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 […]
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 […]
Physician Argues Definition of “Peer” at Formal Administrative Hearing
FACTS: The Agency for Health Care Administration (“AHCA”) is responsible for administering Florida’s Medicaid program and conducting investigations and audits of paid claims to ascertain if Medicaid providers have been overpaid. With regard to investigations of physicians, section 409.9131, Florida Statutes, provides that AHCA must have a “peer” evaluate Medicaid claims before the initiation of formal […]
Adventist Health System Settles Whistleblower Lawsuit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 18, 2013, Adventist Health System/Sunbelt Inc., the parent company of Orlando-based Florida Hospital, settled a whistleblower lawsuit, according to court documents. The whistleblower lawsuit, filed in 2010, stated that seven Adventist hospitals in Florida overbilled the […]
Florida Nursing Home Owner Arrested for Alleged $395,000 Medicaid Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Miami-Dade nursing home owner was arrested for allegedly committing $395,000 worth of Medicaid fraud. The Florida Attorney General (AG) accused the nursing home owner of using the billing names of non-existent businesses to submit fraudulent invoices. The […]
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 […]
Medicaid Fraud Control Unit Arrests Three Florida Women for Allegedly Bilking Medicaid Out of $27,000
By Lance Leider, J.D., The Health Law Firm Three Central Florida women were arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) on July 18, 2013, for allegedly defrauding Medicaid out of $27,000. According to the AG, the owner and two managers of Destiny TCM Corporation are accused of billing Medicaid for services […]
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 […]
Speech Therapist Arrested for Billing Medicaid $500,000 for Work at Florida Day Care Centers While Living in Illinois
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A speech therapist was arrested on March 29, 2013, for allegedly billing Medicaid more than $500,000 for services that she did not provide, according to the Florida Office of the Attorney General (AG). The speech therapist now faces […]
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 […]
Florida Woman Arrested for $400,000 Medicaid Fraud Scheme
By Lance O. Leider, J.D., The Health Law Firm The owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has allegedly been arrested for defrauding Medicaid out of more than $400,000, according to the Florida Office of the Attorney General (AG). The owner is charged with billing Florida’s Aged and Disabled Adult Waiver Program for services […]
Hospitals Allegedly Enforcing Questionable Practices to Increase Bottom Line
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Doctors and hospitals around the country seem to be butting heads. In the past month, an article in The New York Times and a segment on the television “magazine” show 60 Minutes shed light on some questionable practices […]
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 […]
Palm Beach Speech Pathologist Arrested for Alleged Medicaid Fraud
By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm A Palm Beach, Florida, speech pathologist has allegedly been charged with Medicaid fraud and grand theft by the Attorney General’s (AG) Office of Statewide Prosecution. According to the press release posted on June 29, 2012, from the AG’s office, the speech pathologists is accused […]
How to Respond to a Medicaid Fraud Control Unit (MFCU) Investigative Subpoena
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Christopher E. Brown, J.D. The Medicaid Fraud Control Unit (MFCU) is a division of the Florida Office of Attorney General. It is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid […]
$24 Million Medicaid Fraud Scheme Alleged by Connecticut Attorney General
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Connecticut’s Attorney General, George Jepsen, alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. He filed a civil action on May 31, 2012. It is the first case the state has […]
Florida Medicaid Audits Dental Claims
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations […]
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 […]
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 […]
Woman Admits to Defrauding Medicaid For Fake Mental and Behavior Health Services
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly […]
Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the […]
Mother and Daughter-In-Law Arrested for Allegedly Defrauding Medicaid Out of More Than $70,000
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A mother and daughter-in-law duo each face up to 30 years in prison for allegedly defrauding the Florida Medicaid program out of more than $70,000. According to a press release from the Florida Attorney General (AG), released February […]
Key West Pharmacy Blows Whistle on Medicaid Fraud and Comes Out on Top
By Danielle M. Murray, J.D. On September 27, 2012, Public Citizen, a watchdog group, reported whistleblowers have initiated $6.6 billion in penalties against drug manufacturers in 2012. Most of these penalties are for fraudulently overcharging government programs. The report names a small Key West, Florida, pharmacy as one of the top whistleblowers in the country. […]
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 […]
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 […]
The Lone Star State’s New Task Force to Take a Bite Out of Medicaid Dental Fraud
George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law There’s a new task force riding into Texas. According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase […]
Florida’s Medicaid Program Receives Settlement Payment from Pharmaceutical Company
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Florida Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU), 46 other states and the federal government reached a $48 million agreement with pharmaceutical company Healthpoint Ltd., on February 25, 2013. According to the Florida AG, the settlement […]
Health Care Fraud Puts Miami Man in Jail
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law 4.5 Year Sentence for Role in Fraud. A Miami Man voluntarily returned to Miami from Cuba and was immediately met with a 4.5-year long prison sentence. Jose Gerardo Gonzalez, played a role in a scheme to defraud public […]
Feds File Two Lawsuits Against Novartis for Allegedly Giving Kickback to Pharmacists and Physicians
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 […]
Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The two owners of a Minneola, Florida, ministry that helps provide counseling therapy and case management for children and families, each face up to 15 years in prison for allegedly defrauding Medicaid. According to the Florida Attorney General […]
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 […]