$67 Million to Resolve False Claims Act Allegations Relating to Tarceva
The governmental crackdown on fraud committed against its agencies by private companies sometimes has the effect of also ensuring that some of the most vulnerable people in our society – those with severe illnesses – are protected. This was demonstrated earlier this month when the Department of Justice announced that pharmaceutical companies Genentech Inc. and OSI Pharmaceuticals LLC had agreed to pay $67 million to settle False Claims Act allegations that they made misleading statements about the effectiveness of Tarceva a drug used to treat non-small cell lung and pancreatic cancer. Genentech and OSI Pharmaceuticals are located respectively in California and New York. “Pharmaceutical companies have a responsibility to provide accurate information to patients and health care providers about their prescription drugs,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “The Department of Justice will hold those companies accountable that mislead the public about the efficacy of their products.”
The settlement resolved allegations that between January 2006 and December 2011, Genentech and OSI Pharmaceuticals made false statements to physicians and other health care providers boasting of the effectiveness of Tarceva to treat certain non-small cell lung cancer when there was little evidence to support such statements. The evidence indicated that Tarceva was effective mainly in cases where patients had never smoked or had not had mutations in their epidermal growth factor receptor. (These are proteins involved in the growth and spread of cancer cells). As a result of the $67 million settlement, the government will receive $62.6 million and the state Medicaid programs will receive $4.4 million.
“This settlement demonstrates the government’s unwavering commitment to pursue violations of the False Claims Act and recover taxpayer dollars spent as a result of misleading marketing campaigns,” said U.S. Attorney Brian Stretch for the Northern District of California. “The FDA will continue to work to protect the public’s health by ensuring that companies do not mislead healthcare providers about their products,” said Deputy Commissioner Howard R. Sklamberg for FDA’s global regulatory operations and policy. The settlement also resolves allegations filed by a former Genentech employee Brian Shields. His lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act. This act permits individuals to sue on behalf of the federal government and entitles them to receive a portion of any settlement reached in cases of fraud committed against the government and its agencies. Shields portion of the settlement comes to approximately $10 million.
The settlement is another example of the government’s efforts to combat health care fraud and is an achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT). This initiative was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has resulted in the recovery of more than $29.8 billion through False Claims Act cases. If you know of fraud that has been committed against a government program or agency you are encouraged to report it and to consult with a whistleblower law firm.
United States Settles False Claims Act Allegations against 21st Century Oncology for $34.7 Million
Last month the Department of Justice announced that 21st Century Oncology, Inc., had agreed to settle allegations that it performed and billed patients for unnecessary medical procedures. The company is headquartered in Fort Myers, Florida and has offices in 16 states. Specifically, the government alleged that 21st Century knowingly and improperly billed for a procedure called Gamma function which measures the exit dose of radiation from a patient after receiving radiation treatment. The government alleged that (a) 21st century performed and billed for the procedure when there was no medically appropriate reason to do so and that (b) it used physicians and physicists who were not trained to interpret and utilize the results of said tests. Moreover, the government alleged that 21st Century billed for the procedure when no physician had reviewed the results for seven or more days after the last day patients received the procedure. Finally, the government alleged that 21st Century billed for the procedure when results from the test were not available due to technical failures in the imaging equipment.
“The U.S. Attorney’s Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud,” said U.S. Attorney A. Lee Bentley III for the Middle District of Florida. “Healthcare providers may bill for new technologies only when they have been proven to be useful and when individual physicians and staff have been trained to use them properly.” The lawsuit was filed under the qui tam provisions of the False Claims Act by Joseph Ting, a former physicist at South Florida Radiation Oncology. Under the Act, private parties can sue on behalf of the government and receive a portion of any recovery in cases of governmental fraud. Ting’s portion of the settlement comes to more than $7 million. “The waste of health care program dollars will not be tolerated,” said Special Agent in Charge Shimon R. Richmond for the Health and Human Services (HHS) Office of the Inspector General.
