DOJ Files False Claims Suit Against Nursing Homes Over “Substandard Services and Nonexistent” Care

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

On June 15, 2022, the U.S. Department of Justice (DOJ) announced it has sued three nursing homes in Ohio and Pennsylvania, citing their “grossly substandard skilled nursing services.” The False Claims Act (FCA) complaint against the American Health Foundation (AHF), its affiliate AHF Management Corporation, and three nursing homes alleges the facilities fraudulently billed the Centers for Medicare & Medicaid Services (CMS) for often “nonexistent care.”

According to the complaint, all three AHF nursing homes not only provided substandard nursing home care services that failed to meet required standards of care but also did not maintain adequate staffing levels between 2016 and 2018.

Click here to view the complaint filed by the DOJ in the U.S. District Court for the Eastern District of Pennsylvania.

FCA Violations For “Substandard or Nonexistent Care.”

The government alleged AHF Management and its entities violated the FCA stemming from reimbursements for “grossly substandard” care provided at the Cheltenham, Wilmington Place, and Samaritan nursing homes.

“The defendants knowingly submitted, or caused the submission of, false claims to Medicare and Medicaid for nursing home care and services that were blatantly substandard or nonexistent,” the complaint read. “The Medicare and Medicaid programs provided reimbursement for the claims, but these payments were by mistake as CMS didn’t know the true and full extent of the defendants’ failure to provide patients with proper treatment and care.”

Alleged Patient Conditions and Mistreatment.

Examples of the appalling conditions described in the complaint included housing elderly and medically vulnerable patients in “pest-infested” buildings whose belongings were often stolen; giving residents unnecessary medications, including antibiotic, anti-psychotic, anti-anxiety, and hypnotic drugs; subjecting residents to verbal abuse; neglecting to provide residents with activities or stimulation, and failing to provide needed psychiatric care.

Additionally, the complaint outlines the suicide of a resident who was admitted with a history of self-harm and was later hospitalized after slashing his wrists but still was not provided psychiatric services. Tragically, just weeks after readmission, the resident committed suicide by hanging himself from a bedsheet in a shower room, justice officials said.

“Nursing homes are expected to provide their residents, which include some of our most vulnerable individuals, with quality care and to treat them with dignity and respect,” said Assistant Attorney General Brian M. Boynton, head of the DOJ’s Civil Division in a statement. He continued, “the department will not tolerate nursing homes, or their owners or managing entities, who abdicate these responsibilities and seek taxpayer funds to which they are not entitled.”

To read the DOJ’s press release in full on the case, click here.

The United States’ complaint stems from an investigation that the DOJ initiated as part of its “National Nursing Home Initiative.” The department launched the initiative in March 2020 to identify and investigate nursing homes that provide grossly substandard care.

Click here to learn more about the Justice Department’s nursing home initiative.

The case is United States v. American Health Foundation Inc., case number 2:22-cv-02344, in the U.S. District Court for the Eastern District of Pennsylvania.

Contact Health Law Attorneys Experienced in Handling False Claims Act (FCA) Violations, Investigations, and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in defending audits and investigations by the Department of Health and Human Services, the Department of Justice, The Drug Enforcement Administration (DEA), the Florida Department of Health (DOH), Medicaid Fraud Control Unit (MFCU), state boards of medicine, state boards of pharmacy, and state boards of nursing. They also represent health professionals and providers in administrative litigation (state and federal) and civil litigation (state and federal). They represent physicians, nurses, medical groups, nursing homes, home health agencies, pharmacies, dentists, pharmacies, assisted living facilities, and other healthcare providers and institutions in recovery actions and termination from Medicare and Medicaid Programs.

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.

Sources:

D’Annunzio, P.J. “Feds Hit Nursing Home With FCA Suit Over ‘Nonexistent’ Care.” Law360. (June 15, 2022). Web.

Marceas, Kimberly. ‘Grossly substandard’ care leads to False Claims charges for Ohio-based nursing home operator. McKnights Long Term Care News. (June 16, 2022). Web.

