Medical Fraud

Published on: December 5, 2011

Why Do We Have Such a Severe Los Angeles Medicare Fraud Problem?

This blog is not the only blog on the web to voice serious concerns over Los Angeles Medicare fraud investigative practices.

Indeed, it’s common knowledge that both state and federal efforts to identify, track, and thwart Southern California white collar crimes, like Los Angeles’ insurance fraud, credit card fraud, healthcare fraud and the like are stymied by bad processes and systems. It’s a fiasco: there are problems with method, investigators who are not incentivized correctly, evidentiary mistakes, etc. Outsiders introduced to the system often blanch at just how out of control things seem to be.

Last week, an AP article crystallized the frustrations many people out there in the Los Angeles criminal defense community have been feeling:

Published on: November 28, 2011

Being Accused of Los Angeles Medicare Fraud: Can Your Conscience Ever Be Cleared?

by Michael Kraut

If you or someone you care about was recently arrested or investigated for a crime like Southern California Medicare/Medi-Cal fraud, your life has been topsy-turvy.

The penalties associated with your charges could include substantial jail time and forced reparations. You could also lose your dental, medical, or chiropractic license. On top of that, a seemingly endless array of ripple effects could haunt you: e.g. loss of your professional reputation, loss of respect from your family members and peers, financial problems, etc.

Perhaps the most frustrating thing about being tagged for Los Angeles Medicare fraud (or Southern California credit card fraud, Los Angeles insurance fraud, or other so-called white-collar crimes) is the self-recrimination that often follows.

Published on: November 1, 2011

Glendale Medicare Fraud Ring Busted – 17 Accused, Including Glendale Doctor and San Marino Pharmacist

by Michael Kraut

According to a October 28th report in Los Angeles Times, 17 people, including a pharmacist and physician, have been accused of Medicare and Medi-Cal fraud for participating in a sophisticated psychiatric drug recycling ring that bilked benefits programs out of millions of dollars and compelled the government to pay multiple times for the same stolen pills.

Apparently, so-called “runners” in the ring would obtain Medicare beneficiary cards illegally, either by buying them outright from Medicare and Medi-Cal recipients or by stealing them. Then they would use these cards to obtain prescriptions for expensive antipsychotic agents, like Zyprexa and Seroquel. According to q criminal complaint filed in U.S. District Court in Los Angeles last Thursday, the scam was sophisticated, intertwined, and quite organized.

After the runners filled the prescriptions and billed for them, they would then funnel the drugs back to the pharmacies that provided the drugs in the first place. Those pharmacies would then repackage, re-label and dispense the drugs, often to ring members using stolen Medicare cards.

Published on: October 18, 2011

Los Angeles Medicare Scam Alert! 14 People (Including Two Docs) Hit with Federal Charges

by Michael Kraut

Last Thursday, 14 people were indicted on federal charges of Los Angeles Medicare fraud, after billing Medical and Medicare for over $6 million in medical services that were either never performed or completely unnecessary.

The five-count indictment is against Lake Medical Group (based here in LA). The scam artists allegedly bilked insurance companies out of over $2.7 million in Oxycontin-related sub-scam. According to a Thursday report in the San Francisco Chronicle, so far 10 people have either surrendered or been placed under arrest. Pharmacist Theodore Yoon, as well as two doctors – Dr. Morris Halfon and Dr. Eleanor Santiago – were among those who allegedly conceived of and perpetuated this Los Angeles Medicare scam.

Here are the gory details, courtesy the San Francisco Chronicle article: “Investigators said the scam between August 2008 and February 2010 involved the clinic using recruiters known as “cappers” who brought in Medicare and Medical patients who were often issued a prescription for Oxycontin. They were offered up to $500 to get the prescriptions filled… Runners took the patients to pharmacies, including some run by Yoon… the clinic’s administrator was given the pills that were then sold on the street for roughly $25 a piece [the pills usually sell for around $6 each].”

Published on: October 3, 2011

The Southern California Medicare Fraud Epidemic: What’s the Root Cause?

by Michael Kraut

The Obama administration and California state officials are passionately bent on stamping out Southern California Medicare/Medical fraud, and their quest makes a good deal of sense.

Our national and state coffers are challenged by a sluggish economy that shows no signs of long-term stabilization, and the California state budget debacles have made the Golden State something of a laughing stock.

Stories in the news about doctors, dentists, chiropractors, and other health care providers perpetrating schemes to defraud public programs out of much-needed funds have awakened righteous ire, not only in public officials but also in the public at large. The search for justice is understandable, at least from a psychological perspective, but the passion can be dangerous.