Last December, 21st Century paid $19.75 million to settle allegations that it violated the False Claims Act by billing for medically unnecessary urine tests and for encouraging physicians to order these test by offering bonuses based on the number of patients the physicians could refer to its laboratories. The settlement comes as part of the government’s ongoing efforts to combat health care fraud via its Health Care Fraud Prevention and Enforcement Action Team (HEAT.) The initiative was announced back in May of 2009 by then Attorney General Eric Holder and then Secretary of Health and Human Services Kathleen Sebelius. The initiative has resulted in the recovery of $27.4 billion through False Claims Act cases with more than $17.4 billion of that amount recovered in cases involving fraud against federal health care programs.
“This settlement highlights the commitment of the Defense Criminal Investigative Service (DCIS) and its law enforcement partners to protect the integrity of TRICARE, the Department of Defense health care program that serves our warfighters, their family members, and military retirees,” said Special Agent in Charge John F. Khin of DCIS Southeast Field Office. If you know of fraud that has been committed against a government program or agency you are encouraged to report it and to contact a qui tam law firm for advice.
US Files Lawsuit Alleging Guild Mortgage Improperly Originated and Underwrote FHA-Insured Mortgage Loans
The government’s crackdown on fraud committed against its agencies has impacted all areas of the economy including the housing market. Earlier this month, the US Justice Department filed a complaint against Guild Mortgage Company (Guild) – a mortgage lender based in San Diego – under the False Claims Act for improperly originating and underwriting mortgages insured by the Federal Housing Administration (FHA). “This case is another example of the Justice Department’s continued efforts to ensure that lenders that participate in the FHA mortgage insurance program act in good faith and conduct appropriate due diligence when committing the United States to insure home loans,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.
Guild participated in the FHA insurance program as a direct endorsement (DE) lender and as such had the authority to originate, underwrite and certify mortgages for FHA insurance. Moreover, if a DE lender goes into default at any point on his/her loan, the U.S. Department of Housing and Urban Development (HUD), FHA’s parent agency suffers the losses caused by the defaulted loan. Since neither the FHA nor HUD reviews the underwriting of loans, both agencies rely on DE lenders to follow all applicable FHA standards in their endorsement of loans. The government alleges that from January 2006 through December 2011, Guild knowingly submitted claims for hundreds of improperly underwritten FHA-insured loans. The government also alleges that Guild grew its business by ignoring FHA rules and that it falsely certified compliance with underwriting requirements all for the purpose of reaping profits from FHA-insured mortgages. Finally, Guild is alleged to have used unqualified, uncertified junior-underwriters to wave mandatory conditions on higher risk loans where HUD required that underwriting only be done by trained DE underwriters.
The government’s complaint further alleges that Guild’s senior management focused on growth and profits and ignored quality. For example, the complaint alleges that between 2006 2011 Guild’s quality control reviews found that 20% of its loans had significant defects while over half had either significant or moderate defects. (Significant defects included fraud, misrepresentation and moderate defects meant not following stated guidelines.) However, Guild did not calculate, distribute or submit to management these findings. In the quarters where Guild management actually did review quality control findings, it did so almost a year after the loans closed and failed to timely remediate any identified problems.
Lastly, the government’s complaint alleges that as a result of Guild’s improper underwriting practices, HUD has paid tens of millions of dollars of insurance claims on loans that were improperly underwritten by Guild. Some of the loans currently in default could result in further insurance claims on HUD. “This lawsuit is designed to help the FHA – and American taxpayers — recoup tens of millions of dollars in losses attributable to a lender accused of improperly underwriting FHA-insured mortgages and committing the government’s guarantee to mortgages that failed to comply with program rules,” said U.S. Attorney Channing D. Phillips for the District of Columbia. “FHA relies on the honesty and integrity of those lenders participating in our program,” said HUD’s General Counsel Helen R. Kanovsky. “The action we take…should send a clear message that we will not tolerate the abuse of our programs or of the families who should benefit from them.” The lawsuit was brought under the qui tam provisions of the False Claims Act by a former Guild employee. Under the Act, a private party can bring suit on behalf of the US and share in any recovery.
