Former University of Florida Professor and Researcher Charged With Fraud and Hiding China Ties

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

On February 3, 2021, a former University of Florida professor was indicted on allegations of fraudulently obtaining a federal grant from the U.S. by concealing his ties with the Chinese government. He is accused of fraudulently obtaining $1.75 million in federal grant money from the National Institutes of Health (NIH). He was able to do this by concealing support he received from the Chinese government and a company that he founded in China to profit from that research, according to the U.S. Department of Justice (DOJ).

The former professor is charged with six counts of wire fraud and four counts of making false statements to an agency of the United States.

A Scheme to Defraud National Institutes of Health and the University of Florida.

According to the indictment, the ex-professor obtained a $1.75 million grant from NIH to support his development work on an imaging informatics tool for muscles known as “MuscleMiner.” Additionally, he served as the principal investigator for the grant between September 2014 and July 2019. According to prosecutors, he was required to disclose any foreign research support and any financial conflicts of interest, including financial connections to foreign companies, but he failed to do so.

The indictment alleges that he concealed the information in order to keep his job at the University of Florida and continue to receive NIH grant money. Additionally, the ex-professor signed a document from UF’s College of Engineering in 2019 that said he had no affiliation with any business, business entity, or university in China. Prosecutors said that he left the United States in August of 2019 for China and has not returned.

Each wire fraud count carries a maximum penalty of 20 years in prison and a $250,000 fine. The maximum penalty for each count of making a false statement is five years in prison and a $250,000 fine. You can read the complaint in this case here.

To read the press release issued by the DOJ, click here.

Research Fraud, Grant Application Fraud, and Scientific Misconduct Allegations Have Serious Consequences.

An accusation, even if later proven to be unfounded, may unfairly tarnish the personal and professional reputation of any scientific, medical, or clinical researcher. It can cause the researcher to lose grants, bonuses, and promotions; his or her employment may be terminated; and, as in this case, he or she may face criminal prosecution for fraud, theft, or other applicable crimes.

To learn more on clinical research fraud and misconduct, click here to visit our Areas of Practice Page on our website and read one of my prior blogs here.

Contact Health Law Attorneys Experienced in Defending Against Allegations of Clinical Research Fraud and Misconduct.

The Health Law Firm and its attorneys have experience in representing researchers, investigators, academicians, and clinicians who are the subject of clinical research fraud and misconduct allegations. The Health Law Firm and its attorneys also have experience in representing students, employees, researchers, investigators, and “whistleblowers” who report such matters including those who become the victim of reprisals and retaliation by the person against whom the report is made.

Don’t wait. Obtain the advice and counsel of experienced attorneys who are familiar with such matters and can assist you before it is too late.

If you are facing allegations of research misconduct, research fraud, medical investigation misconduct, please visit our website for more information at www.TheHealthLawFirm.com or call The Health Law Firm at (407) 331-6620 or toll-free (888) 331-6620.

Sources:

Clough, Chris. “Former Fla. Professor Charged With Fraud, Hiding China Ties.” Law360. (February 3, 2021). Web.

Swirko, Cindy. “Former Florida professor indicted for fraudulently obtaining $1.75M federal grant.” The Gainesville Sun. (February 5, 2021). 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 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.

By |2021-03-10T11:46:09-05:00May 18th, 2021|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Impaired Practitioner Programs: What You Need to Know if You’ve Been Accused

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

In an industry that revolves around helping others physicians and other health professionals sometimes find that they are the ones being pushed toward a treatment program. Long hours, heavy workloads, and stress among health care professionals can sometimes lead to unsafe, unprofessional behavior and impairment allegations.

We routinely work with pharmacists and other health professionals who are accused by employers, hospitals, competitors, or terminated employees of impairment due to drug or alcohol abuse, or mental impairment, of being a “disruptive physician” or of sexual boundary issues. However, not all health professionals who are referred to a health program are in actual need of rehabilitation services.


What is the Impaired Practitioners Program?

