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Compliance: Medical Director and Office Staff charged with healthcare fraud scheme.

Posted by Doris Dike | Jan 21, 2022 | 0 Comments

Summer 2019

DEFENDANTS

Innad Husaini, is a medical doctor and owner of Verimed Health and Medical Wellness Clinic Inc. (Verimed). Dr. Husaini's license to practice medicine was restricted in 2016. Dr. Husaini did not have the ability to prescribe controlled substances.

Hanh Hong Thi Nguyen, was a staff member of Verimed

Douglas Sharp, DO was the Medical Director of Verimed Health and Medical Wellness Clinic Inc. (Verimed)

KEY DEFINITIONS:

The False Claims Act (FCA) bars companies from intentionally making or filing false claims that defraud a government program. However, the healthcare industry dominates False Claim Act claims. In fact, health-care accounted for 90 percent of the government's False Claims Act recoveries during 2017 and 2018.No specific intent to defraud is required to violate the civil FCA. 

Medicare Abuse is seen as the practice of directly or indirectly taking affirmative steps that result in unnecessary costs to the Medicare program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care. 

Medically necessary are health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

FACTS:

The defendants participated in a health care fraud scheme where they submitted false and fraudulent claims to Medicare and Medicaid for home health care services, diagnostic tests and eye procedures, including injections into the eye, that were medically unnecessary, not provided or both. One defendant allegedly ordered diagnostic tests on and conducted physical examinations of patients, even though she was not a licensed medical professional.The indictment alleges that the defendants submitted approximately $16 million in fraudulent claims to Medicare and Medicaid. Medicare paid approximately $12.2 million on those claims. Medicaid paid approximately $67,000 on those claims. The indictment also seeks two properties owned by Nguyen and one property owned by Husaini, which were paid for, at least in part, using proceeds of the alleged fraud.

Sharp, Husaini and Nguyen were each charged with one count of conspiracy to commit health care fraud. In addition, Sharp was charged with three counts of false statements relating to health care matters, Husaini was charged with three counts of health care fraud and Nguyen was charged with two counts of health care fraud

CLOSING THOUGHTS:

The Medicare Fraud Strike Force, a joint initiative between the Department of Justice and Health and Human Services to prevent and deter fraud around the country, is not slowing down. Healthcare providers need to make sure they are abiding by healthcare fraud and abuse laws or they can end up in jail. In this case, its likely that Dr.Sharp was asked to be the medical director because Dr. Husaini's license was restricted. The facts do not tell us if Dr. Sharp knew this before he agreed to become the medical director at Verimed Health. Unfortunately, medical directors often never see a clinic's patients and have no idea how patients are being billed. However, that does not prevent the government from going after these doctors; this is why it is important that you and your attorney properly vet any medical director agreement before signing. Have a good understanding about the organization, its billing, and the owners before agreeing to anything. 

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