Minnesota-Based Medtronic Inc. Pays U.S. $23.5 Million to Settle Claims That Company Paid Kickbacks to Physicians
U.S. Department of Justice December 12, 2011

Office of Public Affairs (202) 514-2007/TDD (202) 514-1888

WASHINGTON—Medtronic Inc. of Fridley, Minn., has agreed to pay the United States $23.5 million to resolve allegations that it violated the False Claim Act by using physician payments related to post-market studies and device registries as kickbacks to induce doctors to implant the company’s pacemakers and defibrillators, the Justice Department announced today.

Post-market studies are intended to assess the clinical performance of a medical device or drug after that device or drug has been approved by the Food and Drug Administration. Registries are collections of data maintained by a device manufacturer concerning its products that have been sold and implanted in patients.

The United States contends that Medtronic caused false claims to be submitted to Medicare and Medicaid by using two post-market studies and two device registries as vehicles to pay participating physicians illegal kickbacks to induce them to implant Medtronic pacemakers and defibrillators. Although Medtronic collected data and information from participating physicians, each of the studies and registries required a new or previous implant of a Medtronic device in each patient, and in each case Medtronic paid participating physicians a fee ranging from approximately $1,000 to $2,000 per patient. The United States contends that Medtronic solicited physicians for the studies and registries in order to convert their business from a competitor’s product and/or persuade the physicians to continue using Medtronic products.

“Patients who rely on their healthcare providers to implant vital medical devices expect that those decisions will be made with the patients’ best interests in mind,” said Tony West, Assistant Attorney General for the Civil Division. “Kickbacks, like those alleged here, distort sound medical judgments with financial incentives paid for by the taxpayers.”

“Medicare and Medicaid beneficiaries depend on their physicians to make decisions based on sound medical judgment, especially when they are choosing which pacemaker or defibrillator to implant,” said B. Todd Jones, U.S. Attorney for the District of Minnesota. “Medical device manufacturers must not be permitted to use improper payments to cloud that judgment.”

“Today’s settlement highlights one of the key purposes of the Anti-Kickback law—to ensure that the judgment exercised by health care providers in treating Medicare and Medicaid patients is not influenced by unlawful payments,” said Benjamin Wagner, U.S. Attorney for Eastern District of California.

“Patients trust that decisions to implant certain pacemakers or other medical devices are based on their own health interests and not influenced by kickbacks,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Companies distorting medical decision-making through kickbacks can expect that OIG investigators and our law enforcement partners will actively investigate and prosecute such unlawful conduct.”

The settlement resolves allegations contained in two whistleblower lawsuits filed under the qui tam provisions of the False Claims Act that are pending in Minnesota and California, respectively. As part of today’s resolution, the whistleblowers will receive payments totaling more than $3.96 million from the federal share of the recovery.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover nearly $6.5 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are more than $8.5 billion.

This settlement was the result of an investigation by the Justice Department’s Civil Division, the U.S. Attorney’s Office for the District of Minnesota, the U.S. Attorney’s Office for the Eastern District of California, the Office of Inspector General at the U.S. Department of Health and Human Services, and the FBI.

Click here to see and review the top 10 most wanted fugitives for Health Care Fraud

See the quick video about Palm Scans at El Centro Hospital:

Palm Scanning started at facilities back east. Good to see its arrival here in California. This procedure can assist in the prevention of Medical Identity Theft and Identity Fraud!

Did you realize you can pull your official employment history for free and check the accuracy and for signs of employment identity theft.

Have you thought about the fact, when you apply for a new job that an employer will do a background check? What if someone has taken your identity, found a new job and now erroneous information has been posted? Don’t forget, that employer may also check you out on Facebook, LinkedIn or your blogs.

The Fair Credit Reporting Act (FACT Act) is the law that lets you obtain a free credit report from the three credit-reporting agencies every 12 months. You may not know that the FACT Act also lets prospective or current employers gather information about you for background checks. This is a a great tool to know what they’re seeing about you – and to check for signs of possible identity theft.

Some credit reporting agencies and investigation companies compile what is known as “investigative consumer reports”, which are used in limited circumstances such as background checks for employment, insurance policies, and rental housing. These reports do not contain information about your credit record that is obtained directly from a creditor or from you. (For example, it won’t have information about a late payment).

