According to reports, FBI Director Kash Patel plans to team up with Nassau County Executive Bruce Blakeman to tackle widespread Medicaid fraud scams ongoing in New York state. The duo plans on creating a coordinated effort led by the FBI and the Nassau Police Department to specifically go after New York state’s alleged Medicaid fraud involving Nassau University Medical Center.

The healthcare organization is alleging that New York state has illegally and unfairly withheld over $1 billion in Medicaid funds over the past 20 years by refusing to pay out valid insurance claims.

The state’s refusal to pay out these valid claims could be, according to Attorney General Pam Bondi, a violation of federal Medicaid laws and an intentional breach of contract with the federal government.

After looking into the situation, it’s clear that these allegations have been ongoing for a long time. The Nassau Health Care Corporation, which oversees the hospital, decided to initiate a lawsuit last year regarding the situation. The lawsuit names Nassau County Interim Finance Authority as being grossly negligent in handling the hospital’s claims. NIFA reportedly assumed financial control of the medical center in 2020 but failed to acknowledge the widespread Medicaid fraud and reduced aid were creating a financially distressing situation for both the hospital and some of the patients.

Now, the company additionally believes they are being retaliated against.

Facing Fraud Charges in New York

Under the law in New York, fraud is defined as falsely representing facts by conduct or words that are misleading or in a way that conceals relevant information that should be disclosed. Fraud is deliberate, and Medicaid fraud happens when someone intentionally misrepresents their situation in order to receive monetary benefits through the Medicaid program.

Some of the most common forms of Medicaid fraud are phantom billing, upcoding, unbundling services, arranging kickback agreements, double billing, patient identity theft, prescription drug fraud, and misrepresenting qualifications.

Medicaid fraud is taken very seriously in New York. Each individual violation could lead to up to 10 years in prison. If the fraud led to a serious bodily injury for a patient, then the violation could result in up to 20 years in prison. Each violation could also result in fines of up to $250,000 for individuals and $500,000 for organizations.

If you’re a healthcare provider, then you will likely have your medical license suspended or revoked entirely. You might also face mandatory supervision requirements and more stringent reporting requirements. You might also be excluded from participating in the Medicaid program for a minimum of five years depending on the nature of your specific violation. Unfortunately, a conviction often leads other private insurance companies to also terminate contracts with your organization.

The best way to avoid all these consequences is to prevent a Medicaid fraud conviction. A solid lawyer can help you navigate your situation and help you minimize the fallout from facing charges.

Schedule a free phone call with our team to discuss your case and get a free evaluation from our lawyers.

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On November 22nd, a jury delivered a guilty plea to Dr. Pyaam Toobian and his company, America’s Imaging Center, Inc. The charges against the doctor and company included multiple felony charges related to medical misconduct. The group is accused of participating in a fraudulent kickback scheme.

Dr. Toobain has been convicted of third degree grand larceny, third degree health care fraud, violating social services law statutes, and first degree falsifying of business records.

According to court records, an investigation into the company began back in January 2006. The investigation was prompted when it was alleged that Dr. Toobin was paying two physicians in gift cards and cash in exchange for referring patients to his business for treatment.

During the years-long case, investigators discovered that Toobin was directing his employees to add unordered radiological procedures that were not necessary for patients. The goal of doing this was to increase the patient’s bill fraudulently and increase the payments the company would receive from Medicaid insurance. Toobin reportedly continued to commit this scheme from January of 2014 to August of 2017. He reportedly charged extra for unnecessary procedures like invasive injections, MRIs of the brain, and MRI scans of the cervical spine. All of these unnecessary tests were ordered without the knowledge of physicians who were referring patients to the clinic.

Unfortunately, this case revealed how some doctors are not prioritizing patient health but instead attempting to upcharge insurance companies to keep their businesses going.

Medicaid Fraud: Is it Really That Serious?

Some people believe Medicaid fraud isn’t that serious, but the consequences of this type of behavior from a medical professional can be significant. This type of medical fraud causes a patient undue harm.

