A New Jersey case has ended with a father and son getting time behind bars for more than $890,000 worth of allegedly illegal Medicaid billings. Unqualified people were providing physical therapy at the medical practice leading to the conviction and sentencing of both the father and son to time in prison for Medicare fraud.
Medicare Fraud Includes False Medical Claims
The father received a 30 month prison sentence and the son received 12. Furthermore, the judge ordered them to pay $890,000 in restitution costs. The pair will also have three years of supervised release requirements after their time is served.
The defendants were accused of conspiracy to commit Medicare fraud with their medical practice, Atlantic Spine & Joint Institute. Both individuals pled guilty in June to those charges and had agreed to settle nearly $2 million in addition to interest payments to the federal government assorted with civil claims. A billing manager at the practice came forward and alleged that fraudulent bills were provided to Medicare and argued that the scheme being carried out by the father and son were in violation of the False Claims Act.
What to Know About Government Protection for Whistleblowers
The employee in this case is a whistleblower and whistleblowers are highly encouraged to come forward with information about illegal actions for fraud. In return, they receive protection from the federal government in the event that their employer tries to retaliate against them and when filing allegations under the False Claims Act. Whistleblowers may also be entitled to a portion of the ultimate recovery.
The whistleblower in the above-mentioned case will receive approximately $338,000 for the settlement in addition to her legal fees.
A whistleblower who suspects that they have grounds to pursue a claim or assist the government with an investigation may help to curb fraudulent activities now and in the future.
The government, in their efforts to encourage whistleblowers to come forward, provides rewards as well as protections so long as the person in question has a reasonable belief that fraud has occurred. In recent years, the federal government’s attempted crackdown on Medicare and Medicaid fraud has made these cases more prevalent.
A doctor following Medicare regulations can bill an agency for physical therapy that is given to a Medicare recipient if the therapy was supervised by a licensed physical therapist, a graduate of a physical therapist program, or if the doctor administered the therapy directly. This means that the doctor must be present and available in the office in the event that questions arise; if not, then billing as if a medical professional administered the treatment is Medicare fraud.
If you or someone you know believes you have allegations of healthcare fraud, you need to consult with a whistleblower attorney immediately- the attorneys at Bradley/Grombacher are currently investigating claims. Fill out the form on this page to learn more about your options.
The Medicare fraud whistleblower cases are USA v. Robert Claude McGrath and USA v. Robert Christopher McGrath, Case No. 1:17-CR-00215 and 1:17-CR-00216 in the U.S. District Court for the District of New Jersey.
Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.