Medicaid | The Health Law Firm Blog

Medicaid audits and regulation are a concern for health care professionals. Learn more about regulations and updates concerning Medicaid.

Accused of “Irregular Behavior” on Your USMLE Step Exams: What to Do

Many students, foreign medical graduates and those applying to receive a medical license in the United States find themselves accused of “irregular behavior” while taking the Step 1, Step 2 or Step 3 exams of the United States Medical Licensing Examinations (USMLE) administered by the National Board of Medical Examiners (NBME). Often the conduct turns out to be something that is not significant, was inadvertent, was not intended to provide any unfair advantage to the test-taker or is otherwise justifiable or explainable. Nevertheless, because of the extremely serious consequences a finding of “irregular behavior” may have, the applicant should act immediately […]

By The Health Law Firm|2024-03-14T10:00:26-04:00June 1, 2018|Health Care Industry, In the Know, Medicaid, NBME, The Health Law Firm Blog|

Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC

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

Health Integrity, LCC, was named the Zone 4 Program Integrity Contractor (ZPIC) for the Medicare and Medicaid programs. As the ZPIC for Zone 4, Health Integrity has been performing benefit integrity activities aimed to reduce fraud, waste and abuse in Medicare and Medicaid data matching programs.

A ZPIC is a business entity that contracts with Medicare and Medicaid and works with state Medicaid agencies, the Centers for Medicare and Medicaid Services (CMS), and law enforcement officials to identify improper billing and utilization patterns throughout Zone 4.

ZPIC Zone 4 includes Texas, Colorado, New Mexico, and Oklahoma.

What […]

By The Health Law Firm|2024-03-14T10:00:46-04:00June 1, 2018|Medicaid, Medicaid audit, Medicare, Medicare Audit, The Health Law Firm Blog|

Emergency Suspension Orders and Medicaid Fraud

In the recent case of Mendelsohn v. State of Florida Department of Health, Mendelsohn’s license to practice medicine was suspended under an Emergency Suspension Order (ESO).

According to the ESO, Mendelsohn is licensed to practice medicine in Florida pursuant to the provisions of chapter 458, Florida Statutes. On December 9, 2010, he entered a plea of nolo contendere in federal court to a charge of conspiracy to commit fraud upon the United States in violation of 18 U.S.C. § 371. As a result of his conviction, the Florida Department of Health immediately suspended his medical license without a hearing pursuant to section 456.074(1), Florida Statutes (2010), which states:

(1) The department shall issue an emergency […]

By The Health Law Firm|2024-03-14T10:00:27-04:00June 1, 2018|Department of Health, Health Care Industry, Medicaid, The Health Law Firm Blog|

Tips for Responding to a Medicaid Audit

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

Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong. State and federal governments conduct audits for many different reasons. Typical reasons include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

Medicaid Audits in Florida.

The Agency for […]

By The Health Law Firm|2024-03-14T10:00:46-04:00June 1, 2018|Medicaid, Medicaid audit, The Health Law Firm Blog|

Doctor or Nurse, Please, Please, Please: Talk to an Attorney Before You Talk to an Investigator

Despite mailing out hundreds of thousands of postcards and letters to physicians, nurses, dentists, pharmacists, and psychologists throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Department of Health (DOH) investigators (who are sometimes titled “Medical Quality Assurance Investigators” or “Medical Malpractice Investigators“), Drug Enforcement Administration (DEA) special agents, police officers, sheriff’s deputies, or criminal investigators of any type.

Let me state this as succinctly and clearly […]

By The Health Law Firm|2024-03-14T10:00:27-04:00June 1, 2018|Department of Health, Health Care Industry, Medicaid, Medicare, Nurses, The Health Law Firm Blog|

Speech Therapist Arrested for Billing Medicaid $500,000 for Work at Florida Day Care Centers While Living in Illinois

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

A speech therapist was arrested on March 29, 2013, for allegedly billing Medicaid more than $500,000 for services that she did not provide, according to the Florida Office of the Attorney General (AG). The speech therapist now faces charges of Medicaid fraud and grand larceny.

Click here to read the press release from the AG.

Billed Medicaid for Services Provided in Florida, While Living in Illinois.

According to an article in The Palm Beach Post, authorities began investigating the speech therapist when they received a tip that she was overbilling for services provided. During the investigation […]

By The Health Law Firm|2024-03-14T10:00:47-04:00June 1, 2018|Medicaid, Medicaid audit, The Health Law Firm Blog|

Halifax Whistleblower Claims Hospital Overbilled Medicare

The U.S. Department of Justice has joined a whistleblower suit filed against Halifax Hospital by the hospital’s director of physician services, according to the Daytona Beach News-Journal.

The U.S. Department of Justice filed its part of the lawsuit on Friday. It claims that Halifax Health defrauded the federal government by submitting thousands of false claims for Medicare and Medicaid payments worth millions of dollars. By filing, the U.S. Department of Justice hopes to recover millions of dollars in Medicare and Medicaid payments that it says were made in error to Halifax.

Elin Baklid-Kunz filed a lawsuit against Halifax in 2009. As a whistleblower, he could be awarded a percentage of whatever the government recovers. […]

By The Health Law Firm|2024-03-14T10:00:27-04:00June 1, 2018|Health Care Industry, In the News, Medicaid, Medicare, The Health Law Firm Blog|

Medicaid Fraud Control Unit Arrests Three Florida Women for Allegedly Bilking Medicaid Out of $27,000

By Lance Leider, J.D., The Health Law Firm

Three Central Florida women were arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) on July 18, 2013, for allegedly defrauding Medicaid out of $27,000. According to the AG, the owner and two managers of Destiny TCM Corporation are accused of billing Medicaid for services never rendered and also bribing people in order to obtain their Medicaid recipient numbers.

To read the press release from the AG’s office, click here.

Violated Medicaid Fraud Kickback Statute.

An article in the Orlando Sentinel states that the Destiny TCM Corporation was supposed to provide targeted case-management services and link Medicaid recipients with mental health service […]

By The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|Medicaid, Medicaid audit, The Health Law Firm Blog|

What to do if You Receive a Medicaid Fraud Control Unit Investigative Subpoena

The Medicaid Fraud Control Unit is charged with investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. It is a division of the Florida Office of the Attorney General .When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records. The practice tips below were prepared to assist a health care provider in properly responding to and defending against such a subpoena.

1. Immediately contact an attorney knowledgeable in Medicaid fraud and abuse prior to responding to the government’s requests.

The Medicaid Fraud Control Unit does not issue a subpoena without reason. An investigation by the Medicaid Fraud Control Unit is a […]

By The Health Law Firm|2024-03-14T10:00:29-04:00June 1, 2018|Medicaid, The Health Law Firm Blog|

Florida Hospice to Pay $1 Million to Settle Whistleblower Lawsuit Over False Billing Claims

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

The Hernando-Pasco Hospice (HPH Hospice) in Hudson, Florida, agreed to pay $1 million to resolve allegations that it violated the False Claims Act by submitting false claims for services to the Medicare and Medicaid Programs. According to the U.S. Attorney’s Office for the Middle District of Florida, the hospice allegedly admitted patients that did not meet the requirements for end-of-life care. This lawsuit was originally filed in 2010, by two former hospice employees. The announcement was made on July 22, 2013.

Click here to read the entire press release from the U.S. Attorney’s […]

By The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|Medicaid, Medicare, The Health Law Firm Blog, Whistleblower|