What You Need to Know Right Now If the DEA is Knocking on Your Door!

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

Is the Drug Enforcement Administration (DEA) knocking at your door or, even worse, going through your files inside your office?

If so, this is what you need to know right now!

YES, you do have the right to call your attorney. Call your attorney right now. If you cannot, ask one of your employees or spouse to call your attorney. Get your attorney involved right now!

NO, do not sign a document to relinquish or voluntarily give up your DEA registration number. If you do so, this will probably be the biggest mistake you make in your life.

NO, do not sign a document waiving your right to a grand jury investigation before the DEA is authorized to charge you. Why would you voluntarily give up one of your most important constitutional rights?


Don’t Get Fooled By What the DEA Agents Tell You.

The DEA has the reputation (and, in my experience, deservedly so) of making false statements to individuals about what will happen to them or not happen to them if they do not “Cooperate” with the DEA by giving up their rights.

Often they will handcuff the pharmacist or the physician who is the subject of their raid, search warrant, or subpoena as a method of intimidating them. Then they will threaten the person by arresting them and jailing them immediately if they do not sign a “voluntary” relinquishment of their DEA registration. Yet once you do this, your DEA registration is gone, and you will most likely never get one again.

We have even had the report from a physician recently where the DEA agents, during executing a search warrant (not an arrest warrant, by the way), of having the doctor sign a document waiving her right to having a grand jury hearing on any charges she may have been facing. The threat was that she needed to waive her rights or be arrested on the spot and taken to jail. She signed without consulting an attorney.

If you are a pharmacist or pain management physician, or you own or operate a pain management practice, or if you prescribe or dispense opioids, you must have the name and phone number of a good health lawyer and a good criminal lawyer on hand and post at all times! It is only a matter of time before you need to use it.

Have this information in your wallet and taped to every telephone and computer in your office. But use it right away. Call your attorney right away. Your attorney will come over or brief you on what to do or not do.

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, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2022 The Health Law Firm. All rights reserved.

By |2024-03-14T20:00:41-04:00March 16, 2024|Categories: Medical Education Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on What You Need to Know Right Now If the DEA is Knocking on Your Door!

Is the DEA Knocking on Your Door? What You Need to Know Right Now!

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

Is the Drug Enforcement Administration (DEA) knocking at your door or, even worse, going through your files inside your office?

This is what you need to know right now!

YES, you do have the right to call your attorney. Call your attorney right now. If you cannot, ask one of your employees or spouse to call your attorney. Get your attorney involved right now!

NO, do not sign a document to relinquish or voluntarily give up your DEA registration number. If you do so, this will probably be the biggest mistake you make of your life.

NO, do not sign a document waiving your right to a grand jury investigation before the DEA is authorized to charge you. Why would you want to voluntarily give up one of your most important constitutional rights?


Don’t be fooled by what the DEA agents tell you.

The DEA has the reputation (and, in my experience, deservedly so) of making false statements to individuals about what will happen to them or not happen to them if they do not “Cooperate” with the DEA by giving up their rights.

Often they will handcuff the pharmacist or the physician who is the subject of their raid, search warrant, or subpoena as a method of intimidating them. Then they will threaten the person by arresting them and jailing them immediately if they do not sign a “voluntary” relinquishment of their DEA registration. Yet once you do this, your DEA registration is gone, and you will most likely never get one again.

We have even had the report from a physician recently where the DEA agents, during executing a search warrant (not an arrest warrant, by the way), of having the doctor sign a document waiving her right to having a grand jury hearing on any charges she may have been facing. The threat was that she needed to waive her rights or be arrested on the spot and taken to jail. She signed without consulting an attorney.

If you are a pharmacist or pain management physician, or you own or operate a pain management practice, or if you prescribe or dispense opioids, you must have the name and phone number of a good health lawyer and a good criminal lawyer on hand and post at all times! It is only a matter of time before you need to use it.

Have this information in your wallet and taped to every telephone and computer in your office. But use it right away. Call your attorney right away. Your attorney will come over or brief you on what to do or not do.

