How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Law Educator, Esq. Your Own Question

Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Business Law
Satisfied Customers: 92531
Experience:  All corporate law, including non-profits and charitable fraternal organizations.
10285032
Type Your Business Law Question Here...
Law Educator, Esq. is online now
A new question is answered every 9 seconds

This is related to my previous questions. Just a brief background

Resolved Question:

This is related to my previous questions. Just a brief background here.
Bought a business two years ago. The seller mis-represented earning because at least half of the earning were not legimate billing to government Medicaid. A civil lawsuit was filed. The defendant has avoided both sheriff and speical bailiffs's summon service. My attorney is trying Warning Order similar to publication. In the meantime, I report the false billing to government Medicaid and Office of attorney general. The government DEA office is also investigating another dental business owned by the defendant. The government investigator said they will not disclose their findings during the investigation. I asked them whether their investigation result can be helpful to my civil case. One investigator said this kind of mis-billing is quite common among doctors. He told me I can consult with Medicaid policy dept regarding whether defendant's conduct is in violation of government's regulation or not. I am a bit confused by that. As a branch of manager of Medicaid audit and investigation unit, don't he know this is a violation or not? Besides, if government does not take serious action, and instead only takes something like educating the defendant what should be the right way of billing, will that be bad to my civil case? I think it is easy to show or convince the defendant's conduct was violation. However if the violation does not end up with government's serious action, how that will affect the civil case? I know that if government is not serious, then there is no point to do qui tam. Does the civil case still have strong ground?
Submitted: 2 years ago.
Category: Business Law
Expert:  Law Educator, Esq. replied 2 years ago.
The issue is that they cannot tell you anything until the case is completed and the investigation is referred to the US attorney for determination of whether or not they are going to pursue criminal charges, civil charges or no charges against the doctor. The US attorney has to make a determination and until they do the Medicaid and Medicare investigators cannot tell you anything at all about the case.


I truly aim to please you as a customer, but please keep in mind that I do not know what you already know or don't know, or with what you need help, unless you tell me. Please consider that I am answering the question or question that is posed in your posting based upon my reading of your post and sometimes misunderstandings can occur. If I did not answer the question you thought you were asking, please respond with the specific question you wanted answered.
If you did not get all of the information you may have wanted PLEASE USE THE REPLY TO EXPERT LINK IF YOU HAVE FOLLOW UP QUESTIONS AND NOT THE FEEDBACK BUTTON FOR BAD SERVICE. PLEASE CLICK ON “OK,” “GOOD” or “EXCELLENT” SERVICE. Kindly remember to ONLY rate my answer when you are fully satisfied. If you feel the need to rate anything less than OK, please stop and reply to me via the or REPLY TO EXPERT button with whatever issue or clarification you may need.
Also remember, sometimes the law does not support what we want it to support, but that is not the fault of the person answering the question, so please be courteous.
PLEASE NOTE WELL WE ARE DEALING WITH LAWS OF 50 STATES PLUS FEDERAL LAWS, AS WELL AS DEALING WITH OTHER CUSTOMERS, SO PLEASE BE PATIENT AND BE ASSURED YOU ARE NOT BEING IGNORED.
There can also be a delay of an hour or more in between my answers because I may be helping other customers or taking a break.
You can always request me through my profile at http://www.justanswer.com/law/expert-paulmjd/ or beginning your question with “For PaulMJD…”
Customer: replied 2 years ago.


Thanks. Let me summarize my question and hope you are able to answer to the point.

 

1) I am suing the defendant in civil court as mis-representation of business earning and breach of contract (i.e the contract has warantee of financial truth and fairness). In this regards, XXXXX XXXXX asking for the refund of the entire business purchase. In terms of damage caused to plaintiffs, it is large.

2) Because the business is in government healthcare. The business mis-representation also violated government Medicaid's billing regulation and drug prescription rule. But the damage to government may not be significant even if the violation is obvious and conclusive. The US attorney may not pursue this defendant based on damage caused to public or government.

 

The question: if the government found violation of defendant's conduct in terms of false billing and drug prescription, but the government does not pursue the case further, will that be negative to the civil case?

