Medicaid Fraud Cases In Louisiana

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Louisiana Doctor Indicted For Illegally Dispensing Over One Million Doses Of Opioids And Health Care Fraud Scheme

Pharmacy owner convicted of Medicaid fraud

NEW ORLEANS, La – A Louisiana physician has been indicted for his role in distributing over one million doses of Schedule II controlled substances, including oxycodone, morphine, and for using his professional practice for the purpose of illegal distribution.

Adrian Dexter Talbot, M.D., 55, is also charged with defrauding health care benefit programs, including Medicare, Medicaid, and Blue Cross Blue Shield of Louisiana of more than $5 million because the opioid prescriptions were filled using health insurance benefits.

Talbot owned and operated a medical clinic in Slidell that accepted cash payments from individuals seeking prescriptions for Schedule II controlled substances. In 2015, Talbot took a full-time job in Pineville, Louisiana, and although he was no longer physically present at the Slidell clinic, he pre-signed prescriptions to be distributed to individuals there without seeing or examining those individuals. In 2016, Talbot hired another practitioner who also pre-signed prescriptions to be distributed in the same manner at the Slidell clinic.

With Talbots knowledge, individuals were filling their prescriptions that were issued outside the scope of professional practice and not for a legitimate medical purpose using their insurance benefits, thereby causing health care benefit programs to be fraudulently billed for filling prescriptions that were written without an appropriate patient examination or determination of medical necessity for the prescription.

You Need A Health Care Fraud Defense Lawyer

The ideal attorney for Louisiana Medicare fraud defense is a health care fraud defense lawyer. Health care fraud defense lawyers understand health care laws and they also have experience dealing with federal criminal charges. As you speak with attorneys, ask the following four questions:

  • Do they have a verifiable track record of success?
  • Do they have experience in the health care industry and do they have criminal law knowledge?
  • How well do they understand health care law?
  • Do they have litigation experience?
  • If the answer is yes to those questions, then you must address their actual experience in handling Medicare fraud cases. Ask these three questions:

  • Throughout your legal career, how many Medicare fraud cases have you handled?
  • Out of those cases, how many resulted in no civil charges, no criminal charges, or total dismissals?
  • How many of those cases did you try in court?
  • Defending Against Healthcare Fraud Allegations

    Professional clients facing serious and sometimes complicated charges of healthcare fraud require the services of a law firm with knowledge and experience in this area. At the Baton Rouge law offices of Hymel Davis & Petersen, we have the resources and knowledge required to provide effective representation for medical professionals facing state or federal criminal charges as well as civil suits involving healthcare fraud.

    Founded by former veteran federal prosecutors with over 100 years of combined experience, Hymel Davis & Petersen is built to handle the most complicated legal matters for individuals and organizations. Partner Glen Petersen was director of Louisianas Medicaid Fraud Control Unit. He now uses that experience to provide skilled defense to clients facing Medicaid fraud, Medicare fraud, and other serious healthcare fraud allegations.

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    Louisiana Ag Busts Pharmacy Kickback Scam

    June 25, 2015 by JP

    Louisiana AG Busts Pharmacy Kickback Scam

    States are becoming more aggressive in pursuing Medicaid fraud cases. A recent case involving Accredo Health Group demonstrates that many states are willing to partner with federal prosecutors to take down illegal Medicaid schemes.

    Like a growing number of states, Louisiana has a robust whistleblower law that allows state prosecutors to pay awards to concerned citizens who come forward and report Medicaid fraud. To be eligible for an award, one must have inside or original source knowledge about a fraud involving a government program. Since Medicaid is funded with state and federal tax dollars, it is eligible for awards.

    Under the states Medical Assistance Programs Integrity Law, whistleblowers are entitled to 15% to 30% of whatever is recovered by the state.

    According to a release from Louisiana Attorney General Buddy Caldwell, Accredo Health Group, a Memphis based specialty Pharmacy Company, agreed to settle Medicaid fraud allegations claiming the company received kickbacks for recommending certain drugs.

    Kickback arrangements have long been forbidden in the health care field. Congress, the states and Medicaid want to insure that care decisions are not motivated by money. Kickbacks also lead to overuse of medical care.