The Florida Department of Health’s (DOH) Impaired Practitioners Program (IPN), Section 456.067, Florida Statutes, is administered by the Intervention Project for Nurses or “IPN” (for nurses and nurse practitioners) and by the Professionals Resource Network or “PRN” (for physicians, dentists, pharmacists, and all other health professionals). IPN is responsible for all nurses and works with and through the Florida Board of Nursing. PRN works with and through the Florida Board of Medicine, Board of Dentistry, Board of Pharmacy, and other Department of Health Professional Boards.


You’re told You Need to Report Yourself to IPN; What Now?

These types of allegations discussed above made against a pharmacist, nurse, physician, or other health professional are extremely serious because they are usually treated by the DOH as “Priority 1” or “Fast Track” offenses. This means that the charges against the individual will usually be automatically considered for an Emergency Suspension Order (ESO) issued by the Florida Surgeon General at the request of the Department of Health. Unless a qualified, experienced health care attorney is able to immediately produce reliable documentation and evidence showing the health professional is not impaired, the Surgeon General will usually issue an ESO. Click here to read one of my prior blogs to learn more.

Even in cases where the individual may actually have committed an offense, there are a number of administrative and procedural measures that may be used to avoid a suspended license. For the innocent health professional, an experienced attorney familiar with such matters may be able to obtain additional drug testing, polygraph (lie detector) testing, medical examinations, scientific evidence, expert witnesses, evaluations by certified addictions professionals, character references, or other evidence which may help to show innocence and lack of impairment.


Call an Attorney Immediately, Before Making Any Decisions or Calls!

If you are accused of wrongdoing, especially accusations involving drug or alcohol abuse or impairment, even if you are threatened with being reported to the DOH or the Board of Pharmacy, then it may be much better to defend yourself and fight such charges instead of trying to “take the easy way out.” This is especially true if you are being falsely accused. There are many problems that you can avoid by having good legal advice before you make a stupid mistake. We are often consulted and retained by clients when, after they have made the mistake of talking to the wrong people about the wrong things, they are in a situation they could have avoided.

Our firm has extensive experience in representing pharmacists, physicians, and other professionals accused of drug abuse, alcohol impairment, mental impairment, and sexual boundary issue, as well as in dealing with the IPN and the PRN, their advantages and disadvantages, their contracts, their policies and procedures, and their requirements.

The bottom line is: if you are accused of drug impairment, alcohol impairment, drug diversion, sexual boundary issues, sexual misconduct, or of being mentally or physically impaired, immediately contact an attorney experienced with IPN and PRN and with the Board of Pharmacy, Board of Medicine, Board of Dentistry, and other professional boards. Don’t risk losing your livelihood by just taking the apparently easy way out without checking into it. There may be other options available for you, especially if you are innocent and not impaired.

To read one of my prior blogs about the recent changes to Florida’s Impaired Practitioners Program, click here.

Contact Experienced Health Law Attorneys in Matters Involving PRN & IPN.

The Health Law Firm’s attorneys routinely represent pharmacists, nurses, physicians, dentists, and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.

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:

Masterson, Les. “Physician wellness, quality of care go hand-in-hand, analysis finds.” Healthworks Collective. (September 10, 2018). Web.

Maria Panagioti, Keith Geraghty, Judith Johnson. “Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction.” Journal of American Medical Association (JAMA). (September 4, 2018). 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., 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.

Federal Judge Tells Florida Pediatric Group It Must Face Nurse’s EEOC Suit

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

On November 4, 2020, a Florida federal court judge ruled that a Tampa-based pediatric medical group cannot escape a U.S. Equal Employment Opportunity Commission (EEOC) lawsuit, denying its attempts to dismiss the case. According to the federal agency, Pediatric Health Care Alliance unlawfully retaliated against a nurse after the nurse reported a doctor for sexual harassment. U.S. District Judge Thomas Barber denied the medical group’s motion to dismiss, saying it neglected to confront or defend against the nurse’s claim that the medical group demoted her as punishment.

