July 12, 2013 — Health care fraud hurts all of us. It robs taxpayer funds and takes advantage of our most vulnerable community members. The Justice Department relies on tipsters and informants to help them fight fraud against the government. The qui tam provisions of the False Claims Act authorize whistleblowers to file suit on behalf of the federal government and receive a portion of any funds recovered by federal authorities through the suit. Insiders, like health care employees, are in a particularly good position to collaborate with authorities to fight health care fraud.
Power Wheelchair Fraud on Medicare Leads to Guilty Pleas
Dr. Emmanuel Ayodele and Alejandro Maciel have pleaded guilty to health care fraud and conspiracy to commit health care fraud for participating in a Medicare fraud scheme that defrauded the Medicare program of more than $10.1 million.
According to the Justice Department, Dr. Ayodele admitted that he participated in a power wheelchair fraud scheme along with the operators of durable medical equipment (DME) supply companies. The DME suppliers hired by street-level patient recruiters, like Mr. Maciel, who illegally solicited Medicare beneficiaries to receive power wheelchairs and other DME that was not medically necessary. In exchange, the patient recruiters received illegal kickbacks. The patient recruiters took Medicare beneficiaries to fraudulent medical clinics, including Dr. Ayodele’s clinic, and obtained personal information that the conspirators used to bill Medicare. Dr. Ayodele then prescribed power wheelchairs and DME that he knew were medically unnecessary. He admitted that he knew the prescriptions would then be used to file false claims against Medicare.
Dr. Ayodele and Mr. Maciel are scheduled for sentencing on September 30, 2013, and each man faces a maximum sentence of 10 years in prison as well as a possible $250,000 fine.
Tipsters Help Fight Fraud by Collaborating With Federal Authorities
Insiders, such as health care employees, can be important partners in the fight against health care fraud. Before they become government informants, however, whistleblowers should understand their rights under the False Claims Act. The lawyers at Waters & Kraus provide the skilled legal counsel that whistleblowers need. Contact us by email or phone our False Claims Act attorneys at 855.784.0268 to learn more about our qui tam practice.