health care fraud | The Health Law Firm Blog

The RACs, They’re Back! The Return of Medicare Recovery Audits

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

All good things must come to an end. This includes the two-month hiatus from Recovery Audit Contractors (RACs) that healthcare professionals enjoyed. The Centers for Medicare and Medicaid Services (CMS) is restarting audits of Medicare fee-for-service claims on a limited basis. The program has been suspended since June 1, 2014, due to expired contracts.

CMS announced the return of RACs on August 4, 2014.

Click here to read the latest announcements on Medicare recovery audits from CMS.

From what we have heard, there were serious problems with some of the audits that had been conducted by the RACs and CMS desired to start over with a clean slate. Just saying!

What Does Limited Basis Mean?

According to CMS, current RACs will conduct a limited number […]

Revised Readmission Penalties are Coming Due to Calculation Errors

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

Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. To see that blog, click here.

In October of 2012, the Centers for Medicare and Medicaid Services (CMS) announced it has discovered errors in its initial calculations. This means, 1,422 hospitals with high readmission rates will lose slightly more money than first expected, according to Kaiser Health News.

Click here to read the entire article from Kaiser Health News.

Hiccup in Medicare’s Hospital Readmission Reduction Program.

According to Kaiser Health News, the revisions were relatively small, averaging two-hundredths of a percent of a hospital’s regular Medicare […]

Apopka Woman to Serve 18-Month Prison Sentence After $47K Medicaid Scam

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

An Apopka businesswoman was recently sentenced to 18 months in prison after she was found guilty of a Medicaid scam. According to the Florida Attorney General’s Office, Shanqual Marshall-Gunn was arrested in September on suspicion of submitting more than $47,000 in fraudulent Medicaid claims.

Company Provided Targeted Case Management Services (TCMs).

Marshall-Gunn owned Second Chances TCM, Inc. TCMs are intended to provide Medicaid recipients who have mental-health disorders with connections to resources in their community, and to assist them in leading a more normal life. Prosecutors said Marshall-Gunn gave employees and clients kickbacks when they submitted referrals to her company.

Three of her employees were also arrested in September 2014 for billing Medicaid for targeted case management services that were fraudulent or not authorized.

Marshall-Gunn Entered a No Contest […]

By The Health Law Firm|2024-03-14T10:01:00-04:00June 1, 2018|Categories: In the News, The Health Law Firm Blog|Tags: criminal defense, criminal representation, defense attorney, defense counsel, defense lawyer, Florida Attorney General, Florida's Medicaid program, fraudulent claims, health care fraud, health law criminal defense, health law criminal representation, home health care, medicaid, Medicaid claims, Medicaid fraud, medicaid fraud control unit, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicaid investigation, medicaid scam, mfcu, overbill medicaid, targeted case management provider, TCM, the health law firm|Comments Off

South Florida Pharmacy Owner Pleads Guilty to $23 Million Health Care Fraud Scheme

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

A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks, according to a Department of Justice (DOJ) press release.

Click here to read the entire press release from the DOJ.

Pharmacy Owner Used Kickbacks and Referrals to Allegedly Scam Medicare and Medicaid.

According to court documents, the pharmacy owner allegedly admitted to paying illegal kickbacks to an unnamed number of co-conspirators in return for Medicare and Medicaid beneficiary information. That information was then used […]

Specialty Pharmacy Agrees to Pay A $11.4 Million Settlement in Whistleblower Case

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

The Department of Justice (DOJ) announced on December 27, 2012, that a specialty pharmacy, based in San Diego, California, has agreed to pay a $11.4 million settlement. That payment is to resolve allegations that the company used kickbacks to persuade doctors to write prescription for its products. The allegations came from a whistleblower lawsuit filed by a former employee.

Click here to read the press release from the DOJ.

Specialty Pharmacy Allegedly Used Expensive Kickbacks to Bribe Doctors.

An article in Modern Healthcare states that the specialty pharmacy allegedly used tickets to sporting events, concerts, plays, spa outings, golf games and ski trips to bribe doctors to write prescriptions for […]

By The Health Law Firm|2024-03-14T10:00:43-04:00June 1, 2018|Categories: Pharmacy, The Health Law Firm Blog, Whistleblower|Tags: Anti-kickback statue, Department of Justice (DOJ), false claims act, health care fraud, health care scheme, kickback scheme, legal representation, pharmaceutical company, qui tam suits, specialty pharmaceutical company, whistleblower, whistleblower attorney, whistleblower lawyers, whistleblower protection|Comments Off

Major Medicare Offender Sentenced to Prison for Multi-Million Dollar Health Care Fraud Scheme

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

The former owner of four mental health facilities in South Florida and North Carolina was sentenced to fourteen (14) years in federal prison on February 25, 2013. The former business owner pleaded guilty to defrauding Medicare out of tens of millions of dollars from 2004 through 2011, according to the Department of Justice (DOJ). He had previously been convicted of cocaine trafficking but decided to move to Medicare fraud supposedly because he thought it would be safer. In total the former mental health facility owner was indicted for defrauding the government of nearly $63 million. As part of his plea, he was ordered to repay $28 million.