The EEOC Complaint: Nurse Forced to Quit After Reporting Sexual Harassment.

On June 22, 2020, the EEOC filed an employment lawsuit in the United States District Court for the Middle District of Florida. According to the complaint, a female nurse at Pediatric Alliance reported that a doctor at the company inappropriately touched her on two different occasions. Notably, that doctor was also the Vice President (VP) of the company.

According to the suit, the nurse suffered almost immediate retaliation for filing the complaint against the VP. The EEOC alleges that Pediatric Alliance transferred her to a different location against her wishes, replaced her nursing duties with administrative ones, and docked her pay. As a direct consequence of the retaliation, the EEOC contends that the long-time employee was, in effect, forced to resign.

To read the EEOC’s press release on the lawsuit, click here.

To read the EEOC’s lawsuit, in this case, click here.

Retaliation for filing A Sexual Harassment Complaint is Unlawful, Even if it Later Turns Out the Complaint Wasn’t Valid: Title VII of the Civil Rights Act.

Under federal law (Title VII of the Civil Rights Act of 1964), employees have a legal right to raise workplace discrimination or harassment complaints. If an employee exercises this right, their company or organization is strictly prohibited from retaliating against them for doing so. Employers cannot take adverse employment action against an employee in retaliation for making a formal or informal complaint of harassment.

Adverse action occurs when an employee is penalized or punished in some form. In this case, transferring the nurse to a less desirable location, reducing salary, and taking away job duties are all examples of adverse action.

Analysis of the Ruling.

In this case, the defendant’s medical group/employer tried to get the court to dismiss the lawsuit (complaint) based on the EEOC’s earlier determination that the nurse failed to sufficiently support charges of sexual harassment. If the employer had not retaliated against the nurse, in this case, would have then been over. But that didn’t happen. The complaint asserted a claim of retaliation in violation of Title VII, not sexual harassment.

The court also noted that the medical group did not argue that the EEOC’s retaliation allegation was insufficient. Accordingly, the judge denied the motion to dismiss filed by Pediatric Alliance, the employer.

To view the court’s opinion in full, click here.

Tips for Employers to Avoid EEOC Complaints.

1. The employer should adopt a “zero tolerance” policy for discrimination and harassment.

2. Make sure your officers, supervisors, and key employees are instructed on a regular basis about what situations are considered sexual harassment or discrimination.

3. Make sure your officers, supervisors, and key employees sign a statement each year, stating that they are aware of the company’s “zero tolerance” policy and what constitutes harassment and discrimination.

4. Establish a method by which employees can submit reports of harassment and discrimination without the perpetrator becoming aware of it. This should be part of the employer’s compliance program.

5. Be sure your company or group has a good directors and officers (D&O) liability insurance and excess liability insurance policy that covers sexual harassment and discrimination claims.

6. Include an indemnification clause in the contracts of officers, supervisors, and key employees, requiring them to indemnify the employer in any case where the employer is held liable for acts of sexual harassment or discrimination.

7. Be sure that an employee who files a complaint does not have adverse employment action taken against him or her, especially based solely upon the word of the person against whom the complaint was filed. Bring a human relations expert in as early as possible to consult on the case, as well as an employment law defense attorney.

8. Make sure that all employees, including officers, supervisors, and key personnel, receive training once a year on avoiding sexual harassment and discrimination and document it in their personnel/human resources file. Hiring an outside trainer can make this less burdensome and more enjoyable. Again, this should be part of the employer’s compliance plan.

 

Don’t Wait Until It’s Too Late, Talk to an Experienced Attorney Now.

Florida workers have a right to report sexual harassment or discrimination without facing retribution, but workers often file complaints that are not valid. The EEOC advances opportunities in the workplace by enforcing federal laws prohibiting employment discrimination. Find out how The Health Law Firm can help if you are an employer that finds itself in this legal situation.

Additionally, please read one of our recent blogs dealing with a similar EEOC lawsuit.

Contact Health Law Attorneys Experienced in Representing Nurses and Other Healthcare Professionals.

