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:

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.

According to the indictment, Dr. Ajit Trikha (ah-JEET' TREEK'-ah) a 55-year-old psychiatrist pleaded guilty last June in U.S. District Court in East St. Louis to two counts of health care fraud. Trikha submitted bills to Medicare for reimbursement claiming that he had therapy sessions with patients, when in truth he never met the patient and in some instances was out of the country on vacation. He also billed for group-therapy sessions that far exceeded the 12-person limit set by Medicare and Medicaid.

Additionally, the indictment specifically alleged that the doctor and his medical practice "regularly submitted claims with [erroneous] . . . codes when spending little or no time with the patient rather than approximately 20 to 30 minutes face-to-face with the patient as required by 08 17, or approximately 45 to 50 minutes face-to-face with the patient as required by 9081. TRIKHA and TRX also submitted claims with these codes for visits with patients who were not able to communicate verbally at all."

A federal judge has ordered Trikha to reimburse the government for the money he bilked.

According to a report filed early last fall, by the Inspector General for the U.S. Department of Health and Human Services, health care providers in Broward, Miami-Dade and Palm Beach submitted $2.5 billion in claims to Medicare on behalf of HIV/AIDS patients in 2005.

Labrada was convicted of conspiring with Angel Castillo, Jr. to commit health care fraud by serving as a straw owner of a medical equipment company known as JJ & D Medical Equipment, Inc. The company submitted more than $6.8 million dollars in bogus claims and received approximately $1.6 million in payments. In the second case, Labrada was convicted of money laundering charges in connection with a $2.3 million laundering scheme orchestrated by his co-defendant, Angel Castillo, Jr.

Miguel Castillo was also convicted of related health care fraud and money laundering conspiracy charges. In addition to serving as a straw owner of a medical equipment company, Miguel Castillo collected hundreds of thousands of dollars in fraud proceeds from check cashers at the direction of his cousin and co-conspirator, Angel Castillo, Jr.

The challenge of obtaining full comprehension of the complex and constantly changing, laws and regulations governing Medicare and Medicaid is well documented. Nonetheless, in the current environment of ever increasing government scrutiny of the healthcare industry, there is no room for error. With staggering settlements extracted to date and the increased potential for criminal penalties, it is imperative that you fully understand the implications of every statement and action you, your client, and employees of your institution make when you are the target of an investigation into Medicare and Medicaid practices.

The evidence at trial demonstrated that Guerrero established the corporation in her name, opened a bank account as the sole signatory, applied for all state and federal licenses and signed the Medicare Supplier Application so as to obtain a provider number. She worked at the office in a warehouse district daily from 8 am to 12 noon.

CEO Magazine reports that healthcare costs are within the top three business concerns, and for good reason: U.S. healthcare spending has increased from a mere $27 billion in 1960 to $2 trillion in 2005. That is a 7,100 percent increase in spending! Employers today face many unique regulations, systems, procedures and records, with the potential for fraudulent activity at a heightened level. Fraud fighters need an improved understanding of these staggering numbers and the types of healthcare fraud that may occur. This two-day, instructor-led course is designed for anti-fraud and audit professionals who work in the payer, provider, vendor and employer benefit areas or advise clients who operate within the healthcare continuum. Get the targeted training you need to keep up with the latest fraud schemes and related laws affecting this highly complex profession.

For more info, please visit http://www.ACFE.com

Ben Kuehne was my law partner for 5+ years during the 1980'-1990's (Sonnett…Kuehne) and he mentored me since 1983 when I served as his 'associate' at the predecessor firm, Bierman, Sonnett, Shohat et. al.

I served as a full-time Visiting Professor of Law in 2005, after which I resumed private practice, now largely in the corporate compliance field (invariably circuitous to white collar criminal defense representation, particularly in the health care industry.).

Ben Kuehne is clearly a 'lawyer's lawyer' who instilled in me the highest appreciation of academic excellence in the practice of federal law. More critically, Ben sensitized me to the distinct ethical dilemmas presented institutionally to criminal defense counsel and ALWAYS taught me (AND CONTINUOUSLY REINFORCES THE NEED) to uphold and exceed our profession's highest ethical/legal standards.

Practicing criminal law in the federal courts places these dedicated, tenacious professionals in legal jeopardy merely by discharging their duties oaths, and obligations to the Sixth Amendment of the US Constitution, coextensively with duties to the courts and clients.

Weintraub has served as a full-time Professor of Law. During his legal career, Porf. Weintraub has successfully represented complex white collar targets, corporations, business entities, executives, defendants, and witnesses as a tenacious, exclusively federal white collar criminal defense lawyer for more than 25 years.

