health care fraud defense lawyer | The Health Law Firm Blog

Mississippi Businessman Sentenced to 18 Years in Prison For $288 Million Tricare Fraud Scheme

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

On January 15, 2021, a Mississippi man was sentenced to 18 years in prison by a federal judge for his role in a $287.6 million scheme to defraud the Tricare health benefits program. According to the U.S. Department of Justice (DOJ), he committed fraud by paying doctors and drug distributors kickbacks.

What is Tricare?

Tricare is the health care benefit program serving active-duty military personnel, military retirees, and […]

By The Health Law Firm|2024-03-14T09:59:50-04:00January 29, 2021|In the Know, In the News, Pharmacy Law Blog|

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

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

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

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

The federal government filed the suit on behalf of the U.S. […]

By The Health Law Firm|2024-03-14T10:00:18-04:00January 30, 2019|Pharmacy Law Blog|

Florida Woman Lands Herself 6.5 Years in Prison, Owes $45 Million for Medicare Fraud Scheme

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

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets.

Sila Luis received an 80-month prison sentence in addition to being ordered to pay $45 million in restitution. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Her case continued in 2017 following a 5-3 ruling by the Supreme Court holding that the government could not freeze assets […]

By The Health Law Firm|2024-03-14T10:01:31-04:00May 15, 2018|Health Facilities Law Blog|

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

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

On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care […]

By The Health Law Firm|2024-03-14T10:01:41-04:00May 15, 2018|Pharmacy Law Blog|

Florida Woman Lands Herself 6.5 Years in Prison, Owes $45 Million for Medicare Fraud Scheme

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

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets.

Sila Luis received an 80-month prison sentence in addition to being ordered to pay $45 million in restitution. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Her case continued in 2017 following a 5-3 ruling by the Supreme Court holding that the government could not freeze […]

By The Health Law Firm|2024-03-14T10:01:42-04:00May 15, 2018|Pharmacy Law Blog|

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

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

On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care […]

By The Health Law Firm|2024-03-14T10:01:52-04:00May 15, 2018|Mental Health Law Blog|

X-Ray Company Owner Receives 10 Years in Prison For $8M Medicare and Medicaid Fraud Which Lead to the Death of Two Patients

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On June 15, 2016, A medical diagnostics company owner found guilty of Medicare and Medicaid fraud for billing $8 million for X-rays whose botched analysis by amateurs led to the death of two patients was sentenced in Maryland federal court to 10 years in prison, the U.S. Department of Justice said. The diagnostics company, Alpha Diagnostics, LLC (Alpha), operated in Maryland, Delaware, Pennsylvania, Virginia and Washington, D.C.

Alpha’s president and chief executive officer (CEO) Rafael Chikvashvili, was convicted by a jury in February 2016 of two counts of health care fraud resulting in death, nine counts […]

By The Health Law Firm|2024-03-14T10:01:10-04:00May 15, 2018|Health Facilities Law Blog|

Home Health Care Company Admits to FCA Violations, Agrees to Pay Millions

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On July 7, 2016, a Kentucky-based home health care chain, MD2U Holding Co. (MD2U), agreed to pay up to $21.5 million and admit False Claims Act (FCA) violations. According to the U.S. Department of Justice (DOJ), the deal is in connection with “extreme” billing practices that saw Medicare billed for false and unnecessary treatments.

The Complaint.

According to a complaint filed, MD2U frequently utilized billing codes reserved for the highest level of treatment when delivering primary care services in residential settings. The frequency with which the codes were used by MD2U made the company an “extreme outlier” among […]

By The Health Law Firm|2024-03-14T10:01:10-04:00May 15, 2018|Health Facilities Law Blog|

Appeals Court Rules Against Nursing Home: Bankruptcy Cannot Affect Prevent Cancellation of Medicare or Medicaid Contacts

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On July 11, 2016, a federal appeals court stated that a bankruptcy judge did not have the authority to block government health officials from cutting off Medicare and Medicaid payments to a Florida nursing home that was alleged to have violated patient-care regulations. A three-judge panel of the 11th U.S. Circuit Court of Appeals sided with the U.S. Department of Health and Human Services (HHS) and the Florida Agency for Health Care Administration (AHCA) in the dispute with nursing home operator Bayou Shores SNF LLC (Bayou Shores).

The Violations.

In 2014, state inspectors cited a St. Petersburg nursing […]

By The Health Law Firm|2024-03-14T10:01:11-04:00May 15, 2018|Health Facilities Law Blog|

Doctor Indicted In Home Health Medicaid Fraud Suit Hit With 3-Year Prison Sentence

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

On December 7, 2016, Banio Koroma was convicted in a northern Illinois court of falsely certifying elderly patients for in-home care will spend the next three years in prison and be forced to reimburse the government for the $1.5 million in losses he caused, an Illinois federal judge ruled.

Paying For His Crimes.

In June 2016, Banio Koroma, 67, appeared in court in an orange jumpsuit after being jailed for violating his bond when it was discovered that he had again committed fraud by mailing fake checks to strangers. On December 7,2016, he was […]

By The Health Law Firm|2024-03-14T10:01:22-04:00May 15, 2018|Health Facilities Law Blog|