Articles Posted in Health Care and Insurance Fraud

Prosecutors and investigators for the United States Department of Justice and the State of New York announced last week an indictment on federal health care fraud charges on a licensed pharmacist and business owner in New York. The basic allegations are that the pharmacy owner paid off customers (in other words, provided kickbacks) to fill fake prescriptions at his pharmacy. The pharmacy would then bill the prescriptions to Medicaid and Medicare. However, the government alleges that either prescriptions drugs were never actually given to the customers or that drugs of lesser value were given, and that it was a scheme to fraudulently get reimbursed by Medicaid and Medicare.

What is a kickback under federal law?

The prescription fraud lawyers at the Barone Defense Firm have provided a detailed discussion about the Federal Anti-Kickbacks Statute previously.  The statute refers to a kickback payment as “remuneration.” Remuneration basically means cash or anything else in value. For example, in this case, the government alleges that the pharmacy owner gave customers coupons valued up to $5,000.00 in exchange for customers submitting fraudulent prescriptions.

US News and World Report has once again included the Barone Defense Firm as among the region’s Best Law Firms for DUI/DWI Defense. The Firm has been so listed since 2010.

US News and World Report ranks lawyers based on a variety of criteria. While the award is granted by the publication, it is essentially based on peer review. For a law firm to be ranked by US News and World Report a lawyer in the subject firm must first be among those lawyers who have previously received a “Best Lawyers” award by US News and World Report. These lawyers have passed peer review, meaning that other lawyers in the region, or nationally if applicable, have indicated that the lawyer possesses sufficient subject matter expertise, is known to possess and execute a high level of responsiveness to the rigors and demands of the profession, including things such as decorum with the courts, timely filing of pleadings and papers, responding to clients and opposing counsel, and many other professional demands. Peers are also asked whether they would refer a matter to a firm and whether they consider a firm a worthy competitor. On this basis, the Barone Defense Firm has a tier one regional ranking for the area of DUI/DWI.

For more than 20 years the Barone Defense Firm has developed its pristine reputation for DUI/DWI defense and distinguished itself among its peers for excellence in this challenging area of criminal law. However, for the later portion of the past 20-year period the Barone Defense Firm has expanded its practice to include other areas of criminal defense at both the State and Federal level and has developed expertise in such disparate areas as firearms law, criminal sexual conduct including the possession manufacture and distribution of child pornography (at the Federal level) and CSAM (child sexually abuse material) and other CSC cases at the state level, and many areas of white collar criminal including health care fraud, prescription fraud, complex financial crimes and RICO.

The Barone Defense Firm is pleased to announce that Patrick Barone, the Firm’s founding member, has been admitted to practice before the Federal District Court for the Western District of Michigan. Mr. Barone has been admitted to practice before the Federal District Court for the Eastern District since 1993.

Mr. Barone was admitted to the State Bar of Michigan in 1991. He was admitted to the State Bar of Illinois in 1993.  However, being admitted to the state bar in one or more states does not authorize a lawyer to practice before any Federal Court.  This is because the rules applicable to Federal Courts differ from State Courts in several ways.  First, simply being admitted to a state bar is necessary but insufficient. Admission before a specific Federal Court requires that the attorney seeking admission prepare a petition to be filed with the Federal Court.  This petition must be supported by a sponsoring attorney who vouches for the attorney seeking admission.  The sponsoring attorney must already be a member of Federal Court where the petitioning lawyer is seeking admission.

Barone-2020-381-300x200

Federal Criminal Defense Team

Michigan doctors are under heightened risk of prosecution for prescription fraud.  This is because Michigan, and specifically the Eastern District of Michigan, has been identified as one of the top 12 places in the Country for opioid fraud and abuse. For this reason alone it’s important for Michigan doctors to be aware of how prescription fraud cases are identified and prosecuted.

Broadly speaking, prescription fraud is committed when someone fraudulently obtains prescription drugs. The fraud can be committed in various ways. For example, there have been cases in which doctors wrote fake prescriptions for pain killers and gave the scripts to a “runner.” The runner then takes the scripts to a knowing or unknowing pharmacy for the prescription to be filled. In these cases, the drugs are typically re-sold on the street at a very high markup. The funds are then distributed back up the chain.

Another example comes from a recent prescription fraud case in Michigan. In this case, two men worked together. One would impersonate a doctor and call a prescription into a pharmacy. The two men then drove to the pharmacy and the other would go in and try to obtain the prescription drugs.

Doctor Roger D. Beyer recently pleaded guilty to conspiracy to commit healthcare fraud in the United States District Court for the Western District of Michigan. In a complaint filed on May 8, 2020, the US Attorney assigned to the case set out several allegations.

Regarding healthcare fraud, the complaint alleged that Dr. Beyer’s office improperly coded procedures reported to Medicare. The complaint alleged that Dr. Beyer directed his staff to perform a rectal diagnostic procedure repeatedly, beyond the initial diagnostic purpose of the procedure. Dr. Beyer’s offices then continuously billed Medicare for the diagnostic service even though they weren’t medically necessary. By continuously performing the diagnostic service, Dr. Beyer’s office could bill Medicare each time for that service even though it wasn’t medically necessary.

What are CPT codes?

Contact Information