Miami Hospital Pays $15.4 Million to Resolve Fraud Case for Kickbacks and Unnecessary Treatments
December 14, 2006 by brian
via United States Department of Justice
THURSDAY, NOVEMBER 30, 2006
WASHINGTON – Larkin Community Hospital in Miami and its current and former owners, Dr. Jack Michel, Dr. James Desnick, Morris Esformes and Philip Esformes, have paid $15.4 million to settle federal and Florida civil health care fraud claims against them, the Justice Department announced today. Additionally, 34 related companies owned by the Esformes that were used to operate nine assisted living facilities are part of the settlement along with Claudia Pace, an employee of one of the Esformes-owned companies; and Frank Palacios, a long-time employee of the hospital.
The settlement resolves the civil case entitled United States v. Jack Jacobo Michel, M.D., et al., which the government filed in 2004, alleging violations of the False Claims Act. The state of Florida joined the suit later that year.
The government alleged that in 1997, Larkin, then owned by Desnick, paid kickbacks to physicians in return for patient admissions. The United States contended that the primary recipient of the kickbacks was Jack Michel, who was paid for patient admissions to Larkin by himself and his brother, Dr. George Michel. Jack Michel purchased Larkin in 1998. In 2000, Desnick was a party to a $14 million settlement with the United States for a similar kickback scheme from 1992 to 2000 at another facility he owned, Doctors Hospital of Hyde Park in Chicago.
The United States also alleged in the Michel suit that from 1998 to 1999, Jack Michel, George Michel, Morris Esformes, Philip Esformes, Frank Palacios and Claudia Pace conspired to admit patients to Larkin for medically unnecessary treatment. The government asserted that some of these patients came from assisted living facilities owned and operated by Jack Michel, Morris Esformes and Philip Esformes.
“The Department of Justice is committed to vigorously litigating cases about conduct that undermines the integrity of the Medicare and Medicaid programs,†said Peter D. Keisler, Assistant Attorney General for the Department’s Civil Division. “We will not tolerate health care providers who pay kickbacks or perform medically unnecessary treatments on elderly beneficiaries in order to generate Medicare and Medicaid payments.â€
The case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; and the Florida Medicaid Fraud Control Unit. The case was handled by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the Southern District of Florida in Miami and the Office of the Attorney General of the state of Florida.
Bobby L. Maxwell – Fighting the Good Fight
December 3, 2006 by bob
Bobby L. Maxwell – another modern day hero trying to make the world a better place.
Over the course of his distinguished career as an auditor for the Interior Department, he recovered hundreds of millions of dollars from oil companies that were routinely and consistently underreporting royalty payments to the federal government. He was so successful at making the oil companies toe the line that he was eventually promoted to a position where he was supervising 120 people.
You’d think that someone who had been praised by the Secretary of the Interior as recently as 2003 for their outstanding job performance and leadership skills would have at least a little job security, but Bobby Maxwell recently found out that this isn’t always the case.
Francine and Rhea Did the Right Thing
November 10, 2006 by bob
As part of a 1998 settlement, Francine Mettevelis and Rhea Jones received $903,899 for reporting that Charter Behavioral Health Systems, in Orlando, Florida, billed Medicare for medically unnecessary psychiatric care for elderly patients with severe dementia, Alzheimer’s Disease and other organic brain disorders.
Medicare fraud, where doctors, HMO’s, or hospitals create frauludent items on patient invoices and submit them to Medicare for reimbursement, is a growing problem, and contributes to the enormous and rising costs of health care in this country. It is important for patients, family, and friends of people who use these services to report cases of suspected fraud.
If you’ve witnessed Medicare fraud in your workplace, you may be able to receive up to one-third of the money recovered in the fraud case under the Federal False Claims Act. And, you can sleep soundly at night, knowing that you did the right thing, and that you are helping lower health care costs for everyone by reporting the fraud to the people.
We can help you if you’ve witnessed this type of activity – contact us to receive information about what you can do to help stop these abuses.
Anonymous Hero Gets Fair Share Of $140 Million
November 5, 2006 by bob
As part of a $140 million civil settlement with Health Care Service Corporation, a private plaintiff was paid more than $21 million for exposing that this Medicare carrier had submitted false information to the Health Care Financing Administration, failed to process claims in accordance with HCFA’s guidelines, and failed to process correspondence and reviews in a timely manner.
This private plaintiff, who preferred to remain anonymous through what must have been a very lengthy and stressful ordeal, helped stop these abuses of the health care system, saving U.S. taxpayers millions of dollars. And, because the Federal False Claims Act stipulates that whistleblowers who catch large companies or individuals red-handed in the act of defrauding the government should be rewarded by up to 30% of the total amount awarded, this anonymous hero walked away with over twenty million dollars.