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, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2022 The Health Law Firm. All rights reserved.

By |2024-03-14T09:59:11-04:00March 2, 2024|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Is the DEA Knocking on Your Door? What You Need to Know Right Now!

Florida Pharmacy Owner Pleads Guilty For Role in $8.3 Million Medicare Fraud Scheme

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

On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 million scheme. The scheme involved securing orders for medically unnecessary prescriptions billed to Medicare and paying bribes and kickbacks, the Department of Justice (DOJ) announced. Read the DOJ’s press release here. Read the DOJ’s press release here.

The Fraudulent Scheme.

Michael Murphy allegedly invested in Cure Pharmacy in Jacksonville, Florida, and two other pharmacies participated in the Medicare program. From around November 2019 through March 2021, the government alleged, Murphy and his co-conspirators paid kickbacks and bribes to telemarketing companies to recruit Medicare beneficiaries to accept prescriptions for various medications. According to court documents, the medicines were mainly topical creams, which the beneficiaries usually did not want or need.

Additionally, they paid kickbacks and bribes to telemedicine companies that employed or contracted with physicians who signed the prescriptions. According to court documents, the physicians typically signed the prescriptions after a cursory telephone conversation or without contact with beneficiaries. After obtaining Medicare beneficiary information and the signed medications, the pharmacy owner and co-conspirators submitted claims to Medicare, sometimes through multiple pharmacies they owned and controlled in practice known as “recycling.”
In total, they were reimbursed $8.3 million by Medicare Part D.

The Repercussions of the Guilty Plea to Conspiracy to Commit Health Care Fraud.

Murphy pleaded guilty to one count of conspiracy to commit healthcare fraud. He faces a maximum of 10 years in prison. According to the DOJ, a federal district court judge will determine his actual sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Click here to read about a similar case involving a Florida pharmacy owner.

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, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

American Health Law Association. “Pharmacy Owner Pleads Guilty in $8.3 Million Fraud Scheme.” AHLA Health Law Weekly. (September 30, 2022). Web.

“Pharmacy Owner Pleads Guilty in $8.3 Million Fraud Scheme.” Bloomburg Law. (September 30, 2022). Web.

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

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

KeyWords: False Claims Act defense attorney, FCA legal counsel, FCA defense lawyer, Anti-Kickback Statute (AKS) defense attorney, FCA representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, FCA violations attorney, health care fraud representation, DEA defense representation,  health law defense attorney, health care fraud defense attorney, The Health Law Firm, representation for health care fraud investigations, compounding pharmacy lawyer, prescription reimbursement representation, pharmacy defense attorney, pharmacist defense lawyer, representation for pharmacies, representation for pharmacists, legal representation for health care facilities, representation for health care professionals, U.S. Department of Justice (DOJ) investigation representation, DOJ defense attorney, representation for DOJ matters, attorney reviews of The Health Law Firm, The Health Law Firm attorney reviews, defense of Medicare audits and investigations, Medicaid audits and investigations, pharmacy and pharmacists audits, defense of DEA investigations and subpoenas and audits, Medicaid audit defense lawyer, representation for DEA investigation, pharmacy 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 © 2022 The Health Law Firm. All rights reserved.

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

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

On 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.

