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Scoundrel Spotlight - Medicare Fraudster Jesus Virlar-Cadena

Posted 10/2/23

This week’s Scoundrel in the Spotlight is Jesus Virlar-Cadena, a former medical director of a Texas-based healthcare provider called Merida Group, who was recently sentenced to over four years in prison in connection with a fraudulent scheme involving over $150 million in false Medicare claims, according to a DOJ press release. The Merida Group marketed hospice services to patients with long-term incurable...

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Provider Fraud,

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Posted 01/28/22

A federal judge in Texas sentenced Bradley Harris, former head of Novus Health Services, Inc. hospice company in Frisco, to more than thirteen years in prison and ordered him to pay $27.6 million in restitution. The sentence, announced in a DOJ press release, follows his guilty plea on charges of conspiracy and fraud on Medicare and Medicaid. Harris is the latest to be sentenced in a fraud scheme spanning...

Tagged in: Catch of the Week, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Improper Medical Facility, Improper Medical Personnel, Lack of Medical Necessity, Medicaid, Medicare,

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Posted 01/28/22

Individuals involved in financial and healthcare fraud schemes face not just civil liability, but also criminal penalties – including prison time. In 2021, the Department of Justice obtained substantial prison sentences in a myriad of cases involving healthcare and financial frauds, many of which involved convictions of the type of fraudulent schemes that whistleblowers report. Whistleblowers play an essential role...

Tagged in: Compounding Pharmacy Fraud, COVID-19, Criminal Proceedings, Education Fraud, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medicare, Money Laundering, Ponzi Schemes, Securities Fraud, Top 10,

Catch of the Week: Bayada Home Health Care Settles Kickback Allegations for $17 Million in Case Demonstrating that Kickbacks Come in Many Forms

Posted 09/17/21

Last week, Bayada Home Health Care, Inc., a national home health company with more than $1.5 billion in reported revenues and offices in twenty-two states, agreed to pay the United States $17 million to settle allegations that it violated the federal Anti-Kickback Statute (AKS). The AKS prohibits paying illegal remuneration in any form to induce business or referrals paid for with federal health care dollars, and...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Whistleblower Case,

Catch of the Week: Final Merida Hospice Fraudster Sentenced in $150 Million Scheme

Posted 04/23/21

Hands in handcuffs behind back of white man in business suit

Jose Garza, the former operations manager of Merida Group, a Texas-based hospice, and home health chain, just landed a 27-month prison sentence for his role in a $150 million hospice fraud scheme. Garza is the latest to receive a sentence in connection with the decade-long Merida Group scheme, which saw people with long-term illnesses falsely told they would die soon, while executives at the company pocketed millions...

Tagged in: Catch of the Week, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice,

Disturbing New Evidence Suggests Fraud Underlies Five-Star Ratings for Some Nursing Homes

Posted 03/19/21

Nurse helping elder man walking in rehab facility

Twelve years after the implementation of the nursing-home star-ratings system, a disturbing New York Times exposé and a lawsuit by California against Brookdale Senior Living reveals how the ratings are manipulated to the detriment of families in their time of crisis. The NYT’s investigation and California’s allegations in combination paint the troubling picture of profits tied to higher star ratings, and...

Tagged in: FCA Federal, Financial and Investment Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Provider Fraud, SNF,

DOJ Previews False Claims Act Enforcement Priorities for 2021

Posted 03/5/21

Department of Justice Seal on the United States Flag

The False Claims Act is the federal government's primary enforcement tool to combat fraud against the public. Every year the government recovers billions of dollars under the statute, primarily with the help of whistleblowers. Under the so-called qui tam provisions of the act, whistleblowers are authorized to act as private attorneys general and bring lawsuits on behalf of the government and recover a portion of...

Tagged in: COVID-19, Cybersecurity and Data Breaches, Electronic Health Records, FCA Federal, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Pharma Fraud, SNF,

Top Ten Healthcare Fraud Recoveries of 2020

Posted 01/5/21

Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, FCPA, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted 08/28/20

Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days. Here are the top takeaways:

- COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...

Tagged in: Anti-Kickback and Stark, COVID-19, Electronic Health Records, FCA Federal, Government Loan Programs, Home Health and Hospice, Importance of Whistleblowers, Risk Adjustment Fraud, Whistleblower Eligibility,

OIG Audit Suggests Home Health Agencies Submit Unsupported Visits to Trigger Higher Medicare Reimbursement

Posted 07/31/20

visiting nurse with elder woman sitting on a couch

OIG released results from its targeted audit of certain home health care claims submitted for payment and found $191.8 million of overpayments in 2017 alone. OIG's objective was to determine whether payments for home health services with five to seven visits in a payment episode complied with Medicare requirements. During the 2017 audit period, under Medicare's home health prospective payment system, home health...

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

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Scoundrel Spotlight - Medicare Fraudster Jesus Virlar-Cadena

Catch of the Week: Texas Hospice CEO Gets 13 Year Sentence in $60 Million Fraud Scheme

Top Ten Financial and Healthcare Fraud Prison Sentences of 2021

Catch of the Week: Bayada Home Health Care Settles Kickback Allegations for $17 Million in Case Demonstrating that Kickbacks Come in Many Forms

Catch of the Week: Final Merida Hospice Fraudster Sentenced in $150 Million Scheme

Disturbing New Evidence Suggests Fraud Underlies Five-Star Ratings for Some Nursing Homes

DOJ Previews False Claims Act Enforcement Priorities for 2021

Top Ten Healthcare Fraud Recoveries of 2020

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

OIG Audit Suggests Home Health Agencies Submit Unsupported Visits to Trigger Higher Medicare Reimbursement

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