US Intervenes in False Claims Act Lawsuit Against Prime Healthcare Services Inc. Alleging Unnecessary Inpatient Admissions from Emergency Rooms
Often the Justice Department’s ongoing effort to root out fraud against its agencies reveals illegal activity on a massive scale that involves several entities. This was demonstrated when last week it intervened in a lawsuit against Prime Healthcare Service, Inc (Prime)., the company’s CEO, Dr. Prem Reddy; and 14 Prime hospitals in California alleging that emergency departments at Prime’s facilities improperly admitted patients to their hospitals and that Prime submitted false claims to Medicare. The suit alleges that Dr. Reddy pressured Prime’s Emergency Department physicians and hospital administrators to raise inpatient admission rates regardless of whether it was medically necessary to admit the patients. The suit also alleges that Prime’s corporate officers were pressured by Reddy to admit patients into the Emergency Departments who could have been observed, treated as outpatients or discharged. Finally, the government contends that Prime hospitals submitted false claims to Medicare in an effort to justify these medically unnecessary admissions.
“Charging for medically unnecessary services, as alleged in this case, raises costs in government health programs and remorselessly passes that bill along to taxpayers,” said Special Agent in Charge Christian J. Schrank of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Our investigation into the allegations in this case, along with our law enforcement partners, led to the government’s decision to intervene.” The lawsuit was originally filed in the Los Angeles District court by relater Karin Bernsten who worked at one of the Prime hospitals where the alleged fraudulent activity took place. The lawsuit was filed under the qui tam provisions of the False Claims Act, which permits private parties to sue on behalf of the United States when they believe that a party has submitted false claims to governmental agencies. The Act also permits those same parties to receive a share of any recovery.
The government’s intervention in this lawsuit is an example of its ongoing efforts to combat health care fraud through its Health Care Fraud Prevention and Enforcement Action Team (HEAT). The initiative began back in 2009 and is being spearheaded by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has resulted in the recovery of more than $29 billion through False Claims Act cases. More than $17 billion of that amount has been recovered in cases involving fraud against federal health care programs.
Hayner Hoyt Corporation to Pay $5 Million to Resolve False Claims Act Liability
The Hayner Hoyt Corporation to Pay $5 Million to Resolve False Claims Act Liability
Last month Hayner Hoyt Corporation agreed to pay $5 million to resolve charges that its chairman and CEO Gary Thurston, its president, Jeremy Thurston, employees Ralph Bennett and Steve Benedict and Hayner Hoyt affiliates, LeMoyne Interiors and Doyner Inc., exploited contracting opportunities reserved for service-disabled veterans. The government uses contracting to promote all small businesses but in particular those businesses connected to or owned by service-connected veterans who are disabled. In fact, there is a targeted procurement program for the U.S. Department of Veterans Affairs (VA) which requires the VA to set goals for contracting with service-disabled veterans who own, control, make the decisions for and mange their own businesses.
The settlement resolves allegations that Gary and Jeremy Thurston took advantage of the service-disabled, veteran-owned small business program to obtain government contracts for their now defunct company, 229 Constructors, LLC. They are also alleged to have fraudulently secured subcontracts for Hayner Hoyt and its affiliates. The Thurstons – neither of whom is a veteran – exerted influence over 229 Constructors during the bidding and performance of government contracts. They also allegedly staffed the company with Hayner Hoyt employees and their spouses. Their allocation and command of resources meant for service-disabled, veteran-owned businesses gave them a competitive advantage over legitimate veteran owned businesses.
