Florida Pharmacy Owner Accused of Medicare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Drug Enforcement […]
Internal Medicine Specialists Should Be Aware of Impending Medicare Audits
Coming to a medical practice near you. . . It’s scary, it’s horrible, and it could cost you a lot of money! It’s the dreaded Comprehensive Error Rate Testing (CERT) audit. The Horror! The Horror! First Coast Service Options, the Medicare contractor for Florida, announced a new prepayment audit program that will impact Internal Medicine […]
The RACs, They’re Back! The Return of Medicare Recovery Audits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law All good things must come to an end. This includes the two-month hiatus from Recovery Audit Contractors (RACs) that healthcare professionals enjoyed. The Centers for Medicare and Medicaid Services (CMS) is restarting audits of Medicare fee-for-service claims on […]
Kansas Cancer Treatment Center and Owner Pay $2.9 Million Settlement for Alleged False Claims Act Violations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A whistleblower or qui tam lawsuit against a cancer treatment facility in Kansas has been settled. On April 14, 2014, the Hope Cancer Institute and its owner agreed to pay $2.9 million to resolve allegations that they violated […]
Centers for Medicare and Medicaid Services Puts Recovery Audit Contractor Program on Hold
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On February 18, 2014, the Centers for Medicare and Medicaid Services (CMS) announced it is in the procurement process for the next round of Recovery Audit Program contracts. This means the program is, for the time being, on […]
Miami Medical Clinic Owner Pleads Guilty to $20 Million in Medicare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The owner of a Miami-based medical clinic pleaded guilty on January 8, 2014, for her involvement in several health care fraud schemes that allegedly cost the Medicare program around $20 million. The schemes allegedly involved fraudulent billing for […]
Miami “Rock Doc” Arrested on Medicare Fraud Charges
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An osteopathic physician in Miami, Florida, dubbed the “Rock Doc,” was arrested on September 30, 2013. He is charged with twelve (12) counts of health care fraud, according to the Department of Justice (DOJ). The “Rock Doc” is […]
Cardiologists Face Higher Scrutiny by CMS
By Lance O. Leider, J.D., The Health Law Firm As the U.S. population ages and heart disease continues to be a leading cause of health issues, cardiologists and cardiology practices are finding themselves billing Medicare for more and more visits and procedures. Along with that increase in reimbursement from Medicare comes an increase in scrutiny. […]
Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Health Integrity, LCC, was named the Zone 4 Program Integrity Contractor (ZPIC) for the Medicare and Medicaid programs. As the ZPIC for Zone 4, Health Integrity has been performing benefit integrity activities aimed to reduce fraud, waste and […]
You Must Challenge Overpayment Demands from Medicare and Medicaid Audits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We have recently received numerous communications from health care professionals, including physicians, physical therapists, occupational therapists, mental health counselors, durable medical equipment (DME) providers, assisted living facilities (ALFs), group homes, and psychologists, who have been placed on prepayment […]
Major Medicare Offender Sentenced to Prison for Multi-Million Dollar Health Care Fraud Scheme
By Lance O. Leider, J.D., The Health Law Firm The former owner of four mental health facilities in South Florida and North Carolina was sentenced to fourteen (14) years in federal prison on February 25, 2013. The former business owner pleaded guilty to defrauding Medicare out of tens of millions of dollars from 2004 through […]
Occupational Therapists, Podiatrists, Psychologists and Optometrists Being Scrutinized in Medicare Audits
George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Our firm has recently seen an increase in the number of occupational therapists (OTs), speech therapists (STs), podiatrists, psychologists, optometrists and other licensed health professionals being scrutinized in Medicare audits and recovery actions. Often these result from claims submitted […]
Government Discovers Extensive Overbilling of Cancer Drug to Medicare
By Lance O. Leider, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It’s no surprise that the government is aggressively pursuing Medicare fraud. Recently, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), made a surprising discovery. […]
New Hampshire City Auditing Ambulance Service for Allegedly Overbilling
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response (AMR), after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article. AMR […]
Medicare Put the Hospice Industry Under the Microscope
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It’s no surprise to anyone that Medicare is cracking down on hospices around the country. According to a report by the Office of Inspector General (OIG), eighty-two percent (82%) of hospices’ claims did not meet Medicare coverage requirements. […]
Tennessee-Based Nursing Care Company Being Investigated for Medicare Fraud
By Danielle M. Murray, J.D. The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer’s centers across the country. The […]
American Hospital Association (AHA) Sues U.S. Government for Denied Medicare Payments by RACs, ZPICs and Other Auditors
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the U.S. Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions […]
Revised Readmission Penalties are Coming Due to Calculation Errors
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. To see that blog, click here. In October of 2012, the […]
Phony Medical Equipment Supplier will Spend 30 months in Prison for Medicare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The claims were almost all for expensive, high-end power wheelchairs. The man was sentenced on October […]
Ambulance Company in Tennessee Settles A $2 Million Overpayment Lawsuit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney A Tennessee ambulance company and the U.S. Department of Health and Human Services (DHHS) announced a settlement in a case over a post payment audit for […]
E&M Services Now Under Review by the Recovery Audit Contractors (RACs)
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In September 2012, the Centers for Medicare and Medicaid Services (CMS) made the decision to allow Recovery Audit Contractors (RACs) to begin reviewing the billing codes for office visits for healthcare providers. Those at issue are the codes […]
Hospice of the Comforter Inc., Faces Whistleblower Lawsuit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 6, 2012, the Department of Justice (DOJ) announced it will join in a whistleblower lawsuit alleging false Medicare billings against Hospice of the Comforter Inc., (HOTCI). The hospice is located in Altamonte Springs, a suburb of […]
Office of Inspector General (OIG) Scrutinizes Billing at South Florida Mental Health Clinics
By Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 16, 2012, the Office of Inspector General (OIG) released a report on questionable billing by mental health centers. The report focuses on the nation’s mental health clinics that overbilled Medicare in […]
U.S Department of Justice (DOJ) Investigating the Cardiology Services at Florida Hospitals
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On Monday, August 6, 2012, a New York Times article revealed that cardiology services at some Florida HCA hospitals are under investigation by the U.S. Department of Justice (DOJ) for allegedly performing unnecessary procedures to increase profits. Click […]
South Florida Man Admits to a $42 Million Medicare Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice (DOJ), the FBI and the Department of […]
August 27, 2012, Marks the Start Date of the CMS Recovery Audit Prepayment Review (RAPR)
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012. The CMS originally announced the Recovery Audit Prepayment Review (RAPR) […]