Health Care Fraud Blog

BOSTON, MASSACHUSETTS (AUGUST 29, 2011) - Massachusetts State Attorney General Martha Coakley’s office released information that it had recovered $69 million in Medicaid fraud during the fiscal year 2011. The previous record was $14 million in 2009.

Since she took office in 2007, AG Coakley’s office has added $200 million in Medicaid fraud back to the state fund’s coffers. The $69 million figure alone represents more than the total previously collected in the ten years prior to Coakley’s tenure. For every dollar the AG’s Medicaid Fraud Division has allocated to its budget, $18 is recovered to the taxpayer.

NEWARK, NEW JERSEY (AUGUST 2, 2011) - The FBI wants the public's help in preventing health care fraud and they're putting up advertisements in malls and on highways to bring attention to their campaign. Digital ads went up in malls in Paramus, Wayne, Hackensack and Atlantic City, as well as on the Jersey Turnpike near the Lincoln Tunnel and several major highway systems.

The Newark office of the FBI is credited with the idea for the program. For the next two months that the ads are up, the Bureau hopes to see an increase in the number of tips reporting health care fraud. If the New Jersey campaign is successful, the Bureau will turn it into a national program with the help of Clear Channel, who also assists on the "Most Wanted" digital billboards.

Health care fraud costs the American taxpayer approximately $60 billion a year, and in New Jersey the loss was $8 million in 2010. As the number of reported health care fraud cases has fallen off in recent years, the FBI hopes to educate the public on how much they're losing by not reporting fraud. Agent Sean Keyes says "all of the best criminal investigations are human-source driven."

TAMPA, FLORIDA (AUGUST 1, 2011) - The Office of the Inspector General in the Department of Health and Human Services is now calling Tampa, "ground zero for pain clinics and prescription drug diversion." It seems Tampa has taken South Florida's place in the number of pill mill clinics supplying the illegal painkillers trade. Chris Rule of the Hillsborough County Sheriff's office said it likens back to the crack cocaine problem in the 1990s.

The death toll is rising. Out of 277 drug-related deaths in 2009, 199 of those could be attributed to an oxycodone overdose or other cocktailed drugs. And Rule further states that opiate-based painkillers are the easiest drugs to buy on the street these days. In order for the patients or dealers to get the drugs from the clinic, they need only submit to a blood pressure screening or an MRI.

Of the 70 pain clinics located in the county, 35 are in Tampa. Rule says he doesn't feel every clinic is illegal trading in prescription painkillers. Some operate within the confines of the law and "some are shady," he says.

MIAMI, FLORIDA (JULY 26, 2011) - The Government Accountability Office recently issued a report stating the federal government's analysis systems for Medicare and Medicaid are "inadequate and underused." The report further reveals that the systems don't even analyze Medicaid data, and of the 639 analysts targeted for training with the system, only 41 have received it. The technology slated to save $21 million in Medicare and Medicaid lacks the formal planning for implementation, even though $150 million has been invested in the technology.

When the new system went live in 2009, it was intended for use by the Center for Medicare and Medicaid Services (CMS), contractors, law enforcement and state agencies, with access to the information shared across all states. Because funding for the software was delayed, the rollout date has been pushed to November 2011.

In the meantime, CMS has another fraud prevention technology program in the works, similar to the system that screens for credit card fraud. That contract came with a $77 million price tag. With approximately 4.5 million claims processed on a daily basis, rollout of these programs can't come fast enough for the taxpayer's wallet.

WASHINGTON D.C. (JULY 13, 2011) - In an effort to prevent billions lost each year in fraudulent Medicare claims, a nationwide computer system for tracking claims was launched in South Florida. The system is designed to examine the millions of daily claims for reimbursement using "predictive modeling," which can identify suspected hot beds of suspicious activity throughout the country.

To avoid detection, business owners who intend to defraud the Medicare system will often move their business to other areas of the country and begin working the same scam in the new locale. In June, law enforcement charged 21 alleged fraudsters in a $23 million scam; 15 of which were from Michigan, the other six from Florida. Strike force investigators have located Medicare criminal fraud networks extending from Miami to Detroit and Houston to Los Angeles. Since March 2007, strike force investigators have identified that $1.85 billion in fraudulent claims originated in South Florida, which represented the largest portion of the total $2.3 billion nationwide. Officials estimate that Medicare fraud could total as much as $60 billion per year.

