Medicaid or Medicare Fraud

Elder Abuse and Medicare Fraud

When it comes to financial matters, senior citizens are vulnerable to exploitation—otherwise known as elder abuse—from family members, friends, neighbors, caregivers and even businesses. More than half of elder financial fraud is committed by strangers, one-third by loved ones, and about one-tenth by businesses.

Medicare is one of the areas in which elders are at risk of becoming the victims of fraud. Unscrupulous individuals or businesses attempt to use a senior citizen’s personal and/or Medicare information to charge the Medicare program for items and/or services the elder never received.

According to the Medicare.gov website, individuals and businesses attempt to cheat Medicare in the following ways:

  • a doctor or healthcare provider bills the program for services and elder never received
  • a healthcare supplier bills Medicare for equipment an elder never ordered
  • an unauthorized person uses and elder’s Medicare card to get medical care, supplies or equipment or bills Medicare for home medical equipment after that equipment has been returned
  • a company offers a Medicare drug plan not yet approved by Medicare or willfully uses false information to mislead an elder into joining a Medicare plan

Those elders most vulnerable to financial fraud range from 80 to 89 years of age. Statistics show that these seniors usually live alone and that they are female: nearly twice the number of women as men become the victims of fraud. Perpetrators of elder financial fraud are both genders. However, the majority are men between the ages of 30 and 59 while female perpetrators are between the ages of 30 and 49.

Current estimates suggest that Americans over the age of 50 control 70% of the national wealth. Given these numbers, it’s no surprise that elder financial abuse is on the rise throughout the United States. If you suspect that you or an elderly loved one has been the victim of Medicare financial fraud, contact the attorneys at the Barrera Law Firm. We have the know-how and experience to help seniors restore their good name and peace of mind.

Health Care Fraud

If you know of health care fraud, contact us safely and confidentially to take action and make things right.

One area The Barerra Law Firm services is health care fraud. We represent the taxpayers when a person is committing fraud against the government. What is health care fraud? Health care fraud is when a health care agency, a doctors clinic, a home hospice, a nursing home, a psychiatrist, a chiropractor, anybody is making a claim to the government for compensation on behalf of another and that claim is false.

Some types of health care provider fraud have to do with unnecessary billing, unnecessary treatment, false billing or providing a basic false picture to the government for so-called services which were never rendered and false claims have been submitted.

If an individual suspects fraud within whatever area they work in, they should come to my law office and we will inform them of what their rights are concerning reporting this on behalf of the taxpayers. One of the things that they would need to have is information or evidence to show that false claims have been provided to the government on behalf of the health care industry.

They should bring that information to The Barrera Law Firm and we will evaluate that claim so that that person can then be a party to a lawsuit on behalf of the taxpayers against that health care provider that is bringing the false claims.

The Barrera Law Firm in Harlingen provides legal services to Harlingen, Brownsville, McAllen and the Rio Grande Valley. Legal services offered include: divorce law, personal injury (such as auto or 18-wheeler accident), wrongful death, criminal defense, and civil rights actions.

Avoiding Medicare Fraud During Open Enrollment Season

Are you a Medicare beneficiary? If so, then this is the time of year when you can change your health and prescription drug plans. But watch out! The Centers for Medicare and Medicaid Services (CMS) report that fraudulent activities increase dramatically during this period.

Elderly are unfortunately common victims of Medicare fraud.

According to Golocalprov.com, “billions of American taxpayers’ dollars are wasted on improper payments to individuals, organizations and contractors.” These benefits are paid out to the wrong person, for the wrong reason and in the wrong amounts. A whopping $98 billion in improper payments—with more than half coming from Medicare and Medicaid—were made in 2009 alone. Thanks to the dedicated efforts of almost 25,000 volunteers across the United States, however, millions of Americans have been learning about Medicare fraud and helped prevent it since 1997.

Sadly, not every senior who needs this information gets it and falls prey to fraudulent schemes. If you are a Medicare recipient or know someone who is, here are some easy ways you can help prevent Medicare fraud:

  • Keep your Medicare number private—treat it as you would your Social Security and bank account numbers.
  • If someone you don’t know contacts you and asks for personal information, don’t give it to them. Remember that it can be used for fraudulent purposes.
  • Beware of people claiming to be a Medicare representatives who ask for your Medicare number. Real Medicare officials “wouldn’t need to ask and they wouldn’t call or visit unless call first.”
  • When you receive your Medicare summary notice, make sure the figures posted tally with all the expenses you have accrued for that month.
  • Don’t hesitate to report any suspicious activity to the Office of the Inspector General in your state.

Maintaining awareness is key to staying protected. But if you do find yourself in the position of Medicare fraud victim, a competent lawyer can help you regain both your good name—and your long-term security.

Medicaid Fraud Settlement Results in Millions to Texas

A recent success in combating Texas Medicaid fraud will result in $72 million being returned to the state.

The Texas Attorney General’s Office charged Par Pharmaceutical Inc., based in New Jersey, and three other drug manufacturers with defrauding the state’s Medicaid program by improperly reporting drug prices.

