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Dermatologist Pays $1.74 Million Settlement in FCA Suit For Inflated Medicare Claims in Florida

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 13, 2020, a Florida dermatologist and cosmetic surgeon agreed to pay $1.74 million to resolve allegations that he violated the False Claims Act (FCA). United States Attorney Maria Chapa Lopez announced that Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, L.L.C. agreed to settle the case involving allegedly inflated Medicare claims. The settlement concludes the qui tam (whistleblowers) civil lawsuit originally filed in the United States District Court for the Middle District of Florida.

Alleged Inflated Claims to Medicare.

According to the settlement agreement, from 2011 through 2016, Dr. Tran and Village Dermatology billed for 14,000 tissue transfers, which should have been billed as lower-level wound repairs. These submissions allegedly resulted in inflated claims that Medicare paid at rates higher than it should have paid. The exaggerated claims that were submitted to Medicare were for wound repairs related to Mohs surgery, a common, in-office procedure for dermatologists.

Qui Tam, Whistleblower Provisions.

The suit was originally filed under the qui tam, or whistleblower, provisions of the False Claims Act. This law, originally enacted during the Civil War, allows a private citizen to sue on behalf of the United States for false claims the government paid; if successful in recovering money, the whistleblower shares in the recovery. The Act also allows the United States to intervene and prosecute the action. According to the DOJ, the whistleblowers in this suit will receive over $305,000 of the proceeds from the settlement it made with Dr. Tran and Village Dermatology.

This case just shows that even physicians can and should bring such claims and be rewarded for their whistleblowing activities.

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

Read about a recent case involving FCA allegations by reading one of my prior blogs here.

False Claims Act Cases Can Often be Settled Early and Greater Penalties, Including Prison, Avoided.

This case shows that getting an experienced attorney involved early in the proceedings can lead to a monetary settlement on a case for a much lower price than if it were unnecessarily and aggressively defended. False Claims Act cases carry with them the threat of a possible criminal prosecution which can result in years in prison for a physician. They could also result in civil monetary penalties in the millions of dollars. This is because the government is allowed to pursue treble dames, plus $11,500 (adjusted for inflation), plus attorneys fee and costs, for each claim. Thus, if a physician has only 100 possibly false claims that Medicare paid for $100 each, this could result in over $1,150,300.00, plus attorney fees and costs for them. 1,000 false claims, over $11 million in possible penalties.

If the physician can retain the services of an experienced health lawyer who can negotiate down the amount sought by the government millions of dollars in penalties, legal fees and lost time from medical practice may be achieved. On the other hand, in the right case, if a physician is not guilty of any false billings, these cases can be identified early and a cohesive, organized defense planned early.

Contact Health Law Attorneys Experienced with Qui Tam, Whistleblower Cases, and False Claims Act Violations.

Attorneys with The Health Law Firm represent dermatologists and other physicians, nurse practitioners and other nurses, and health professionals who need to defend a False Claims Act case, or who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups, and health facilities who have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.

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

Sources:

Pederson, Joe. “Villages doctor agrees to pay $1.7 million to settle False Claims Act Liability after inflating Medicare claims.” Orlando Sentinel. (March 13, 2020). Web.

“Villages doctor agrees to pay $1.7 million to settle False Claims Act after inflating Medicare claims.” MSN News. (March 16, 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.

Keywords: qui tam lawyer, health law attorney, dermatologist defense lawyer, Mohs surgery defense lawyer, dermatologist legal representation, legal representation in Mohs surgery litigation, The Health Law Firm, health law attorney, health law defense lawyer, health care fraud attorney, whistle blower attorney, Anti-Kickback Statute (AKS) attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, complex medical litigation defense lawyer, complex health care litigation defense attorney, legal representation in complex medical business litigation, FCA legal representation, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

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

By |2020-05-07T12:54:14-04:00June 18th, 2020|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Dermatologist Pays $1.74 Million To Settle Medicaid FCA 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 March 13, 2020, a Florida dermatologist and cosmetic surgeon agreed to pay $1.74 million to resolve allegations that he violated the False Claims Act (FCA). United States Attorney Maria Chapa Lopez announced that Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, L.L.C. agreed to settle the case involving allegedly inflated Medicare claims. The settlement concludes the qui tam (whistleblowers) civil lawsuit originally filed in the United States District Court for the Middle District of Florida.

