Another physician may soon be headed to jail. Simply because of greed; greed which resulted in a criminal conviction for a Medicaid fraud related charge. Dr. Clifford Hurley of Rochester pleaded guilty to falsification of healthcare records. His practice pleaded guilty to a felony theft charge.
Medicaid is the insurer of last resort for millions of Americans. Primarily designed for lower income folks, Medicaid relies on both federal and state tax dollars for funding. Because budgets are squeezed in most states, Medicaid is inadequately funded in many areas of the country. That means that truly needed patients are denied care or must wait for months. And to think that a few greedy doctors, nursing home operators and clinic owners simply want to steal a few more dollars. Profits before patients.
Medicaid fraud is a national problem but is especially acute in New York. Experts say that the state’s healthcare fraud rate puts the Empire State in the top ten percent nationwide for fraud. And in some cities, fraud is rampant. Thankfully, New York enjoys a dedicated state Medicaid Fraud Control Unit. That law enforcement unit brought back $63 million last year. Unfortunately, the state’s annual fraud loss is estimated to be in the billions.
According to the state attorney general’s office, Dr. Hurley was billing Medicaid for patents he did not even see. Sometimes a patient would stop in the office for a prescription refill. Hurley would bill as if he had an office visit with the patient even if he never saw the patient.
What concerns us more is that “ineligible staff” were allegedly conducting counselling sessions with patients. Stealing money is bad enough but having unqualified staff see patients can be dangerous.
In addition to the criminal charges, Hurley also must repay the state $500,000. Medicaid fraud can be punished both criminally (meaning possible jail time) and civilly. Claims for monetary damages are civil and usually brought under the False Claims Act.
The prosecution of Hurley was handled jointly by the state Attorney General and the N.Y. Medicaid Fraud Control Unit with assistance from the NY Department of Financial Services. In announcing the convictions, NY’s Superintendent of Financial Services, Maria Vullo, said, “Victims in crimes like this are honest, hard-working New Yorkers who are unnecessarily forced to pay more for health insurance and more in taxes to support Medicaid. The Department of Financial Services is committed to aggressively fighting and stamping out health care fraud and we are pleased to work with the Office of the Attorney General in resolving this case.”
New York’s Attorney General Eric Schneiderman made similar comments, saying “Health care providers who defraud Medicaid hurt taxpayers and the vulnerable New Yorkers who rely on the critical services the Medicaid program provides. We will fight to hold fraudulent medical professionals accountable and recover those ill-gotten gains.”
New York Medicaid Fraud and Whistleblower Awards
Most Medicaid and Medicare fraud cases are uncovered by whistleblowers. Billing professionals, coders, nurses and even other doctors are the best line of defense against healthcare fraud.
In New York, whistleblowers with inside information about Medicaid fraud can earn an award from the state of up to 30% of whatever is collected from the wrongdoer. Because the law allows for triple damages and huge monetary penalties, awards measured in the millions of dollars are not uncommon.
29 states have Medicaid fraud whistleblower award laws but even in states that do not, the federal government can always pay awards for the federal matching dollars used for Medicaid programs. In New York that means it is possible to collect two whistleblower awards for the same information.
Our mission is to encourage would be whistleblowers to step forward and report wrongdoing. We empower healthcare professionals to report greed and misconduct and protect patient safety. We also defend our whistleblower clients from any employer retaliation. Finally, we work tirelessly to get our clients the maximum award possible.
If you have inside information about Medicare or Medicaid fraud, give us a call. All inquiries are protected by the attorney – client privilege and kept strictly confidential. For more information, please contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct).
MahanyLaw – America’s Medicaid Fraud Whistleblower Lawyers