Because the defendants provided inaccurate market prices for their drugs, the Medicaid program over-reimbursed pharmacies for Par’s products.

Under the agreement, Par must pay $154 million to resolve enforcement actions filed by Texas and four other states.

Read the full article here.

Common Types of Medicaid and Medicare Fraud

Sadly we live in a day when some of those that are supposed to be keeping us in health instead take risks with our health for their own personal gain. While most physicians and clinics are free from Medicaid and Medicare fraud, there are many that use patients in order to gain access to these funds, and in doing so risk the health and safety not only of their own patients but also of others who depend on these funds for actual health issues. There are many ways in which Medicare and Medicaid fraud can occur, and knowing how to spot these crimes will help you from falling victim to them.

  1. Billing fraud. Billing fraud is one of the most common abuses of the Medicare/Medicaid system. There are many different scams that are perpetrated. One is billing for services that were never rendered, either by using genuine patient information, identity theft, padding real claims with false information or simply by fabricating entire claims altogether. Billing fraud is rarely committed by one person. All those who knowingly participate in billing fraud can be held liable. Reporting this type of fraud will prevent you from being found financially responsible for the theft.
  2. Falsification of patient diagnosis. Another type of Medicare/Medicaid fraud is the falsification of patient records, including tests and exams, in order to justify surgeries, treatments, procedures or drug regiments. As a patient, nurse or loved one, it is important to carefully check the information you are given to ensure that a proper diagnosis has been given. Falsification of patient records that leads to unnecessary procedures can cause serious damage and even death to these victims. Convincing patients that they have a life threatening condition that must be treated by some medical procedure is both unethical and unlawful and these physicians need to be reported for health care fraud.
  3. Unbundling of procedures. Medical procedures often require multiple steps. Typically, these steps are bundled into one cost instead of being billed separately. Unscrupulous physicians will sometimes have their accountants bill each step separately instead of in a bundle as it is supposed to be. Unbundling means that the doctor or clinic will receive much more money for the service than is deserved, and fewer funds are left over for other work.
  4. Kickback fraud. We have all heard of kickback fraud, but do you know how pervasive it actually is? Pharmaceutical companies wine and dine doctors and clinics, offering substantial kickbacks to those who push their prescription drugs. When these drugs are actually necessary for a real medical condition and result in a bettering of a condition for the patient, then no harm is done. However, all too often physicians write prescriptions for drugs which have absolutely nothing to do with the patients condition simply to take advantage of kickbacks. As well, if patients must return to the doctor month after month for a prescription refill, they profit off the charge of each office visit. Kickback fraud can be dangerous because often the drugs prescribed cause harmful side effects in patients, some even leading to death.

Texas Medicaid Fraud: A Dark Part of a Darker Picture

Below is an excerpt, and a link, to an article about the astonishing amount of Medicare and Medicaid fraud perpetrated yearly in the United States.

One of the areas The Barrera Law Firm specializes in is this type of fraud, perpetrated to the tune of billions of dollars each year.

Some key points on Medicare and Medicaid Fraud:

  • Medicare and Medicaid lose at least $87 billion per year to fraudulent and otherwise improper payments
  • Approximately 10.5 percent of Medicare spending and 8.4 percent of Medicaid spending was improper in 2009
  • Every year since 1990, the U.S. Government Accountability Office has released a list of federal programs it considers at a high risk for fraud. Medicare appeared on the very first list and has remained there for 22 straight years. Medicaid assumed its perch eight years ago.

Read all of “Entitlement Bandits” here.

Considering the state of the U.S. economy and the need to reduce runaway debt, Medicare and Medicaid fraud needs more than just an article or two written about it, it needs people who know of this fraud to bravely step forth and decide to do something about it.

Dangers of Medicaid and Medicare Fraud

If you are aware of Medicaid or Medicare fraud, call The Barrera Law Firm

It is an unfortunate system we find ourselves in today, when the institutions of medicine we entrust with our health commit fraud in order to gain access to government funds. Medicaid and Medicare fraud is rampant in America, and the ramifications effect society at multiple levels. You may become aware of Medicaid or Medicare fraud being committed either as a patient or as a health care professional. Due to the inherent dangers of medicaid and Medicare fraud, it is important for it to be reported to authorities through the proper channels with the aid of a lawyer.

