By Heba Elsherif  |  February 14, 2018

Category: Consumer News

healthcare costsA Detroit, Michigan-based physician, Gerald D., 41, was sentenced to 24 months by a U.S. District Judge of the Eastern District of Michigan for his alleged role in a 1.7 million health care fraud plot.

According to a press release by the United States Department of Justice (DOJ), the physician was convicted of one count of conspiracy to commit health care fraud in May 2017 after a two week jury trial.

The health care fraud plot allegedly involved him along with two other co-defendants, Stephen M. and Leonard G., both physicians,  who worked for Lake MI Mobile Doctors (Mobile Doctors), a physician home visiting company.

Stephen underwent prior sentencing of an 18 month sentence on Aug. 22, 2017 while Leonard currently awaits sentencing, according to the DOJ.

The one count conspiracy to commit health care fraud was also pleaded guilty by the two co-defendants.

Through the health care fraud plot the physicians schemed to bill Medicare for patient home visits either through unwarranted treatment codes or billing for home visits that were medically unnecessary. After doing so, they would then receive unfittingly high compensations even though the visits were unwarranted or unnecessary.

All three physicians worked for Mobile Doctors from August 2012 through August 2013, according to trial evidence, the DOJ states. The home visiting company allows physicians to provide home visiting care to homebound Medicare patients.

However, through the patient home visits, the physicians would bill for patients that were either not homebound Medicare patients or were they sick and needed physician care. The three co-defendants billed Medicare for the highest visit paying codes, according to the DOJ.

Additionally, Gerald is also said to bill Medicare by referring patients for other unnecessary home health services. By doing so, he would be compensated more by Mobile Doctors.

The chief executive officer of Mobile Doctors was convicted to a 15-month prison sentence in the Northern District of Illinois through a related case. A physician based out of the company’s Chicago branch faces a 40-month prison sentence.

According to the DOJ, the announcement was made by the U.S. Acting Attorney of the Justice Department’s Criminal Division, the U.S. Attorney of the Eastern District of Michigan, Special Agent in Charge of the FBI’s Detroit Division, and Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-IOG) Chicago Regional Office.

This case was brought under the direction of the Criminal Division’s Fraud Section through the Medicare Fraud Strike Force. According to the DOJ, the Medicare Fraud Strike Force is led by the Division’s Fraud section, a joint initiative between the HHS and the DOJ. This section focuses “their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.”

Since its foundation, more than 3,500 defendants have been charged for health care fraud associated with falsely billing Medicare. Amounts have reached over $12.5 billion for health care fraud Medicare billing. The Force operates with nine locations around the country.

The case was investigated by the HHS-OIG and the FBI, and was also supervised by the U.S. Attorney’s Office for the Eastern District of Michigan.

In general, whistleblower and qui tam lawsuits are filed individually by each plaintiff and are not class actions. Whistleblowers can only join this investigation if they are reporting fraud against the government, meaning that the government must be the victim, and that the alleged fraud should be a substantial loss of money.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual qui tam lawsuit or whistleblower class action lawsuit is best for you. Hurry — statutes of limitations may apply.

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If you believe that you have witnessed fraud committed against the government, you may have a legal claim. Whistleblowers can only join this investigation if they are reporting fraud against the government, meaning that the government must be the victim, and that the alleged fraud should be a substantial loss of money.

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