March 6, 2013 — Taxpayers foot the bill when health care providers bill Medicare and Medicaid for nonexistent or unnecessary medical treatment. But patients and taxpayers aren’t the only ones harmed by health care fraud. Health care workers may be instructed to participate in the fraud themselves. They may even be threatened with the loss of their jobs.
Many health care workers refuse to stand for it. The federal False Claims Act allows tipsters to file a whistleblower lawsuit on the government’s behalf. Under the qui tam provisions of the statute, government collaborators are permitted to retain a share of the government’s recovery.
False Medicare Claims by HCSN Add Up to $63 Million
Three owners of assisted living facilities near Miami and a psychologist have been sentenced to prison as a result of their participation in a Medicare fraud scheme involving Health Care Solutions Network Inc. (HCSN). According to the Justice Department, between 2004 and 2011, HCSN submitted close to $63 million in false claims to Medicare and Medicaid for alleged mental health services.
HCSN, now defunct, operated Miami community mental health centers that included partial hospitalization programs (PHP) that provide intensive treatment for patients with severe mental illness. HCSN devised a scheme to increase its Medicare and Medicaid billings for PHP services by recruiting ineligible patients from assisted living facilities (ALF) and nursing homes.
Raymond Rivero, Daniel Martinez and Ivon Perez each owned Miami-area ALFs. All three admitted that they accepted cash bribes in exchange for referring Medicare beneficiaries to HCSN. The residents who the former ALF owners referred to HCSN did not need treatment for mental illness. They were selected only because they were Medicare or Medicaid beneficiaries. Some were mentally retarded. While others had Alzheimer’s disease or dementia. The patients either received treatment that did not benefit them or no treatment at all.
HCSN hired a licensed psychologist to oversee the fabrication of medical records to support the phony claims for PHP treatment. The psychologist created the records herself and directed individual therapists to create their own fraudulent records to back up the false submissions for payment to Medicare.
Health Care Fraud Uncovered by Insider Employees
Before coming forward, informants need to be informed about their rights. The experienced lawyers at Waters & Kraus offer courageous whistleblowers with the representation they deserve in the battle against health care fraud. Contact us or call our whistleblower attorneys at 800.226.9880 to learn more about our Medicare fraud practice and how we can help government collaborators.