To report Medicaid or Medicare fraud, contact Frohsin & Barger.

The report acknowledges that “[i]t is unusual for a firm that is just a few years old to be singled out for distinction, but the accomplishments of Frohsin & Barger warrant the wealth of accolades it has received.”

The study is “the culmination of a six-month research period” and “extensive interviews with litigators and their clients.” Benchmark’s researchers “examine recent casework handled by the firms and ask sources to offer their professional opinions on litigators practicing within their state or national practice areas.”

The findings specifically single-out Frohsin & Barger’s “highly developed” False Claims Act whistleblower practice, representing “individuals who have the tenacity to expose fraud against the government and taxpayers.”  According to the report:

“[Frohsin & Barger] has a profound understanding of both sides of whistleblower litigation that they use to develop cogent litigation strategy.”

In addition to the firm, the study recognized Jim Barger individually as one of Alabama’s “litigation stars,” among 50 some-odd attorneys in the state who “were recommended consistently as reputable and effective litigators by clients and peers.” Barger — an Adjunct Professor of Law at the University of Alabama School of Law — is identified by the study for his legal analysis of the False Claims Act which “has been referenced by state legislators in their adoption of qui tam statutes,” according to the study’s findings.

Other Alabama litigation firms identified in the study include: Beasley Allen Crow Methvin Portis & Miles, Cunningham Bounds, Hare Wynn Newell & Newton, Marsh Rickard & Bryan, Copeland Franco Screws & Gill, Cory Watson Crowder & DeGaris, and Pittman Dutton & Hellums.

“Recommendations are based on interviews with the nation’s leading private practice lawyers and in-house counsel. These interviews were conducted between January and June 2011. Firms cannot pay to be recommended for the guide.” No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

To report home health fraud or other Medicare fraud, contact Frohsin & Barger.

Many commenters focused on what they believe is nothing more than the typical corporate greed:

• “Greed will eventually take everything precious away.”
• “The most ultra-wealthy people I have ever personally met (picture $100K/month yacht maintenance expenses) are in the business of custodial healthcare for the elderly, indigent and mentally retarded.  All patients’ billings have always been fully covered by our wonderful government.”
• “Government programs like Medicare would certainly be less wasteful if people didn’t abuse them and line their own pockets with money intended for good purposes. I don’t care how much incentive they had, these folks are despicable. Even more despicable are the healthcare professionals who recommended patients and attested to their eligibility. Not only did they participate in this rip-off knowingly and willingly, but with total disregard for patient welfare.”

Others blamed lack of oversight by the government, allowing such unscrupulous practices:

• “These greedy doctors/businesspeople (and yes, they were morally wrong) couldnt have made this scheme work without the recklessness of government!  They had incentive to do these things because Medicare foot the bill.”
• “Its like if a teacher left the test answers on his/her desk and left the room during the examination. YES the students who cheat are wrong for doing so, and their is no excuse for it.  But what kind of teacher would provide such strong incentive to cheat?  I don’t even want to know how much taxpayers paid for the 110,000 improperly admitted patients.”
• “Observing the way our financially strapped federal, state and local governments are systematically raped by savvy executives is like watching someone steal silverware off the sinking Titanic.”
• “Mostly, the money earned is technically legal and due to exploiting inefficiencies and vagaries in government bureaucracy.  But the mindset is anything but patriotic.  What shame.”

Others blamed corruption of the medical industry:

• “This is clearly the medical industry that is taking advantage of the taxpayer.”
• “The medical industry, pharmas, hospitals, doctors insurance companies are killing the poor and middle class. Period. Clear enough????

Still others concentrated on the effect that alleged gaming of the Medicare Hospice Benefit may have on the otherwise noble mission of hospice:

• “Yes, there are some bad companies that may be taking advantage of the situation. But remember, there are thousands of hospices doing the right thing and they bring comfort, dignity and compassion to the dying and their family caregivers.  Don’t let bad players malign the entire field.”
• “I remember Hospise before it was enveloped in government” garb.  It has changed drastically…wit the access to all the “free” services.”

While most concentrated on the possible effect upon patients themselves who need care but are apparently getting the wrong care in order to maximize profits:

• “Just went through several months of hospice care with one of my parents. Two short nursing visits per week, 3 baths per week, most medication, and the chaplin twice a month for approx $4700 mo. in billing to medicare. This service will be the next big government episode of waste, fraud and abuse.”
• “We lived through a gruesome hospice experience that killed our dad last year.  Try to get ANYONE to help or even bring notice of this fact to the public.  No one’s interested.  We were chased down by the medical insurance plan for years to enroll him in hospice.  Yes, a major benefit to THEM if we did.  He was dead in six weeks.  What more a perfect tool than Hospice??”
• “Suddenly all those recent articles that advocate against ‘aggressive care’ take on a much more sinister tone.”