Inflated Claims to Medicare Alleged in Suit.

According to the settlement agreement, from 2011 through 2016, Dr. Tran and Village Dermatology billed for 14,000 tissue transfers, which should have been billed as lower-level wound repairs. These submissions allegedly resulted in inflated claims that Medicare paid at rates higher than it should have paid. The exaggerated claims that were submitted to Medicare were for wound repairs related to Mohs surgery, a common, in-office procedure for dermatologists.

Qui Tam, Whistleblower Provisions.

The suit was originally filed under the qui tam, or whistleblower, provisions of the False Claims Act. This law, originally enacted during the Civil War, allows a private citizen to sue on behalf of the United States for false claims the government paid; if successful in recovering money, the whistleblower shares in the recovery. The Act also allows the United States to intervene and prosecute the action. According to the DOJ, the whistleblowers in this suit will receive over $305,000 of the proceeds from the settlement it made with Dr. Tran and Village Dermatology.

This case just shows that even physicians can and should bring such claims and be rewarded for their whistleblowing activities.

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

Read about a recent case involving FCA allegations by reading one of my prior blogs here.

False Claims Act Cases Can Often be Settled Early and Greater Penalties, Including Prison, Avoided.

This case shows that getting an experienced attorney involved early in the proceedings can lead to a monetary settlement on a case for a much lower price than if it were unnecessarily and aggressively defended. False Claims Act cases carry with them the threat of a possible criminal prosecution which can result in years in prison for a physician. They could also result in civil monetary penalties in the millions of dollars. This is because the government is allowed to pursue treble dames, plus $11,500 (adjusted for inflation), plus attorneys fee and costs, for each claim. Thus, if a physician has only 100 possibly false claims that Medicare paid for $100 each, this could result in over $1,150,300.00, plus attorney fees and costs for them. 1,000 false claims, over $11 million in possible penalties.

If the physician can retain the services of an experienced health lawyer who can negotiate down the amount sought by the government millions of dollars in penalties, legal fees and lost time from medical practice may be achieved. On the other hand, in the right case, if a physician is not guilty of any false billings, these cases can be identified early and a cohesive, organized defense planned early.

Contact Health Law Attorneys Experienced with Qui Tam, Whistleblower Cases, and False Claims Act Violations.

Attorneys with The Health Law Firm represent dermatologists and other physicians, nurse practitioners and other nurses, and health professionals who need to defend a False Claims Act case, or who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups, and health facilities who have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.

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

Sources:

Pederson, Joe. “Villages doctor agrees to pay $1.7 million to settle False Claims Act Liability after inflating Medicare claims.” Orlando Sentinel. (March 13, 2020). Web.

“Villages doctor agrees to pay $1.7 million to settle False Claims Act after inflating Medicare claims.” MSN News. (March 16, 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.

Keywords: qui tam lawyer, health law attorney, dermatologist defense lawyer, Mohs surgery defense lawyer, dermatologist legal representation, legal representation in Mohs surgery litigation, The Health Law Firm, health law attorney, health law defense lawyer, health care fraud attorney, whistle blower attorney, Anti-Kickback Statute (AKS) attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, complex medical litigation defense lawyer, complex health care litigation defense attorney, legal representation in complex medical business litigation, FCA legal representation, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

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

By |2020-05-07T12:48:38-04:00May 28th, 2020|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Dermatologist in Florida Agrees to Pay $1.74 Million To Settle Medicaid FCA 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 March 13, 2020, a Florida dermatologist and cosmetic surgeon agreed to pay $1.74 million to resolve allegations that he violated the False Claims Act (FCA). United States Attorney Maria Chapa Lopez announced that Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, L.L.C. agreed to settle the case involving allegedly inflated Medicare claims. The settlement concludes the qui tam (whistleblowers) civil lawsuit originally filed in the United States District Court for the Middle District of Florida.

