Dental Office Manager Sentenced to 12 Months in Prison for Defrauding Medicaid Out of More Than $813,000

Attorney Carole C. Schriefer Headshot

By Carole C. Schriefer, J.D.

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.


The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.


Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.


Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

About the Author: Carole C. Schriefer is an attorney and former registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456 or Toll-Free: (888) 331-6620. Its main office is in the Orlando, Florida area.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

By |2024-04-21T20:00:09-04:00April 23, 2024|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Dental Office Manager Sentenced to 12 Months in Prison for Defrauding Medicaid Out of More Than $813,000
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Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

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

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements will fall by 3.4 percent under the PFS in 2024.

However, in a piece of good news, the 2024 final rule allows marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill the program, for the first time ever.

Telehealth Expansions.

The PFS 2024 final rule expanded telemedicine and established that telehealth providers will be paid the non-facility rate for telehealth services. Under the rule, CMS will temporarily add health and well-being coaching services to the Medicare Telehealth Services List in 2024. Social Determinants of Health Risk Assessments will also be permanently added to the Telehealth Services List. The final rule also expanded the types of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists, and audiologists.

The final rule allows all diabetes self-management training services via telehealth. It also enables teaching physicians to be present using telecommunications when a resident furnishes telehealth services.

Finally, the rule established that rural health clinics and federally qualified health centers will continue receiving payment for telehealth services.

Outpatient Program Payment Increases.

CMS increased Medicare payments for hospital outpatient departments and ambulatory surgical centers by 3.1 percent for 2024. Stipulations in the Outpatient Prospective Payment Program final rule require hospitals to display standard charge information that conforms to a CMS template. Hospitals have been required to post the prices of services online since 2021, but compliance could be better.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

“Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule

“CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC).” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

“CMS issues CY 2024 physician fee schedule final rule.” American Hospital Association. (2 November 2023) https://www.aha.org/news/headline/2023-11-02-cms-issues-cy-2024-physician-fee-schedule-final-rule

“CMS Issues Physician Fee Schedule Final Rule with Payment Rate Cut.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/e144866d-b571-4b10-98d0-530c46f3f5e7/CMS-Issues-Physician-Fee-Schedule-Proposed-Rule-wi?Token=fe443b47-6081-4bae-bc4a-936ffe203608

HHS Press Office. “CMS Finalizes Physician Payment Rules that Advances Health Equity.” United States Department of Health and Human Services. (2 November 2023) https://www.hhs.gov/about/news/2023/11/02/cms-finalizes-physician-payment-rule-advances-health-equity.html

“Medicare Payments for Hospital Outpatient Services to Increase 3.1% in 2024.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/dcc44d7b-c122-49fd-9e5a-9918549f2c44/Medicare-Payments-for-Hospital-Outpatient-Services

Pifer, Rebecca. “CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements.” Healthcare Dive. (3 November 2023) https://www.healthcaredive.com/news/cms-medicare-hospital-doctor-rates-2024-340b-transparency/698706/

Vaidya, Anuja. “New PFS Rule Includes Telehealth Payment, Address Reporting Wins.” mHealth Intelligence Healthcare Media. (3 November 2023) https://mhealthintelligence.com/news/new-pfs-rule-includes-telehealth-payment-address-reporting-wins

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.

Hartley Brooks is a law clerk with The Health Law Firm.

The Health Law Firm’s main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced by anyone in any medium without the author’s express written permission. The author reserves the right to have his name associated with this work at all times.

By |2024-03-14T09:59:08-04:00April 15, 2024|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors
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Florida Man Pleads Guilty To $36.2 Million Telehealth 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 March 20th, 2024, the U.S. Attorney’s Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. As part of the scheme, the Fort Lauderdale-based pharmacy owner paid kickbacks and bribes to telemarketers and telemedicine providers for medically unnecessary prescriptions that were billed to Medicare.

Kickbacks & Bribes to Telemarketing Companies.

According to the plea agreement, the Fort Lauderdale-based, Florida man and his co-conspirators owned and operated pharmacies participating in the Medicare program. From September 2018 through November 2021, they paid kickbacks and bribes to telemarketing companies in exchange for recruiting Medicare beneficiaries to accept prescriptions for various medications that the patients did not want or need. The Florida man also owned and operated a telemarketing company, according to court documents. This allowed him to receive kickbacks from the pharmacies in exchange for the beneficiary (patient) leads he provided to them, the DOJ said.

But wait, there’s more!

The Role of the Telemedicine Companies.