To report Medicare Hospice Fraud, contact Frohsin & Barger.

Uriel Sharef, a former member of the central executive committee of Siemens AG;

• Herbert Steffen, a former chief executive officer of Siemens Argentina;
• Andres Truppel, a former chief financial officer of Siemens Argentina;
• Ulrich Bock, Stephan Signer and Eberhard Reichert, former senior executives of Siemens Business Services (SBS); and
• Carlos Sergi and Miguel Czysch, who served as intermediaries and agents of Siemens in the bribe scheme.

“Today’s indictment alleges a shocking level of deception and corruption,” said Assistant Attorney General Breuer.   “The indictment charges Siemens executives, along with agents and conduits for the company, with committing to pay more than $100 million in bribes to high-level Argentine officials to win a $1 billion contract.” According to the indictment:

the government of Argentina issued a tender for bids in 1994 to replace an existing system of manually created national identity booklets with state of the art national identity cards (the DNI project).  The value of the DNI project was $1 billion.  In 1998, the Argentine government awarded the DNI project to a special-purpose subsidiary of Siemens AG.

“As alleged, the defendants in this case bribed Argentine government officials in two successive administrations and paid off countless others in a successful effort to secure a billion dollar contract,” said U.S. Attorney Bharara.  “When the project was terminated, they even sought to recover the profits they would have reaped from a contract that was awarded to them illegitimately in the first place.”  The indictment also alleges that”the defendants and their co-conspirators caused Siemens to commit to paying nearly $100 million in bribes to sitting officials of the Argentine government, members of the opposition party and candidates for office who were likely to come to power during the performance of the project.”

According to the indictment, “members of the conspiracy worked to conceal the illicit payments through various means:

For instance, Bock made cash withdrawals from Siemens AG general-purpose accounts in Germany totaling approximately $10 million, transported the cash across the border into Switzerland and deposited the funds into Swiss bank accounts for transfer to officials.  Bock, Truppel, Reichert and other conspirators also allegedly caused Siemens to wire transfer more than $7 million in bribes to a bank account in New York disguised as a foreign exchange hedging contract relating to the DNI project.  Over the duration of the conspiracy, the conspirators allegedly relied on at least 17 off-shore shell companies associated with Sergi, Czysch and other intermediaries to disguise and launder the funds, often documenting the payments through fake consulting contracts.

To report Foreign Corrupt Practices Act violations or other securities fraud, contact Frohsin & Barger.

“Health care providers that make billing compliance, self- policing, and self reporting a priority foster trust in the health care industry” said Nick DiGiulio, Special Agent in Charge for the United States Department of Health and Human Services’ Office of Inspector General. “These actions demonstrate that Diakon Hospice Saint John cares about returning money, incorrectly attained, to our federal health payment programs.”

Unfortunately, very few companies act so responsibly once they discover false claims to Medicare. As Bloomberg News and others have recently reported, false claims to Medicare by profit-driven hospices are a widespread practice according to former employees and executives. Others should follow the lead of Diakon and report their false claims and seek reform through implementing rigorous corporate compliance programs. If they fail to do so, the False Claims Act encourages individuals who have knowledge of such false claims to come forward and share as much as 25% or more of the recovery.

To report Medicare Hospice Fraud, contact Frohsin & Barger.

“Hospice care, once chiefly a charitable cause, has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.”

The Bloomberg story chronicles the plight of Janet Stubbs, who “didn’t know that her aunt, Doris Midge Appling, was admitted to Hospice Care of Kansas during the company’s “Summer Sizzle” promotion drive, which paid employees as much as $100 a head for referrals.” For many who have experienced hospice as it was intended — palliative and comfort care for near-death patients and their families — it is shocking to learn that hospice care is promoted like the sale of used cars or mattresses.

But where there are endless amounts of taxpayer dollars for the taking, there will be those who line up with hands outstretched like crazed shoppers at a Black Friday sale. And it’s the patients and their families who suffer, because medical judgment gets thrown out the window in the frenzy of such “Summer Sizzle” hospice sales events:

“It doesn’t seem right,” Stubbs told Waldmen. “What incentive did the doctor have to put my aunt on hospice? How much was she being paid?”

Bloomberg’s investigation reports that the incentives for false certification of terminal illness are apparently huge:

“Compensation based on enrollment numbers, pay to nursing- home doctors who double as hospice medical directors, and gifts to the nursing facilities have helped fuel the boom, according to an examination of 1,000 pages of court documents and interviews with more than 45 current and former hospice employees, patients and family members.”

