legal representation for health care fraud | The Health Law Firm Blog

Miami Man to Remain Jailed for Trial in Nation’s Largest Medicare Fraud Case

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

On December 3, 2018, a Florida judge ruled that a Miami businessman who has been jailed for more than two years on $1 billion health care fraud charges, must remain in custody through his trial next year. U.S. District Judge Robert N. Scola Jr. found no violation of his due process rights. He also denied Philip Esformes’ motion to dismiss several money laundering charges.

Trial Date is Set.

A February 11, 2019, trial date has been set for one of the nation’s biggest Medicare fraud cases that Esformes allegedly orchestrated through nursing homes and assisted living facilities he owned. According to the government, the scheme resulted in $1 billion in false billing and at least $464 million in improper reimbursement payments from Medicare and Medicaid.

Esformes, has been in […]

Florida Woman Accused of Operating Illegal Dental Practice Out of Her Garage

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

On November 16, 2018, a Florida woman was accused of practicing as an unlicensed dentist, operating out of her home garage. After receiving an anonymous tip, Palm Beach County Sheriff’s deputies arrested Alexandra Gallego after a month-long investigation into the illegal practice.

She is facing charges of Practicing Dentistry without a License, and Unlawful Use and Control of Dental Equipment.

Practicing Without a License.

In addition to running an illegal practice, Gallego is accused of offering discounted rates to patients who paid in cash, couldn’t afford insurance or did not have the proper documents to legally be in the United States. When investigators searched the home, they found a makeshift dental office, including X-rays, medications and payment receipts located in the garage.

She told authorities she would see about 160 […]

CMS Woes: Zone Program Integrity Contractors (ZPICs) Criticized for Oversight in Fraud Investigations

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

Zone Program Integrity Contractors (ZPIC) are private companies or business entities, that have contracted with the Centers for Medicare and Medicaid Services (CMS). Their purpose is to carry out certain functions related to auditing for possible fraud, that Medicare regional carriers (now called Medicare Administrative Contractors or “MACs”) performed in the past. They are specifically charged by CMS to data mine, identify, and investigate potentially fraudulent behavior in Medicare providers.

Because of this, health care providers that receive a letter from the ZPIC often see it as a potential death sentence, and certainly an eye-opening event, because it involves investigating for fraudulent activity. However, in recent years CMS has been criticized about its oversight (actually, […]

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Responding to a Medicaid Audit: Important Tips You Should Know

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

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid Program Integrity, is the Florida agency responsible for routine audits of Medicaid health care providers. Each state has a similar state agency, though it may have a different name. The agency’s job is to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving large payments from Medicaid or who practice in areas that typically see the most abuse or fraudulent billings, are the ones most likely to be audited. These include pediatricians, Ob/Gyns, family practice physicians and pediatric dentists.

A different state agency that may also conduct Medicaid audits is the state Medicaid Fraud Control Unit (MFCU). However, by definition, the MFCU is investigating allegations […]

By The Health Law Firm|2024-03-14T10:01:30-04:00May 15, 2018|Categories: Pharmacy Law Blog|Tags: health care fraud attorney, health care fraud defense attorney, health care fraud investigation defense attorney, legal representation for fraudulent billing, legal representation for health care fraud, legal representation for health care fraud investigation, legal representation for Medicaid audits, legal representation for Medicaid fraud, legal representation for overbilling, legal representation for submitting false claims to the government, Medicaid audit defense attorney, Medicaid fraud defense attorney, reviews of The Health Law Firm, reviews of The Health Law Firm attorneys, the health law firm|Comments Off

6 Charged In Florida Chiropractic PIP Insurance Fraud Scheme

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

On October 4, 2017, federal prosecutors charged six Florida residents with running a multi-million dollar insurance fraud scheme through a dozen chiropractic clinics. The alleged scheme involved paying kickbacks to chiropractors and tow truck companies to refer accident victims and then fraudulently billing insurers for services the victims did not need.
An indictment unsealed in Fort Lauderdale charges three of the individuals involved with racketeering, conspiracy to commit fraud and making false statements relating to health care matters. Three additional people were also charged with conspiracy to commit fraud.

Insurance Fraud Scheme.