In the past, Medicare reimbursements paid first and then examined the claims for discrepancies, which investigators dubbed "pay and chase." The new system will screen and analyze claims first before payouts are made. If any healthcare providers are found to be submitting suspicious claims, they will first be excluded from participating in the Medicare system and then turned over to law enforcement.

WASHINGTON D.C. - Health care fraud task forces are turning their attention to the executive level of health care enterprises. In an effort to crackdown on those who would perpetrate health care fraud, investigators have begun aiming their efforts at the owners and operators of drug companies, medical device manufacturers, nursing home chains and any health care business involved with Medicare and Medicaid. Senior executives could find themselves facing criminal charges even if they had no knowledge of their company's activities, but were in a position to stop it.

Prosecutors have become fed up with repeated violations, which cost taxpayers more than $60 billion per year and have decided to use enforcement tools that have long been in place, but simply not used. A simple writing of a check to repay the federal funds and a promise not to repeat the offense have been used too often, so now corporate executives must pay closer attention to how their company is billing Medicare and Medicaid lest they find themselves in hot water with the feds.

The crackdown may result in a company's ban from participating in Medicare and Medicaid reimbursements, but the power to ban lies solely with the inspector general, not a judge. The FDA has also begun using the "Park Doctrine" which allows prosecutors to bring criminal charges against executives. Any corporate officer in the chain of command could charged with a criminal misdemeanor if found to have the ability within their power to prevent the fraud.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement activity in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

WASHINGTON D.C. - The Office of the Inspector General of the Department of Health & Human Services has been working hard. In its semi-annual report for October 2010 through March 2011, the OIG's office reported that it expected to recover approximately $222 million from audits and another $3.2 billion from criminal and civil actions. As a result of investigations during that time period the OIG also doled out 883 new exclusions to persons and entities, barring them from participating in Federal health care programs.

The OIG's report continued by revealing more than 100 perpetrators of health care fraud had been arrested, and in February 2011, Medicare Strike Force teams with more than 300 agents fanned out across the country and arrested more than 100 suspects in nine cities. Owners and executives of health care service companies, doctors and nurses, among others found themselves accused of fraudulent billing practices, money laundering, receipt of kickbacks and identity theft.

The OIG's success resulted from a collaborative effort with the Department of Justice, the Centers for Medicare & Medicaid Services, State Medicaid Fraud Control Units, other OIGs offices, State agencies and local law enforcement.

Federal Healthcare Fraud Strike Force teams are currently operating in 9 locations: Miami, Los Angeles, Houston, Detroit, Brooklyn, Tampa, Baton Rouge, Dallas and Chicago.

If you, or someone you know is facing prosecution as a result of aggressive law enforcement activity in the area of health care fraud, make sure you contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

MIAMI-DADE, FLORIDA (May 19, 2011) - A fraudulent billing scam masterminded by Gregory Campbell, the 28-year-old son of State Rep. Daphne Campbell, has brought first-degree felony charges of grand theft, organized fraud and Medicaid fraud down on Mr. Campbell's head. He stands accused of billing the joint state and federally funded Medicaid program for $299,000 for services he never provided.

It appears Campbell billed for the same patients at two separate adult care facilities. Investigators also found Campbell billed for patients that did not live at either facility, and he offered kickbacks to the owner of one of the care sites.

Campbell was being held in the Miami-Dade county jail following his arrest on May 12. When contact by the press regarding her son's arrest, Rep. Campbell had no comment.

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.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

PALM BEACH COUNTY, FLORIDA (May 26, 2011) - State Attorney Michael McAuliffe and Sheriff Ric Bradshaw will co-host Palm Beach County's Prescription Drug Abuse and Pain Clinic Summit. The event takes place today, May 26, from 9 a.m. to 12:30 at the Clayton Hutcheson Agricultural Center.

The summit focuses on prevention of the consequences surrounding addiction and prescription drug dealing before they occur.

In February of this year, as previously reported here, raids of 11 pain clinics spread from Miami to West Palm Beach netted 23 arrests and more than $2.5 million in cash and vehicles. State Attorney McAuliffe believes that integrating the message of public health with enforcement helps officials refine their philosophy and not focus simply on arresting people.

