Medicare and Healthcare Fraud: Putting Honest Medical Professional at Risk of being Wrongfully Accused

On Aug. 25, 2015, a “now former” owner and operator of multiple health care clinics in New York City was sentenced to 87 months in prison and three years of supervised release after pleading guilty to defrauding Medicare of more than $30 million. Oscar Huachillo, the man convicted of Medicare fraud and tax evasion, was also ordered to pay $31,177,987 in forfeiture and $3,454,244 in restitution.

The fraudulent scheme was committed through claimed provision of infusion treatments and injection to Medicare-eligible HIV/AIDS patients. In reality, however, the patients were all recruited and made to visit any of Huachillo’s Clinics many times a week for many months in order to receive expensive “treatments” which included administration of very expensive drugs that were reserved for anemia and cancer patients. Many times, however, no medications were actually provided or, if ever these were provided, these were given at highly diluted doses to people who really had no need for said medical treatment.

The $300 paid weekly by Huachillo and his companions to the HIV/AIDS patients in exchange for their coming to the Clinics and undergoing treatments was nothing compared to the tens of thousands of dollars that Huachillo received as reimbursement from Medicare. And, to make sure that they will never run out of people to treat, patients were offered about $50 more for every additional person they will be able to take and refer to the Clinics.

Medicare and Healthcare fraud, which financially burden the Medicare program, cheat honest taxpayers, put patients at risk, compromise the integrity of honest healthcare providers, and cost the US tens of billions of dollars every year. According to the Federal Bureau of Investigation (FBI), the prime agency tasked to expose and investigate health care fraud in private and federal insurance programs, this criminal activity, which continuously threatens the financial aspect of various government programs, is committed in many different ways, like:

  • Filing claims for treatments and tests (lab test) that were never performed;
  • Falsification of names when filing insurance claims;
  • Making claims for illnesses or injuries that do not exist;
  • Over-charging the government for treatments provided to patients; and,
  • Filing a claim for medical supplies that were not used;

To be able to identify and catch, especially those who aggressively commit fraud, the FBI works determinedly with the help of: various federal and state agencies; private investigative associations; and, different insurance groups. Due to the overzealousness of authorities and prosecutors, the federal government was able to recover $5.7 billion in 2014 (this was $1.9 billion higher than 2013). Besides this, many doctors, sources of medical supplies, executives and practice owners, now also get charged almost weekly. According to the U.S. Department of Health & Human Services, during the second quarter of 2015, about 243 individuals were charged for their alleged participation in Medicare fraud schemes. The arrests of the 243 individuals, which included doctors, nurses and other licensed medical professionals, were results of a nationwide sweep led by the Medicare Fraud Strike Force; some providers were also suspended by the Centers for Medicare & Medicaid Services (CMS) for their possible involvement in the fraud that amounted to $712 million in false billings.

Recovered money and people getting arrested are definitely good news for patients and taxpayers; however, for those who have been, and will be, wrongly charged, getting arrested is already a nightmare, how much more if they get convicted.

From the website of the law firm Kohler Hart Powell, SC, it is mentioned that the government, in an attempt to recover losses from fraud, often makes mistakes which result to the accusation of innocent medical professionals committing federal criminal offenses. Sadly, it is also irrelevant for many government authorities how this wrongful accusation will affect a person’s practice, family, career, and reputation.

Clearly, wrongfully accused healthcare professionals can lose more than just their profession and credibility. It is their very source of livelihood and, thus, their lives which are at stake in the event of a wrongful accusation.

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Defective Seat Belts Causing More Injuries and Deaths Than One Thinks

According to the National Highway Traffic Safety Administration (NHTSA), highway injuries and fatalities have declined for the last 10 years. One major reason for this decline is the rapid increase of seat belt use by motor vehicle drivers. Due to the protection it can provide, all U.S. states, with the exception of New Hampshire, now have mandatory seat belt use laws to make sure that motorists will buckle up or face the possibility of getting a citation.

Today, the best safety device that can protect car drivers and passengers from getting injured (or killed) during an accident is still a seat belt, a crash-safety device designed to protect car occupants from hitting with great force any of a car’s interior parts, like the dashboard, the door window or the windshield, as their car collides with another vehicle or a fixture on the road. A seat belt would also help keep a car occupant from smashing the windshield and getting thrown outside the car. State legislations on the use of seat belt was actually preceded by Title 49 of the United States Code, Chapter 301- Motor Vehicle Safety Standard, a federal law that took effect on January 1, 1968, and which required that all types of vehicles, with the exception of buses, be fitted with a seat belt in all seating positions designated by the law.

The most common stipulation of seat belt laws in all states is the use of a seat belt by the driver. With regard to passengers, the law considers the age and the specific seat where he or she is seated; thus, a person (depending on his or her age) at the backseat may not be required to buckle up. Only children seven years old and below should be restrained by a seat belt at all times.

In 2009, the Centers for Disease Control and Prevention (CDC) recorded 33,000 deaths and 2.2 million injuries due to road crashes; more than half the number of those killed were not restrained at the time of the crash. But while seat belts have saved thousands of lives, these devices have also been identified as the cause of injury or death rather than protection – due to poor design. Fatal car crash records, in fact, show that, of the more than 30,000 deaths every year, at least 10,000 are said to have died due to a faulty seat belt.

Defects in seat belts include a seat belt buckle loosening by itself, the belt tearing easily, the release buttons not working properly, and a vehicle being equipped only with a lap belt (which does not include an upper torso restraint).  These defects can cause serious harm, like spine fracture, head and facial injuries, abdominal injuries, lacerations, internal organ damage, dislocations, concussions, and whiplash; the severity of some injuries eventually result to death.

The dangers presented by defective seat belts are too serious to ignore. This is why even giant automobile manufacturers are either ordered (by the NHTSA) to recall or are forced to make voluntary recalls of certain vehicle models due to technical problems and design flaws in seat belts. Chrysler, for example, had more than 14 million of its vehicles recalled due to malfunctioning of defectively designed seat belts.

In its website, The Benton Law Firm strongly emphasizes the huge responsibility of automobile manufacturers and parts makers in accidents caused or exacerbated by their defective auto parts, accidents that can all too easily result in severe and long-term injuries such as those mentioned above. Following this thought, the firm Spiros Law, P.C. says that those who get involved in an accident and get injured or killed due to mechanical defect or malfunction in a seat belt may be eligible for financial compensation to help offset the costs associated with treatment and recovery.

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