KeyWords: Legal representation for pharmacists, pharmacy lawyer, legal representation for pharmacies, pharmacists lawyer, legal representation for healthcare fraud, health care fraud representation, healthcare fraud defense lawyer, legal representation for submitting false claims to the government, False Claims Act defense attorney, FCA legal counsel, FCA defense lawyer, Anti-Kickback Statute (AKS) defense attorney, FCA representation, legal representation for allegations of violating Anti-Kickback Statute, AKS representation, 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, Medicare audit defense attorney, ZPIC audit defense lawyer, RAC audit defense legal counsel, pharmacy Tricare audit defense attorney, Medicare pharmacy defense lawyer, Medicaid audit of pharmacy defense counsel, pharmacy defense attorney for overpayment demand, pharmacy civil fine defense attorney, pharmacy DEA defense attorney, pharmacy Order to Show Cause (OTSC) defense lawyer, Medicare Fraud Control Unit (MFCU) investigation defense legal counsel, pharmacy administrative and civil litigation attorney, health care fraud defense legal representation, TRICARE fraud attorney, health law defense attorney, health care fraud defense attorney, The Health Law Firm, representation for health care fraud investigations, compounding pharmacy lawyer, prescription reimbursement representation, pharmacy defense attorney, pharmacist defense lawter, representation for pharmacies, representation for pharmacists, legal representation for health care facilities, representation for health care professionals, legal defense of TRICARE providers, U.S. Department of Justice (DOJ) investigation representation, DOJ defense attorney, representation for DOJ matters, attorney reviews of The Health Law Firm, 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 © 2018 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:19-04:00December 26, 2018|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Pharmacist Gets More Than Six Years in Prison For Role in Compounding Fraud Scheme

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

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

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 DEADOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigationadministrative 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.

KeyWords: False Claims Act defense attorneyFCA legal counselFCA defense lawyer, Anti-Kickback Statute (AKSdefense attorneyFCA representation, legal representation for allegations of violating Anti-Kickback StatuteAKS representation, 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, FCA violations attorneyhealth care fraud representation, TRICARE fraud attorneyhealth law defense attorneyhealth care fraud defense attorney, The Health Law Firm, representation for health care fraud investigations, compounding pharmacy lawyer, prescription reimbursement representation, pharmacy defense attorneypharmacist defense lawter, representation for pharmacies, representation for pharmacistslegal representation for health care facilities, representation for health care professionals, legal defense of TRICARE providers, U.S. Department of Justice (DOJ) investigation representation, DOJ defense attorney, representation for DOJ matters, attorney reviews of The Health Law Firm, 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 © 2018 The Health Law Firm. All rights reserved.

New DOJ Memo Shifting Government Policy in False Claims Act Cases Should make Healthcare Providers Happy!

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 29, 2018, the U.S. Department of Justice (DOJ) released a new internal memorandum that we believe signals a backing-off of government support for False Claims Act cases. The memorandum sent by Associate Attorney General Rachel Brand, references “vast reams” of government agency guidance explaining the government’s views and interpretation of various laws. It includes laws related to requirements for accurate billing of Medicare and Medicaid by healthcare providers.

The “Brand Memorandum.”

In the memo, Brand said the DOJ “may not use its enforcement authority to effectively convert agency guidance documents into binding rules.” The memo is a product of Attorney General Jeff Sessions’ move in November 2017, to curtail “regulation by guidance.”

It states that it specifically applies to civil enforcement of laws, including the False Claims Act (FCA), that the Associate Attorney General oversees.

Click here to view the DOJ’s Brand Memorandum in full on our website.

Implications of the Brand Memorandum.

Brand’s memorandum stopped short of completely forbidding the use of agency guidance in support of DOJ cases. The memorandum indicates that, while violations of agency guidance can’t be used to prove violations of law, they can still be used “to help prove that the party had the requisite knowledge” of its legal obligations, Brand wrote.

FCA cases can be affected by many types of guidance. Medicare contractors provide guidance on billing when appropriate and the U.S. Food and Drug Administration (FDA) issues guidance on illicit off-label promotion. Additionally, the Office of the Inspector General (OIG) issues guidance and bulletins related to kickbacks and improper physician referrals.

To learn more about the DOJ’s role in health care fraud and compliance, click here to read one of my prior blogs.

Visit our website to find out how The Health Law Firm can assist you with Medicaid fraud defense, Medicare fraud defense and False Claims Act defense cases.

What Will the Long Term Effects Be?

We see these latest actions by the DOJ to announce a policy of allowing big corporations unbridled discretion to steal from the tax payers. We believe it signals a change to discouraging False Claims Act cases from being brought. It is difficult to see why DOJ is easing off of matters that help the prosecution of False Claims Act cases, especially those by individual relators (whistle blowers). Whistle blower or qui tam cases brought by hundreds of individual whistle blowers are now recovering billions of dollars each year in Medicare and Medicaid fraud. Why would anyone want to stifle such a successful program?

