Doctor Indicted in $1.3 Million Medicare Fraud Kickback Case Seeks Reinstatement of Medicare Billing Privileges
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On November 2, 2021, a doctor and his wife who had been indicted for their roles in a $1.3 million Medicare fraud scheme asked a New Jersey court to eliminate a bail condition. The doctor argued that the bail condition impeded his ability to practice medicine. Additionally, the doctor indicated that he was seeking to directly address CMS and the Medical Practice’s ability to bill Medicare and Medicaid.
According to the brief, the defendants argued that the court should not get involved in a licensed physician’s medical practice. They argued that this is the role of the state board of medicine.
Background of Their Case.
Both of the defendants, in this case, were arrested and charged in July 2020 for accepting bribes and kickbacks in exchange for […]
Florida Surgeon, Device Company Owner Arrested For Paying Bribes, Kickbacks
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees.
Accused in an indictment in Boston federal court for violating the federal Anti-Kickback Statute (AKS) and conspiracy to commit money laundering, is the company’s founder and CEO from Florida. Also charged in the indictment were the company’s chief financial officer from Massachusetts and the device company itself. The charges of AKS violations carry a maximum prison sentence of 10 years, while the money laundering conspiracy charge carries a maximum sentence of 20 years.
Click here to view the indictment in full.
Alleged Bribes & Kickbacks.
The allegations […]
Centene Reaches $166 Million Settlement With Texas Over Its Medicaid Drug Pricing
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The nation’s largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly announced until September 19, 2022. The agreement makes Texas the 12th state to settle pharmacy billing claims with St. Louis-based Centene. It’s also the health insurance giant’s biggest payout over its drug pricing practices.
The Allegations Across Many States.
The allegations focused on Centene’s pharmacy benefit manager business, claiming it overbilled the state’s Medicaid programs for prescription drugs and pharmacy services. Such benefit managers act as middlemen between drugmakers and health insurers and as intermediaries between health plans and pharmacies. Multiple states have pursued allegations against Centene’s pharmacy manager business, […]