 

Let me give you the detail scenario here:

Dr. A is a healthcare business owner. Dr. A hired Dr. B to treat patients from Medicaid, and Dr. A is an absentee owner and he does not practice and treat patient.

Dr. B is a doctor but he is not credentialed to treat Medicaid patient. In KY, a doctor is required to be credentialed by Medicaid program in order to treat Medicaid patients. Because Dr. A owns the business, he wants to make money through Dr. B who cannot treat Medicaid patients. As a result, Dr. A uses his own Medicaid credential to bill Medicaid pretenting he is the doctor who actually treated patients. The Medicaid, without kowing Dr. B actually treated patients, paid Dr. A. Dr. A then take a commisson to pay Dr. B. In this whole process, Medicaid never knows Dr. B. Dr. A also did similar thing to prescribe controled substances like pain management drug to Medicaid patients because Dr. B does not have such license.

 

When Dr. A sold his business, he failed to disclose above information to the buyer. In the purchase contract, the buyer is waranteed the financial statement are "truth and fair". The buyer also assume the earning are legimate because the doctors produced those earning are suppose to be fully licensed and credentialed and billing (to Medicaid) are legimate. So, the buyer is suing for damage caused by

mis-representation of earning and breaching of contract.

 

Now from government's point view, Dr. A's conduct is problematic and a violation of the Medicaid regulation. Should the government have known that the true biling used by Dr. A, the government would not have paid him. However, the government may not charge Dr. A on criminal case or fine him because although Dr. A billed for service not rendered by himself, the service was provided by Dr. B. This is a lot of different in the typical fraud case when a doctor billed government for service nobody rendered. Considering cost and other factors, government may only do administration or education correction. This may include warning etc.

 

Now, the goal of plaintiff and government are different. Defendant caused different damage to plaintiff and government. The question here is whether the plaintiff sitll has ground against the defendant given the government does not pursue the defendant on criminal or other severious punishment including refund or fine.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expert:  Law Educator, Esq. replied 2 years ago.
No, the fact that the government does not pursue the case criminally or civilly does not necessarily mean that there was no violation and thus it does not necessarily hurt your case. It hurts your case if the government investigation finds there was no violations of any laws, then you could not use that investigation to your advantage in your case against the dentist.
Customer: replied 2 years ago.


Thanks. I am confidence there was a violation of law or policy. Based my conversation with the DEA(Drug Enforcement Administration) investigator, he said clearly that this is a violation. I have this question because when I was reporting this Medicaid billing violation, the investigation branch manager said the billing behavior is quite COMMON. I am not sure the COMMON means acceptable, no violation or what. He asked me to consult with Medicaid policy department for violation. I am confused becase he even cannot explain the policy given he is the investigation branch manager of Medicaid audit & investigation. But from other Medicaid consultation, I heard this is a clear violation.

 

Will the government call witness (those people who verify that the doctor who billed Medicaid did not practice) to prove the violation? If not, then civil court has to call wintness to verify plaintiff's claim and then consult with government policy/guideline to determine there was violaton or not. But without government's conclusion, how the civil court determine a violation or not? Do the civil court has to wait until the government reaches a conclusion? Or I can ask government to give me a general statement or interpreation indicating that if the secnario I reported are the fact (verified) then that is a violation. With that statement, the civil can determine whether there was violation by the two factors: 1) plaintiff's claim is a fact or not (the court can call wintesses, or check other document);

2) government's policy or government's interpration of the violation guideline. In such a way, there no need to wait for government's investigation results.

Expert:  Law Educator, Esq. replied 2 years ago.
Common is not acceptable, it just means many people violate the law this way and Medicaid generally only fines them and do not prosecute them.

Yes, the government will put on witnesses regarding the violation and it is typically their investigator. The government will not give you anything in writing other than the final report when the case is closed as then that report is public record, but you can actually subpoena their investigator who investigated the case and have him testify.

You can subpoena the government investigator to get the information at trial as long as it is not an open criminal investigation.
Customer: replied 2 years ago.

