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The benefit of having competent New York City federal criminal attorney is priceless. We will always be glad to discuss you case with you or answer.
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Many people are unaware of what the difference between a private criminal lawyer and a public attorney is. The explanation is rather straightforward. A public defender is the legal representation that is provided to a person who is unable to afford one. The public defender is thus charged to protect the interests of the clients while being paid by the government. But before a public defender is awarded to the accused individual, an eligibility test is carried out involving an assessment of a person's assets and income. Although public lawyers come freely, many people question the devotion and dedication that a client will get from such representation.
Public defenders are very effective as criminal lawyers. Like most lawyers they handle a wide range of cases during the day. Again, just like most attorneys, they tend to specialize in different areas. Some choose to specialize in attending to personal injury cases or they may opt instead to focus on drunk driving charges as found with DUI lawyers. Because of their close and frequent relationship with the court rooms, most public defenders develop an understanding and decent rapport with the local court and judges. This can be of great benefit to their clients.
However, despite all these benefits, hiring a private attorney is still a far better idea if this option is within a person's ability. Private attorneys are far more likely to work harder at providing you with a credible defense. Although they are undoubtedly more expensive than publicly appointed representation, most people who hire private attorneys find that they end up having lighter fines or shorter jail sentences. This is because of the increased effort put into a person's by private attorneys.
A better way to see the difference between being represented by a private lawyer and one provided by the government is to take a look at statistics that have been accumulated over the years. These results clearly show that amongst people being tried for similar crimes, majority of those who were represented by public attorneys ended up serving longer jail terms. For people who plan on pleading guilty and wish to receive a shorter or softer sentence, hiring a private attorney will provide a better guarantee of this.
There are many reasons behind the disparity in results found between public lawyers and private attorneys. By far the most obvious is the amount of work experienced by both. Because of their position in the government most public defenders attend to far more cases than private lawyers. As a result of this they tend to get overworked and are unable to focus as much attention on the case of their client as a private attorney would. In most instances, clients who have public representation find that they are unable to have regular meetings with their attorneys outside the periods shared in the courtrooms.
Another observation found amongst public defenders is their willingness to accept plea bargains because of the speedy resolution which it offers to a case. By forcing their clients to accept a plea bargain, they effectively deny them the full option of justice which a trial would have provided them. None of this is found amongst a private attorney. Whilst a plea bargain might also be used, a private attorney is more likely to push for firmer and better terms. Because of their more detailed investigation, they will also be able to better improve a client's defense making the option of courtroom success far more likely.
Legal representation is extremely important if a person requires legal assistance or is being charged with a crime. For people who are unable to afford an attorney, seeking the counsel of a public defender creates a welcomed and effective idea. Such people will however be required to first qualify by passing a strict screening process. However, for those who are able to afford hiring a private attorney, resorting to this option will prove a far more effective choice.
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Are you troubled with your search, where you do not know where that criminal currently lives? Then, I advice and suggest that you should access these Federal criminal records. In this article, I will discuss to you, what are these important national level criminal records, and how you can obtain them, for your own safety.
Several people nowadays might have heard of criminal records, but do not know what they really are. These files document the criminal history of one person. This means that it will include the crimes you committed, the corresponding punishments, location where the mentioned crime happened, and the names of those victims.
The United States of America is a federal country, where we have a state that governs our local government, and the White House, which manages the national government. With this definition, we can say that federal criminal records are national level criminal documents, where the Federal Bureau of Investigation or FBI hold them.
Now, why do these exist? Most likely, these documents are present for those national criminals, who basically, move from one state to another, where they had several felony records. Because of this, all states can gain access to these national criminal files, which will help you pinpoint those criminals.
In a legal point of view, access to these valuable documents are supported by the Freedom of Information Act of 1966, which is commonly known as the FOIA. However, the Privacy Act regulates your access to these important files, in the hopes that identity theft will be reduced or curbed down.
To tell you honestly, these records are very powerful. Why? It is because that they hold very powerful criminal information about a person. Because of this, you can only check the criminal histories of yourself, deceased individuals, and those persons who had allowed you to access their criminal documents.
In obtaining these records, you may ask the assistance of the FBI. However, you can utilize the services offered by CrimCheck on the Internet, which is free of charge. When you are on their website, you will just write the person's name and his location. After which, you can grab those important and valuable criminal files.
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Hospice fraud in South Carolina and the United States is an increasing problem as the number of hospice patients has exploded over the past few years. From 2004 to 2008, the number of patients receiving hospice care in the United States grew almost 40% to nearly 1.5 million, and of the 2.5 million people who died in 2008, nearly one million were hospice patients. The overwhelming majority of people receiving hospice care receive federal benefits from the federal government through the Medicare or Medicaid programs. The health care providers who provide hospice services traditionally enroll in the Medicare and Medicaid programs in order to qualify to receive payments under these government programs for services rendered to Medicare and Medicaid eligible patients.
While most hospice health care organizations provide appropriate and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may result in the payments of large sums of money from the federal government, there are tremendous opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As recent federal hospice fraud enforcement actions have demonstrated, the number of health care companies and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.
