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One of 2019’s Largest Healthcare Fraud Case Ever: No Surprise, Florida Wins!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds. Often joked and written about by Florida novelists such as Carl Hiassin and Tim Dorsey, this case serves to highlight why the “Debtor’s Haven” state often excels in cases of healthcare fraud.

In April 2019, after decades of alleged schemes, illegal kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid, Phillip Esformes was sentenced to 20 years in prison. He was also ordered to pay $44.2 million in money forfeitures and restitution, and forfeiture of his ownership interests in several skilled nursing homes.

A federal district judge sentenced the South Florida health care facility owner after he was found guilty in the largest health care fraud scheme ever charged by the U.S. Justice Department (DOJ).

A Case of “Epic” Fraud.

The nursing home mogul was accused of paying bribes and receiving kickbacks in a massive $1 billion Medicare fraud case touted by federal prosecutors as the largest in the nation. During an eight-week jury trial, prosecutors argued that Esformes himself made $38 million from Medicare and Medicaid payments between 2010 and 2016. Additionally, his South Florida network received more than $450 million through bribes and though services that weren’t medically necessary or which were never provided, according to the prosecution’s case.

To learn more about this case, click here to read one of my prior blogs.

Convicted, But Not of Healthcare Fraud.

The shocker, in this case, is that the federal jury convicted Esformes on 20 counts of conspiracy to defraud the taxpayer-funded Medicare program. The lack of a conviction for healthcare fraud itself was puzzling. Many of his alleged co-conspirators had already pled guilty to health care fraud and some had even testified against him at trial. To learn more, click here to read one of my prior blogs on another individual involved in the case.

Despite being billed as the largest healthcare fraud case prosecuted in U.S. history, it is also a stark reminder to prosecutors of how tricky it can be to secure a conviction on any particular charge.

To read the DOJ’s press release about this case in full, click here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in Medicare and Medicaid audits, and in ZPIC and RAC audits throughout Florida and across the U.S. We also represent health providers in civil and administrative litigation by government agencies and insurance companies attempting to recoup claims that have been paid. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, recovery actions and administrative actions seeking termination from Medicare and Medicaid Programs.

The Health Law Firm’s attorneys routinely represent physicians, dentists, pharmacists, psychotherapists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Weaver, Jay. “Miami healthcare exec Esformes sentenced to 20 years in biggest Medicare fraud case.” Miami Herald. (September 12, 2019). Web.

Hale, Nathan. “The Biggest Stories In Florida Legal News Of 2019.” Law360. (December 20, 2019). Web.

Jackson, David. “Nursing home mogul Philip Esformes sentenced to 20 years for $1.3 billion Medicaid fraud.” Chicago Tribune. (September 13, 2019). 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.

Keywords: Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud defense, Medicare and Medicaid fraud defense legal counsel, Medicare and Medicaid fraud defense lawyer, defense of Medicare and Medicaid fraud charges, CMS, ZPIC and RAC audit defense attorney, CMS, ZPIC and RAC audit defense lawyer, CMS, ZPIC and RAC audit legal representation, Medicaid Fraud Control Unit (MFCU) defense attorney, health care clinic fraud audit, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicaid Fraud Control Unit (MFCU) defense legal counsel, Medicaid Fraud Control Unit (MFCU) subpoena defense attorney, Medicaid Fraud Control Unit (MFCU) subpoena legal representation, Medicaid Fraud Control Unit (MFCU) subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense attorney, OIG, HHS, DOJ and U.S. Attorney subpoena legal representation, legal representation for allegations of Medicare fraud, legal representation for health care fraud, healthcare fraud defense attorney, healthcare fraud defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, healthcare fraud defense legal representation, legal representation for submitting false claims, false claims defense lawyer, false claims legal defense representation, false claims defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigation defnse, DOJ defense representation, False Claims Act (FCA) legal defense attorney lawyer, False Claims Act (FCA) defense legal representation counsel, Anti-Kickback Statute (AKS) defense attorney, AKS legal defense representation, AKS defense lawyer

“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 © 2019/2020 The Health Law Firm. All rights reserved.