Inflated Claims to Medicare Claimed in Suit.

According to the settlement agreement, from 2011 through 2016, Dr. Tran and Village Dermatology billed for 14,000 tissue transfers, which should have been billed as lower-level wound repairs. These submissions allegedly resulted in inflated claims that Medicare paid at rates higher than it should have paid. The exaggerated claims that were submitted to Medicare were for wound repairs related to Mohs surgery, a common, in-office procedure for dermatologists.

Qui Tam, Whistleblower Provisions.

The suit was originally filed under the qui tam, or whistleblower, provisions of the False Claims Act. This law, originally enacted during the Civil War, allows a private citizen to sue on behalf of the United States for false claims the government paid; if successful in recovering money, the whistleblower shares in the recovery. The Act also allows the United States to intervene and prosecute the action. According to the DOJ, the whistleblowers in this suit will receive over $305,000 of the proceeds from the settlement it made with Dr. Tran and Village Dermatology.

This case just shows that even physicians can and should bring such claims and be rewarded for their whistleblowing activities.

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

Read about a recent case involving FCA allegations by reading one of my prior blogs here.

False Claims Act Cases Can Often be Settled Early and Greater Penalties, Including Prison, Avoided.

This case shows that getting an experienced attorney involved early in the proceedings can lead to a monetary settlement on a case for a much lower price than if it were unnecessarily and aggressively defended. False Claims Act cases carry with them the threat of a possible criminal prosecution which can result in years in prison for a physician. They could also result in civil monetary penalties in the millions of dollars. This is because the government is allowed to pursue treble dames, plus $11,500 (adjusted for inflation), plus attorneys fee and costs, for each claim. Thus, if a physician has only 100 possibly false claims that Medicare paid for $100 each, this could result in over $1,150,300.00, plus attorney fees and costs for them. 1,000 false claims, over $11 million in possible penalties.

If the physician can retain the services of an experienced health lawyer who can negotiate down the amount sought by the government millions of dollars in penalties, legal fees and lost time from medical practice may be achieved. On the other hand, in the right case, if a physician is not guilty of any false billings, these cases can be identified early and a cohesive, organized defense planned early.

Contact Health Law Attorneys Experienced with Qui Tam, Whistleblower Cases, and False Claims Act Violations.

Attorneys with The Health Law Firm represent dermatologists and other physicians, nurse practitioners and other nurses, and health professionals who need to defend a False Claims Act case, or who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups, and health facilities who have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters.

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

Sources:

Pederson, Joe. “Villages doctor agrees to pay $1.7 million to settle False Claims Act Liability after inflating Medicare claims.” Orlando Sentinel. (March 13, 2020). Web.

“Villages doctor agrees to pay $1.7 million to settle False Claims Act after inflating Medicare claims.” MSN News. (March 16, 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.

Keywords: qui tam lawyer, health law attorney, dermatologist defense lawyer, Mohs surgery defense lawyer, dermatologist legal representation, legal representation in Mohs surgery litigation, The Health Law Firm, health law attorney, health law defense lawyer, health care fraud attorney, whistle blower attorney, Anti-Kickback Statute (AKS) attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, complex medical litigation defense lawyer, complex health care litigation defense attorney, legal representation in complex medical business litigation, FCA legal representation, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

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

By |2020-05-07T12:43:17-04:00May 7th, 2020|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Massachusetts Mental Health Centers Submitted False Claims According to Suit

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 January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.

The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”

According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.

The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.

Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.

There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:

Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.

Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 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.

KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, psychiatrist and psychologist defense attorney, medical group defense attorney, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense counsel, psychiatrist and psychologist defense counsel, Board of Medicine and Psychology license defense attorney, Board of Medicine and Psychology license defense lawyer, Board of Medicine and Psychology license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, mental health facilities defense counsel, mental health facilities defense attorney, mental health facilities defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, mental health counselor and social worker defense attorney, mental health counselor and social worker defense lawyer, mental health counselor and social worker defense counsel.

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2018 The Health Law Firm. All rights reserved

By |2020-02-13T14:32:53-05:00May 15th, 2018|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |1 Comment

Massachusetts Mental Health Centers Submitted False Claims According to Suit

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

On January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.

