Prosthetics Company in North Carolina Accused of Medicaid Fraud
Bradley/Grombacher, LLP • January 16, 2018
A prosthetics provider based in North Carolina allegedly fraudulently billed Medicaid for more than $12 million in unnecessary medical equipment costs and other charges that should never have been sent to the federal government for reimbursement, according to federal prosecutors.
Medicaid Fraud Includes Multiple Claims of Illegal Activity
The provider allegedly billed Medicaid for durable medical equipment that was never purchased or given to patients. Furthermore, the claims from state and federal governments against the prosthetics company allege that these overpayments were due to claims for support products that were never needed. Furthermore, many of these devices were never even given to the patients.
A court-appointed receiver took over for the company temporarily while there was a legal battle over who rightfully owned the company. The court-appointed receiver identified the alleged Medicaid fraud and reported it to the government after working for the company for a short period of time.
More than $9 million in Medicaid payments is alleged in the Medicaid fraud lawsuit including unnecessary purchases of bone growth stimulators, powered air flotation beds, foot, ankle and knee orthotics, power wheelchair accessories, and calf stimulating devices.
As in this and other Medicaid fraud cases, the insight from a whistleblower was the first way the government identified the scheme. Whistleblowers are often employees working for a company who become aware of inside information related to fraud and illegal activity.
Most Common Types of Medicaid Fraud
There are many different types of federal Medicaid fraud, including billing for services never rendered, billing the government for services not needed or for patients who did not exist, or billing more than one for the same product or service.
The receiver statements included in the Medicaid fraud lawsuit were allegedly false and fictitious. Furthermore, Medicaid paid $900 for breast prosthetics and mastectomy bras for a patient who did not have cancer and other device claims totaling $26,000 for that same patient were never given to the patient or needed at all.
Another example was a power wheelchair. The Medicaid fraud scheme illustrated comprehensive strategies to obtain government funds for items that were never needed or used. According to the Medicaid fraud lawsuit, the products were provided for more than a year before the business even opened and for patients who had been dead for longer than a year.
Although the government did not reimburse all of these claims, some of them were approved according to the Medicaid fraud lawsuit.
If you believe you have grounds to come forward with a whistleblower claim because you have become aware of illegal or fraudulent activity, consult with an experienced attorney. The attorneys at Bradley/Grombacher are currently investigating whistleblower allegations of Medicaid fraud- fill out the form on this page to learn more about your rights.
The Medicaid fraud case is United States of America et al v. A Perfect Fit for You Inc. et al., Case No. 4:17-CV-00174 in the U.S. District Court for the Eastern District of North Carolina.
Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.
The smoke has cleared, the embers have cooled, but the challenges of rebuilding after a wildfire are just beginning. One of the most important steps in your recovery is filing a claim with your homeowner's insurance company. This process can be complex and fraught with potential pitfalls. Making the wrong move could significantly impact the compensation you receive, delaying your recovery or even jeopardizing your claim altogether. Here are 10 crucial mistakes to avoid when filing a wildfire insurance claim: Delaying the Filing of Your Claim: Time is of the essence. Most insurance policies have deadlines for reporting losses. Delaying your claim can raise red flags with your insurer and potentially jeopardize your coverage. Contact your insurance company as soon as reasonably possible after the fire to initiate the claims process. Failing to Document Everything: Thorough documentation is your most powerful weapon in the claims process. Photograph and Videotape: Take extensive photos and videos of all damage to your property, both inside and out, before any cleanup or repairs begin. Capture wide shots and