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Three Charged For Roles in $109 Million Medicare Fraud Scheme, HIPAA Violations

Attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In October 2020, Massachusetts federal prosecutors charged three people for their alleged roles in a multi-million dollar plot to defraud Medicare. Two individuals allegedly collected patient data and sold it to the purported mastermind, who used it to submit $109 million in false claims.

The two individuals who allegedly obtained the patient information were both located in Florida, wouldn’t ya know. They were each charged with one count of receiving more than $1.6 million kickbacks in connection with a federal health care program. Prosecutors charged the third individual with criminal violations of the Health Insurance Portability and Accountability Act (HIPAA).

Fraudulently Collecting & Using Patient Information.

According to court documents, both individuals in Florida owned marketing companies that enlisted foreign call centers to contact Medicare beneficiaries. Using a prepared script, they allegedly asked the patients they called if they would be interested in receiving durable medical equipment (DME) such as knee braces or compression sleeves “at little to no cost.”

The call centers would then collect information, including the patient’s name, address, insurance number, Medicare number, and doctor’s name and address, prosecutors said. The information was then sold to the third individual, who filed fraudulent Medicare claims for DME that were never prescribed and not medically necessary.

According to court records, the alleged co-conspirators used the same patients’ information repeatedly through a different shell company each time. More than 1,000 of the claims were made under the names of deceased beneficiaries. Click here to view the criminal information in this case.

Read the DOJ’s press release on this case for additional information.

Also, you can read one of my prior blogs on a similar case in Florida.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.

The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and other health care providers in Medicare audits, ZPIC audits, MAC audits, and RAC audits throughout Florida and across the U.S. They also health care providers in qui tam or False Claims Act (whistleblower) litigation and in other complex medical litigation. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid programs, They represent health care providers in formal and informal administrative hearings, federal or state.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

Sinay, Reenat. “Feds Charge 3 In Alleged $109M Medicare Fraud Scheme.” Law360. (October 2, 2020). Web.

Szaniszlo, Marie. “Three charged in multi-million dollar fraud scheme.” Sentinel Enterprise. (October 2, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law

 

 

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Cheating, Irregular Behavior and Other Challenges Facing Medical Students and Graduates

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The road to becoming a physician is paved with many unique challenges. The long, exhausting journey begins and students are faced with the first battle: rigorous undergraduate course work, followed by the MCAT and medical school applications. During medical school, and for some, after graduation, the USMLE (United States Medical Licensing Examination) and its STEP 1, STEP 2, and STEP 3 exams provide another hurdle in the uphill battle. At any of these stages, medical students can face a gauntlet of accusations including cheating, misrepresentation, falsification of information, unfair advantages, and the many faces under the general label of “irregular behavior.”

Challenges Prior to Entering Medical School.

Prior to medical school, pre-med students must be ambitious, inquisitive, and extra cautious about any disciplinary action. A minor blemish on a pre-med student’s academic record (from academic dishonesty or other accusations), will become a major red flag once that student begins applying. Not only will any kind of discipline record hinder a student’s chances of acceptance, but an infraction can also ruin that student’s reputation as they apply for residency and beyond.

Because the process of becoming a physician is difficult without having a discipline record, any charge against a pre-med student must be taken with the utmost seriousness. Don’t raise a white flag early on in the uphill battle!

Challenges After Medical School.

The battle continues for medical students; medical school courses and clinical rotations will be rigorous and challenging, calling on every neuron you possess to fire efficiently. You will be tested, in more ways than one. You will forget the term “MCAT” and substitute for it a new acronym–“USMLE” which stands for United States Medical Licensing Examination.

The USMLE is a four-stage examination required for medical licensure in the United States. Because the USMLE is the barrier between you and your medical license, it is an extremely important component of your medical education.

One such issue is being accused of “irregular behavior.” This broad label includes anything from cheating to disruptions during testing or soliciting information on actual examination content. In the event that your test score is held up or invalidated due to irregular behavior you will want to correct the situation immediately, or you may be prohibited from taking future exams (meaning you won’t be able to obtain your license or a residency in the U.S.). If you are accused of irregular behavior or if you feel that you were faced with inadequate testing conditions, resolving the issue may be as simple as requesting a rescoring of the examination or a retest. Sometimes, because of problems at a test site or because of technical problems, retesting is an option.

The National Board of Medical Examiners and the USMLE take all such matters concerning the administration and the security of the test contents extremely seriously. In certain cases, they have sued those they believe may have compromised actual test contents. Click here to read more about the case.

