Articles Posted in Pre-Filing Investigations

What makes a Los Angeles Medicare fraud story newsworthy?

• Is it the sheer amount of fraud involved?
• Is it the number of people allegedly harmed by deception?
• Is it the stress that the case puts both on the Medicare system and on the court system?
• Is it the elaborateness of the Rube Goldberg machinations that doctors, caregivers, and other collaborators use to bend or break the system’s rules?

These elements surely help determine what’s “intriguing” or not about Southern California Medicare fraud cases.

But there’s another key element: DRAMA.

After all, we live in the heart of the entertainment industry. Angelinos appreciate compelling, emotionally riveting stories.

In that context, consider a Medicare fraud case just settled up in White Plains, New York. It concerns a company called Park Avenue Medical Associates. At the heart of the case is a family feud between a father and son.

Michael Wolfson, a founder of Park Avenue and its Chief Medical Officer, must have been devastated when he learned that his son, Zachary Wolfson, blew the whistle on him and his associates. The crime, allegedly? Submitting an enormous number of bogus claims for reimbursement.

For instance, the company charged Medicare for psychiatric services for patients with advanced dementia – who could never have benefited from the services! According to Zachary’s accusations – which were supported by the Manhattan U.S. Attorney – the company often failed to adhere to Medicare rules and also billed for unnecessary services.

Since Zachary Wolfson blew the whistle under the False Claims Act, he will be entitled to a sum of the cash settlement that Park Avenue offered to end the legal drama.

News reports have speculated on the intriguing dynamic between Zachary and his father. What went wrong in the company and why? The internal family and company politics may be forever opaque to news sources – and perhaps it should be.

This bring up an important point: the psychological and financial motivations that compel people to commit healthcare fraud, insurance fraud, or other Southern California white collar crimes often are complex. The news likes to paint certain defendants as “bad guys” and talk about them in black and white terms.

Here’s the reality.

People who get involved in fraud schemes are not inherently evil. Rather, their motivations often come from needs not met, such as needs for fair compensation, autonomy, power, and so forth.

The point is that, if you or someone you love stands accused of a similar crime, you need a thorough defense. Trust attorney Michael Kraut of Los Angeles’s Kraut Criminal & DUI Lawyers, to provide a free and thorough consultation about your options. Mr. Kraut is a Harvard Law School educated ex-prosecutor who wracked up a very impressive 99+% rate at jury trials as a prosecutor.

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Medicare fraud cases in Southern California (and elsewhere) can start to sound pretty similar to one another, especially if you report on these crimes month after month, year after year, as we’ve done on this blog.

But every once in a while, a riveting, different kind of story bursts through and merits extended commentary.

Recently, prosecutors charged Dr. Atiq Durrani with unfairly billing Medicare to the tune of $11 million for surgeries he performed between February 2010 and January 2013. Prosecutors say that these surgeries were not medically necessary for patients. They also hit him with healthcare fraud charges and charges for making false statements.

Why did you commit healthcare fraud in Southern California?

Now that you’ve been investigated (or, perhaps, arrested), your life path certainly doesn’t seem fully rational. After all, you now face massive jail time, thousands (or millions) of dollars in forced restitution, public humiliation, the loss of your medical, dental, or chiropractic license (or other professional credentials), and problems with your relationships and self-esteem.

So… why did you do it?

The Los Angeles Weekly recently ran a fantastic, compelling, and extremely disturbing story on Medicare fraud in Los Angeles and beyond. Entitled: “How Medicare fraud became the nation’s most lucrative crime,” the story blisteringly attacks a system of corruption that’s so deep and so diverse, it’s almost unbelievable.

It’s no secret that healthcare fraud in Southern California and beyond costs taxpayers $100 billion a year (some say that figure is as high as $300 billion). The Obama administration has clearly made it a priority to crack down on fraud, and the new awareness of the problem has undoubtedly led to improved policing.

Right?