It is argued by DOJ that the DOJ’s budget is limited and U.S. Attorneys need to be freed up to go after serious crime, but that is exactly why the False Claims Act was passed in the first place. If the government doesn’t have the resources, personnel or, more importantly, the interest in pursuing those who files false claims and state form the tax payer, then private whistle blowers or relators are authorized to do this. All the government has to do is to decline to intervene in the case and then the relator can go ahead and pursue the case on its own, without costing the government anything. It was because of war profiteers’ treating the U.S. treasury as a piggy bank, to be looted anytime they felt like it, that caused the False Claims Act’s passage in the Civil War era.

There is also a big concern that if there is less guidance on such complex topics as how to properly document valid medical services and procedures delivered to patients, then how can busy doctors, health care professionals and health facilities hope to understand what is require of them. It is my understanding that such “guidance” is for just such a purpose, to guide those who are trying to comply.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent 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:

Overley, Jeff. “New DOJ Memo Will Make Waves In Fraud Cases.” Law360. (January 29, 2018). Web.

“New DOJ Memo Will Make Waves In Fraud Cases.” Institute for Legal Reform. (January 29, 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: Fraudulent billing defense attorney, fraudulent billing representation, Medicare fraud defense attorney, Medicaid fraud defense attorney, representation for health care fraud, representation for Medicare fraud, representation for Medicaid fraud, False Claims Act (FCA) attorney, FCA defense attorney, FCA representation, false filling representation, false billing defense attorney, health care fraud defense attorney, U.S. Department of Justice (DOJ) guidance representation, DOJ investigation representation, DOJ defense attorney, DOJ investigation defense attorney, OIG investigation representation, OIG defense attorney, health care professional defense attorney, health care professional representation, health care compliance representation, health care compliance attorney, reviews of The Health Law Firm, 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 © 2018 The Health Law Firm. All rights reserved.

 

New DOJ Memo Shifting Government Policy in False Claims Act Cases Should make Healthcare Providers Happy!

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

On January 29, 2018, the U.S. Department of Justice (DOJ) released a new internal memorandum that we believe signals a backing-off of government support for False Claims Act cases. The memorandum sent by Associate Attorney General Rachel Brand, references “vast reams” of government agency guidance explaining the government’s views and interpretation of various laws. It includes laws related to requirements for accurate billing of Medicare and Medicaid by healthcare providers.

The “Brand Memorandum.”

In the memo, Brand said the DOJ “may not use its enforcement authority to effectively convert agency guidance documents into binding rules.” The memo is a product of Attorney General Jeff Sessions’ move in November 2017, to curtail “regulation by guidance.”

It states that it specifically applies to civil enforcement of laws, including the False Claims Act (FCA), that the Associate Attorney General oversees.

Click here to view the DOJ’s Brand Memorandum in full on our website.

Implications of the Brand Memorandum.

Brand’s memorandum stopped short of completely forbidding the use of agency guidance in support of DOJ cases. The memorandum indicates that, while violations of agency guidance can’t be used to prove violations of law, they can still be used “to help prove that the party had the requisite knowledge” of its legal obligations, Brand wrote.

FCA cases can be affected by many types of guidance. Medicare contractors provide guidance on billing when appropriate and the U.S. Food and Drug Administration (FDA) issues guidance on illicit off-label promotion. Additionally, the Office of the Inspector General (OIG) issues guidance and bulletins related to kickbacks and improper physician referrals.

To learn more about the DOJ’s role in health care fraud and compliance, click here to read one of my prior blogs.

Visit our website to find out how The Health Law Firm can assist you with Medicaid fraud defense, Medicare fraud defense and False Claims Act defense cases.

What Will the Long Term Effects Be?