After years of schooling, don’t allow an allegation of irregular behavior to mark your test transcripts and prevent you from attaining your goals and reaping the benefits of your hard work.

To learn more about USMLE, irregular behavior, and how we can help you, click here to read one of my prior blogs.  Check our Medical Education Law Blog Regularly to stay on top of news and tips!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Doctor, You Might Need A Home Medical Equipment Provider License, If . . .

By Michael L. Smith, J.D., R.R.T. Board Certified by The Florida Bar in Health Law

Physicians frequently utilize electrostimulation or transcutaneous electrical nerve stimulation (TENS) units, and other medical equipment in the course of their practice. Most often the physician or the practice bills the patient or the patient’s insurance for the medical equipment. Unfortunately, some physicians do not know that a special Home Medical Equipment Provider (HMEP) license may be required in Florida in order to legally bill patients for TENS units, and other durable medical equipment that the physicians provide to their own patients. Violating the laws that require a license can place the physician and the practice in some serious legal trouble.

Requirements for Physicians.

Under Florida law, a special Home Medical Equipment Provider (HMEP) license is required before a physician may provide and bill a patient or the patient’s insurance company for TENS units and most other durable medical equipment. Physicians who provide and bill for medical equipment and supplies without the required license may be charged with a second-degree misdemeanor. The same physicians may also be subjected to an administrative fine of $5,000 for each violation. Additionally, insurance companies routinely refused to pay for TENS units and other durable medical equipment that physicians have provided to their own patients because the physician has not obtained a Home Medical Equipment Provider license.

New Legislation.

The Florida Legislature recently passed an amendment to the Home Medical Equipment Provider license requirement that would allow allopathic, osteopathic, and chiropractic physicians to sell or rent electrostimulation medical equipment and supplies to their patients in the course of their practice without first obtaining the Home Medical Equipment Provider license. However, the amendment does not change the license requirements for other durable medical equipment that physicians sell or rent to their own patients in the course of their practices. The amendment became effective on July 1, 2020.

Any Florida physician providing TENS units or other durable medical equipment to their own patients and billing the patients or the patient’s insurer for those services should consult with an experienced health law attorney to ensure the services are provided legally.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.ThehealthLawFirm.com

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

Florida Defends Medical Pot Law in High-Stakes State Supreme Court Battle

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On May 6, 2020, in a highly-important case for the medical marijuana industry in Florida, the state defended its regulatory framework before the Florida supreme court. The case focuses on whether Florida has properly carried out a 2016 constitutional amendment that broadly legalized medical marijuana for patients. The Florida Department of Health (DOH) argues that there is no conflict between the voter-approved medical marijuana amendment and the state’s caps on providers.

Ongoing Battle in the Courts.

The case primarily centers on a requirement that the Legislature put in the 2017 law about marijuana firms allowed to operate in the state. That requirement says the companies must be able to handle all aspects of the business, including growing, processing, and distributing products. The Florida DOH appealed to the Supreme Court after lower courts sided with Florigrown, a Tampa-based company. For several years, Florigrown has unsuccessfully sought approval to become a licensed medical-marijuana operator in Florida. Click here to read my prior blog and learn more.

Arguing Over Semantics.

The key part of the case focuses on the text of the amendment in determining whether the vertical integration model is proper. The language in question is the difference in the words “or” and “and” in the amendment’s definition of a medical marijuana treatment center (MMTC).

The constitutional amendment defined MMTCs as “an entity that acquires, cultivates, possesses, processes … transfers, transports, sells, distributes, dispenses, or administers marijuana, products containing marijuana, related supplies, or educational materials.”

Meanwhile, the implementing 2017 law defines MMTCs as an entity that “cultivates, processes, transports and dispenses marijuana for medical use.”

Florigrown argues that the switch from “or” to “and” creates wording that establishes the vertically integrated system, as it establishes a need to perform all aspects of the business.

In its defense, the Florida DOH argued that the 2017 law does not directly conflict with a “proper, textual interpretation” of the constitutional amendment and directly calls for regulations on the availability and safe use of the substance.

To read more on this ongoing case and Florigrown’s lawsuit, click here to read my prior blog.

Contact Experienced Health Law Attorneys for Medical and Recreational Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists, and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting and/or licensing, while complying with Florida law. We can also represent doctors, pharmacies and pharmacists facing proceedings brought by state regulators or agencies.

