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Articles Posted in Health Care Fraud

laboratory-2815641_1920-300x200One of Florida’s largest health insurance fraud cases resulted in the arrest of 10 Miami businessmen Monday. 

According to federal prosecutors, the men were charged with submitting $1.4 billion in fraudulent claims for urinalysis and blood tests at several rural hospitals in Florida, Georgia, and Missouri. 

An indictment for the men shows that they are accused of submitting claims to Florida Blue and other private insurance companies for $400 million worth of tests that were executed at private labs and not the rural hospitals. The U.S. Attorney’s Office in Jacksonville says that the men were able to increase their reimbursements by doing this as the rural hospitals received higher insurance payments from 2015 to 2018. 

The men charged reside in Miami-Dade County, Broward County, Marion County, Citrus County, Chicago, and Atlanta. 

According to the indictment, some of the defendants allegedly used the financial reins of rural hospitals that were facing troubles and then billed private insurers, like Florida Blue, for pricey blood tests and urinalysis that were conducted at other private labs.

Prosecutors claim that the men used these rural hospitals facing financial hardships as a shell to fraudulently bill for these tests to get a higher reimbursement. 

The indictment goes on to say that these tests were also not medically necessary. The men are also accused of paying kickbacks to patients with alleged drug problems as well as other healthcare providers.

The rural hospitals include:  

Campbellton Graceville Hospital

5429 College Dr, Graceville, FL 32440

Regional General Hospital

125 SW 7th St, Williston, FL 32696

Chestatee Regional Hospital 

227 Mountain Dr Dahlonega, GA 30533

Putnam County Memorial Hospital

1926 Oak St, Unionville, MO 63565

When someone is accused of healthcare fraud, the prosecution must prove that they participated in a scheme to bilk money out of a healthcare program, which in this case is allegedly Florida Blue. Healthcare fraud cases are extremely complex and usually evolve after years of investigations. These cases and their charges cover a broad span of conduct. Most insurance fraud cases involve “tricks” or bribery to steal money and the government takes these allegations quite seriously. These cases can be quite in-depth and involve deliberate dishonesty, which is why the government targets any suspicious activity to catch those believed to be playing a role in these crimes. 

Many insurance fraud cases involve billing for unnecessary services or for services that were never actually provided. Upcoding, double billing, kickbacks, and other infractions go hand in hand with these charges. Our South Florida Healthcare Fraud Attorneys at Whittel & Melton help clients accused of fraud charges at the state and federal level. We will go to work right away for you and help you establish a compelling defense for your charges. After reviewing the facts of your case, we may be able to show that the claims submitted were legitimate or that you were unaware the insurance claim was not correct and you did not submit it intentionally. Every case is different and requires a unique defense strategy. As former prosecutors, we can put our experience to work for you and make sure you have a powerful defense. We will fight aggressively to obtain an outcome that you can live with. 

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The Justice Department charged 10 former NFL players, among them a group of former Washington Redskins that includes running back Clinton Portis and cornerback Carlos Rogers, with defrauding a health-care program for retired players of nearly $4 million, according to court documents.

After an FBI investigation, the Justice Department filed charges Thursday morning in the Eastern District of Kentucky against Robert McCune, John Eubanks, Tamarick Vanover, Ceandris Brown, James Butler, Frederick Bennett, Correll Buckhalter, Etric Pruitt, Portis and Rogers.

The government also intends to charge former NFL wide receivers Joe Horn and Reche Caldwell with conspiracy to commit health-care fraud, according to a news release.

The specific combination of charges for the 10 players vary by individual but include conspiracy to commit health-care wire fraud, wire fraud and health-care fraud. Portis was charged with all three. The charges carry a legal maximum penalty of 50 years combined. 

nfl-3644686_1280-300x300Four former NFL players were arrested Thursday morning, and the others, including Portis, are expected to surrender at some point. The arrested players were McCune in Georgia, Eubanks in Mississippi, Brown in Texas and Rogers in Georgia.

The players allegedly submitted false claims to the Gene Upshaw NFL Player Health Reimbursement Account Plan for reimbursement for medical equipment — such as hyperbaric chambers, cryotherapy machines, ultrasound machines used to conduct women’s health exams and electromagnetic therapy devices designed for use on horses — costing between $40,000 and $50,000. According to the indictments, the players fabricated documents, including invoices and prescriptions, to execute the plan.

Under the terms of the collective bargaining agreement, the Gene Upshaw NFL Player Health Reimbursement Account Plan is funded by NFL teams and jointly administered by the NFL and the NFL Players Association. 

The accused players filed $3.9 million in false claims, and between June 2017 and December 2018, the health plan paid them more than $3.4 million on those claims, according to court documents.

“The expensive medical equipment described in the Reimbursement Request Forms that the Defendants submitted or caused to be submitted to the Plan were never purchased or received from the Participant, and the invoices from medical equipment companies, letters from health care providers, and prescriptions from health-care providers accompanying the Reimbursement Request Forms were all fabricated,” the indictment reads.

According to the indictments, the players fall into two groups: those who recruited former players and helped file fraudulent claims and others who agreed to provide their personal information knowing it would be used to defraud the health-care fund for fellow retired players. The players who filed the fraudulent claims on behalf of others received “payment of kickbacks and bribes” of up to $10,000 for each false claim.