“Nursing Homes Face DOJ False Claims Suit Over Standards of Care.” Bloomberg Law. (June 15, 2022). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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.

 

Supreme Court Explores Doctor Intent in “Pill Mill” Criminal Prosecutions Under the Controlled Substances Act

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

Physicians and other healthcare professionals usually have broad scope to prescribe most drugs, including potentially dangerous ones. However, over the past decade, many limits, often imposed arbitrarily through criminal prosecutions or drastic administrative sanctions, have been used to impose limits.

The question was recently put before the U.S. Supreme Court as to how far a physician’s judgment can be allowed to go in the context of prescribing controlled substances before it becomes criminal. This was in the context of criminal prosecution of a physician for allegedly over-prescribing.

On March 1, 2022, the U.S. Supreme Court confronted the question of whether good faith is a defense for a doctor criminally prosecuted for unlawful distribution of controlled substances. For nearly 90 minutes, the Supreme Court heard oral arguments from both sides, struggling with the exact wording of the Controlled Substances Act (CSA), the clarity of the relevant federal regulation, and the proposition that a doctor who lacked subjective criminal intent could nevertheless go to jail for a substantial period of time, up to life imprisonment.

The two physicians whose cases are being considered are Xiulu Ruan, who was sentenced to 21 years in prison in 2017 for allegedly running a “pill mill,” and Shakeel Kahn, who was sentenced to 25 years in prison in 2019 for crimes including drug distribution of controlled drugs resulting in the death of a patient. The court consolidated their cases for the Supreme Court’s hearing.

Controversial Legal Standards Used to Convict.

The legal standard in question centers heavily on a disputed sentence in the Controlled Substances Act (CSA) that says, “Except as authorized by this subchapter, it shall be unlawful for any person knowingly or intentionally” to distribute controlled substances. The central question is how juries should assess the intentions of a doctor accused of prescribing narcotic painkillers outside “the usual course of his professional practice.”

The U.S. Department of Justice (DOJ) argued that the criminal intent standard is an objective one — or an “honest effort” to comply with professional norms. On the other hand, the attorneys for the doctors who were prosecuted argue that the standard must be subjective; that is did the doctor subjectively believe they were not prescribed for a legitimate medical purpose. This distinction gives rise to whether there is merely a violation of regulation as opposed to a crime having been committed.

Throughout the oral arguments, various justices seemed to cast doubt on whether deviating from mainstream standards on opioid prescribing is sufficient to throw physicians in jail, which could result in years or life in prison. In some states, this might even result in a death sentence, pretty drastic for what would otherwise be medical negligence.

How This Ruling Will Impact Future Prosecutions.

This case and the upcoming ruling raise alarms for healthcare providers and advocates for pain patients. Many fear that the ruling could enable even more aggressive prosecutions of opioid prescribers. They warn that such a decision could discourage doctors from providing opioids even when they’re fully warranted. In addition, the outcome could affect civil litigation accusing large pharmaceutical companies of recklessly selling prescription narcotics.

After hearing the oral arguments, the Supreme Court seemed likely to demand more substantial proof of intentional wrongdoing when the DOJ prosecutes opioid prescribers. A decision from the High Court is expected by late June 2022. The cases are Ruan v. U.S., case number 20-1410, and Kahn v. U.S., case number 21-5261, in the Supreme Court of the United States.

We will definitely keep you posted on the outcome of this case.

Click here to read one of my blogs about controlled substances and compliance.

Contact Health Law Attorneys Experienced in the Representation of Health Professionals and Providers.