The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”

According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.

The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.

Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.

There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:

Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.

Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 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.

KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, psychiatrist and psychologist defense attorney, medical group defense attorney, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense counsel, psychiatrist and psychologist defense counsel, Board of Medicine and Psychology license defense attorney, Board of Medicine and Psychology license defense lawyer, Board of Medicine and Psychology license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, mental health facilities defense counsel, mental health facilities defense attorney, mental health facilities defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, mental health counselor and social worker defense attorney, mental health counselor and social worker defense lawyer, mental health counselor and social worker defense counsel

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2018 The Health Law Firm. All rights reserved

By |2020-02-12T15:48:22-05:00May 15th, 2018|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Kmart Agrees to Pay $32.3 million to Settle Whistle Blower’s False Claims Act Suit

PS 3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 22, 2017, Kmart Corporation agreed to pay $32.3 million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

The Whistle Blower False Claims Act (FCA) Suit.

The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). This provision permits private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.

The 2008 lawsuit, which was filed by a former Kmart pharmacist, alleged that Kmart pharmacies offered discounted generic drug prices to cash paying customers through various club programs. The pharmacies then knowingly failed to disclose those prices when reporting to federal health programs. According to the suit, in one case, Kmart had sold a 30-day supply of a generic version of a prescription drug for $5 to customers of its discount program, but then filed for reimbursement from the government for $152 for that same drug for its Medicare customers.
To read more on the 2008 suit, click here.

The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The former pharmacist will receive a whistle blower award of $9.3 million. The case was heard in the U.S. District Court in the Southern District of Illinois.

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

To read about a similar case of a pharmacy inflating prices to government health care programs, click here to read one of my prior blogs.

Who Knew Medicare Part D Claims Could Yield Such Big Whistle Blower Settlements?

Who knew Medicare part D claims could yield such big whistle blower settlements? I know I didn’t. I didn’t even think about such claims until I read this case. This could mean some serious compliance issues for big chain stores that have pharmacies (note that I said “could”). Walmart, Publix, Albertsons, Costco, Sam’s Club, Winn Dixie, Engel’s, and every other chain that owns and operates pharmacies, may be in jeopardy.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim (the whistle blower). We have also defended health professionals and institutions in litigation of whistle blower complaints filed against them.

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

Sources:

McCausland, Phil. “Kmart to pay $32.3M to settle health care-related whistleblower case.” NBC News. (December 22, 2017). Web.

The Associated Press. “Kmart to pay $32.3 million to settle prescription drugs case.” ABC News. (December 22, 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.

KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, pharmacy defense attorney, pharmacist defense attorney, pharmacy defense lawyer, pharmacist defense lawyer, pharmacy defense counsel, pharmacist defense counsel, Board of Pharmacy license defense attorney, Board of Pharmacy license defense lawyer, Board of Pharmacy license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel

 

“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 |2018-03-15T18:28:21-04:00May 15th, 2018|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Qui Tam Cases: If You Are Thinking About Blowing the Whistle, Follow These Tips

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

At The Health Law Firm, we have represented many clients that were involved in qui tam cases brought because of false claims under the Medicare False Claims Act (FCA).  We have defended health facilities and health professionals, but we have also brought whistle blower cases against health facilities and health professionals, representing the whistle blower.  If you are thinking about blowing the whistle on any type of fraud or unlawful conduct by your current or former employer, there are important facts that you should know.

Filing a qui tam (whistle blower) case can be complicated, complex, and time consuming.  It’s important to seek experienced legal counsel to guide you through the difficult process. It is crucial that a whistle blower’s attorney have a good working relationship with the U.S. Attorney’s Office and the State Attorney’s Office, as well.
Based on years of experience with these types of cases, from both sides, here are some key tips to remember if you are thinking about filing a qui tam or whistle blower suit:

1.     You Are Doing the Right Thing.  It is important to remember in qui tam cases that you are doing the right thing. Qui tam whistle blowers often save taxpayers millions of dollars and help the government recover stolen funds by coming forward with cases of fraud or unlawful conduct.  Additionally, they help to put an end to fraudulent activities and illegal conduct that may harm patients.