A recent example of hospice fraud involving a South Carolina hospice is Southern Care, Inc., a hospice company that in 2009 paid $24.7 million to settle an FCA case. The defendant operated hospices in 14 other states, too, including Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the company marketed to potential patients with the promise of free medications, supplies, and the provision of home health aides. Southern Care also entered into a 5-year Corporate Integrity Agreement with the OIG as part of the settlement. The qui tam relators received almost $5 million.
Understanding the Consequences of Hospice Fraud and Whistleblower Actions
U.S. and South Carolina consumers, including hospice patients and their family members, and health care employees who are employed in the hospice industry, as well as their SC lawyers and attorneys, should familiarize themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have developed across the country. Consumers need to protect themselves from unethical hospice providers, and hospice employees need to guard against knowingly or unwittingly participating in health care fraud against the federal government because they may subject themselves to administrative sanctions, including lengthy exclusions from working in an organization which receives federal funds, enormous civil monetary penalties and fines, and criminal sanctions, including incarceration. When a hospice employee discovers fraudulent conduct involving Medicare or Medicaid billings or claims, the employee should not participate in such behavior, and it is imperative that the unlawful conduct be reported to law enforcement and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice employee from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may benefit financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States.
Types of Hospice Care Services
Hospice care is a type of health care service for patients who are terminally ill. Hospices also provide support services for the families of terminally ill patients. This care includes physical care and counseling. Hospice care is normally provided by a public agency or private company approved by Medicare and Medicaid. Hospice care is available for all age groups, including children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to provide care for the terminally ill patient and his or her family and not to cure the terminal illness.
If a patient qualifies for hospice care, the patient can receive medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services. The hospice patient will have a team of doctors, nurses, home health aides, social workers, counselors and trained volunteers to help the patient and his or her family members cope with the symptoms and consequences of the terminal illness. While many hospice patients and their families can receive hospice care in the comfort of their home, if the hospice patient's condition deteriorates, the patient can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.
Hospice Care Statistics
The number of days that a patient receives hospice care is often referenced as the "length of stay" or "length of service." The length of service is dependent on a number of different factors, including but not limited to, the type and stage of the disease, the quality of and access to health care providers before the hospice referral, and the timing of the hospice referral. In 2008, the median length of stay for hospice patients was about 21 days, the average length of stay was about 69 days, almost 35% of hospice patients died or were discharged within 7 days of the hospice referral, and only about 12% of hospice patients survived longer than 180 days.
Most hospice care patients receive hospice care in private homes (40%). Other locations where hospice services are provided are nursing homes (22%), residential facilities (6%), hospice inpatient facilities (21%), and acute care hospitals (10%). Hospice patients are generally the elderly, and hospice age group percentages are 34 years or less (1%), 35 - 64 years (16%), 65 - 74 years (16%), 75 - 84 years (29%), and over 85 years (38%). As for the terminal illness resulting in a hospice referral, cancer is the diagnosis for almost 40% of hospice patients, followed by debility unspecified (15%), heart disease (12%), dementia (11%), lung disease (8%), stroke (4%) and kidney disease (3%). Medicare pays the great majority of hospice care expenses (84%), followed by private insurance (8%), Medicaid (5%), charity care (1%) and self pay (1%).
As of 2008, there were approximately 4,700 locations which were providing hospice care in the United States, which represented about a 50% increase over ten years. There were about 3,700 companies and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations.
General Overview of the Medicare and Medicaid Programs
In 1965, Congress established the Medicare Program to provide health insurance for the elderly and disabled. Payments from the Medicare Program arise from the Medicare Trust fund, which is funded by government contributions and through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is the federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid.
In 2007, CMS reorganized its ten geography-based field offices to a Consortia structure based on the agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children's health, survey & certification and quality improvement. The CMS consortia consist of the following:
• Consortium for Medicare Health Plans Operations
• Consortium for Financial Management and Fee for Service Operations
• Consortium for Medicaid and Children's Health Operations
• Consortium for Quality Improvement and Survey & Certification Operations
Each consortium is led by a Consortium Administrator (CA) who serves as the CMS's national focal point in the field for their business line. Each CA is responsible for consistent implementation of CMS programs, policy and guidance across all ten regions for matters pertaining to their business line. In addition to responsibility for a business line, each CA also serves as the Agency's senior management official for two or three Regional Offices (ROs), representing the CMS Administrator in external matters and overseeing administrative operations.
Much of the daily administration and operation of the Medicare Program is managed through private insurance companies that contract with the Government. These private insurance companies, sometimes called "Medicare Carriers" or "Fiscal Intermediaries," are charged with and responsible for accepting Medicare claims, determining coverage, and making payments from the Medicare Trust Fund. These carriers, including Palmetto Government Benefits Administrators (hereinafter "PGBA"), a division of Blue Cross and Blue Shield of South Carolina, operate pursuant to 42 U.S.C. §§ 1395h and 1395u and rely on the good faith and truthful representations of health care providers when processing claims.
Over the past forty years, the Medicare Program has enabled the elderly and disabled to obtain necessary medical services from medical providers throughout the United States. Critical to the success of the Medicare Program is the fundamental concept that health care providers accurately and honestly submit claims and bills to the Medicare Trust Fund only for those medical treatments or services that are legitimate, reasonable and medically necessary, in full compliance with all laws, regulations, rules, and conditions of participation, and, further, that medical providers not take advantage of their elderly and disabled patients.