The Health Law Firm and its attorneys have represented physicians, pharmacists, nurses, clinics, dentists, pharmacies, health facilities, and other health care providers in different cases involving allegations of over-prescribing narcotics and pain medications. These include criminal investigations by local police and law enforcement authorities, investigations by the U.S. Drug Enforcement Agency (DEA), U.S. Department of Justice (DOJ), complaints against professional licenses by the Florida Department of Health, investigations, and prosecutions by the Medicaid Fraud Control Units (MFCU), and other types of cases. Having attorneys familiar with the medical standards of care and guidelines for prescribing narcotics and having access to expert medical and pharmacy professionals who can testify as expert witnesses in such cases is also crucial. We have represented professionals in administrative investigations and administrative hearings at both the state and federal levels.

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

Sources:

Overley, Jeff. “High Court Poised To Make DOJ’s Job Harder In Opioid Cases.” Law360. (March 1, 2022.) Web.

Gluck, Abby. “In opioids “pill mill” case, justices grapple with physician intent.” SCOTUS Blog. (March 2, 2022). Web.

Joseph, Andrew. “Fight over opioid prescribing — and when it turns criminal — heads to Supreme Court.” STAT News. (February 28, 2022). Web.

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 Toll-Free: (888) 331-6620

“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.

2022-06-24T16:22:15-04:00June 24th, 2022|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Two Admins at a Veterans Home Criminally Charged For Mishandling Deadly COVID-19 Outbreak

George Indest Headshot

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

On September 25, 2020, two administrators at a Massachusetts veterans home were criminally charged with negligence for their role in a COVID-19 outbreak that killed 76 veterans. Attorney General (AG) Maura Healey reportedly stated that the criminal case involving Soldiers’ Home in Holyoke (SHH) is the first in the country against nursing home operators related to the pandemic.

Mishandling of the Coronavirus Outbreak.

The superintendent and the facility’s former medical director were indicted by a grand jury and charged with recklessly permitting bodily injury or abuse to the residents. The charges stem from their decision to combine two dementia units in March of 2020. They are accused of packing residents who were positive for the coronavirus into the same space as those with no symptoms. According to the AG, the decision contributed to the death of at least 76 residents at the facility.

The Investigation.

The AG’s Office began investigating in early April 2020 after learning of serious issues with COVID-19 infection control procedures at SHH. The investigation found that staffing shortages led to the decision to consolidate the two dementia units, totaling 42 residents. It resulted in confirmed COVID-19-positive residents being placed within feet of other veterans at the facility. The AG’s Office alleges that this decision was reckless from an infection control perspective and put the asymptomatic veterans at an increased risk of contracting COVID-19 from the positive ones.

Since March 1, 2020, 76 veterans who contracted the coronavirus at SHH have died, officials said. Click here to read the Attorney General’s press release on the case.

To read about a similar case against a Florida nursing home, click here.

Contact a Health Law Attorney Experienced in the Representation of Veterans Administration (VA) Physician Representation and Military Physician Representation.

The attorneys of The Health Law Firm have represented nursing home administrators, health care executives, nurses, nurse practitioners, assisted living facilities, skilled nursing facilities, and health professionals working for the Veterans Administration (VA) throughout the United States. Representation has included personnel and employment issues, disciplinary action, investigations, peer review investigations, clinical privileges actions, fair hearings, National Practitioner Data Bank (NPDB) actions, and appeals.

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

Sources:

Durkin, Alanna. “2 Charged Over Handling of Virus Outbreak at Veterans Home.” Associated Press. (September 25, 2020). Web.

Dowling, Bryan. “Mass. Vet Home Leaders Charged Over Deadly Virus Outbreak.” Law360. (September 25, 2020). Web.

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

“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 © 2020 The Health Law Firm. All rights reserved.

 

Two Administrators Charged With Negligence For Deadly COVID-19 Outbreak at Veterans Home

George Indest Headshot

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

On September 25, 2020, two administrators at a Massachusetts veterans home were criminally charged with negligence for their role in a COVID-19 outbreak that killed 76 veterans. Attorney General (AG) Maura Healey reportedly stated that the criminal case involving Soldiers’ Home in Holyoke (SHH) is the first in the country against nursing home operators related to the pandemic.

