Healthcare Fraud LawsuitIllegitimate psychiatric holds are costing Americans and their healthcare system millions of dollars per year. In these scams, patients are held in psychiatric facilities beyond the therapeutic point solely to increase the profits of the healthcare provider(s). People and their insurance carriers are being bilked in many of these fraudulent psychiatric holds, while Medicare and Medicaid fraud in psychiatric hold cases are running rampant across the country. A healthcare fraud lawsuit may right such wrongs.
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Our law firm is investigating healthcare fraud. We are evaluating healthcare fraud lawsuits in all 50 states and Puerto Rico. If you or someone you love was illegally detained in a psychiatric hold beyond the therapeutic point, contact us today for a free legal consultation.
Related: Big Pharma and Organized Crime
$40 Billion per Year in Psychiatric Fraud
Authorities have estimated that psychiatric fraud accounts for 20 percent of fraudulent health care claims paid yearly. That places the annual cost of psychiatric fraud up to $40 billion per year.
That makes psychiatrists responsible for a disproportionate share of the fraud and corruption within the health care industry. As far back as 1985, a U.S. Justice Department probe found that while psychiatrists represented only eight percent of U.S. physicians, they accounted for 18 percent of the crooked doctors suspended from Medicaid programs over a 15-year period. That is the worst performance of any group in the medical field.
Crimes included charging for therapy when they had only doled out drugs; billing for patients who did not exist; falsely billing for up to 24 hours of therapy per day; having sex with patients and billing the government for it.
In 1994, Florida Medicare investigators found that 40 percent of all mental health outpatient service billings in 1994 were fraudulent.
Psychiatry leads in Healthcare Fraud
If fines collected by the federal government are an index, psychiatry is responsible for nearly 90 percent of the health care fraud in the United States. Of the $411 million paid in health-care-related fines in 1994, $379 million were paid by psychiatric hospitals.
2017 Healthcare Fraud Settlements
Healthcare fraud has become a mounting problem not only for industry but for federal and state governments.
$472,000 (Nov. 2017) – a Virginia doctor was fined $472,000 and lost his license after admitting to illegally prescribing Ritalin and hydrocodone.
76 Deaths by Rx (Oct. 2017) – a Massachusetts pharmacist was found guilty of racketeering, racketeering conspiracy, mail fraud and introduction of misbranded drugs into interstate commerce with the intent to defraud and mislead. Glenn Chin triggered a tragic outbreak in 2012, when 753 patients in 20 states were diagnosed with a rare fungal form of meningitis, as well as joint or spinal infections from tainted injections of preservative-free methylprednisolone acetate. The Chicago Tribune had the death toll at 76. Chin was sentenced to nine years in prison.
$2.8 Million (Oct. 2017) – An Ohio man was charged for his alleged role in a conspiracy to defraud the Cleveland Clinic of at least $2.8 million, the DOJ said. Wisam Rizk was charged with one count of conspiracy to commit wire fraud and honest services wire fraud, 27 counts of wire fraud and honest services wire fraud and one count of obstruction of justice. Rizk worked as chief technology officer at Interactive Visual Health Records, a company formed by Cleveland Clinic Innovations to develop a conceptual visual medical charting project into a functioning product.
$100 Million (Oct. 2017) – Dozens of New York doctors were ensnared in a healthcare fraud investigation. Three will serve more than two years in prison for taking bribes as part of a years-long test referral scheme operated by Biodiagnostic Laboratory Services of Parsippany, New Jersey and various personnel. George Roussis and Nicholas Roussis of Staten Island were sentenced to 37 and 24 months in prison. Ricky J. Sayegh of Scarsdale, New York will serve 2 1/2 years. All three pleaded guilty to charges of accepting bribes in violation of the Federal Travel Act. The Roussis admitted to accepting some $175,000 in cash from BLS employees and associates from October 2010 to April 2013. BLS rewarded them by paying for strip club trips, including personal performances and sex acts The dirty brothers in turn referred their patients’ blood specimens to BLS, generating more than $1.7 million in total lab business for BLS. (Source: DOJ).