Moreover, Hayner Hoyt officials allegedly made false certifications and statements representing that 229 Constructors met all the requirements necessary to be a service-disabled, veteran-owned business when in fact it did not. By engaging in this activity Hoyt and its affiliates undercut the original intent of Congress’s efforts to aid service-disabled, veteran owned small businesses. The investigation revealed that Bennett – who is a service-disabled veteran who allegedly ran 229 Constructors, served as its president and oversaw $14.4 million in government contracts – was not involved in making decisions for the company. He instead performed minor duties at Hayner Hoyt. To aid in the deception, Jeremy Thurston set up an email account that forwarded all of Bennett’s mail to him. Further, Gary Thurston wrote others that he and his brother would likely terminate 229 Constructors after the government began questioning its affiliation with Hayner Hoyt.
Several months later, Bennett and Benedict – both of whom were listed as “co-owners” of 229 Constructors and with Benedict being listed as one of five “key” officials on Hayner Hoyt’s website – transferred $52,000 to Gary Thurston’s personal bank account to allegedly show appreciation for the assistance he had provided. During the settlement agreement, the defendants admitted that their conduct violated federal regulations, that 229 Constructors provided $1.3 million in small business contracts to Hayner Hoyt, LeMoyne Interiors and Doyner and that those companies generated nearly $300,000 in gross profits as a result their deception.
“Those who do business with the federal government must do so honestly,” said U.S. Attorney Richard S. Hartunian for the Northern District of New York “As today’s settlement demonstrates, this office will vigorously pursue those individuals and entities who game programs designed to help our nation’s veterans succeed in starting small businesses.” “This settlement demonstrates the Department of Veterans Affairs, Office of Inspector General’s continued commitment to aggressively pursue individuals and companies that misrepresent themselves as service-disabled veteran-owned small businesses and deny legitimate disabled veterans the opportunity to obtain VA set-aside contracts,” said Special Agent in Charge Jeff Hughes for the Office of Inspector General for the Department of Veteran Affairs (VA-OIG).
The government’s investigation was prompted by a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act. This act allows private citizens to sue on behalf of the government in cases involving fraud against the government and entitles them to a portion of any recovery. If you have knowledge of fraud committed against the government you should report it and contact a qui tam law firm. Qui tam law firms will be able to assist you by explaining to you and protecting your rights in such cases.
Respironics to Pay $34.8 Million for Allegedly Submitting False Claims to Medicare, Medicaid and Tricare Related to the Sale of Sleep Apnea Masks
Respironics to Pay $34.8 Million for Allegedly Submitting False Claims to Medicare, Medicaid and Tricare Related to the Sale of Sleep Apnea Masks
The government’s crackdown on fraud committed against its agencies has resulted in numerous cases involving not only fraud but violations of the Anti-Kickback statute. An example of this is a case that the Justice Department announced back in March of this year. In March, the Justice Department that Respironics Inc. had agreed to pay $34.8 million to resolve alleged False Claims Act violations for paying kickbacks. The government says that these kickbacks took the form of free call center services for durable medical equipment (DME) suppliers that referred Respironics’ sleep apnea masks for the supplier’s patients. “The payment of illegal remuneration in any form to induce patient referrals threatens public confidence in the health care system,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) prohibits the payment of remuneration to induce the referral of services or items that are paid for by a federal healthcare program such as Medicare, Medicare or TRICARE. Thus, claims submitted to these programs are in violation of the Anti-Kickback statute and the False Claims Act. Specifically, the government alleged that Respironics provided free services to DME suppliers to induce them to purchase their sleep apnea masks. The United States alleged that Respironics provided these call center services to DME companies at no charge on the condition that they refer patients to Respironics’ products. Moreover, the government alleged that the conduct occurred from April 2012 to November 2015.