2019’s Largest Healthcare Fraud Case Ever Prosecuted: No Surprise, Florida Wins!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds. Often joked and written about by Florida novelists such as Carl Hiassin and Tim Dorsey, this case serves to highlight why the “Debtor’s Haven” state often excels in cases of healthcare fraud.

In April 2019, after decades of alleged schemes, illegal kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid, Phillip Esformes was sentenced to 20 years in prison. He was also ordered to pay $44.2 million in money forfeitures and restitution, and forfeiture of his ownership interests in several skilled nursing homes.

A federal district judge sentenced the South Florida health care facility owner after he was found guilty in the largest health care fraud scheme ever charged by the U.S. Justice Department (DOJ).

A Case of “Epic” Fraud.

The nursing home mogul was accused of paying bribes and receiving kickbacks in a massive $1 billion Medicare fraud case touted by federal prosecutors as the largest in the nation. During an eight-week jury trial, prosecutors argued that Esformes himself made $38 million from Medicare and Medicaid payments between 2010 and 2016. Additionally, his South Florida network received more than $450 million through bribes and though services that weren’t medically necessary or which were never provided, according to the prosecution’s case.

To learn more about this case, click here to read one of my prior blogs.

Convicted, But Not of Healthcare Fraud.

The shocker, in this case, is that the federal jury convicted Esformes on 20 counts of conspiracy to defraud the taxpayer-funded Medicare program. The lack of a conviction for healthcare fraud itself was puzzling. Many of his alleged co-conspirators had already pled guilty to health care fraud and some had even testified against him at trial. To learn more, click here to read one of my prior blogs on another individual involved in the case.

Despite being billed as the largest healthcare fraud case prosecuted in U.S. history, it is also a stark reminder to prosecutors of how tricky it can be to secure a conviction on any particular charge.

To read the DOJ’s press release about this case in full, click here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in Medicare and Medicaid audits, and in ZPIC and RAC audits throughout Florida and across the U.S. We also represent health providers in civil and administrative litigation by government agencies and insurance companies attempting to recoup claims that have been paid. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, recovery actions and administrative actions seeking termination from Medicare and Medicaid Programs.

The Health Law Firm’s attorneys routinely represent physicians, dentists, pharmacists, psychotherapists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Weaver, Jay. “Miami healthcare exec Esformes sentenced to 20 years in biggest Medicare fraud case.” Miami Herald. (September 12, 2019). Web.

Hale, Nathan. “The Biggest Stories In Florida Legal News Of 2019.” Law360. (December 20, 2019). Web.

Jackson, David. “Nursing home mogul Philip Esformes sentenced to 20 years for $1.3 billion Medicaid fraud.” Chicago Tribune. (September 13, 2019). 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.

Keywords: Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud defense, Medicare and Medicaid fraud defense legal counsel, Medicare and Medicaid fraud defense lawyer, defense of Medicare and Medicaid fraud charges, CMS, ZPIC and RAC audit defense attorney, CMS, ZPIC and RAC audit defense lawyer, CMS, ZPIC and RAC audit legal representation, Medicaid Fraud Control Unit (MFCU) defense attorney, health care clinic fraud audit, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicaid Fraud Control Unit (MFCU) defense legal counsel, Medicaid Fraud Control Unit (MFCU) subpoena defense attorney, Medicaid Fraud Control Unit (MFCU) subpoena legal representation, Medicaid Fraud Control Unit (MFCU) subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense attorney, OIG, HHS, DOJ and U.S. Attorney subpoena legal representation, legal representation for allegations of Medicare fraud, legal representation for health care fraud, healthcare fraud defense attorney, healthcare fraud defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, healthcare fraud defense legal representation, legal representation for submitting false claims, false claims defense lawyer, false claims legal defense representation, false claims defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigation defnse, DOJ defense representation, False Claims Act (FCA) legal defense attorney lawyer, False Claims Act (FCA) defense legal representation counsel, Anti-Kickback Statute (AKS) defense attorney, AKS legal defense representation, AKS defense lawyer

