Legal Services for Veterans Clinics
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What is “Health Care Fraud in Veterans Clinics?”
When the men and women of our armed forces need health care, they sometimes go to a government-run clinic. But just as often they end up in a private clinic for treatment. When that happens, the private clinic sends the bill to the federal government, which has multiple programs that pay for the health care of veterans and their families. If those private clinics provide false information to the federal government about treatment given to veterans, they may get money for services that weren’t provided. The government sees this as health care fraud—even if it’s the result of an accident or mistake.Example #1:
Rosie owns an acupuncture clinic. In the past few years, Rosie has had dozens of veterans referred for pain management. She never had to bill the government before the opioid crisis, and it turns out that Rosie has been doing it wrong the whole time. A simple mistake in a complicated system—but now investigators are circling her family business.Example #2:
Calvin is a family doctor who’s certified for veterans for disability claims. But he’s also a soccer dad, and the season is heating up. Scheduling is hectic, and if he can’t make it to the office, he just has one of the junior doctors do the disability exams. He trusts them completely and has no problem putting his name on their paperwork—even though the VA hasn’t certified them. No big deal, right? Unfortunately, both Rosie and Steve could be charged with defrauding veterans’ health care programs. And, if they don’t hire an experienced fraud defense attorney, they could both easily be convicted. The federal government is always looking to make an example of health care providers who run afoul of the laws and regulations surrounding veterans’ treatment.Who can be charged with health care fraud in veterans clinics?
Anyone who bills a veteran health care program for services that were not provided, not necessary, or not done how the federal government requires, can be charged with veteran health care fraud.What Types of Charges Can Someone Accused of Health Care Fraud in Veterans Clinics Face?
That’s a complicated question. If you look at the news stories below, you’ll see that “health care fraud,” charged under the Federal Health Care Fraud Statute is the most common charge
But it’s not the only one. “Kickbacks” charges are not unheard of in these cases. These usually happen when one health care provider helps another provider “defraud” the government, and gets some money in return. Then again, what health care provider doesn’t have trusted specialists that they refer patients to regularly?
Working with others can also mean conspiracy charges. This will read as “conspiracy to commit health care fraud” or “conspiracy to pay kickbacks.”
Then there’s the infamous “Stark Law,” which prohibits physicians from referring patients to health care providers that they have a financial interest in.
How Does the Government Prove That I Committed Health Care Fraud In Connection With the Practices of My Veterans Clinic?
Let’s go down the list of the most commonly charged statutes in federal health care fraud cases.
Health Care Fraud[1]
The Federal Health Care Fraud statute states that health care fraud occurs when someone either defrauds a health care benefit program or gets money or other property from a health care benefit program by way of deceit.
In practice, that means billing government health care programs—like TRICARE—for treatments that were unnecessary. Or that never occurred at all.
The statute also says you don’t have to know that you’re committing fraud to be found guilty of it. That’s terrible news for Rosie, the acupuncturist, or Calvin, the disability doctor.
Health care fraud is worth up to 10 years in prison and restitution of the defrauded money. But if the fraud puts someone’s life in danger, causes extreme pain, disfigurement, or permanent maiming, the penalty is up to 20 years in prison. If they die, the law allows prosecutors to seek a life sentence.
Federal Anti-Kickback Statute[2]
Makes asking for, getting, or paying money in connection with federal health care fraud a felony. If Adam runs a massage therapy clinic and pays Dr. Jane a “referral bonus” for sending people to him whether or not they need treatment, they have both violated the “anti-kickback” statute.
Conspiracy[3]
Conspiracy charges requires the prosecution to prove the following elements:
(1) that more than one person planned a crime, and
(2) that one of those people actually committed the crime.
Stark Law[4]
Stark Law says that physicians cannot refer patients to “health care services” if the doctor (or an immediate family member) has a financial stake in those services. Technically, this is only illegal if a government program or other third-party (like an insurance agency) is footing part of the bill. The law applies even if the doctor isn’t getting a “kickback” and even if the services are medically necessary. There are exceptions, but the gist is that if Adam is Dr. Jane’s brother, she can’t send patients to him—even if they need treatment and he’s the best massage therapist in town. You can see how someone might accidentally get in hot water over this stuff.
