Alert To California Professionals And Licencees: Potential License Denial Or Suspension For Failure To Pay California Taxes Starting In July 2012

Effective July 1, 2012, ALL of the licensing boards in California (Medical Board, Board of Psychology, State Bar, Dental Board, Contractors Board, Veterinary Board,  Accountancy Board, Optometry Board, Pharmacy Board, Board for Professional Engineers, etc.) are required to deny an application for licensure and to suspend the license/certificate/registration of any applicant or licensee who has outstanding tax obligations due to the Franchise Tax Board (FTB) or the State Board of Equalization (BOE) and appears on either the FTB or BOE's certified lists of top 500 tax delinquencies over $100,000. This is pursuant to legislation AB 1424, Perea, Chapter 455, Statutes of 2011.

Once it has been determined that an applicant or a licensee is on a certified list, the applicant or licensee has 90 days from the issuance of a preliminary notice of suspension to either satisfy all outstanding tax obligations or enter into a payment installment program with the FTB or BOE. Any such person who fails to come into compliance will have his/her license denied or suspended until the Medical Board of California receives a release from the FTB or BOE. The form for requesting a release will be included with the preliminary notice of suspension.

The law prohibits the Boards from refunding any money paid for the issuance or renewal of a license where the license is denied or suspended as required by AB 1424.

The FTB and BOE are currently expanding the certified lists from 250 to 500, but you can check if you are currently on the FTB's certified list at: www.ftb.ca.gov/individuals/txdlnqnt.shtml or the BOE's certified list at: www.boe.ca.gov/cgi-bin/deliq.cgi. If you believe you are on either list in error, please call the FTB at (866) 418-3702 or the BOE at (916) 445-5167.   

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Any questions or comments  should be directed to Tracy Green, a very experienced California board attorney, administrative attorney, and California licensing attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers in California and throughout the country. Their website is: http://www.greenassoc.com/

Why Does Medicare Fraud Occur More Frequently In Clinics Run By Managers? Los Angeles Clinic Manager Sentenced To 60 Months For Using Physician Identities To Write Unnecessary Prescriptions And To Bill Medicare

One of the frequent fact patterns we see in California is the presence of "managers" or "management companies" in health care fraud cases. Why is that? It has to do with California's prohibition that prohibits non-physicians from owning medical practices. It also has to do with some of the people that open health care businesses without realizing the level of regulation and the potential consequence of not following the rules and regulations. When business people want to open a medical practice in California, they need to open the clinic in a doctor's name and sometimes the doctor is a nominal owner and he has little or no control over the practice and relies on the managers to run it properly. 


A recent case illustrates the ugly side of health care fraud involving unscrupulous managers. On January 9, 2011, Carolyn Ann Vasquez, 47, from Los Angeles medical clinic manager, was sentenced to 60 months in federal prison after having pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million.  U.S. District Judge Consuelo B. Marshall of the Central District of California sentenced Ms. Vasquez and also ordered her to pay $6.2 million in restitution. 

Originally, Ms. Vasquez was charged with two other persons: (1) physician assistant David Garrison and (2) co-manager Eduard Aslanyan.  Mr. Aslanyan pleaded guilty in April 2011 to conspiracy charges related to this case and is scheduled for sentencing on February 6, 2012. David Garrison, a physician assistant who worked at the fraudulent medical clinics with Vasquez and Aslanyan, is scheduled for trial on January 24, 2012. Mr. Garrison has a prior state health care fraud case that may be complicating his sentence that also arises from working at a clinic run by a manager.


In March 2011, Mr. Vasquez pleaded guilty to conspiracy to commit health care fraud. In her plea agreement, Ms. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Ms. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. So the physician is not at the clinic but his name is on the prescription pads that are signed by the PAs or the manager using a stamp signature or even forging the name, and he may have no idea that power wheelchairs are being prescribed to patients and only look at the medical chart that shows a routine medical visit with no improper billing at the medical clinic.  


According to court documents, Ms. Vasquez physician assistants recruited to work at the clinics by Vasquez, and working at her direction and the direction of others, performed services that were medically unnecessary and prescribed and ordered the wheelchairs, medical equipment and diagnostic tests that were medically unnecessary.