“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 © 2019/2020 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:05-04:00January 27, 2020|Categories: Pharmacy Law Blog|Tags: AKS defense lawyer, AKS legal defense representation, Anti-Kickback Statute (AKS) defense attorney, CMS, defense of Medicare and Medicaid fraud charges, Department of Justice (DOJ) investigation defnse, DOJ and U.S. Attorney subpoena defense attorney, DOJ and U.S. Attorney subpoena defense lawyer, DOJ and U.S. Attorney subpoena legal representation, DOJ defense representation, False Claims Act (FCA) defense legal representation counsel, False Claims Act (FCA) legal defense attorney lawyer, false claims defense attorney, false claims defense lawyer, false claims legal defense representation, health care clinic fraud audit, health law defense attorney, healthcare fraud defense attorney, healthcare fraud defense lawyer, healthcare fraud defense legal representation, hhs, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for Medicare and Medicaid fraud defense, legal representation for Medicare and Medicaid investigations, legal representation for OIG investigations, legal representation for submitting false claims, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal counsel, Medicaid Fraud Control Unit (MFCU) subpoena defense attorney, Medicaid Fraud Control Unit (MFCU) subpoena defense lawyer, Medicaid Fraud Control Unit (MFCU) subpoena legal representation, Medicare and Medicaid fraud defense attorney, Medicare and Medicaid fraud defense lawyer, Medicare and Medicaid fraud defense legal counsel, Medicare and Medicaid investigation defense attorney, OIG, OIG investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, ZPIC and RAC audit defense attorney, ZPIC and RAC audit defense lawyer, ZPIC and RAC audit legal representation|Comments Off

Looking Back at 2019’s Largest Healthcare Fraud Case Ever Prosecuted: Surprise! No Surprise, Florida Wins!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds. Often joked and written about by Florida novelists such as Carl Hiassin and Tim Dorsey, this case serves to highlight why the “Debtor’s Haven” state often excels in cases of healthcare fraud.

In April 2019, after decades of alleged schemes, illegal kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid, Phillip Esformes was sentenced to 20 years in prison. He was also ordered to pay $44.2 million in money forfeitures and restitution, and forfeiture of his ownership interests in several skilled nursing homes.

A federal district judge sentenced the South Florida health care facility owner after he was found guilty in the largest health care fraud scheme ever charged by the U.S. Justice Department (DOJ).

A Case of “Epic” Fraud.

The nursing home mogul was accused of paying bribes and receiving kickbacks in a massive $1 billion Medicare fraud case touted by federal prosecutors as the largest in the nation. During an eight-week jury trial, prosecutors argued that Esformes himself made $38 million from Medicare and Medicaid payments between 2010 and 2016. Additionally, his South Florida network received more than $450 million through bribes and though services that weren’t medically necessary or which were never provided, according to the prosecution’s case.

To learn more about this case, click here to read one of my prior blogs.

Convicted, But Not of Healthcare Fraud.

The shocker, in this case, is that the federal jury convicted Esformes on 20 counts of conspiracy to defraud the taxpayer-funded Medicare program. The lack of a conviction for healthcare fraud itself was puzzling. Many of his alleged co-conspirators had already pled guilty to health care fraud and some had even testified against him at trial. To learn more, click here to read one of my prior blogs on another individual involved in the case.

Despite being billed as the largest healthcare fraud case prosecuted in U.S. history, it is also a stark reminder to prosecutors of how tricky it can be to secure a conviction on any particular charge.

To read the DOJ’s press release about this case in full, click here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in Medicare and Medicaid audits, and in ZPIC and RAC audits throughout Florida and across the U.S. We also represent health providers in civil and administrative litigation by government agencies and insurance companies attempting to recoup claims that have been paid. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, recovery actions and administrative actions seeking termination from Medicare and Medicaid Programs.

The Health Law Firm’s attorneys routinely represent physicians, dentists, pharmacists, psychotherapists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Weaver, Jay. “Miami healthcare exec Esformes sentenced to 20 years in biggest Medicare fraud case.” Miami Herald. (September 12, 2019). Web.

Hale, Nathan. “The Biggest Stories In Florida Legal News Of 2019.” Law360. (December 20, 2019). Web.