    In announcing the settlement, Attorney General Caldwell said

    The awards are real, the call is free and always confidential.

    MahanyLaw Americas Medicare & Medicaid Fraud Lawyers

    How Health Care Fraud Defense Lawyers Can Help

    Medicaid Fraud

    A federal fraud lawyer can help as soon as you learn about a fraud investigation. Legal representation can protect you from saying the wrong thing during a fraud interview. An experienced attorney can also inform you of your legal rights and the potential consequences of a plea agreement. A fraud attorney can also help negotiate favorable settlements to get the best possible resolution and avoid jail time or other severe penalties.

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    Medicaid Fraud And Related Crime

    Of particular concern currently as being vulnerable to fraudulent Medicaid practices are home health and personal care service providers, a segment of care that has grown in the push to keep the elderly at home.

    Medicaid and other government health programs are governed by very complex laws and regulations. Medicaid fraud may be charged as a crime under Medicaid laws specifically or sometimes under general government health care or government benefit fraud laws. Examples of the type of behavior that could result in criminal charges:

    • A provider billing the government for services never provided
    • A provider submitting duplicate billing
    • A provider falsifying a diagnosis or providing care with no medical need
    • A provider ordering unnecessary prescriptions, medical tests or lab work
    • A provider billing for a different service than that which was actually provided
    • A provider taking illegal kickbacks for referrals
    • A group of providers or patients conspiring to commit fraud
    • A provider or patient making a false statement to the government
    • Anyone obstructing a health care offense investigation
    • A patient claiming medical services not received
    • A patient illegally selling pharmaceuticals obtained via Medicaid
    • A patient using another persons Medicaid account
    • A patient forging claims or receipts
    • And many more

    In extreme cases, white collar crimes like racketeering or money laundering could even be charged.

    Louisiana Doctor Sentenced To Prison For Conspiring To Receive Health Care Kickbacks

    A Louisiana doctor was sentenced today to 18 months in prison for his role in a scheme to receive approximately $336,000 in illegal health care kickback payments.

    Gray Wesley Barrow, M.D., 61, of Baton Rouge, pleaded guilty to one count of conspiracy to pay and receive health care kickbacks on Nov. 20, 2018. According to court documents, Barrow was a co-owner of Louisiana Spine & Sports LLC, a pain management clinic located in Baton Rouge. Barrow agreed to send urine specimens collected from his patients to a drug testing laboratory in return for an unlawful kickback calculated as a percentage of the reimbursements paid to the laboratory by Medicare and other health care benefit programs.

    From approximately January 2014 through July 2016, Barrow sent specimens collected from his patients to the laboratory and received approximately $1.58 million in disbursements from the laboratory. Of that $1.58 million, approximately $336,000 represented kickback payments associated with testing performed on specimens of Medicare beneficiaries, which the court ordered Barrow to forfeit as part of todays sentence. Additionally, Barrow was ordered to pay $336,000 in restitution.

    HHS-OIG and the FBI investigated the case.

    Assistant Chief Dustin M. Davis and Trial Attorney Justin M. Woodard of the Criminal Divisions Fraud Section and Assistant U.S. Attorney Elizabeth E. White of the U.S. Attorneys Office for the Middle District of Louisiana prosecuted the case.

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    How We Did This Study

    OIG conducted the inspection of the Louisiana Unit in December 2020 using a remote format. Our inspection covered the 3-year period of Federal federal years 2018-2020. We based our inspection on an analysis of data and information from the following 6 sources: Unit documentation financial documentation structured interviews with key stakeholders structured interviews with the Unit’s managers and selected staff a review of a random sample of 98 case files from the 1,682 nonglobal case files that were open at some point during the review period and a review of all convictions submitted to OIG for program exclusion and all adverse actions submitted to the National Practitioner Data Bank during the review period.

    What Can You Do About Healthcare Fraud

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    Louisiana Healthcare Connections is serious about finding and reporting waste, fraud or abuse. Our staff is available to talk to you about this or you can tell the Louisiana Department of Health about it.

    To speak with Louisiana Healthcare Connections, call our Compliance Department at or email .