2.     Choose an Experienced Attorney.  Because filing a qui tam suit under the False Claims Act (FCA) can be a difficult and complicated task, choosing an attorney with the proper experience is very important. Litigation of whistle blower cases, either prosecuting them or defending them, is a highly complex, technical area of law and not all attorneys have the experience to make the process easier, let alone be successful.

3.     Don’t Drag Your Feet If You Have Evidence of Fraud.  Once you have evidence of fraud, you need to act quickly or you may lose your opportunity to receive a monetary award. The FCA limits the time in which a suit can be filed. Generally, a qui tam suit must be filed within six years of the date the fraud was committed. Most qui tam laws, including the FCA also have a “first to file” rule. This means that a qui tam whistle blower must be the first to file a case in order to be eligible to receive an award.  Additionally, if the fraud becomes public knowledge or the government discovers the fraud on its own, it is too late for the whistle blower.

4.     Whistleblowers Are Legally Protected from Retaliation by the False Claims Act.  One concern clients have when filing a qui tam suit, is the effect it might have on their future professional career as well as their personal life.
First, because the case is filed under seal, there is no record of any kind that even shows a case has been filed, much less the name of the person filing it.  The U.S. Attorney and its investigators (including the FBI and the OIG Special Agents) will know, but they ain’t telling.  It often takes several years before the court will order the case unsealed. Second, the False Claims Act contains a provision that prohibits any type of retaliation against the whistle blower. The act  makes it unlawful for any employer to retaliate against you for exercising your rights as a whistle blower.  Additionally, if it occurs, you will have a separate right to sue an employer just for the retaliation.  I saw a whistle blower case recently which the court dismissed because there wasn’t specific information contained in the complaint about any false claim being submitted.  However, because the employer had retaliated against the whistle blower, the court did not dismiss the whistle blower’s claim for wrongful retaliation against the employer.  This was a big mistake by the employer.

5.     Silence is Golden in Qui Tam Cases. Do not discuss your case with anyone but your lawyer. Do not tell your friends. Do not tell your family. Do not even disclose that you are thinking of filing a lawsuit. Public discussions can be detrimental to your case. Qui tam suits are filed under the “seal” provision of the FCA, which prohibits the disclosure of any aspect of the case to anyone without prior court approval.

6.    Most Important, Documentation of Actual False Claims is Required. Recent court cases have strictly emphasized the requirement that you must have documented proof of actual false claims being submitted to the government.  Whether these are copies of claims, copies of superbills, copies of explanations of benefits (EOBs), copies of ledgers, copies of book keeping documents or whatever, you must have several actual claims that are false that were submitted for payment.  You must be able to specifiy these by patient name, date of service, CPT code billed, amount billed, etc.  Internal memos, policies and procedures, billing guidance and instructions, medical record entries, and other documents that show the employer’s intent to defraud the government are useful in showing a conspiracy, or organized scheme to falsely bill. However, you must also have copies of false claims documentation, as well.

Remember: Those who file qui tam cases under the FCA are valuable and important for our nation’s health care system. They help stop health care fraud and help the government recover billions of dollars. They prevent the theft or waste of millions of dollars that could be spent on actual, needed health care.  They also help prevent harm that may be caused to patients from receiving substandard treatment, unnecessary procedures and treatments or no treatment. Through qui tam lawsuits, whistle blowers have stopped harmful practices that endanger the health and lives of Medicare, Medicaid, Tricare and VA patients.

For more information, read my prior blog on whistleblowers who report fraud.

Contact an Experienced Health Law Attorney to Assist in Whistle blower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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

KeyWords: False Claims Act, FCA defense attorney, legal representation for FCA violations, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, whistle blower attorney, complex health care litigation defense attorney, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense lawyer, medical professionals defense counsel, medical professionals defense lawyer, medical professional 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 © 2018 The Health Law Firm. All rights reserved.

