One lucky Florida ophthalmologist managed to snare a cool $21 million from his medicare billings last year. A hundred less fortunate doctors made due by sharing $610 million from the total doctor’s billings to medicare of $600 billion. All of this information was disclosed when medicare finally opened its books on individual doctors share of medicare billings. The strategy and tactics of robust billings allow some of our lowly medicare doctors to make even more money than those fancy doctors on television. But when does robust billing become fraud worthy of an FBI investigation?
|Is there a Doctor in my House?
Hidden behind the rush of these recent news stories is the fact that federal investigators will begin shifting thru the cloud of statistics in order to begin targeting individual doctors in hundreds of fraud investigations.
Indicting doctors and other health care providers allegedly involved in health care fraud will become a high priority of the FBI and the United States Attorney’s Office not only in the Middle District of Florida but throughout the entire country.
Medicare fraud typically arises from either over billing or from fake billings. To prove over billing or fake billing the FBI will investigate doctors for medicare fraud under Plan B in the following ways:
First, the FBI will be look for an average mean medicare billing for each specialty. For example, it might not be unreasonable for larger billings in specialties which require more expertise.
Second, the FBI will look for an average mean in medicare billing for each part of the country segregating the billings based on the costs and history of billings in every location.
Third, the FBI will target doctors and hospitals that have billed medicare for more than the average mean of specialty and location.
Fourth, the FBI will look for disgruntled employees and former employees to gain insight as to whether there was a criminal conspiracy to over-bill medicare. Employees will be given two significant incentives of not being indicted laced with the possibility of whistle blower status with financial reward. Employees who fail to co-operate by remaining faithful to the hospital or doctor may find themselves indicted as part of a criminal conspiracy to defraud medicare.
Fifth, the FBI will gain access to business records by utilizing search warrants for criminal conduct. This can temporarily shut down the doctor’s office inducing enough immediate financial hardship to scare the doctor into co-oporating with the Government.
With the Government focused on lowering health care costs, it’s clear that it will soon declare war on doctors who may have robustly billed medicare. The ultimate objective of the Government will be the arrest, conviction and imprisonment of imminent doctors to deter others from who received payments from Medicare under Part B.
Doctors who are under investigation may not receive target letters informing them of the fact. In fact in most medicare fraud investigations a target letter is only sent after a completed investigation as a prelude to a possible negotiation with the doctor to avoid a grand jury indictment by allowing him or her to plead guilty in federal court to a significant federal crime. Any doctor who believes he or she may be a target of a federal investigation concerning medicare billing should secure immediate help from a knowledgeable federal criminal defense lawyer to avert federal indictment and prosecution.
|Florida Governor Rick Scott?
Just after the Florida election an unusual note made its way to my office. The letter looked at first to be a prank; like a blackmailer’s note every word was cut out from magazines and pasted to the page. The envelope bore a Tallahassee postmark yet no return address.
Here’s the note:
I’m a hard-working entrepreneur, a people person, a man of character and integrity, a reformer as well as a powerful former CEO indirectly involved in a $400 million health care fraud, which was a mere misunderstanding I had nothing to do with, as I was never indicted. Since then I’ve done my best to lead a law abiding lie, errr… life.
I was doing fine until the people swept me into office making me the Governor of a desolate, backward Southern State with some 29 electoral votes and no high speed rail. I enjoy being Governor except for the foul tasting seafood people eat here and the damn elections folks demand every few years. My god, these people are always wanting to vote instead of just finding jobs!
Recently some friends in the Government and I made voting more orderly by restricting the number of polling places, reducing the number of voting days and making it possible for some folks to wait up to eight hours to vote – no wonder they don’t have jobs!
Now I’m worried about investigations and indictments. Could even a people person’s Governor be indicted for being part of a criminal conspiracy to restrict votes? Would it be a better defense to say I didn’t know what I was doing, that I knew what I was doing but didn’t know it was unlawful or that I’m just incompetent?
While we all can agree that you’re incompetent, it still might be difficult for you to avoid an indictment if criminal conduct was established at Grand Jury hearings where absolute immunity could be granted for those testifying against you. If the Grand Jury found you were in fact part of a criminal conspiracy with others to restrict voting among minorities, women and those who enjoy Florida seafood, you could face indictment and a lengthy term in prison.
Many Americans are under the impression that the right to vote is one of the cherished rights of a democracy that unites us as Americans and protects us from people like you.
Clearly, your best defense is that you and other co-conspirators in the Florida Government were making broad political decisions to reduce the vote among minorities rather than conducting a criminal conspiracy. Even more than the restrictions on voting you implemented, criminalizing politics by punishing the losers, folks like you and your friends, with jail terms could undermine democracy. Anyway, to the anonymous letter writer, good luck and if you ever find yourself as an indicted Governor in need of Clearwater Criminal Defense Lawyers feel free to call.
Three days ago the Federal Appeals Court with jurisdiction over Florida overturned a Doctor’s conviction in US v. Ignasiak because the government at Trial failed to produce witnesses for autopsy reports and handwritten testimony. The Doctor, known to his friends and family as ‘Dr. Bob’ in over twenty years of practice wrote hundreds of prescriptions for vicodin, oxycondin and other drugs and according to the government at trial contributed to the deaths of at least five of his patients, while causing many others to become addicted to powerful painkilling drugs.