Third-degree grand larceny, one of the crimes Dr. Toobin was convicted of, is a class D felony in New York. It commonly leads to a prison sentence of up to seven years. Third degree health care fraud is also a class D felony. It can result in a prison sentence of up to seven years. First degree falsifying of business records is a class E felony and carries a sentence of up to four years in prison.

While each of these crimes on their own is very serious, getting convicted of three felonies at once is a big deal. The severity of the convicted individual’s sentence will increase with each additional charge.

Have you recently been charged with healthcare fraud, Medicaid fraud, grand larceny, or a similar crime? Are you in New York or a nearby city? If so, then our qualified attorneys are prepared to help you determine your best legal strategy to navigate your charges. We’ll listen to the facts of your case, inform you about the potential defense strategies that might apply in your situation, and help you build a solid defense.

Are you ready to get started? Schedule a meeting with our firm now to learn more about how our criminal defense team can help you navigate your situation.

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In mid-May, the Assistant Attorney General spoke to the American Bar Association about the problem of health care fraud.  According to the Department of Justice transcript of the remarks, the focus of the discussion was on the Criminal Division’s efforts to fight against fraudulent claims made by healthcare providers.

Healthcare fraud takes many forms, including billing for services not performed and unbundling services that should be grouped under one insurance code in order to get paid more for each individual service. Healthcare fraud costs billions and since a Strike Force began targeting specific Medicare billing categories in 2007, the Strike Force has identified more than 2,100 people who collectively billed Medicare for more than $6.5 billion in fraudulent claims.

Medicare fraud is taken very seriously by federal investigators, and those who are under suspicion of fraud need to act quickly to get help resolving their legal problems before they find themselves facing criminal charges and with bank accounts and other assets frozen. If you are under investigation or if you have been indicted for healthcare fraud, an insurance fraud defense lawyer should be your first call.
DOJ Takes Action Against 16 Hospitals

While the Department of Justice has been aggressive in going after people involved in many different types of healthcare fraud, one of the most recent cases involved allegations that hospitals were inappropriately billing Medicare for unnecessary psychotherapy services.

According to the DOJ’s news release, 16 hospitals agreed to pay $15.69 million to resolve allegations made under the False Claims Act. The False Claims Act is one of the government’s most important tools for fighting healthcare fraud and other types of fraud against Medicare or other government programs. The False Claims Act allows private individuals with knowledge of fraud to file a civil lawsuit. Those who file the suit under the False Claims Act can receive a portion of the money that the government is able to obtain when fraud is identified.

The 16 hospitals that were named in this False Claims Act case were accused of fraud in connection with Intensive Outpatient Psychotherapy (IOP) services. IOP services provide a variety of different types of active treatment to people who have mental disorders who are covered by Medicare.

Between 2005 and through 2013, the hospitals allegedly submitted claims for IPO services despite knowing that the claims should not qualify for Medicare reimbursement since the patient’s treatments were not provided pursuant to individualized treatment plans designed to address specific mental health issues and reach achievable goals. The patients also reportedly received inappropriate levels of treatment, including therapy that was recreational or diversional and not targeted towards addressing a specific mental issue. Finally, the progress of the patients’ was not tracked, in violation of Medicare guidelines.

This latest case is just one more in the efforts of the DOJ to crack down on fraud in Medicare claims.  The Assistant Attorney General indicated that one of the DOJ’s major areas of focus was the billing of medical equipment to Medicare. However, Medicare provides broad coverage of all different types of therapy and treatments and fraud can exist within any healthcare industry.

In many cases, it is not always clear to providers whether the treatment they are offering actually should be covered or not. The result is that a provider or care facility could end up being subject to criminal investigations and to civil actions under the False Claims Act even without knowingly violating the law.

Insurance fraud cases are complicated, and it is imperative that those accused of breaking the rules have proper legal help defending themselves. Call an insurance fraud defense lawyer for assistance with your case if you are accused of wrongdoing in connection with Medicare, Medicaid, or other health insurance claims.

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When Richard developed lung cancer from exposure to asbestos while on the job, neither he or his wife, Christie, thought their case would make it to the Supreme Court.

