By Thu Pham, O.D., Law Clerk, The Health Law Firm
On August 9, 2012, the United States Court of Appeals for the Fifth Circuit, located in New Orleans, Louisianna, affirmed the conviction of a patient recruiter in Texas for Medicare Fraud committed after Hurricane Katrina.
To read the court's decision, click here.
The Recruiter's Charges.
The patient recruiter was charged with conspiracy to defraud Medicare. Starting in 2007, the recruiter solicited potential beneficiaries and gathered information from those beneficiaries. The recruiter supplied the information to a durable medical equipment (DME) company. The company used the information to bill Medicare for equipment that was never received, or if received, was a cheaper piece of equipment than what was billed to Medicare.
The recruiter was also charged with aiding and abetting the fraudulent submission of a claim to Medicare for reimbursement of a power wheelchair. The recruiter told a Medicare recipient that he was eligible to receive a free wheelchair even though his doctor had refused to prescribe him a new wheelchair. Medicare prohibits suppliers of DME from representing the equipment as "free," because the recipients are responsible for paying twenty percent (20%) of the cost. The Medicare recipient never received the wheelchair.
The Recruiter's Defense.
The recruiter claimed that she was not involved in any of the fraudulent activities. The recruiter argues that the fraudulent claim submissions occurred in "the back office" and that she had no involvement in the claim submission process.
The Court's Ruling.
The Court ruled that the recruiter was educated and had experience in the healthcare industry. The Court concluded that the jury was correct in rejecting the recruiter's "ignorance" defense.
To read the article from the American Health Lawyer's Association, click here.
Everyone knows that "ignorance of the law" is no defense to a criminal or administrative charge. Often, as demonstrated in this case, ignorance of the facts is not a successful defense, either.
Contact Health Law Attorneys Experienced in Handling Medicare Audits.
Medicare fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicare fraud criminal charges arise out of routine Medicare audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
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U.S. v. Whitfield, No. 10-20505 (5th Cir. 2012).
Reform U. "Eleventh Circuit Affirms Convictions of Patient Recruiter Involving Medicare Fraud For Power Wheelchairs." American Health Lawyers Association. (August 17, 2012). From: http://reform.pyaloupe.com/ahla/62099.
About the Author: Dr. Thu Pham, OD, is a law clerk with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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