    To speak with LDH, call their Waste, Fraud and Abuse hotline at or visit their website at new.dhh.louisiana.gov/index.cfm/page/219.

    To report waste, abuse, or fraud, gather as much information as possible.

    When reporting about a provider include:

    • Name, address, and phone number of provider
    • Name and address of the facility
    • Medicaid number of the provider and facility, if you have it
    • Type of provider
    • Names and phone numbers of other witnesses who can help in the investigation
    • Dates of events

    When reporting about someone who gets benefits, include:

    • The persons name
    • The persons date of birth, Social Security Number, or case number if you have it
    • The city where the person lives
    • Specific details about the waste, abuse, or fraud

    If you think a provider, member or other person is misusing Medicaid benefits, please tell us right away. Louisiana Healthcare Connections will take your call seriously and you do not need to give your name.

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    Louisiana Settles Medicaid Fraud Litigation For $884 Million

    Louisiana Attorney General Buddy Caldwell has reached an $88.4 million settlement with 25 pharmaceutical companies in the states ongoing Medicaid Fraud litigation. Beasley Allen attorneys W. Daniel Dee Miles, III, Clay Barnett, Roman Shaul, Chad Stewart, and Alison Hawthorne, along with in-house counsel, represented Louisiana in the litigation, which began three years ago over Average Wholesale Pricing . The lawsuit accused 100 drug makers and their subsidiaries of fraudulently inflating the price of drugs sold to states and reimbursed by Medicaid, overcharging the state.

    Included in the recent settlement are Abbott Laboratories, which will pay $6.2 million Sanofi, $7 million Novartis and its Sandoz unit, which will pay a combined $20 million Johnson & Johnson, $10 million Par Pharmaceutical, $6 million and Ranbaxy Laboratories, which will pay $5 million. Including the latest settlement, since beginning the litigation, Louisiana has reached settlements totaling $238.1 million.

    In a statement, Attorney Gen. Caldwell said, These companies took advantage of the state and its taxpayers by fraudulently over-pricing and marketing prescription drugs, thereby forcing the states Medicaid program to grossly over-pay for those prescriptions. This kind of success sends a clear message to companies who dont do business honestly.

    Experienced Medicare And Medicaid Whistleblower Lawyers Representing Healthcare Workers In New Orleans Louisiana

    At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower legal representatives, we support your brave choice to come forward to report abuse and scams in the industry. understand that stepping forward is challenging and many things might be at stake. When you come to us, your case is held in the strictest confidence .

    With our extensive experience representing whistleblowers nationwide, we thoroughly examine your claim, carefully prepare your case, for court, and work tirelessly with you and the state of federal government to assist in bringing deceptive Medicaid or Medicare activity to justice.

    The MA provider reviews charts to add additional diagnosis codes.

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    Seek A Vigorous Defense

    Medicaid claims, billing and reimbursement are extremely complicated and it is not hard to make an innocent mistake with no fraudulent intent.

    An experienced lawyer will know the exceptions and rules that apply in a Medicaid fraud case and can launch a strong defense on behalf of a defendant. This is especially important to avoid fines, prison and a criminal record. For medical providers, the negative consequences can include damage to reputation, loss of licensure, and Medicaid and Medicare delisting.

    The lawyers at Damico & Stockstill, Attorneys at Law, in Baton Rouge represent medical professionals and others who need Medicaid fraud defense as well as in other health care fraud and white collar charges in Louisiana, Texas and beyond.

    The Potential Punishment For Medicaid Fraud In Louisiana

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    Normally a prison sentence is accorded to serious offenders of the Medicaid crime. Nevertheless, you should do all you can to avoid any of the potential punishments of a Medicaid fraud. A conviction of this crime will not only get you time behind bars, but it will also soil your record for life. The one chance you have at defending yourself from this damning charge, is to engage an experienced criminal defense attorney Orleans. Barkemeyer Law firm has its door, wide open to you in New Orleans and our criminal defense attorneys may handle your case personally.

