Federal Crimes
Physician Fraud and Kick backs
“A New York doctor was found guilty yesterday by a federal jury for causing the submission of over $24 million in fraudulent claims to Medicare for medically unnecessary laboratory tests and orthotic braces.” Baldonado authorized hundreds of cancer genetic tests for Medicare beneficiaries who attended COVID-19 testing events at assisted living facilities, adult day care…
Read MoreFederal Anti Kickback Statutes Apply to all Healthcare Payments
Physicians that have children in healthcare positions can not take advantage of their circumstances to create a false billing scheme or ask for kick backs. This is health care fraud. These scheme are easily discovery as health care kickback schemes.
Read MoreWhat is actual loss pursuant to USSG § 2B1.1(b)(1)(G)
In every federal criminal indictment, trial, and sentencing after a plea or conviction, a defendant’s fate is guided by the actual financial loss the criminal acts caused. In United States v. Banks, — F.4th —- (Nov. 30, 2022), Frederick Banks was convicted of fraud. At sentencing, the federal judge applied the USSG § 2B1.1(b)(1)(G)’s enhancement for the intended fraud loss, not actual loss, because there was no actual monetary loss. Banks appealed and on November 30, 2022, the 3d Circuit court of appeal reversed his sentence.
Read MoreRuan and How the Courts and Prosecutors are Managing it
Translating this case into my client’s legal defense is easy. Having handled many physician prescribing prosecutions, long-term physician patient relationships are easily documents through chart reviews. Medically appropriate prescriptions can only be proven through clear charts, well documented and proper physical examinations, objective medical tests and diagnostic imaging. Call me to discuss your case, your patient load, your prescribing history, any state or federal DEA investigatory subpoenas. Lets talk about debarment, public or private health insurance audits and claw backs for care properly rendered and medically necessary.
Read MoreDAUPHIN COUNTY ARD RULES CHANGE DURING COVID
Ard rules for Dauphin County
Read MorePA Constitution Requires a Warrant Before Police Search Your Car. Commonwealth v. Alexander December 22, 2020 (Merry Christmas)
In Pennsylvania, obtaining a warrant prior to searching a care is now the default rule. If an officer proceeds to conduct a warrantless search, a reviewing court will be required to determine whether exigent circumstances existed to justify the officer’s judgment that obtaining a warrant was not reasonably practicable.
Read MorePennsylvania Suspends Certain Licensure Requirements for State Board of Psychology, and State Board of Social Work, Marriage and Family Therapy, and Professional Counselors
March 22, 2020 Pennsylvania Suspends Certain Licensure Requirements for State Board of Psychology, and State Board of Social Work, Marriage and Family Therapy, and Professional Counselors In order to increase the number of health-care practitioners available to respond to the COVID- 19 emergency, Governor Wolf has granted the Department of State’s request to suspend some…
Read MoreCovid -19 and Health Care Disciplinary Process
Covid-19 and the Practice of Law and Pending Health Care Disciplinary Cases
Read MoreBilling issues can lead to fraud charges
Many people in the greater Philadelphia area rely on federal healthcare programs, like Medicare and Medicaid, to cover all or part of their needs for medical care. Many if not most other Pennsylvanians get their insurance through private companies who also front the money for medical care in exchange for premiums. What this means is…
Read MoreLicensure Applications — Disclosing a Record — Part 1 — The Cover Up is Worse than the Crime
Professional license applications require potential licensees disclose prior criminal convictions or open criminal cases. Current licensees seeking an additional license must also answer these questions. This self reporting obligations establishes a base level of honesty, ethics, and moral turpitude Pennsylvania’s licensing boards expect from their licensees. Board investigations of licensee’s criminal record (disclosed or not)…
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