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.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

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.

Dr. DeLeon was indicted for illegal distribution of the narcotic painkiller, Oxycodone, and the DEA's investigation concluded that the good doctor had not only traded illegal prescriptions for addictive controlled substances, but also offered free office visits and money in exchange for sexual favors from patients.

For this unusual method of pill mill operation, Dr. DeLeon faces up to 20 years for each of the 55 counts he was indicted on and a $1,000,000 fine if he is convicted.

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.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

WASHINGTON 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

New applications to become Medicare healthcare providers will be subject to tighter screening, including fingerprinting and criminal background checks by the FBI, if the applicant demonstrates a high-risk potential. Budetti feels a new computer payment system, complete with new software and payment algorithms, will leave the Medicare/Medicaid programs far less open to fraudulent practices. Built into this new system is the capability of immediately suspending payments to providers when fraud allegations prove to be credible.

Budetti believes that smarter computers can outwit the would-be frauders of Medicare and Medicaid thereby saving the American taxpayers and the U.S. government billions of dollars per year.

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 Medicare fraud defense.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

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.

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.

If you or someone you know is a healthcare provider and in need of serious healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

TALLAHASSEE, 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.

The last loophole concerns the lack of drug testing for patients. The medical board wanted patients to undergo regular drug screenings if they receive pain medications, but lawmakers struck down the idea in order to get the bill passed. Regular testing could cost patients $44, each or $60 million, collectively, per year.

Loopholes aside, the bill provides stiff penalties for abusers. An automatic six-month license suspension and $10,000 fine awaits doctors found guilty of prescription abuse.

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.

If you or someone you know is a healthcare provider and in need of serious pill mill defense, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

COLUMBUS, 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.

Getting rid of the pill mills reduces the problem in part, but addicts and drug dealers may simply shop harder and use out-of-state sources. Taylor feels that although the legislation will help reduce the supply, the demand side of the problem will still be there.

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.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

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.

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.

If you or someone you know is a healthcare provider and in need of serious doctor shopping, pharmacy hopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

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.

If you or someone you know is a healthcare provider and in need of serious pill mills, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

MONROE, 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.

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.

If you or someone you know is a healthcare provider and in need of serious billing practices, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

TAMPA, 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.

If you or someone you know is a healthcare provider and in need of serious billing practices, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

ORANGE 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.

If you or someone you know is a healthcare provider and in need of serious insurance fraud, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

CINCINNATI, OHIO (May 3, 2011) The Oxy Express could be responsible for more deaths than any other drug-related death in the country. It comes as no surprise to local law enforcement then that the doctors who write the most prescriptions of Oxycodone have all practiced in the heart of the Oxycodone supply area, South Florida.

The more than 800 pain clinics in Florida issue 85% of the Oxycodone prescriptions in the country. Addicts climb into vans, cars and buses to make the trip from Kentucky, Ohio and Indiana to get their hands on powerful narcotic painkillers. They'll shoot it, snort it or smoke it, unless they're also dealers and buying for the lucrative resale market.

The DEA says pain clinics can make up to $20,000 in a morning and will even hire armed guards to patrol the clinic parking lot. The DEA makes it clear that it doesn't want to target legitimate doctors issuing legitimate pain prescriptions.

While the DEA crack down on Florida pain clinics has made some impact in the pipeline, pain clinic owners have gotten wise and started to move their practices to neighboring states. The special agent in charge of the crackdown has a message for those owners, "we probably made [undercover] buys in your clinic and we're probably coming for you at some point in time."

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.

If you or someone you know is a healthcare provider and in need of serious pill mill defense, doctor shopping or any healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

Healthcare providers have been subjected to increased scrutiny by the Drug Enforcement Administration (DEA) policing the medical profession’s prescriptive and dispensing policies with respect to Schedule II narcotics, including Vicodin, Percocet, OxyContin.

The IOS — Immediate Order of Suspension — is an emergency provision of federal law that permits the Attorney General to suspend a practitioner’s license to dispense narcotics without a hearing or presentation of evidence.

Under 21 U.S.C. §§ 823-824, the DEA has authority to shut down a medical provider’s practice. The IOS imposes a presumption of guilt and places the burden of establishing medical necessity on the practitioner.

