Impatient to Get Patients: This Medicare/Medicaid Fraud Made Me Really Mad

Sometimes a case about Medicare and Medicaid fraud just makes me through-and-through
mad, and the ongoing case about Health Care Solutions Network (HCSN) is
one of those cases.

According to a January 24, 2013,
Justice Department press release, HCSN ran a mental health center in Miami, as well as a second one in
North Carolina. Apparently impatient to get patients, the company paid
kickbacks to owners and operators of assisted living facilities to get
them to send elderly people for treatments at HCSN. According to DOJ,
the services were “medically unnecessary and, in many instances,
not even provided.” HCSN was not concerned with whether the patients
actually needed the treatment. In fact, according to DOJ, some of the
patient “suffered from dementia, Alzheimer’s disease or mental
retardation, or were otherwise unable to benefit from mental health services.”
Nonetheless, HCSN gave these patients treatments and billed Medicare and
Medicaid for the “services” it was providing. HCSN even put
some of these patients into a “partial hospitalization program”
(PHP), a program that is supposed to involve intensive treatment for severe
mental illness. Again, HCSN billed Medicare and Medicaid for the “services”
it provided. Per the press release, these patients did not qualify for
the partial hospitalization program, and “were only selected because
they had Medicare or state of Florida Medicaid benefits.”

Wow. Seriously? I am a
whistleblower lawyer and so I regularly represent people who are blowing the whistle on fraud
against the Government. I see a lot of fraud, and every time I pay my
taxes, I think about the fact that when somebody rips off Medicare, Medicaid
– or any other government program – they are stealing from
all of us who are U.S. taxpayers. But sometimes a defendant does something
so out-and-out callous and hurtful to others that it manages to stand
out even in a pretty bad crowd – and for me, HCSN fits in that category.

Over a seven-year period between 2004 and 2011, HCSN billed Medicaid $63,000,000
for “purported mental health services.”

DOJ issued the press release to announce that the owners of three assisted
living facilities and “an affiliated psychologist” were sentenced
to prison after they pled guilty to conspiracy to violate the anti-kickback
statute. The psychologist reportedly “conspired with other HCSN
employees to fabricate medical records to support HCSN’s fraudulent
billing to the Medicare program.” As part of the plea agreement,
the psychologist even admitted that many of the patients were not qualified
for the treatments. She also agreed to give up her North Carolina mental
health treatment license. For their part in the defrauding Medicaid, the
three owners of the assisted living facilities are now banned from ever
operating assisted living facilities again.

Instead of being able to live out their lives in peace and with tender
care, these elderly people were subjected to mental treatments and even
partial hospitalizations they did not even need. And the DOJ tells us
that the only reason was so somebody could make money from Medicare?

That’s outrageous. And it’s why I am going to keep representing
whistleblowers in qui tam and False Claims Act cases – because things
like this ought not happen. Sometimes the Government finds out about fraud
on its own – and it may have done so in the case of HCSN, because
the press release does not mention a whistleblower. But a large part of
the time, the Government needs a relator (whistleblower) to come forward
to let it know when and how it is being ripped off.