close-ups, documenting the full extent of the destruction. Create a Detailed Inventory: Compile a comprehensive list of all damaged, destroyed, or lost personal belongings. Include descriptions, quantities, estimated values, and any available receipts, purchase records, or appraisals. Keep All Receipts: Save every receipt related to expenses incurred due to the fire, including temporary housing, meals, clothing, transportation, and any other out-of-pocket costs. Throwing Away Damaged Items Before the Adjuster's Inspection: Resist the urge to discard damaged items before the insurance adjuster has had a chance to inspect them. These items serve as crucial evidence to support your claim. If you must dispose of anything for safety or health reasons, take detailed photographs and videos first, and notify your adjuster. Not Understanding Your Policy: Your homeowners insurance policy is a complex legal document. Failing to thoroughly understand its terms, coverage limits, exclusions, and your responsibilities as a policyholder can lead to costly mistakes. If anything is unclear, seek clarification from your agent or an attorney. Pay particular attention to: Dwelling Coverage Limits: The maximum amount your insurer will pay to repair or rebuild your home. Personal Property Coverage: The limits for replacing your belongings. Loss of Use/Additional Living Expenses (ALE): The extent of coverage for temporary housing and other living expenses. Deductibles: The amount you must pay out-of-pocket before your coverage kicks in. Exclusions: Any specific types of damage or losses that are not covered. Accepting the First Offer Without Question: The first settlement offer from your insurance company is often a lowball offer, especially after a major event like a wildfire. They are hoping you'll accept it out of desperation or lack of knowledge. Don't be afraid to negotiate or seek a second opinion from an independent contractor or a lawyer. Downplaying Your Losses or Damages: Be honest and thorough when describing your losses to the insurance adjuster. Don't minimize the damage or omit items from your inventory. It's better to overestimate initially than to leave something out and have to fight for it later. Making Permanent Repairs Before Authorization: Avoid making any permanent repairs to your property before obtaining authorization from your insurance company. They may deny coverage for repairs made without their approval. Emergency repairs to prevent further damage are usually acceptable, but document them thoroughly and notify your insurer as soon as possible. Not Keeping Records of Communication: Document every interaction with your insurance company, including phone calls, emails, and in-person meetings. Note the date, time, name of the representative, and a summary of the conversation. This creates a valuable paper trail that can help protect your rights if a dispute arises. Failing to Seek Professional Help: The insurance claims process can be overwhelming, especially after a traumatic event like a wildfire. An experienced wildfire insurance lawyer can provide invaluable assistance by: Evaluating your policy and explaining your rights. Gathering and organizing evidence to support your claim. Negotiating with the insurance company on your behalf. Filing a lawsuit if necessary to challenge a denial or bad faith practices. Ignoring Deadlines: Insurance claims are subject to various deadlines, including the time to file a claim, submit documentation, and file a lawsuit if necessary. Missing a deadline can have serious consequences, potentially barring you from recovering the compensation you deserve. Bradley/Grombacher LLP: Your Advocates for a Fair Recovery At Bradley/Grombacher LLP, we understand the devastation that wildfires inflict on California homeowners. We're committed to helping victims of events like the Palisades Fire secure the full and fair compensation they need to rebuild their lives. With over 50 years of combined experience in employment law, personal injury, and consumer protection , we're well-equipped to handle complex wildfire claims and fight for your rights. Don't let the insurance company take advantage of you during this vulnerable time. If you're facing challenges with your wildfire insurance claim, contact us today for a free, confidential consultation. Call us at (866) 881-0403 or fill out our online contact form. We're here to help you every step of the way.
