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 […]
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. […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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. […]
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 […]
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. […]
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 […]
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 […]
Copying and Pasting Clinical Notes in Electronic Health Records Could Be Considered Healthcare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is concerned about healthcare providers carelessly copying and pasting clinical notes in electronic health records (EHRs). According to an audit report released on December 10, […]
ZPICs Seek “Voluntary” Agreements from Physicians for Auto-Denial Edits for Home Health Services
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to the Centers for Medicare and Medicaid Services (CMS), the primary purpose of Zone Program Integrity Contractors (ZPICs) is to investigate instances […]
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 […]
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 […]
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 […]
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 […]
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 […]
“Doctor of Death” Trial Could Ignite Stricter Oversight in the Healthcare Industry
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On paper, one Detroit-area oncologist appeared to be a wildly successful professional with impeccable medical credentials. According to his medical practice’s website, he went to medical school at Cornell Medical College, did an internal medicine residency at Maimonides […]
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 […]
Ohio Hospital Settles Whistleblower Case to Resolve False Claims Act Allegations
By Lance O. Leider, J.D., Attorney, The Health Law Firm A group of doctors accused of performing an unusually high number of heart procedures on patients at an Ohio hospital has settled a whistleblower lawsuit, according to the Department of Justice (DOJ). The settlement agreement covers accusations that the doctors and the hospital billed Medicare […]
Responding to a Medicare Audit – Practice Tips
Although you may speak of a “routine” Medicare audit, there is really no such creature. This is like saying you have a “routine IRS audit.” The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused […]
ZPIC or Medicare Audit and Site Visit Checklist
As a physician, medical group or other healthcare provider, if you receive a notice of an audit and site visit from Medicare, the Medicare Administrative Carrier (MAC) or the Zone Program Integrity Contractor (ZPIC), things happen fast with little opportunity to prepare. Hopefully this checklist will help you to prepare for the on-site visit that […]
Jurisdiction 12 Gets New Medicare Administrative Carrier
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with […]
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 […]
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) […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
Doctor Dubbed “King Of Nursing Homes” Downplayed Patient Harm From Illegal Kickback Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 8, 2016, federal prosecutors blasted Dr. Venkateswara Kuchipudi, a Chicago physician nicknamed the “King of Nursing Homes,” convicted of sending nursing home patients to a hospital he believed was subpar allegedly in exchange for free staff. […]
New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due […]
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 […]