By: James W. Kraus
On Friday, September 18, the medical biller for a Chicago-area visiting physician practice was sentenced to 45 months in prison, by U.S. District Judge Gary Feinerman of the Northern District of Illinois, for her role in a $4 million healthcare fraud scheme. Mary Talaga was convicted in May of this year following a jury trial on numerous charges relating to a billing scheme, including conspiracy to commit healthcare fraud. Ms. Talaga was also sentenced to pay approximately $1 million in restitution.
From 2007-2011, Talaga was the primary medical biller for Medicall Physicians Group, Ltd., a physician practice that visited patients in their home and prescribed home healthcare. The primary method of billing fraud that came to light at trial was the billing of Medicare for a service known as “Care Plan Oversight” or “CPO,” which would have indicated that the doctors had provided oversight of patient care plans. In fact, the doctors at Medicall rarely provided the service.
Talaga and her co-conspirators also billed Medicare for other services that were never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall and services purportedly provided by medical professionals who, based on billing records would have had to have worked over 24 hours per day. In all, the evidence presented at trial indicated that, through the period of the 5-year conspiracy, Medicall submitted bills to Medicare for more than $4 million in services never provided and Medicare paid more than $1 million on those claims.
Talaga’s co-conspirators, Rick Brown and Roger A. Lucero, Medicall’s former medical director, were also convicted in this matter. Brown was convicted as part of the same trial with Talaga, and has been sentenced to serve more than 7 years in prison. Lucero pleaded guilty and will be sentenced at a later date.
According to the government, since its inception in March 2007, the Medicare Fraud Strike Force, which investigated and prosecuted this case, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion.
James W. Kraus, of Pietragallo Gordon Alfano Bosick & Raspanti, LLP, has been selected as the recipient of the DRI’s Albert H. Parnell Outstanding Program Chair Award which will be presented during the DRI Annual Meeting on October 17 in Chicago, Illinois. This award honors a program chair who created a dynamic educational program enhancing… Read more »Read More
James W. Kraus has been appointed to serve as the Chair of the Directors and Officers Coverage Subcommittee of the Defense Research Institute’s (DRI) Government Enforcement and Corporate Compliance Committee (GECC). DRI is the largest international membership organization of attorneys defending the interests of business and individuals in civil litigation. The GECC provides opportunities for education… Read more »Read More
Nationally-recognized qui tam attorney, Marc S. Raspanti, will be speaking at the Federal Bar Association’s 2020 Qui Tam Conference in Washington, DC on Thursday, February 27, 2020. This two-day conference will feature experienced FCA litigators from a variety of perspectives who will dive into advanced topics and discuss emerging trends and key developments pertaining to… Read more »Read More
Pietragallo Gordon Alfano Bosick & Raspanti, LLP Partner Michael A. Morse will be presenting at the Pennsylvania Bar Institute’s (“PBI”) Health Law Institute on March 11-12, 2020. Mr. Morse’s session topic is, “Preparing for the Fight of Your Life: Anatomy of a Health Care Fraud Prosecution.” The PBI notes that the Health Law Institute is,… Read more »Read More