To learn more about Stark Law and the penalties for violating it, click here.
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Free Confidential Case ReviewWhat makes defrauding veterans programs different than defrauding Medicaid?
In practice and penalty, nothing. The difference is the zeal with which these cases are investigated and prosecuted.
Remember, many federal agents started their career in the military. They take these cases personally. More importantly, protecting veterans makes the agencies look useful to the public. Prosecuting health care fraud in veterans clinics is a good PR move in any political climate.
All of which is to say that the government might bring more to the table than they otherwise would. Expect them to work harder, to bring more charges, and to push for the maximum penalties the law allows. Fraud defense attorneys without specific veterans health care fraud experience may not be up to this challenge.
You mentioned federal agencies?
Health care fraud in veterans clinics is investigated by many federal agencies:
-The Federal Bureau of Investigation
–The Department of Justice Criminal Division
-The Defense Criminal Investigative Service
-The Department of Veterans Affairs—Office of the Inspector General
-The Department of Labor—Employee Benefits Security Administration
Not to mention the state and local agencies that may become involved in these investigations, which often go on for years. Expect law enforcement to work together in a coordinated effort to investigate and prosecute.
What are defensive strategies against veterans health care fraud charges?
There’s no easy answer to this question. Most of the statutes covering these laws are complicated by themselves; add in the federal bureaucracy of billing and reimbursement, and the additional entanglements of just running a business, and you’ve got a real web to unravel before you decide on a strategy.
Ironically, that “web” may be your best strategy—or your worst. The simple fact is that it’s easy to accidentally commit health care fraud where veterans are concerned.
It’s true that the law says that ignorance is no excuse. Then again, proving willful intent is a big part of any criminal conviction. So what’s the difference between the two? A skilled legal team that can show you were acting in good faith.
“Health Care Fraud in Veterans Clinics” in the News
Mississippi Nurse and Clinic Owner Sentenced to Prison for Role in Compounding Pharmacy Scheme to Defraud Tricare
Charge: Conspiracy to Commit Health Care Fraud
Allegations: Defrauding Federal Veteran Health care Programs
In 2018, a Mississippi-based nurse, Susan K. Perry, was sentenced to 42 months in prison, three years of supervised release, and ordered to pay $1,375,692 in restitution. A former health care clinic owner, Perry’s sentence came after pleading guilty to a single count of Conspiracy to Commit Health Care Fraud.
According to the DOJ press release, Perry—who lives in Alabama—prescribed patients medication that they did not need. Specifically, she sent them to a compounding pharmacy in Missouri, knowing that the pharmacy would then submit false claims for reimbursement to Federal health care programs.
In some cases, Perry prescribed medications without even seeing a patient. The scheme, which ran from 2014 to 2015, defrauded the government of more than $1.5 million. Some of that money came from TRICARE, a federal health care program that takes care of veterans and their families.
Perry’s arrest was part of a multi-state Federal investigation that spanned the Southeast US. Investigating agencies included the FBI, IRS-CI, DCIS, and Mississippi Bureau of Narcotics.
To learn more about this case, click this link, or copy the URL below:
Owner of Independence Clinic Pleads Guilty to Health Care Fraud Scheme
Charge: Health Care Fraud, Making False Statements to a Federal Agency
Allegations: Unqualified Individuals Conducting Veteran Disability Examinations, Lying to Investigators
In 2017, David Biersmith of Kansas City pled guilty to obstruction and health care fraud charges related to work his health care clinic did from 2013 to 2015.
According to the DOJ press release,
a health care organization secured a federal contract to perform veterans’ disability examinations, among other services. Those examinations were then contracted out to Industrial Medical Center, a clinic that Biersmith owned. Biersmith agreed that a licensed and qualified doctor would conduct all disability examinations.
At first, Biersmith honored the agreement. But when his disability physician left the clinic, Biersmith replaced him with two other men—neither of whom met the qualifications specified in Biersmith’s contract or federal law. In fact, one of those men had his medical license revoked in 2010 after committing fraud and distributing narcotics. IMC examined 53 veterans during this time, all of those cases now require federal review.