Thanks. That is very helpful. I subpoena government investigator to testify 1) whether the kind of conduct(billing) by the defendant is a violation or not ;


2) whether the defendant commited the kind of conduct. If the government investor has't completed investigation of 2), and cannot answer question 2), then the court can calll witness to independently prove or disapprove 2). Is my understanding correct? I hope the court does not have to wait for the outcome of government's investigation.

Expert:  Law Educator, Esq. replied 2 years ago.
Yes you subpoena the investigator an get them to testify as to the investigation if it is closed. If the investigation is still open, then the court would continue your case until the investigation is complete. The "court" does not call any witnesses, you would have to call your own witnesses and get them to testify.
Law Educator, Esq., Attorney
Category: Business Law
Satisfied Customers: 92531
Experience: All corporate law, including non-profits and charitable fraternal organizations.
Law Educator, Esq. and 7 other Business Law Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
< Last | Next >
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
  • My Expert was fast and seemed to have the answer to my taser question at the tips of her fingers. Communication was excellent. I left feeling confident in her answer. Eric Redwood City, CA
  • I am very pleased with JustAnswer as a place to go for divorce or criminal law knowledge and insight. Michael Wichita, KS
  • PaulMJD helped me with questions I had regarding an urgent legal matter. His answers were excellent. Three H. Houston, TX
  • Anne was extremely helpful. Her information put me in the right direction for action that kept me legal, possible saving me a ton of money in the future. Thank you again, Anne!! Elaine Atlanta, GA
  • It worked great. I had the facts and I presented them to my ex-landlord and she folded and returned my deposit. The 50 bucks I spent with you solved my problem. Tony Apopka, FL
  • Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help. Mary C. Freshfield, Liverpool, UK
 
 
 

Meet The Experts:

 
 
 
  • Law Pro

    Attorney

    Satisfied Customers:

    1767
    20 years experience in business law - sole proprietor, partnership, and corporations
< Last | Next >
  • http://ww2.justanswer.com/uploads/LA/lawpro/2012-6-25_171315_PT206740s.64x64.jpg Law Pro's Avatar

    Law Pro

    Attorney

    Satisfied Customers:

    1767
    20 years experience in business law - sole proprietor, partnership, and corporations
  • http://ww2.justanswer.com/uploads/dkaplun/2009-05-17_173121_headshot_1_2.jpg Dimitry K., Esq.'s Avatar

    Dimitry K., Esq.

    Attorney

    Satisfied Customers:

    1495
    Run my own successful business/contract law practice.
  • http://ww2.justanswer.com/uploads/DC/DCraneEsq/2012-8-14_14436_DCrane.64x64.jpg MShore Law's Avatar

    MShore Law

    Attorney

    Satisfied Customers:

    1233
    Drafted Negotiated and/or Reviewed Thousands of Commercial Agreements
  • http://ww2.justanswer.com/uploads/FL/FLAandNYLawyer/2012-1-27_14349_3Fotolia25855429M.64x64.jpg FiveStarLaw's Avatar

    FiveStarLaw

    Attorney

    Satisfied Customers:

    1174
    25 years of experience helping people like you.
  • http://ww2.justanswer.com/uploads/scottymacesq/2009-6-10_221523_small.jpg RGMacEsq's Avatar

    RGMacEsq

    Attorney

    Satisfied Customers:

    504
    Licensed Texas General Practice Attorney
  • http://ww2.justanswer.com/uploads/ohioatty/2009-1-22_185545_me.jpg J.Hazelbaker's Avatar

    J.Hazelbaker

    Attorney

    Satisfied Customers:

    393
    Experienced and trained in the area of business law.
  • http://ww2.justanswer.com/uploads/BA/barristerinky/2012-6-10_22423_office.64x64.jpg Barrister's Avatar

    Barrister

    Attorney

    Satisfied Customers:

    373
    14 years practicing attorney, MBA
 
 
 

Related Business Law Questions

Chat Now With A Business Lawyer
Law Educator, Esq.
Law Educator, Esq.
Attorney At Law
4987 Satisfied Customers
All corporate law, including non-profits and charitable fraternal organizations.