Jackson, David. “Nursing home mogul Philip Esformes sentenced to 20 years for $1.3 billion Medicaid fraud.” Chicago Tribune. (September 13, 2019). 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.

Keywords: Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud defense, Medicare and Medicaid fraud defense legal counsel, Medicare and Medicaid fraud defense lawyer, defense of Medicare and Medicaid fraud charges, CMS, ZPIC and RAC audit defense attorney, CMS, ZPIC and RAC audit defense lawyer, CMS, ZPIC and RAC audit legal representation, Medicaid Fraud Control Unit (MFCU) defense attorney, health care clinic fraud audit, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicaid Fraud Control Unit (MFCU) defense legal counsel, Medicaid Fraud Control Unit (MFCU) subpoena defense attorney, Medicaid Fraud Control Unit (MFCU) subpoena legal representation, Medicaid Fraud Control Unit (MFCU) subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense attorney, OIG, HHS, DOJ and U.S. Attorney subpoena legal representation, legal representation for allegations of Medicare fraud, legal representation for health care fraud, healthcare fraud defense attorney, healthcare fraud defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, healthcare fraud defense legal representation, legal representation for submitting false claims, false claims defense lawyer, false claims legal defense representation, false claims defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigation defnse, DOJ defense representation, False Claims Act (FCA) legal defense attorney lawyer, False Claims Act (FCA) defense legal representation counsel, Anti-Kickback Statute (AKS) defense attorney, AKS legal defense representation, AKS defense lawyer

“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 © 2019/2020 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:06-04:00January 13, 2020|Categories: Medical Education Law Blog|Tags: AKS defense lawyer, AKS legal defense representation, Anti-Kickback Statute (AKS) defense attorney, CMS, defense of Medicare and Medicaid fraud charges, Department of Justice (DOJ) investigation defnse, DOJ and U.S. Attorney subpoena defense attorney, DOJ and U.S. Attorney subpoena defense lawyer, DOJ and U.S. Attorney subpoena legal representation, DOJ defense representation, False Claims Act (FCA) defense legal representation counsel, False Claims Act (FCA) legal defense attorney lawyer, false claims defense attorney, false claims defense lawyer, false claims legal defense representation, health care clinic fraud audit, health law defense attorney, healthcare fraud defense attorney, healthcare fraud defense lawyer, healthcare fraud defense legal representation, hhs, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for Medicare and Medicaid fraud defense, legal representation for Medicare and Medicaid investigations, legal representation for OIG investigations, legal representation for submitting false claims, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal counsel, Medicaid Fraud Control Unit (MFCU) subpoena defense attorney, Medicaid Fraud Control Unit (MFCU) subpoena defense lawyer, Medicaid Fraud Control Unit (MFCU) subpoena legal representation, Medicare and Medicaid fraud defense attorney, Medicare and Medicaid fraud defense lawyer, Medicare and Medicaid fraud defense legal counsel, Medicare and Medicaid investigation defense attorney, OIG, OIG investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, ZPIC and RAC audit defense attorney, ZPIC and RAC audit defense lawyer, ZPIC and RAC audit legal representation|Comments Off

Florida Pharmacy Hit With FCA Suit for Illegal Kickback Scheme Targeting Tricare

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

On October 19, 2018, the federal government filed suit against a Florida pharmacy for allegations of illegal kickback schemes involving industry marketers. The U.S. Attorney’s Office for the Middle District of Florida alleges that Oldsmar Pharmacy was involved in illegal schemes that resulted in the federal Tricare program paying more than $21 million in reimbursements for prescriptions and False Claims Act (FCA) violations.

Suit Filed on Behalf of The Defense Health Agency (DHA).

The federal government filed the suit on behalf of the U.S. Department of Defense, including its Defense Health Agency (DHA). The DHA administers the Tricare program, which provides health insurance for active duty military personnel, military retirees and their dependents.

The government is seeking treble damages, civil penalties and restitution, based on its claims that the pharmacy submitted claims to Tricare for reimbursement for prescriptions of costly compound medications. The government claims that they knew were fraudulent under the FCA because of the kickbacks paid to marketers.