  1. Medicare fraud is harmful to the elderly. Medicare is supposed to be available for those of our society who are 65 and older. Often times, the elderly have health problems or complications that can stick them with medical bills that are financially unable to pay. Medicare fraud, or the funneling of Medicare funds to those who don’t really need it, means that these funds aren’t available for the elderly patients who need them to survive.
  2. Can result in the wrongful diagnosis of disease. Too often, medicare professionals diagnose an illness too quickly and prescribe medication to patients in order to get a hold of Medicare funds. For example, in Texas, unscrupulous psychiatrists often take advantage of children from low income families by convincing the family that their child has a psychological illness that must be treated by them and their prescription drugs. More often than not, the wrongful diagnosis actually prevents the real issue, if there even is one, from being discovered. These children often end up suffering permanent damage from the treatment. As a health care worker who is witness to this type of fraud, you can be held liable in a lawsuit if you do not report it.
  3. Results in wrongful healthcare statistics. Many science studies today depend on data from reports filed by physicians. When patients are misdiagnosed by deceitful physicians trying to access Medicare and Medicaid funds, the data reported to health agencies results in a skewed view of the actual health of the nation. Since these statistics are used by lawmakers and those who direct policies regarding public health, wrongful diagnosis by those knowingly committing health care fraud actually has nationwide ramifications.
  4. Drugging of the elderly in nursing homes. One of the most types of Medicare and Medicaid fraud is the drugging of the elderly in nursing homes. These are some of the most vulnerable members of our society. Nursing homes often time receive kickbacks from pharmaceutical companies for prescribing powerful anti-psychotic drugs to the elderly, whether they need them or not. Oftentimes, these drugs lead to other complications and even an early death to their users. If you are a private citizen or health care worker who is witness to this type of action taking place, you have a lawful and moral obligation to report it to the proper authorities. A law firm specializing in Medicare and Medicaid fraud can guide you on a correct course of action.

New Testimonial

I have just received a new testimonial that I would like to share.

Attorney Ric Barrera successfully got my case dismissed when the Texas Board of Nursing attempted to take my license away after I reported abuse in a Texas psych ward. Mr. Barrera dismantled the case against me, got to the root of the people behind it and turned it around on the perpetrators after he got my case thrown out. — AA

Are Whistleblowers Stopped from Reporting Fraud by Non- Disclosure Agreements?

In general, non-disclosure agreements do not effectively silence whistleblowers who would report a fraud designed to bilk government health programs under certain circumstances. In fact, there is strong public policy in favor of protecting whistleblowers who report fraud against the government. However, the Court will consider the scope and the volume of the documents that are taken in making its consideration as well as many other factors in order to determine that the whistleblower acted reasonably and did not conduct extra judiciary discovery.

In fact, the American Psychiatric Association required its task force members for the new Diagnostic Statistical Manual 5 (DSM 5) to execute a non-disclosure agreement, which essentially eliminated transparency. The DSM is the psychiatric catalog of mental illnesses which has grown to over 370 mental illnesses in its latest rendition, including dubious diagnoses such as reading disorder, disorder of written expression, mathematics disorder and caffeine intoxication disorder. Each named disorder is coded for government and private insurance billing purposes.

The interesting part about that is that each member of the 27-person DSM-5 task force, those writing and editing the manual, had to sign a non-disclosure agreement and that 69% of those task force members had ties to the pharmaceutical industry, which arguably can be seen to load the deck for voting purposes.

Unfortunately, the DSM 5 task force made it is easier than ever to diagnose many people with a mental disorder due to the broad categories now available and suspect “illnesses” such as internet gaming addiction, binge eating and caffeine withdrawal. The taxpayer is going to be shelling out big bucks for pharmaceuticals and mental health “treatment” for these things, straining an already overburdened health care system.

Whistleblowers may be entitled to a portion of the recovery of any found to be part of a scheme to defraud government health programs.

It is necessary that an attorney that is competent to advise whistleblowers be utilized early in the reporting of fraud when a non-disclosure agreement is employed so that the information may be effectively employed and the whistleblower may be effectively protected.

Successfully Protecting Nurses and Doctors from Whistleblower Retaliation and Board Complaints

Can a hospital or medical clinic bring a State licensing board complaint against a whistleblower for blowing the whistle on fraud and/or substandard care?

Unfortunately, this is an all too often strategy used to discredit those who seek to take a stand in protecting their patients and their own professional licenses.

The Federal False Claims Act (FCA) provides protection for whistleblowers against retaliation. However, it is necessary for a skilled attorney to be brought on early in the fraud reporting process to provide the strong legal armor needed to fend off the desperate attempts of civilly and criminally liable fraudsters.

The FCA allows an individual with evidence of fraud against the federal government, to sue the perpetrator to recover the stolen funds and is rewarded by a percentage of the funds recovered. Prohibited retaliation includes: termination, suspension, demotion, harassment or any other discrimination in the terms and conditions of employment. In order to prevail, an employee must prove: (1) that the employee took action in furtherance of an FCA action; (2) that the employer knew about these acts; and (3) that the employer discriminated against the employee because of such conduct.

A person with knowledge of a scheme to defraud government health programs such as medicare, medicaid, and tri-care is essentially between a rock in hard place. If a person ignores the fraud exists, they may be implicated later for being complicit with the scheme, lose their state license, and face the embarrassment of a government probe, or they can retain an attorney with skill and knowledge on the Federal False Claims Act so that they may retain their rights and earn a portion of the money recovered.

The correct strategy is to consult an attorney prior to taking steps and actions that may lead you into the traps that are carefully laid to discredit the whistleblower and strip them of their professional credentials.

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