The Medicaid Program is available only to certain low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines regarding eligibility and services. Although administered by individual states, the Medicaid Program is funded primarily by the federal government. Medicaid does not pay money to patients; rather, it sends payments directly to the patient's health care providers. Like Medicare, the Medicaid Program depends on health care providers to accurately and honestly submit claims and bills to program administrators only for those medical treatments or services that are legitimate, reasonable and medically necessary, in full compliance with all laws, regulations, rules, and conditions of participation, and, further, that medical providers not take advantage of their indigent patients.
Medicare & Medicaid Hospice Laws Which Affect SC Hospices
Hospice fraud occurs when hospice organizations, by and through their employees, agents and owners, knowingly violate the terms and conditions of the applicable Medicare and Medicaid hospice statutes, regulations, rules and conditions of participation. In order to be able to recognize hospice fraud, hospices, hospice patients, hospice employees and their attorneys and lawyers must know the Medicare laws and requirements relating to hospice care benefits.
Medicare's two main sources of authorization for hospice benefits are found in the Social Security Act and the U.S. Code of Federal Regulations. The statutory provisions are primarily found at 42 U.S.C. §§ 1395d, 1395e, 1395f(a)(7), 1395x(d)(d), and 1395y, and the regulatory provisions are found at 42 C.F.R. Part 418.
To be eligible for Medicare benefits for hospice care, the patient must be eligible for Medicare Part A and be terminally ill. 42 C.F.R. § 418.20. Terminal illness is established when "the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course." 42 C.F.R. § 418.3; 42 U.S.C. § 1395x(d)(d)(3). The patient's physician and the medical director of the hospice must certify in writing that the patient is "terminally ill." 42 U.S.C. § 1395f(a)(7); 42 C.F.R. § 418.20. After a patient's initial certification, Medicare provides for two ninety-day benefit periods followed by an unlimited number of sixty-day benefit periods. 42 U.S.C. § 1395d(a)(4). At the end of each ninety- or sixty-day period, the patient can be re-certified only if at that time he or she has less than six months to live if the illness runs its normal course. 42 U.S.C. § 1395f(a)(7)(A). The written certification and re-certifications must be maintained in the patient's medical records. 42 C.F.R. § 418.23. A written plan of care must be established for each patient setting forth the types of hospice care services the patient is scheduled to receive, 42 U.S.C. § 1395f(a)(7)(B), and the hospice care has to be provided in accordance with such plan of care. 42 U.S.C. § 1395f(a)(7)(C); 42 C.F.R. § 418.56. Clinical records for each hospice patient must be maintained by the hospice, including plan of care, assessments, clinical notes, signed notice of election, patient responses to medication and therapy, physician certifications and re-certifications, outcome data, advance directives and physician orders. 42 C.F.R. § 418.104.
The hospice must obtain a written notice of election from the patient to elect to receive Medicare hospice benefits. 42 C.F.R. § 418.24. Importantly, once a patient has elected to receive hospice care benefits, the patient waives Medicare benefits for curative treatment for the terminal disease upon which is the admitting diagnosis. 42 C.F.R. § 418.24(d).
The hospice must designate an Interdisciplinary Group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. 42 C.F.R. § 418.56. The IDG members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. A registered nurse that is a member of the IDG must be designated to provide coordination of care and to ensure continuous assessment of each patient's and family's needs and implementation of the interdisciplinary plan of care. The interdisciplinary group must include, but is not limited to, the following qualified and competent professionals: (i) A doctor of medicine or osteopathy (who is an employee or under contract with the hospice); (ii) A registered nurse; (iii) A social worker; and, (iv) A pastoral or other counselor. 42 C.F.R. § 418.56.
The Medicare hospice regulations, at 42 C.F.R. § 418.200, summarize the requirements for hospice coverage in pertinent part as follows:
To be covered, hospice services must meet the following requirements. They must be reasonable and necessary for the palliation and management of the terminal illness as well as related conditions. The individual must elect hospice care in accordance with §418.24. A plan of care must be established and periodically reviewed by the attending physician, the medical director, and the interdisciplinary group of the hospice program as set forth in §418.56. That plan of care must be established before hospice care is provided. The services provided must be consistent with the plan of care. A certification that the individual is terminally ill must be completed as set forth in section §418.22.
The Social Security Act, at 42 U.S.C. § 1395y(a), limits Medicare hospice benefits, providing in pertinent part as follows: "Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services-... (C) in the case of hospice care, which are not reasonable and necessary for the palliation or management of terminal illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and necessary for the palliation and management of terminal illness"). Palliative care is defined in the regulations as "patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice." 42 C.F.R. § 418.3.
Medicare pays hospice agencies a daily rate for each day a beneficiary is enrolled in the hospice benefit and receives hospice care. The daily payments are made regardless of the amount of services furnished on a given day and are intended to cover costs that the hospice incurs in furnishing services identified in the patient's plan of care. There are four levels of payments which are made based on the amount of care required to meet beneficiary and family needs. 42 C.F.R. § 418.302; CMS Hospice Fact Sheet, November 2009. These four levels, and the corresponding 2010 daily rates, are as follows: routine home care ($142.91); continuous home care ($834.10); inpatient respite care ($147.83); and, general inpatient care ($635.74).