Qui Tam Cases: If You Are Thinking About Blowing the Whistle, Follow These Tips

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At The Health Law Firm, we have represented many clients that were involved in qui tam cases brought because of false claims under the Medicare False Claims Act (FCA).  We have defended health facilities and health professionals, but we have also brought whistle blower cases against health facilities and health professionals, representing the whistle blower.  If you are thinking about blowing the whistle on any type of fraud or unlawful conduct by your current or former employer, there are important facts that you should know.

Filing a qui tam (whistle blower) case can be complicated, complex, and time consuming.  It’s important to seek experienced legal counsel to guide you through the difficult process. It is crucial that a whistle blower’s attorney have a good working relationship with the U.S. Attorney’s Office and the State Attorney’s Office, as well.
Based on years of experience with these types of cases, from both sides, here are some key tips to remember if you are thinking about filing a qui tam or whistle blower suit:

1.     You Are Doing the Right Thing.  It is important to remember in qui tam cases that you are doing the right thing. Qui tam whistle blowers often save taxpayers millions of dollars and help the government recover stolen funds by coming forward with cases of fraud or unlawful conduct.  Additionally, they help to put an end to fraudulent activities and illegal conduct that may harm patients.

2.     Choose an Experienced Attorney.  Because filing a qui tam suit under the False Claims Act (FCA) can be a difficult and complicated task, choosing an attorney with the proper experience is very important. Litigation of whistle blower cases, either prosecuting them or defending them, is a highly complex, technical area of law and not all attorneys have the experience to make the process easier, let alone be successful.

3.     Don’t Drag Your Feet If You Have Evidence of Fraud.  Once you have evidence of fraud, you need to act quickly or you may lose your opportunity to receive a monetary award. The FCA limits the time in which a suit can be filed. Generally, a qui tam suit must be filed within six years of the date the fraud was committed. Most qui tam laws, including the FCA also have a “first to file” rule. This means that a qui tam whistle blower must be the first to file a case in order to be eligible to receive an award.  Additionally, if the fraud becomes public knowledge or the government discovers the fraud on its own, it is too late for the whistle blower.

4.     Whistleblowers Are Legally Protected from Retaliation by the False Claims Act.  One concern clients have when filing a qui tam suit, is the effect it might have on their future professional career as well as their personal life.
First, because the case is filed under seal, there is no record of any kind that even shows a case has been filed, much less the name of the person filing it.  The U.S. Attorney and its investigators (including the FBI and the OIG Special Agents) will know, but they ain’t telling.  It often takes several years before the court will order the case unsealed. Second, the False Claims Act contains a provision that prohibits any type of retaliation against the whistle blower. The act  makes it unlawful for any employer to retaliate against you for exercising your rights as a whistle blower.  Additionally, if it occurs, you will have a separate right to sue an employer just for the retaliation.  I saw a whistle blower case recently which the court dismissed because there wasn’t specific information contained in the complaint about any false claim being submitted.  However, because the employer had retaliated against the whistle blower, the court did not dismiss the whistle blower’s claim for wrongful retaliation against the employer.  This was a big mistake by the employer.

5.     Silence is Golden in Qui Tam Cases. Do not discuss your case with anyone but your lawyer. Do not tell your friends. Do not tell your family. Do not even disclose that you are thinking of filing a lawsuit. Public discussions can be detrimental to your case. Qui tam suits are filed under the “seal” provision of the FCA, which prohibits the disclosure of any aspect of the case to anyone without prior court approval.

6.    Most Important, Documentation of Actual False Claims is Required. Recent court cases have strictly emphasized the requirement that you must have documented proof of actual false claims being submitted to the government.  Whether these are copies of claims, copies of superbills, copies of explanations of benefits (EOBs), copies of ledgers, copies of book keeping documents or whatever, you must have several actual claims that are false that were submitted for payment.  You must be able to specifiy these by patient name, date of service, CPT code billed, amount billed, etc.  Internal memos, policies and procedures, billing guidance and instructions, medical record entries, and other documents that show the employer’s intent to defraud the government are useful in showing a conspiracy, or organized scheme to falsely bill. However, you must also have copies of false claims documentation, as well.

