The Price You Pay for Submitting False Claims:
Worst Case Scenario?
PENNSYLVANIA: In late March, William Matura, DC, pleaded guilty to conspiracy to commit health care fraud and obstruction of a health care investigation, and agreed to $1 million in fines for submitting false patient claims to health insurers.
As part of the plea, he agreed to pay the $1 million within 90 days of his June 23 sentencing.
He and his wife will also forfeit, if necessary, their homes, his 14 Philadelphia commercial properties and investment accounts.
Matura also faces a likely sentence of up to 9 years in prison.
Prosecutors say Matura was the last of four defendants to plead guilty to a scheme which netted about $2 million from eight health insurers between 1997 and 2002.
Filing a False Tax Return Can Be Pricey, Too.
FLORIDA: A Palm Harbor chiropractor pleaded guilty, earlier this year, to filing a false tax return, according to the U.S. Attorney’s Office. Terry Lynn McNight faces up to three years in prison, a $250,000 fine and one year of court supervision for lying about advertising expenses on his clinic’s 1999 federal income tax return. According to a plea agreement filed in Tampa federal court, McNight admitted to claiming more than $80,000 in advertising expenses for his practice when, in fact, he spent almost nothing.
McNight told federal prosecutors he used a Costa Rican group that sells, implements and manages so-called tax reduction strategies to falsify his clinic’s return.
That organization, Anderson’s Ark and Associates, is a multinational, membership-based organization that, according to the U.S. Department of Justice, has assisted thousands of clients in evading income taxes and laundering money. Complaints pending in federal court say the organization obtained approximately $28-million in illegal tax refunds for more than 1,500 clients from 1998 to 2001.
St Petersburg Times Online
Whistle-Blowers Bring in Big Bucks
WASHINGTON: A series of major settlements against health care companies has boosted the government’s fraud recovery rate, thanks to whistle-blower provisions in federal law.
According to the latest figures from the Justice Dept., federal enforcement officials recouped $2.1 billion under the False Claims Act in 2003. Of that total, $1.7 billion came from health care companies and practitioners, up from $500 million only four years earlier.
Four of the 10 largest settlements in the history of the act came in 2003, and all involved health care companies. Of the $2.1 billion in False Claims Act recoveries in 2003, $1.48 billion came from suits initiated by whistle-blowers.
The settlements are attributed in large part to False Claims Act amendments by Sen. Charles Grassley (R, Iowa) in 1986 that strengthened the qui tam, or whistle-blower, provisions by offering private citizens who report fraudulent claims a share of the recovered funds.
While federal officials have focused on larger corporate offenders, even the smallest of physician practices can be prosecuted under the False Claims Act.
Michigan Chiropractic Association Sues Blue Cross
MICHIGAN: On March 12, lawyers for the Michigan Chiropractic Association (MCA) took the first legal step to change the discriminatory practices of Blue Cross/Blue Shield (BCBS) by filing a lawsuit in Ingham County Circuit Court.
In the 20-page complaint, the MCA charged that BCBS has interpreted and applied the rules in a way that “prevents subscribers from getting the care that Blue Cross/Blue Shield advertises is available to them.”
Among the issues raised are that Blue Cross is wrongfully attempting to restrict the methods of diagnosis or treatment methods of chiropractors. The complaint also says “that Blue Cross has committed continual breaches of its contract by its improper interpretation of the scope of chiropractic and the services for which reimbursement is allowed, as well as by its failure to provide equitable relief for those provider services for which it does allow reimbursement.”
Dr. Bill Goss, chairman of Michigan Chiropractic Legal Action Committee said, “Blue Cross arbitrarily denies claims that are within the scope of accepted treatment, and they are moving toward a model of care that is based on pain instead of accepted objective findings.”
In the meantime, Goss said, financial support from MCA members continues to be important as legal fees mount. “We also need chiropractors to keep us informed of abuses so we can update the attorneys as the suit continues”
“Walkin’ thru Missouri…”
MISSOURI: On a final, and more positive note, there’s a chiropractor in Rolla, MO, who’s getting some good press in his community for starting up a Walkers Club. Dr. Alan Singer held the first meeting of, what he likes to call, the “Back Acres”, on a Thursday morning in mid-May.
Dr. Singer, a long distance runner who formerly practiced in New York State, started the group walking sessions there, and thought it a “perfect” idea to continue the custom in his new location.
On the walks, Dr. Singer plans to provide information about safe ways to reduce body fat, the proper mechanics of walking, and how to achieve and measure optimum heart rates while walking and doing stretching exercises. TAC