The aggregate annual cap per patient in 2009 was $23,014.50. This cap is determined by adjusting the original hospice patient cap of $6,500, set in 1984, by the Consumer Price Index. See CMS Internet-Only Manual 100-04, chapter 11, section 80.2; 42 U.S.C. § 1395f(i); 42 C.F.R. § 418.309. The Medicare Claims Processing Manual, at Chapter 11 - Processing Hospice Claims, in Section 80.2, entitled "Cap on Overall Hospice Reimbursement," provides in pertinent part as follows: "Any payments in excess of the cap must be refunded by the hospice."
Hospice patients are responsible for Medicare co-insurance payments for drugs and respite care, and the hospice may charge the patient for these co-insurance payments. However, the co-insurance payments for drugs are limited to the lesser of $5 or 5% of the cost of the drugs to the hospice, and the co-insurance payments for respite care are generally 5% of the payment made by Medicare for such services. 42 C.F.R. § 418.400.
The Medicare and Medicaid programs require institutional health care providers, including hospice organizations, to file an enrollment application in order to qualify to receive the programs' benefits. As part of these enrollment applications, the hospice providers certify that they will comply with Medicare and Medicaid laws, regulations, and program instructions, and further certify that they understand that payment of a claim by Medicare and Medicaid is conditioned upon the claim and underlying transaction complying with such program laws and requirements. The Medicare Enrollment Application which hospice providers must execute, Form CMS-855A, states in part as follows: "I agree to abide by the Medicare laws, regulations and program instructions that apply to this provider. The Medicare laws, regulations, and program instructions are available through the Medicare contractor. I understand that payment of a claim by Medicare is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, the Federal AKS and Stark laws), and on the provider's compliance with all applicable conditions of participation in Medicare."
Hospices are generally required to bill Medicare on a monthly basis. See the Medicare Claims Processing Manual, at Chapter 11 - Processing Hospice Claims, in Section 90 - Frequency of Billing. Hospices generally file their hospice Medicare claims with their Fiscal Intermediary or Medicare Carrier pursuant to the CMS Claims Manual Form CMS 1450 (sometime also called a Form UB-04 or Form UB-92), either in paper or electronic form. These claim forms contain representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of essential information may serve as the basis for civil monetary penalties and criminal convictions; (2) submission of the claim constitutes certification that the billing information is true, accurate and complete; (3) the submitter did not knowingly or recklessly disregard or misrepresent or conceal material facts; (4) all required physician certifications and re-certifications are on file; (5) all required patient signatures are on file; and, (6) for Medicaid purposes, the submitter understands that because payment and satisfaction of this claim will be from Federal and State funds, any false statements, documents, or concealment of a material fact are subject to prosecution under applicable Federal or State Laws.
Hospices must also file with CMS an annual cost and data report of Medicare payments received. 42 U.S.C. § 1395f(i)(3); 42 U.S.C. § 1395x(d)(d)(4). The annual hospice cost and data reports, Form CMS 1984-99, contain representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of information contained in the cost report may be punishable by criminal, civil and administrative actions, including fines and/or imprisonment; (2) if any services identified in the report were the product of a direct or indirect kickback or were otherwise illegal, then criminal, civil and administrative actions may result, including fines and/or imprisonment; (3) the report is a true, correct and complete statement prepared from the books and records of the provider in accordance with applicable instructions, except as noted; and, (4) the signing officer is familiar with the laws and regulations regarding the provision of health care services and that the services identified in this cost report were provided in compliance with such laws and regulations.
Hospice Anti-Fraud Enforcement Statutes
There are a number of federal criminal, civil and administrative enforcement provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, including hospice fraud, and which help maintain program integrity and compliance. Some of the more prominent enforcement provisions of the Medicare statutes include the following: 42 U.S.C. § 1320a-7b (Criminal fraud and anti-kickback penalties); 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-8 (Civil monetary penalties for fraud); 42 U.S.C. § 1320a-7 (Administrative exclusions from participation in Medicare/Medicaid programs for fraud); 42 U.S.C. § 1320a-4 (Administrative subpoena power for the Comptroller General).
Other criminal enforcement provisions which are used to combat Medicare and Medicaid fraud, including hospice fraud, include the following: 18 U.S.C. § 1347 (General health care fraud criminal statute); 21 U.S.C. §§ 353, 333 (Prescription Drug Marketing Act); 18 U.S.C. § 669 (Theft or Embezzlement in Connection with Health Care); 18 U.S.C. § 1035 (False statements relating to Health Care); 18 U.S.C. § 2 (Aiding and Abetting); 18 U.S.C. § 3 (Accessory after the Fact); 18 U.S.C. § 4 (Misprision of a Felony); 18 U.S.C. § 286 (Conspiracy to defraud the Government with respect to Claims); 18 U.S.C. § 287 (False, Fictitious or Fraudulent Claims); 18 U.S.C. § 371 (Criminal Conspiracy); 18 U.S.C. § 1001 (False Statements); 18 U.S.C. § 1341 (Mail Fraud); 18 U.S.C. § 1343 (Wire Fraud); 18 U.S.C. § 1956 (Money Laundering); 18 U.S.C. § 1957 (Money Laundering); and, 18 U.S.C. § 1964 (Racketeer Influenced and Corrupt Organizations ("RICO")).