    Depending on the severity of your Medicaid crime in the state of Louisiana, you can be charged as either civil or criminal Medicaid fraud. For civil offenses, you may incur $2,000 cash fine for every false claim. While for criminal offenses, you may incur cash fines totaling up to $20,000 and 5 years behind bars. Regardless of whether you are charged for a civil or criminal Medicaid Fraud, you would lose your access to the Medicaid program.

    The criminal attorneys at the Barkemeyer Law Firm are experienced and you can count on them to explore every angle of your case for the best outcome possible.

    422 S. Broad Avenue

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    Carr: Two Indicted In Clayton County For Conspiracy To Commit Medicaid Fraud

    ATLANTA, GA Attorney General Chris Carr today announced the indictment of Deanna Granger and George Granger Jr. on one count each of Conspiracy to Commit Medicaid Fraud.

    Our office remains dedicated to protecting taxpayer dollars and pursuing potential instances of healthcare fraud, said Carr. Through our Medicaid Fraud Control Unit, we work diligently to uphold the integrity of Georgias Medicaid program and hold accountable those who would abuse this public trust. We are proud of our efforts and look forward to seeking justice in this case.

    The Office of the Attorney Generals Medicaid Fraud Control Unit presented evidence to a Clayton County grand jury, resulting in the Grangers indictment* on Dec. 13, 2021. Specifically, the indictment charges the defendants with the following which, if convicted, can carry the respective penalties:

    • Conspiracy to Commit Medicaid Fraud, O.C.G.A. §§ 16-4-8 and 49-4-146.1 between one and five years in custody and a fine of not more than $5,000.00

    The following law enforcement agencies assisted in this investigation:

    • Louisiana Attorney Generals Medicaid Fraud Control Unit

    The indictment can be found here, and no further information about the investigation or about the Grangers alleged crimes other than that stated in the indictment may be released at this time.

    Ag Landry Announces 21 Arrests By Medicaid Fraud Control Unit

    BATON ROUGE, La. – Twenty-one people have been arrested by the Louisiana Attorney General Office Medicaid Fraud Control Unit as part of the 2019 National Health Care Fraud Takedown.

    I applaud my Medicaid Fraud Control Unit and our law enforcement partners for their efforts to end criminal activity. These top-notch professionals aggressively work to protect our most vulnerable citizens and vigorously prosecute criminals who prey on them, said Attorney General Jeff Landry. Medicaid welfare fraud jeopardizes healthcare resources for Louisianas poor and steals from our states taxpayers. This unlawful and immoral act is especially heinous when perpetuated by people who are supposed to be taking care of our states most needy.

    The following people were arrested as part of the takedown:

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    • 1025 S. Norman C. Francis Pkwy.
    • New Orleans, LA 70125

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    Protection From Retaliation Under The Louisiana Whistleblower Law

    The Louisiana whistleblower law protects whistleblowers who suffer employment retaliation because of their whistleblowing. Protection under the Louisiana whistleblower law includes:

    • Reinstatement with the same seniority status that the whistleblower would have had but for the retaliation
    • Two times the amount of back pay
    • Interest on the back pay
    • Compensation for any special damages sustained as a result of the retaliation

    In successful whistleblower retaliation cases, the defendant is also required to pay litigation costs and reasonable attorneys fees.

    Damages In Louisiana False Claims Act Cases

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    False claims are subject to three times the actual damages incurred by the violations plus civil fines. The Act includes specific definitions of actual damages depending on whether the case involves a voucher program, in which case damages are defined within the voucher program. Otherwise, it is said to be equal to the difference between what the medical assistance programs paid or would have paid and the amount that should have been paid if there had not been a false claim.

    The relators share under the Louisiana False Claims Act is similar to that of the federal law. The relator can obtain 15 to 25 percent of a case, in which the government intervenes, or 25 to 30 percent in a case in which the relator pursues the matter on their own and succeeds.

    There is also an unusual provision which provides that a sale or merger does not end liability for an action under this law. It would seem to protect the State and the relator from not collecting in the event the defendant tries to disappear into the corporate night.

    There is a $1,000 minimum amount to bring a case under the Louisiana law. Oddly, there is no such limit under the federal law, and indeed there is case law which says that there need not be damages at all for liability to attach under the Federal Act.

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