A wildfire can turn your life upside down in an instant. In the aftermath of such a devastating event, it's easy to feel overwhelmed and unsure of where to turn. Knowing your legal rights is a crucial first step toward recovery and rebuilding. While the specifics of each situation may differ, there are some fundamental legal principles that apply to wildfire victims in California. 1. Your Right to Compensation for Property Damage If your home or property was damaged or destroyed in a wildfire, you may be entitled to compensation from several potential sources: Your Homeowners Insurance: Your insurance policy is a contract, and your insurance company has a legal obligation to honor its terms. This can include coverage for: Dwelling: The cost to repair or rebuild your home. Other Structures: Damage to detached garages, sheds, fences, etc. Personal Property: Loss or damage to your belongings, such as furniture, clothing, electronics, and appliances. Loss of Use/Additional Living Expenses (ALE): Costs associated with temporary housing, meals, and other essential expenses if you are displaced from your home. Potentially Liable Third Parties: Utility Companies: In California, utility companies can be held strictly liable under the principle of "inverse condemnation" if their equipment is a substantial cause of a wildfire (as is being investigated with SCE in the Palisades Fire ). Government Entities: If a government entity's negligence contributed to the fire's spread (such as the alleged LADWP hydrant failures during the Palisades Fire ), they may also be held liable. Negligent Individuals or Businesses: If the fire was started by a private individual's or business's negligence (e.g., arson, improperly maintained equipment), they could be held responsible for the resulting damages. 2. Your Right to a Fair Insurance Claims Process Insurance companies have a legal duty to act in good faith when handling your claim. This means they must: Investigate Promptly: Conduct a thorough and timely investigation of your claim. Communicate Honestly: Keep you informed about the status of your claim and respond to your inquiries in a timely manner. Pay Fairly: Offer a settlement that accurately reflects your covered losses and is consistent with the terms of your policy. Insurance Bad Faith: If your insurer unreasonably denies your claim, delays payment, offers an unfairly low settlement, or otherwise acts in bad faith, you may have grounds for a separate legal action against them. 3. Your Right to Compensation for Personal Injuries Wildfires can cause a range of physical injuries, including: Smoke Inhalation: Respiratory problems, lung damage, and other health complications. Burns: Severe burns requiring extensive medical treatment and potentially causing long-term disability. Other Injuries: Injuries sustained during evacuation or as a result of the fire's spread. If you or a loved one suffered a personal injury due to someone else's negligence in connection with a wildfire, you may be entitled to compensation for: Medical Expenses: Past and future medical bills related to your injuries. Lost Wages: Income lost due to your inability to work. Pain and Suffering: Compensation for physical pain, emotional distress, and mental anguish. Loss of Consortium: Compensation to your spouse for the loss of companionship and support. 4. Your Right to Compensation for Lost Income or Business Interruption If a wildfire forced you to miss work or resulted in the closure of your business, you may have legal recourse: Lost Wages: If your employer wrongfully terminated you, failed to pay you, or denied you reasonable accommodations after a wildfire, you may be able to recover lost wages under California employment law. Business Interruption Insurance: If you have business interruption coverage as part of your commercial insurance policy, you may be able to recover lost profits and other expenses incurred due to the wildfire's impact on your business. 5. Your Right to Legal Representation Navigating the legal complexities after a wildfire can be daunting. An experienced attorney can be your advocate and guide, helping you to: Understand Your Rights: Provide clear explanations of your legal options and the applicable laws. Gather Evidence: Collect and preserve the necessary evidence to support your claims. Negotiate with Insurance Companies: Engage in strategic negotiations to secure a fair settlement. File Lawsuits: Take legal action against responsible parties, whether it be insurance companies, utility companies, government entities, or negligent individuals. Represent You in Court: Provide skilled representation in court if litigation becomes necessary. Bradley/Grombacher LLP: Dedicated to Helping Wildfire Victims At Bradley/Grombacher LLP, we understand the impact wildfires have on individuals, families, and communities. With over 50 years of combined experience in personal injury, employment law, and consumer law , we have the knowledge and skills to effectively advocate for your rights and secure the compensation you deserve. We're committed to: Holding negligent parties accountable. Maximizing your financial recovery. Providing compassionate and personalized legal representation. Take the First Step: Contact Us for a Free Consultation If you've been affected by a California wildfire, including the recent Palisades Fire, don't hesitate to contact Bradley/Grombacher LLP for a free, confidential consultation . We'll listen to your story, answer your questions, and provide an honest assessment of your legal options. Call us at (866) 881-0403 or fill out our online contact form. Let us help you navigate the path toward recovery and justice.
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