In a separate case, Biersmith also lied to federal investigators about forging the signature of a chiropractor on physical exams of commercial truck drivers.
During sentencing, Biersmith could face 15 years in prison and hundreds of thousands of dollars in fines. He may also be required to pay $39,155 to the federal government—the amount of money IMC defrauded.
To learn more about this case, click this link, or copy the URL below:
Pharmacist and Pharmacy Employees Sentenced for Involvement in Over $30 Million Health Care Fraud
Charge: Health Care Fraud, Conspiracy to Commit Health Care Fraud, Money Laundering, Conspiracy to Pay Kickbacks, Paying Kickbacks, Introducing Misbranded Drugs, Making False Statements
Allegations: Carrying Out Largest TRICARE Fraud Scheme to Go to Court
In 2018, two Florida men were sentenced for their roles in a massive health care fraud scheme that targeted veterans’ services. Serge Francois, a pharmacist, and Patrick Tonge, his employee, were each given more than 15 years in prison.
According to the DOJ press release,
Francois owned Atlantic Pharmacy in Pompano Beach, FL. Together with Tonge, his assistant, Francois employed “marketers” to recruit physicians into a massive health care fraud scheme. The doctors would prescribe an expensive topical medication to patients, and send them to Francois’ pharmacy. In some cases, the doctors did this without ever seeing a patient.
Francois and Tonge made the medication in-house, charging up to $17,000 for one bottle of topical ointment.
Atlantic Pharmacy then billed TRICARE—a veterans’ federal health care program—for the cost of the medication. Targeting TRICARE was, in fact, the whole point of the scheme. The conspirators automatically “refilled” these medications without patient request or knowledge, charging the government each time.
All told, the conspiracy defrauded TRICARE of more than $30 million. This money made its way to the “marketers” and physicians, but Francois and Tonge spent much of it on their lavish lifestyles. Purchases included multi-million-dollar mansions and luxury automobiles.
Francois was given 204 months of incarceration, three years supervised release, and ordered to pay $31 million in restitution. Tonge was given 188 months in prison and three years supervised release. He was also ordered to pay $31 million in restitution.
To learn more about this case, click this link, or copy the URL below:
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Free Confidential Case ReviewDo You Need An Experienced Health Care Attorney? Let Us Help.
When federal agents decide that you’ve committed health care fraud in relation to your veterans clinic you’re in hot water. They’ll stack the deck against you in any way possible, and they’ll leave no stone unturned. Accidents, mistakes, and the actions of others will pile up. And soon the governments argument will turn into a case that seems insurmountable.
It’s just not enough to have a lawyer with fraud experience. The difference between beating a fraud case and defending against the prosecution of health care fraud in veterans clinics is night and day. Don’t get us wrong—it’s wonderful to have a legal team with good intentions. But that’s not enough. After all, didn’t you have good intentions as a health care provider? The government doesn’t care.
You deserve justice.
Decades behind bars. Thousands—or even millions—in fines. The end of your medical practice as you know it. That’s the kind of “leniency” you can expect from the federal government.
Here’s what you can expect from us:
A tier-one legal team that’s seen it all. Researchers that will comb through records. Attorneys with real federal court experience. A staff that is there to help when the feds come sniffing around. In one sentence? A tough, seasoned firm that won’t stop working and isn’t impressed by federal showmanship.
Remember—calling sooner doesn’t just mean help sooner. It means that we can do more on your behalf by:
- Protecting your rights during questioning by government agents, prosecutors, and investigators;
- Helping you to secure the best deal offers, if you choose to do so; and
- Ensuring that you get the justice you deserve and the best possible outcome for your case.
If you or someone you care for is under investigation for or being charged with “health care fraud in veterans clinics,” call our firm today for a free legal consultation.
[1] 18 U.S.C. § 1347
[2] 42 U.S.C. § 1320a–7b
[3] 18 U.S.C. § 371
[4] 42 U.S.C. § 1395nn