Last month the Justice Department and Medicare Fraud Strike Force led a nationwide dragnet that charged 243 people with Medicare fraud. Prosecutors say those 243 people caused $712 million in false Medicare billings. Since Medicare is financed by tax dollars, the 243 are essentially charged with stealing from every American.
Typically, most Medicare fraud is centered in certain cities such as Houston, Miami, Detroit, Chicago and Philadelphia. Although quite small population wise as compared to the larger cities on this list, New Orleans is another Medicare fraud hotspot. In fact, 11 of the 243 people arrested in last month’s sweep come from New Orleans. More importantly, $110 million of the total $712 million in alleged false billings come from the Crescent City.
Since 1938, New Orleans has been known as the City that Care Forgot. As a former police officer in New Orleans, I will share the city’s unofficial nickname; the “city that forgot to care.” Obviously that label isn’t fair for the tens of thousands of hard working people that call New Orleans home. Unfortunately, the city is also home to a visible minority of fraudsters, corrupt politicians and apparently, Medicare thieves.
The New Orleans charges stem from a federal grand jury that returned several indictments against 13 companies involved in a wide variety of healthcare businesses including home health care services, psychological testing services, durable medical equipment and psychotherapy services. The common theme of all these businesses is Medicare fraud – billing for services never provided or services that were medically unnecessary.
Two physicians associated with a company called Christian Home Health Care, Inc. were among the many people indicted. According to court documents, Elaine Davis (owner of Christian Home Health) and the two physicians, Pramela Ganji, M.D., and Godwin Ogboukiri, M.D., falsely claimed that thousands of Medicare recipients in and around New Orleans were in need of home health care services. Between 2007 and 2015, Christian submitted more than $33.2 million in claims for home health care services to Medicare, the vast majority of which were fraudulent.
In order to be reimbursed by Medicare, home healthcare services must be medically necessary and approved by a physician. Prosecutors say that Doctors Ganji and Ogboukiri falsely assisted Davis and her company by providing the false medical necessity documents.
The doctors profited by receiving hundreds of thousands of dollars in payments from Medicare.
Like many blatant Medicare fraud schemes, prosecutors say that Davis and Christian Home Health Care relied on a system of patient recruiters, people that are frequently paid in cash to find Medicare eligible patients or obtain Medicare billing ID numbers.
The trio are charged with five counts of federal Medicare fraud and conspiracy to commit healthcare fraud, all felonies.
In a press release issued after the nationwide dragnet, Attorney General Loretta Lynch said,
“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement. The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered. In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives. We are prepared – and I am personally determined – to continue working with our federal, state, and local partners to bring about the vital progress that all Americans deserve.”
Also indicted for Medicare fraud were psychologist Rodney Hesson and Gertrude Parker for their roles in a $25 million psychological testing scheme carried out through eight companies in four states. The indictment alleges that these companies contracted with nursing homes to allow clinical psychologists to administer psychological tests to nursing home residents. Dr. Hesson and Ms. Parker caused the companies to bill Medicare for psychological testing services that these nursing home residents did not need or did not receive. Between 2009 and 2015, companies involving the pair submitted over $25.2 million in claims to Medicare, a significant amount of these claims being fraudulent.
Separately, Geoffrey Ricketts, Marla Ricketts, Sunyup Kim and Samuel Kim were indicted for their participation in a $38 million fraud scheme involving the distribution of “talking glucose meters” that were not medically needed and were often not even requested. Court documents allege that the defendants paid kickbacks to workers at call centers in California and South Carolina. There operators would cold-call Medicare recipients to convince them to accept talking glucose meters and related supplies. From 2007 through 2015, the defendants caused more than $38.2 million in claims to be submitted to Medicare virtually all of which were fraudulent.
Separately, a grand jury s charged Sheila White with Medicare fraud in connection with the alleged provision of psychotherapy services to Medicare beneficiaries. The indictment alleges that White fraudulently billed Medicare for psychotherapy services claimed to be provided at Brandye’s House of New Orleans, a company she operated. The indictment further alleges that White used the Medicare provider number of a licensed clinical social worker who did not work for Brandye’s House, without lawful authority. Between 2011 and 2015, Brandye’s House allegedly submitted over $1.8 million in claims to Medicare, virtually all of which were fraudulent.
Finally, Louella Givens was charged by criminal complaint for a fraud scheme carried out through two companies — Maxima Home Health Services (Maxima), and House Call Home Health Care (House Call). The complaint alleges that Givens caused Maxima and House Call to submit claims for home health services to Medicare beneficiaries in and around New Orleans. The complaint alleges that a vast majority of these services were not medically necessary and/or not provided. From 2008 through 2014, Maxima and House Call submitted claims to Medicare amounting to more than $12.2 million, the vast majority of which were fraudulent.
Medicare fraud is a national problem. The FBI calls it an epidemic costing taxpayers $80 billion per year. While government auditors catch some fraudsters, many more are caught because of whistleblowers.
Under the federal False Claims Act, Medicare fraud whistleblowers can receive up to 30% of whatever monies are recovered by the federal government. Many states have similar healthcare fraud laws that pay can pay whistleblower awards in Medicaid fraud cases.
Unfortunately, most whistleblowers do not know about the False Claims Act and the very precise rules that must be followed to collect an award. Instead, many whistleblowers use the Medicare fraud hotline to report fraud. While all whistleblowers should be commended, calling the hotline will generally just get you a $1000. Filing a lawsuit under the False Claims Act can generate millions.
Are Million Dollar Medicare Fraud Whistleblower Awards “Real”?
Last year the federal government handed out over $635 million in awards under the False Claims Act program. The awards are real but picking up the Medicare fraud hotline won’t get you those big awards.
To claim an award under the False Claims Act, one must have original source (inside) information about fraud and file a sealed complaint in a federal court.
Need more information? We help whistleblowers collect the maximum awards possible. Our clients have received over $100,000,000.00 in whistleblower awards. For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). All inquiries are protected by the attorney – client privilege and kept strictly confidential.
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