Texas Home Health Agency Defrauding Medicare

The owners, the director of nursing and patient recruiters of a home-health agency based in Houston were arrested for their alleged roles in conspiracies to defraud Medicare, to pay illegal healthcare kickbacks and to commit money laundering. 

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services-Office of the Inspector General Dallas Regional Office and Special Agent in Charge D. Richard Goss of the Internal Revenue Service-Criminal Investigation Division Houston Field Office made the announcement.

According to the indictment, Ebong Tilong, 51, and Marie Neba, 51, both of Sugar Land, Texas, used the Texas-based, home-health agency that they owned to bill Medicare for home-health services that were not provided or not medically necessary.  They allegedly orchestrated this scheme by paying kickbacks to a series of individuals.  First, Tilong and Neba allegedly paid illegal kickbacks to physicians in exchange for authorizing medically unnecessary home-health services.  Using the money that Medicare paid for such fraudulent claims, Tilong and Neba allegedly paid illegal kickbacks to Daisy Carter, 56, of Wharton, Texas, and Connie Ray Island, 48, of Houston, in exchange for referring Medicare beneficiaries for home-health services.  Finally, all four defendants allegedly paid illegal kickbacks to Medicare beneficiaries, in exchange allowing Tilong and Neba to bill Medicare using their Medicare information for home-health services that were not medically necessary or not provided.  Neba, who also served as the company’s director of nursing, also allegedly falsified medical records to make it appear that Medicare beneficiaries qualified for and received home-health services.  From in or around February 2006 to in or around June 2015, Tilong and Neba received approximately $13 million for these allegedly fictious or unnecessary home-health services. 

GM Being Blindsided By The Number Of Lawsuits

 

 

General Motors Co. (GM), which as we all know has been under intense media, congressional and courtroom scrutiny over fatalities caused by its defective ignition switches, is now defending 104 death and injury lawsuits brought by victims whose accidents were caused by defects in the company’s cars. Another 108 suits seeking class action status over depressed car prices are pending in federal and state courts. GM released the numbers in early February in a filing with the U.S. Securities and Exchange Commission (SEC). The company is also the target of investigations by state and federal agencies. GM had this to say in the SEC filing:   Such lawsuits and investigations could in the future result in the imposition of damages, substantial fines, civil lawsuits and criminal penalties. We cannot currently estimate the potential liability, damages or range of potential loss as a result of the legal proceedings and governmental investigations.

GM spent $2.9 billion last year on recalls and loaner cars after calling in 36 million vehicles for repairs worldwide. Recalls in the United States were a record 26.9 million. GM recalled 2.59 million vehicles because the ignition switch in some cars can slip out of the “run” position, shutting off the engine and safety features including air bags while the car is moving. GM now admits to at least 57 deaths having been linked to the defective switch. Based on what we have learned in the GM litigation, we believe the number to be much higher. The program set up by GM to settle claims by victims of accidents related to faulty ignition switches in the U.S. has paid out $93 million so far. We have learned that GM estimates the settlement program will eventually cost $600 million. GM had net income of $2.8 billion in 2014.

GM received another 33 claims for compensation for ignition switch defects in its cars during the week of Feb. 11-22, bringing the total to 4,345. This comes from a report by Ken Feinberg, the administrator of the company’s compensation program. At press time, GM had received 479 claims for death, 292 for catastrophic injuries and 3,574 for less-serious injuries requiring hospitalization. This puts the total injury claims at 3,866. According to the Feinberg report, the number of claims found to be eligible for compensation so far is 151. So far, Mr. Feinberg has determined that 57 deaths, nine severe injuries and 85 other injuries are eligible for compensation.

The report also said 666 claims have been deemed ineligible, while 1,457 are still under review. Another 1,104 lacked sufficient paperwork or evidence and 967 had no documentation at all. The deadline for filing claims was Jan. 31, but any claims postmarked by that date are eligible for review.

Detroit-based GM was aware of faulty ignition switches on Chevrolet Cobalts and other small cars for more than a decade, but it didn’t recall them until 2014. Fienberg’s office has said that it likely will take until late spring to sort through all of the claims it has received. It should be noted that those who agree to payments give up their right to sue the automaker.

While GM set aside $400 million to make payments, it has now conceded that the payouts could grow to $600 million. GM placed no cap on the amount of money that the Feinberg fund can spend. At the end of last year, Feinberg had paid out $93 million in claims, according to GM’s annual report. But it should be noted that GM still faces 104 wrongful death and injury lawsuits due to the faulty ignition switches, as well as 108 class-action lawsuits alleging that the ignition switch debacle reduced the value of customers’ cars and trucks. The lawsuit filed by Ken and Beth Melton got all of this started and it’s the one case—out of hundreds—that GM has no answer for.

$4 Million Medicare Fraud Scheme Medical Supply Company in LA

A federal jury in Los Angeles convicted a Los Angeles man and owner of a medical supply company today for his role in a $4 million Medicare fraud scheme. 

