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A federal grand jury in New Orleans has indicted several people, including two elderly doctors, who allegedly netted more than $21 million in a phony Medicaid and Medicare billing scam last Friday.

The defendants allegedly schemed to bill the government for thousands of tests that were never performed, and for others done unnecessarily, the indictment alleges.

According to federal prosecutors, people involved in the scam would take patients to clinics in Metairie and Kenner in exchange for prescription drugs and cash. Prosecutors say patients also were driven to various clinics for redundant tests.

Prosecutors say unneeded neurology tests, pulmonary tests, echocardiograms and other exams were rampant in the scheme, which ran in 2009 and 2010, according to the indictment. An earlier indictment in April named nine defendants and placed the cost of the alleged scam at about $12 million.

Executives for a California company ironically named, Solo Lucky Claims Processing, submitted the phony claims for the clinics, and money was laundered through another California company, Med-Tech, through inflated purchases of old or obsolete medical equipment charged to the clinics, the indictment alleges.  These companies ended up not being so lucky after all.

The clinics would bill the government for the same tests for the vast majority of patients, regardless of their complaints, the indictment alleges.

The indictment alleges that one clinic billed for about 1,000 Medicaid and Medicare beneficiaries, another for 1,100, and two others for about 1,500, although the numbers overlap, with some patients visiting more than one clinic.

One of the criminal defense attorneys said that his client thought he was just doing some general medical tests.  In addition, he said that his 80 year-old client is being exploited because of his age.

All of the defendants face a conspiracy charge and numerous counts of healthcare fraud.

In Louisiana, healthcare fraud is defined as:

(1) to defraud any health care benefit program; or

(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury, such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.

(b) With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.

Baton Rouge Criminal Defense Lawyer Carl Barkemeyer represents those accused of white-collar crimes in Louisiana such as fraud, money laundering, bribery, extortion, corruption, conspiracy, healthcare fraud, mail fraud, wire fraud, tax fraud, and securities fraud.  If you or someone you know has been charged with healthcare fraud or another white-collar crime, contact Baton Rouge Criminal Defense Attorney Carl Barkemeyer for a free consultation.

Source: The Advocate, “Doctors accused of scam,” December 18, 2011.


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