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False Claims Act Lawyer Discusses Durable Medical Equipment Fraud

As attorneys who represent persons that want to blow the whistle on governmental fraud, I thought it would be useful to provide you with this information on a mission trio convicted of healthcare fraud in a probe by state and federal officials in Texas.

The owner of a now defunct McAllen, Texas area durable medical equipment (DME) business, his wife and another former employee have been convicted for their rolls in a conspiracy and scheme to defraud Medicare and Medicaid through fraudulent billings.  From early 2004 through late 2011, Monticello Herrera, who did business as RGV DME in the McAllen, Texas area engaged in and directed a scheme to submit fraudulent claims to Medicare and Texas Medicaid for power wheelchairs, incontinent supplies, hospital beds and mattresses, as well as other DME supplies.  The government contended that this fraudulent scheme submitted or caused to be submitted more than $11,000,000 in false and fraudulent claims to Medicare and Texas Medicaid for which Herrera received an excess of $6.1 million dollars.  The trio admitted that 85% of their Medicare and Texas Medicaid billings were false and fraudulent.

The trio admitted marketers were used to obtain Medicare and Medicaid identification numbers and other information from beneficiaries which they in turn used to fraudulently bill Medicare and Medicaid for DME that was either never prescribed or prescribed but never delivered.  The Herrera’s also admitted that they and their marketers attempted to obtain referrals or patients or orders for DME from doctors in exchange for gifts.

Also in Texas, a Houston medical equipment company manager was sentenced to 120 months in prison, and a delivery driver was sentenced to 41 months in prison for a Medicare fraud scheme.  Houston area residents Oliver and Nkuku and Calistas Edoize were sentenced to 120 months in prison and 41 months in prison, respectively, for their roles in a DME fraud scheme.  According to court documents, Nkuku was the manager of and controlled the day-to-day operations of KO Medical, Inc., a Houston area DME company.  Edoize was the delivery driver.  Nkuku was convicted of Count I of conspiracy to commit healthcare fraud and three counts of healthcare fraud after a week long trial in July 2010.

They began billing Medicare for fraudulent DME in 2007 according to court documents.  Nkuku submitted over $1,000,000 in claims to Medicare on behalf of KO for DME, including power wheelchairs that were medically unnecessary.  For the wheelchairs and accessories were billed as catastrophe related in connection with hurricanes Katrina, Rita, Ike and Gustav, even though many of the Medicare beneficiaries, including some who testified at trial, never owned a power wheelchair during these catastrophes or had owned one that was not damaged during these catastrophes.  Edoize admitted to delivering medically unnecessary DME including power wheelchairs, the Medicare beneficiaries who he knew did not need, and in some cases did not even want, the DME.

A prevalent area of false claims against the government involve durable medical equipment, which includes supplies such as wheelchairs, hospital beds, hospital mattresses, and more.  If you have knowledge about a company that is submitting false claims to the government for durable medical equipment, including distributing power wheelchairs to persons that do not need them, or do not even want them, or you are aware of a company that is billing Medicare for durable medical equipment that is never delivered, we would welcome the opportunity to discuss that false claims investigation with you.  Please call us immediately at 1-800-632-1404, or please fill out the form on this page for more information.

If you have any knowledge about a similar cause of action involving improper medical benefits offered to the public, improper kickbacks received by doctors or healthcare providers, or similar alleged false claims, please contact us.

THE SCOPE OF FRAUD

Amazingly, some estimates have suggested that approximately 10% of the entire annual United States budget is lost to companies or individuals who are defrauding the government. The United States Federal budget for 2010 was $3.456 billion, meaning around $345.6 million was wrongfully wasted on fraud.

The entities defrauding the government do so in a variety of ways: Medicare or Medicaid fraud whereby they bill the government for services which they never provided or overbill for services that were provided; SEC Trading; Tax Fraud; TARP Fraud; Military/Defense contract fraud; Pharmaceutical Manufacturing;contract fraud involving any number of large government spending programs; or other types public benefit fraud.

HELPING THE PUBLIC.

As a whistleblower attorney, we are interested in speaking with persons willing to make known the truth about company practices and are willing to file a qui tam or whistleblower action. One area in particular we are interested in discussing are lawsuits involving medical device companies where the company is alleged to have overcharged, engaged in kickback programs, and the like. We will nevertheless investigate claims in a variety of areas.

Workers and persons all across the country witness actions at their work that may be unlawful or even corrupt. Unfortunately, some employees and workers feel that they will be fired, terminated, harrassed or punished if they report an unlawful or corrupt action. These reporters, however, are protected by the law as a Whistleblower and can receive compensation because of the False Claims Act or the Medicaid False Claims Act. If you have reported actions that may be fraudulent, then you should talk to a Whistleblower or qui tam lawyer about your facts.

Whistleblowers help the government to get back billions of dollars each year with the help of the False Claims Act. In fact, fraudulent Medicaid claims are also caught by whistleblowers having the Medicaid False Claims Act on their side. If you report a false claim or fraudulent action to the government, then the government will give you, the whistleblower, a part of the money that gets recovered. This is because of qui tam requirements. Qui Tam means that a person files a lawsuit for the king and also for him or herself. The phrase is qui tam pro domino rege quam pro se ipso in hac parte sequitur, or, “he who sues for the king as well for himself.”

These requirements and lawsuits were made popular during the Civil War when many people were getting away with fraudulent actions against the government. In 1986, the False Claims Act was amended to raise the total compensation given to people who reported fraudulent actions, or whistleblowers. If a whistleblower works with a lawyer then it may be possible for them to get three times the amount the government would get in damages and also get additional compensation for general fines.

TYPES OF CASES

The most common situations that could form the basis of a Qui Tam action include:

• Submitting a false or fraudulent record, bill or statement to the government in order to fraudulently obtain money such as reporting a medical service that was never performed for Medicare or Medicad;
• Conspiring with a third party to submit or present have a false or fraudulent claim to the government;
• Withholding property of the government with the intent to defraud or conceal the property from the government;
• Fraudulently buying property of the government from someone not authorized to sell that property; and
• Making a false statement to fraudulently avoid paying money to the government or to avoid delivering property to the government.

FOR HELP, PLEASE CONTACT US.

We help whistleblowers on a contingency basis, meaning there is no fee charged for our work unless there is a recovery. We also front any and all expenses. No matter where you are located — we will represent you. We will come to you, you will not have to come to us.

Attorneys in our firm and attorneys that we work with on Whistleblower, Qui Tam, False Claims Act cases have represented a host of persons making claims, for violations of federal tax law, Medicare law and more.

For more information, please contact our team of whitsleblower and qui tam attorneys today.

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