Florid Man Strikes Again–Government Asks for Life Sentence for Florida Man in $187M Medicare Fraud Case

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one hundred million dollars. At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. He was ordered to pay $187 million in restitution.

I have to say it. They need to lock up that Florida man once and for all! I see his wanton actions all over Florida, reported time and time again. Now that Tim Dorsey is deceased (bless his Florida soul) we don’t have a character like Serge Storms to go around and assassinate (at least literarily) such evildoers as Florida man. Will this mean a big upsurge in crimes committed by Florida man?

Specifics of the Health Care Fraud Committed.

From 2016 to 2019, the ex-CEO operated with co-conspirators out of Palm Beach County to conduct a scheme that spanned the entire country. The Florida Man was the CEO of the laboratory company and the architect of the fraudulent scheme. The ex-CEO oversaw and approved every step of the Medicare fraud process.

The Florida Man recruited and bribed patient brokers, directed the use of deceptive marketing techniques, encouraged the use of telemedicine companies that gave approval without consideration, and took measures to conceal the fraud and make it seem legitimate.

The ex-CEO bribed patient brokers, telemedicine companies, and telemarketing companies to contact Medicare beneficiaries and pressure them into taking medically unnecessary genetic tests through his laboratory company.

I would find it hard to believe that such willful and wanton illegal acts occur in the great state of Florida, except that I get about ten phone calls a day from these people trying to hook me into their phony schemes. Well, after this conviction, maybe I’ll only be getting nine phone calls a day from them (unless they allow Florida man unlimited phone calls for such purposes from his prison cell; and since this is Florida, they may well do that!).

He also instructed co-conspirators to go to nursing homes, bingo halls, adult day care facilities, and poor communities in the Atlanta area to pressure Medicare beneficiaries into taking the genetic test.

A single genetic test billed to Medicare could earn the ex-CEO $9,000. In three years, the lab billed Medicare $463 million, of which $187 million was paid out. The Florida Man personally earned $21 million which he spent on luxury purchases, like a Ferrari.

Effects of the Fraud.

The Florida Man exposed Medicare to a fraud where it paid $187 million for medically unnecessary genetic tests; an exorbitant loss. The scheme also confused patients and confounded doctors.

One victim of the fraud was led to believe that the genetic test would tell her if her cancer would return. She took the test and, since it was negative for the mutated gene, she was wrongly led to believe her cancer would not return. Her cancer did return.

Another victim of the fraud tested positive for a gene mutation that they did not actually have. This made their primary care doctor re-bill the genetic test to Medicare to confirm the results. This test came back negative for the gene mutation. The lab’s test was faulty and gave an inaccurate result.

The federal prosecutors argued that the Florida Man preyed on cancer survivors, elderly patients, and people afraid of getting cancer to steal hundreds of millions of dollars from a social safety net.

Sentencing Recommendation.

The government recommended that the Florida Man’s sentencing be considered in decades, rather than months or years, due to the seriousness of the crime and the man’s unwillingness to accept responsibility or show remorse.

During the trial and in post-conviction pleadings, the ex-CEO continuously placed blame on his lawyers, his employees, and the lab directors. He claimed that the kickbacks and bribes were contracts reviewed and negotiated by lawyers and the genetic tests were appropriate and properly signed by physicians.

The government also recommended that the restitution be increased because, even though only $187 million was paid out by Medicare, the laboratory company billed Medicare $463 million. Prosecutors argued that the restitution should be calculated based on the intended loss of $463 million.

The federal prosecutors claimed that since this is one of the largest genetic testing scheme ever brought to trial, the sentencing must act as a deterrent. The prosecutors argued that a life sentence for the Florida Man would reflect the seriousness of the Medicare fraud and deter others from conducting similar healthcare fraud schemes.

Contact Health Law Attorneys Experienced Health Care Fraud and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Integrity Contractor audits RAC audits, and False Claims Act cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Authors: 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. Hartley Brooks is a law clerk with the health law firm. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. 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.

“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 © 2023 The Health Law Firm. All rights reserved.