The False Claims Act (FCA)
Hospice fraud whistleblowers may benefit financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States. The plaintiff in a hospice fraud whistleblower suit is also known as a relator. The most common FCA provisions upon which hospice fraud qui tam or whistleblower relators rely are found in 31 U.S.C. § 3729: (A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; (B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim; (C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);..., and, (G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government.... There is no requirement to prove specific intent to defraud. Rather, it is only necessary to prove actual knowledge of the false claims, false statements, or false records, or the defendant's deliberate indifference or reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b).
The FCA anti-retaliation provision protects the hospice whistleblower from retaliation from the hospice when the employee (or a contractor) "is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment" for taking action to try to stop the fraudulent activity. 31 U.S.C. § 3730(h). A hospice employee's relief includes reinstatement, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination or retaliation, including litigation costs and reasonable attorneys' fees.
A SC hospice fraud FCA whistleblower would initially file a disclosure statement, complaint and supporting documents with the U.S. Attorney's Office in Columbia, South Carolina, and the US Attorney General. After the disclosures are filed, a federal court complaint can be filed. The SC division where the frauds occurred, the relator's residence, and the defendant residence, will determine which division the case will be assigned. There are eleven federal court divisions in South Carolina. Once the case has been filed, the government has 60 days to decide whether or not to intervene. During this time, federal government investigators located in South Carolina will investigate the claims. If the case involved Medicaid, SC Medicaid fraud unit investigators will likely become involved as well. If the government intervenes in the case, the U.S. Attorney for South Carolina is usually the lead attorney. If the government does not intervene, the relator's SC attorney will prosecute the case. In South Carolina, expect a qui tam case to take one to two years to get to trial.
Tips on Recognizing Hospice Fraud Schemes
The HHS Office of Inspector General (OIG) has issued Special Fraud Alerts for fraudulent and abusive practices of hospices. U.S. and South Carolina hospices, patients, hospice employees and whistleblowers, their attorneys and lawyers, should be familiar with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. are:
• A hospice offering free goods or goods at below market value to induce a nursing home to refer patients to the hospice.
• False representations in a hospice's Medicare/Medicaid enrollment form.
• A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the patient not been enrolled in the hospice.
• False statements in a hospice's claim form (CMS Forms 1450, UB-04 or UB-92).
• A hospice falsely billing for services that were not reasonable or necessary for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid considered included in its room and board payment to the hospice.
• A hospice paying above fair market value for "additional" non-core services which Medicaid does not consider to be included in its room and board payments to the nursing home.
• A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice.
•A hospice providing free (or below fair market value) care to nursing home patients, for whom the nursing home is receiving Medicare payment under the skilled nursing facility benefit, with the expectation that after the patient exhausts the skilled nursing facility benefit, the patient will receive hospice services from that hospice.
• A hospice providing staff at its expense to the nursing home to perform duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at specific intervals.
• Plan of Care did not include an assessment of needs.
• Fraudulent statements in a hospice's cost report to the government.
• Notice of Election was not obtained or was fraudulently obtained.
• RN supervisory visits were not made for home health aide services.
• Certification or Re-certification of terminal illness was not obtained or was fraudulently obtained.
• No Plan of care was included for bereavement services.
• Fraudulent billing for upcoded levels of hospice care.
• Hospice did not conduct a self-assessment of quality and care provided.
• Clinical records were not maintained for every patient.
• Interdisciplinary group did not review and update the plan of care for each patient.
Recent Hospice Fraud Enforcement Cases
The DOJ and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.
In 2009, Kaiser Foundation Hospitals settled an FCA lawsuit by paying $1.8 million to the federal government. The defendant allegedly failed to obtain written certifications of terminal illness for a number of its patients.
In 2006, Odyssey Healthcare, a national hospice provider, paid $12.9 million to settle a qui tam suit for false claims under the FCA. The hospice fraud allegations were generally that Odyssey billed Medicare for providing hospice care to patients when they were not terminally ill and ineligible for Medicare hospice benefits. A Corporate Integrity Agreement was also a part of the settlement. The hospice fraud qui tam relator received $2.3 million for blowing the whistle on the defendant.
In 2005, Faith Hospice, Inc., settled claims an FCA claim for $600,000. The hospice fraud allegations were generally that Faith Hospice billed Medicare for providing hospice care to patients more than half of whom were not terminally ill.
In 2005, Home Hospice of North Texas settled an FCA claim for $500,000 regarding allegations of fraudulently billing Medicare for ineligible hospice patients.
In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, including violation of the AKS for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, settled an FCA suit for $2 million.
Conclusion
Hospice fraud is a growing problem in South Carolina and throughout the United States. South Carolina hospice patients, hospice employees, and their SC lawyers and attorneys, should be familiar with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and typical hospice fraud schemes. Hospice organizations should take steps to ensure full compliance with Medicare/Medicaid hospice billing requirements to avoid hospice fraud allegations and FCA litigation.
© 2010 Joseph P. Griffith, Jr.
