Florida Woman Arrested for $400,000 Medicaid Fraud Scheme

Lance Leider headshotBy Lance O. Leider, J.D., The Health Law Firm

The owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has allegedly been arrested for defrauding Medicaid out of more than $400,000, according to the Florida Office of the Attorney General (AG). The owner is charged with billing Florida’s Aged and Disabled Adult Waiver Program for services not rendered and billing for services to ineligible recipients. This Medicaid fraud scheme allegedly happened between January 2008 and June 2011.

To read the press release from the AG, click here.

Business Owner Accused of Fraud and Grand Theft.

The Florida Times-Union states that some of the people the business owner claimed to have provided services for were in jail at the time she supposedly rendered the services. The AG’s Medicaid Fraud Control Unit (MFCU) has charged the owner with two counts of Medicaid provider fraud and one count of grand theft.

The business owner is also accused of falsifying her application to become a Medicaid provider by hiding previous felony convictions and using a phony social security number, according to The Florida Times-Union.

Click here to read The Florida Times-Union article.

Defrauding Medicaid Comes with Hefty Consequences.

The business owner now faces up to 90 years in prison and a $30,000 fine. She is already serving time in prison for prescription drug trafficking charges.

What is the MFCU?

The MFCU is a division of the Florida Office of the AG. It is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit.

Click here to read a previous blog on ways to properly respond to a MFCU subpoena. Remember that the MFCU does not issue a subpoena without reason. If you are contacted by the MFCU, your first step should be to call an attorney experienced in Medicaid fraud.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.


The Health Law Firm’s 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 Medicaid and Medicare investigations, audits and recovery actions.

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


Comments?

Would you know how to respond to a subpoena from the MFCU? Tell us below.

Sources:

Meale, Jenn. “Attorney General Bondi Announces the Arrest of Duval County Resident for $400,000 in Medicaid Fraud.” My Florida Legal. (February 14, 2013). Press Release From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/36E3A9F88A5AC81785257B12006F3A8D

Treen, Dana. “Jacksonville Woman Charged with Medicaid Fraud in $400,000 Scam.” The Florida Times -Union. (February 14, 2013). From: http://jacksonville.com/news/crime/2013-02-14/story/law-disorder-woman-faces-charges-400000-medicaid-scam

About the Author: Lance O. Leider is an attorney with 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 Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Speech Therapist Arrested for Billing Medicaid $500,000 for Work at Florida Day Care Centers While Living in Illinois

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A speech therapist was arrested on March 29, 2013, for allegedly billing Medicaid more than $500,000 for services that she did not provide, according to the Florida Office of the Attorney General (AG). The speech therapist now faces charges of Medicaid fraud and grand larceny.

Click here to read the press release from the AG.

Billed Medicaid for Services Provided in Florida, While Living in Illinois.

According to an article in The Palm Beach Post, authorities began investigating the speech therapist when they received a tip that she was overbilling for services provided. During the investigation it was found that while the speech therapist reported to Medicaid she lived in Florida, she has been allegedly living in Illinois for the past eight years. The speech therapist allegedly employed two unlicensed speech therapists to work for her in two Florida day care centers. From January 2008 until February 2013, the speech therapist billed Medicaid for services she allegedly did not administer.

To read the entire article from The Palm Beach Post, click here.

Speech Therapist Faces Restitution and Prison Time.

The Florida AG’s Medicaid Fraud Control Unit (MFCU) and the West Palm Beach Police Department made the arrest. If convicted, the speech therapist faces up to $20,000 in fines, 60 years in prison and restitution.

MFCU and State and Federal Auditing Agencies.
The MFCU receives referrals from many other states and federal agencies. Often, matters that could be resolved as simple billing errors get escalated to criminal charges when Medicaid providers are interviewed and give evidence against themselves. Admitting to any misconduct, no matter how slight, may lead to far more serious criminal charges.

Click here for tips on how to respond to a Medicaid audit.

Faced with an Medicaid Audit? Contact Health Law Attorneys Experienced in Handling Medicaid Audits.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Comments?