To contact The Health Law Firm please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Saunders, Jim. “Case challenging Florida law on medical marijuana licenses may hinge on ‘and’ vs. ‘or’.” Miami Herald. (May 6, 2020).

Bolado, Carolina. “Fla. Defends Medical Pot Regulations Before State High Court.” Law360. (May 6, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: medical marijuana regulation attorney,  legal representation for medical marijuana issues, health care business application attorney, Florida marijuana law attorney, representation for marijuana growers, representation for marijuana distributors, defense attorney for marijuana growers, defense attorney for marijuana distributors, defense lawyer for medical marijuana, health law defense attorney, Florida medical cannabis legal representation, medical cannabis lawyer, cannabis defense lawyer, health lawyers for medical marijuana distributors, legal counsel for medical marijuana growers and distributors, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys, legal counsel for complex medical business dispute, complex healthcare law dispute attorney, complex healthcare business transaction attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

House Committee Advances Medical Marijuana Bill to Expand Research

Attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On September 9, 2020, a U.S. House of Representatives committee advanced a bill to expand access to marijuana for research purposes. The House Committee on Energy and Commerce voted unanimously by voice vote in favor of HR 3797, the Medical Marijuana Research Act of 2019. The bill would: “amend the Controlled Substances Act to make marijuana accessible for use by qualified marijuana researchers for medical purposes, and for other purposes.”

HR 3797 – Medical Marijuana Research Act.

The amendment to existing federal law would allow researchers to use “marijuana products available through State-authorized marijuana programs” until there are federally-approved suppliers who can meet the demand of the federal researchers. More specifically, there will be no limit on the number of entities that could be federally approved to cultivate and distribute cannabis for research purposes. Additionally, the Secretary of Health and Human Services would be required to submit a report to Congress that includes a review of cannabis research and a note on whether cannabis should be rescheduled on the drug schedules that are used to decide what drugs are controlled substances.

The amendment also takes care of a problem in the law it amends to prevent government law enforcement officials from interfering with the sale or distribution of research marijuana.


Advancement in Cannabis Cultivation.

Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws, (NORML) said in a statement that the amendments to the law advanced by the bill were “necessary and long overdue.”

“Rather than compelling scientists to access marijuana products of questionable quality manufactured by a limited number of federally licensed producers, federal regulators should allow investigators to access the cannabis and cannabis-infused products that are currently being produced in the legal marketplace by the multitude of state-sanctioned growers and retailers,” Armentano said.

George F. Indest III, President and Managing Partner of The Health Law Firm also stated: “This is a law that is necessary and long overdue.” He urged everyone to contact their U.S. Representative and Senators and ask them to vote in favor of it.

The next step for the bill is a vote on the House floor; however, it is unclear whether this will happen and when it will happen, given everything that is occurring at present.

To read HR3797 in full, click here.

EVERYONE SHOULD WRITE THEIR U.S. CONGRESSIONAL REPRESENTATIVE AND THEIR TWO SENATORS AND REQUEST THAT THEY SUPPORT THIS BILL.

Click here to go to our Marijuana Law Blog page and read my prior blog on this subject to learn more.

Contact Experienced Health Law Attorneys for Medical and Recreational Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists, and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting, and/or licensing while complying with Florida law. We can also represent doctors, pharmacies, and pharmacists facing proceedings brought by state regulators or agencies.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Reisman, Sam. “House Committee Advances Medical Marijuana Research Bill.” Law360. (September 9, 2020).

Rashidian, Nushin. “Key House Committee Advances Cannabis Research Bill.” Cannabis Newswire. (September 9, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

 

Multiple Settlements with HHS for HIPAA Security Rule Violations & Data Breaches

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In September 2020, the Department of Health and Human Services (HHS) announced three settlements to resolve alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. The settlements, totaling $10.6 million, stem from data breaches in which hackers were able to access and obtain individuals’ protected health information (PHI) from U.S. health providers. Combined, the three hacking incidents compromised the health information of more than 16 million patients.

Summary of the HIPAA Security Rule Settlements.

On September 21, 2020, the Office of Civil Rights, or OCR, the division of HHS which receives and investigates HIPAA complaints, announced a settlement with an orthopedic clinic in Georgia. The clinic agreed to pay $1.5 million after a 2016 hacking incident that compromised over 200,000 patient records. Part of the settlement included a Corrective Action Plan, or CAP, which the clinic agreed to adopt, to help prevent future breaches of privacy. Click here to view the resolution agreement and Corrective Action Plan (CAP).