We see these latest actions by the DOJ to announce a policy of allowing big corporations unbridled discretion to steal from the tax payers. We believe it signals a change to discouraging False Claims Act cases from being brought. It is difficult to see why DOJ is easing off of matters that help the prosecution of False Claims Act cases, especially those by individual relators (whistle blowers). Whistle blower or qui tam cases brought by hundreds of individual whistle blowers are now recovering billions of dollars each year in Medicare and Medicaid fraud. Why would anyone want to stifle such a successful program?

It is argued by DOJ that the DOJ’s budget is limited and U.S. Attorneys need to be freed up to go after serious crime, but that is exactly why the False Claims Act was passed in the first place. If the government doesn’t have the resources, personnel or, more importantly, the interest in pursuing those who files false claims and state form the tax payer, then private whistle blowers or relators are authorized to do this. All the government has to do is to decline to intervene in the case and then the relator can go ahead and pursue the case on its own, without costing the government anything. It was because of war profiteers’ treating the U.S. treasury as a piggy bank, to be looted anytime they felt like it, that caused the False Claims Act’s passage in the Civil War era.

There is also a big concern that if there is less guidance on such complex topics as how to properly document valid medical services and procedures delivered to patients, then how can busy doctors, health care professionals and health facilities hope to understand what is require of them. It is my understanding that such “guidance” is for just such a purpose, to guide those who are trying to comply.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent 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:

Overley, Jeff. “New DOJ Memo Will Make Waves In Fraud Cases.” Law360. (January 29, 2018). Web.

“New DOJ Memo Will Make Waves In Fraud Cases.” Institute for Legal Reform. (January 29, 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: Fraudulent billing defense attorney, fraudulent billing representation, Medicare fraud defense attorney, Medicaid fraud defense attorney, representation for health care fraud, representation for Medicare fraud, representation for Medicaid fraud, False Claims Act (FCA) attorney, FCA defense attorney, FCA representation, false filling representation, false billing defense attorney, health care fraud defense attorney, U.S. Department of Justice (DOJ) guidance representation, DOJ investigation representation, DOJ defense attorney, DOJ investigation defense attorney, OIG investigation representation, OIG defense attorney, health care professional defense attorney, health care professional representation, health care compliance representation, health care compliance attorney, reviews of The Health Law Firm, 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 © 2018 The Health Law Firm. All rights reserved.

 

Cardiologist Faces HIPAA Privacy Violation Charges for Over Sharing Patient Information

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

On February 26, 2018, a pediatric cardiologist was charged with wrongfully disclosing protected patient health information in Massachusetts federal court. Prosecutors alleged that in 2013, Dr. Eduardo Montaña disclosed patient data to representatives of Aegerion Pharmaceuticals.

The Alleged HIPAA Privacy Violations.

Prosecutors said that Dr. Montaña violated the Health Insurance Portability and Accountability Act (HIPAA) by sharing electronic medical records and prescription forms with representatives of Aegerion in 2013 without patient permission. He also allegedly gave his personal access code for an electronic medical records system to an Aegerion representative in March 2013 so the employee could review the patients’ health information without the patient’s knowledge or permission. That unauthorized disclosure constitutes a violation of HIPAA, prosecutors alleged.

Click here to read the court document in full.

The Consequences of HIPAA Violations.

The failure to comply with HIPAA can result in both civil and criminal penalties. There has been an increase in penalties regarding HIPAA violations. With an increase in the popularity and availability of social media platforms, also comes an increase in potential privacy violations. To read a previous blog I wrote on this, click here.

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

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:
Posses, Shayna. “Doctor Charged Over Sharing Patient Info With Aegerion.” Law360. (February 26, 2018). Web.