From the opinion: During Ignasiak’s trial, the government introduced the autopsy reports of five of Ignasiak’s former patients in which the cause of death was determined to be, at least in part, intoxication from controlled substances… defense counsel objected based upon the Confrontation Clause…
Astonishingly, at trial the government failed to bring in the actual doctors who wrote the autopsy reports. Recently this blog noted the trend toward greater scrutiny of the Confrontation Clause which requires the government at trial to produce the actual witnesses who conduct laboratory and forensic evidence rather than merely producing the reports generated by the witnesses. If you’re a Doctor falsely accused of medical fraud, pain mismanagement or dispensing controlled substances call a Clearwater Drug Attorney for an immediate consultation.
The purpose of a trial should always be to find the truth. The truth can be found by a jury only if the Defense is allowed to question the expert authors of reports which are based on opinions and conclusions. This decision furthers the argument that it’s unconscionable that the government was allowed to introduce expert opinions at a criminal trial without being required to subject those opinions to cross-examination. All the Courts in Florida – State and Federal, including those in Tampa, Clearwater, St. Petersburg and Pinellas are bound by this decision.
Synopsis of the Case (Full U.S. v. Ignasiak Opinion): The Defendant was a doctor licensed in the State of Florida who appeals his convictions for dispensing controlled substances in violation of the Controlled Substances Act (CSA), 21 U.S.C. 801 and for health care fraud. The Defendant contends that the district court at trial abused its discretion by allowing the introduction of autopsy reports and handwritten medical reports without requiring testimony by their authors.
The Federal Appeals Court for the 11th Circuit reversed defendant’s convictions because the admission of the autopsy reports and testimony about those reports, without live in-court testimony from the medical examiners who actually performed the autopsies, violated the Confrontation Clause under the facts of the case and that because the government’s case was not overwhelming the violation of the Defendant’s right to cross-examine witnesses was not harmless error in this case.
Is Justice just a game? The purpose of a Criminal Trial is to find the truth – maybe it’s hiding behind black’s King…Checkmate!
|Daumier, The Chess Players, 1863.
Here in a new Federal case of interest to every medical professional, the Court determines that enhancement of a sentence for a doctor under the Federal statute requiring a cause-in-fact connection between the victim’s ingestion of the drugs and death, does not require that the defendant’s conduct proximately caused the death. Be careful Doctors, you’re at risk every time you write a script if this case holds.
United States v. David W. Webb, No. 10–10574
(September 12, 2011) Appeal from the United States District Court for the Northern District of Florida Panel: Hull, Black and Stapleton, Circuit Judges.
Per Curiam: Affirmed Defendant–Appellant David W. Webb, a Florida-licensed physician, was convicted of 130 counts of wire fraud, health care fraud, and unlawful dispensing of controlled substances, including three counts charging that a patient’s death resulted from the use of controlled substances dispensed by Webb, or from his health care fraud violation. In two related issues of first impression, the Eleventh Circuit held that no foreseeability or proximate cause requirement is contained in the enhanced penalty under § 841(b)(1)(C) which applies whenever “death or serious bodily injury results from the use of” the controlled substance. That is, the government is not required to prove a defendant’s conduct proximately caused the victim’s death or that the death was reasonably foreseeable to the defendant. Rather, under § 841(b)(1)(C), the government must prove only that the death “results from” the victim’s use of a controlled substance charged in the indictment. Put yet another way, the statute requires a cause-in-fact connection between the victim’s ingestion of the drugs and death. It does not require that the defendant’s conduct proximately cause the death.
Next, the Court held that Congress did not insert a foreseeability or proximate cause requirement into § 1347(a)’s penalty enhancement, either. This enhanced penalty applies if “the [health care fraud] violation results in death.” The Court stated that there was no principled way to distinguish between the “results in” language in § 1347(a) and the “results from” language in § 841(b)(1)(c). The lack of foreseeability or proximate cause language in § 1347(a) was telling, the Court wrote, because Congress has included such language in numerous other criminal statutes, including statutes where the required connection is between the defendant’s offense conduct and death or bodily injury. Third Circuit Judge Stapleton, sitting by designation, concurred with the first result but dissented from the second, agreeing with the conclusion of the Sixth Circuit on this issue that proximate cause is the appropriate standard to apply in determining whether a health care fraud violation “results in death,” writing that Section 1347 . . . does not deal with a discrete problem arising from products involving an inherent risk of serious injury or death. Rather, it provides an enhanced penalty for health care fraud if the fraudulent scheme of the defendant resulted in death or serious bodily injury. Section 1347 thus applies to a wide variety of economically motivated health care activities and focuses on the relationship between the defendant’s conduct and the consequences thereof. The full text of the decision can be found here: http://www.ca11.uscourts.gov/opinions/ops/201010574.pdf
Drug Crimes Trial Lawyer & Criminal Defense Attorney in Clearwater, FL
Federal Crimes Trial Lawyer & Criminal Defense Attorney in Florida