Among his credits has defended more than 60 Physicians, Health Care Delivery Corporations & Organizations, DME Distributors, Internet Pharmacies, Pharmacists, Pharmaceutical Manufacturers, and public officials on hospital regulatory boards throughout the nation.

He also represented David Paul in the failed CenTrust Bank case as well as reputed drug lords, Willie Falcon and Salvador Magluta.

Weintraub recently represented Arne Soreide, a high profile telecom executive convicted after trial (by other counsel) in Fort Lauderdale of a $22m fraud, successfully convincing the U.S. Court of Appeals for the Eleventh Circuit in Atlanta that his 25 year sentence of imprisonment must be reversed, which the appellate court conceded was improper.

Weintraub was appointed by the first Chairman of the US Sentencing Commission to assist the fledgling agency in drafting its initial sentencing guidelines for organizations and individuals.

His extensive academic writing has been widely published or cited in Yale L.J., Harvard Law Review, Federal Sentencing Reporter, Stanford Journal of Law & Policy, Notre Dame Law Review, Federal Probation (US Courts), etc., and health care blogs.

Florida Board Certified Criminal Trial Lawyer Robert David Malove is Of Counsel to Benson Weintraub, LLC, upon whom a Masters Degree in Forensic Science, was conferred on Malove by the distinguished George Washington University in Washington DC. Malove received his JD from Pepperdine University School of Law. He has completed the Graduate Certificate Program in Healthcare Corporate Compliance at George Washington University and is Certified in Healthcare Compliance (CHC) by the Compliance Certification Board of HCCA. For more information visit www.healthcarefraudblog.com.

Romero took part in a scheme in which a phantom health clinic, named “The Real Group & Associates, Inc.,” was incorporated in South Florida and subsequently billed Medicare for reimbursement for non-existent drug infusion and injection therapies typically prescribed to AIDS and chemotherapy patients. Nearly $17 million of false claims were submitted to Medicare for reimbursement, resulting in payments of more than $2.5 million on the false claims. To date, law enforcement has recovered more than $1.6 million of the fraud proceeds. At sentencing, Romero was held responsible, in part, for recruiting and managing the straw owner of the clinic, and for the creation and control of the clinic’s corporate bank accounts that were used to transfer and disburse the Medicare fraud proceeds through a series of fraudulent financial transactions.

If you or someone you know has been charged with healthcare fraud or is under investigation, call attorney Robert Malove.

Jackson, 48, of Ashford Drive, Waldorf, Maryland, will face up to ten years of incarceration when he is sentenced by the Honorable Emmet G. Sullivan on May 2, 2008. Under the federal sentencing guidelines, the advisory sentence Jackson faces is between 24 and 30 months in prison. The guidelines' recommended sentence sentence takes into consideration specific offense characteristics including a loss in excess of $200,000 and abuse of position of trust. Jackson will be ordered to pay restitution of $95,000 to St. Elizabeths and $140,882 to Kaiser Foundation Health Care Plan.

Healthcare compliance is a relatively new industry, born out of the government's crackdown on Medicare fraud. Compliance professionals come from a variety of backgrounds including coding, medical records, nursing, medical practice. law and government. Regardless of background, compliance professionals are tasked with assuring that health care providers follow federal, state and local regulations that govern the delivery of healthcare.

CCB President Debbie Troklus, noted, "The United States government constantly updates the laws and regulations surrounding Medicare to ensure proper billing and to eliminate fraud. These new regulations demand professionals who both understand the new regulations and how to implement programs to ensure compliance within their companies."

Founded by the Health Care Compliance Association in 1998, the Compliance Certification
Board exists to develop criteria for the determination of competence in the practice of healthcare compliance at a variety of levels and to recognize individuals meeting these criteria.

The five defendants who were sentenced in Miami are: Rodolfo Aenlle, 47, who was sentenced to 84 months in prison; Simon Seruya, 74, who was sentenced to 50 months; Alberto Gourie, 35, who was sentenced to 51 months in prison; William Garcia, 31, who was sentenced to 41 months; and Marina Ruiz, 48, who was sentenced to 24 months in prison. In total, these individuals were ordered to repay more than $13 million in restitution.

“We are continuing to seek appropriate sentences for the most serious Medicare fraud offenders,” said Assistant Attorney General Fisher. “The Strike Force in South Florida has successfully prosecuted some of the most egregious cases of Medicare fraud, and the average prison sentence for these violators is now up to almost 52 months which is above the national average of 31 months, with many Strike Force defendants receiving over 10 years.”