According to court documents, Ms. Vasquez obtained access to physicians’ personal and Medicare information, which she stole to further the fraud scheme at the medical clinics. For example, Ms. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the medical clinics, but the physician decided not to accept the job. Nevertheless, Ms. Vasquez’s clinic printed prescription pads with the physician’s name and Medicare provider number on them. Ms. Vasquez admitted that she instructed a physician assistant working at one of the medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician’s name even though Ms. Vasquez knew that the physician did not work at the clinic.


Attorney Commentary: For those managers that are unethical or are seeking a doctor's license to use for their own purpose, they will target doctors who are desperate for money, older or have some other issues (alcoholism, depression, etc.) and use that doctor's license and NPI number to run their business without regard for how it will ruin the doctor's provider numbers, expose them to great financial liability and jeopardize their license. In some cases, there is actual identity theft of the physician's license and NPI number. 


In many cases, the clinics offer to employ the physician, pay them several thousand dollars per month and tell the physician that they do not have to come to the clinic except once or twice a month since a Physician Assistant (PA) is seeing the patients and all that the physician needs to do is to supervise the PA. The manager will reassure the physician that the clinic is well run and has been in business for years without any issues. For physicians who are looking for extra easy money, they often fall prey to these offers without seeking legal counsel about the legality and fail to do any due diligence about the managers running the clinic. 


What the physician or physician assistant often do not know is that the manager also has ownership interest in other businesses related to the clinic: pharmacy, durable medical equipment, diagnostic company, etc. Even if the manager does not make much money on the medical clinic, the prescriptions for these ancillary services can be very profitable. So everything can look pretty good at the clinic but if someone is not paying attention to the prescriptions for potentially unnecessary ultrasounds, DME (expensive wheelchairs or beds) or drugs, the fraud may not be apparent to the physician. 


In the Vasquez case and other cases, all that the manager needs to do is to post an advertisement in the Los Angeles Times or other publication and unsuspecting physicians will fax in resumes that list all their identifying information. Physicians should be very careful in sending identifying information in response to job ads and should not list license or DEA or NPI numbers unless and until they have done due diligence on the medical clinic. 


In addition, in any situation where there is a mangement agreement, physicians should have their own legal representation to ensure that the arrangement is legal and that there is little or minimal chance for any fraudulent conduct to occur. Physicians and those in the health care field often tend to be trusting but trying to clean up fraudulent billing and identity theft -- including the loss of a provider number or addressing a large overpayment incurred -- can take years and can be very expensive.  Practice preventative measures BEFORE you enter into any such arrangements.

Posted by Tracy Green, Esq. 

Any questions or comments  should be directed to Tracy Green, a very experienced California health care fraud attorney  and California Medicare fraud attorney at tgreen@greenassoc.com.

If you have questions regarding your own situation, please call Tracy at 213-233-2260 or email at tgreen@greenassoc.com to schedule a complimentary 15 minute consultation. 

The firm Green and Associates focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. 

Recent OIG Investigation Into Hospices Reveals Compliance, Marketing And Kickback Issues

A recent Bloomberg article (Dec. 6, 2011) on hospices and in particular Harden Healthcare LLC  entitled "Aunt Midge Not Dying In Hospice Reveals $14B Market" reveals issues with some hospices and the focus of government investigations. Hospices are meant for the terminally ill and given that Medicare's reimbursement rates are higher for hospice care, this has been a growth industry.

The article relays a story that caught the interest of the Department of Justice. Janet Stubbs' aunt, Doris Midge Appling, was admitted to Hospice Care of Kansas (HCK) during the company’s “Summer Sizzle” promotion drive, which paid employees as much as $100 a head for referrals. Ms. Stubbs said she had no clue that the nursing home doctor who referred her aunt for hospice moonlighted as medical director for the hospice company. The aunt was discharged after 20 months in HCK, and lived four more years before her death in April at age 106. Medicare paid nearly $80,000 for her hospice care. The aunt is now known as Patient 11 in a civil lawsuit filed by the Justice Department against HCK and its owners.

Hospice care, once chiefly a charitable cause, has become a growth industry, with $14 billion in revenues, 1,800 for-profit providers and a base of Medicare-covered patients that doubled to 1.1 million from 2000 to 2009.

The article discusses the investigations pending in the hospice business - and these are often publicly traded companies and national hospice chains. This means that independent owned hospices will also be under scrutiny and will often have less funds to devote to compliance and responding to government investigations. It is therefore critical for hospices to engage in compliance immediately since there is increased scrutiny on the industry.