Mishandling of the Coronavirus Outbreak.

The superintendent and the facility’s former medical director were indicted by a grand jury and charged with recklessly permitting bodily injury or abuse to the residents. The charges stem from their decision to combine two dementia units in March of 2020. They are accused of packing residents who were positive for the coronavirus into the same space as those with no symptoms. According to the AG, the decision contributed to the death of at least 76 residents at the facility.

The Investigation.

The AG’s Office began investigating in early April 2020 after learning of serious issues with COVID-19 infection control procedures at SHH. The investigation found that staffing shortages led to the decision to consolidate the two dementia units, totaling 42 residents. It resulted in confirmed COVID-19-positive residents being placed within feet of other veterans at the facility. The AG’s Office alleges that this decision was reckless from an infection control perspective and put the asymptomatic veterans at an increased risk of contracting COVID-19 from the positive ones.

Since March 1, 2020, 76 veterans who contracted the coronavirus at SHH have died, officials said. Click here to read the Attorney General’s press release on the case.

To read about a similar case against a Florida nursing home, click here.

Contact a Health Law Attorney Experienced in the Representation of Veterans Administration (VA) Physician Representation and Military Physician Representation.

The attorneys of The Health Law Firm have represented nursing home administrators, health care executives, nurses, nurse practitioners, assisted living facilities, skilled nursing facilities, and health professionals working for the Veterans Administration (VA) throughout the United States. Representation has included personnel and employment issues, disciplinary action, investigations, peer review investigations, clinical privileges actions, fair hearings, National Practitioner Data Bank (NPDB) actions, and appeals.

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

Sources:

Durkin, Alanna. “2 Charged Over Handling of Virus Outbreak at Veterans Home.” Associated Press. (September 25, 2020). Web.

Dowling, Bryan. “Mass. Vet Home Leaders Charged Over Deadly Virus Outbreak.” Law360. (September 25, 2020). Web.

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

“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 © 2020 The Health Law Firm. All rights reserved.

 

Ex-UCLA Phlebotomist Awarded $1.6 Million in Harassment Lawsuit

Headshot of attorney George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 7, 2019, a jury awarded almost $1.6 million to a woman who alleged she was fired for complaining about coworker’s subjecting her to racial insults and discriminatory comments at her job. Nicole Birden claimed that UCLA Medical Center, Santa Monica, failed to investigate when supervisors harassed and insulted her and several other African-American employees. Additionally, she alleged that she was fired from her job as a phlebotomist after raising concerns about the issue, according to the verdict filed in  Los Angeles Superior Court.

Alleged Hostile Work Environment.

According to Birdnne’s complaint, she began working at UCLA Medical Center Santa Monica, as a phlebotomist in 2015. Shortly after, she claims coworkers made disparaging remarks about the color of her skin and racially stereotyped her in Spanish. In June of 2016, the UC Board of Regents abruptly terminated her employment despite the fact that she had never previously received any kind of disciplinary action against her.

Following her termination she filed a complaint in 2017, alleging that the UCLA Health created a hostile work environment. Additionally, she alleges that the University of California Board of Regents violated California’s Fair Employment and Housing Act for harassment, race and age discrimination, and retaliation, according to the complaint.

To read the verdict for this case in full, click here.

Click here to read one of my prior blogs that also deals with discrimination in the workplace.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in defending allegations of employment discrimination and other complaints from employees and patients. We represent employers and employees in unemployment compensation hearings, in defending against EEOC (discrimination) complaints, and in defending litigation involving wage and hour disputes, as well as other types of contract or employment litigation. We also can investigate such allegations and attempt to negotiate settlements where warranted. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

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

Sources:

“UC Regents to Pay $1.5 Million in Hostile Work Environment Case.” Associated Press. (August 7, 2019). Web.

