Archives : 2011 : March

LA Women Pleads Guilty to $6,268,899 in Medicare Fraud

Medicare fraud is a serious federal crime. Medicare fraud crimes occurring in California are investigated by the Medicare Fraud Strike Task Force, part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which is a joint Department of Justice-HHS effort consisting of federal, state and local investigators.You can stiff face fines, jail time, restitution to victims and insurance companies and loss of your professional healthcare license for committing Medicare fraud.

Acts of Medicare fraud include submitting bills for services that were never performed or submitting other fraudulent cost reports, billing more than once for the same services, falsely certifying or giving false information, ordering unnecessary tests (42 U.S.C. §1347, Social Security Act: 42 U.S.C. § 1320a-7b(a), 42. U.S.C. § 1320a-7a(a)(1)(A) and (B)), kickbacks or self referrals (42 U.S.C. § 1320a-7b(b), 42 U.S.C. § 1320a-7a(a)(7), 42 U.S.C. § 1395nn or the physician self-referral/”Stark” law under 42 U.S.C. § 1395nn(g)(3)). Medicare fraud can be committed by healthcare professionals such as doctors, dentists, chiropractors, physical and occupational therapists, psychologists, psychiatrists, hospitals, clinics, nursing homes, assisted living facilities, HMO’s, medical equipment companies and home health care providers.

Penalties:

Under the Health Insurance Portability Act Health, 42 U.S.C. §1347, anyone who knowingly or willingly defrauds any healthcare benefit program faces a fine or imprisonment for not more than 10 years or both. If bodily injury results because of the fraud, imprisonment may be up to 20 years. If death results because of the fraud, the imprisonment may be any term of years or for life.  For making false statements under the Social Security Act, 42 U.S.C. §1320a-7b(a) through (h), you face a fine of not more than $25,000 or imprisonment of not more than 5 years or both per offense.

Sample Case

Carolyn Ann Vasquez, age 46, of Los Angeles plead guilty on March 28, 2011, before  U.S. District Judge Terry J. Hatter Jr. in the Central District of California to using fraudulent medical clinics and stolen physician identities to defraud Medicare of approximately $6,268,899 from 2007 to 2008.  Ms. Vasquez instructed her co-conspirators to submit false claims to Medicare for reimbursement for services that were never performed by physicians and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. Vasquez admitted that she had instructed a physician assistant working at one of the fraudulent medical clinics to use clinic/physician prescription pads to write fraudulent prescriptions and order medical services for diagnostic tests, power wheelchairs and other medical equipment in a physician’s name who Vasquez knew did not work at the clinic. A sentencing hearing is scheduled for July 11, 2011. Vasquez could face a maximum 10 years in prison and a $250,000 fine.

The case was brought by the Medicare Fraud Strike Task Force, part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which is a joint effort between the Department of Justice and HHS. The case is also being investigated by the FBI.

If you are arrested or accused of Medicare fraud, you should hire a California Medicare fraud attorney to defend you. The attorney may be able to raise the defenses of mistake, misunderstanding, that you are a victim and you may be able to testify against those who committed the fraud, or argue illegal evidence or violation of civil rights to get your case dismissed or charges reduced to a lesser offense and/or penalties.

Lindsay Lohan Charged With Felony Grand Theft

Under California Penal Code Section 487, grand theft is defined as “the unlawful taking of another’s property” valued above $950. Property valued under $950.00 is considered a petty theft under Penal Code 484. California grand theft can be carried out by larceny (taking of another’s property) which occurs most often in shoplifting cases, embezzlement (unlawful taking of something entrusted to you), which occurs most often in an employment situation, tricking or deceiving someone to turn over their property without ownership rights or making false representations to defraud someone out of either the possession of their property or their ownership of the property. A California grand conviction theft carries up to three years in a California state prison. A petty theft conviction carries a fine up to $1,000 or up to six month’s jail time in a county jail or both.

Case Example:

Actress Lindsay Lohan was charged with felony grand theft on Wednesday February 9, 2011 for allegedly stealing a $2,500 necklace from a Venice jewelry store on January 22, 2011. Surveillance video at the jewelry store showed her wearing the necklace while at the store, and photos taken a week later show her wearing a similar necklace. The necklace was returned to a police station before investigators arrived to search her home in Venice, CA. If found guilty, should could face up to three years in state prison and in violation of her current probation terms. She was recently released from three months of mandatory rehab treatment because she had failed a drug test while on probation for her 2007 drug and alcohol DUI conviction.

Lohan plead not guilty to felony grand theft charges through her attorney Shawn Chapman Holley. Lohan claims the necklace was on loan to her. Judge Schwartz set bail at $40,000. He told Lohan that it appeared she had violated her 2007 DUI probation, and warned her that if she violated the law while out on bail, he would have her arrested and held. Judge Schwartz also ordered Lohan not to have any contact with the jewelry store that reported the missing necklace after someone had sent flowers to the store on behalf of Lohan. On March 10, 2011, Lohan turned down a plea agreement offered by Los Angeles prosecutors that would have meant a guaranteed jail sentence. She will return to court in April 2011 for a preliminary hearing.

If you have been arrested for a felony grand theft/shop lifting or petty theft in California, you should hire a California criminal defense attorney. A conviction is generally based upon the store’s video camera evidence. The attorney may be able to get the charges reduced to a misdemeanor petty theft, trespass, an infraction or get the case dismissed for lack of evidence or witnesses, or get you probation or community service.