Articles Posted in Anti-Fraud Enforcement

Photobucket LAKE WORTH, FLORIDA (May 18, 2011) – The DEA’s Operation Pill Nation

crackdown thought it was just another pill mill investigation, but in a strange twist the agency also found that Dr. Cesar DeLeon, a Lake Worth physician was not operating the typical pill mill out of his clinic, the Trinity Medical Center. The doctor received methods of compensation other than money for prescriptions; he was sometimes paid with sex.


PhotobucketWASHINGTON D.C. – Peter Budetti, Washington’s watchdog for Medicare and Medicaid fraud warns would-be program fraudsters that he’s cracking down and plans to use technology and a new long-range, far-reaching strategy to do it.

The FBI estimates figures in the double- to possible triple-digit billions are lost annually to healthcare fraud, and the State of Florida, due to its high elderly population, leads the country in Medicare scams. Medicare fraud isn’t limited to criminal practices by healthcare professionals, including nurses, doctors and pharmacists, but also business owners, Medicare beneficiaries, drug dealers and even organized crime groups defraud the fund.

The Crackdown

fraudandcuffs.jpg WASHINGTON D.C. (May 15, 2011) – A District of Columbia health care provider was indicted by a federal grand jury on “one count of health care fraud and 39 counts of false statements in a health care matter.” Jacqueline Wheeler faces a possible maximum sentence of 10 years incarceration and $250,000 in fines. Wheeler, a registered naturopath with the District of Columbia Department of Health, Health Professional Licensing Administration is not a medical doctor licensed to practice medicine.

Wheeler acted as CEO of Health Advocacy Center, Inc., which is a registered Medicaid provider. She also owns Sheridan Rehabilitative and Wellness Centers, Inc, which is not a registered Medicaid provider. Wheeler did all the billing for Health Advocacy and controlled the finances of both facilities. At Health Advocacy, Wheeler worked with a licensed medical doctor and billed D.C. Medicaid for $6.2 million as reimbursement of therapy services. Wheeler claimed 22 patients each received 20 continuous hours of therapy in one 24-hour period. There are 1,440 minutes in a day and sometimes Wheeler would bill for as many as 2,910 minutes (equal to more than 48 hours) for a single patient, for a single visit.

Wheeler used the proceeds from the fraud to buy property in Florida, North Carolina and the D.C. area. The United States Attorney’s Office is prosecuting the case, and the investigation is ongoing at this time.

money-pile.jpgTALLAHASSEE, FLORIDA (May 10, 2011) – Florida’s legislature scored a big win with the passage of the bill to target pill mills, prescription drug dealers and users. Supporters of the bill consider the loopholes minor.

House Bill 7095 bill makes provisions for a state prescription database and requires drugstores to log the sale of every prescription pain pill. It does not, however, require doctors and pharmacists to check the database before handing the patient their pills. Mandating a database check could catch abusers through cross-referencing all places where they fill prescriptions.

Certain doctors and practices also fall under an exemption for registration with the database. Board-certified pain specialists, such as anesthesiologists, neurologists and surgeons can dispense pain meds without registering the transaction. Non-exempt physicians must register their office, have an inspection and follow set standards of patient care. With more than one-half of Florida’s pain clinics run by board-certified pain doctors, potential for abuse runs high. State officials offer that the class of exempted doctors generally are much less likely to abuse the system.

u_s_capitol_building.jpg WASHINGTON D.C. (May 6, 2011) – U. S. Senator Sherrod Brown (D-OH) has introduced the “Stop Trafficking of Pills Act’’ or the ‘‘STOP” Act target patients and drug dealers looking for narcotic pain medications. The Senator wants individual states to take a tougher stance in fighting Medicaid fraud where prescription medications are involved.

Last year Medicaid shelled out $820 million for prescription drugs in Ohio alone last year. Drug seekers use their Medicaid card to go from doctor to doctor and pharmacy to pharmacy, and although Florida boosts the highest number of Oxycodone prescriptions filled yearly, Ohio ranks number two. The Senator claims Oxycodone, morphine and methadone are the increasing deaths and overdoses.

