As reported in the Walls Street Journal last week, the U.S. Department of Justice and other government agencies charged 94 individuals across five states on Friday, accusing them of submitting a combined $251 million in fraudulent claims to Medicare, the largest takedown since the Medicare Fraud Strike Force began operating three years ago.

The government’s multi-agency task force unveiled the charges related to separate schemes in Miami, Baton Rouge, La.; Brooklyn, N.Y.; Detroit and Houston, which included using a variety of medical services and fraud schemes that overcharged the government’s health program in order for the defendants to pocket reimbursement money.

“The Department of Justice has increased efforts to combat Medicare Fraud. ” says Texas Attorney & Partner, Joel Androphy of Berg and Androphy.  ”Criminal charges have been brought against medical service providers in 5 cities.   Although a whistleblower - qui tam - lawsuit is the best weapon to combat fraud, it is important for the DOJ to independently pursue criminal charges.   Qui Tam lawsuits are about money.    Many qui tam lawsuits are not pursued, however,  because the perpetrators have no money.  Criminal cases will send people to jail.”

Today’s students are tomorrow’s lawyers, judges and court clerks. Learn more about how Berg & Androphy has been working with a local community college to give students real-life experience that will make the next generation’s justice process authentic and well executed.

ACC Students Learn From Mock Trial
Alvin Community College students enrolled in the criminal justice, paralegal and court reporting programs had the unique opportunity to address these issues, gain valuable courtroom experience and be part of an intriguing case with the help of attorneys from the Houston law firm of Berg & Androphy during a mock trial at the Friendswood Municipal Court on April 22. Read More

In the previous fiscal year, the department of Health and Human Services reported winning and settling over $1.63 billion worth of fraud cases in court. In addition to this fraud money returned, the Health Care Fraud and Abuse Control Program, within the HHS, reported the transfer of $2.51 billion in new funds to the Medicare Trust Fund. A total of 583 defendants were convicted on health care fraud-related charges.

On the whole, $2.576 billion was deposited with the Department of the Treasury and the Centers for Medicare and Medicaid Services. The money was gained through criminal fraud penalties, civil monetary penalties, and gifts and bequests made toward the funds.

The Office of Inspector General excluded a total of 2,556 individuals and entities from the healthcare sphere during the previous year. These were based on criminal convictions for crimes related to Medicare and Medicaid and other healthcare programs, and also expanded to patient abuse or neglect.

Under the reform overhaul, whistleblowers — a role doctors sometimes can play — are given more opportunities to help root out fraud, said Joel M. Androphy, a partner at the Houston-based firm of Berg & Androphy, who specializes in whistleblower litigation. The health reform law now allows them to initiate false claims actions based on information already publicly disclosed through state or local administrative reports or proceedings, such as a state Medicaid audit. Read More

The recent health care reform has left many Facebook friends in an unfriendly situation. In the midst of political debates, individuals let the health care issue become personal, often resorting to name calling and four-letter-words in response to political talking points they disagree with. Fox News Houston covers the controversy here, with input from Berg & Androphy’s own Geoff Berg.

Health Care Debate Leads to Deleted Friends?
The health care debate has spilled onto Facebook.com, creating intense online conversation like never before. Some argue it is great to see Americans getting involved in a critical national debate, but the social networking website did not start off as a pulpit for politics, and now that, in some cases, has progressed to digital egos getting bruised. Read More

This week a Pennsylvania doctor who admitted to over $1 million in false insurance claims submitted to Medicare and private insurers for over 5 years was sentenced to a year in prison. The doctor, John Kristofic, age 62, already paid $3.3 million in retribution to the government following his admission of guilt in January of this year.

Dr. Kristofic was found guilty for submitting false claims for services never rendered between 2003 and 2008. The doctor had been accused of healthcare fraud before, but had never been found guilty by a court until this week’s verdict. Chief U.S. District Judge Donetta Ambrose pointed out that when a doctor such as Kristofic commits healthcare fraud, it’s a national cost and everyone suffers, particularly in today’s tough economic climate. “It’s cheating… It’s stealing.” Ambrose said.

In 1991 Dr. Kristofic had a brush with the law when he was convicted of withholding assets on a federal form. After that incident, he only lost his medical license for a month. Now, it’s likely that the internal medicine specialist never be allowed to practice medicine again.

As harsh as this punishment will be for Kristofic, it’s neither as harsh as it could have been (the maximum sentence for this level of fraud is 3 years) nor undeserved.

Following a lengthy Qui Tam trial, the former Chief Executive Officer of Haven Healthcare, a company responsible for the mismanagement of several nursing homes on the East Coast. Raymond Termini of Middletown was also sentenced to three years of supervised release following his release from prison. In addition to jail time and supervised time following release, United States District Judge Stefan R. Underhill also sentenced Termini to a fine in the amount of $6,000 and a relinquishment of $500,000 to the federal government.

Termini and his colleagues set up a scheme to defraud Omega Healthcare Investors, an East Coast real estate firm specializing in nursing homes. Omega agreed to provide funding requested by Haven in order to finance improvements to the nursing facilities’ fire sprinkler systems. Although Haven executives received the $956,090 from Omega, they did not spend the money on the intended changes and instead used the funds, along with a loan taken out on behalf of Haven, for private family investments.

Learn how the healthcare attorneys at Berg & Androphy have helped recover hundreds of millions for the government and whistleblowers.

A nurse in a small Texas town blew the whistle on a doctor who she believed was improperly performing surgeries and mis-prescribing drugs. See what whistleblower attorney Joel Androphy has to say in this short video clip from ABC:

Physician Alan Silber of West Bloomfield, Michigan and Detroit-area resident Hassan Reeves have been convicted in a Medicare fraud case. The scheme ultimately took $1 million from Medicare, and Silber was charged on six counts of Medicare fraud by a federal jury, following the week long trial of himself and Reeves.

Reeves played a role as a patient recruiter and was charged with one charge conspiracy to commit health care fraud and one count of conspiracy to pay health care kick backs. The two will be sentenced on August 6th of this year. Each count of conspiracy is worth up to 10 years in prison and a $250,000 fine, while the charge of conspiracy to pay health care kickbacks carries a maximum of only 5 years and $250,000.

The scheme was started by Denisse and Jose Martinez, the owners of the clinic, who have previously plead guilty for the scheme. According to reports, the clinic consistently billed Medicare for services that were neither performed or necessary. Evidence used in the trial showed that while many medications were prescribed, most were prescribed based on Medicare reimbursement policies and were never purchased or distributed to patients.

Denisse Martinez routinely filled out the diagnosis and treatment sections of patient folders, which Silber would then sign without examining patients or understanding their symptoms. Many of the medications prescribed were not medically necessary for the patients to whom they were prescribed and, in some cases, could have actually harmed patients if they had been taken.

The respected Robert Wood Johnson University Hospital is set to pay over $6 million in order to settle allegations of Medicare fraud.

Two federal lawsuits brought against the hospital claim that bills to the hospital’s Medicare patients were fraudulently inflated in order to gain larger payments from the Medicare program. The federal program supplies supplemental reimbursements, known as “outlier payments,” to health care institutions when the cost of care is unusually high. Robert Wood Johnson University Hospital is accused of inflating costs in order to gain access to these outlier payments, which were created as a protection to health care providers who might be giving care to patients with extraordinary conditions.

Both federal lawsuits were brought under Qui Tam provisions of the False Claims Act. The whistle blowers will receive just over $1.1 million in compensation for reporting the alleged fraud.

To date, with the help of whistle blowers, the Justice Department has been able to regain nearly $1.1 billion in outlier payment fraud.