The Steiners filed a lawsuit citing personal injury against the Volkswagen Group of America, Ford Motor Company and others. Volkswagen moved early in the hearings to order Simona Farrise, the Steiners’ lawyer to take down two pages of her website which Volkswagen claimed publicized her victory over Ford in similar cases.

Volkswagen told the judge that the pages were provocative and prejudicial and would affect their case against the Steiners if the pages were viewed by a juror.

Steiners’ attorneys counter-argued that any order requiring the removal of the two pages in question would trample on Farrise’s Constitutional right of freedom of speech. They went on to suggest that the proper remedy was simply to instruct the jury not to search the Internet for information about the case.

The Court of Appeals sought direction from the Supreme Court and then issued an order to show cause. By then though, the point was moot. The trial was over. However, claiming public interest, the Court of Appeal reviewed the order.

Subsequently the Court of Appeal said the trial court’s order was basically a gag order and placed an unfair restraint on Farrise’s right to freedom of speech.

Usually gag orders are scrutinized by judicial review. A gag order can’t be imposed unless the speech poses a clear and current threat to a protected interest. Even when a gag order meets that criteria, it is still required to be narrowly written.

Volkswagen’s attorneys claimed the order should be looked at under the less restrictive light of commercial speech. Historically, there are four criteria that applies to state regulations on commercial speech. First, the court has to determine if the speech concerns lawful activity and isn’t misleading. Depending on the court’s findings, the court must then decide if the asserted interest of the government is substantial, if the restraint directly advances that interest and the extent in which it is necessary to serve that interest.

The Court of Appeal determined that the order of the trial court didn’t pass the Constitutional “smell test” under the commercial speech argument. The Court of Appeal also found the order would not pass the even more rigorous scrutiny analysis.

With no evidence that Farise’s webpages about prior cases was misleading, the government had to seek another tack to keep jurors from learning about past victories.

Trial courts have wrestled with the problem of tech-savvy jurors for years. There has been vigorous debate on the subject and no one has suggested prior restraints on speech because of the possibility a juror will do online research. The trial court’s order did not apply to any other possible websites that described Ford’s loss in previous cases — only Farrise’s website.

The instructions of the trial court were enough to protect both parties’ right to a fair trial and the court instructed jurors about not accessing the internet or social media until after the verdict was in.

Download full opinion here.

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For the past six months, New York prosecutors and the FBI have collected evidence concerning health insurance fraud, perpetrated by Russian diplomats.  They are now confident that they have enough evidence to mount a solid case.  According to Prosecutor Preet Bharara, the diplomats falsified income statements and other information regarding marital status and nationality to gain access to cheaper health insurance.

The prosecutors provided the media with the names of 49 Russian diplomats and their family members who were involved in the scandal.  It regards members such as the Consulate General and the Russian Delegate to the UN, as well as other members of the diplomatic community who have since left the United States.  Of the 49 diplomats accused, only 11 remain in the United States.

The fraudulent scheme has been in place since 2004 and has cost the US treasury approximately half a million dollars.  Officials from Moscow stated that any suspicion of illegal activity buy Russian diplomats should have been voiced to the Russian Government through proper diplomatic channels before going public.  Russia’s Deputy Foreign Minister, Sergei Ryabkov, says that the case has no basis in reality and that it is nothing more than a Russia-phobic PR stunt to please the American public.  He went on to say that, the illegal surveillance of diplomats who held official diplomatic passports was in direct violation of the international laws and that they reject any accusations that were made against their diplomats.

One of the controversial issues surrounding the case is that the 11 members of the diplomatic community who remain in the United States, all possess diplomatic immunity and as a result of this, they cannot be arrested by American officials or prosecuted in an American Court of Law.  The prosecutors on the case noted that they would request that the immunity be revoked, lest the accused parties risk being expulsed from the United States.

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Cancer doctor Meera Sachdeva and her former billing clerk are officially guilty of a multi million dollar medical care fraud case in Mississippi. [USDC No. 3:11-CR-65-1 Case: 11-60639] The doctor pleaded “guilty to one count of healthcare fraud and two counts of making false statements.” According to reports, used needles and syringes that were recycled for other patients, chemo medicines were watered down and insurance companies were dramatically overbilled. Dr. Sachdeva, 50, founded the Rose Cancer Center. Cancer centers are one of the most highly regarded medical practices, as they are often times the last lifeline a patient has.

