Will a Death from COVID-19 be Considered “Accidental Death” for Life Insurance Policies or a Death from “Accidental Causes?”
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Almost all life insurance policies, including term policies, pay a “double indemnity,” that is, double the limits of coverage if a death occurs from “accidental causes” as opposed to “natural causes.” A question arises, given the COVID-19 pandemic, of whether a death caused by […]
Tips for Responding to a Medicaid Audit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. The most important thing is that […]
Apopka Woman to Serve 18-Month Prison Sentence After $47K Medicaid Scam
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An Apopka businesswoman was recently sentenced to 18 months in prison after she was found guilty of a Medicaid scam. According to the Florida Attorney General’s Office, Shanqual Marshall-Gunn was arrested in September on suspicion of submitting more […]
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 […]
Duke University Health System Pays $1 Million to Settle Allegations of False Claims in Whistleblower Lawsuit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On March 21, 2014, Duke University Health System in Raleigh, North Carolina, settled a whistleblower/qui tam lawsuit, according to the Department of Justice (DOJ). The lawsuit, filed in 2012, stated that the three-hospital academic medical center is alleged […]
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 […]
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 […]
Central Florida Pain Management Clinic Falls Victim to Civil Forfeiture
By Christopher E. Brown, J.D., The Health Law Firm On June 14, 2013, Drug Enforcement Administration (DEA) agents, along with local police and sheriffs’ deputies raided a Longwood, Florida, pain management clinic. In addition to criminal charges, the physicians and employees associated with this clinic face another lesser known threat, the civil forfeiture of their […]
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 […]
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 […]
Specialty Pharmacy Agrees to Pay A $11.4 Million Settlement in Whistleblower Case
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 The Department of Justice (DOJ) announced on December 27, 2012, that a specialty pharmacy, based in San Diego, California, has agreed to pay a $11.4 million settlement. That payment is to resolve allegations […]
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 […]
Medicare Fraud Initiative Leads to Arrests of Over 100 Health Professionals
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A recent Medicare fraud operation conducted between several federal agencies has resulted in the arrest of over 100 doctors, nurses and other medical professionals. They have been charged with various crimes relating to Medicare fraud. The arrests were made on May […]
CMS Recovery Audit Prepayment Reviews to Begin Summer 2012
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Centers for Medicare & Medicaid Services (CMS) is planning to start the Recovery Audit Prepayment Review (RAPR) Demonstration Project on June 1, 2012. It was originally scheduled to begin January 1, 2012. Recovery Audit Contractors (RACs) to Review […]
Walgreens Reaches Settlement in False Claims Act Case
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Walgreens has reached a $7.9 million settlement with the United States and participating states that resolves allegations that Walgreens violated the False Claims Act. The DOJ announced the settlement on April 20, 2012. To view the DOJ’s press […]
WellCare Health Plans Reaches Settlement in False Claims Act Case
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law WellCare Health Plans Inc.(WellCare) has reached a $137.5 million settlement with the federal government and nine states. The settlement resolves four lawsuits alleging violations of the False Claims Act. WellCare is based in Tampa, Florida. The company provides managed […]
Man Charged with Medicare Fraud in Ambulance Scheme
By Miles Indest A Pennsylvania man has been charged in a 23-count indictment in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. The charges were announced by the Department of Justice (DOJ) on June 29, 2012. Man Allegedly “Straw” Owner Used to Start Ambulance Company. According to the indictment the […]
Be Prepared for a Medicaid Audit Request
By Lance O. Leider, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country. The reason is that Florida has become synonymous with healthcare fraud. As a result, auditing and subsequent overpayment demands are some […]
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 […]
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) […]
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 […]
Excess Readmissions Mean Lower Medicare Reimbursement Rates for More than 2,000 Hospitals, Including 131 in Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida. This is allegedly due to excessive readmission rates in these hospitals between July 2008 and June 2011, according […]
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 […]
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 […]
What Should I Do If I Have Property That Is the Subject of a Seizure under the Civil Forfeiture Act?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The civil forfeiture of property has become a popular tool for state and federal agencies to fight alleged criminal activity. It is a civil proceeding that permits the government to seize personal property if it is believed that […]
The Government’s Use of Civil Forfeiture to Combat Health Care Fraud and Pill Mills in Florida
By Christopher E. Brown, 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 Recently we have seen government prosecutors and agencies, including the Medicaid Fraud Control Unit (MFCU), the U.S. Attorney General’s (AG) Office, and local sheriff and police departments use the […]
Specialty Pharmacy Settles Lawsuit Over Illegal Kickbacks
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 The Department of Justice (DOJ) announced on December 27, 2012, that a specialty pharmacy, based in San Diego, California, has agreed to pay a $11.4 million settlement. That payment is to resolve allegations […]
A New Trend in the Government’s Fight Against Health Care Fraud and Pill Mills: Civil Forfeiture
By Christopher E. Brown, 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 Recently, we have noticed government prosecutors and agencies, including the Medicaid Fraud Control Unit (MFCU), the U.S. Attorney General’s (AG) Office, and local sheriff and police departments use the […]
Connecticut Dentist Gets Drilled in Huge Medicaid Fraud Case
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A dentist and owner of a number of clinics in Connecticut is feeling the pain of justice. According to a number of news sources, Gary Anusavice will spend the next eight (8) years in prison for targeting poor […]
New Hampshire Dentist Indicted on 189 Counts of Medicaid Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 20, 2013, a New Hampshire dentist was indicted on 189 counts of Medicaid fraud, according to a number of news sources. The dentist is alleged to have made false claims to the New Hampshire Medicaid office […]
Florida HB 0653 Signed Into Law; Effective 2/1/2012
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Florida Legislature unanimously passed HB 653 which relaxes some of the draconian exclusions enacted under SB 1986, which went into effect on July 1, 2009. SB 1986, which added provisions to Chapter 456, Florida Statutes, among others, prevented […]
Settlement Reached in WellCare False Claims Case
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law WellCare Health Plans Inc.(WellCare) has reached a settlement in its False Claims Act case. WellCare will pay $137.5 million to the federal government and nine states to settle four lawsuits. The lawsuits alleged violations of the False Claims Act. […]
New Database Allows Consumers to Evaluate Nursing Homes Across the Country
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Consumers have a new online tool to see which nursing homes are being hit with fines for poor quality, safety or maintenance. Nursing Home Inspect 2.0 is a free database that assists users in evaluating nursing homes across […]
Florida Pharmacy Owner Admits 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 […]