Physicians, providers indicted for health care fraud

May 9, 2018

Over the past week, the United States indicted a number of physicians for allegedly causing fraudulent claims to be submitted to Medicare or Medicaid and to other health insurance entities.

In Pennsylvania, five physicians of Redirections Treatment Advocates, LLC, an opioid addiction treatment practice with offices in Pennsylvania and West Virginia, were charged last week for alleged unlawful dispensing of controlled substances and for having committed health care fraud, Attorney General Jeff Sessions, United States Attorney Scott W. Brady of  the Western District of Pennsylvania and United States Attorney William J. Powell of the Northern District of West Virginia announced on May 1, 2018.

The United States alleged that these physicians, working as contractors at various locations, created and distributed unlawful prescriptions for buprenorphine, known as Subutex and Suboxone, a drug that should be used to treat individuals with addiction.  The government alleged that the physicians caused fraudulent claims to be submitted to Medicare or Medicaid for payments to cover the costs of the unlawfully prescribed buprenorphine.

In Portland around the same time, a federal Grand Jury handed down an indictment charging Abdirashid Ahmed, 38, of Lewiston and Garat Osman, 32, of Auburn, with health care fraud involving the MaineCare program and soliciting and receiving health care kickbacks from May 2015 through December 2017.

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According to the indictment, Ahmed sought payments from a MaineCare provider and in return referred some beneficiaries to the provider.

Ahmed and Osman allegedly took beneficiaries to the provider and served as Somali interpreters during the visits.  As a result, fraudulent bills were allegedly submitted to MaineCare, with overstated health and interpreter services. MaineCare reimbursed the provider based on the fraudulent billing.

An indictment is merely an accusation, and a defendant is presumed innocent unless proven guilty in a court of law.

Medicare fraud is still robustly going on, with only a fraction of it being detected and caught. Oftentimes unless a whistleblower comes forward there is no way to find out about illegal kickbacks, overbilling or a variety of other overbilling that may happen.

Under the False Claims Act (FCA), a whistleblower can come forward initially anonymously and collect a whistleblower award up to 30% of what the government recovers under Federal Law and some state statutes provide higher awards.  In order to commence a False Claims Act you must have a whistleblower lawyer.

If you know of similar cases of medicare fraud or wrongdoing that could be risking your health on top of unfairly charging our health care, call Toll Free (877) 561-0000.