Medicare Fraud in the Big Easy
Some say that Louisiana is the most corrupt state in the United States. While others might argue that honor should go to Illinois or some other state, everyone agrees that Louisiana is corrupt. Even the former U.S. Attorney from Louisiana, Jim Letten, said “Louisiana is famous, if not infamous, for its corruption.”
The feds say that Miami and South Florida holds the record for Medicare fraud. Unfortunately, cities like Detroit and New Orleans appear to be vying for top honors.
Corruption and fraud has become so intertwined in the culture of Louisiana and New Orleans that many people barely yawn when yet another criminal indictment is unsealed.
My first legal job was with the Orleans Parish District Attorney’s Office (back in the days of Harry Connick Sr.). I was also a cop in the Big Easy. Fraud was everywhere back then. Unfortunately nothing has changed.
The New Orleans Times Picayune recently covered the story about criminal Medicare fraud charges against Louella Givens. Until recently, Givens was a leader in the New Orleans community and a member of the Louisiana Board of Elementary and Secondary Education. Now she is a defendant charged with Medicare fraud, conspiracy to commit health care fraud and violation of the federal anti-kickback statute*. The charges are all felonies.
The feds say that Givens owned two health care companies, Maxima Home Health Services and House Call Home Health Care. They say she paid others for referrals and billed Medicare for services that either were medically unnecessary or were never provided.
According to court records, Givens found a physician willing to sign medical necessity forms certifying that the patients needed treatment. That doctor, identified only as “cooperating physician 1” has now agreed to cooperate with prosecutors.
Unfortunately, this story isn’t an isolated incident nor does it appear that Givens was operating alone. Three other family members have been implicated, seven physicians and numerous patients and employees. Reading the affidavit of the Health and Human Services special agent, it looks like everyone was making money.
Everyone except taxpayers, of course.
Medicare is funded with tax dollars. The Justice Department says that Maxima and House Call submitted $12.2 million in claims to Medicare, most of which were fraudulent. Those numbers don’t include charges submitted by the doctors involved in the scheme.
What is even worse is the reaction of many folks in New Orleans. The opening words to the Times Picayune story were, “Another day, another public official indicted.”
Judging by the comments to the story, readers appear weary as well. Said one reader, “Another “public benefit” person in “high” places taking theirs before others…….. does it ever stop? Does there exist an honest person handling public money and administering programs for the public good?”
Fortunately there are still honest people in government. Ditto for those in the health care profession. Although the bad apples get all the publicity, most public servants and healthcare workers are decent, hard working people. A few even rise to the challenge and become whistleblowers.
Under the federal False Claims Act, Medicare fraud whistleblowers are entitled to keep a portion of whatever the government collects from wrongdoers. Awards of $1 million or more are quite common. (We have helped our clients collect whistleblower awards in excess of $100 million.)
Louisiana has its own Medicaid fraud whistleblower law called the Medical Assistance Programs Integrity Law. It too can pay awards of up to 30%.
The FBI calls Medicare fraud an epidemic. Despite a record number of indictments, it continues today. Some say it is getting worse. The Medicare folks can’t audit every claim and every provider. Whistleblowers, however, are the best weapon in the war against fraud and corruption.
[Editors Note: Givens was convicted of Medicare fraud. See our cornerstone page on New Orleans Medicare fraud for complete details.]
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