Florid Man Strikes Again: Government Asks for Life Sentence for Florida Man in $187M Medicare Fraud Case

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one hundred million dollars. At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. He was ordered to pay $187 million in restitution.

I have to say it. They need to lock up that Florida man once and for all! I see his wanton actions all over Florida, reported time and time again. Now that Tim Dorsey is deceased (bless his Florida soul) we don’t have a character like Serge Storms to go around and assassinate (at least literarily) such evildoers as Florida man. Will this mean a big upsurge in crimes committed by Florida man?

Specifics of the Health Care Fraud Committed.

From 2016 to 2019, the ex-CEO operated with co-conspirators out of Palm Beach County to conduct a scheme that spanned the entire country. The Florida Man was the CEO of the laboratory company and the architect of the fraudulent scheme. The ex-CEO oversaw and approved every step of the Medicare fraud process.

The Florida Man recruited and bribed patient brokers, directed the use of deceptive marketing techniques, encouraged the use of telemedicine companies that gave approval without consideration, and took measures to conceal the fraud and make it seem legitimate.

The ex-CEO bribed patient brokers, telemedicine companies, and telemarketing companies to contact Medicare beneficiaries and pressure them into taking medically unnecessary genetic tests through his laboratory company.

I would find it hard to believe that such willful and wanton illegal acts occur in the great state of Florida, except that I get about ten phone calls a day from these people trying to hook me into their phony schemes. Well, after this conviction, maybe I’ll only be getting nine phone calls a day from them (unless they allow Florida man unlimited phone calls for such purposes from his prison cell; and since this is Florida, they may well do that!).

He also instructed co-conspirators to go to nursing homes, bingo halls, adult day care facilities, and poor communities in the Atlanta area to pressure Medicare beneficiaries into taking the genetic test.

A single genetic test billed to Medicare could earn the ex-CEO $9,000. In three years, the lab billed Medicare $463 million, of which $187 million was paid out. The Florida Man personally earned $21 million which he spent on luxury purchases, like a Ferrari.

Effects of the Fraud.

The Florida Man exposed Medicare to a fraud where it paid $187 million for medically unnecessary genetic tests; an exorbitant loss. The scheme also confused patients and confounded doctors.

One victim of the fraud was led to believe that the genetic test would tell her if her cancer would return. She took the test and, since it was negative for the mutated gene, she was wrongly led to believe her cancer would not return. Her cancer did return.

Another victim of the fraud tested positive for a gene mutation that they did not actually have. This made their primary care doctor re-bill the genetic test to Medicare to confirm the results. This test came back negative for the gene mutation. The lab’s test was faulty and gave an inaccurate result.

The federal prosecutors argued that the Florida Man preyed on cancer survivors, elderly patients, and people afraid of getting cancer to steal hundreds of millions of dollars from a social safety net.

Sentencing Recommendation.

The government recommended that the Florida Man’s sentencing be considered in decades, rather than months or years, due to the seriousness of the crime and the man’s unwillingness to accept responsibility or show remorse.

During the trial and in post-conviction pleadings, the ex-CEO continuously placed blame on his lawyers, his employees, and the lab directors. He claimed that the kickbacks and bribes were contracts reviewed and negotiated by lawyers and the genetic tests were appropriate and properly signed by physicians.

The government also recommended that the restitution be increased because, even though only $187 million was paid out by Medicare, the laboratory company billed Medicare $463 million. Prosecutors argued that the restitution should be calculated based on the intended loss of $463 million.

The federal prosecutors claimed that since this is one of the largest genetic testing scheme ever brought to trial, the sentencing must act as a deterrent. The prosecutors argued that a life sentence for the Florida Man would reflect the seriousness of the Medicare fraud and deter others from conducting similar healthcare fraud schemes.

Contact Health Law Attorneys Experienced Health Care Fraud and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Integrity Contractor audits RAC audits, and False Claims Act cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Authors: 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. Hartley Brooks is a law clerk with the health law firm. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. 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.

“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 © 2023 The Health Law Firm. All rights reserved.

Steps to Take If You Receive an OIG Subpoena from the U.S. Department of Health and Human Services

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

The U.S. Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG). This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. These subpoenas are very broad, usually requiring the production of thousands of pages of documents. Click here to see a sample of a subpoena duces tecum issued by the OIG. 