“Our commitment has made this district one of the leaders on behalf of whistleblowers. We hope that those who commit fraud will recognize that it is our goal to make the consequences more than just the cost of doing business,” said U.S. Attorney Bill Nettles of the District of South Carolina. Respironics will pay roughly $34.14 million to the federal government and roughly $660,000 to various state governments based on their participation in the Medicaid program. The settlement resolves a lawsuit brought by Dr. Gibran Ameer – who has worked for different DME companies – under the qui tam provisions of the False Claims Act. The act permits private citizens with knowledge of fraud against the government to bring a lawsuit on the government’s behalf and to share in any recovery. Under the settlement, Dr. Ameer will receive $5.38 million.
“Medical equipment manufacturers that boost profits by providing kickbacks to suppliers will be held accountable for their improper conduct,” said Special Agent in Charge Derrick L. Jackson of the Department of Health and Human Services, Office of Inspector General (HHS-OIG). The settlement illustrates the ongoing initiative by the government to crackdown on health care fraud through its Health Care Fraud Prevention and Enforcement Action Team (HEAT). The initiative began in May of 2009 and to date has recovered more than $27.4 billion through False Claims Act cases with more than $17.4 billion of that recovered in cases involving fraud against health care programs. If you have knowledge of fraud that has been committed against the government you should report it and contact a Whistleblower law firm. An attorney there will be able to inform you about your rights under the law.
California-Based Z Gallerie LLC Agrees to Pay $15 Million to Settle False Claims Act Suit Alleging it Evaded Customs Duties
If you have knowledge of fraud that has been committed against the government you should report it and consult a false claim act lawyer. A false claims act attorney will inform you about your rights in these cases. Sometimes the government’s crackdown on fraud helps to protect private companies as well as governmental agencies. This is illustrated by its enforcement of anti-dumping laws designed to protect private industry. Last month the Justice Department announced that Z Gallerie LLC agreed to pay $15 million to resolve allegations that it engaged in a scheme to evade custom duties on imports of bedroom furniture from China in violation of the False Claims Act. Z Gallerie is a seller of furniture and accessories throughout the United States. The company’s headquarters are in Los Angeles, California. “This settlement reflects the Department of Justice’s commitment to ensure that those who import and sell foreign-made goods in the United States comply with the law, including laws meant to protect domestic companies and American workers from unfair competition abroad,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.
In this case, it is alleged that Z Gallerie attempted to evade antidumping duties. These regulations are designed to protect domestic manufacturers from foreign companies “dumping” products on US markets at prices below cost. Imports of wooden bedroom furniture made in China have been subject to antidumping duties since 2004. The Department of Commerce and the Department of Homeland Security and Border Protection (CPB) assesses and collects anti-dumping duties. The settlement resolved allegations that Z Gallerie evaded antidumping duties on furniture imported from the PRC from 2007 to 2014. Moreover, Z Gallerie is alleged to have done so by misclassifying, or conspiring with others to misclassify, the imported furniture as pieces intended for non-bedroom use on documents it presented to (CPB).
“Under the new Trade Facilitation and Trade Enforcement Act, CBP will likely see an increase in these types of settlements as the streamlined processes take effect concerning allegations of duty evasion,” said CBP Commissioner R. Gil Kerlikowske. “Companies that intentionally mislabel shipments or misrepresent the value of goods being imported into the United States to avoid paying the appropriate duties do so in an attempt to create an unfair advantage over businesses that play by the rules,” said Special Agent in Charge Nick S. Annan of U.S. Immigration and Customs Enforcement’s Homeland Security Investigations (ICE HSI) in Atlanta.
The allegations in this case were originally brought by whistleblower Kelly Wells, an e-commerce furniture retailer, under the qui tam provisions of the False Claims Act. The act permits private parties to sue on behalf of the United States and to collect a share of any settlement in cases of fraud. Wells is expected to receive $2.4 million as her share of the settlement.