On September 24, 2020, the OCR publicized a settlement with an information technology (IT) and health information management company. The business agreed to pay $2.3 million to settle claims of systemic security rule violations relating to a 2014 hacking incident impacting the personal health information (PHI) of more than 6 million individuals. Click here to read the settlement agreement.

Days later, the OCR released information about a $6.85 million settlement with Premera Blue Cross, the largest health plan in the Pacific Northwest. The settlement, the second largest to date, related to a 2015 cyber-attack which exposed the health information of more than 10 million individuals. To read the resolution agreement in full, click here.

In regard to these settlements, the OCR alleged that the following security rule violations had occurred:

1. Failure to conduct an adequate and thorough risk analysis;

2. Failure to implement sufficient mechanisms to record and examine system activities;

3. Failure to enter into business associate agreements with vendors with access to electronic protected health information;

4. Failure to implement reasonable security measures to reduce risks and vulnerabilities;

5. Failure to respond to and document a known security incident;

6. Failure to implement technical policies and procedures regarding access; and

7. Failure to implement procedures to regularly review system activity logs and reports.

Readers could use the above as a compliance checklist to make sure their own systems of records are being properly protected.

Consequences of HIPAA Rule Noncompliance.

The HIPAA Security Rule establishes a set of national standards for confidentiality, integrity, and availability of e-PHI. HHS is responsible for administering and enforcing these standards, along with enforcement of the HIPAA Privacy Rule. Therefore, the agency may conduct complaint investigations and compliance reviews. To learn more details about the HIPAA Security Rule, click here.

HHS looks for systems failures, prior breaches, missing risk analyses, or absence of or inadequate HIPAA policies. Without question, any compliance violations will result in an enforcement action. And as these three settlements have demonstrated, enforcement can be costly.

Don’t Wait Until It’s Too Late, Protect Yourself from HIPAA Security Rule Compliance Violations.

Businesses and organizations need to acknowledge the need to act and create a HIPAA security rule compliance plan. Locating existing security policies and the last completed risk analysis is an essential step in compliance. If it’s been over a year, perform or update risk analysis to identify risks or vulnerabilities on all systems that contain any e-PHI. Security rule compliance requires regular attention and detailed records. Take steps now to help protect e-PHI from data breaches, and avoid millions of dollars in settlements or fines.


Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions to investigate and defend alleged HIPAA complaints and violations and prepare Corrective Action Plans (CAPs). Our attorneys regularly defend OCR HIPAA audits, defend in HIPAA complaint investigations, assist in preparing a HIPAA Risk Analyses, defend in federal administrative actions and administrative hearing cases, and defend in civil or administrative litigation of HIPAA/breach of medical confidentiality law suits.

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

Kraus, Anna and Carrier, Tara. “HHS Announces Multiple HIPAA Settlements Related to Data Breaches and the Right of Access Initiative.” Lexology. (October 6, 2020). Web.

Castricone, Dena. “The Crushing Cost Of HIPAA Security Rule Noncompliance.” Law360. (October 1, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law

Three Charged For Roles in $109 Million Medicare Fraud Scheme and HIPAA Violations

George F. Indest III with 30+ years of experience, is Board Certified in Health Law

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In October 2020, Massachusetts federal prosecutors charged three individuals for their alleged roles in a multi-million dollar plot to defraud Medicare. Two individuals allegedly collected patient health data and sold it to the purported mastermind, who then used it to submit $109 million in false Medicare claims.

Both individuals obtaining the personal health information were located in Florida, wouldn’t you know it. Each was charged with one count of receiving more than $1.6 million kickbacks in connection with a federal health care program. Prosecutors charged the third individual with criminal violations of the Health Insurance Portability and Accountability Act (HIPAA).

Stealing and selling personal health information is one of those HIPAA violations that will really, really get you in trouble. Very few people even know that such a HIPAA violation can be prosecuted as a federal felony crime.

Fraudulently Collecting & Using Patient Information.

According to court documents, both individuals in Florida owned marketing companies that enlisted foreign call centers to contact Medicare beneficiaries (which, I believe, I have received a number of). Using a prepared script, they allegedly asked if patients would be interested in receiving durable medical equipment (DME) such as knee braces or compression sleeves “at little to no cost.” (Does: “We are calling because of your back pain,” sound familiar?)