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Within the legal system of the United States lawyers act as advocates and advisors. As advocates they represent clients in civil and criminal trials, presenting evidence and arguing on their behalf. As advisors they counsel clients about their legal rights and obligations. Most lawyers concentrate on either civil or criminal law. Criminal lawyers represent people who have been charged with crimes. Civil lawyers help their clients with all aspects of business and personal life not covered by criminal law.
Criminal lawyers represent clients who are faced with any of dozens of different types of crimes, from aiding and abetting to homicide to theft. Federal laws, which apply in all states, govern many crimes. But other crimes are covered by state laws, which vary from state to state. That's why it's important for a person charged with a crime to find a criminal lawyer in the state in which the crime is being prosecuted. Someone in Miami or Fort Lauderdale, for example, should choose a Florida criminal attorney. In San Francisco or Los Angeles, a California criminal attorney will be in the best position to defend a person accused of a crime.
Criminal attorneys may specialize in particular types of crime. White collar crimes, for example, are financial crimes that people of high social, professional, or economic status commit in relation to their professions. A typical crime involves deception but not violence. White collar crimes such as bribery, embezzlement, insider trading, public corruption, identity theft, forgery, money laundering, and fraud overlap with the area of corporate crimes. Within the broad area of fraud there is corporate fraud, healthcare fraud, mortgage fraud, insurance fraud, bankruptcy fraud, and hedge fund fraud, and government fraud, to name a few. Recent crimes investigated by the F.B.I. include adoption scams, celebrity memorabilia fraud, staged auto accidents, options backdating, computer fraud, and environmental crimes.
Anyone who has been charged with this kind of crime should contact a criminal attorney as soon as possible. Whether or not they are convicted, people accused of white collar crimes often suffer from negative publicity and the resulting loss of reputation, social status, assets, and business. The consequences of conviction are even worse, of course. People convicted of these crimes may face jail time, large fines, forfeiture of assets, home detention, supervised release, and/or restitution to victims of the crime. Criminal attorneys who specialize in white collar crimes have the experience and knowledge to protect the rights of the accused. A criminal attorney can help the accused avoid or mitigate charges by gaining a dismissal or winning if the case goes to trial.
Rapid advances in computer technology make white collar crimes more feasible. In fact, white collar crimes are on the rise in the United States. In recent years arrests for violent crimes have decreased, but arrests for fraud and embezzlement have increased. The F.B.I. estimates white collar crimes cost the country more than $300 billion each year. As Americans become more concerned about white collar crimes, judges and juries are becoming less lenient in convicting and punishing them.
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If you have been arrested for a drug trafficking charge, you are probably wondering what in the world you should do now. This isn't some small time controlled substance charge. This felony charge is serious, no matter which state you are in. Here are some tips on how to fight a drug trafficking charge.
Don't Talk to Anyone but Your Attorney
Before you talk to the police or any detectives, it is best to ask for your attorney. Most attorneys will advise you not to speak to anyone about your case. When you ask for an attorney, the police are required to stop asking you questions. However, the police are not the only ones that you have to worry about! If you remain in custody, you will also need to be careful what you say to those who are in a cell with you or even the jailers. Anything you say can be used against you - you've heard it before. Don't let a simple conversation with someone in a jail cell be your downfall.
Get a Great Criminal Defense Attorney
Do not just get the cheapest attorney you can find. You need an experienced, aggressive attorney who understands the best way to fight a drug trafficking charge. This may be through a "suppression of the evidence." This means that the evidence or at least part of it, can be thrown out because it was obtained illegally. Most of the drug trafficking cases that are dismissed are due to this reason.
For example, if you accepted a ride from someone who was transporting huge amounts of a controlled substance and cash under the driver's seat, could you be charged with drug trafficking. It happens more often than you might think, even if the passenger had no idea what was in the car. A great criminal defense attorney can work with circumstances such as these and get you the best possible outcome for your case.
A Little Bit of Luck
You know, it doesn't hurt to have a bit of luck on your side. You already had enough bad luck by getting arrested. It also doesn't hurt your case to make sure you are courteous and respectful to all parties involved. That means the arresting officers, the jailers, and the judges. "Copping" an attitude, so to speak, will only harm your case.
In Closing
When you are facing a drug trafficking charge, you may think that things couldn't get any worse. If you hire an inexperienced attorney, you will likely find out just how bad things can get!
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A criminal defense attorney blog is a great source of information for the layman. There is much about the legal world that is alien to the majority of the populace. Often, this can lead to an improper handling of defense cases in court.
No one wants to get arrested. Cultural and spiritual values brand those accused of committing criminal offenses as dangerous social deviants. Associations with such people are discouraged and even condemned. For fear of social incrimination, if not for inborn humanity, most rational beings would not even think of breaking the law.
But then there are those who are not even aware that they are breaking the law. Teenagers vandalizing a public school wall usually have no idea they are actually committing a federal offense, for example. A criminal defense attorney blog can enlighten everyone on the essential facts that people need to know about the constitution and their individual rights. It may also serve as a resource for informative news concerning the legal field.
If the criminal attorney who authors the blog provides insightful content, it is safe to say that he and his law firm can be depended on for legal assistance should the time arise. No one wants to get arrested, but it is good to have some insurance as protection from unfortunate circumstances. A reader who follows a defense law blog and actively engages with it is most likely to turn to the author for help should he find himself having a run in with the law.