The “boom” to which Waldman refers is an industry where death has become a commodity to be bought and sold on the open market. One former hospice chaplain told Waldman that doctors were paid “$3,000 or $4,000 a month from a hospice to work one day a week” and that the natural result was for doctors to refer their patients to the hospice company. “They wanted us to admit, admit, admit,” Waldman reports that a former marketer for Vitas Healthcare, said. “All of us competed against each other to make our numbers. You lived or died by your numbers.” Vitas Healthcare operates the hospice brand of Chemed Corporation, whose other division is RotoRooter, the septic cleaning service chain.  A salesperson for another large corporation apparently told Waldman, “There was always pressure to get the patient census up, any way we could, to sell the company.”  Yet another hospice worker told Waldman that her supervisors instructed her: “Put everyone on hospice, don’t ask questions and build!…“They were there to make a buck.”

Most people would be shocked at the idea of marketing and salespeople in hospice, but in many of the big businesses, marketing and sales make-up a large part of their employee force.  And the leadership and equity investment behind such sales efforts comes from the ethically-challenged culture of Wall Street.  According to Waldman:

“Publicly traded companies like Chemed and Gentiva Health Services Inc. (GTIV) have created hospice chains through serial takeovers in the last decade. Hospice buyouts and investments by private-equity firms have also led to boosted enrollments.

Funding from Kohlberg Kravis Roberts & Co. enabled closely- held Harden’s acquisition of Hospice Care of Kansas’s parent last year. The seller: private-equity investor Apax Partners, ofLondon and New York.”

In addition to the “Summer Sizzle” event, Waldman discovered numerous other hospice sales blitz events around the country such as “Christmas Cash Blitz” and “Fall Frenzy” hospice admission drives at various companies. When care for the dying is described with words like “sizzle” and “cash blitz” and “frenzy”, it should be abundantly clear that the system is out of control.

To report hospice fraud or other Medicare fraud, contact Frohsin & Barger.

Langford quotes Assistant United States Attorney Justo Mendez as saying that the federal government knows that taxpayer dollars are being lost to ‘”fraudsters’ who “bill for services not rendered.” But determining which companies are cheating and which ones are not and learning the information necessary to bring legal action to recover the money proves to be a monumental if not insurmountable task for authorities to tackle alone. Langford’s report quotes Rachel Hammon, director of clinical practice and regulatory affairs for the Texas Association of Home Care & Hospice, who insinuates that part of the problem is a bureaucratic breakdown. “I think the big problem I see is how the various government agencies coordinate. Each one says ‘That’s not what I do’ or ‘I’m not funded.’ ” says Hammon. The Association’s executive Director, Anita Bradberry agrees, telling Langford, “I have a problem with the government not watching who is billing what.”

The Chronicle’s investigation found the following deeply disturbing facts:

• “384 million was paid to 468 Houston companies in 2010″ alone
• “Even in the tiny town of Edinburg in South Texas, 27 home health care agencies have received $331 million over the last four years” [FraudBlawg note: At the town's population of 72,000 -- that's nearly $5,000 of taxpayer dollars for every man, woman, and child in the city]
• “Medicare’s direct contact with the companies that bill the mammoth insurance agency for the elderly and disabled is minimal.”
• “No one from the $760-billion CMS ever sets an eyeball on a home health agency in Houston”
• “Federal auditors repeatedly have noted the exploding and profitable growth of home health care in the Lone Star State, where Medicare spending has blown up to three times the national growth rate.”
• “Even before Houston’s explosive growth in home health care, federal auditors noted that not only had the number of people getting Medicare benefits doubled, but so did the number of times agencies billed for a visit to a patient: from 36 times to 73.”

The Chronicle story reports shocking instances of elder abuse and other serious problems and follows the story of one Houston man whose mother was put on home health to watch a wound on her foot and who “quickly became alarmed about all the doctors and health aides who were practically falling all over themselves to schedule house calls,” many of whom apparently lied about their credentials — at least one of whom fraudulently claimed to be a doctor.

If the Authorities Aren’t Going to Do Anything, Insiders Must Come Forward

There is one small ray of hope, however.  Like everything else in this country, it is the people who can effect a change.  The federal False Claims Act — enacted by President Abraham Lincoln who was shocked by defense contractor fraud during the Civil War (Texas has a similar state law) — permits people who have direct and independent knowledge of such fraud to file independent lawsuits on behalf of the taxpayers to recover false claims like the widespread practices that are apparently rampant in Houston.  Under the False Claims Act, fraudsters can be forced to repay to the taxpayers up to three times the amount of their false claims plus a civil penalty of up to $11,000 per false claim.  The whistleblower (or relator) who uncovers the fraud can be rewarded with between 15-30% of the total recovery, plus attorneys’ fees and costs of the lawsuit.

To report home health care fraud or other Medicare fraud, contact Frohsin & Barger.

To report physical therapy or other Medicare fraud, contact Frohsin & Barger.