Click here to read the press release from the DOJ.

Unnecessary Services, Illegal Kickbacks and Fake Mental Health Records.

The scheme, headed by the former business […]

By The Health Law Firm|2024-03-14T10:00:45-04:00June 1, 2018|Categories: Assisted Living Facilities, In the News, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|Tags: assisted living facility (ALF), defense attorney, defense lawyer, Department of Health and Human Services (HHS), fabricating medical records, false billing, false medical records, Federal Bureau of Investigation (FBI), Florida health care attorney, Florida health care lawyer, Florida Medicare defense attorney, Florida Medicare defense lawyer, health care fraud, Health Care Fraud Prevention and Enforcement Action Team (HEAT), health care fraud scheme, illegal kickbacks, kickbacks, medicare, medicare audit, Medicare beneficiaries, Medicare fraud, Medicare Fraud Strike Force, mental health facility, Office of Inspector General (OIG)|Comments Off

Tips for Responding to a Medicaid Audit

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

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

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

Medicaid Audits in Florida.

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG) and Bureau of Medicaid Program Integrity are the Florida agencies responsible for routine audits of Medicaid health care providers to ensure […]

Medicare Fraud Initiative Leads to Arrests of Over 100 Health Professionals

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

A recent Medicare fraud operation conducted between several federal agencies has resulted in the arrest of over 100 doctors, nurses and other medical professionals. They have been charged with various crimes relating to Medicare fraud. The arrests were made on May 2, 2012 in seven cities nationwide, but more than half took place in South Florida.

This multi-agency attack on medical professionals and health care providers was a joint effort between law enforcement agents from the Federal Bureau of Investigation (FBI), Department of Health and Human Services-Office of Inspector General (HHS-OIG), Medicaid Fraud Control Units (MFCU) and other state and local law enforcement agencies. In addition to arresting over 100 medical professionals, these agents also executed 20 search warrants in connection with ongoing Medicare fraud investigations.

Some of the charges against the health care professionals include conspiracy to commit health care fraud, health care fraud, […]

By The Health Law Firm|2024-03-14T10:00:30-04:00June 1, 2018|Categories: Health Care Industry, In the News, Medicaid, Medicare, The Health Law Firm Blog|Tags: Affordable Care Act, anti-kickback statute, conspiracy, Department of Health and Human Services, false billing, FBI, health care fraud, hhs, medicare, medicare audit, Medicare fraud, Medicare fraud attorney, Medicare Fraud Control Unit, Medicare investigation, mfcu, money laundering, Office of the Inspector General, OIG, overpayment|3 Comments

Strike Force Busts 89 People, Mostly Health Care Professionals, in Nationwide Crackdown on Medicare Fraud

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

In a nationwide takedown nearly 100 people, including doctors, nurses and other medical professionals, in eight cities were all allegedly charged in separate Medicare fraud schemes. These individual scams involved approximately $223 million in false billing, according to the Department of Justice (DOJ) and the Department of Health and Humans Services (DHHS). On May 14, 2013, more than 400 law enforcement officials with the Medicare Fraud Strike Force spread out between Miami, Detroit, Los Angeles, New York, New Orleans, Houston, Chicago and Tampa to make the arrests of these 89 people, according to the DOJ.

Click here to read the press release from the DOJ.

Medicare Schemes Could Not Have Happened Without the Help of Health Professionals.

According to an article in Reuters, one out […]

New Database Allows Consumers to Evaluate Nursing Homes Across the Country

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

Consumers have a new online tool to see which nursing homes are being hit with fines for poor quality, safety or maintenance. Nursing Home Inspect 2.0 is a free database that assists users in evaluating nursing homes across the country. The database was first introduced by ProPublica, a nonprofit investigative news organization, in August 2012. On December 17, 2012, the same organization introduced the 2.0 version that includes information about federal fines imposed on nursing homes in the past three years.

The website can be found at Propublica.org/nursinghomes.

According to the website, the information provided comes from government inspection reports from the Centers for Medicare and Medicaid Services (CMS).

Fines Against Nursing Homes are Handed Out Inconsistently.

On the front page the website shows colored maps of […]

By The Health Law Firm|2024-03-14T10:01:56-04:00May 15, 2018|Categories: ALFs, Discipline, Nursing Law Blog|Tags: best nursing homes, Centers for Medicare and Medicaid Services, CMS, defense attorney, defense lawyer, health care attorney, health care fraud, health care lawyer, nursing home fines, nursing home fraud, nursing home inspection report, nursing homes, Office of Inspector General (OIG) Department of Health and Human Services (HHS)|Comments Off