Chronic pain is a condition affecting vast numbers of patients nationwide. The DEA largely misunderstands complex set of circumstances regarding the treatment of chronic pain and often times punishes health care providers for the exercise of sound professional medical judgment.

It probably goes without saying that there are unscrupulous health care providers that flaunt the law and properly fall within the scope of the statute’s broad reach. However, when there is direct physician/patient interaction, a medical history, and physical examination, it is reminiscent of Orwell's "Big Brother" and an abuse of government power to conclude as a matter of law that such conduct is intended to skirt federal and state statutes and DEA administrative regulations.

Healthcare providers must be vigilant in properly documenting the need for administration of opioids to patients and attentive to patients’ drug seeking behavior with no evidence to support medical necessity. Otherwise, the vast reach of the DEA may find otherwise ethical and dedicated and law-abiding physicians trapped within the wide net cast upon unscrupulous providers by the government second-guessing proper medical judgment.

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 defense. Criminal defense attorney Robert Malove represents the Florida Academy of Pain Medicine, Florida Academy of Physician Assistants, American Academy of Pain Management, and Florida Society of Neurology and has filed an amicus curiae brief in federal court challenging the constitutionality of the Florida statutes regulating the operation of pain clinics, i.e., pill mills.

If you or someone you know is a healthcare provider and in need of serious pill mill defense or healthcare fraud defense, please contact attorney Robert Malove, co-author of the noted treatise, WHITE COLLAR CRIME: HEALTH CARE FRAUD (West)(2010-2011 ed.) to arrange an immediate consultation.

Congress is moving forward toward granting the Obama administration's request for a record $1.7 billion to fight health-care fraud, in part to almost triple investigations into crime rings that steal from Medicare.

The money, included in both House and Senate versions of a fiscal 2011 spending bill for the Health and Human Services Department, amounts to a $250 million increase. Almost half of that, $116 million, would go toward expanding a program of fraud “strike forces” to 20 cities from seven.

The health care fraud strike force program has stopped fraud schemes totaling about $1.9 billion and led to charges against more than 800 people.

The amount of fraud the strike forces have deterred from happening is “far higher but nearly impossible to calculate” according to former United States Department of Justice Kirk Ogrosky, a partner at Arnold & Porter LLP in Washington, who began the strike force program in Miami in 2007.

In the strike force’s first year operating in south Florida, Ogrosky said, the Center for Medicare Services observed a $1.2 billion decrease in claims from the area for purchases of durable medical equipment, the industry targeted.

The Obama administration forecasts that a budget increase for anti-fraud programs will pay for itself and then some, bringing in $10 billion for the government over a decade.

Jay Darden, another former federal prosecutor who is now a partner at Patton Boggs LLP in Washington, said that the government should consider stepping up its law enforcement in places like Miami -- a hotbed for health-care fraud -- before expanding to more cities.

“I think there’s 20 cities where Medicare fraud is a problem,” Darden said in a phone interview. “I’m not sure you could say there are 20 cities where Medicare fraud is the size of the problem as it is in South Florida and L. A. and in the Southern District of Texas.”

The Southern District of Texas includes Houston and McAllen, a town that was the focus of a New Yorker story last year examining differences in Medicare spending across the U.S.

The legislation carrying the extra money for fraud-fighting is stalled in Congress due to a partisan debate over government spending. Senator Tom Harkin, the Iowa Democrat who is chairman of the appropriations subcommittee that wrote the bill, said last week that it is unlikely to become law before the end of the year. The full Senate Appropriations Committee approved the bill last week on an 18-12 vote. The additional cities weren’t identified.

The legislation is S.3686. It states in relevant part:

Healthcare Fraud and Abuse Control Account

In addition to amounts otherwise available for program integrity and program management, $561,000,000, to remain available through September 30, 2012, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as authorized by section 201(g) of the Social Security Act, of which $376,167,000 shall be for the Centers for Medicare and Medicaid Services Program Integrity Activities, including administrative costs, to conduct oversight activities for Medicare Advantage and the Medicare Prescription Drug Program authorized in title XVIII of the Social Security Act and for activities listed in section 1893 of such Act and for Medicaid and Children’s Health Insurance Program (‘CHIP’) program integrity activities; of which $94,830,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act; and of which $90,003,000 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act: Provided, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year 2011 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and CHIP programs for the funds provided by this appropriation.