Immediate Action to Take If You Receive an OIG or DHHS Subpoena.

Immediately review the subpoena in detail to see what it requests and from whom. A subpoena may be issued to or served on the wrong person or organization. If so, have your attorney contact the issuer and attempt to resolve the matter. Document everything in writing.

However, the most important thing you can do is to contact an experienced healthcare attorney. There is something going on that has led to an investigation so you need to try to get to the bottom of it. A review of the documents being subpoenaed will give you and your experienced healthcare attorney an idea of what type of case is being investigated by the OIG. Additionally, your attorney can contact and begin dealing with the OIG’s Office and the U.S. Attorney’s Office if it is involved.

Many Different Circumstances Can Lead to Investigation and Subpoena.

If someone has filed a False Claims Act (FCA) complaint or suit, also known as a whistleblower or qui tam suit, this may be why the OIG is investigating. A patient complaint can cause an investigation to be opened. A suspicion of violating the rules for Medicare and Medicaid participation, including the Conditions of Participation or the Conditions for Payment (Federal Regulations). For example, if you have committed violations of program requirements such that the government can seek Civil Monetary Penalties, this may give rise to such an investigation. If you are suspected of Medicare fraud, including upcoding or billing for medically unnecessary supplies or services, this may lead to such an investigation. The matter is serious, so you should retain experienced healthcare counsel.

Follow These Steps to Enable an Organized Response:

1. Immediately review the subpoena to ensure you know the expected delivery date of the requested documents and how they will be delivered.

2. Immediately retain the services of an experienced healthcare attorney to start dealing with the OIG or any other government office involved.

3. Immediately start assembling the documents requested by the subpoena so they may be reviewed by your attorney before they are reorganized, labeled, page numbered, and produced. This will take longer than you think.

4. Request an extension of time to respond, if needed, before the due date for the production of the documents. These are routinely given, especially for large document productions. Document the granting of the extension of time in writing.

5. Completely read the instructions given in the subpoena regarding how documents produced are to be organized, page-numbered, labeled, copied, and delivered. It is essential to produce them this way to the address requested.

6. If documents are archived, in storage, require the re-reinstallation of old software to reproduce, or otherwise will take a long time to produce, request a “rolling production.” This is an agreement to produce the documents as you obtain them.

7. In reviewing the documents and the subpoena, attempt to determine exactly what the OIG and agency may be investigating. This will afford you time to begin preparation for your defense.

8. Do not personally communicate with OIG special agents, other investigators, or attorneys working for the OIG or U.S. Attorney’s Office. Anything you say to them, orally or in writing, can be used against you in their case. Any incorrect or false information you provide, orally or in writing, can result in a felony charge under 18 U.S.C. Sect. 1001. Have your attorney do all communicating.

9. Remember, you do not have to produce any documents in your custody. Likewise, you do not have to create documents to produce.

10. Never alter, destroy, delete or create documents for which the subpoena is issued after you have received the subpoena. Consider all documents to be “frozen.” Also, immediately notify whoever is in charge of your document retention or document destruction program (if you have one) to ensure no further documents are destroyed or deleted.

11. If you do not have a document destruction program for obsolete documents in place as you read this blog, then you need to create one (subject to number 10 immediately above). Make sure it addresses e-mails, text messages, messages over social media (such as Instagram and Whats App), electronically stored documents, and any paper copies. Do not keep any documents for longer than you are required to keep them by law (including federal regulations).

12. Provide an explanation for any documents or categories of records that you should have but were destroyed by natural disasters, fires, etc. Include documentation (fire department, police report, insurance company appraisal, etc.) that shows this. Do not ever lie or exaggerate.

For additional information, click here to read one of the recent blogs on preparing for a healthcare audit request.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes, and other healthcare providers in Medicaid and Medicare investigations, audits, and recovery actions.

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 or toll-free (888) 331-6620.