The Health Law Firm’s attorneys routinely provide legal representation to nurses, physicians, medical groups, pharmacists, pharmacies, physicians, and other health providers. We provide legal representation for employers in EEOC complaints, workplace discrimination complaints, and suits involving harassment or discrimination complaints. We also provide legal representation in Department of Health, Board of Medicine, Board of Nursing investigations and complaints, DORA investigations and complaints. We provide litigation services in state and federal courts and state and federal administrative hearings. We provide legal representation across the U.S., not just in Colorado, Florida, Louisiana, Virginia, and Washington, D.C.

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:

Shanes, Alexis. “Fla. Pediatric Group Can’t Dodge EEOC Retaliation Suit.” Law360. (November 4, 2020). Web.

“EEOC Sues Pediatric Health Care Alliance for Retaliation Over Harassment Complaints.” U.S. Equal Employment Opportunity Commission (EEOC). (June 22, 2020). Web.

Bean, Mackenzie. “Florida practice retaliated against nurse for reporting harassment, EEOC says.” Becker’s Hospital Review. (November 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 Avenue, Suite 1000, Altamonte Springs, FL 32714. Call (407) 331-6620 or Toll-Free at (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

 

 

Florida Court Agrees With University of Miami, Tosses Medical Malpractice Suit

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

On October 28, 2020, a Florida appeals court tossed out a medical malpractice suit accusing a University of Miami doctor of providing negligent treatment at a public teaching hospital. A panel of the Florida Third District Court of Appeal upheld a circuit judge’s ruling that the university is protected by sovereign immunity when faculty members provide care at Jackson Memorial Hospital, a teaching hospital.


Background of the Suit.

The ruling arose out of a case in which a University of Miami physician provided treatment in 2013 to a patient at Jackson Memorial. A medical malpractice lawsuit was filed against parties including Jackson Memorial, the university, and the physician. The suit alleged that a failure to provide anticoagulants resulted in disabilities.

Jackson Memorial Hospital is owned and operated by Miami-Dade County through the Public Health Trust. It is supported by Miami-Dade County residents through a portion of the county’s sales tax. Because of this, it is considered to be the same as a state agency, and its employees have the same sovereign immunity as state employees do.

The judge dismissed the suit against the doctor, saying that because the doctor provided services at the public teaching hospital, pursuant to the University’s agreement with Jackson Memorial, he should be considered an agent of the hospital. Therefore, he is entitled to sovereign immunity.

Pointing to state law and an agreement with Jackson Memorial, the university also argued that it was shielded by immunity from liability. The university claimed it was entitled to immunity under Sections 768.28(9)(a) and (10)(f), Florida Statutes. Since any liability the university had would be vicarious liability based on the alleged negligence of the physician, if the physician was determined to be immune, the university would have the same defense.

Additionally, Section 768.28, Florida Statutes, was amended by the Florida Legislature in 2011 to cover nonprofit independent universities that provide patient care at government-owned teaching hospitals. The same year, Jackson Memorial and Miami University amended the terms of their agreement to incorporate the amended sovereign immunity statute, according to the judge’s opinion in the case.

The Trial Court’s Ruling.

The appellate court panel agreed with the circuit judge, saying it was undisputed that the doctor was a University of Miami faculty member and employee at the time of the treatment. Additionally, the agreement between Jackson Memorial and the University of Miami was properly redrafted in 2011 to reflect the amendment to the statute. “Under the terms of the 2011 agreement and section 768.28, Florida Statutes, the university is immune from suit here because the physician treated the patient while acting as Jackson’s statutory agent,” the appellate panel said in the opinion.

Click here to read the court’s opinion in full.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in prosecuting and in defending complex civil litigation in state and federal courts. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

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:

“State Appeals Court: University Of Miami Shielded From Medical Malpractice Lawsuit.” Miami CBS Local. (October 28, 2020). Web.

Kang, Peter. “Fla. Court Says Univ. Of Miami Immune To Med Mal Suit.” Law360. (October 28, 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 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 Firm. All rights reserved.