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Driving under the influence of alcohol is extremely dangerous. Auto accidents involving a drunk driver often end in death. In 2008, drunk driving killed nearly 11,773 people. There are several important reasons why you should never drink and drive.
Drinking and driving can be very dangerous to people's lives. It can not hurt only the person that driving intoxicated, but it can also seriously injure or even kill others on the road when the driver drunkcomes in contact with another vehicle. In fact, more often than not, the person driving drunk unhurt, while people in the vehicle, they will collide with serious injuries. This is because reaction time slowed significantly when the drunk driver and often not enough time to react and tense during the collision. Who in the event of a collision are more relaxed often receive much less serious injuries.
Drunkenness can also carry seriousConsequences for a person's ability to drive in the future. The majority of people with a DUI have their license revoked by the DMV for an extended period of time. This can make it very difficult to handle for the guilty and complete tasks that they need. A lack of mobility can also cause problems with employment.
There are other legal implications of drinking and driving next to a loss of license. A DUI is traveling to a person record for the rest of their lives. Ifpotential employers want to check a criminal background, a DUI, often reducing the applicant's mark appears in the eyes of employers. There are certain occupations in which a person is not automatically a DUI for a job would be.
Intoxicated driving is dangerous for anyone on the street. There are always alternatives to drunk driving, and there is never an excuse. Understand why you should not drink and drive is extremely important,Entering a situation that can be used in the drink before operating a motor vehicle.
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Non-profit organizations mission is the defense lawyer is to ensure justice and deal with people accused of crimes of. They provide ongoing legal education and the support of public attention on civil rights. They help with the legal process and perform the role of criminal defense practitioners.
Criminal defense lawyers are competent, insured, concerned and pre-screened material suitability and experience of legal grounds. There are serious> Criminal defense lawyers to answer the questions all the legal and ensure that the defendant receives his due in her case. These criminal defense counsel are allowed to defend violence to all kinds of charges, including drug possession, driving under the influence of alcohol and at home. Criminal defense attorneys are required to start the case from which they negotiate and fees and hire investigators.
There are non-profit associationsLawyers who practice criminal defense, in many countries. They offer free advice and the costs are minimal. The consultations are in criminal law, driving under the influence, drug offenses, assault, manslaughter, murder and other crimes including.
There are many cases of innocent people who spend time in jail for something they did not. This is essentially the driving force behind the criminal defense law firms in the country. The Local criminal defense lawyer to protect the rights of citizens accused of crimes.
These criminal defense counsel have developed strategies, original, haunting and dynamic defense, the protection of their customers. These lawyers prepare each case for a trial, instead of rushing for a complaint. This preparation and exceptional reputation court considers most cases of trial and better results.
There are non-profit criminal defense> Law firms that practice in the many facets of the law, but also focus and practice criminal defense. They take care of most state and federal crimes, specializing in the defense of adultery and drug offenses.
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Regardless of the severity of the charges against you, seek the advice of legal experts, experienced Federal Criminal defense is critical for achieving the results at best. His or her legal services to be able to handle a big difference at every stage of the proceedings, or to take steps to make to close the case by a comparison.
If legal representation is used when an indictment is filed against you, you can be sure thatYour lawyer will do everything in his power to reduce your costs, if not dropped entirely. The lawyer can also work out, check the actual charges made against. This can also ensure a survey of police, witnesses and other concerned parties, that no exaggerations or complete lies thrown at you.
If the case goes to court, the defender, a thorough investigation in preparation for trial. In order for the collection of facts and evidence that mayAssistance in formulating an aggressive defense lawyer can also enlist the services of a private investigator, ballistics expert polygraphist or as law-related professions. It is also possible to seek the testimony of an expert in a particular area, if the lawyer maintains that strengthening this is your case.
Most importantly, if a crime was actually committed, the lawyer in the negotiations with the prosecution, the potential penalties to be as straightforward aspossible. grave offenses, using the legal aid of one of the most qualified Federal Defender can help in protection against too steep penalties such as jail time and heavy fines expanded.
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For most people, choosing the right lawyer (or doctor or accountant, etc.) is difficult. Our work is highly specialized, so that for ordinary people know what to ask hard questions. Here are five questions you should ask before hire defense lawyers. There are many other questions to ask, but there are good.
1. What will you do if the prosecutor refuses to negotiate, and plea is an admission of guilt?
The correct answer is that your criminalLawyer fighting the case. In this situation, the defendant has nothing to lose by fighting. The worst that can happen when you are fighting is that you will be found guilty after a trial - the same result as if you are guilty. Practically, it is possible that the sentence would be worse in this situation, but in my experience, there is either no difference or a better result. Plus, you can actually win. A follow-up question is to ask on this, how much it costs for the fight.
2. How manyJury trials have you done?
The answer is hopefully at least five. For more serious cases you would want someone with 10 or more attempts. If the answer is zero, then you may not want that lawyer. I have had over 40 jury trials (perhaps over 50 - I stopped counting). Most of my attempts have cases of injuries, but I still have a few criminal trials jury. this idea, a good follow-up question to ask here, how many criminal jury trials the attorneyhad.