The investigation has so far yielded 50 convictions, including 36 physicians. The bribery scheme involved millions of dollars in bribes and more than $100 million in payments to BLS from Medicare and various private payers. “It is believed to be the largest number of medical professionals ever prosecuted in a bribery case,” said the DOJ.
$667,000 (Oct. 2017) – A former Missouri healthcare CEO received a 3 ½-year prison sentence and a $667,000 fine after pleading guilty to stealing Medicaid funds meant for nursing homes. Theft by John Mac Sells, CEO of Benchmark Healthcare of Festus and other long-term care facilities in Missouri, Kentucky, and Tennessee caused living conditions to deteriorate. The DOJ said Sells stole Medicaid funds meant to provide care for elderly and disabled residents. Due to Sells’ theft, residents did not receive medication, food and needed dietary supplements.
$8.6 Million (Oct. 2017) – Four Houston, Texas-area hospitals must pay $8.6 million to settle allegations they took kickbacks from ambulance companies in exchange for rights to the hospitals’ more lucrative Medicare and Medicaid transport referrals. (Source: DOJ).
The hospitals are all affiliated with the Nashville-based company Hospital Corp. of America, also known as HCA. They include Bayshore Medical Center, Clear Lake Regional Medical Center, West Houston Medical Center and East Houston Regional Medical Center.
$25 Million (Sept. 2017) – A New Jersey doctor faces 10 years in prison, tens of millions in restitution, and a huge fine for selling his signature and signing prescriptions for patients he never saw. Dr. John Gaffney was part of an elaborate healthcare fraud scheme that spawned $25 million in losses to state health benefits programs, said the DOJ. Gaffney pleaded guilty to conspiracy to commit healthcare fraud.
$35 Million (Sept. 2017) – Novelion Therapeutics subsidiary Aegerion Pharmaceuticals will pay more than $35 million to settle criminal and civil charges related to its cholesterol drug Juxtapid. The drug carries a warning label that says it can cause serious liver and stomach issues and is only approved to treat high cholesterol in patients who have a rare genetic disease called homozygous familial hypercholesterolemia, or HoFH. For three years, Aegerion management sales staff violated the Federal Food, Drug, and Cosmetic Act by distributing Juxtapid as a general treatment for high cholesterol but did not provide adequate directions for such use. (Source: DOJ)
$4.8 Million (Sept. 2017) – A Miami doctor will serve eight years and pay millions in restitution for his role in a nearly $5 million health care fraud scheme involving fraudulent Medicare claims and illegal prescriptions for controlled substances including oxycodone and hydrocodone. (Source: DOJ)
$30 Million (Sept. 2017) – A Florida pharmacist and employee were convicted on multiple charges related to a massive fraud scheme that bilked the federal TRICARE program for more than $30 million. TRICARE provides coverage for active duty military and their families, and retired veterans. The fraudulent scheme also yielded losses for the Federal Employee Health Benefit Program. (Source: DOJ)
$2.7 Million (Sept. 2017) – A former Cleveland Clinic executive was charged with accepting an estimated $130,000 in payment from a shell company that allegedly defrauded the health system out of more than $2.7 million. Gary Fingerhut, 57, of Solon, Ohio, was charged with one count of conspiracy to commit wire fraud and honest services wire fraud and one count of making false statements. The Cleveland Clinic fired him in 2015. (Source: DOJ).
Other Penalties for Healthcare Fraud in 2017
$12.2 Million – (Oct. 2017) St. Vincent Regional Medical Center, Christus Health for illegal donations.
$2.2 million (Oct. 2017) — Kaiser Permanente over data reporting
$580,000 (Oct. 2017) – Oklahoma City doctor over false Medicare billing
$417 Million (Oct. 2017) – Verdict against Johnson & Johnson in Talc Cancer Lawsuit
$465 Million (August 2017) – over EpiPen Medicaid drug rebates. The company mis-classified
EpiPen as a generic drug to avoid paying Medicaid rebates, a violation of the False Claims Act.
$20 Million (Oct,. 2017) Texas home healthcare company owner defrauded Medicare, convicted of conspiracy and multiple counts of healthcare fraud.
$268 Million (Aug. 2017) – A Texas doctor was hit with a 35-year sentence and $268M in restitution for massive fraud scheme.
