Medicaid and Medicare fraud are federal crimes. Defraud a government backed healthcare program and you could go to prison for 10 years. If someone is harmed as the result of the fraud the maximum penalty is 20 years! One might think that would stop many would-be fraudsters from committing these crimes. Not so, experts believe that 10% of all the money spent on healthcare is paid out on fraudulent claims.
There is so much money to be made in Medicare fraud that it seems everyone is doing it, even doctors. Last month federal prosecutors charged a 60 year old physician in Englewood, New Jersey with one count of Medicare fraud and 35 counts of making false statements relating to healthcare matters. If convicted, Dr. Albert Ades faces 185 years in prison plus the loss of his medical license (not that he will need it).
Prosecutors say that Ades billed Medicaid, Medicare and private insurers for face-to-face office visits even though he never actually saw some of the patients. Sometimes he billed prescription refills as office visits. Ultimately an insurance company that was auditing patient bills questioned him. Instead of coming clean, prosecutors say that he compounded the problem by shredding patient records and creating fake replacements.
Ades is presumed innocent until proven guilty.
According to the indictment, at least four of Ades’ former employees told him that his actions were illegal. One employee recorded a conversation in 2013 in which Ades when allegedly confronted about his illegal activities said, “I wrote something — the fact that I wrote something, documented something – somebody’s paying me for that.”
The indictment doesn’t say how Ades was ultimately caught. We know, however, that he was audited once by a private insurance company and that at least one of his employees recorded him discussing what appears to be clear Medicare fraud.
Thousands of people report Medicare fraud each year. Only a handful of would-be whistleblowers, however, hire a lawyer and file a complaint under the federal and state false claims acts. Just over 700 complaints were filed last year resulting in whistleblower award payments of $635,000,000.00.
Calling a Medicare fraud hotline doesn’t get you an award. While we have no compliant with folks using hotlines, often whistleblowers will seek our services after a case comes to light in the press. By then it is usually too late.
A whistleblower under the federal False Claims Act can receive up to 30% of whatever the government collects. Because each bogus Medicare reimbursement request is a “false claim” subject to an $11,000 penalty, damages and award monies can mount quickly in Medicaid and Medicare fraud cases.
To learn more about becoming a whistleblower and earning a cash award, give us a call. We help ordinary people become heroes, stop fraud, protect patient health and earn the maximum possible award. Need more information? Contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). All inquiries protected by the attorney – client privilege and kept in strict confidence.
MahanyLaw – America’s Medicare Fraud Lawyers