18 Former NBA Players Indicted For Alleged $4 Million Health Care Fraud Scheme

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

On October 7, 2021, 18 former NBA players were charged in New York federal court for an alleged health insurance fraud scheme to rip off the league’s benefit plan, according to an indictment filed in the Southern District of New York. The defendants allegedly engaged in a scheme from at least 2017 through 2020 which involved the submission of fraudulent claims for reimbursement of medical and dental services that were not provided, prosecutors said. The claims totaled nearly $4 million.

The NBA Players Health and Welfare Benefit Plan provide additional medical coverage on top of existing medical coverage for active and former NBA players and their families. It is primarily funded by contributions from NBA teams.

Their Playbook Included False Claims and Deception.

Allegedly, the defendants provided […]

By |2024-05-04T20:00:14-04:00May 6, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on 18 Former NBA Players Indicted For Alleged $4 Million Health Care Fraud Scheme

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 […]

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 […]

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

Author HeadshotBy 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 |2024-03-14T09:59:09-04:00March 14, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

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

Author HeadshotBy 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 |2024-03-14T09:59:11-04:00February 23, 2024|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations

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

Author HeadshotBy 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 |2024-03-14T09:59:13-04:00February 1, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations

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

Author HeadshotBy 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 |2024-03-14T09:59:14-04:00January 8, 2024|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations

Supreme Court Rules Against HHS in Hospital Medicare Reimbursement Case

Author HeadshotBy 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. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals.  This came in a ruling that limits regulators’ power to control what the program pays for certain drugs.  In this case, the Supreme Court justices sided unanimously with a group of hospitals suing over drug reimbursement rates for facilities that serve low-income communities. In writing for the court, Justice Brett Kavanaugh said the U.S. Department of Health and Human Services (HHS) improperly calculated reimbursement rates using a methodology Congress authorized for use only in limited circumstances.

Were the Reimbursement Cuts Unlawful?

The Supreme Court overturned a lower court’s 2020 decision that HHS had the authority to reduce the yearly Medicare reimbursement […]

By |2024-03-14T09:59:16-04:00November 18, 2023|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Supreme Court Rules Against HHS in Hospital Medicare Reimbursement Case

Supreme Court Rules FCA Case Liability Requires Defendants’ Subjective Belief

Author and attorney headshot leaning with hands folded in frontBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 1, 2023, the Supreme Court handed down an opinion on the knowledge standard required in False Claims Act (FCA) cases in a precedential decision that leaves the whistleblower plaintiffs bar reeling. In a unanimous ruling, the high court said liability of defendants in FCA cases would be based on their own belief in the falsity of their claims, rather than an “objectively reasonable” interpretation of the law or regulation. This appears to set the age-old maxim of “ignorance of the law is no excuse” on its head. Now, apparently, a defendant can argue that he, she or it was ignorant of the law and win.

The case before the Supreme Court […]

Supreme Court Rules FCA Case Liability Requires Defendants’ Subjective Belief

Author and attorney headshot leaning with hands folded in frontBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On June 1, 2023, the Supreme Court handed down an opinion on the knowledge standard required in False Claims Act (FCA) cases in a precedential decision that leaves the whistleblower plaintiffs bar reeling. In a unanimous ruling, the high court said liability of defendants in FCA cases would be based on their own belief in the falsity of their claims, rather than an “objectively reasonable” interpretation of the law or regulation. This appears to set the age-old maxim of “ignorance of the law is no excuse” on its head. Now, apparently, a defendant can argue that he, she or it was ignorant of the law and win.

The case before the Supreme Court […]

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