In particular, our Fort Lauderdale criminal defense attorneys know that prosecutors are aggressively coming after doctors and other health care professionals with allegations of exaggerated billing, also sometimes called “upcoding.”
This was the case in U.S. v. Raul Ramirez, argued recently in the U.S. Court of Appeals for the Eleventh Circuit.
This was a case in which the executive director of a medical center in Miami was convicted federally on multiple counts of conspiracy to commit health care fraud, health care fraud and money laundering.
Ramirez’s attorneys argued upon appeal that the district court had erred when it refused to dismiss the original indictment, failed to conduct competency hearings, made a number of questionable evidentiary rulings during the trial and then also erred during the sentencing phase.
Unfortunately for Mr. Ramirez, the appellate court justices upheld the original conviction.
That conviction was in large part due to testimony from lab technicians who testified that it appeared patient blood samples had been manipulated in order to show a decreased blood platelet count that would justify billing Medicare for costly prescription medications.
Apparently, the blood samples that were submitted by Ramirez’s company were markedly different than those submitted by different health care professionals on those same patients. In one case, a neighboring location found that a patient’s blood platelet level was at 198,000, which would be a normal level. But a week later, that same patient was tested at Ramirez’s facility, and showed a precariously low platelet level of 47,000.
Having not personally worked on this case, our Fort Lauderdale criminal defense lawyers can’t say with any certainty whether this defendant was indeed guilty of the fraud for which he was accused. However, we do know that the majority of these cases originate from the issue of over-billing.
The New York Times recently conducted an in-depth analysis on the issue. The article indicates that while Medicare fraud is real and a serious problem, many of these billing errors may actually be the result of electronic billing.
In fact, this is the same billing system for which the federal government provided big incentives to hospitals and doctors’ offices that updated their records from paper form to electronic. The government had maintained that keeping such records resulted in a reduction of fraud.
However, the New York Times’ analysis, based on a new report by the Inspector General’s Office, indicates that variances in the new coding system may result in potential errors. These errors, the Times reports, have led to billions of dollars in overage charges across the country.
Again, we’re not saying that Medicare fraud doesn’t exist. Clearly, it does. But there may be more than one explanation for why a physician may be overcharging, and it may not even be something they are aware is happening.
Medicare fraud is an offense that carries very serious penalties. In Ramirez’s case, it resulted in a 10-year prison term, followed by an additional 7.5 years for money laundering.
These are cases that require experienced legal professionals with proven success.
If you are charged with a crime in Palm Beach or Broward counties, contact the Law Offices of Leifert & Leifert, a Partnership of Former Prosecutors, for a free consultation to discuss your rights. Call 1.888.5.DEFEND.
U.S. v. Raul S. Ramirez, U.S. Court of Appeals for the Eleventh Circuit, Justia Case Law Files
Medicare Bills Rise as Records Turn Electronic, Sept. 21, 2012, By Reed Abelson, Julie Creswell and Griff Palmer, The New York Times
More Blog Entries:
Undercover Investigation No Guarantee of Conviction, Sept. 19, 2012, Fort Lauderdale Criminal Defense Lawyer Blog