Two Separate Lawsuits Against Novartis Pharmaceuticals Corporation Allege Illegal Kickbacks and False Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Novartis Pharmaceuticals Corporation (NPC) is currently fielding two different lawsuits, filed just days apart from each other, by the U.S. Department of Justice (DOJ). The first lawsuit was filed on April 23, 2013, alleging the company gave illegal […]
More Medicare Audits Now Than Ever Before
George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in the Legal Specialty of Health Law A Medicare audit, whether it is performed by a contractor of the Centers for Medicare & Medicaid Services (CMS), or by another organization, can be a daunting process. It is never “routine” and should never […]
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 […]
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 […]
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 […]
Hawaii Hospital to Pay More Than $451,000 to Resolve Whistleblower/Qui Tam Allegation of Improper Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Wahiawa General Hospital in Honolulu, Hawaii, agreed to pay $451,428 to settle two lawsuits alleging that the hospital improperly billed Medicare, Medicaid and Tricare. The settlement stemmed from a civil whistleblower/qui tam lawsuit. The lawsuit was filed by […]
New York-Based MRI Company to Pay $3.57 Million Settlement to Resolve False Claims Act Allegations in Whistleblower/Qui Tam Case
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 27, 2013, the Department of Justice (DOJ) announced a settlement between the government and New York-based Imagimed LLC, its former owners and its former chief radiologist. This $3.57 million settlement resolves whistleblower/qui tam allegations of false […]
Oncologist Accused of Billing Medicare for Unnecessary Chemotherapy-Employee Whistleblowers Filed First Claim
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Michigan oncologist is accused of deliberately misdiagnosing patients with cancer so he could allegedly administer chemotherapy treatments and bill the government for those treatments, according to the Department of Justice (DOJ). For more than two years the […]
CMS Fights Medicare Fraud With Ban on New Home Health Agencies and Ambulance Suppliers in Three Cities
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 The Centers for Medicare and Medicaid Services (CMS) announced it will temporarily ban new home health providers and ambulance suppliers from enrolling in Medicare, Medicaid and the Children’s Health […]
Fifty-Five Hospitals Around the Country to Pay the Government $34 Million Settlement for False Claims Allegations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Fifty-five (55) hospitals in twenty-one (21) states have agreed to pay the Department of Justice (DOJ) more than $34 million to settle allegations of Medicare fraud in a whistleblower case, according to the DOJ on July 2, 2013. […]
Health Care Professionals and Providers Beware: The Health Care Fraud Prevention and Enforcement Action Team (HEAT) Is Catching Fire
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In May 2009, the Department of Health and Humans Services (HHS) and the Department of Justice (DOJ) created the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT’s mission is to focus its efforts on preventing and […]
Department of Justice Seeks up to $600 Million in Whistleblower Case Against Halifax Health in Daytona Beach, Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Department of Justice (DOJ) is asking for between $350 million and $600 million in damages and penalties from Halifax Health Medical Center in Daytona Beach, according to The Daytona Beach News-Journal. A Halifax employee filed the […]
The Affordable Care Act Offers the Government New Tools to Fight Healthcare Fraud
By Catherine T. Hollis, J.D., The Health Law Firm In 2013, the government reported recovery of a record-breaking $10.7 billion in healthcare fraud in the past three years, according to the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ). The HHS credits the Affordable Care Act’s tough stance […]
Strike Force Busts 89 People, Mostly Health Care Professionals, in Nationwide Crackdown on Medicare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In a nationwide takedown nearly 100 people, including doctors, nurses and other medical professionals, in eight cities were all allegedly charged in separate Medicare fraud schemes. These individual scams involved approximately $223 million in false billing, according to […]
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. […]
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 […]
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 […]
South Florida Pharmacy Owner Pleads Guilty to $23 Million Health Care Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to […]
Signing False Medicare Claims Lands Nurse Behind Bars for 30 Months
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Detroit-area registered nurse was sentenced on November 19, 2012, to 30 months in federal prison for his alleged part in a nearly $13.8 million Medicare fraud scheme. According to a Department of Justice (DOJ) press release, he […]
Former Daytona Beach Chiropractor Will Spend More Than 15 Years Behind Bars
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A former Daytona Beach chiropractor will spend more than 15 years in federal prison for an alleged health care fraud scheme and illegally prescribing pills, according to the Federal Bureau of Investigation (FBI), Jacksonville Division. He was also […]
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 […]
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 […]
Whistleblower Lawsuit Alleging Medicare Fraud Against Blackstone Medical, Inc., Dismissed
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A whistleblower lawsuit against Blackstone Medical, Inc., alleging Medicare fraud against Parrish Medical Center, was dismissed by a U.S. District Judge in Tampa, Florida, on August 15, 2012. According to Orthopedics This Week, the case was unsealed on […]
Medicare Fraud Lands More Than 30 Suspects Behind Bars in South Florida
By Dr. Thu Pham, O.D., Law Clerk On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. Payment of bribes and kickbacks, as well as payments to patient recruiters were an issue in this investigation. To read the entire article from the Miami Herald, […]
Whistleblower Case Against Tennessee-Based Nursing Care Company
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law 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 […]
Detroit Nurse Will Spend Time Behind Bars for Signing False Medicare Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Detroit-area registered nurse was sentenced on November 19, 2012, to 30 months in federal prison for his alleged part in a nearly $13.8 million Medicare fraud scheme. According to a Department of Justice (DOJ) press release, he […]
Have You Received a Notice of Termination of Your Medicare Provider Number?
By Danielle M. Murray, J.D. Have you received a notice of termination of your Medicare provider number? Medicare has been revoking the Medicare provider numbers of many different Medicare providers including psychologists and other mental health providers, based on returned mail sent to old addresses which have not been updated or based on inspection team […]
Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals – Part 2
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals. I have recently seen a number of audits initiated against psychologists and mental health […]
Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals – Part 1
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals. I have recently seen a number of audits initiated against psychologists and mental health […]
Director of Center for Developmentally Challenged Adults Accused of Medicaid Fraud
By George F. Indest III J.D., LL.M., Board Certified by The Florida Bar in Health Law The director of a center for developmentally challenged adults in Okaloosa County, Florida, was arrested on August 16, 2012, for allegedly fraudulently billing Medicaid for more than $270,000 for services under the Medicaid Developmentally Disabled Waiver Program, according to […]
The American Nurses Association Breathes New Life Into The Nursing Code of Ethics For 2015
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On a daily basis, the average nurse uses knowledge, training and ethical standards to make vital decisions regarding patient health. Nurses are required to quickly process simple and complex emergency situations, which leaves little room for second guessing. […]