Byram Healthcare and Hollister, Inc. to Pay $20.9 Million to Resolve Kickback Allegations
Last month the Justice Department announced that Hollister, Inc., and Byram Healthcare Centers Inc., had agreed to pay $11.44 million and $9,372,882.50, respectively to resolve allegations that Hollister – a supplier of medical products – paid kickbacks to Byram – a manufacturer – and that Byram received kickbacks from Hollister and several other companies. Moreover, the government alleges that Hollister intended to induce Byram to conduct promotional campaigns in an effort to refer patients to the manufacturer’s products. The settlement with Byram also calls for the company to play $127,117.50 to the State of California to resolve allegations that Byram submitted falsely inflated claims to the state’s Medicaid (Medi-Cal) program in violation of California regulations.
“This settlement demonstrates the Justice Department’s continuing determination to prevent manufacturers and suppliers of medical devices covered by federal health care programs from paying or receiving kickbacks,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.
The settlement with Hollister resolved allegations that from 2007 through 2014 it paid kickbacks to Byram in return for marketing promotion and referrals of patients to Hollister’s healthcare products. Furthermore, on seven occasions from 2007 – 2012, Hollister allegedly agreed to pay Byram the cost of bonus commissions that Byram then paid to its sales personnel for each new patient order for a Hollister product. Hollister – for each year between 2009 and 2014 – is also alleged to have agreed to pay $200,000 for “catalog funding” that was intended to induce Byram’s recommendation of Hollister products to patients.
The settlement with Byram resolved claims that it also participated in the catalog funding claims and that it – from 2012 to 2013 – received numerous kickbacks from Hollister and three other manufacturers of healthcare products. In return the companies – Coloplast Corp, Montreal Ostomy and Safe N’ Simple – agreed to promote Byram’s products and to refer patients to Byram’s products. The settlement also resolved allegations that Byram submitted false claims to California Medi-Cal in violation of the program’s upper billing limit regulation, Cal. Code Regs., tit. 22, § 51008.1. The United States and California alleged that when Byram billed Medi-Cal for products it sold to Medi-Cal beneficiaries it knowingly failed to account for discounts it knew would reduce the prices it paid for the products. In conjunction with the False Claims Act settlement, Byram entered into a corporate integrity agreement with the HHS-OIG.
“Health care product manufacturers that financially reward suppliers in exchange for the referral of business can improperly direct patients to certain products over others,” said Special Agent in Charge Phillip M. Coyne of HHS-OIG. “We will continue to investigate such wasteful business arrangements.” The settlement also resolves allegations in a whistleblower lawsuit filed by former and current employees of Coloplast. The settlement falls under the Qui tam provisions of the False Claims Act which allows private parties to sue on behalf of the government and to share in any recovery. Claims against defendants in the lawsuit, Coloplast Corp. and Liberator Medical Supply Inc., were resolved in December 2015 for a total of $3.66 million. The announced settlements brought about the recovery in the case to $24.6 million. The whistleblowers are pursuing certain additional claims in the case. If you have knowledge of fraud that has been committed against governmental agencies you should report it and consult a Qui tam attorney. A Qui tam lawyer can explain your rights and protections under the law.
Chicago Couple Indicted in Schemes to Defraud Medicare and Force Labor
Some of the fraud that is alleged to have taken place against governmental agencies appears to have come from defendants who tried to keep their illegal activities in the family. This is illustrated by the case of a married couple and the husband’s mother. Earlier this month, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division – along with several other agencies and individuals including the FBI and HHS-OIG – announced that a Chicago couple had been charged in an indictment with a scheme to defraud Medicare. The couple was also charged with conspiring to employ a woman against her will. Richard Tinimbang and his wife Maribel were charged with participating in a $45 million fraud scheme involving three home health care companies owned by Richard Tinimbang’s mother, Josephine. The companies are alleged to have paid bribes and kickbacks to obtain Medicare beneficiaries, ignored doctors who refused to certify beneficiaries of being in need of home health care and falsified Medicare records.
In total, three defendants have pleaded guilty in this case which is part of a larger investigation into health care fraud. Ten others, including Josephine Tinimbang are awaiting trial. Richard and Maribel Tinimbang’s business – Patients First Physical Therapy – ostensibly provided in-home therapy services to patients of three home health care companies – Donnarich Home Health Care Inc., Josdan Home Health Care Inc. and Pathways Home Health Services LLC.