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Eileen M. Decker of the Central District of California, Special Agent in Charge Christian J. Schrank of the U.S. Department of Health and Human Services-Office of Inspector Generals  Los Angeles Region and Assistant Director in Charge David L. Bowdich of the FBI’s Los Angeles Field Office made the announcement.

According to evidence presented at trial, Valery Bogomolny, 43, used his company, Royal Medical Supply, to bill Medicare $4 million between January 2006 and October 2009 for power wheelchairs, back braces and knee braces that were medically unnecessary, not provided to beneficiaries or both.  The evidence further showed that Bogomolny created false documentation to support his false billing claims, including creating fake reports of home assessments that never occurred.  Bogomolny personally delivered PWCs to beneficiaries who were able to walk without assistance and signed documents stating that he had delivered equipment when the equipment was not actually delivered.  Bogomolny ultimately received $2.7 million from Medicare on these false claims.

HCA Settles Shareholders Lawsuit For $215 Million

Hospital giant HCA Holdings has reached a preliminary agreement to pay $215 million to settle a class action lawsuit filed by shareholders who alleged the company used false and misleading information to sell stock during its 2011 initial public offering.

Those behind the 2011 lawsuit alleged that HCA sold more than $4.3 billion of HCA common stock at $30 a share based on a misleading registration statement it filed with the Securities and Exchange Commission.

They allege that the registration statement omitted important facts, including that at the time of the IPO, the company's Medicaid revenue was “suffering from adverse trends,” and that the Medicaid revenue was suffering from declining demand for cardiovascular and other services because of physician attrition and changes in Medicare regulations. They also alleged improper accounting led to HCA overstating its earnings by $790 million.

HCA also announced Wednesday in an SEC filing that it had reached preliminary agreements to settle several shareholder derivative cases also related to the 2011 IPO. Shareholder derivative cases are those in which a shareholder sues a third party, often a company director or officer, on behalf of the company. HCA estimated it would face legal claim costs of about $120 million for the settlements of the shareholder action and shareholder derivative cases.

Hospitals Pay United States $250 + Million to Resolve False Claims Act Allegations Related to Implantation of Cardiac Devices

The Department of Justice has reached 70 settlements involving 457 hospitals in 43 states for more than $250 million related to cardiac devices that were implanted in Medicare patients in violation of Medicare coverage requirements, the Department of Justice announced.

An implantable cardioverter defibrillator, or ICD, is an electronic device that is implanted near and connected to the heart.  It detects and treats chaotic, extremely fast, life-threatening heart rhythms, by delivering a shock to the heart, restoring the heart’s normal rhythm.  Only patients with certain clinical characteristics and risk factors qualify for an ICD covered by Medicare. 

Medicare coverage for the device, which costs approximately $25,000, is governed by a National Coverage Determination.  The Centers for Medicare and Medicaid Services implemented the NCD based on clinical trials and the guidance and testimony of cardiologists and other health care providers, professional cardiology societies, cardiac device manufacturers and patient advocates.  The NCD provides that ICDs generally should not be implanted in patients who have recently suffered a heart attack or recently had heart bypass surgery or angioplasty.  The medical purpose of a waiting period -40 days for a heart attack and 90 days for bypass/angioplasty - is to give the heart an opportunity to improve function on its own to the point that an ICD may not be necessary.  The NCD expressly prohibits implantation of ICDs during these waiting periods, with certain exceptions.  The Department of Justice alleged that from 2003 to 2010, each of the settling hospitals implanted ICDs during the periods prohibited by the NCD.  

  Most of the settling defendants were named in a qui tam, or whistleblower, lawsuit brought under the False Claims Act, which permits private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant.  The lawsuit was filed in federal district court in the Southern District of Florida by Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a health care reimbursement consultant.  The whistleblowers have received more than $38 million from the settlements.  The Department of Justice is continuing to investigate additional hospitals and health systems.

 

Mesothelioma Asbestos Exposure Lawsuit By Victims Family Nets $3.5 Million

The family of a mesothelioma victim is awarded $3.5 million in a recent asbestos lung cancer lawsuit.

Plaintiff Barbara B. contracted mesothelioma from second-hand exposure to asbestos allegedly caused by washing her husband’s work clothes. Barbara claimed she would regularly wash his clothes for his next shift at Brown’s Ferry Nuclear Plant in Limestone County.

She was diagnosed with mesothelioma in 2011 and claimed that it had been directly caused by the asbestos fibers on her husband’s clothes. The plaintiff’s husband died from asbestosis in 1997, while Barbara died from mesothelioma on Sept. 7, 2013.

Before her death, Barbara filed an asbestos mesothelioma lawsuit against Tennessee Valley Authority (TVA) which was then carried out by her daughters after her demise.

According to the mesothelioma lawsuit, TVA should have provided James B., the decedent’s husband, proper safety equipment and protection masks when working with the hazardous material.

Additionally, the asbestos lung cancer lawsuit claims that TVA should have warned employees of the possible health risks associated with working with the cheap material.