The call centers would then collect information including the Medicare patient’s name, address, insurance number, and doctor’s name and address, prosecutors said. The information was then sold to the third individual, who used it to file fraudulent Medicare claims for the DME that was never prescribed by a legitimate physician and was not medically necessary.

According to court records, the alleged co-conspirators used the same patients’ information repeatedly through a different shell company each time. More than 1,000 of the claims were made under the names of deceased beneficiaries. (Click here if you are deceased).

Click here to view the criminal information in this case.

Read the DOJ’s press release for more information.

Also, read one of my prior blogs on a similar case in Florida.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Health care Fraud Issues Now.

The attorneys of The Health Law Firm represent physicians, durable medical equipment (DME) suppliers, and other health care providers in Medicare audits, investigations and subpoenas, ZPIC audits, subpoenas and investigations, MAC audits, RAC audits, Department of Health (DOH) subpoenas and investigations, Department of Health and Human Services (DHHS) subpoenas and investigations, Medicaid Fraud Control Unit (MFCU) subpoenas, audits and investigations, OIG subpoenas, audits and investigations, and Department of Regulatory Agencies (DORA) subpoenas, audits, and investigations, in Florida, Colorado, Louisiana, the District of Columbia, Virginia, and throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid program, and state and federal administrative hearings and litigation.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

Sinay, Reenat. “Feds Charge 3 In Alleged $109M Medicare Fraud Scheme.” Law360. (October 2, 2020). Web.

Szaniszlo, Marie. “Three charged in multi-million dollar fraud scheme.” Sentinel Enterprise. (October 2, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law

 

 

 

Yale University Agrees to Pay $87,500 to Settle Allegations It Underpaid Female Doctors

Attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Yale University agreed to pay $87,500 to resolve discrimination allegations with the U.S. Department of Labor. The discrimination alleged that the Ivy League school paid four women cardiologists significantly less than their male colleagues from October 2016 to September 2017. While not admitting the allegations, the university agreed to the settlement which will reportedly cover the difference in pay for the women affected, the Office of Federal Contract Compliance Programs (OFCCP) said.

Alleged Pay Discrimination.

The OFCCP first detected the pay disparities during a routine compliance audit of the university’s medical school, the agreement said. The agency found that in 2016, Yale University paid four female cardiologists less than similarly situated male physicians at the School of Medicine’s Cardiovascular Medicine Section.

According to the settlement, Yale hired the doctors as part of the university’s “acquisition of community practices and hospitals associated with the Yale-New Haven Hospital System.” In 2018, Yale allegedly cut the women doctors’ employment category and moved them to a new faculty category. OFCCP claims that the medical school category is supposed to have a uniform compensation structure in place. Click here to read the settlement agreement in full.

In response to the allegations, a Yale was quoted as saying: “The conciliation agreement involves only four employees out of a workforce of over 16,000. OFCCP admitted that it found no pay disparities as to any but these four employees, who held roles in an employment category that has not existed for over two years.”

To read the press release issued by the Department of Labor, click here.

Additionally, read my recent blog on a previous discrimination lawsuit against Yale.

What does this show us? That at least in federal programs and in educational institutions and medical programs receiving federal funds, discrimination is prohibited and action will be taken to remedy it.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for physicians, including residents, and fellows, as well as medical students. We also represent other health professionals, clinical professors, dentists, psychologists, psychiatrists, mental health counselors, and other healthcare providers. We represent health facilities, medical groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, physicians, including those involved in clinical research, complaints, and investigations.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

Ottaway, Amanda. “Yale Settles OFCCP Claims That It Underpaid Female Doctors.” Law360. (October 5, 2020). Web.

Smith, Paige. “Yale University Settles DOL Claims of Pay Bias Against Women (1).” Bloomberg Law. (October 2, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm

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Two FL Pill Mill Owners Get Prison Time For Illegal Distribution Of Opioids

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 7, 2020, two owners of a medical practice in Tampa, Florida, were sentenced to federal prison time for their roles in the illegal distribution of opioids. U.S. District Judge Mary S. Scriven sentenced Ernest Gonzalez to 46 months and Rosa Colon to 24 months in federal prison for conspiracy to distribute and dispense controlled substances for no legitimate medical purpose.

Plot to Illegally Distribute Controlled Substances.

