A federal jury recently found that State Farm Fire and Casualty Company had inappropriately characterized homeowners’ claims as a result of Hurricane Katrina. The relators – two sisters who were insurance adjusters for State Farm – alleged that State Farm paid flood policy limits of $250,000 on a North Biloxi house that was actually destroyed by wind before Hurricane Katrina's tidal surge washed ashore. State Farm and other insurance companies adjusted their claims for wind damage and submitted their claims to the federal government under the National Flood Insurance Program.
Accordingly, the jury returned a verdict finding that State Farm had knowingly presented, or caused to be presented, a false and fraudulent claim to the federal government in violation of the False Claims Act, along with a $250,000 single damages verdict against State Farm in favor of the government. This case is just the first case in thousands of other similar post-Katrina cases.
A New York doctor was recently convicted of health care fraud conspiracy and health care fraud following an eight-week trial before a federal jury. Evidence showed that Bay Medical Care, of which the defendant was president, paid cash kickbacks to Medicare beneficiaries and submitted $77 million in fraudulent Medicare billings for unnecessary medical procedures. Dr. Gustave Drivas will be sentenced on July 9, 2013, and faces 20 years in prison.
A Texas judge recently sentenced Dr. Michael David Goodwin, an orthodontist who practiced in Amarillo, Texas and Crown Point, Indiana, to 50 months in federal prison and ordered him to pay $1,810,960 in restitution for health care fraud. Dr. Goodwin pleaded guilty to one count of healthcare fraud related to the Texas Medicaid program in December 2012. Dr. Goodwin must also forfeit $1,558,911 in proceeds traceable to his fraudulent activities and $244,000, which the government seized in May and July 2011 from his JP Morgan Chase accounts.
Goodwin’s conviction stemmed from allegations that, between January 2008 and March 2011, he caused the submission of $2,626,125 in fraudulent billings to the Texas Medicaid program for services that were not medically necessary or were performed by dental assistants without the supervision of a dentist or orthodontist.
The scheme was devised by maximizing the number of Medicaid patients seen and billed, often scheduling more than 100 patients per day, with a large number of Medicaid patients scheduled for those days when he was out of town. At these times, a dental assistant would perform medical services that the dental assistant was not licensed to perform. Goodwin also devised a generic treatment guideline for his dental assistants to follow when treating Medicaid patients without his examination of the patient. Substitute general dentists who were not enrolled in Medicaid orthodontic providers were hired to give the appearance that there was direct supervision of dental assistants. Goodwin instructed his billing staff to falsely and fraudulently state on Medicaid claims that he was the performing provider for all services performed when he was out of town and dental assistants were actually providing the services.
Please contact us at (312) 863-7222 if you would like to learn more about any of the aforementioned whistleblower news updates or would like to schedule a free, confidential appointment with one of our nationally recognized whistleblower attorneys.