The pharmacy owner and his co-conspirators also paid kickbacks and bribes to telemedicine companies that employed or contracted with physicians who signed the prescriptions. The physicians had no physician-patient relationship and often signed the prescriptions after only a brief telephone conversation or without any contact at all. The defendant and co-conspirators then submitted claims to Medicare, sometimes through multiple pharmacies they owned and controlled. As a result, Medicare Part D reimbursed them more than $36.2 million.

He faces up to ten years in federal prison and has agreed to forfeit $6,341,240.58 to cover the proceeds he made during the scheme. He also agreed to forfeit four pieces of real estate property, two jet skis, and numerous watches and pieces of jewelry. That last 58 cents in forfeitures is going to be the hardest to part with.

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

Contact Health Law Attorneys Experienced in Health Care Fraud and Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists, pharmacies and physicians in DEA, DOH, and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections, and audits. The firm’s attorneys include those who are board-certified by The Florida Bar in Health Law, as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

DOJ. (March 20, 2024). “Fort Lauderdale man pleads guilty to $36.2 million medicare fraud scheme.” United States Attorney’s Office Middle District of Florida. Retrieved from https://www.justice.gov/usao-mdfl/pr/fort-lauderdale-man-pleads-guilty-362-million-medicare-fraud-scheme#:~:text=Handberg%20announces%20that%20Omar%20Solari,prescriptions%20that%20were%20billed%20to

Health Law Weekly. (March 22, 2024). “Pharmacy operator pleads guilty to $36.2 million medicare fraud scheme.” American Health Law Association. Retrieved from https://www.americanhealthlaw.org/content-library/health-law-weekly/article/b486e0d0-287f-4a33-97ea-80b71af9a178/Pharmacy-Operator-Pleads-Guilty-to-36-2-Million-Me

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. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.

Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

By |2024-04-08T13:33:43-04:00April 8, 2024|Categories: The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme
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Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

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

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

By |2024-03-24T20:02:07-04:00March 26, 2024|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000
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Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements will fall by 3.4 percent under the PFS in 2024.

However, in a piece of good news, the 2024 final rule allows marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill the program, for the first time ever.

Telehealth Expansions.

The PFS 2024 final rule expanded telemedicine and established that telehealth providers will be paid the non-facility rate for telehealth services. Under the rule, CMS will temporarily add health and well-being coaching services to the Medicare Telehealth Services List in 2024. Social Determinants of Health Risk Assessments will also be permanently added to the Telehealth Services List. The final rule also expanded the types of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists, and audiologists.

The final rule allows all diabetes self-management training services via telehealth. It also enables teaching physicians to be present using telecommunications when a resident furnishes telehealth services.

Finally, the rule established that rural health clinics and federally qualified health centers will continue receiving payment for telehealth services.

Outpatient Program Payment Increases.

CMS increased Medicare payments for hospital outpatient departments and ambulatory surgical centers by 3.1 percent for 2024. Stipulations in the Outpatient Prospective Payment Program final rule require hospitals to display standard charge information that conforms to a CMS template. Hospitals have been required to post the prices of services online since 2021, but compliance could be better.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

“Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule

“CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC).” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

“CMS issues CY 2024 physician fee schedule final rule.” American Hospital Association. (2 November 2023) https://www.aha.org/news/headline/2023-11-02-cms-issues-cy-2024-physician-fee-schedule-final-rule

“CMS Issues Physician Fee Schedule Final Rule with Payment Rate Cut.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/e144866d-b571-4b10-98d0-530c46f3f5e7/CMS-Issues-Physician-Fee-Schedule-Proposed-Rule-wi?Token=fe443b47-6081-4bae-bc4a-936ffe203608

HHS Press Office. “CMS Finalizes Physician Payment Rules that Advances Health Equity.” United States Department of Health and Human Services. (2 November 2023) https://www.hhs.gov/about/news/2023/11/02/cms-finalizes-physician-payment-rule-advances-health-equity.html

“Medicare Payments for Hospital Outpatient Services to Increase 3.1% in 2024.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/dcc44d7b-c122-49fd-9e5a-9918549f2c44/Medicare-Payments-for-Hospital-Outpatient-Services

Pifer, Rebecca. “CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements.” Healthcare Dive. (3 November 2023) https://www.healthcaredive.com/news/cms-medicare-hospital-doctor-rates-2024-340b-transparency/698706/

Vaidya, Anuja. “New PFS Rule Includes Telehealth Payment, Address Reporting Wins.” mHealth Intelligence Healthcare Media. (3 November 2023) https://mhealthintelligence.com/news/new-pfs-rule-includes-telehealth-payment-address-reporting-wins

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.

Hartley Brooks is a law clerk with The Health Law Firm.

The Health Law Firm’s main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced by anyone in any medium without the author’s express written permission. The author reserves the right to have his name associated with this work at all times.