The presiding judge agreed with the allegations and awarded the decedent’s family $3.5 million judgment against TVA, which owns and operates Brown’s Ferry. 

One of the most prominent problems plaguing elderly citizens in America is contending with the long-term consequences of asbestos exposure. In particular, it is estimated that 4,800 people die from asbestos lung cancer per year in the United States, which represents 4 percent of all fatalities in the country related to lung cancer.

Since the late 1800s, manufacturing companies have used asbestos for construction and insulation purposes. It was cheap and easy to use and soon become a popular construction material for its fire and chemical resistant qualities. While it is harmless in a dormant state, problems start arising when the asbestos sites are disturbed, which are then released.

After experts had officially linked asbestos exposure to lung cancer in the 1940s, the Occupational Safety and Health Administration (OSHA) proclaimed that asbestos lung cancer was a prominent risk to workers who were exposed to asbestos.  Asbestos lung cancer attacks the mucus lining of the lungs rather than the actual organs, this condition is typically diagnosed at a latent stage due to how long it takes symptoms to show. 

Asbestos lung cancer can take years for victims to experience any symptoms leaving few treatment options and short life survival expectancies for patients. Experts warn that it can take up to 50 years before any signs of asbestos cancer to show, as the fibers can sit generations in the lungs before festering.

 

Lumber Liquidators Guilty Plea Costs Them $13 Million

According to the Department of Justice-Virginia-based hardwood flooring retailer Lumber Liquidators Inc. pleaded guilty today in federal court in Norfolk, Virginia, to environmental crimes related to its illegal importation of hardwood flooring, much of which was manufactured in China from timber that had been illegally logged in far eastern Russia, in the habitat of the last remaining Siberian tigers and Amur leopards in the world, announced the Department of Justice.

Lumber Liquidators was charged earlier this month in the Eastern District of Virginia with one felony count of importing goods through false statements and four misdemeanor violations of the Lacey Act, which makes it a crime to import timber that was taken in violation of the laws of a foreign country and to transport falsely-labeled timber across international borders into the United States.  The charges describe Lumber Liquidators’ use of timber that was illegally logged in Far East Russia.  This is the first felony conviction related to the import or use of illegal timber and the largest criminal fine ever under the Lacey Act.

“Lumber Liquidators’ race to profit resulted in the plundering of forests and wildlife habitat that, if continued, could spell the end of the Siberian tiger,” said Assistant Attorney General John C. Cruden for the Justice Department’s Environment and Natural Resources Division.  “Lumber Liquidators knew it had a duty to follow the law, and instead it flouted the letter and spirit of the Lacey Act, ignoring its own red flags that its products likely came from illegally harvested timber, all at the expense of law abiding competitors. Under this plea agreement, Lumber Liquidators will pay a multi-million dollar penalty, forfeit millions in assets, and must adhere to a rigorous compliance program.  We hope this sends a strong message that we will not tolerate such abuses of U.S. laws that protect and preserve the world’s endangered plant and animal species.”

According to a joint statement of facts filed with the court, from 2010 to 2013, Lumber Liquidators repeatedly failed to follow its own internal procedures and failed to take action on self-identified “red flags.”  Those red flags included imports from high risk countries, imports of high risk species, imports from suppliers who were unable to provide documentation of legal harvest and imports from suppliers who provided false information about their products.  Despite internal warnings of risk and non-compliance, very little changed at Lumber Liquidators.

On other occasions, Lumber Liquidators falsely reported the species or harvest country of timber when it was imported into the United States.  In 2013, Lumber Liquidators imported Mongolian oak from Far East Russia which it declared to be Welsh oak and imported merpauh from Myanmar which it declared to be mahogany from Indonesia. 

The illegal cutting of Mongolian oak in far eastern Russia is of particular concern because those forests are home to the last 450 wild Siberian tigers, Panthera tigris altaica.  Illegal logging is considered the primary risk to the tigers’ survival, because they are dependent on intact forests for hunting and because Mongolian oak acorns are a chief food source for the tigers’ prey species.  Mongolian oak forests are also home to the highly endangered Amur leopard Panthera pardus orientalis, of which fewer than 50 remain in the wild.  In June 2014, in response to illegal logging and the decline in tiger populations, Mongolian oak was added to the Convention on the International Trade in Endangered Species.

Under the plea agreement, Lumber Liquidators will pay $13.15 million, including $7.8 million in criminal fines, $969,175 in criminal forfeiture and more than $1.23 million in community service payments.  Lumber Liquidators has also agreed to a five year term of organizational probation and mandatory implementation of a government-approved environmental compliance plan and independent audits.  In addition, the company will pay more than $3.15 million in cash through a related civil forfeiture.  The more than $13.15 million dollar penalty is the largest financial penalty for timber trafficking under the Lacey Act and one of the largest Lacey Act penalties ever.  The company is scheduled to be sentenced on Feb. 1, 2016.