Healthcare Fraud Case Summary

He has been sentenced to 130 months in prison followed by three years of supervised released. Richard was convicted of wire fraud, securities fraud, willful certification of false statements to SEC, failure to pay over payroll taxes, and income tax evasion.

The charges included conspiracy, money laundering, obstruction of justice and perjury (Johnson & Johnson, 2005, p. 37).

Contrary to the alleged, Dr. Brock refuted the claim, defending that he never established a doctor-patient relationship with Anita, which relieves him of liability. In order to validate his refute, Dr. Brock provided four factual elements that were supported by his counterparts; Dr. Whitfield and Dr. Ketcham. The four elements that were presented in the affidavit included: (1) That there has never been a doctor-patient relationship between Dr. Brock and Anita Oliver, (2) Dr. Brock has never seen or talked to Anita or Cathy Oliver, (3) Dr. Brock was not employed, engaged or requested to serve as a consultant to treat Anita, (4) and Dr. Brock was not employed or engaged to consult with doctors treating Anita, concerning complaints or medical problems. In order to support Dr. Brock’s refute, Dr. Whitfield and Dr. Ketcham provided affidavit’s as

I reviewed the case of Mr. Sam Superstar and Dr. Peters, in regards to possible proceedings and to which party would be at fault. I have found that in this case both parties could be found at fault in many different violations, both civil and criminal. Therefore there could be possible proceedings brought against both parties. It shows many aspects, of many, violations of laws. These violations range from simple breach of contract to theft of property. We will need to look into the violations more in depth. Following you will find a summary of my findings.

The decision made by the Virginia Board of Nursing concluded with an indefinite suspension of her license until a monitoring rehabilitation program has been completed. The Health Care Practitioners Program will be customized for the specific criteria that the defendant needs. If the defendant does not complete all parts of the program, she will have to come before the board to discuss the issue. The defendant stated during the hearing that she “does not trust herself around narcotics and needles.” Therefore, the board decided that she will not be able to work in a setting where she has access to either of those. The rest of the details of her implications are to be determined as a later time.

The secondary criminal case, in which Harig faced up to three years in prison for on a single count of intimidation, was dismissed by the court after the state declined to pursue the criminal matter.

Commonwealth v. Barbara Winston. On October 17, 2016, in Scott County Circuit Court, Barbara Winston (Winston) pled guilty to one count of obtaining money by false pretense, one count of conspiracy to obtain money by false pretense, one count of Medicaid fraud and one count of conspiracy to commit Medicaid fraud. She was sentenced to five years, with five years suspended, and an indefinite period of probation on each count. The sentences were ordered to be run concurrently. She was also ordered to pay $6,845.97 in restitution, excluded from being a Medicaid provider for 10 years, sentenced to 50 hours of community service and to pay $250 court costs. Winston was hired by her Medicaid eligible mother to provide attendant care and respite

is a nurse practicing in Missouri that has, already, previously been placed on probation for testing positive for heroin. She has recently had a relapse in her recovery and is fighting to get her license back so she can practice nursing. The state board has already given her one chance and she was practicing in Missouri. She has been sober for nearly 3 years and has taken suboxone the entire time of her sobriety to help with withdrawal. E.M. hates that she has a dependency on the suboxone and wanted very badly to wean herself off of it. She spoke with her physician about this matter and her physician strongly suggested that she not be taken completely off her prescription of suboxone. Her physician lowered her dose and she began taking a lower dose. After time passed, E.M. felt like she had things under control and she completely stopped taking her prescription. E.M. went under some stress at her job and ended up leaving the facility she was working at. She knew that one of her old co-workers had access to heroin and after running into him at a local store, she started abusing again. Beginning at the time of her first time being placed on probation E.M. has been required to provide urine samples at randomly selected intervals. During her time of remission, when she was abusing, she failed to call and leave urine samples. At this time, E.M. explained that she was focusing on bettering herself and working on her sobriety. I feel that E.M. was very sincere and was accountable for her actions. She truthfully took responsibility for her wrongful actions. E.M. stated that she now realizes that her heroin addiction is a lifelong addiction that will always be knocking at her door and she cannot stop taking suboxone. The board questioned her and wanted to make sure she did not have plans of going against her physician’s orders again. E.M. was in tears almost the entire time she was explaining her actions to the members of the board and I feel like they were true

Attempts to stop fraud were enhanced under Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The purpose was to improve the Medicare program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system. This public law encouraged the development of a health information system through standards and requirements for the electronic transmission of certain health information (aspe.hhs.go). The Act established a program to take action against fraud committed against public and private health plans. The legislation required the establishment of a national Health Care Fraud and Abuse Control Program (HCFAC), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS) acting through the Department 's Inspector General (HHS.gov). The HCFAC program is designed to coordinate Federal, State and local law enforcement activities with respect to health care fraud and abuse. The Act requires HHS and Department of Justice (DOJ) detail in an Annual Report the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such deposits. (HHS.gov) I will summarize the impact of these laws as it pertains to how they are impacting the healthcare delivery system. (HHS.gov)

They appealed on penalty, The hearing officer made fundamental errors in both principals and law. She considered disciplinary matters for 1999 and 2000 which clearly postdated 1997 offence, when making the decision of the 12 day suspension she clearly had antecedents in her mind. Clearly they where not antecedents and should not have been considered. After getting a new hearing they decided that

On the month of September 2007, Amy Jo Hicks applied for Social Security Disability Benefits. With help from counsel Eric C. Conn in preparing her application, she testified at an administrative hearing and was soon after awarded benefits. At some point years later, authorities discovered a Social Security scam that involved Conn, administrative law judge David Daugherty and four doctors. The basis of the scheme involved Conn creating a template medical form that would allow doctors to falsify a claimant's medical examination. By July 2014, the SSA’s Office of the Inspector General (OIG) identified 1,787 people--all which were Conn’s clients-- who submitted that medical template sometime between 2007 and 2011. Amy Jo Hicks’s unfortunately,

The typically overlooked crime of healthcare fraud has resulted in a significant monetary loss on the part of the American public paying into government run medical programs, as well as private insurance company programs. Historically, we have seen that in any instance where money is involved people have found ways to or at least have attempted to obtain it illegally. Some do it through overt acts of violence such as a robbery. Others choose more covert ways of illegally obtaining money. This is usually conducted through fraudulent activities. This is the nature of white-collar crime. There is no force or violence involved but it is still illegal. (SSA) Obviously, when such a large amount of money is involved there is

downgraded from a felony Attempted Rape charge. Mr. Clark broke into a home and according

On November 19, 2015, we attended the disciplinary hearings at the Missouri State Board of Nursing. The first case we heard was that of T. O., who had violated the terms of her settlement agreement with the State Board that took effect back in June. Originally disciplined for being under the influence and testing positive for benzodiazepines and opiates, she failed to call the third party administrator of her random drug screens daily on several occasions. She also tested positive for oxazepam on at least one occasion.

As HealthSouth started reviving from the scandal, Scrushy’s problems were only starting. In October of the year 2003 Scrushy faced more than 85 charges, including charges that he falsified accounts at the HealthSouth’s company which lead to $2.7 billion fraud of investors, by reporting conjured