February 26, 2013 — Health care providers that submit false claims to Medicare and other government healthcare programs for nonexistent or unnecessary medical procedures cost the taxpayers money. To put a stop to the fraud, employee insiders are frequently in the best position to help. Health care workers themselves may become aware of the fraud or even be asked to participate in it. That’s when many workers decide to blow the whistle.
Medicare fraud scams are often brought to light when a tipster files a whistleblower lawsuit under the qui tam provisions of the federal False Claims Act. The statute allows government collaborators to keep a share of the government’s recovery.
False Medicare Claims Land Former Miami HIV Clinic Director in Prison
The former director of a Miami HIV infusion clinic who was extradited back to the U.S. after fleeing to Peru has been sentenced to a 70 month prison sentence and ordered to pay $17,590,896 in restitution to the Department of Health and Human Services. According to the Justice Department, Enrique Gonzalez, 67, pleaded guilty to causing the submission of false claims to the United States, paying health care kickbacks, conspiracy to defraud the United States and conspiracy to commit health care fraud.
From August 2002 to March 2004, Gonzales conspired with a Miami physician and others to operate two HIV clinics — Physicians Med-Care and Physicians Health — that were supposed to be in the business of treating HIV patients. In reality, these clinics were just fronts for committing Medicare fraud. Gonzalez handled the clinics’ finances, shepherding the money received from Medicare out of the clinics’ bank accounts and into accounts owned by Gonzales’ co-conspirators. Gonzalez also provided cash for paying bribes and kickbacks to Medicare beneficiaries in exchange for the beneficiaries’ participation in the scam. During Gonzales’ tenure with the two clinics, Medicare was fraudulently billed more than $26 million and the clinics received over $17 million in Medicare payments.
Medicare False Claims Act Violations Uncovered by Employees
Before coming forward, tipsters deserve to be informed of their rights. The experienced lawyers at Waters & Kraus offer government collaborators with the assurance they need to help in the fight against health care fraud. Contact us or call our whistleblower lawyers at 800.226.9880 to find out more about our health care fraud practice and how we can help.