Medicaid Fraud Control Unit Busts Florida Pharmacist in Alleged $600,000 Medicaid Fraud Case

Monday, August 26, 2013

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

An investigation by the Florida Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) uncovered almost $600,000 in alleged Medicaid fraud. According to the AG, a pharmacist and owner of a Hialeah, Florida, pharmacy, was arrested on August 22, 2013. A press release from the AG stated that the pharmacist was charged with one count of first-degree Medicaid fraud.

Click here to read the press release from the AG.


Pharmacist Allegedly Submitted False Claims to Agency for Health Care Administration.

According to the Miami Herald, the pharmacist allegedly submitted fraudulent invoices to the Agency for Health Care Administration (AHCA). The invoices made it appear that the pharmacy had dispensed the correct amount of medication for which they had billed the Medicaid program. However, MFCU investigators discovered the pharmacy never dispensed the medicine, yet still billed the government’s Medicaid program.

If convicted, the pharmacist faces up to 30 years in prison and more than $2.9 million in fines, according to the Miami Herald.

To read the Miami Herald article, click here.


Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state's Medicaid program.  When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.


Take Fraud Charges Seriously.

We have been consulted by many individuals similar to the subject of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.


Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.


Sources:

Meale, Jenn. “Miami-Dade Pharmacy Owner Arrested for Nearly $600,000 in Medicaid Fraud.” Florida Attorney General. (August 22, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/048466C1167ADE9085257BCF006885EC

Miami Herald. “Hialeah Pharmacy Owner Accused of Defrauding Medicaid of Nearly $600,000.” Miami Herald. (August 22, 2013). From: http://www.miamiherald.com/2013/08/22/3579481/hialeah-pharmacy-owner-accused.html


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


Tag Words: Medicaid, Medicaid fraud, Medicaid investigation, pharmacist, pharmacy, Florida Medicaid, Florida Medicaid Program, Medicaid audit, Medicaid claims, fraudulent claims, Attorney General (AG), Agency for Healthcare Administration (AHCA), Medicaid Fraud Control Unit, defense attorney, defense lawyer, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Florida attorney, Florida lawyer, The Health Law Firm



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8/26/2013

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