On October 18, 2018, the U.S. Department of Justice (DOJ) released a press release announcing the involvement of three military members in the scheme as sales representatives for Centurion Compounding, Inc. All three were indicted for paying kickbacks to Tricare beneficiaries to obtain prescriptions for compounded medications. You can learn more about this in the section below.21

Click here to read the DOJ’s press release.

Former Whistleblower Suit.

The lawsuit against Oldsmar Pharmacy and company President, Larry Smith, stems from a whistleblower suit filed in 2015 by Jennifer Silva and Jessica Robertson, former employees, according to the complaint.

The schemes allegedly occurred between September 2014 and February 2015 by Smith and Oldsmar and different pharmacy services administration organizations.

Tricare Reimbursements and Kickback Schemes.

According to the complaint, Centurion Compounding Inc., hired sales representatives as independent contractors who marketed costly compound medications to Tricare beneficiaries. Patients recruited by the sales reps were directed to send their prescriptions to Centurion, which then directed them to Oldsmar pharmacy.

From November 2014 to February 2015, Tricare paid about $18 million for approximately 4,000 claims for compound prescriptions as part of the kickback scheme, according to the federal government. Oldsmar paid Centurion more than $6.1 million in kickbacks, some of which was distributed to the individual sales representatives involved.

Additionally, prosecutors claim that pharmacy President, Larry Smith, entered into a second kickback scheme with several marketing companies. These companies published online advertisements offering free consultations for pain creams via telemedicine, without ever seeing a physician in person. In return, Oldsmar Pharmacy paid a 41 percent kickback to the marketers, the complaint alleges.

Click here to read the complaint in full.

The suit brings forward false or fraudulent claims; recovery of payments made by mistake by Tricare; and unjust enrichment. To learn more, click here to read one of my prior blogs on a similar case.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The Firm also represents both plaintiffs (whistle blowers or relators) and defendants in False Claims Act (whistle blower or qui tam) cases. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Hale. Nathan. “Fla. Pharmacy Hit With False Claims Suit Over Kickbacks.” Law360. (October 19, 2018). Web.

Stringini, Mary. “St. Pete doctor pleads guilty to receiving kickbacks, BMW in $5.3 million pharmacy conspiracy.” ABC Action News. (March 8, 2018). 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 the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Pharmacy legal representation, False Claims Act defense attorney, FCA legal counsel, Anti-Kickback Statute (AKS) defense attorney, legal representation for allegations of violating Anti-Kickback Statute, TRICARE false claims legal defense attorney, TRICARE physician representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, whistle blower lawyer, FCA violations representation, pharmacy representation, pharmacy defense attorney, pharmacist representation, pharmacist defense lawyer, TRICARE fraud attorney, The Health Law Firm, fraud investigations representation, health care fraud defense lawyer, compounding pharmacy lawyer, prescription reimbursement leagl representation, legal defense of military physicians, legal defense of TRICARE providers, attorney reviews of The Health Law Firm, Veterans Administration (VA) physician defense attorney, The Health Law Firm attorney reviews

“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 © 2019 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:18-04:00January 30, 2019|Categories: Pharmacy Law Blog|Tags: Anti-Kickback Statute (AKS) defense attorney, attorney reviews of The Health Law Firm, compounding pharmacy attorney, compounding pharmacy lawyer, False Claims Act defense attorney, FCA legal counsel, FCA violations representation, fraud investigations representation, fraudulent practices of pharmaceutical companies, health care fraud defense lawyer, legal defense of military physicians, legal defense of TRICARE providers, legal representation for allegations of violating Anti-Kickback Statute, legal representation violating False Claims Act, pharmaceutical fraud lawyer, pharmacist defense lawyer, pharmacist representation, pharmacy defense attorney, Pharmacy legal representation, pharmacy representation, prescription reimbursement leagl representation, the health law firm, The Health Law Firm attorney reviews, TRICARE false claims legal defense attorney, Tricare fraud attorney, TRICARE physician representation, Veterans Administration (VA) physician defense attorney, whistle blower lawyer|Comments Off

Florida Pharmacist Gets More Than Six Years in Prison For Role in Compounding Fraud Scheme

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

On November 29, 2018, a Florida pharmacist was sentenced to six and a half years in prison and ordered to pay $3.4 million, for her role in a scheme to defraud the government. Marjorie Robinson pled guilty one count of conspiracy to commit health care fraud for submitting fraudulent claims to Tricare, Medicare and private insurance programs for compounded creams that were not necessary.

