mfcu | The Health Law Firm Blog

What to do if You Receive a Medicaid Fraud Control Unit Investigative Subpoena

The Medicaid Fraud Control Unit is charged with investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. It is a division of the Florida Office of the Attorney General .When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records. The practice tips below were prepared to assist a health care provider in properly responding to and defending against such a subpoena.

1. Immediately contact an attorney knowledgeable in Medicaid fraud and abuse prior to responding to the government’s requests.

The Medicaid Fraud Control Unit does not issue a subpoena without reason. An investigation by the Medicaid Fraud Control Unit is a very serious matter that can lead to both the recoupment of Medicaid reimbursements and criminal charges. It is essential that you immediately retain an attorney experienced in Medicaid fraud and abuse claims when served with such a subpoena. If retained early, an experienced health care attorney can review the requested records and determine what concerns the government may have and how best to defend against them. An experienced attorney can also determine if the subpoena has been properly served and what documents will be most responsive to the government’s requests.

2. The Medicaid Fraud Control Unit can only subpoena and seize the records of Medicaid patients.

The Medicaid Fraud Control Unit has the right to subpoena and review the patient records for Medicaid patients only. The records of a non-Medicaid patient may not be reviewed by the government without the patients’s prior written consent.

3. The government investigator is not on your side.

It is not uncommon for a government investigator to notify you that the subpoena you have been served with is a routine matter and that there is nothing to fear. The investigator may also tell you that your practice is not the subject of the investigation and that retaining counsel is unnecessary. A subpoena issued by the Medicaid Fraud Control Unit is always a very serious matter and should be treated as such. Remember, the investigator’s job is to build a case against you and, in our experience, they will use whatever tactics are at their disposal to do so.

4. DO NOT provide the Medicaid Fraud Control Unit with more documents than have been requested.

It is almost never advisable to provide the Medicaid Fraud Control Unit with more documents than requested in the subpoena. Providing the government investigator with additional information beyond what was requested will only provide the government with more evidence to use against you at a later date.

5. DO NOT provide the Medicaid Fraud Control Unit with your original records.

Unless required by the government, do not provide the Medicaid Fraud Control Unit with your original records. These investigations can often taken years to reach a final resolution and once the original records have been produced it is very difficult to get them back. In most cases, if the government is provided with an organized bates stamped copy of the requested records, they will not require you to produce the originals.

6. If proper and lawful, you must respond to the subpoena.

If the Medicaid Fraud Control Unit properly serves you with a lawful subpoena, you must produce the written records within the time prescribed. If the subpoena is not obeyed, the government will petition the court to compel compliance, and you will likely have to pay the government’s attorney’s fees and costs associated with enforcing the investigative subpoena.

7. Your employees are not required to speak with government investigators unless subpoenaed.

After your records have been produced, it is important to remember that neither you nor your employees are required to speak with government investigators, absent a subpoena. As noted above, it is rarely advisable to volunteer information to the Medicaid Fraud Control Unit, and in most cases, this information will be used to build a case against you.

8. Remain patient after complying with the subpoena.

Finally, it is important to remain patient after you have submitted your records to the government for review. The Medicaid Fraud Control Unit investigates hundreds of cases each year, involving thousands of records, and it is not uncommon for an investigation to go years without a final determination. Legal representation is extremely important at this time, as the communications between the your counsel and the government can make the difference between a civil penalty and criminal charges.

For more information on the Medicaid Fraud Control Unit and Medicaid audits, please visit our website at www.TheHealthLawFirm.com.

The Health Law Firm2012-04-30T14:26:05-04:00June 1st, 2018|Categories: Medicaid, The Health Law Firm Blog|Tags: medicaid, medicaid audit, medicaid fraud control unit, medicaid fraud control until subpoena, mfcu, mfcu subpoena|1 Comment

Medicare Fraud Initiative Leads to Arrests of Over 100 Health Professionals

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

A recent Medicare fraud operation conducted between several federal agencies has resulted in the arrest of over 100 doctors, nurses and other medical professionals. They have been charged with various crimes relating to Medicare fraud. The arrests were made on May 2, 2012 in seven cities nationwide, but more than half took place in South Florida.

This multi-agency attack on medical professionals and health care providers was a joint effort between law enforcement agents from the Federal Bureau of Investigation (FBI), Department of Health and Human Services-Office of Inspector General (HHS-OIG), Medicaid Fraud Control Units (MFCU) and other state and local law enforcement agencies. In addition to arresting over 100 medical professionals, these agents also executed 20 search warrants in connection with ongoing Medicare fraud investigations.