How did the speech therapist get away with this for so long? What are your thoughts on this story? Please leave any thoughtful comments below.

Sources:

Seltzer, Alexandra. “Authorities: Woman billed Medicaid $500,000 for working at West Palm Beach day care centers while in Illinois.” The Palm Beach Post. (March 28, 2013). From: http://www.palmbeachpost.com/news/news/crime-law/authorities-she-billed-medicaid-500k-for-working-a/nW6ht/

Meale, Jenn. “Medicaid Fraud Control Unit Arrests Speech Therapist for $500,000 of Medicaid Fraud.” Florida Office of the Attorney General. (March 29, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/AE5D612364AD29C285257B3D004BE6B5

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.

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Key West Pharmacy Blows Whistle on Medicaid Fraud and Comes Out on Top

By Danielle M. Murray, J.D.

On September 27, 2012, Public Citizen, a watchdog group, reported whistleblowers have initiated $6.6 billion in penalties against drug manufacturers in 2012. Most of these penalties are for fraudulently overcharging government programs. The report names a small Key West, Florida, pharmacy as one of the top whistleblowers in the country. The pharmacy noticed and reported that drug manufacturers were charging highly inflated prices to Medicaid.

To read the entire report on from Public Citizen, click here.

Whistleblowing Can Pay Off Big.

The study shows that the government collected billions of dollars, just in 2012, as a result of whistleblower efforts.

For whistleblowers such as the Key West pharmacy, helping the government fight fraud has its rewards. According to the Miami Herald, the government collected an estimated $1.3 to $2.5 billion dollars thanks to the pharmacy. As a reward for its whistleblowing, the government gave the pharmacy an estimated $340 million dollars.

Click here to read the Miami Herald article.

One major victory was in 2012, the pharmacy won a settlement with Boehringer Ingelheim, a large pharmaceutical company, for $289 million for overcharging government health programs for various drugs.

To read the entire whistleblower complaint file, click here.

States Low on Funds Take Closer Look at Medicaid Fraud.

It’s no surprise that states are short of funds to pay for Medicaid. As a result, fraud enforcement is increasing, in hopes that the recoveries will make up that deficit. According to studies, states that have elected to enforce whistleblower claims against the pharmaceutical industries have found that the outcome pays for the cost of enforcement.

How This Affects Providers.

If states find that fraud recovery produces large results, they will increase their efforts in other areas besides the pharmaceutical industry. This could result in additional audits against individual providers, with states hopeful that they will uncover overpayments and other problems that would allow recoupment of funds. In fact, this is already happening in some areas, and the auditors are actually incentivized to find mistakes that providers make.

Faced with an Medicaid Audit? Contact Health Law Attorneys Experienced in Handling Medicaid Audits.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.  Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Comments?


Like this story? Don’t like it? Any Comments? Please submit any
thoughtful comments below.

Sources:

Dorschner, John. “Key West Pharmacy Top Whistle-Blower.” Miami Herald.(September 27, 2012). From: http://www.miamiherald.com/2012/09/27/3023894/key-west-pharmacy-top-whistleblower.html

About the Author: Danielle M. Murray is an attorney with 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.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

The Lone Star State’s New Task Force to Take a Bite Out of Medicaid Dental Fraud

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

There’s a new task force riding into Texas. According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children. The article, published on October 10, 2012, states the creation of the Medicaid and orthodontic task force was created in response to a significant increase in fraud by Medicaid providers.

To read the full article from The Texas Tribune, click here.

Everything is Bigger in Texas, Including Fraud.

A report released in April 2012, by the U.S. House Committee on Oversight and Government Reform, stated that in 2010 the Lone Star State spent as much on orthodontic services as every other state in the U.S. combined. In the report the state said the reason fraud was so widespread is that the organization the state hired to assess prior authorization forms was “rubber stamping” the forms for approval.

Click here to read the entire report from the U.S. House Committee on Oversight and Government Reform.

Patient Recruiting Contributing to Medicaid Fraud Problems.