Stawiki. Kevin. “Ex-UCLA Blood Tech Wins $1.6M In Racial Harassment Suit.” Law360. (August 7, 2019). Web.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for healthcare employee discrimination, legal representation for home health facilities, nursing home legal representation, home health care facility legal presentation, nursing law defense attorney, legal representation for discrimination in health facilities, intentional infliction of emotional distress lawyers, legal representation for physicians and health facilities accused of wrongdoing, defense lawyer for health facilities and doctors, legal representation for physicians, legal representation for nurses, legal representation for health care facilities, health care facility defense attorney, legal representation for sexual harassment and discrimination, employment law, legal representation for health employment matters, employment law defense attorney for health providers, unemployment compensation hearings for health facilities, defending health facilities against EEOC (discrimination) complaints, defending health facilities in litigation involving wage and hour disputes, legal representation for health and medical contract law, legal representation for medical and health contract litigation, legal representation for employment litigation in health facilities, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2019 The Health Law Firm. All rights reserved.

Former UCLA Phlebotomist Awarded Nearly $1.6 Million in Harassment Suit

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 7, 2019, a jury awarded almost $1.6 million to a woman who alleged she was fired for complaining about coworker’s subjecting her to racial insults and discriminatory comments at her job. Nicole Birden claimed that UCLA Medical Center, Santa Monica, failed to investigate when supervisors harassed and insulted her and several other African-American employees. Additionally, she alleged that she was fired from her job as a phlebotomist after raising concerns about the issue, according to the verdict filed in  Los Angeles Superior Court.

Alleged Hostile Work Environment.

According to Birdnne’s complaint, she began working at UCLA Medical Center Santa Monica, as a phlebotomist in 2015. Shortly after, she claims coworkers made disparaging remarks about the color of her skin and racially stereotyped her in Spanish. In June of 2016, the UC Board of Regents abruptly terminated her employment despite the fact that she had never previously received any kind of disciplinary action against her.

Following her termination she filed a complaint in 2017, alleging that the UCLA Health created a hostile work environment. Additionally, she alleges that the University of California Board of Regents violated California’s Fair Employment and Housing Act for harassment, race and age discrimination, and retaliation, according to the complaint.

To read the verdict for this case in full, click here.

Click here to read one of my prior blogs that also deals with discrimination in the workplace.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in defending allegations of employment discrimination and other complaints from employees and patients. We represent employers and employees in unemployment compensation hearings, in defending against EEOC (discrimination) complaints, and in defending litigation involving wage and hour disputes, as well as other types of contract or employment litigation. We also can investigate such allegations and attempt to negotiate settlements where warranted. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

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

Sources:

“UC Regents to Pay $1.5 Million in Hostile Work Environment Case.” Associated Press. (August 7, 2019). Web.

Stawiki. Kevin. “Ex-UCLA Blood Tech Wins $1.6M In Racial Harassment Suit.” Law360. (August 7, 2019). Web.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for healthcare employee discrimination, legal representation for home health facilities, nursing home legal representation, home health care facility legal presentation, nursing law defense attorney, legal representation for discrimination in health facilities, intentional infliction of emotional distress lawyers, legal representation for physicians and health facilities accused of wrongdoing, defense lawyer for health facilities and doctors, legal representation for physicians, legal representation for nurses, legal representation for health care facilities, health care facility defense attorney, legal representation for sexual harassment and discrimination, employment law, legal representation for health employment matters, employment law defense attorney for health providers, unemployment compensation hearings for health facilities, defending health facilities against EEOC (discrimination) complaints, defending health facilities in litigation involving wage and hour disputes, legal representation for health and medical contract law, legal representation for medical and health contract litigation, legal representation for employment litigation in health facilities, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2019 The Health Law Firm. All rights reserved.

Florida Pharmacist Gets More Than Six Years in Prison For Role in Compounding Fraud Scheme

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

On November 29, 2018, a Florida pharmacist was sentenced to six and a half years in prison and ordered to pay $3.4 million, for her role in a scheme to defraud the government. Marjorie Robinson pled guilty one count of conspiracy to commit health care fraud for submitting fraudulent claims to Tricare, Medicare and private insurance programs for compounded creams that were not necessary.

