legal representation in Medicaid managed care plan overpayment demand

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine 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 February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts. The fraud was allegedly perpetrated through two Florida companies the man owned, Expansion Media, LLC, and Hybrid Management Group, LLC. According to federal prosecutors in Boston, the scheme involved utilizing telemedicine and telemarketing enterprises to create fabricated orders for medical equipment, particularly knee braces. The scheme allegedly lasted from March 2016 to January 2023.

Specifics on this Medicare Fraud Scheme.

The Florida businessman and owner of Expansion Media, LLC, and Hybrid Management Group, LLC, allegedly sold medically unnecessary Durable Medical Equipment (D.M.E.) to medical staffing companies. According to the government, he […]

By The Health Law Firm|2024-03-14T09:59:08-04:00April 15, 2024|Categories: Pharmacy Law Blog|Tags: civil monetary penalty hearing, CMS defense attorney, CMS legal defense lawyer, Florida health law defense attorney, health insurance audit defense attorney, healthcare fraud defense legal representation, legal representation for CMS investigation, legal representation for healthcare professionals, legal representation in Medicaid managed care plan audit appeal, legal representation in Medicaid managed care plan audit defense, legal representation in Medicaid managed care plan overpayment demand, Medicaid managed care plan audit appeal attorney, Medicaid managed care plan audit legal defense attorney, Medicare Medicaid audit appeal lawyer, Medicare Medicaid audit defense attorney, Medicare Medicaid audit defense lawyer, Medicare Medicaid audit overpayment demand defense attorney, Medicare Medicaid investigation defense lawyer, Medicare Medicaid overpayment demand defense attorney, Office of Inspector General (OIG) investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine 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 February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts. The fraud was allegedly perpetrated through two Florida companies the man owned, Expansion Media, LLC, and Hybrid Management Group, LLC. According to federal prosecutors in Boston, the scheme involved utilizing telemedicine and telemarketing enterprises to create fabricated orders for medical equipment, particularly knee braces. The scheme allegedly lasted from March 2016 to January 2023.

Specifics on this Medicare Fraud Scheme.

The Florida businessman and owner of Expansion Media, LLC, and Hybrid Management Group, LLC, allegedly sold medically unnecessary Durable Medical Equipment (D.M.E.) to medical staffing companies. According to the government, he […]

By The Health Law Firm|2024-03-14T09:59:09-04:00March 25, 2024|Categories: Health Facilities Law Blog|Tags: civil monetary penalty hearing, CMS defense attorney, CMS legal defense lawyer, Florida health law defense attorney, health insurance audit defense attorney, healthcare fraud defense legal representation, legal representation for CMS investigation, legal representation for healthcare professionals, legal representation in Medicaid managed care plan audit appeal, legal representation in Medicaid managed care plan audit defense, legal representation in Medicaid managed care plan overpayment demand, Medicaid managed care plan audit appeal attorney, Medicaid managed care plan audit legal defense attorney, Medicare Medicaid audit appeal lawyer, Medicare Medicaid audit defense attorney, Medicare Medicaid audit defense lawyer, Medicare Medicaid audit overpayment demand defense attorney, Medicare Medicaid investigation defense lawyer, Medicare Medicaid overpayment demand defense attorney, Office of Inspector General (OIG) investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

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

On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.

The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.

Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s […]

By The Health Law Firm|2024-03-14T09:59:09-04:00March 14, 2024|Categories: Nursing Law Blog|Tags: Centene Sunshine State Health Plan audit legal defense attorney, Centene Sunshine State Health Plan audit overpayment appeal lawyer, Centene Sunshine State Health Plan audit overpayment demand defense lawyer, Centers for Medicare & Medicaid Services (CMS) defense attorney, civil monetary penalty hearing, CMS defense attorney, CMS legal defense lawyer, CMS legal defense representation, Department of Health and Human Services (HHS) civil investigative demand (CID) defense attorney, Department of Health and Human Services (HHS) subpoena defense attorney, False Claims Act (FCA) suit defense attorney, Florida health law defense attorney, health insurance audit defense attorney, healthcare fraud defense legal representation, legal representation for CMS investigation, legal representation for healthcare professionals, legal representation in Centene Sunshine State Health Plan audit, legal representation in Centene Sunshine State Health Plan audit overpayment appeal, legal representation in Centene Sunshine State Health Plan audit overpayment demand, legal representation in Medicaid managed care plan audit appeal, legal representation in Medicaid managed care plan audit defense, legal representation in Medicaid managed care plan HMO audit, legal representation in Medicaid managed care plan overpayment demand, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid managed care plan audit appeal attorney, Medicaid managed care plan audit legal defense attorney, Medicaid managed care plan HMO audit appeal attorney, Medicaid managed care plan HMO audit defense attorney, Medicaid managed care plan HMO overpayment defense lawyer, Medicare Medicaid audit appeal lawyer, Medicare Medicaid audit defense attorney, Medicare Medicaid audit defense lawyer, Medicare Medicaid audit overpayment demand defense attorney, Medicare Medicaid investigation defense lawyer, Medicare Medicaid overpayment demand defense attorney, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) investigation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations

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

On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.

The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.

Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s […]

Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations

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

On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.

The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.

Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s […]

Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations

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

On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.

The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.

Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s […]

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, […]