July 10, 2013 — Heath care fraud is a massive drain on programs like Medicare and Medicaid. The Justice Department relies on the information it receives from whistleblowers to recover millions every year that would otherwise be lost to Medicare and Medicaid fraud. The qui tam provisions of the False Claims Act permit health care workers who discover overbilling, misreporting, and/or misconduct like bribery to file suit on behalf of the government. In exchange, these insiders are eligible to share in any settlement or judgment.
Bribery, Kickbacks, and Overbilling Lead to Convictions in Medicare Fraud Case
Four Florida residents have been convicted by a federal jury for taking part in a $70 Medicare fraud scheme involving fraudulent billing by Hollywood Pavilion (HP), a Miami-area mental health care hospital, according to the Justice Department.
The four HP employees—Karen Kallen-Zury, Daisy Miller, Michele Petrie, and Christian Coloma—were found guilty crimes including health care fraud, wire fraud, bribery, and conspiracy to commit health care fraud, pay bribes, and wire fraud.
The defendants paid bribes to patient recruiters and falsified documents to give the appearance that they were providing substantial psychiatric services when, in fact, they were not. The defendants were defrauding and taking advantage of the government and the Medicare beneficiaries. Over a period of nearly 10 years, the defendants caused Medicare to be billed for almost $70 million in services that were:
- not actually provided,
- for patients who did not qualify for the services, and/or
- for patients procured through payments of bribes and kickbacks.
Insiders Can Fight Fraud Through False Claims Act
Whistleblowers have a valuable role to play in fighting fraud against the government, but it is important that they fully understand their rights under the False Claims Act before they come forward to collaborate with the government. The experienced qui tam lawyers at Waters & Kraus can provide the skilled representation that tipsters and informants need. Contact us by email or phone our whistleblower attorneys at 855.784.0268 to discover how we can assist and protect you.