The Fraud Scheme.

According to the U.S. Department of Justice (DOJ), Robinson was one of three owners of ASC Pharmacy Inc., a now defunct compounding pharmacy in Miami. Under her direction, the pharmacy made compounded creams that were made to maximize reimbursement from government and private insurance programs, not for patients needs, according to the plea deal. Click here to read the press release from the DOJ.

The other owners were charged separately and have also pled guilty.

This isn’t the first time a Florida pharmacy has defrauded government programs like Tricare, click here to read one of my prior blogs on a similar case.

Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal charges were brought for fraud or related offenses. In many cases, those subject to Medicare and Medicaid fraud audits and investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding Medicare and Medicaid audits.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of Medicare or Medicaid fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent pharmacists and healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also defend pharmacists, physicians, pharmacies and medical groups in actions by Tricare, Medicare, Medicaid and private insurers to recoup overpayments, obtain civil fines and penalties and take other actions against them. They represent pharmacies and pharmacists in DEA actions and administrative (Order to Show Cause ) hearings, Medicare Fraud Control Unit (MFCU) investigations, and administrative and civil litigation, 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.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Bolado, Carolina. “Fla. Pharmacist Gets 6½ Years For Bogus Claims For Creams.” Law360. (November 29, 2018). Web.

“South Florida pharmacist sentenced to more than six years in prison for role in $3.4 million compounding pharmacy scheme.” MD Linx. (November 30, 2018). Web.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for pharmacists, pharmacy lawyer, legal representation for pharmacies, pharmacists lawyer, legal representation for healthcare fraud, health care fraud representation, healthcare fraud defense lawyer, legal representation for submitting false claims to the government, False Claims Act defense attorney, FCA legal counsel, FCA defense lawyer, Anti-Kickback Statute (AKS) defense attorney, FCA representation, legal representation for allegations of violating Anti-Kickback Statute, AKS representation, TRICARE false claims legal defense attorney, TRICARE physician representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, Medicare audit defense attorney, ZPIC audit defense lawyer, RAC audit defense legal counsel, pharmacy Tricare audit defense attorney, Medicare pharmacy defense lawyer, Medicaid audit of pharmacy defense counsel, pharmacy defense attorney for overpayment demand, pharmacy civil fine defense attorney, pharmacy DEA defense attorney, pharmacy Order to Show Cause (OTSC) defense lawyer, Medicare Fraud Control Unit (MFCU) investigation defense legal counsel, pharmacy administrative and civil litigation attorney, health care fraud defense legal representation, TRICARE fraud attorney, health law defense attorney, health care fraud defense attorney, The Health Law Firm, representation for health care fraud investigations, compounding pharmacy lawyer, prescription reimbursement representation, pharmacy defense attorney, pharmacist defense lawter, representation for pharmacies, representation for pharmacists, legal representation for health care facilities, representation for health care professionals, legal defense of TRICARE providers, U.S. Department of Justice (DOJ) investigation representation, DOJ defense attorney, representation for DOJ matters, attorney reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2018 The Health Law Firm. All rights reserved.

2018-12-26T19:49:51-05:00December 26th, 2018|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Pharmacy Owner to Serve 15 Years in Prison for $100 Million Billing Fraud Scheme

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

On April 26, 2018, the owner of several Florida pharmacies was sentenced to 15 years in prison and ordered to give up $54.5 million in restitution. Nicholas A. Borgesano Jr., owner of A to Z Pharmacies, pled guilty to his role in a $100 million scheme involving bogus insurance reimbursements for prescription drugs.

He pled guilty in November to charges of conspiracy to commit health care fraud and conspiracy to engage in monetary transactions in property derived from specified unlawful activity, according to the order. Click here to read more.

Health Care Billing Fraud Schemes. 