Eight Tips For Academic, Disciplinary or Legal Problems with Your Residency Program

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

Here are some tips to set the record straight on various inaccurate information I have heard from physicians in medical residency programs in representing them in appeals of disciplinary actions including suspension and terminations.

1. Nothing you tell your Program Director, advisor, mentors, attendings, senior resident, or co-resident is confidential. Go ahead and pour your heart out about all of your problems and concerns, but none of it is confidential, even if you said it was “in confidence.” What is confidential: what you tell your priest or religious adviser (preacher, rabbi, imam) and what you tell your own personal physician or psychotherapist (unless you have signed a waiver) that you have hired and you are paying. Anyone else, it is not confidential. So if you tell your program director you were raped when you were younger, not confidential. If you tell your senior resident you suffer from panic attacks, not confidential. You tell your attending that you had cancer ten years ago, not confidential. This applies no matter what “magic words” you attach to it.

2. Take and use whatever time period is offered to you to retain counsel and prepare. If you are given ten (10) days to file an appeal or a request for hearing, take the full ten (10) days. Do not file it on the same day. Otherwise, you are using up valuable preparation time that you cannot get back.

3. Make sure that whatever you are required to file is actually received by the due date indicated. If a request for a hearing must be filed within fifteen (15) days, that means that it must be received within the fifteen days. Check after you send it or deliver it to make sure it has been successfully received.

4. It is never too early to hire an attorney. Hire an attorney to represent and advise you at the first sign of trouble. However, you must be sure to hire an attorney who is experienced in representing residents and fellows in disputes with graduate medical education programs. An experienced attorney can help you prepare any written submissions you make, organize your response and any documents you care to submit, and otherwise assist you in identifying what is relevant and what is not relevant.

5. Always read your program’s graduate medical education (GME) manual, residency manual, due process policy or whatever handbook or manual contains your hearing and appeal rights. Be familiar with them and follow them.

6. If you are given remedial actions you must take, documents your completion of each one. Whether the requirement you must perform is in a corrective action plan (CAP), a remediation letter, or a probation letter, document your completion of it in writing and report it to whatever authority gave you the requirement. Send a courtesy copy (“cc”) to your program director.

7. Make sure any correspondence you send to anyone is complete, correct and in the form of a professional business letter. Make sure it meets all of the requirements of a professional business letter. This is especially true for rebuttals, appeals, hearing requests, etc. What, you don’t know what this is? Then go online and Google it. Your letter should look very similar to any letter you received from your program director or institution. Be sure it has all of your return contact information on it as well as a date. Do not start your letter with “Hi,” “Hello,” or “Good day.” Do place a reference (“Re:”) line or subject line on your letter that states what the subject of your letter is.

8. Do not be afraid to appeal, file a discrimination complaint or exercise any of your legal rights. Often I hear from residents, after they are already terminated from their program, that they are afraid to get a lawyer involved. I usually ask: “What are you afraid of? What is the worst that can happen? You have already been terminated.” Remember, also, that if your program retaliates against you for exercising any of your rights, that is illegal. The ACGME would like to hear about that and in almost all cases, you will then have a legal cause of action upon which you can sue the program.

Contact a Health Care Attorney Experienced in the Representation of Medical Resident Physicians, Fellows, Medical Students, Dental Students and Residents, Pharmacy Students and Residents, Mental Health Counselor Interns, and other health professionals. The attorneys of The Health Law Firm, also represent those applicants accused of irregular behavior by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), in responses, hearings and appeals, including on charges of “unprofessional conduct” and “improper behavior.”

The Health Law Firm and its attorneys 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 at (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., 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 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.