As noted by a NY criminal defense lawyer Arkady Bukh, most would venture a guess that Dr. Sachdeva thought when she founded the center it would be the perfect opportunity to develop her career into an incredibly lucrative one. Lawyers don’t have that luxury. We must always assume a client is not guilty until it is proven without any doubt that they are guilty. The public tends to trust, or at least respect, anything a doctor says. That’s a big reason why healthcare fraud is so prevalent in our country. This woman billed government insurance companies over 15 million dollars just for chemo drugs. The funny thing is she didn’t even order that many drugs from suppliers. Not surprisingly, she got caught. Dr. Sachdeva’s practice was responsible for 11 hospitalizations from the same bacterial infection being spread at her facility. One man allegedly passed away of HIV that he contracted from the Rose Cancer Center. His family is filing a civil suit, but no formal criminal charges have been made on this count. The health department released a statement saying that no patients of the Rose Cancer Center had any blood borne viruses that could be correlated with medical care at the center. Over 300 people had to be tested for infections.

What I find interesting about this case and many others like it is the prosecutor’s willingness to make a deal. Dr. Sachdeva was accused of many things, but all of those charges just went away when she pleaded guilty. This leads me to say that her lawyer was really good at negotiation. If she had gone to trial and lost, as she was likely to since the prosecution had excellent evidence, she could have been sentenced for to up to one hundred sixty five years in prison. Not to mention she would have to have paid $3.2 million in restitution. As it stands now, her guilty plea could send her to prison for up to 20 years. It’s not a bad trade off at all. She may be able to get out of prison in a decade and enjoy her retirement years in her home country. Sachdeva has been in jail since August of 2011 awaiting trial. Because she emigrated from India, the courts ruled that she is a flight risk. This means she will receive credit for time served.

In a case such as this, it’s important to have a lawyer that has a record for standing up for immigrants’ rights. One who has an excellent background as a criminal lawyer specializing in white collar crimes, misconduct cases and fraud. Having an attorney that is willing to sit down and scour every inch of evidence and paperwork is imperative. It’s also essential to have someone who can handle tough media questions. But above all else, it’s vital to have a lawyer who knows how to drive a hard bargain with the prosecution. Without having someone like that on your side, a sentence of 165 years is very possible.

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Today’s WSJ summarizes the debate between Thaler, a leading skeptic of market efficiency, and Fama, the leading defending of the efficient capital markets hypothesis. As the article notes, the debate could have implications for privatizing social security. It quotes Thaler as saying, “[i]f you give people 456 mutual funds to choose from, they’re not going to make great choices.” The result may be that the securities markets get detached from fundamental values and misallocate resources.

Thaler concedes that “it is not easy to beat the market, and most people don’t.” This is an important point, since it follows that we have no alternative to accepting the wisdom of markets, even if it’s imperfect.

But even if we can’t beat the market, we should be concerned if the market is detached from real values, because then investment dollars would be misallocated. On this point Thaler has little doubt, saying that Fama “is the only guy on earth who doesn’t think there was a bubble in Nasdaq in 2000.” In fact, Fama’s not alone, as I’ve noted.

Assuming markets are inefficient in the weaker sense just noted, what should we do about it? Those who align with Thaler suggest that privatizing social security would further misalign securities prices from value by bringing more irrational investors into the market. The WSJ says that “in a rational world, share prices should move only when new information hit the market. But with more than one billion shares a day changing hands on the New York Stock Exchange, the market appears overrun with traders making bets all the time.”

My main point here is that this conclusion, if true, has implications beyond social security. As I’ve noted, our securities laws are based on the principle that markets should be safe for ordinary investors. If we’re really concerned about a lot of irrational investors running around, then we should be skeptical not only about privatizing social security, but about the securities laws as well. This would mean drastic revisions of disclosure rules, and being honest with investors and voters about what the securities laws are able to accomplish. Investors are either rational or irrational. Public policy should follow logically and consistently from whichever conclusion we choose to accept.

Originally posted by Larry Ribstein on Ideoblog.

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