The compliance issues noted in the article include:
(1) paying salespeople bonuses for increasing the number of patients enrolled and/or length of stay;
(2) admitting ineligible patients;
(3) giving salespeople a budget of $500 a month to buy lunches and gifts for doctors and nursing-facility managers and staff;
(4) paying enrollment bonuses to doctors, admissions directors and branch managers;
(5) giving pizza parties, gift cards and other extras to its registered nurses and social workers for meeting admission targets;
(6) pay to nursing home doctors who double as hospice medical directors; and
(7) paying incentives to medical directors of hospices.


The inspector general of the U.S. Health and Human Services Department is probing hospice marketing practices and financial relationships with nursing facilities. The inquiry was spawned by a 2009 report by the Medpac commission, a congressional advisory body, that found hospices “aggressively marketed” to nursing-home patients, and paid incentives to medical directors for “inappropriate” referrals and enrollments.

Complicated Laws

Under various federal statutes, paying for patient referrals or compensating employees based on the number of Medicare patients recruited may be illegal. But the laws are painfully complicated and loaded with exceptions.  A conservative view of health care laws bars all employees and contractors from earning bonuses based on Medicare enrollment goals, including salesmen and managers. In structuring bonuses, it is critical to seek legal advice from an established and experienced health care lawyer before establishing the parameters.


Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 15-minute consultation.  

Any questions or comments  should be directed to Tracy Green, a very experienced Medicare fraud attorney, Medi-Cal fraud attorney, California health care attorney, and California compliance attorney at tgreen@greenassoc.com.

Ex-Beverly Hills School Employee Convicted By Jury In Felony Conflict Of Interest Case: What Can We Learn From This Case?

A recent conflict of interest criminal case serves as a reminder to employees and consultants (public and private) of the need to seek legal advice before entering into contracts and taking actions that could benefit oneself privately.  In the public sector, there could be conflict of interest charges and in the private sector it could lead to embezzlement charges. Compliance is the key and seeking legal advice upfront is important. 


On November 21, 2011, Karen Anne Christiansen, a former Beverly Hills Unified School District official was convicted by a jury of four counts of felony conflict of interest and taking more than $1.3 million through a building management contract she allegedly steered to herself. The criminal case was prosecuted by the Los Angeles County District Attorney, Public Integrity Division. A very experienced prosecutor, Deputy District Attorney Max Huntsman, was assigned to the case.


The jury took two days to reach a guilty verdict. Once the verdict was returned, the trial judge, Los Angeles Superior Court Judge Stephen Marcus, immediately ordered Christiansen remanded into custody and increased her bail to $400,000.


What happened here? The facts are interesting in that some of the actions Ms. Christiansen and her lawyers took might have forced the government's hand in filing charges against her. Or perhaps her lawyers knew a criminal case was coming and attempted to use civil litigation as a defense. Either way, it was a gamble.


In 2004, Ms. Christiansen was hired by the Beverly Hills School District at a salary of $113,000 per year to be the project manager for the $334 million Measure E Bond.  The allegation was that the secretly negotiated a deal to be an independent contractor through her company Strategic Concepts while performing her employee duties for the school district. Strategic Concepts received the contract and was paid $5.2 million for consulting services between 2006 and 2009. The Beverly Hills School District terminated Strategic Concepts in 2009. 


This case began with civil litigation commenced by Strategic Concepts suing the District for $16 million in damages. The District countersued for $4 million in damages. After the District spent over $1 million on the civil case, the District Attorney's Office became interested, investigated and ultimately filed criminal charges and stayed the civil lawsuit. The conviction in the criminal case will probably be a ground for the District to file a motion for summary judgment. Query as to whether Ms. Christiansen's attorney had fully evaluated her criminal exposure prior to filing a lawsuit and negotiated a comprehensive settlement with the District or decided not to file a civil lawsuit, would the result in this case have been different? 

Sentencing for Ms. Christiansen is scheduled for January 5, 2012 in Department 102 of the Los Angeles County Superior Court in downtown Los Angeles, and she faces a maximum state prison term of eight years. Given that the jury reached a finding that there was an "excessive taking" of $1.3 million, probation may not be an option for Judge Marcus and may be grounds for the higher end of the sentencing range. 