For more click: here.

As reported previously here, a central feature of the Obama administration’s health care reform has been the HEAT (Health Care Fraud Prevention and Enforcement Action Team) initiative is the use of Strike Force teams. Strike Forces are multi-agency units of Federal and State law enforcement personnel designed to identify, investigate, and prosecute Medicare fraud. Strike Forces are supported by a CMS data analysis team and CMS program experts.

Since May 2009, this Administration has expanded Strike Force cities from Miami and Los Angeles, when Strike Force teams were launched in Houston and Detroit in May 2009 and in Brooklyn, Baton Rouge, and Tampa in December 2009. (To read more, click: here).

Building on the momentum started last May, U.S. Department of Health and Human Services Deputy Secretary William Corr and U.S. Department of Justice Acting Deputy Attorney General Gary Grindler, testified earlier this month before the United States House of Representatives Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Committee on Appropriations and stated that the entire $250 million increase in the President’s Budget advances the goals of the HEAT initiative.

Strike Force defendants are also more likely to receive prison sentences and longer terms of imprisonment than more traditional criminal health care fraud defendants. Since the Strike Force’s inception, over 94% of all Strike Force defendants were convicted and sentenced to terms of imprisonment compared to 64% of all criminal health care fraud defendants. The average prison term for Strike Force defendants was 45 months, which was about 10% longer than the overall national average for federal health care fraud defendants over this same period.

New Strike Force locations are chosen based on thorough analysis of Medicare claims data, which helps identify hot spots of unexplained high-billing levels in concentrated areas, and a review of the most effective allocation of investigative and prosecutorial resources. The cost associated with Strike Forces expansion resulting in 20 locations by end-of-year FY 2011 is an estimated $46 million.

U.S. Senator Tom Coburn of Oklahoma, who is also a medical doctor, is proposing that the United States root out Medicare Fraud through the use of undercover patients. Actually this is not new a new idea, government agents have in the past used undercover activities for precisely this purpose; recently, undercover agents posing as patients have been used extensively for investigations of pain management clinics.

Part of the problem is that often the undercover agent has to come up with a malady that would be the pretense of the visit. Generally, undercover agents posing as patients generate a false identity as well as a false medical history; sometimes going as far as to use test results, x-rays or the like from other, real patients. Sometimes, for example with pain clinics, the condition could be somewhat subjective; “My back hurts.” Such investigations can have good, bad and sometimes even funny results. In one undercover investigation, a Medicaid fraud agent, posing as a patient going to physician’s offices where it was alleged patients were paid, learned that one of the physicians he went to see diagnosed him with, among other things, erectile dysfunction. On the not so funny side, one department of insurance agent investigating chiropractors posed as a patient and wound up receiving an adjustment that injured his back.

In the Medicare arena, since the program is for persons over 65, the challenge would be to use retired or near retired agents and then address the same quandary; do you falsify conditions or symptoms? This can be more difficult to do with an older agent/patient; some conditions or diagnoses that might lend to potential fraudulent activity by physicians such as cancer and cardiac conditions are difficult to fake. Although scenarios can always be found to avoid a circumstance where a patient will receive certain treatments or injections, sometimes the outcomes are hard to determine.

To read more, click here.

The FY 2011 Budget requests a $234.6 million increase, including 708 new positions (143 agents and 157 attorneys), to restore confidence in U.S.markets, protect the federal treasury and defend the interests of the U.S. Government.

This includes an additional $96.8 million for economic fraud enforcement, which is a 23 percent increase over the FY 2010 level. This increase will continue the department’s efforts to aggressively pursue traditional law enforcement and litigation activities ranging from mortgage fraud, corporate fraud and other economic crimes, to other mission-critical activities that support the overall functioning and efficiency of the department.

The Department of Health and Human Services’ (HHS) budget requests a $60.2 million increase specifically for DOJ components involved in the investigation and litigation of health care fraud cases. This increase will further the efforts of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced last year by Attorney General Holder and HHS Secretary Kathleen Sebelius.

