Medicaid fraud defense attorney, Medicare false claims, legal representation for FCA violations, legal representation for overbilling Medicare and Medicaid, legal representation for submitting false claims to the government, Legal representation for Medicare fraud, legal counsel for Medicare audit, legal representation for whistleblower, qui taim, qui tam suits, qui tam relator, whistleblower defense attorney, Medicare fraud defense attorney, Medicaid fraud defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.