Raymond, Nate. “Georgia doctor to plead guilty to disclosing patient info to Aegerion.” Reuters. (February 27, 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: Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defense attorney, Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defense counsel, Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defense lawyer, HIPAA compliance attorney, data security legal representation, HIPAA legal representation, HIPAA defense attorney, HIPAA defense lawyer, HIPAA compliance audit legal representation, legal representation for HIPAA violation, legal counsel for penalties for HIPAA violation, criminal penalties for HIPAA violation, civil penalties for HIPAA violation, legal counsel for HIPAA compliance, HIPAA defense attorney, HIPAA violation representation, Department of Justice (DOJ) investigation attorney, DOJ defense attorney, legal representation for DOJ issues, legal representation for licensure matters, licensure defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Office of Civil Rights (OCR) defense attorney, Office of Civil Rights (OCR) defense lawyer, Office of Civil Rights (OCR) defense counsel, physician defense attorney, physician defense counsel, physician defense lawyer, Office of Civil Rights (OCR) investigation defense attorney, Office of Civil Rights (OCR) investigation defense lawyer, Office of Civil Rights (OCR) investigation defense counsel, Board of Medicine defense attorney, Board of Medicine defense lawyer, Board of Medicine defense counsel, HIPAA corrective action plan (CAP) attorney, HIPAA corrective action plan (CAP) lawyer, HIPAA corrective action plan (CAP) 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 |2024-03-14T10:01:23-04:00May 15, 2018|Categories: Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Cardiologist Faces HIPAA Privacy Violation Charges for Over Sharing Patient Information

Cardiologist Faces HIPAA Privacy Violation Charges for Over Sharing Patient Information

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

On February 26, 2018, a pediatric cardiologist was charged with wrongfully disclosing protected patient health information in Massachusetts federal court. Prosecutors alleged that in 2013, Dr. Eduardo Montaña disclosed patient data to representatives of Aegerion Pharmaceuticals.

The Alleged HIPAA Privacy Violations.

Prosecutors said that Dr. Montaña violated the Health Insurance Portability and Accountability Act (HIPAA) by sharing electronic medical records and prescription forms with representatives of Aegerion in 2013 without patient permission. He also allegedly gave his personal access code for an electronic medical records system to an Aegerion representative in March 2013 so the employee could review the patients’ health information without the patient’s knowledge or permission. That unauthorized disclosure constitutes a violation of HIPAA, prosecutors alleged.

Click here to read the court document in full.

The Consequences of HIPAA Violations.

The failure to comply with HIPAA can result in both civil and criminal penalties. There has been an increase in penalties regarding HIPAA violations. With an increase in the popularity and availability of social media platforms, also comes an increase in potential privacy violations. To read a previous blog I wrote on this, click here.

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

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:
Posses, Shayna. “Doctor Charged Over Sharing Patient Info With Aegerion.” Law360. (February 26, 2018). Web.

Raymond, Nate. “Georgia doctor to plead guilty to disclosing patient info to Aegerion.” Reuters. (February 27, 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: Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defense attorney, Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defense counsel, Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule defense lawyer, HIPAA compliance attorney, data security legal representation, HIPAA legal representation, HIPAA defense attorney, HIPAA defense lawyer, HIPAA compliance audit legal representation, legal representation for HIPAA violation, legal counsel for penalties for HIPAA violation, criminal penalties for HIPAA violation, civil penalties for HIPAA violation, legal counsel for HIPAA compliance, HIPAA defense attorney, HIPAA violation representation, Department of Justice (DOJ) investigation attorney, DOJ defense attorney, legal representation for DOJ issues, legal representation for licensure matters, licensure defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Office of Civil Rights (OCR) defense attorney, Office of Civil Rights (OCR) defense lawyer, Office of Civil Rights (OCR) defense counsel, physician defense attorney, physician defense counsel, physician defense lawyer, Office of Civil Rights (OCR) investigation defense attorney, Office of Civil Rights (OCR) investigation defense lawyer, Office of Civil Rights (OCR) investigation defense counsel, Board of Medicine defense attorney, Board of Medicine defense lawyer, Board of Medicine defense counsel, HIPAA corrective action plan (CAP) attorney, HIPAA corrective action plan (CAP) lawyer, HIPAA corrective action plan (CAP) 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 |2024-03-14T10:01:28-04:00May 15, 2018|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Cardiologist Faces HIPAA Privacy Violation Charges for Over Sharing Patient Information
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