According to prosecutors, Borgesano was at the center of an alleged scheme in which the pharmacy owner used his six stores to peddle prescription compound medications. He would then submit fraudulent reimbursement claims to Medicare, Tricare and private insurance companies.

Borgesano and his co-conspirators are accused of manipulating billing codes in the reimbursement claims and submit claims for pharmaceutical ingredients they didn’t even have. Additionally, he used one of his pharmacies in Florida as the hub of operations and paid his co-conspirators through shell companies, checks and the purchase of assets, prosecutors said.

From the pharmacy owner and his group of conspirators, the U.S. Department of Justice (DOJ) has seized $7.6 million worth of property, including several luxury vehicles and a 50-foot racing boat, the DOJ said. To read more about the co-conspirators, click here to read the press release issued by the DOJ.

To read the judgement in full click here.

The expensive prescription medications and creams involved in this case have been targeted by prosecutors in a handful of other Florida suits alleging Medicare and Tricare fraud by pharmacy owners and others. Click here to read one of my prior blogs involving a similar case.


Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEADOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigationadministrative hearings, inspections and audits. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Greene, Kat. “Pharmacy Owner Gets 15 Years For Role In $100M Scheme.” Law360. (April 27, 2018). Web.

Manning, Margie. “New Port Richey pharmacy owner sentenced in $100 million fraud scheme.” Tampa Bay Business Journal. (April 26, 2018). Web.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act defense attorneyFCA legal counselFCA defense lawyer, Anti-Kickback Statute (AKSdefense attorneyFCA representation, legal representation for allegations of violating Anti-Kickback StatuteAKS representation, TRICARE false claims legal defense attorney, TRICARE physician representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, FCA violations attorneyhealth care fraud representation, TRICARE fraud attorneyhealth law defense attorneyhealth care fraud defense attorney, The Health Law Firm, representation for health care fraud investigations, compounding pharmacy lawyer, prescription reimbursement representation, pharmacy defense attorneypharmacist defense lawter, representation for pharmacies, representation for pharmacistslegal representation for health care facilities, representation for health care professionals, legal defense of TRICARE providers, U.S. Department of Justice (DOJ) investigation representation, DOJ defense attorney, representation for DOJ matters, attorney reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2018 The Health Law Firm. All rights reserved.

Pennsylvania Nursing Home Settles Wrongful Death Suit, Agrees to Pay $800,000

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

On December 21, 2017, the Devereux Foundation in Philadelphia, agreed to pay $800,000 to end a wrongful death suit against staff at The Devereux Pocono Center. The suit accused staff at the organization’s residential behavioral health facility in northeast Pennsylvania of failing to recognize symptoms of an infection in a developmentally disabled resident.

Details of the Wrongful Death Suit.

The family of Megan Ramsey, who died in the care of the Devereux Pocono Center in July 2014, asked a Pennsylvania federal judge to sign off on the settlement to end allegations that staff failed to detect symptoms of a perforated bowel and infection. According to court records, the patient had suffered from a rare genetic disorder known as Cornelia de Lange syndrome. Her symptoms included slow growth, small stature, gastroesophageal reflux disease, and issues with behavior and communication.

In July 2014, Ramsey complained of shoulder pain, a symptom of bowel perforation, according to the complaint. She was administered a pain reliever and observed to be uncharacteristically irritable and aggressive and was treated with doses of an anti-anxiety medication, the suit said. Ramsey asked staff members to be taken to the hospital. A residential manager at the facility, however, said only to monitor her closely, offer her fluids, and advise nursing staff of any worsening of her symptoms.

She was found dead the next morning.

The Settlement.

The patient’s family filed a pretrial memorandum in September 2017, in which investigations by state agencies resulted in findings of neglect, intentional or reckless failure to provide treatment, and intentional use of a chemical restraint or isolation.

The settlement of $800,000 includes fees for the plaintiff’s counsel of just under $267,000, the filing said. Click here to read the settlement in full.

To read one of my prior blogs about a similar case involving 14 deaths at a Florida nursing home, click here.