Richard Tinimbang also allegedly submitted to the U.S. Department of Homeland Security false forms in order to allow a Filipino woman to legally work in the U.S. Moreover, Tinimbang told officials that her field of employment was as a business analyst in order to enable her to qualify for an H-1B visa. According to the indictment, when the woman arrived in the US, Tinimbang put her to work as a nanny and housekeeper. The couple then allegedly forced the woman to sign a seven year contract the terms of which provided that her pay would only be $66 per day regardless of how much work she had done. Further, the contract stipulated that if the women quit before the seventh year, she would be required to play $25,000 in damages. Finally, the couple is also alleged to have threatened to send the woman back to the Philippines without pay for work she had already performed.
As far as the fraud charges are concerned, the couple allegedly used – along with Josephine Tinimbang – the proceeds to make numerous personal purchases including shares of stock. The indictment also alleged that the couple concealed the money they had illegally obtained by claiming them to as business expenses. All of the charges boil down to: one count of conspiracy to defraud Medicare, one count of conspiracy to pay or receive health care kickbacks and two counts of paying kickback to induce referrals to Medicare beneficiaries against Richard Tinimbang. He is also facing one count of money laundering, one count of conspiracy to obtain forced labor and one count of presenting false statements in an immigration document. His wife, Mirabel Tinimbang, is charged with one count of conspiracy to defraud Medicare as well as one count of money laundering and one count of conspiracy to obtain false labor.
The HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. If you have any information regarding companies and/or individuals who you believe are defrauding the government you should contact a false claims act attorney and contact the Health Care Fraud Prevention and Enforcement Action Team (HEAT) or go to www.stopmedicarefraud.gov.
Unlicensed Physician Pleads Guilty to $6.2 Million Medicare Fraud Scheme
The government’s crackdown on Medicare fraud often uncovers some startling surprises that not only involve the actual crime(s) that have been committed, but also reveals interesting facts about the background of individuals charged with those crimes. Take for example the case of an Ohio man who pleaded guilty last week for his role in attempting to defraud Medicare out of approximately $6.2 million while acting as an unlicensed physician at a Detroit in-home physician services company. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division and the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG), along with other representatives from several other federal agencies made the announcement this month. The man, Cecil Alexander Kent Jr, pleaded guilty before U.S. District Judge John Corbett O’Meara to one count of conspiracy to commit health care fraud, two counts of health care fraud and five counts of making false statements regarding health care matters. He will be sentenced on August 16, 2016 before the same judge.
Kent admitted that while he was employed at B&M Visiting Doctors PLC (B&M) he saw patients, and falsified their records including billing documents all while being unlicensed. Moreover, Kent admitted that he falsified prescriptions for controlled substances while claiming to be a licensed medical doctor. Kent prescribed the drug Fentanyl by using the name and DEA number of a licensed physician. Medicare does not pay for patient visits by unlicensed individuals and although Kent knew this, he nonetheless submitted claims to Medicare through B&M. Two other men – Charles McRae, a part owner of B&M and Alvin Williams – were each charged in the same incident with Kent and each pleaded guilty for participating in the fraud scheme. Neither man was a licensed physician.
The FBI and HHS-OIG investigated this case as part of the Medicare Fraud Strike Force. Several other agencies and individuals participated in the prosecution of this case. Since it began in March 2007, the Strike Force has charged over 2,300 individuals who have collectively billed Medicare more than $7 billion. The initiative uses, as a tool for prosecuting cases, the Whistleblower Protection Act which protects people who provide the government with information about fraudulent activity. Such individuals are also entitled to a portion of any award collected by the government in its efforts. If you need a false claims act lawyer or whistleblower protection act lawyers you should seek one who is experienced in this area of the law. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