The Fraud Scheme.

According to the U.S. Department of Justice (DOJ), Robinson was one of three owners of ASC Pharmacy Inc., a now defunct compounding pharmacy in Miami. Under her direction, the pharmacy made compounded creams that were made to maximize reimbursement from government and private insurance programs, not for patients needs, according to the plea deal. Click here to read the press release from the DOJ.

The other owners were charged separately and have also pled guilty.

This isn’t the first time a Florida pharmacy has defrauded government programs like Tricare, click here to read one of my prior blogs on a similar case.

Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal charges were brought for fraud or related offenses. In many cases, those subject to Medicare and Medicaid fraud audits and investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding Medicare and Medicaid audits.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of Medicare or Medicaid fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

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

The attorneys of The Health Law Firm represent pharmacists and healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also defend pharmacists, physicians, pharmacies and medical groups in actions by Tricare, Medicare, Medicaid and private insurers to recoup overpayments, obtain civil fines and penalties and take other actions against them. They represent pharmacies and pharmacists in DEA actions and administrative (Order to Show Cause ) hearings, Medicare Fraud Control Unit (MFCU) investigations, and administrative and civil litigation, 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 Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Bolado, Carolina. “Fla. Pharmacist Gets 6½ Years For Bogus Claims For Creams.” Law360. (November 29, 2018). Web.

“South Florida pharmacist sentenced to more than six years in prison for role in $3.4 million compounding pharmacy scheme.” MD Linx. (November 30, 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 the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., 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 © 2018 The Health Law Firm. All rights reserved.

Florida Pharmacy Owner to Serve 15 Years in Prison for $100 Million Billing Fraud Scheme

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

On April 26, 2018, the owner of several Florida pharmacies was sentenced to 15 years in prison and ordered to give up $54.5 million in restitution. Nicholas A. Borgesano Jr., owner of A to Z Pharmacies, pled guilty to his role in a $100 million scheme involving bogus insurance reimbursements for prescription drugs.

He pled guilty in November to charges of conspiracy to commit health care fraud and conspiracy to engage in monetary transactions in property derived from specified unlawful activity, according to the order. Click here to read more.

Health Care Billing Fraud Schemes.

According to prosecutors, Borgesano was at the center of an alleged scheme in which the pharmacy owner used his six stores to peddle prescription compound medications. He would then submit fraudulent reimbursement claims to Medicare, Tricare and private insurance companies.

Borgesano and his co-conspirators are accused of manipulating billing codes in the reimbursement claims and submit claims for pharmaceutical ingredients they didn’t even have. Additionally, he used one of his pharmacies in Florida as the hub of operations and paid his co-conspirators through shell companies, checks and the purchase of assets, prosecutors said.

From the pharmacy owner and his group of conspirators, the U.S. Department of Justice (DOJ) has seized $7.6 million worth of property, including several luxury vehicles and a 50-foot racing boat, the DOJ said. To read more about the co-conspirators, click here to read the press release issued by the DOJ.

To read the judgement in full click here.

The expensive prescription medications and creams involved in this case have been targeted by prosecutors in a handful of other Florida suits alleging Medicare and Tricare fraud by pharmacy owners and others. Click here to read one of my prior blogs involving a similar case.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Greene, Kat. “Pharmacy Owner Gets 15 Years For Role In $100M Scheme.” Law360. (April 27, 2018). Web.