Contact Health Law Attorneys Experienced with Nursing Home Cases.

The Health Law Firm and its attorneys represent nursing homes, nursing home employees, mental health facilities and mental health professionals, including psychologists, social workers and mental health counselors, in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Fair, Matt. “Pa. Nursing Home Settles Patient Death Suit.” Law360. (December 21, 2017). Web.

The Meyer Law Firm. “Wrongful Death in Nursing Homes.” NursingHomeAbuseGuide.org. (December 22, 2017). Web.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for nursing home, nursing home defense attorney, legal representation for home health care facilities, home health care defense attorney, legal representation for health care facilities, health care facilities defense attorney, legal representation for American Health Care Association (AHCA) investigations, legal representation for nurses, legal representation for physicians, legal representation for licensure issues, legal representation for U.S. Department of Health (DOH) investigations, employment law defense attorney, legal representation for employment issues, legal representation for patient negligence, legal representation for health care negligence, legal representation for wrongful death suits, legal representation for wrongful death allegations, wrongful death suit defense attorney, legal representation for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, health law defense attorney, mental health facility defense counsel, mental health professional defense attorney, psychologist defense counsel and legal representation, social worker legal counsel and mental health counselor defense attorney

“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 © 2018 The Health Law Firm. All rights reserved.

Concierge Medical Services Bring Cash With Few Hassles to Physicians

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

What is concierge medical services?

A concierge medical service or practice is a similar to having a primary care provider such as a family practice physician. However, concierge practices are marked by a promise, explicit or implied, that they provide appointments quickly and give a greater degree of personal attention to patients and their problems. The physician works directly with a family, an individual, or a couple to provide most of the medical needs of the patient. These needs include general and specialized care. Having a concierge medical practitioner means there is constantly a doctor one phone call away, same day medial services and a personal relationship with your provider. But it all comes with a price and often does not accept Medicare or health insurance. More advanced technology and access to advanced medical services and resources over the Internet and via telecommunications, has led to larger profits for doctors choosing to start concierge services.

The price range for a concierge doctor varies incredibly. Although it has been criticized as catering to the wealthy, some doctors believe that concierge services should be available to the common person. However, others choose to only accept the wealthy into their services. Some doctors are willing to fly out to visit their clients or to accompany them to a specialized service across the country.

Benefits of Concierge Services.

A major benefit to a concierge practice for the physician is that the doctors tend to have fewer patients and, therefore, can spend much more time with them. Doing so allows for more personalized services at any time of the day or night. Some doctors even choose to call themselves “asset managers of the body.”

Ethical Dilemmas.

Some are concerned that the individuals almost always taking advantage of concierge medical practices are consistently in the upper or the middle class, never the lower class. Lower class individuals struggle the most with quality health care. Some have ethical issues with providing quality care only to the rich.

Contact an Experienced Health Law Attorney with Any and All Health Care Concerns.

The Health Law Firm and its attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in investigations, audits, recovery actions, and more. Know your rights as a provider who wants to participate in Concierge Services.

If you are a provider who wants to participate in the growing Concierge Services, contact The Health Law Firm.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Luthra, Shefali. “Fueled By Health Law, ‘Concierge Medicine’ Reaches New
Markets.” Kaiser Health News. (27 Mar. 2017). Web.

Schwartz, Nelson D. “The Doctor Is In. Co-Pay? $40,000.” The New York Times. (03 June 2017). Web.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Concierge medical services, private medical, physicians of concierge medical services, legal representation for concierge doctors, legal representation for concierge medical providers, health law attorney, health law defense attorney, legal representation for health care professionals, legal representation for health care professionals, doctor attorney, nurse attorney, reviews of the Health Law Firm, The Health Law Firm attorney reviews, legal representation for health care facilities, health care facilities defense attorney, legal representation for complex litigation, Florida health law attorney

“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 © 2017 The Health Law Firm. All rights reserved.

 

 

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