Remember: Those who file qui tam cases under the FCA are valuable and important for our nation’s health care system. They help stop health care fraud and help the government recover billions of dollars. They prevent the theft or waste of millions of dollars that could be spent on actual, needed health care.  They also help prevent harm that may be caused to patients from receiving substandard treatment, unnecessary procedures and treatments or no treatment. Through qui tam lawsuits, whistle blowers have stopped harmful practices that endanger the health and lives of Medicare, Medicaid, Tricare and VA patients.

For more information, read my prior blog on whistleblowers who report fraud.

Contact an Experienced Health Law Attorney to Assist in Whistle blower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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

KeyWords: False Claims Act, FCA defense attorney, legal representation for FCA violations, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, whistle blower attorney, complex health care litigation defense attorney, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense lawyer, medical professionals defense counsel, medical professionals defense lawyer, medical professional 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 © 2018 The Health Law Firm. All rights reserved.

Kmart Agrees to Pay $32.3 million to Settle Whistle Blower’s False Claims Act Suit

PS 3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 22, 2017, Kmart Corporation agreed to pay $32.3 million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

The Whistle Blower False Claims Act (FCA) Suit.

The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). This provision permits private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.

The 2008 lawsuit, which was filed by a former Kmart pharmacist, alleged that Kmart pharmacies offered discounted generic drug prices to cash paying customers through various club programs. The pharmacies then knowingly failed to disclose those prices when reporting to federal health programs. According to the suit, in one case, Kmart had sold a 30-day supply of a generic version of a prescription drug for $5 to customers of its discount program, but then filed for reimbursement from the government for $152 for that same drug for its Medicare customers.
To read more on the 2008 suit, click here.

The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The former pharmacist will receive a whistle blower award of $9.3 million. The case was heard in the U.S. District Court in the Southern District of Illinois.

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

To read about a similar case of a pharmacy inflating prices to government health care programs, click here to read one of my prior blogs.

Who Knew Medicare Part D Claims Could Yield Such Big Whistle Blower Settlements?

Who knew Medicare part D claims could yield such big whistle blower settlements? I know I didn’t. I didn’t even think about such claims until I read this case. This could mean some serious compliance issues for big chain stores that have pharmacies (note that I said “could”). Walmart, Publix, Albertsons, Costco, Sam’s Club, Winn Dixie, Engel’s, and every other chain that owns and operates pharmacies, may be in jeopardy.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim (the whistle blower). We have also defended health professionals and institutions in litigation of whistle blower complaints filed against them.

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

Sources:

McCausland, Phil. “Kmart to pay $32.3M to settle health care-related whistleblower case.” NBC News. (December 22, 2017). Web.

The Associated Press. “Kmart to pay $32.3 million to settle prescription drugs case.” ABC News. (December 22, 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.

KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, pharmacy defense attorney, pharmacist defense attorney, pharmacy defense lawyer, pharmacist defense lawyer, pharmacy defense counsel, pharmacist defense counsel, Board of Pharmacy license defense attorney, Board of Pharmacy license defense lawyer, Board of Pharmacy license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel

 

“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 |2018-01-30T07:21:11-05:00May 15th, 2018|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Qui Tam Cases: If You Are Thinking About Blowing the Whistle, Follow These Tips

Headshot of The Health Law Firm's 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

At The Health Law Firm, we have represented many clients that were involved in qui tam cases brought because of false claims under the Medicare False Claims Act (FCA).  We have defended health facilities and health professionals, but we have also brought whistle blower cases against health facilities and health professionals, representing the whistle blower.  If you are thinking about blowing the whistle on any type of fraud or unlawful conduct by your current or former employer, there are important facts that you should know.

Filing a qui tam (whistle blower) case can be complicated, complex, and time consuming.  It’s important to seek experienced legal counsel to guide you through the difficult process. It is crucial that a whistle blower’s attorney have a good working relationship with the U.S. Attorney’s Office and the State Attorney’s Office, as well.
Based on years of experience with these types of cases, from both sides, here are some key tips to remember if you are thinking about filing a qui tam or whistle blower suit:

1.     You Are Doing the Right Thing.  It is important to remember in qui tam cases that you are doing the right thing. Qui tam whistle blowers often save taxpayers millions of dollars and help the government recover stolen funds by coming forward with cases of fraud or unlawful conduct.  Additionally, they help to put an end to fraudulent activities and illegal conduct that may harm patients.

