April 2, 2013 — In the midst of rampant health care fraud, the U.S. Department of Justice has turned to the federal False Claims Act to recoup more than ten billion dollars in fraudulent health care cases over the last several years. The anti-fraud statute contains qui tam language that permits tipsters to file claims on behalf of the American government and then participate in any recovery. If the Justice Department decides to intervene in the lawsuit, the whistleblower takes home a smaller portion of the recovery. When the government declines to participate, the informant receives a greater percentage of any proceeds from the lawsuit.
Director of Miami Mental Health Clinic Sentenced for Role in $50 Million Medicare Fraud
The owners of Biscayne Milieu, a mental health clinic in Miami, Florida, have been criminally charged with Medicare fraud, paying kickbacks, and money laundering. Also involved in the Medicare Fraud are the clinic’s managers, doctors, therapists, and employees. Together, they submitted $50 million in false claims to Medicare.
The most recent sentencing was of the clinic’s former medical director, Dr. Gary Kushner, who received a 144-month prison term and three years of supervised release. Kushner is 72. He was convicted of health care fraud in a two-month jury trial in August 2012.
Biscayne Milieu claimed to operate a partial hospitalization program (PHP) that provides specialized treatment for extreme mental illness. What the clinic did in actuality was bill Medicare for millions of dollars in phony services. Biscayne Milieu’s owners, professionals and staff concocted and carried out a scheme to recruit ineligible Medicare patients and then bill the healthcare program for services that Medicare would not reimburse or that were never provided. The Medicare recruits included substance abusers, patients with severe dementia who would receive no benefit from mental illness treatment, and patients with no diagnosis of mental illness at all.
Kushner, as Biscayne Milieu’s medical director, knew the patients he authorized for PHP treatment were ineligible. Sometimes his examinations of the patients lasted just minutes.
Biscayne Milieu then used Kushner’s sham authorizations to bill Medicare for millions of dollars in worthless or nonexistent PHP treatments.
Health Care Tipsters Notify Government of Medicare Fraud
False Claims Act violations involving phony medical authorizations and ineligible Medicare billings frequently are reported by insider employees who want no part of the illegal activity. Before notifying the government, conscientious informants need to learn their own legal rights. The lawyers at Waters & Kraus offer government collaborators the aggressive representation they need in the fight against health care fraud. Contact us or call our Medicare fraud attorneys at 800.226.9880 to learn more about our whistleblower practice.