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Florida Government Officer Charged in Billion Dollar Medicare Fraud

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

Health Care Administrator Accepts Bribes.
An alleged $1 billion health care scheme has lead to the first known prosecution against a Florida Agency for Health Care Administration official. Bertha Blanco faces a wide range of charges including accepting bribes to tip off individuals when state wide investigations were to begin.

The Ring Alleged Ring Leader.

It is reported that Blanco oversaw inspections by the Florida Agency for Health Care Administration or “AHCA” of Florida nursing homes owned by Phillip Esformes. Blanco was allegedly taking bribes to tip off Esformes of violations reported to the state agency before the investigation (or “survey”) even began. This allegedly allowed Esformes to attempt to fix or remedy the deficiencies that were reported even before the investigation began and to maintain his. Esformes […]

Embezzling Administrator of Pediatric Clinic Faces Health Care Fraud Sentencing

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

An administrator of a Louisiana pediatric clinic has recently pleaded guilty in a health care fraud case. She faces up to 10 years in prison and over $200,000 in fines. The charges allege embezzling more than $500,000 of the clinic’s money and diverting it to her personal account, from approximately August through September of 2014. She allegedly used this massive amount of money to purchase luxury items for herself including jewelry, custom artwork and a motorcycle. Much of the money came from reimbursement the clinic received from the state’s Medicaid program.

The Investigation.

The administrator was investigated by the Federal Bureau of Investigations (FBI) and Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). The investigation disclosed that the administrator used a […]

Massachusetts Mental Health Centers Submitted False Claims According to Suit

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

On January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. […]

Kmart Agrees to Pay $32.3 million to Settle Whistle Blower’s False Claims Act Suit

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

On December 22, 2017, Kmart Corporation agreed to pay $32.3 million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

The Whistle Blower False Claims Act (FCA) Suit.

The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). This provision permits private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.

The 2008 lawsuit, which was filed by a […]