Archive for March, 2015

A need for more (effective) False Claims Act ordinances?

Whistleblower Award

Stack Of CashDuring the fiscal year 2014, the Federal government recovered nearly $6 billion from False Claims Act cases as more than 700 whistleblower lawsuits were filed for the second consecutive year.  These statistics plainly show the effectiveness of incentivizing whistleblowers to risk coming forward to report wrongdoing.

Presently 30 states have adopted False Claims Act statutes that share similarities with the Federal model, but have nuances as to the types of fraud each state allows whistleblowers to report and how much of a percentage they can receive from the government’s recovery.  Given the whistleblowing success at the Federal level, we expect these state statutes to continue to proliferate.

The question becomes, why don’t municipalities and counties protect their money with similar False Claims Act ordinances?

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Recovery Home Care Services, a Florida Home Health Care Company, Agrees to Pay $1.1 Million to Resolve F.C.A.

Recovery Home Care Inc., Recovery Home Care Services Inc. (collectively Recovery Home Care) and National Home Care Holdings LLC have agreed to pay $1.1 million to resolve allegations that the Recovery Home Care entities violated the False Claims Act by improperly paying doctors for referrals of home health care services provided to Medicare patients, the Department of Justice announced today.  The Recovery Home Care entities provide home health care services to Medicare beneficiaries and were purchased by National Home Care Holdings LLC in 2012, after the conduct addressed by the settlement occurred.

“Health care providers that attempt to profit by providing illegal inducements will be held accountable,” said Acting Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “We will continue to advocate for the appropriate use of Medicare funds and the proper care of our senior citizens.”

From 2009 through 2012, Recovery Home Care, headquartered in West Palm Beach, Florida, allegedly paid dozens of physicians thousands of dollars per month to perform patient chart reviews.  According to the government’s lawsuit, the physicians were over-compensated for any actual work they performed and, in reality, payments to the physicians were used to induce them to refer their patients to Recovery Home Care, in violation of the Anti-Kickback Statute and the Stark Law.

Read rest of story here

 

James Hoyer Lead Investigator Explains Florida Fraud for the Tampa Bay Times

Al Scuderi- Lead Investigator James Hoyer Law FirmJames Hoyer’s lead investigator Al Scudieri was recently interviewed for an article about the abundance of fraud complaints in Florida by Robert Trigaux of the Tampa Bay Times.

Al’s theory as to why fraud is so prevalent in Florida is that:

Florida’s not only the third most populated, its population is different… I think we have a more affluent, elderly population. With a heavier concentration of those demographics in this state, they are the most susceptible…They are the ones bad people want to target.

You can read the full article here.

 

 

Michigan Psychotherapy Clinic Owner, Gerald Funderburg, Sentenced to 87 Months in Prison for his Role in $3.3 M Medicare Scheme

A former Michigan resident who directed a $3.3 million psychotherapy fraud scheme, was sentenced today to 87 months in prison, announced Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI Detroit Field Office and Special Agent in Charge Lamont Pugh III of the Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Detroit Office.

Gerald R. Funderburg Jr., 35, of Syracuse, New York, was sentenced by U.S. District Judge Stephen J. Murphy III in the Eastern District of Michigan.  In addition to his prison term, Funderburg was ordered to pay $1,453,064.59 in restitution.

According to admissions made in connection with his guilty plea, from November 2006 through April 2011, Funderburg owned and controlled Funderburg Clinical & Community Services (FCCS), which he used to submit false claims to Medicare for purported psychotherapy services.

Funderburg admitted that he used the Medicare information and identities of hundreds of Medicare beneficiaries without their consent to submit claims for psychotherapy services that were not actually provided.  Funderburg also admitted that he used personal information of licensed social workers without their consent to obtain Medicare provider numbers in their names, which he then used to submit false claims to Medicare for services purportedly provided by the same social workers.  The social workers, however, did not provide the care for which Funderburg billed Medicare.

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