Medicare fraud | The Health Law Firm Blog

Walgreens Agrees to Pay $269 Million to Settle Two FCA Suits

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

On January 22, 2019, Walgreens agreed to pay more than $269 million to settle allegations of False Claims Act (FCA) violations for overbilling of various drugs. The deals are some of the largest pay-outs ever by a retail pharmacy, according to the United States Department of Justice (DOJ).

The Two Settlements.

There were two separate complaints involving Walgreens to settle federal and state lawsuits that accused the pharmacy of overbilling federal healthcare programs. Both were unsealed by U.S. District Court judges in Manhattan, according to […]

By The Health Law Firm|2024-03-14T10:00:18-04:00January 29, 2019|Pharmacy Law Blog|

DOJ Announces $2.8 Billion Recovered Funds From Healthcare Cases in 2018

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

On December 21, 2018, the U.S. Department of Justice (DOJ) announced that it recovered more than $2.8 billion from False Claims Act (FCA) (also known as “qui tam” or “whistleblower cases”) cases in 2018. Of the $2.8 billion in settlements and judgments that the government obtained during the year through FCA cases, more than $2.5 billion involved health care fraud. These cases included drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical […]

By The Health Law Firm|2024-03-14T10:00:19-04:00January 28, 2019|Health Facilities Law Blog|

DOJ Announces $2.8 Billion Recovered From Healthcare FCA Cases in 2018

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

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical […]

By The Health Law Firm|2024-03-14T10:00:19-04:00January 14, 2019|Pharmacy Law Blog|

Helpful Tips to Speed Up the Medicare Prepayment Review Process

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

For Medicare providers, being notified of an impending audit is not welcome news. Being notified of a prepayment review is even worse. In a prepayment review, the health care provider must submit documentation to the Centers for Medicare & Medicaid Services (CMS) contractor before ever receiving payment. The health care provider will only receive payment (typically months later) if the contractor is satisfied with the provider’s documentation. This can be financially disastrous for the health care provider, who still must pay day-to-day expenses while waiting for a decision.

CMS Contractors.

If you have received notice of prepayment review, […]

By The Health Law Firm|2024-03-14T10:00:23-04:00August 29, 2018|The Health Law Firm Blog|

Federal Jury Convicts South Florida Doctors of Medicare Fraud

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

Two South Florida doctors, one Miami-area therapist, and two other individuals were convicted by a federal jury for their participation in a Medicare fraud scheme. The scheme allegedly involved more than $205 million in fraudulent billings by American Therapeutic Corporation (ATC), a corporation which provided mental health care services. The jury reached a decision on June 1, 2012. To see the Department of Justice press release, click here.

The two doctors and the therapist were each found guilty of one count of conspiracy to commit health care fraud. […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|Medicare, The Health Law Firm Blog|

Ambulance Company in Tennessee Settles A $2 Million Overpayment Lawsuit

George F. Indest III, Board Certified by The Florida Bar in Health Law

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney

A Tennessee ambulance company and the U.S. Department of Health and Human Services (DHHS) announced a settlement in a case over a post payment audit for more than two million dollars in May 2012. Back in March of 2010, the Nashville ambulance company sued the DHHS after being sent a $2.65 million overpayment demand, according to the Nashville Business Journal.

[…]

By The Health Law Firm|2024-03-14T10:00:37-04:00June 1, 2018|Appeal, Medicare, Medicare Audit, The Health Law Firm Blog|

Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC

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

Health Integrity, LCC, was named the Zone 4 Program Integrity Contractor (ZPIC) for the Medicare and Medicaid programs. As the ZPIC for Zone 4, Health Integrity has been performing benefit integrity activities aimed to reduce fraud, waste and abuse in Medicare and Medicaid data matching programs.

A ZPIC is a business entity that contracts with Medicare and Medicaid and works with state Medicaid agencies, the Centers for Medicare and Medicaid Services (CMS), and law enforcement officials to identify improper billing and utilization patterns throughout Zone 4.

ZPIC Zone 4 includes Texas, Colorado, New Mexico, and Oklahoma.

What […]

By The Health Law Firm|2024-03-14T10:00:46-04:00June 1, 2018|Medicaid, Medicaid audit, Medicare, Medicare Audit, The Health Law Firm Blog|

ZPICs Seek “Voluntary” Agreements from Physicians for Auto-Denial Edits for Home Health Services

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

According to the Centers for Medicare and Medicaid Services (CMS), the primary purpose of Zone Program Integrity Contractors (ZPICs) is to investigate instances of suspected fraud, waste, and abuse. The specific actions employed by ZPICs to fulfil this mission include:

– Investigating potential fraud and abuse for CMS administrative action or referral to law enforcement;
– Conducting investigations in accordance with the priorities established by Center for Program Integrity’s (CPI) Fraud Prevention System;
– Performing medical review, as appropriate;
– […]

By The Health Law Firm|2024-03-14T10:00:53-04:00June 1, 2018|Medicare, The Health Law Firm Blog, ZPIC|

$24 Million Medicaid Fraud Scheme Alleged by Connecticut Attorney General

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

Connecticut’s Attorney General, George Jepsen, alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. He filed a civil action on May 31, 2012. It is the first case the state has initiated under the Connecticut False Claims Act. The Connecticut False Claims Act gives the state the ability to seek compensation for taxpayers from those who submit false claims for reimbursements they are not eligible to receive. To view the Connecticut False Claims Act, click here.

The complaint seeks restitution, […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|Medicaid, The Health Law Firm Blog|

Revised Readmission Penalties are Coming Due to Calculation Errors

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

Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. To see that blog, click here.

In October of 2012, the Centers for Medicare and Medicaid Services (CMS) announced it has discovered errors in its initial calculations. This means, 1,422 hospitals with high readmission rates will lose slightly more money than first expected, according to Kaiser Health News.

Click here to read the entire article from Kaiser […]

By The Health Law Firm|2024-03-14T10:00:38-04:00June 1, 2018|In the Know, Medicare, Medicare Audit, The Health Law Firm Blog|