McCune, a linebacker drafted by the Redskins in 2005 who played in the NFL until 2009, allegedly filed the first fraudulent claim. On Oct. 3, 2017, McCune filed a reimbursement claim in Buckhalter’s name for a PEMF 8000 Equine Unit, electromagnetic therapy mobile device used on horses. He also filed a claim for an electromagnetic therapy magnetic mattress and three associated “butterfly loops” at a total cost of nearly $40,000.

Later that month, McCune apparently filed false claims in the names of Eubanks and Brown. Between February 2018 and April 2018, according to the documents, McCune filed another six claims using the names of Vanover, Portis, Butler and Bennett.

On March 8, 2018, McCune filed a false claim under Portis’s name for a “Crome Pro Cryosauna” — a cryotherapy device that looks like a stand-up tanning bed — and a “Sculpting CryoLipolysis,” equipment used for the cosmetic removal of body fat. Combined, the equipment cost more than $54,000, one of the costliest claims noted in the documents.

The documents allege Buckhalter, a running back for the Philadelphia Eagles and Denver Broncos from 2001 to 2010, used the same scheme with the help of Rogers, recruiting new players to file similar reimbursement forms.

McCune and Buckhalter allegedly called the number that handles reimbursement requests and impersonated other players to check the status of false claims submitted on their behalf.

The investigation was triggered, officials said, by health insurer Cigna, which first took notice of suspicious claims.

Benczkowski said the Justice Department pursued the case “because of the potential impact of these crimes — not only the amount of money at stake but the fact that the crimes potentially impacted a very important benefit that was collectively bargained between the league and the players association to benefit former players and their spouses and their dependents.

Health care fraud is a huge government priority at the moment. At this time, it may be the most commonly prosecuted kind of white collar crime in federal court. The Department of Justice and the Department of Health and Human Services’s Office of Inspector General are spending vast resources investigating and prosecuting health care fraud cases.

The majority of healthcare fraud charges arise from fraudulent billing allegations. They can include any sort of the following:

  • False billing
  • Upcoding (billing a code with a more expensive service)
  • Billing for services not rendered
  • Billing for unnecessary tests and procedures
  • Billing for unnecessary medical equipment
  • Double-billing (billing for Medicaid/Medicare and also private insurance)
  • Billing for more time than provided
  • Kickbacks and referrals
  • Falsifying medical records/documents

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On Friday, a federal jury convicted a Florida health care executive on 20 criminal counts in what prosecutors described as a $1 billion Medicare fraud scheme.

Jurors reached a partial verdict after four days of deliberating. This case is one of the biggest in U.S. history. Jurors were undecided on six additional counts, but prosecutors accepted the verdict rather than sending them back for further deliberations.

The Miami Beach businessman operated a network of nursing homes and assisted living facilities in South Florida.

Jurors found him guilty of paying kickbacks and bribes to doctors and administrators so they would refer patients to his businesses. A former Ivy League basketball coach testified that the man bribed him to get his son into school. He was also convicted of charges of obstruction of justice, for plotting to help one of his co-conspirators flee to another country.

The jury could not decide whether the man was guilty of Medicare fraud conspiracy. They found him guilty of money laundering and of bribing a Florida health regulator to warn him when inspectors planned surprise visits to his facilities and when patients made complaints.

The man plans to appeal the decision.

He has been jailed since his 2016 arrest. The charges he was convicted of add up to more than 250 years in prison, but he is likely to get far less than that under federal sentencing guidelines.

The federal government and the state of Florida are quite serious about prosecuting those accused of health care fraud. Police will use any means necessary to uncover any alleged fraud. Individual doctors and even entire hospitals can be the target of a health care fraud investigation.

The government is very aggressive in its approach to investigating health care fraud. Grand jury investigations are likely to occur. It doesn’t matter if you are under investigation or have already been indicted – you need to enlist the help of a criminal defense attorney as soon as possible who can defend you from these charges.

Our South Florida Medicare Fraud Defense Attorneys at Whittel & Melton can defend you against health care fraud charges in Florida or elsewhere in the country. We will give you an honest assessment of your case and help you understand the possible defenses that may be available. We want to minimize any damage to you and your reputation.

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A former University of Florida football player was sentenced to nearly 22 years in prison and ordered to pay about $18 million for a healthcare fraud conspiracy that stripped millions from the TRICARE program for military members, veterans and their families, according to federal court records.

The 46-year-old man, who played for Steve Spurrier’s Gators from 1990-93, was accused in a 49-count indictment of hiring an independent marketing team that included former Florida and NFL quarterback Shane Matthews in a conspiracy to fleece the TRICARE program.

The man maintained his innocence and denied what the prosecuting attorney described as “buying and selling patients for a pharmacy.”

The man, a former defensive back who spent three years in the NFL with the Chiefs and Jaguars, was accused of receiving and paying kickbacks to score lucrative patient referrals for a major South Florida pharmacy.

Despite his claims of innocence, a jury unanimously convicted him on multiple charges earlier this year, including the conspiracy that funneled more than $20 million from the TRICARE program.

Prosecutors described the conspiracy as a “pyramid scheme” and said there are other “unindicted co-conspirators.”

Healthcare fraud is a crime that is often charged along with conspiracy. Fraud is defined as an attempt to gain money or value by a false representation of fact. If you are facing federal conspiracy and/or fraud charges, or if you have reason to believe you are under investigation for such charges, you need to act fast and consult a Federal Healthcare Fraud Attorney at Whittel & Melton. A free consultation with us can help you learn more about the criminal defense process and the best course of action for your case.

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