According to court documents, Gonzalez served as the president and owner of Health and Pain Center (HPC), a Tampa pain management clinic. In June 2011, he transferred his executive title and ownership of HPC to Colon. The Drug Enforcement Administration (DEA) obtained a warrant in October 2016, while both were active participants of the administration and management of HPC.

The two owners allegedly hired physicians at HPC, who routinely prescribed controlled substances to patients eeking pain mediciations. Federal authorities always allege that such prescriptions are “outside the scope of professional (medical) practice.” Additionally, the owners are alleged to have participated and facilitated the physicians’ illegal prescribing practices by instructing employees to overlook failed urinalysis screens that help to detect drug abusers.

According to court papers, the owners also obtained MRI studies and other documents that the physicians used to justify the high volume of opioid prescriptions. According to court documents, the owners operated HPC as a cash-only business with little to no medical equipment on-site and staff with no medical training.

The owners pled guilty on September 11, 2018. It is unclear as to why they were not sentenced until October 7, 2020. As part of their sentences, the court entered money judgments of $47,780.96 against Gonzalez and $765,356.76 against Colon. This was in addition to the prison time stated above.

The facts above are typical of those in other state and federal prosecutions against physicians, pharmacists, and clinic owners. If you are a physician who is working for a clinic owned by non-physicians, you need to be very careful that you are working for a legitimate organization. If you are being pressured to write prescriptions for narcotics for patients, you need to be very careful about what you do and why you do it. Often physicians who work for pill mills just bury their heads in the sand and rationalize why they are writing and refilling the same prescriptions for opioids month after month.

For the past ten years, in Florida, the DEA, the Department of Health, the state Attorney General, and multi-jurisdictional task forces have been targeting physicians who write prescriptions for narcotics and pharmacies that fill such prescriptions. There are very few left. The cross-hairs of the regulators and law enforcement are now targeting those who are involved in only very small quantities. Watch out, it could be you next!

View the press release issued by the U.S. Attorney’s Office for the Middle District of Florida.

Read my prior blog and learn more about pill mills, here.

Contact Health Law Attorneys Experienced with DEA Cases.

The attorneys of The Health Law Firm are experienced in handling Drug Enforcement Administration (DEA) cases, board of medicine cases, and board of pharmacy case, Department of Health (DOH) investigations, and Department of Regulatory Agencies (DORA) investigations, regarding allegations of over-prescribing and illegal prescribing. If you are currently being investigated or facing other adverse actions by the DEA or a state licensing board, contact one of our attorneys by calling (407) 331-6620 or toll-free at (888) 331-6620. You can also visit our website for more information at www.TheHealthLawFirm.com.


Sources:

“Tampa Pill Mill Owners Sentenced To Prison For Illegal Distribution Of Opioids.” Tampa Free Press. (October 11, 2020). Web.

Otero, Sebastian. “Tampa pill mill owners sentenced to prison for illegal distribution of opioids.” ABC 7 WWSB. (October 8, 2020). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm. All rights reserved.

 

New Law Passed in Florida Aimed at Healthcare Professional Background Screening

Attorney Michael L. SmithBy Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

For several years, many healthcare professionals have been required to pass a Level II background check in order to work in most Florida healthcare facilities licensed by the Agency for Health Care Administration (AHCA). Many healthcare professionals are also required to pass a Level II background check in order to be licensed by the Florida Department of Health (DOH). In March 2020, the Florida Legislature passed House Bill 713, which will add the offenses of battery on a vulnerable adult and battery on a patient or resident of certain healthcare facilities (primarily nursing facilities) as a disqualifying offense. The law took effect on July 1, 2020. Previously, only felony battery and battery on a minor were disqualifying offenses for purposes of the Level II background screening.

More Details on the New Legislation.

A health professional who previously passed the Level II background check may nevertheless be deemed “not eligible” for employment in a licensed health facility on the next Level II background check. This would occur if the practitioner has been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to battery of a vulnerable adult, or battery on a patient or resident of a healthcare facility. (This is the wording of the statute, not mine.)

A practitioner who is determined to be “not eligible” on a Level II background check due to a disqualifying offense must apply for an exemption from that disqualifying offense, in order to be permitted to work. The practitioner seeking an exemption has the burden of proving that the exemption should be granted. The provider must prove this with clear and convincing evidence, a standard that is higher and stricter than that in a civil trial.

Any health professional seeking an exemption from a disqualifying offense should seek the assistance of an experienced health law attorney familiar with the application process, and the types of evidence that can prove that the health professional should be granted an exemption.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

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