An announcement on the Texas HHSC OIG website stated Texas authorities have found that some dental clinics hired representatives to stand outside retail and grocery stores and hand out gift cards in exchange for signing up for a “free” dental exam. The Inspector General said offering incentives to Medicaid clients is illegal. Those caught can be fined up to $10,000 per violation.

To see the announcement from the OIG of the HHSC, click here.

Crackdown Leaving Dentists Uneasy.

The task force and the overall crackdown on dentists and orthodontists have limited the number of dental professionals willing to take referrals for Medicaid patients. In The Texas Tribune article, the HSSC warns orthodontic providers that the Texas dental board can suspend or revoke their license for abandoning Medicaid patients.

Having a license suspended or revoked is an entirely different and very serious issue.
However, patient abandonment is very narrowly defined in the law and is difficult to prove.

What many state Medicaid regulatory authorities fail to appreciate is that indentured servitude is illegal in the United States. They seem to believe that if the professional is dumb enough to sign up for the Medicaid program, then he or she is dumb enough to be forced to provide services without pay or to be forced to see patients they don’t want to.

This may be largely an idle threat, however. I myself have had several articles published in major healthcare publications regarding what is and isn’t “patient abandonment.” Lay people and investigators bandy the term about figuring it will strike fear into the hearts of physicians (and often it does).

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s 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 Medicaid and Medicare investigations, audits and recovery actions.

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

Comments?

What do you think of the new task force? Do you think it will help put a stop to Medicaid dental fraud? Is Medicaid dental fraud a problem in your state? Should providers be charged with “patient abandonment” for not treating Medicaid patients? Please leave any thoughtful comments below.

Source:

Aaronson, Becca. “Joint Task Force Tackles Medicaid Dental Fraud.” The Texas Tribune. (October 10, 2012). From: http://www.texastribune.org/texas-health-resources/medicaid/joint-task-force-tackles-medicaid-dental-fraud/

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.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law

A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the Florida Office of the Attorney General (AG). On March 27, 2013, the facility owner was arrested. She faces charges of racketeering, Medicaid fraud and identity theft. According to the AG, local, state and federal law enforcement officers were all involved in the investigation.

Click here to read the press release from the AG.

Mental Health Counselor Reportedly Billed Medicaid for Services Never Rendered.

According to the Orlando Sentinel, between 2012 and 2013, the mental health counselor billed Medicaid more than $3 million for services provided to Medicaid recipients with mental health needs that were never rendered. The facility owner is also accused of using gift cards to bribe people into letting her use their Medicaid numbers and service applications. Click here to read the entire article from the Orlando Sentinel.

Money was Used on Luxury Items.

Authorities said the mental health counselor allegedly used the money to buy a cruise trip for seven people, a trip to Mexico, jewelry and more than $175 worth of Louis Vuitton products. Agents allegedly searched the mental health counselor’s home and business. They apparently seized a Cadillac Escalade and a Ducati Superbike from her home, according to the AG.

The mental health facility owner is charged with one count of second-degree Medicaid fraud, one count of first-degree racketeering, and one count of second-degree identity theft.


Medicare and Medicaid Investigations and Audits of Psychologists and Other Mental Health Professionals.

Over the past year we have observed an increasing number of Medicare and Medicaid investigations and audits being initiated against all mental health professionals. We have also seen a number of investigations and audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. There is a two-part blog on our website on this topic. Click here for part one, and click here for part two.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s 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 Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?

Do you think there is an increase in investigations on mental health care providers? Please leave any thoughtful comments below.

Sources:

Meale, Jenn. “Medicaid Fraud Control Unit and Partners Arrest Ringleader of $3 Million Medicaid Fraud Scheme.” Office of the Attorney General. (March 27, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/283E6646009F8B9685257B3B00664A79

Pavuk, Amy. “Bondi: Orlando Woman Ran $3M Medicaid Fraud Scheme.” Orlando Sentinel. (March 27, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-medicaid-fraud-investigation-20130327,0,2857142.story

About the Authors: 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.

Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law. He is an attorney with 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.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. 

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

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