KeyWords: Healthcare fraud legal defense representation, healthcare fraud defense lawyer, Office of Inspector General (OIG) subpoena lawyer, Centers for Medicare & Medicaid Services (CMS) subpoena lawyer, Centers for Medicare & Medicaid Services (CMS) audit defense attorney, Office of Inspector General (OIG) investigation defense attorney, legal representation for Centers for Medicare & Medicaid Services (CMS) audit, legal representation for Office of Inspector General (OIG) audit, Office of Inspector General (OIG) Medicare exclusion attorney, Medicare audit defense legal counsel, Medicare overpayment demand attorney, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, attorney legal representation for OIG notice of intent to exclude, legal representation for Medicare and Medicaid audits, health care fraud defense attorney, legal representation for health care fraud, reviews for The Health Law Firm, The Health Law Firm attorney reviews, healthcare fraud legal representation

“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.

 

Florid Man Strikes Again–Government Asks for Life Sentence for Florida Man in $187M Medicare Fraud Case

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On August 12, 2023, federal prosecutors recommended a life sentence for the Florida ex-CEO of a laboratory company who had been found guilty of fraudulently billing Medicare over one hundred million dollars. At the December 2022 trial of the Florida man, the jury convicted the Florida Man of all ten counts against him, including health care fraud, payment of kickbacks, and conspiracy to commit money laundering. He was ordered to pay $187 million in restitution.

I have to say it. They need to lock up that Florida man once and for all! I see his wanton actions all over Florida, reported time and time again. Now that Tim Dorsey is deceased (bless his Florida soul) we don’t have a character like Serge Storms to go around and assassinate (at least literarily) such evildoers as Florida man. Will this mean a big upsurge in crimes committed by Florida man?

Specifics of the Health Care Fraud Committed.

From 2016 to 2019, the ex-CEO operated with co-conspirators out of Palm Beach County to conduct a scheme that spanned the entire country. The Florida Man was the CEO of the laboratory company and the architect of the fraudulent scheme. The ex-CEO oversaw and approved every step of the Medicare fraud process.

The Florida Man recruited and bribed patient brokers, directed the use of deceptive marketing techniques, encouraged the use of telemedicine companies that gave approval without consideration, and took measures to conceal the fraud and make it seem legitimate.

The ex-CEO bribed patient brokers, telemedicine companies, and telemarketing companies to contact Medicare beneficiaries and pressure them into taking medically unnecessary genetic tests through his laboratory company.

I would find it hard to believe that such willful and wanton illegal acts occur in the great state of Florida, except that I get about ten phone calls a day from these people trying to hook me into their phony schemes. Well, after this conviction, maybe I’ll only be getting nine phone calls a day from them (unless they allow Florida man unlimited phone calls for such purposes from his prison cell; and since this is Florida, they may well do that!).

He also instructed co-conspirators to go to nursing homes, bingo halls, adult day care facilities, and poor communities in the Atlanta area to pressure Medicare beneficiaries into taking the genetic test.

A single genetic test billed to Medicare could earn the ex-CEO $9,000. In three years, the lab billed Medicare $463 million, of which $187 million was paid out. The Florida Man personally earned $21 million which he spent on luxury purchases, like a Ferrari.

Effects of the Fraud.

The Florida Man exposed Medicare to a fraud where it paid $187 million for medically unnecessary genetic tests; an exorbitant loss. The scheme also confused patients and confounded doctors.

One victim of the fraud was led to believe that the genetic test would tell her if her cancer would return. She took the test and, since it was negative for the mutated gene, she was wrongly led to believe her cancer would not return. Her cancer did return.

Another victim of the fraud tested positive for a gene mutation that they did not actually have. This made their primary care doctor re-bill the genetic test to Medicare to confirm the results. This test came back negative for the gene mutation. The lab’s test was faulty and gave an inaccurate result.

The federal prosecutors argued that the Florida Man preyed on cancer survivors, elderly patients, and people afraid of getting cancer to steal hundreds of millions of dollars from a social safety net.

Sentencing Recommendation.

The government recommended that the Florida Man’s sentencing be considered in decades, rather than months or years, due to the seriousness of the crime and the man’s unwillingness to accept responsibility or show remorse.