There is a co-defendant in the case as well, Jeffrey Hubbard, 54, the former superintendent of the Beverly Hills Unified School District. He faces three counts of misappropriation of public funds in connection with the case and his case goes to trial next.

Mr. Hubbard – now superintendent of the Newport Mesa Unified School District – was charged in December 2010 with two counts of misappropriation of public funds for allegedly giving Ms. Christiansen more than $20,000 in unauthorized gifts and giving her increases in her car allowance that were unauthorized by the  school board. On Oct. 11, Hubbard was arraigned on a Grand Jury indictment charging him with a new count of misappropriation of public funds. The new charge stems from his alleged direction of a subordinate to give a raise to a female employee without school board authorization. His next court date is December 12 for a pretrial hearing.


We have represented both both private and public employees in criminal investigations or civil lawsuits for "self-dealing" or conflict of interest. Business practices are under greater scrutiny and the laws for public employees are very detailed and complicated. For example, the California Attorney General's Office published a lengthy 136-page Guide to financial conflicts of interest by local and state executive and legislative officials. This is just one small part of conflict of interest laws - and compliance with conflict of interest rules is the best way of avoiding a civil lawsuit, fines or criminal prosecution. 


This case is unusual in that it is a high profile school district and it seems doubtful that Ms. Christiansen did not fully comprehend her criminal exposure prior to filing the civil lawsuit. What seemed like a contract case turned into a criminal case. We have handled many "civil" lawsuits that have criminal implications and therefore become "sensitive" cases that cannot be handled like traditional civil cases. Full evaluation of cases before filing is key to a successful global result.


Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation. 


Any questions or comments  should be directed to Tracy Green, a very experienced California conflict of interest attorney, California self-dealing attorney, California white collar attorney, and California compliance attorney at tgreen@greenassoc.com.

California Medical Association Reverses Their Stance On Legalizing Marijuana - Asks For Legalization And Wider Regulation

The California Medical Association (CMA) has adopted official policy recommending legalization and regulation of cannabis. The decision was based on a CMA white paper that concludes physicians should have access to better research, which is not possible under current drug policy. The CMA's paper, available here, is a study and response to this important and controversial issue. 

CMA is the first statewide medical association to take this official position.

“CMA may be the first organization of its kind to take this position, but we won’t be the last. This was a carefully considered, deliberative decision made exclusively on medical and scientific grounds,” says CMA President James T. Hay, M.D. “As physicians, we need to have a better understanding about the benefits and risks of medicinal cannabis so that we can provide the best care possible to our patients.”

CMA’s Board of Trustees adopted the policy without objection at its October 14 meeting in Anaheim.

The federal government currently lists cannabis as a Schedule I drug. That classification restricts the research and ability to study the substance. Part of the policy adopted by CMA emphasizes that the drug should be rescheduled in addition to being legalized.

“There simply isn’t the scientific evidence to understand the benefits and risks of medical cannabis,” says Paul Phinney, M.D., CMA Board Chair. “We undertook this issue a couple of years ago and the report presented this weekend is clear – in order for the proper studies to be done, we need to advocate for the legalization and regulation.”

“We need to regulate cannabis so that we know what we’re recommending to our patients,” says Dr. Phinney. “Currently, medical and recreational cannabis have no mandatory labeling standards of concentration or purity. First, we’ve got to legalize it so that we can properly study and regulate it.”

Physicians, who are currently only allowed to “recommend” medical cannabis, have been stuck in an uncomfortable position, since California decriminalized the drug in 2006.

“California has decriminalized marijuana, yet it’s still illegal on a federal level,” says Dr. Hay. “That puts physicians in an incredibly difficult legal position, since we’re the ones ultimately recommending the drug.”

The regulation of medical cannabis will allow for wider clinical research, accountable and quality controlled production of the substance and proper public awareness. CMA also recommends the regulation of recreational cannabis so that states may regulate this more widely used cannabis for purity and safety.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Miami Federal Judge Imposes Longest Sentence Ever For Medicare Fraud - 50 Years - On Executive Of Mental Health Care Company

Mr. Lawrence Duran - Sentenced to 50 Years

After a 3-day sentencing hearing, Miami resident Lawrence Duran, the owner of a mental health care company, American Therapeutic Corporation (ATC), was sentenced on September 16, 2011 to 50 years in prison by U.S. District Judge James Lawrence King in the Southern District of Florida. This case arose from an alleged $205 million Medicare fraud scheme by a chain of Miami-based mental health clinics.

