Firm-Wide blog

Ohio Works to Stop Medicare and Medicaid Fraud

By Burg Simpson
May 21, 2018
3 min read

Ohio made headlines last year when a federal grand jury issued indictments against a pair of health care companies and their owners for health care fraud. The indictments suggest that the companies fraudulently billed government health programs for unneeded medical services and/or medication that was never requested.

These indictments represented just a small part of one of the country’s largest actions against health care fraud. The crackdown, led by the Medicare Fraud Strike Force, netted more than 400 defendants across more than 40 federal districts in schemes that included about $1.3 billion in fraudulent billings.

Two Accusations of Fraud

The first indictment states that the Ohio Institute of Cardiac Care in Springfield, Ohio, and its owners collected more than $2 million from Medicare and Medicaid for “medically unnecessary” tests and procedures. If convicted, they could face up to a decade in prison.

The grand jury also indicted a husband and wife who own and manage Health & Wellness Pharmacy in Dublin, Ohio. The indictment claims the couple pulled in more than $3 million “from the Ohio Department of Medicaid and Medicaid Managed Care Organizations through multiple schemes including billing for compound creams that were not provided or not requested by patients, billing for counseling services that were not provided or billing for group counseling sessions as individual counseling services.”

Ohio’s Fraud Control Unit

This is just one example of the types of cases that the state’s attorney general tackles as part of the Medicaid Fraud Control Unit, which is “responsible for the investigation and prosecution of health care providers accused of defrauding the state’s Medicaid program.”  This Unit also enforces Ohio’s Patient Abuse and Neglect Law, which aims to protect vulnerable patients from neglect and abuse in Ohio’s long-term care facilities.

According to the Ohio Attorney General’s Office, the Health Care Fraud Section (which also includes the Workers’ Compensation Fraud Unit) handled 5,856 complaints between 2013-2017. These complaints helped lead to 1,201 indictments, 1,141 convictions, and 115 civil settlements. As a result, the state has been able to recover more than $221 million in restitution and penalties.

Whistleblowers who report incidents of Medicare and/or Medicaid fraud can be eligible for compensation for their actions. If you’re privy to information not known to the public about a possible fraud perpetrated against the government, and you want to do the right thing and expose the fraud, you need counsel you can trust.

A business litigation attorney can help protect your rights and fight for any potential recovery you might be entitled to. Do not wait to contact the Cincinnati office of Burg Simpson Ohio by calling 513-852-5600 or you can fill out our Free Case Evaluation Form Here.

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