Federal law requires your current or prospective employer to get permission from you to conduct the report. The good news is that if the information in the report is used by the employer to make a negative hiring decision, the employer must give the applicant a copy of the report.

We suggest that you be proactive and get a copy of this report once every 12 months, for free, just like your credit report. You can check it to see if someone else with your name has a work history that may be confused with yours, or may be a result of identity theft. You also have the right to correct and dispute inaccurate information in an investigative report, just as with your credit report.

To order your report, check out the LexisNexis Employment History Report. There’s no guarantee that LexisNexis has a file on you however; as it says on its website, “our files would only contain information on you if LexisNexis provided your Employment History Report to an employer.”

Ordering is easy. Call 866-312-8075, Sunday through Friday, to start the automated process. You must give your Social Security number, current street number, zip code and date of birth for the report to be started. Have a pen and paper ready to write down the report tracking number, in case you need to call and follow up. If you’re not comfortable giving information over the phone, you can instead download and send in a report request.

Information courtesy of Debix Newsletters

Department of Justice
Office of Public Affairs Press Release

WASHINGTON – Ninety-four people have been charged for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program in the continuing operation of the Medicare Fraud Strike Force in Miami; Baton Rouge, La.; Brooklyn, N.Y.; Detroit and Houston, announced Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, FBI Director Robert Mueller and Daniel R. Levinson, Inspector General of HHS. The operation announced today is the largest federal health care fraud takedown since Medicare Fraud Strike Force operations began in 2007.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. More than 360 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in today’s operation.

“Our continued Strike Force operations reflect the unprecedented commitment that inspired the creation of the Health Care Fraud Prevention and Enforcement Action Team in May 2009,” said Attorney General Holder. “With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet. The federal government is working aggressively – and collaboratively – to pursue health care criminals around the country and to bring these offenders to justice.”

“Today’s arrests send a strong message that attempts to defraud Medicare will not be tolerated,” said Secretary Sebelius. “With the help of new tools in the Affordable Care Act, including stiffer penalties and better information sharing, we will continue to work with our federal, state and local partners to stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”

Charges were unsealed today against 94 individuals who are accused of various Medicare fraud-related offenses, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home health care schemes, HIV infusion fraud schemes and durable medical equipment (DME) schemes. Thirty-six defendants charged in these schemes have been arrested in Miami, New York, Baton Rouge and Detroit and additional arrests are expected throughout the day.

According to the court documents, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided. In many cases, indictments and complaints allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the treatments that, in reality, were unnecessary or never provided. Collectively, the doctors, health care company owners, executives and others charged in the indictments and complaints are accused of conspiring to submit more than $251 million in false claims to the Medicare program.

In Miami, 24 defendants were charged for allegedly participating in various fraud schemes that led to approximately $103 million in false billings. According to court documents, the fraud schemes involved fraudulent billing for HIV infusion services, home health care and physical therapy services, DME and pharmaceutical medications. The defendants include owners and operators of companies, doctors, nurses, and patient recruiters, as well as a medical biller who is alleged to have billed approximately $49 million for fraudulent services.

Thirty-one defendants were charged in Baton Rouge for various schemes allegedly involving fraudulent claims for DME totaling approximately $32 million. The defendants include the owners and operators of nine different purported medical services companies and four doctors, 14 patient recruiters and other individuals who allegedly worked at the medical services companies.

Twenty-two defendants were charged in Brooklyn for their alleged participation in schemes to submit fraudulent claims totaling approximately $78 million. These fraud schemes involved false billing for physical and occupational therapy and DME. The defendants include the owners and operators, patient recruiters and employees at three different purported medical clinics and a medical equipment company, as well as three doctors. According to court documents, six of the defendants charged are serial Medicare beneficiaries, who purported to seek medical treatment from numerous providers, causing the submission of multiple claims to Medicare for purported medical treatments.

In Detroit, 11 defendants were charged for their alleged roles in schemes to submit fraudulent claims to Medicare for home health services, nerve conduction tests and injection and infusion therapy sessions. The schemes involved a total alleged fraud of approximately $35 million and five different purported medical services companies.

Four defendants were also charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for DME.

In addition to making arrests around the country, law enforcement agents are executing search warrants in connection with ongoing health care fraud investigations.