2.     Choose an Experienced Attorney.  Because filing a qui tam suit under the False Claims Act (FCA) can be a difficult and complicated task, choosing an attorney with the proper experience is very important. Litigation of whistle blower cases, either prosecuting them or defending them, is a highly complex, technical area of law and not all attorneys have the experience to make the process easier, let alone be successful.

3.     Don’t Drag Your Feet If You Have Evidence of Fraud.  Once you have evidence of fraud, you need to act quickly or you may lose your opportunity to receive a monetary award. The FCA limits the time in which a suit can be filed. Generally, a qui tam suit must be filed within six years of the date the fraud was committed. Most qui tam laws, including the FCA also have a “first to file” rule. This means that a qui tam whistle blower must be the first to file a case in order to be eligible to receive an award.  Additionally, if the fraud becomes public knowledge or the government discovers the fraud on its own, it is too late for the whistle blower.

4.     Whistleblowers Are Legally Protected from Retaliation by the False Claims Act.  One concern clients have when filing a qui tam suit, is the effect it might have on their future professional career as well as their personal life.
First, because the case is filed under seal, there is no record of any kind that even shows a case has been filed, much less the name of the person filing it.  The U.S. Attorney and its investigators (including the FBI and the OIG Special Agents) will know, but they ain’t telling.  It often takes several years before the court will order the case unsealed. Second, the False Claims Act contains a provision that prohibits any type of retaliation against the whistle blower. The act  makes it unlawful for any employer to retaliate against you for exercising your rights as a whistle blower.  Additionally, if it occurs, you will have a separate right to sue an employer just for the retaliation.  I saw a whistle blower case recently which the court dismissed because there wasn’t specific information contained in the complaint about any false claim being submitted.  However, because the employer had retaliated against the whistle blower, the court did not dismiss the whistle blower’s claim for wrongful retaliation against the employer.  This was a big mistake by the employer.

5.     Silence is Golden in Qui Tam Cases. Do not discuss your case with anyone but your lawyer. Do not tell your friends. Do not tell your family. Do not even disclose that you are thinking of filing a lawsuit. Public discussions can be detrimental to your case. Qui tam suits are filed under the “seal” provision of the FCA, which prohibits the disclosure of any aspect of the case to anyone without prior court approval.

6.    Most Important, Documentation of Actual False Claims is Required. Recent court cases have strictly emphasized the requirement that you must have documented proof of actual false claims being submitted to the government.  Whether these are copies of claims, copies of superbills, copies of explanations of benefits (EOBs), copies of ledgers, copies of book keeping documents or whatever, you must have several actual claims that are false that were submitted for payment.  You must be able to specifiy these by patient name, date of service, CPT code billed, amount billed, etc.  Internal memos, policies and procedures, billing guidance and instructions, medical record entries, and other documents that show the employer’s intent to defraud the government are useful in showing a conspiracy, or organized scheme to falsely bill. However, you must also have copies of false claims documentation, as well.

Remember: Those who file qui tam cases under the FCA are valuable and important for our nation’s health care system. They help stop health care fraud and help the government recover billions of dollars. They prevent the theft or waste of millions of dollars that could be spent on actual, needed health care.  They also help prevent harm that may be caused to patients from receiving substandard treatment, unnecessary procedures and treatments or no treatment. Through qui tam lawsuits, whistle blowers have stopped harmful practices that endanger the health and lives of Medicare, Medicaid, Tricare and VA patients.

For more information, read my prior blog on whistleblowers who report fraud.

Contact an Experienced Health Law Attorney to Assist in Whistle blower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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

KeyWords: False Claims Act, FCA defense attorney, legal representation for FCA violations, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, whistle blower attorney, complex health care litigation defense attorney, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense lawyer, medical professionals defense counsel, medical professionals defense lawyer, medical professional 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 © 2018 The Health Law Firm. All rights reserved.

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