Feds Charge Three For Role in Multi-Million Dollar Scheme to Defraud Medicare, 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 Private 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

By |2021-02-24T10:52:53-05:00April 28th, 2021|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Three Charged For $109 Million Medicare Fraud Scheme in Massachusetts

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

Florida Judge Won’t Toss Lawsuit Filed By Family of Publix Employee Who Died of Coronavirus

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 February 5, 2021, a judge in Florida refused to dismiss a lawsuit filed by the family of a Publix Super Markets deli worker who died after allegedly catching COVID-19 from a coworker. Judge Carlos Lopez announced that he would not dismiss the lawsuit filed by Gerardo Gutierrez’s family, who died on April 28, 2020, from complications caused by coronavirus. The suit was filed in the Florida Circuit Court for the Eleventh Judicial Circuit of Miami-Dade County, Florida, in November 2020.

Publix Accused of Failing Its Workers & the Miami Beach Community.

The suit alleged that on March 27 and 28, 2020, 70-year-old deli worker Gerardo “Gerry” Gutierrez worked at a Publix supermarket alongside a coworker who showed signs of COVID-19. Unfortunately, at that time, according to the complaint, Publix had made a decision to prohibit its employees from wearing masks and other personal protective equipment (PPE).

On April 2, Gutierrez was told by his supervisors to isolate at home; but by April 7, he tested positive for Covid-19, the complaint says. He died on April 28, 2020.

The family says in its complaint that Publix, a Florida-based grocery store chain, breached its duty to keep its employees safe. It knowingly failed to take proper precautions and prohibited its workers from wearing masks for fear it would “incite panic” among customers, claims the suit. The lawsuit echoes findings from an earlier Tampa Bay Times report that took the position that Publix lagged behind competitors in adopting employee and customer safety protections (such as employee PPE) during the early days of the pandemic.
Click here to learn more.

Additionally, the suit also references several Occupational Safety and Health Administration (OSHA) complaints, where employees repeatedly reported the grocer prohibited mask and glove use.

To view the family’s complaint, click here.

Publix Defends Itself.

In response to the lawsuit, Publix filed a motion to dismiss, calling the suit an attempt to circumvent the worker’s compensation process. Publix also argued that the claims in the case needed to be filed in the Florida Division of Administrative Hearings. The worker’s compensation system in Florida requires that employees of a corporation must file workers compensation claims for injuries sustained on the job. Civil litigation is prohibited against the employer, with a number of exceptions. The judge in the civil case disagreed with Publix, ruling in favor of the estate of the worker.

According to the complaint, it wasn’t until March 2020, after the realization set in that the spread of COVID-19 presented a major national crisis for Publix to post a statement on its website. In the statement, Publix CEO Todd Jones said the company had remained in close contact with the Centers for Disease Control and Prevention (CDC) and would “continue to focus on keeping [its] associates [employees] healthy—and [its] stores open and stocked—to serve and support all our communities.”

Click here to read the statement in full.

Despite the arguments, the family’s attorney Michael Levine said, “Publix has never taken any responsibility for its unthinkable decision to prohibit its employees from wearing masks as COVID-19 swept through Florida. Our case will make sure Publix is held accountable for its reckless decision. We look forward to uncovering the documents behind the mask prohibition and deposing its senior personnel.”

One problem that we see with this case is that many Publix employees work part-time. We had one working for our law firm, for example. By not allowing employees to wear proper PPE, and not requiring them to abide by other protective measures, the employer caused a far wider exposure of others, even many non-customers, and their families, to the COVID virus.

The case is Gutierrez v. Publix Super Markets Inc., case number 2020-025168-CA-01, and you can read the judge’s order in full here.

Read one of my prior blogs about OSHA previously handing out citations for COVID-19 PPE violations.

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.

Sources:

Bolado, Carolina. “Fla. Judge Won’t Ax Suit Over Publix Worker’s COVID-19 Death.” Law360. (February 5, 2021). Web.

Toropin, Konstantin. “Family files suit over Publix employee’s death. It says company failed to protect him from Covid-19.” CNN. (November 23, 2020). Web.

DiNatale, Sara. “A Publix employee died from COVID-19. Now his family is suing over his death.” Tampa Bay Times. (November 23, 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 © 2021 The Health Law Firm. All rights reserved.