For crime, you may also want to ask how many crimes trials. I am ambivalent about this, because I had only to show, have agreed to study a crime and the prosecutor to dismiss him before we selected a jury. All my other felony cases have been long before we are positive of court, most of them got solved.
Although it at a Federal, you should have federal studies. In order that are much rarer and it is probably hard tofind a lawyer who has done them a lot.
3. Who will take my case?
Most defense lawyers are solo practitioners or work in small offices, and they treat their own cases. Our office staff has grown and I have to deal with the essential work. I usually review their papers and most of the hearings and so far all attempts. I am confident that to do with associates of the work is actually better for the customer. You get different types of eyeto look at things and there is still a chance to pick up important details.
The worrying thing is that some lawyers a "business model" that may have not good for you. It's pretty rare, but some lawyers, is campaigning heavily end up doing almost no work on your case. They accept cases far from their office and have someone on site appear to them. Unlike an associate, there is little quality control.
For smaller cases like traffic tickets where the law is simplyNegotiations on a plea deal, this may not matter as much. Easy to say for me, as we do. But I do not feel well with this material in an outside lawyer out of court work for me on a serious criminal case, even on a DWI (which I think is pretty serious).
4. How many cases as you think have handled?
In general, you want to have seen a lawyer, something like that in the past. If you are facing a DWI, you want a lawyer who dealt with a few friends. If it's a federal drugCase, you want someone with that experience. A lawyer with no experience in this area will miss some details. I am a much better DWI lawyer now than I was four years ago. I have seen more, done more and learned more.
Every once in a while I get a call from someone with a really strange case. If you are in this situation, you're not a lawyer, who had ten of them related to the front. You should look for someone with common experience and criminal defenseat least something vaguely related.
For traffic cases, this question a lot. Our company represents many out-of-state driver, and the deals we are trying to get for it are sometimes different than what we do for NY Drivers. We have direct access not only the NY DMV database, but the NJ MVC because we get so many of New Jersey customers. Make sure the attorney understands your circumstances and know how to deal with your particular situation.
5. Do I have come toCourt?
Our customers are rarely in court with us. Most of our performances are routine and nothing of significance happens at them. It is a waste of time for our customers to come, and it can be very stressful for them. By saving them the trip and stress, we offer real benefits.
Also for most hearings and even some studies that we do not bring our customers. You are certainly welcome to come, and is important in some cases, their participation, but we usually need them.Preliminary negotiations are mainly about what to tell the police. Customers rarely at this stage testify.
An exception to complex cases or economic crime, can be the customer's presence is crucial. Even if they do not testify, they can provide insight into the prosecution witnesses lawyer that helps with the cross-examination.
These five questions are a good start. You should be more based on the details of your case and your situation. Choose wisely and you willmuch happier with your defense.
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The role of a criminal lawyer to represent the defendants in the courtroom. There are times the law accepts physical abuse against the people if it is done in self-defense to protect someone else in order to protect his property. All these cases are allowed by the court.
But before the court can them as such, with your criminal defense together have some proof. You need at least four reasons why you had to meetthe act of using physical force against a person. The defense lawyers will have to show that you do not provoke the physical attacks that have hurt you in danger of physical, that you force used only to prevent you from harm directed at, and that you use only that force which was necessary to protect themselves and nothing more.
If your situation was that no one else had to go, when to attack you defend against someone, and you fear that they are going to inflict bodily harm,then your defense lawyer should court to prove that you in the view that the power of it was necessary to protect the person you are before the other, death would lead to harm you or even have caused, you can.
In a breaking down of someone is not necessary and everyone has the right to protect themselves. The only thing that matters is to have this be proved in court. The defense lawyer's job is to make the Court found that underShe had the circumstances, only two possibilities, one is for the other person to kill you, and the second is to use force to stop to kill the other person to wait.
Regardless of the situation, defense lawyers' s duty to fight for innocent because they think you are. He plays a very important role in you from a critical situation.
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At the beginning of the new millennium, Americans were spending 1.3 trillion U.S. dollars annually for health care, everyone recognizes with a real understanding of human nature that when so much money is at stake, the unethical among us their personal profit endeavor at the expense of those around them. The IRS estimates that 3-10% may be the health care costs fraudulent. Even at minimum, that is lost completely paralyzing 39000000000 $, including more than 13 million U.S. dollars in MedicarePayments years.
Obviously something should be done. And yet, as so often, federal investigators and prosecutors generally leave on a heavy hand and foolish, rather than a consistent one, where the influx of money lost to fraud in health care. The strategy seems to be to bring examples of individuals, but as a systemic change that would be uncomfortable and difficult.
Statistics bear this out. According to the governmentStatistics, a mere 466 investigations of fraud in the health sector were carried out between 2005 and 2007, in 203 cases, only the actual costs of sentencing. Investigation and prosecution of fraud is certainly a complex field, but it seems obvious that a 39000000000 $ dollar problem is not caused by a mere 50-60 people every year.
The same human nature that leads to fraud in the health sector leads investigators and prosecutors to cut corners, trying to solve a legitimate problem, with minimalEffort and personal expenses. The problem lies in the fact that when the focus rather than individual persecution become systemic change, it is quite possible for the innocent harassed too much, even falsely accused or convicted wrongly.
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