Judge King ordered Mr. Duran to pay more than $87 million in restitution, jointly and severally with his co-defendants. Mr. Duran was also sentenced to three years of supervised release following his prison term. Mr. Duran’s lawyer, Lawrence Metsch, urged the judge to be realistic and give him a sentence between 20 and 25 years, arguing that 50 years means a “death sentence because he would die in prison.” But Judge King sided with the government’s push for the extraordinarily high sentence, saying there is a “critical need for deterrence against healthcare fraud” in South Florida, the nation’s capital of Medicare corruption.

Previously, the highest Medicare fraud sentence was 30 years — given in 2008 to a Miami physician, Ana Alvarez-Jacinto, convicted in an HIV-therapy scheme.

35 year sentence for Ms. Valera.  On September 19, 2011, Judge King sentenced co-defendant, Marianella Valera, the other owner of ATC and Mr. Duran's girlfriend, to 35 years in prison and ordered her to pay the $87 million in restitution, jointly and severally. This was another long sentence. Miami judges, who were known for long sentences in large drug cases are not treating Medicare fraud cases any differently. Thus, where a defendant is charged can determine his or sentence or exposure to a sentence if they do not win at trial.

Plea Agreement After Superseding Indictment.  These sentences came after a plea agreement. On April 14, 2011, Mr. Duran and Ms. Valera pleaded guilty to all counts charged in a superseding indictment, which was unsealed on Feb. 15, 2011. The superseding indictment charged Duran with 38 felony counts and Valera with 21 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements.  One co-defendant went to trial and was convicted by a jury.


Mr. Duran and Ms. Valera were remanded to the custody of the U.S. Marshals Service after their arrest on Oct. 21, 2010, and have been detained since that time since there was concern that they were a flight risk. Their assets were frozen at the time of their arrests through civil forfeiture proceedings. ATC and Medlink pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.


In pleading guilty, Mr. Duran and Ms. Valera admitted that they orchestrated and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010. Duran and Valera submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. Mr. Duran and Ms. Valera also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.


According to court documents, Mr. Duran, Ms. Valera and others paid bribes and kickbacks to recruit Medicare beneficiaries to attend ATC and ASI and billed Medicare for treatments purportedly provided to these recruited patients. According to court documents, the treatments were medically unnecessary or never provided at all. Mr. Duran and Ms. Valera supported the kickbacks through an extensive money laundering scheme that aimed to conceal the illicit conversion of Medicare payments to cash.


Mr. Duran, Ms. Valera and others admitted they paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. They and others actively recruited ALF and halfway house owners and operators and patient brokers. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $205 million in medically unnecessary services.


Alteration of patient records also played a role in this case. According to the superseding indictment to which they pleaded guilty, Mr. Duran, Ms. Valera, and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments. According to court documents, Mr. Duran and Ms. Valera also instructed employees and doctors to alter diagnoses and medication types and levels to make it falsely appear that ATC patients qualified for PHP services. Mr. Duran, Ms. Valera, and others charged as co-conspirators caused doctors to refer ATC patients to ASI even though the patientsdid not qualify for sleep studies.


According to the superseding indictment to which they pleaded guilty, the defendants also engaged in a money laundering conspiracy to enrich themselves and to provide cash for the millions of dollars in kickbacks paid to recruit Medicare beneficiaries. According to court documents, they used another company they owned and operated, Medlink, to conceal the health care fraud and kickbacks from Medicare and law enforcement.


Once Medicare paid ATC and ASI for the fraudulently billed services, Mr. Duran, Ms. Valera, and others transferred millions of dollars to Medlink. They and others opened phony corporations to receive checks and wire transfers from both ATC and Medlink to convert that money into cash for their personal enrichment and for the payment of kickbacks. According to court documents, Mr. Duran, Ms. Valera, and others cashed checks at different bank branches and different locations to conceal the true purpose of their activities and to evade reporting requirements.


Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Any questions or comments  should be directed to Tracy Green, a very experienced California health care fraud attorney  and California Medicare fraud attorney at tgreen@greenassoc.com.


The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/