by Brian Mahany
Just two days ago we posted a story about health care fraud. 48 hours later and another sad story of patient abuse emerges; patient abuse for profit.
The United States Attorney for New Jersey, Paul Fishman, announced a 68 year old cardiologist pleaded guilty to one of the largest health care frauds in the New York tri-state area. Prosecutors say Jose Katz admitted to felony conspiracy to commit health care fraud. He faces 15 years in prison when sentenced later this year. At 68 years old, that could well be a death sentence.
Katz had a large cardiology practice in New York and New Jersey. The FBI says that between 2005 and 2012, he billed Medicaid and Medicare over $70 million. That sum doesn’t account for the millions more billed to private health insurance companies.
Medicaid and Medicare are funded by tax dollars. When someone steals from the Medicare program, everyone suffers. Although no one likes to pay taxes, its worse when our hard earned tax dollars are taken by fraudsters.
Katz’ illegally billed for services provided by unlicensed practitioners, for needless tests and unnecessary procedures. Many of his patients were told they were suffering coronary artery disease even though they were fine. He told these patients they needed expensive and potentially dangerous enhanced external counter pulsation (EECP) therapy.
Although EECP is a non invasive cardiac treatment, it can be dangerous for patients with certain medical conditions. Since unlicensed practitioners were often used to diagnosing patients, no one knows how many patients were needlessly placed at risk.
In announcing the guilty pleas, U.S. Attorney Paul Fishman said “After years of prominence in his field, Jose Katz will now be remembered for his record-setting fraud. Ripping off the government and insurance companies is bad enough; risking patient health in the bargain is inexcusable.”
It wasn’t just Medicare that Katz ripped off. He also pleaded guilty to Social Security fraud after falsely reporting that his non-working wife made $1.2 million during that same time period thus making her eligible for $263,000 in social security benefits – benefits to which she was not entitled.
Most health care fraud cases come to light through the actions of heroic whistleblowers; ordinary men and women who are tired of seeing massive fraud. Ripping off taxpayers is pretty serious but endangering lives for the sake of profit is even more inexcusable.
To encourage whistleblowers to come forward, Congress passed the federal False Claims Act which allows whistleblowers to keep a percentage of whatever monies are recovered from the person or company committing the fraud. Awards typically are 20 to 25% of the amounts collected. In a $70 million fraud case, that award could be staggering.
To qualify for an award, you must have inside “non public” information about the fraud and its participants. There must also be a loss to taxpayers. Many whistleblowers are concerned citizens. Others are business competitors, disgruntled employees or jilted lovers.Whatever the motivation, whistleblowers play a valuable role in the battle against health care fraud.
For more information or to learn if you may qualify for a cash award, contact attorney Brian Mahany at or by telephone at (direct). All inquiries are kept in strict confidence and protected by the attorney – client privilege.
Mahany & Ertl – America’s Fraud Lawyers. Offices in Milwaukee, Wisconsin; Detroit, Michigan; Minneapolis, Minnesota; Portland, Maine and San Francisco, California. Services available in many jurisdictions.
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