DOJ's efforts to combat health care fraud are funded almost exclusively through reimbursements from the Health Care Fraud and Abuse Control (HCFAC) account administered by the Department of Health and Human Services (HHS). In FY 2010, the HCFAC account provided $211.4 million in mandatory and discretionary funding for the DOJ litigating components and the FBI which are engaged in combating health care fraud. The increased funding will permit DOJ to expand Medicare Fraud Strike Force operations in order to target agents and attorneys to the criminal hubs where health care fraud activities occur. In addition, these funds will be used for civil enforcement efforts, including alleged fraud by pharmaceutical and medical device manufacturers. These anti-fraud efforts have the potential to save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs.

For more information, click here to view the Restore Confidence in our Markets, Protect the Federal Fisc, and Defend the Interests of the United States Fact Sheet.

Recently state and federal authorities announced a regional health care fraud strike force in the Tampa and Orlando region. In what may be one of the first operations of that strike force, a Lakeland, Florida couple, Lilian Pagkaliwangan, 40, and Raymundo P. Arellano, 42, operators of Lakeland Therapy Providers Inc. and Optimum Therapy Inc., were arrested for health care fraud with respect to the operation of those businesses. The charges include alleged fraudulent billing for services not provided.

According to the indictment the couple submitted claims for reimbursement for medical services not rendered, including services that were claimed to have been provided on days when the patients were not present at the clinic and couldn't receive services.

Click here to read more.

According to a report released this earlier this morning, hours ahead of an official announcement scheduled for later today, arrests were made in Miami, Brooklyn and Detroit. Federal agents are expected to take about 30 suspects into custody from three states on charges related to Medicare fraud totaling $61 million.

The arrests follow an investigation by the Medicare Fraud Strike Force, a partnership between the two federal agencies that started nationally in May. Click here to read an earlier blog post.

According to sources speaking on the condition of anonymity, HHS Secretary Kathleen Sebelius will hold a news conference this afternoon in New York to make the announcement of the government’s continued crackdown on Medicare fraud. A key part of President Barack Obama's proposed healthcare overhaul targets eradicating an estimated $60 billion a year lost to Medicare fraud.

Today’s raids come a week after HHS reported that in 2008 Miami-Dade County received more than $500M from Medicare in home healthcare payments intended for the sickest patients. This figure is more than the rest of the country combined. To read the OIG report, click here.

Indictments are expected to charge that Florida scammers arranged for fake patients to bill for home healthcare, including homeless patients and others fraudulently listed as blind diabetics who submitted bills for visits by nurses twice-daily to give them insulin injections. See this Miami Herald video.

In Detroit, suspects paid recruiters to find patients willing to fake symptoms in order to justify expensive testing, and in turn bill Medicare for reimbursement. Two Brooklyn suspects are alleged to have billed Medicare for medically unnecessary durable medical equipment (DME), including expensive shoe inserts reserved for diabetics.

Increasingly the manner in which the government promotes its law enforcement efforts in the Medicare arena sound more and more like military operations or even Saturday morning cartoons. The creation of the “Strike Force” known as HEAT, Health Care Fraud Prevention & Enforcement Action Team, sounds a lot more like commandos than lawyers and agents arresting doctors and white collar criminals. In the press releases you see the use of the words “combat” and “battle” and now the battle also has phases: Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), and Houston (Phase Four).

For more, click here.

According to Senator LeMieux of Florida, Florida is the health care fraud capital of the world and instead of reforming health care, the government should be focusing on fixing the current system, particularly targeting fraud waste and abuse.

Meanwhile, federal authorities are using South Florida as the testing site for the health care fraud initiatives given the prevalence of health care fraud in Dade, Broward and Palm Beach counties. The Obama administration has asked for $300 million to combat health care fraud in 2010.

To view his speech on the Senate floor in this video.

To read more, click here.

WASHINGTON (November 17, 2009) — Today President Barack Obama established by Executive Order an interagency Financial Fraud Enforcement Task Force (FFETF) to strengthen efforts to combat financial crime. According to a press release, the Department of Justice will lead the task force and the Department of Treasury, HUD and the SEC will serve on the steering committee. The task force's leadership, along with representatives from a broad range of federal agencies, regulatory authorities and inspectors general, will work with state and local partners to investigate and prosecute significant financial crimes, ensure just and effective punishment for those who perpetrate financial crimes, address discrimination in the lending and financial markets and recover proceeds for victims.

To read the press release in its entirety, click here.