Florida Judge Sides With AdventHealth, Allows Fraud Claims Over Soured Multi-Million Dollar PPE Deal to Move Forward

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

On February 23, 2021, a federal court in Orlando, Florida, ruled that Adventist Health System Sunbelt (now known as AdventHealth, and which owns Florida Hospital, among others) could pursue claims it has over a bad $57.5 million deal to buy personal protective equipment (PPE). The defendants whom the hospital system is suing include Tomax Capital Management, Inc. (“Tomax”), a California corporation; a California attorney and his law firm; and others.

U.S. District Judge Paul G. Byron said the hospital system provided sufficient evidence that Tomax failed to deliver the promised PPE and then conspired to keep the $2 million which was not returned.

The PPE Contract.

According to the complaint in the case, the contract was for AdventHealth to purchase 10 million 3M N95 ventilator masks, according to the May 2020 complaint. Under the terms of the contract, the hospital was to pay a total of $57.5 million for 10 million 3M N95 masks to protect its workers during the Coronavirus pandemic. AdventHealth paid the $57.5 million into a California lawyer’s trust account. The 10 million masks were to be delivered to AdventHealth’s hospital in Orlando, Florida, by April 18, 2020. However, the masks never arrived.

Now, I just have to jump in and point out something. I don’t claim to have ironclad proof of it, but I have seen and read enough about 3M N95 masks on television and in the press while trying to purchase my own. I may be totally off on this figure, but I seem to remember around the beginning of the Coronavirus pandemic that 3M was only manufacturing approximately 1 million masks a month. So where someone would be able to come up with 10 million of these specific masks is mind-boggling to me. Let’s just say that this is my own opinion.

When the hospital system requested a refund of the $57.5 million it had paid, it claims it was only refunded $55.5 million, with $2 million missing in action. According to the complaint, AdventHealth never saw the remaining $2 million despite assurance from the attorneys involved in the deal that AdventHealth would get it back. Hence, the present lawsuit.

I mean, if you can’t trust an attorney nowadays, who can ya’ trust?

A Civil Conspiracy?

In its suit, AdventHealth makes various claims of breach of contract, conversion, and civil conspiracy and requests actual damages, punitive damages, and prejudgment interest. The conspiracy would involve the allegation that the attorney and law firm conspired with Tomax and others to deprive AdventHealth of the $2 million. Because AdventHealth alleged that it suffered damages in Florida, it was able to bring its case to the federal court here in Orlando.

Read the complaint filed in the U.S. District Court for the Middle District of Florida for more details.

Granted, $2 million isn’t a lot of money to some people, but it was obviously enough money to get these Defendants sued in federal court.

Judge Sides With the Hospital System’s Position on Motion to Dismiss Complaint.

The federal court judge denied a motion to dismiss the complaint filed by Tomax. In his order, the judge stated: “Plaintiff sufficiently pleads facts supporting the existence of a civil conspiracy that caused injury in Florida.” In addition to allowing the claims of the hospital system to move forward, the judge also ruled that the court has the authority to exercise personal jurisdiction over the attorney and law firm that was involved, under the state’s long-arm statute. To obtain more details, read the judge’s order denying the motion to dismiss.  Click here to visit our Areas of Practice page and learn more on how The Health Law Firm can assist you in legal cases like this.

PPE a “Hot Issue.”

In another recent pandemic-related case, OSHA began issuing fines to health care systems over PPE violations such as lack of proper equipment for their employees. We have also read a number of reports about companies and individuals being fined and injunctions being obtained by the Federal Trade Commission and the Food and Drug Administration over phony PPE being sold to Americans over the Internet.

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. The lawyers of The Health Law Firm are experienced in complex litigation in state and federal courts.

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

Sources:

Hale, Nathan. “AdventHealth’s Fraud Claim Over $57M PPE Deal Advanced.” Law360. (February 23, 2021). Web.

Bolado, Carolina. “AdventHealth Sues Attorney Over Failed $57.5M Masks Deal.” Law360. (May 29, 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 © 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

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