Senator Brown’s bill would require patients to “lock-in” their choice of a Medicaid provider and pharmacy, which is already required in many states now. The Ohio Highway Patrol has already been targeting prescription pill couriers on Ohio’s interstates. In March alone, more than 1300 arrests were made for illegal prescription pills. One of the biggest corridors, for illegal prescriptions drugs, runs from Detroit, Michigan to southern Ohio before filtering into other states.

doctor-writing-prescription.jpgCOLUMBUS, OHIO (May 9, 2011) – Joining other states with similar legislation, Ohio’s licensed doctors support the passage of regulations to curb the ‘pill mill’ problem and cut the rapid growth of the painkiller-addiction problem in the state. The physicians are also concerned, however, that patients with legitimate pain relief needs could find it harder to come by their drugs, if doctors are worried they’ll be targeted for investigation. “Nothing about anything that we’re doing is meant to dissuade good physicians,” states Richard Whitehouse, executive director of the State Medical Board. Instead, the aim is to give the board more authority to target pill mills.

Ohio House Bill 93 seeks pharmaceutical licensure of free-standing pain management clinics, which is where the majority of patients receive the narcotic pain killers. In addition, doctors would be required to have an affiliation with a local hospital and be board-certified in pain management. Doctors would also have to report any narcotic pain prescriptions written to a state-monitored automated reporting system.

In the past, physicians prescribed strong pain killers mostly to their cancer patients. After reevaluation of pain as the “fifth” vital sign, doctors began to more freely write for pain killer medications. “Now, there’s a crisis of drug abuse and diversion,” states Dr. Robert Taylor of Ohio State University Medical Center.

dea%20badge.jpg MONROE, MICHIGAN – Dr. Oscar Linares’s DEA registration was suspended for illegally distributing millions of doses of Schedule II and III narcotics and for fraudulently billing Medicare for $5.7 million. Dr. Linares faces up to 20 years in prison and a $1 million fine and was arrested at his office in Monroe, Michigan following a search of the premises. Law enforcement also seized several of the physician’s assets, including four bank accounts, two watercraft and seven luxury vehicles.

Dr. Linares allegedly prescribed narcotics for approximately 250 patients per day and even paid employee bonuses anytime he had more than 200 patient appointments in a single day. The Complaint alleges misconduct based on patient accounts, employee interviews and patient visits by undercover operatives. Reportedly, Dr. Linares viewed his actions as that of a man “building an empire.”

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of pill mill and health care fraud defense.

file-stack.jpgMONROE, NORTH CAROLINA (May 7, 2011) – A gynecologist accused of billing Medicaid for services that patients never received, settled her case for double of what she billed the insurance provider. From 2003 to 2008, Dr. Latika Patel filed false claims for more than 1,000 patients.

The doctor admitted that mistakes were made and accepted responsibility for the errors. Dr. Patel contends her staff made the errors and she had been focusing more on patient care and less on the office management side of the business. Investigators believe the doctor knowingly “upcoded” for more involved and more expensive services that were not performed.

Investigators also found the doctor had billed for services performed at one clinic when she was not at that clinic on the day billed. The terms of the settlement include that Dr. Patel does not have to admit liability, and the government does not agree that its claims were not “well-founded.” No criminal charges were brought in the matter. Dr. Patel will now also be subject to audits, at her expense, of her practice and all billing will be monitored for five years.

courtroom.jpgTAMPA, FLORIDA – Wellness Health Plans saw five of its former executives indicted in a triple-digit million dollar fraud perpetrated on the Florida state Medicaid program. The former executives include Wellcare’s CEO, general counsel and CFO. Wellcare allegedly provided false documentation that claimed costs greater than those incurred for behavioral health services.

In October 2007, federal agents descended on the company’s Tampa headquarters and confiscated evidence of the alleged fraud. In 2010, Wellcare and the Justice Department reached a “preliminary settlement” of $137 million. A former financial analyst of the company and a company whistleblower, contends the settlement is too low when damages of $400 million are possible.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of health care fraud defense.

PhotobucketORANGE COUNTY, FLORIDA – Three employees of an Orange County, Florida health clinic were arrested for allegedly scamming payments of more than $54,000 from Direct General Insurance. The trio, employed by Bethel Health and Rehabilitation Center, concocted a scheme of an intentional motor vehicle accident whereby an SUV of future patients rammed another vehicle. The scammers paid all vehicle passengers for their participation in the accident. Investigators also found that patients had been unaware of the insurance fraud because their signatures has been forged for supposed doctor visits.

Investigators are not certain as to whether or not more arrests will occur in the case as the investigation is ongoing. Presently all three initially-named defendants are free on bond.

Healthcare Fraud Blog Publisher, Attorney Robert Malove, is an expert criminal trial lawyer as recognized by The Florida Bar. Mr. Malove has extensive experience in the area of insurance fraud defense.

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