Manning, Margie. “New Port Richey pharmacy owner sentenced in $100 million fraud scheme.” Tampa Bay Business Journal. (April 26, 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 the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., 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 © 2018 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:24-04:00June 26, 2018|Categories: Legal Defense for Pharmacists, Pharmacist, Pharmacy Law, Pharmacy Law Blog, Uncategorized|Tags: AKS representation, Anti-Kickback Statute (AKS) defense attorney, attorney reviews of The Health Law Firm, compounding pharmacy attorney, compounding pharmacy lawyer, DOJ defense attorney, False Claims Act defense attorney, FCA defense lawyer, FCA legal counsel, FCA representation, FCA violations attorney, fraudulent practices of pharmaceutical companies, health care fraud defense attorney, health care fraud representation, health law defense attorney, legal defense of TRICARE providers, legal representation for allegations of violating Anti-Kickback Statute, legal representation for health care facilities, legal representation violating False Claims Act, pharmaceutical fraud lawyer, pharmacist defense lawter, pharmacy defense attorney, prescription reimbursement representation, representation for DOJ matters, representation for health care fraud investigations, representation for health care professionals, representation for pharmacies, representation for pharmacists, the health law firm, The Health Law Firm attorney reviews, TRICARE false claims legal defense attorney, Tricare fraud attorney, TRICARE physician representation, U.S. Department of Justice (DOJ) investigation representation|3 Comments

Florida-Based Compounding Pharmacy Violated False Claims Act by Overcharging Tricare, Feds Claim

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

On July 3, 2017, a compounding pharmacy based in Tampa, Florida, charged Tricare at least 2,000 percent more for drugs than it charged cash payers, according to the government. Teh government claimed that the Florida pharmacy acted in violation of the False Claims Act (FCA), as it intervened in a whistleblower’s suit.

The government claimed that RS Compounding LLC and its owner, Renier Gobea, knew it was illegal to provide discounts to cash payers but not the government. However, the company still went through with a scheme to do it, the partial-intervention complaint says. Prosecutors are seeking triple damages and civil penalties.

The False Claims Act provisions in Tricare cases are a little different from those in Medicare cases. In Tricare cases, recovery can be had for any “fraud, waste or abuse.” It is not limited to just fraud or false claims. Abusive claims can lead to recoveries by the government and by whistle blowers.

The Whistleblower Suit.

The suit was brought forward by former sales representative McKenzie Stepe. She filed her whistleblower suit in December 2013. Stepe’s suit alleges that RS Compounding used the average wholesale price in place of the lower acquisition cost when reporting what it paid for drugs. Additionally, the company then reported the usual and customary cost of the compounded drug to be equal to the average wholesale price, and as a result the government paid more for the drug that it needed to when reimbursing RS Compounding, the complaint says.

Between January 1, 2012, and January 31, 2014, the company was charging cash customers less without telling the government, according to the complaint.

Click here to read the complaint in full.

Unfortunately, this is not the first time a Florida pharmacy has allegedly defrauded government programs such as Tricare through compounding activities. The Tricare program is a health care program that provides benefits for U.S. military personnel, their defendants and retired military personnel.

Click here to read one of my prior blogs on a similar case against Tricare.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:

Kass, Dani. “Fla. Compounding Pharmacy Ripped Off Tricare, Feds Claim.” Law360. (July 3, 2017). Web.

“Florida Compounding Pharmacy Ripped Off Tricare.” Law of Compounding Medication. (July 4, 2017). 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., 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 © 2017 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:27-04:00May 15, 2018|Categories: Health Facilities Law Blog|Tags: Anti-Kickback Statute (AKS) defense attorney, attorney reviews of The Health Law Firm, compound medication prescriptions, compounding pharmacy attorney, compounding pharmacy lawyer, conflict of interest in physician referrals, consumer reports of health care fraud, defense attorney, False Claims Act defense attorney, FCA legal counsel, FCA violations, financial interest in physician referrals, fraud detection, fraud investigations, fraudulent practices of pharmaceutical companies, health attorney, health law firm, legal defense of military physicians, legal defense of TRICARE providers, legal representation for allegations of violating Anti-Kickback Statute, legal representation violating False Claims Act, pharmaceutical fraud lawyer, prescription reimbursement, the health law firm, The Health Law Firm attorney reviews, TRICARE false claims legal defense attorney, Tricare fraud attorney, TRICARE physician representation, Veterans Administration (VA) physician defense attorney, whistle blower lawyer|Comments Off