Health Care Fraud Blog

BENSON WEINTRAUB, the nationally renown federal sentencing expert and ANTHONY C. VITALE of the Health Law Offices of Anthony C. Vitale, PA presented a novel issue in health care fraud during a 5-day sentencing proceeding against Rodolpho Ramirez, a DME operator sentenced by US District Judge Adalberto Jordan (S.D.Fl.) to 24-months imprisonment for making fraudulent claims to Medicare and paying kickbacks to a local physician.

Weintraub and Vitale were successful in persuading Judge Jordan to assume, without deciding the issue, that an obscure provision of “Special Rules” in the calculation of loss under the Federal Sentencing Guidelines is instructive and resulted in a significant exclusion of “relevant conduct” claimed by the government and a Guideline range approximately half of that requested by John Cunningam and Jay Darden, DOJ Trial Attorneys from the Fraud Section in Washington.

The case attracted considerable attention in the legal profession with both criminal defense lawyers and a Deputy Attorney General observing portions of the extraordinarily lengthy hearing characterized by expert medical testimony about medical necessity, Medicare billing procedures, and medical economics.

The prosecutors argued that for the past year, they consistently employed another loss methodology in 70-100 other cases in the Southern District of Florida, a hotbed of Medicare Fraud, and every Judge accepted it, to which Judge Jordan replied, “Did anyone raise the issue asserted by Mr. Weintraub?” to which the government responded “No.”

Continue reading "DEFENSE LAWYERS PREVAIL IN HEALTH CARE FRAUD CASE" »

Effective July 1, 2008, pursuant to Florida Statutes § 460.4167, no chiropractor may be employed by a health care clinic unless the clinic has a medical director that is an MD or DO. Specifically, the provision is intended to prevent D.C.s from acting as medical directors for such clinics.

The Board of Chiropractic recently addressed the issue of whether any such clinics already existing can be grandfathered. The answer by the Board is no. Therefore, effective July 1, 2008 any clinic that has a D.C. as a medical director or employs a D.C. and does not have an MD or DO medical director will not be able to submit claims or bill for services and D.C.s working for such establishments can be disciplined.

The Statute also addresses several issues for clinics that continue to employ D.C.s and sets limitations, including criminal penalties:

The purpose of this section is to prevent a person other than a licensed chiropractic physician from influencing or otherwise interfering with the exercise of a chiropractic physician's independent professional judgment. In addition to the acts specified in subsection (1), a person other than a licensed chiropractic physician and any entity other than a sole proprietorship, group practice, partnership, or corporation that is wholly owned by one or more chiropractic physicians licensed under this chapter or by a chiropractic physician licensed under this chapter and the spouse, parent, child, or sibling of that physician, may not employ a chiropractic physician licensed under this chapter or enter into a contract or arrangement with a chiropractic physician pursuant to which such unlicensed person or such entity exercises control over the following:

Continue reading "New Florida Law Requires Physician Medical Directors for Health Care Clinics Employing Chiropractors" »

After a six day trial in Miami, a federal jury in Miami convicted Gustavo Smith, 43, the owner of a Miami pharmacy for his role in a $3 million Medicare fraud scheme and for money laundering of all 17 counts charged against him in the September 2007 Indictment.

The charges included: conspiracy to defraud the U.S. government, to commit health care fraud, and to submit false claims to the Medicare program; seven counts of health care fraud; seven counts of submitting false claims to the Medicare program; conspiracy to commit money laundering; and one count of money laundering.

Smith’s co-defendant, Friedhelm Schock, the nominee owner of Medstar, was acquitted by the jury on all charged counts.

According to Schock's defense attorney, Michael Band of Adorno & Yoss, the government argued that Schock was the "nominee" owner of the pharmacy, signed all the Medicare documents, opened all the bank accounts, formed the corporation, received monies far in excess of what reflected the work he performed at the pharmacy and lied to the government to cover up the fraud.

Continue reading "Miami Pharmacy Owner of Convicted of Medicare Fraud, Co-defendant Acquitted" »