“Today’s charges allege attempts by individuals to defraud the Medicare program of $251 million,” said FBI Director Robert S. Mueller, III. “Countless Americans rely on Medicare for their well-being, and the FBI, working in conjunction with our federal agency partners, is resolute in its commitment to stop those who would illegally manipulate the system.”

“Today’s arrests illustrate how health care fraud schemes can replicate virally and migrate rapidly across communities,” said Daniel R. Levinson, Inspector General of HHS. “To combat this fraud, the government’s response must also be swift, agile, and organized – a HEAT initiative goal which is well illustrated by today’s Strike Force actions.”

The Strike Force operations in Miami, Baton Rouge, Brooklyn, Detroit and Houston are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The HEAT task force, co-chaired by Acting Deputy Attorney General Gary G. Grindler and Deputy Secretary Bill Corr, is made up of top-level law enforcement agents, prosecutors and staff from both departments and their operating divisions. In the May 2009 announcement, Attorney General Holder and Secretary Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars. In December 2009, Strike Force operations were expanded to Brooklyn, Baton Rouge and Tampa.

Since its inception in March 2007 with Phase One in South Florida and continuing through its most recent expansion into Tampa, Fla., the Strike Force has obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The cases announced today are being prosecuted and investigated by Strike Force teams comprised of attorneys from the Fraud Section in the Justice Department’s Criminal Division and from the U.S. Attorneys’ Offices for the Southern District of Florida, the Eastern District of New York, the Middle District of Louisiana, the Eastern District of Michigan and the Southern District of Texas; and agents from the FBI and HHS-OIG.

The Railroad Retirement Board Office of Inspector General and the Office of Personnel Management-Office of Inspector General also participated in today’s operation.

An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

To learn more about the HEAT team, go to: www.stopmedicarefraud.gov.

http://www.identitydiet.com/

This is a great explanation that keeps it simple!

Fraud Alert Or Freeze

Sometimes, individuals must select a credit report fraud alert or freeze as the best solution for preventing credit fraud when they face real threats of identity theft due to business notification of their lost or stolen personal information, or, when they suspect they might become a victim of identity theft. In order to decide which identity prevention tool is the best solution for your situation, you need to fully understand the purpose, features, benefits, differences as well as placement and removal requirements of both the fraud alert and credit freeze. Just in case you don’t have enough time to read this entire article but need to quickly learn about credit report fraud alerts and freeze, here’s a quick summary of what they are. A fraud alert can be placed on your credit report to notify creditors that any credit request to open new accounts or modify existing accounts under your name must be confirmed by you. This is to make sure that third parties, whether it’s a credit card company or a mortgage broker, validate your identity and ensure you are the person who has initiated the credit application. Although, there is no guarantee third parties will contact you because you placed a fraud alert, it’s definitely a good way to limit your identity theft risks if you suspect you are at risk. On the other hand, when a credit or security freeze is placed on your credit report, creditors can’t access your reports until you lift the freeze. And since creditors will not make any credit decisions without first looking at a credit report, credit freeze is definitely a better solution than fraud alert in our efforts to prevent identity theft

On the flip side, the placement and removal of credit freeze is much more time consuming than fraud alerts because it requires our direct and proactive involvement which may not be suitable for people who apply regularly for new credit accounts or modifications to existing credit accounts and who need a quick turnaround of their application. In some cases, it can take up to 3 business days to lift a credit freeze and it is also more expensive to place or remove a credit freeze. In summary, if you rarely apply for new credit or don’t mind the wait or the cost, a credit freeze may be just for you.

For those who want the flexibility of a quick turnaround every time they want to buy something on credit, they should consider a fraud alert. A fraud alert provides limited protection against identity theft because we are somewhat at the mercy of third parties to contact us and validate the credit request, but it’s better than having no alert or freeze placed on the reports. I’m not sure why we need to place fraud alerts and remind businesses to be extra cautious when making credit decisions but I guess that’s because we are still at the infancy stage of identity theft protection.

In conclusion, if you rarely apply for credit and want total control over your credit reports, go with a credit report freeze. And, if you often apply for credit to buy things and want flexibility and quick turnaround with limited identity theft protection, consider a fraud alert instead. You can’t go wrong with either a fraud alert or freeze for preventing credit identity theft since they are both better than having no protection at all.

To protect your existing accounts, you may also consider an account freeze if it is offered by your bank, phone company or other types of accounts. An account freeze will block any use of your accounts until you remove the freeze.