Prosecutors claim that beginning in 2010, two of the individuals charged, ran a scheme through chiropractic clinics in South Florida that were used to commit automobile insurance fraud. They are alleged to have set up the […]

Michigan Dentist Accused of Million Dollar Medicaid Fraud Scheme Captured in Caribbean

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

A Michigan dentist accused of Medicaid fraud was recently captured in the Dominican Republic after evading charges for months, state authorities announced. Dr. David Johnson operated the alleged scheme through Livernois Dental in Detroit, which he owned at the time but has since sold.

27 Charges.

Dr. Johnson was charged by Michigan Attorney General Bill Schuette in May 2017, after allegedly using another dentist’s information to improperly bill Medicaid $1.7 million over a three year period of time. The charges include one count of racketeering, punishable by up to 20 years in prison; 20 counts of false Medicaid claims, punishable by up to 10 years in prison; and six counts of false health care claims, punishable by up to four years in prison.

According to the Attorney General’s […]

Health Care Software Double-Bills Government For Anesthesia Services According to FCA Suit

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

On November 2, 2017, a relator in a Florida federal False Claims Act (FCA) case, claimed that Epic Systems’ (Epic) health software wrongly defaults to double-billing for anesthesia services. As a result, the government is being overbilled by hundreds of millions of dollars, according to relator Geraldine Petrowski.

The Relator’s Allegations.

In an amended complaint, the relator alleges Epic billing software, used by hundreds of hospitals in the United States, defaults to charging for both the applicable “base units” for anesthesia provided on a procedure, as well as the actual time taken for the procedure. “This unlawful billing protocol has resulted in the presentation of hundreds of millions of dollars in fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims,” Petrowski said.

The relator […]

Florida Woman Lands Herself 6.5 Years in Prison, Owes $45 Million for Medicare Fraud Scheme

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

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets.

Sila Luis received an 80-month prison sentence in addition to being ordered to pay $45 million in restitution. This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Her case continued in 2017 following a 5-3 ruling by the Supreme Court holding that the government could not freeze assets belonging to her that were not tied to the alleged fraud scheme. This decision has the effect of making it more difficult for law enforcement authorities to swoop in and […]

Jury Finds Four New Orleans Doctors and Others Guilty for Participation in $13.6 Million Medicare Fraud Scheme

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

On May 9, 2017, a federal jury found four New Orleans doctors and two others guilty for their participation in a Medicare fraud scheme. According to prosecutors the defendants netted more than $13.6 million in fraudulent Medicare reimbursements.

Details of the Scheme.

The six defendants worked for or with Abide Home Care Services (Abide) in New Orleans. Federal prosecutors said Abide routinely falsified diagnoses so Medicare reimbursements were inflated. Abide also falsified medical records that supported medically unnecessary home health services, prosecutors said. Abide was owned by Lisa Crinel, who pleaded guilty to her role in the scheme in 2015.

In exchange for their role in the scheme, Abide made monthly payments to the doctors that were falsely characterized as medical consultant or director fees. Abide also […]

Florida Woman Who Performed Illegal Silicone Injections Sentenced After “Patient’s” Death

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

On May 26, 2017, a Sanford, Florida, woman who performed illegal cosmetic silicone injections was sentenced to 11 years in federal prison. According to prosecutors, the illegal procedures done by Deanna Roberts, led to serious health problems and the death of a prominent night club performer.
Illegal Injections.

From reports, Deanna Roberts bought about 178 gallons of non-medical grade liquid silicone between 2004 and 2015. She apparently told officials checking on this that she used the substance to lubricate medical equipment, according to the U.S. Department of Justice (DOJ). Despite what she told officials, prosecutors said she falsely claimed to be a licensed medical practitioner and illegally injected liquid silicone into at least five people during cosmetic procedures.

Come on, you know that if she purchased 178 […]

By The Health Law Firm|2024-03-14T10:01:35-04:00May 15, 2018|Categories: Nursing Law Blog|Tags: DOJ investigation representation, Florida health law attorney, health care fraud defense attorney, health care fraud investigation representation, health law defense attorney, legal representation for health care fraud, legal representation for health care fraud investigations, legal representation for health care professionals, legal representation for U.S. Department of Justice (DOJ) investigations, review of The Health Law Firm attorneys, The Health Law Firm reviews|Comments Off