By |2024-03-14T09:59:09-04:00March 25, 2024|Categories: Health Facilities Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors
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Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements will fall by 3.4 percent under the PFS in 2024.

However, in a piece of good news, the 2024 final rule allows marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill the program, for the first time ever.

Telehealth Expansions.

The PFS 2024 final rule expanded telemedicine and established that telehealth providers will be paid the non-facility rate for telehealth services. Under the rule, CMS will temporarily add health and well-being coaching services to the Medicare Telehealth Services List in 2024. Social Determinants of Health Risk Assessments will also be permanently added to the Telehealth Services List. The final rule also expanded the types of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists, and audiologists.

The final rule allows all diabetes self-management training services via telehealth. It also enables teaching physicians to be present using telecommunications when a resident furnishes telehealth services.

Finally, the rule established that rural health clinics and federally qualified health centers will continue receiving payment for telehealth services.

Outpatient Program Payment Increases.

CMS increased Medicare payments for hospital outpatient departments and ambulatory surgical centers by 3.1 percent for 2024. Stipulations in the Outpatient Prospective Payment Program final rule require hospitals to display standard charge information that conforms to a CMS template. Hospitals have been required to post the prices of services online since 2021, but compliance could be better.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

“Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule

“CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC).” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

“CMS issues CY 2024 physician fee schedule final rule.” American Hospital Association. (2 November 2023) https://www.aha.org/news/headline/2023-11-02-cms-issues-cy-2024-physician-fee-schedule-final-rule

“CMS Issues Physician Fee Schedule Final Rule with Payment Rate Cut.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/e144866d-b571-4b10-98d0-530c46f3f5e7/CMS-Issues-Physician-Fee-Schedule-Proposed-Rule-wi?Token=fe443b47-6081-4bae-bc4a-936ffe203608

HHS Press Office. “CMS Finalizes Physician Payment Rules that Advances Health Equity.” United States Department of Health and Human Services. (2 November 2023) https://www.hhs.gov/about/news/2023/11/02/cms-finalizes-physician-payment-rule-advances-health-equity.html

“Medicare Payments for Hospital Outpatient Services to Increase 3.1% in 2024.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/dcc44d7b-c122-49fd-9e5a-9918549f2c44/Medicare-Payments-for-Hospital-Outpatient-Services

Pifer, Rebecca. “CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements.” Healthcare Dive. (3 November 2023) https://www.healthcaredive.com/news/cms-medicare-hospital-doctor-rates-2024-340b-transparency/698706/

Vaidya, Anuja. “New PFS Rule Includes Telehealth Payment, Address Reporting Wins.” mHealth Intelligence Healthcare Media. (3 November 2023) https://mhealthintelligence.com/news/new-pfs-rule-includes-telehealth-payment-address-reporting-wins

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.

Hartley Brooks is a law clerk with The Health Law Firm.

The Health Law Firm’s main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced by anyone in any medium without the author’s express written permission. The author reserves the right to have his name associated with this work at all times.

By |2024-03-14T09:59:10-04:00March 4, 2024|Categories: Mental Health Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors
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Manager of Dental Office Sentenced to Prison for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

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

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

By |2024-03-14T09:59:33-04:00February 25, 2023|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Manager of Dental Office Sentenced to Prison for Defrauding Medicaid Out of More Than $813,000
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Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

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

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As part of the scheme, it is alleged that both of them proceeded to bill Medicaid for thousands of provisional crowns, a significant number of which were allegedly not actually provided to the patients. From August 2012 through February 2014, D.C. Medicaid reportedly paid Universal Smiles approximately $5.4 million in Medicaid reimbursement. Of that amount, it is alleged that the office manager received approximately $813,184.

As part of the sentence, she has been ordered to pay back the full amount she received and will be on three years of supervised release following the completion of her prison term.

Click here to read the press release by the Department of Justice (DOJ) and learn more.

To read about a similar case that also deals with a healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits and Investigations of Dentists and Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to dentists, dental hygienists, physicians, medical groups, nurses, nurse practitioners, CRNAs, physical therapists, behavior analysts, pharmacists, psychologists, mental health counselors, health care facilities, and other health providers in Medicaid and Medicare investigations, audits, fraud charges, and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Martin, Colleen. “Rockville Woman Defrauded Medicaid At Dental Office: US Attorney.” Patch. (October 4, 2021). Web.

Bethesda Beat Staff Reporter. “Rockville woman to serve prison term over D.C. Medicaid fraud.” Bethesda Magazine. (October 4, 2021). Web.

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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

By |2024-03-14T09:59:34-04:00February 11, 2023|Categories: Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000
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“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 © 2022 The Health Law Firm. All rights reserved.
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