Published on: September 26, 2011

Los Angeles Medical Crime Blotter: Michael Jackson’s Doc Told Paramedics Star Was “Fine” When He Was in Fact “Dead”

by Michael Kraut

Crimes like Los Angeles Medicare, Medical, and Medicaid fraud are serious and scary for defendants. But the details often make for dry, complicated reading.

michael-jackson-conrad-murray-los-angeles-drug-crime.jpg

Readers interested in pulpy, tabloid-like Southern California medical crimes might be more galvanized by an amazing revelation in the trial of Michael Jackson’s erstwhile doctor, Conrad Murray.

According to a report from the UK paper, The Mirror, the transcript of a witness statement “revealed that the doctor [Conrad Murray] stood in front of a lifeless Jacko in the singer’s bedroom and claimed: “He doesn’t have a problem. He is fine. He was practicing all night. I am just treating him for dehydration.””

Published on: September 4, 2011

Southern California Medicare Fraud Crackdown: It’s Real and Becoming More Vigorous

by Michael Kraut

Were you or a close family member or friend recently arrested and charged with Los Angeles healthcare fraud? If so, you are not alone.

According to recently released government statistics – thanks to the Obama administration’s efforts, federal healthcare fraud prosecutions spiked more than 85% in 2011 over 2010. The Transactional Records Access Clearinghouse (TRAC) statistics show that the federal government has prosecuted over 900 people so far this year for healthcare fraud. In all of fiscal year 2010, only 731 people were prosecuted across the U.S. The TRAC data suggest that prosecutions have spiked more than 70% from just half a decade ago.

A spokesman for the Justice Department, Alisa Finelli, confirmed the TRAC data analysis: “the trend certainly looks accurate and on track with our data.” Over the past 12 months, the Justice Department has brought out the heavy ammunition to nail executives, nurses, doctors, and other caregivers (e.g. chiropractors, dentists, etc.) for defrauding programs like Medicare and Medicaid. Here are some fraud arrest highlights from 2011:

Published on: August 21, 2011

Los Angeles Medicare Fraud Bust Nabs a Man of God. What is Our World Coming to?

by Michael Kraut

Last Tuesday, a jury convicted Pastor Christopher Iruke in a multimillion dollar Los Angeles healthcare fraud case. Iruke, an employee, and Iruke’s wife were nailed on charges of healthcare fraud and conspiracy to commit fraud for devising and carrying out a scam that bilked Medicare for $14 million.

A story last week in the Los Angeles Times painted a vivid picture of Iruke’s last moments before his arrest. As federal authorities zeroed in on his fraud ring, the pastor of a South LA storefront church started to “shove pages upon pages of incriminating evidence into a shredder until the machine overheated. He then stuffed papers into the toilet and tried flushing his problems away…the documents linked him to bogus prescriptions for power wheelchairs for which he billed the government about $6,000 a piece, prosecutors alleged.”

Prosecutors said that the pastor collected about $6.6 million in reimbursements from the false claims (out of $14.2 million in claims filed) and that “the money funded a lavish lifestyle, including several luxury cars, international travel, and about $0.5 million remodeling on his Baldwin Hills home.”

Published on: August 9, 2011

Southern California Medicare Fraud “Shot Across the Bow” – 26 Busted for Defrauding Medicare and Medicaid out of Nearly $60 Million

by Michael Kraut

Newsflash: the Southern California Medicare fraud crackdown is real.

The Drug Enforcement Administration, Department of Health and Human Services, FBI, and other organizations are taking dead aim at fraud rings. They want to punish schemers and sending a warning to would-be white collar criminals in Los Angeles: consequences can be dire.

The latest shot across the bow comes out of Detroit. Last week, 26 people were indicted in US District Court. Allegedly, they bilked Medicare and Medicaid out of over $58 million in a fraudulent prescription scheme. The alleged mastermind, Babubhai “Bob” Patel, allegedly purchased a number of local Detroit pharmacies and then “set them up with store owners to conceal his stake in the enterprise.” Using this structure, Patel and his fellow coconspirators wrote bogus prescriptions and collected kickbacks. Patients were recruited to bribe individuals “to bill their insurance for medications and services that were either never provided or unnecessary.”

Published on: July 25, 2011

Will New Computer Models Lead to Dozens of New Los Angeles Medicare Fraud Arrests?

by Michael Kraut

Brace yourself for a slew of high profile Southern California medicare fraud arrests.

According to a July 10 article in Los Angeles Times, “Medicare Anti-fraud Detection System Launched,” federal officials have set up a powerful new predictive modeling system to identify Medicare fraud and punish syndicates and individuals who bill for false claims and engage in other types of fraud.

The LAT describes the computer predictive modeling system – which was honed in South Florida over a few years – as working “much like credit card systems that raise alerts about suspicious purchases – such as 20 pairs of shoes or unusually large sales – to help block criminals from using stolen cards or IDs.”