During the trial and in post-conviction pleadings, the ex-CEO continuously placed blame on his lawyers, his employees, and the lab directors. He claimed that the kickbacks and bribes were contracts reviewed and negotiated by lawyers and the genetic tests were appropriate and properly signed by physicians.

The government also recommended that the restitution be increased because, even though only $187 million was paid out by Medicare, the laboratory company billed Medicare $463 million. Prosecutors argued that the restitution should be calculated based on the intended loss of $463 million.

The federal prosecutors claimed that since this is one of the largest genetic testing scheme ever brought to trial, the sentencing must act as a deterrent. The prosecutors argued that a life sentence for the Florida Man would reflect the seriousness of the Medicare fraud and deter others from conducting similar healthcare fraud schemes.

Contact Health Law Attorneys Experienced Health Care Fraud and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Integrity Contractor audits RAC audits, and False Claims Act cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Authors: 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. Hartley Brooks is a law clerk with the health law firm. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. 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.

“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 © 2023 The Health Law Firm. All rights reserved.

What Payers Are Considered to Be “Federal Payers” Under the Federal Anti-kickback Statute?

Author Headshot standing with arms crossed in dark suitBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The federal Anti-Kickback Statute prohibits remuneration in relation to the provision of a “good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program.”  42 U.S.C. § 1320a-7b(b).  The Anti-Kickback Statute goes on to define “federal health care program” as any government-funded plan or program that provides health benefits or any state health care program.  42 U.S.C. § 1320a-7b(f).  But exactly which payers are considered Federal health care programs?  There is a lot of confusion on this issue.  Hopefully, this will clarify it.
The List of Federal Payers for To Which the Anti-Kickback Statute Applies.
The list of federal and state programs to which the Anti-Kickback Statute applies is a long one.  The state ones are on there primarily because they receive some level of federal funding.  This list includes many programs, some of which you may have never heard or guessed.  Here are the ones of which I am aware:
The Medicare Program (along with managed care plans that may contract with the Medicare Program, a number of private insurers);
The Medicaid Program (along with managed care plans that may contract with the various state Medicaid Programs-the private insurers which do this);
State Children’s Health Insurance Program (CHIP or SCHIP);
TRICARE and Tricare for Life;
CHAMPVA;
Veterans Administration (VA) Services;
Indian Health Services (IHS);
Federal Health Program for Alaska Natives;
Railroad Employees National Health and Welfare Plan (RENHWP);
Federal Employees’ Compensation Act (FECA) program;
The Longshore and Harbor Workers’ Compensation Act (LHWCA);
The Federal Black Lung Benefits Act program (FBLBA);
The Energy Employees Occupational Illness Compensation Program Act (EEOIC) (also known as the “Beryllium Exposure Compensation Act”) program;
Refugee Medical Assistance (RMA) program;
Federal Reimbursement of Emergency Health Services to Undocumented Aliens program;  and
The Ryan White HIV/AIDS Program.
These programs cover a very wide swath of all health services offered in the United States.  Therefore, nearly every medical item, facility, service, or equipment is potentially payable by a federal health care program.
Note, however, the Federal Employee Health Benefit (FEHB) Program, the program that provides insurance and benefits to federal civilian employees, is not included in the above list of payers, by statutory exemption.  42 U.S.C. § 1320a-7b(f); 5 U.S.C. Ch. 89.
The Public Health Service (PHS) and its programs may also be excluded from the application.  See 42 U.S.C. § 1320a-7b(b)(3)(D).
Cross-over with the False Claims Act.
Compliance with the Anti-Kickback Statute is a Condition of Payment for federal health care programs.  Every claim that is submitted for payment contains an attestation that the provider providing the goods or services for which payment is sought has complied with the federal Conditions of Payment.”  Therefore, if there has been a kickback in relation to such goods or services for which a claim is made, the False Claims Act will also apply.
Contact Health Law Attorneys Experienced with Health Care Fraud,  False Claims Act Violations, and Anti-Kickback Statute Violations.
The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Integrity Contractor audits and RAC audits, False Claims Act cases, and whistleblower/qui tam cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or 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.
“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 © 2023 The Health Law Firm. All rights reserved.
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