$280 Million (July 2017) – Celgene improperly promoted cancer drugs.
$6.6 Million (July 2017) – Scopemaker Olympus fined for superbug outbreaks. Must pay $1 million to dead patient’s family.
$147 Million (July 2017) – California doctors, others, 400 defendants charged with fraud in distributing oxycodone to addicts. Fraud caused $1.3 billion in losses, said DOJ.
$1.3 Billion (July 2013) – HHS says largest fraud takedown in history, charges 400 defendants in schemes involving $1.3 billion in false billings.
$6.5 Million (July 2017) – Carolinas Healthcare System cheated health codes to get larger payments from federal healthcare coffers. Whistleblower gave evidence.
$42 Million (June 2017) – Los Angeles Hospital Pacific Alliance Medical Center must pay to settle kickback allegations.
$115 Million (June 2017) – Anthem data breach case. Information of 79 million people was stolen after a 2015 attack on attorney giant Anthem.
$1.4 Million (June 2017) – Alabama doctor fined for overcharging scheme.
$54 Million (June 2017) – Genesis Healthcare must pay $54 million to resolve claims of unnecessary hospice care, rehabilitation therapy.
$730 Million (June 2017) – The Centers for Medicare and Medicaid Services overpaid more than $729 million in incentive payments to eligible providers that didn’t meet meaningful use requirements, according to a U.S. Department of HSS.
$4.2 Million (June 2017) – Virginia’s Fredericksburg Hospital Group fined for Medicare Fraud.
$3 Million (June 2017) – Texas provider Union Treatment Center fined for Medicare Fraud.
$1 Billion (May 2017 – UnitedHealth Group doctored patient records, overbilled Medicare by $1 billion. (Source: DOJ)
$34 Million (May 2017) – Missouri Hospitals fined for improper payments to oncologists.
$25 Million (May 2017) – Blue Cross Blue Shield and states sued in Texas by Victory over trying to force out-of-net-work providers to become in-network to accept below market contractual terms.
$20 Million (April 2017) – Vaccine division of Sanofi-Pasteur fined $20 million for overcharging Veteran’s Affairs.
$150 Million (Jan. 2018) – McKesson was fined for controlled substance act violations, as the company’s actions encouraged and capitalized on the opiod problem sweeping the country.
Not a Complete List
This interminable list is nothing less than proof of just how broken our medical system is. And this is not a complete or even an exhaustive list, but just a sampling of healthcare penalties this year. It’s also further proof that our brand of Western medicine was designed not for health but for profit. Rockefeller medicine, the infamous Flexner Report, the terrible rise of the AMA and duplicitous organizations like the American Cancer Society – all of it has come together to give us the broken mess that is now our system of waste and despair. This system has done little more than make the sick sicker. Americans are now dying faster than in years past, millennials, too, even according to Bloomberg, normally a good NWO cheerleader. Meanwhile, those who own our broken medical system make more and more money in direct dis-proportion to the dysfunction they oversee.
Medical Frauds and Charlatans Proliferate
Drug makers, nursery home operators, clinics, hospitals, pharmacists, pharmacies, doctors, all manner of providers, insurance companies, ambulance operators – the list is long and growing longer daily of frauds and charlatans making money on the sick. You’ve only to look at the long list above and look around at all of you unhealthy neighbors and friends. We can’t blame it all on the medical system, but any fool can see the system is partly to blame.
What’s the Fix?
The medical system we live under is obviously badly broken, but what can fix it? When something becomes an industry, like military weapons, the national security state, or the medical industrial complex, it begins to generate so much money to buy U.S. Senators, Congressional reps , and governors that it circles back on itself, creating a monster that becomes increasingly separate from, and insensitive to, the people it is supposed to be serving. Money serves only itself, as corporations serve first their own officers and shareholders, and the devil take the hindmost.
Meanwhile, the only thing these corporations understand is money, their bottom line. When we catch them cheating or defrauding people, we sue them. That’s the only thing they understand, and the only way we can do anything to shed light on the problems and help fix them.
Healthcare Fraud Lawsuit
Contact our law firm for a free legal consultation if you have been a victim of a false psychiatric hold or have been otherwise defrauded by our broken medical system.