Some of the charges against the health care professionals include conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged Medicare fraud schemes involving medical treatments and services such as home health care, mental health services, physical and occupational therapy, durable medical equipment (DME), mental health counseling and ambulance services. These alleged Medicare fraud schemes resulted in a combined $452 million in false billings.

HHS also took other administrative action against 52 other health providers. These providers were tracked down through data analysis and are also accused of Medicare fraud. Because of the Affordable Care Act, HHS will be able to suspend payments to these providers the entire time until the investigations are completed.

Because of the severe state budget shortfalls and the federal deficit, we are seeing a tremendous increase in both Medicare and Medicaid fraud initiatives. If you are being accused of Medicare or Medicaid fraud, it is extremely important to retain an experienced health attorney immediately.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now Before it is Too Late

The lawyers of The Health Law Firm routinely represent physicians and other healthcare professionals in Medicare and Medicaid investigations, audits and recovery actions. They also represent physicians and health professionals 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.

Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

Sources Include:

Weaver, Jay. “Feds Arrest More Than 100 Medicare Fraud Suspects in South Florida, Nationwide.” Miami Herald. (May 02, 2012). From
http://www.miamiherald.com/2012/05/02/2779369/feds-arrest-about-100-medicare.html

U.S. Department of Justice, Office of Public Affairs. “Medicare Fraud Strike Force Charges 107 Individuals for Approximately $452 Million in False Billing.” U.S. Department of Justice. Press Release. (May 02, 2012). From http://www.justice.gov/opa/pr/2012/May/12-ag-568.html

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 Firm2012-05-04T17:16:45-04:00June 1st, 2018|Categories: Health Care Industry, In the News, Medicaid, Medicare, The Health Law Firm Blog|Tags: Affordable Care Act, anti-kickback statute, conspiracy, Department of Health and Human Services, false billing, FBI, health care fraud, hhs, medicare, medicare audit, Medicare fraud, Medicare fraud attorney, Medicare Fraud Control Unit, Medicare investigation, mfcu, money laundering, Office of the Inspector General, OIG, overpayment|3 Comments

Settlement Reached in GlaxoSmithKline Healthcare Fraud Case

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

GlaxoSmithKline (GSK), a prescription drug manufacturer, will pay $3 billion in fines to resolve allegations of healthcare fraud. The settlement was announced by federal prosecutors on July 1, 2012, and in a press release from the Florida Attorney General on July 2, 2012. This is the largest healthcare fraud settlement in U.S. history.

Settlement Resolves Allegations Against GSK Related to Healthcare Fraud.

The settlement resolves allegations that GSK:

Marketed the depression drug Paxil for off-label uses, such as use by children and adolescents;
Marketed the depression drug Wellbutrin for off-label uses, such as for weight loss and treatment of sexual dysfunction, and at higher-than-approved dosages;
Marketed the asthma drug Advair for off-label uses, including first-line use for asthma;
Marketed the seizure medication Lamictal for off-label uses, including bipolar depression, neuropathic pain, and various other psychiatric conditions;
Marketed the nausea drug Zofran for off-label uses, including pregnancy-related nausea;
Made false representations regarding the safety and efficacy of Paxil, Wellbutrin, Advair, Lamictal, Zofran, and the diabetes drug Avandia;
Offered kickbacks to healthcare professionals to induce them to promote and prescribe certain prescription drugs; and
Submitted incorrect pricing data for various prescription drugs, thereby underpaying rebates owed to Medicaid and other federal healthcare programs.

GSK Will Also Plead Guilty to Criminal Charges as Part of Settlement.

As part of the settlement, GSK has will plead guilty to criminal charges that it violated the federal Food, Drug, and Cosmetic Act (FDCA). Allegedly, GSK introduced Wellbutrin and Paxil into interstate commerce when the drugs contained labels that were not in accordance with their FDA approvals. Additionally, GSK allegedly failed to report certain clinical data regarding Avandia to the FDA.

Florida to Receive Over $56 Million In Settlement.

Florida will receive more than $56 million as part of the settlement with GSK. Florida Attorney General, Pam Bondi, announced the state’s participation in the settlement on July 2, 2012.

Settlement Stems From Whistleblower Actions.

The settlement is based on four qui tam, or whistleblower, actions brought by individuals pursuant to state and federal false claims. To view the federal False Claims Act, click here. A National Association of Medicaid Fraud Control Units team, along with several other federal agencies, investigated the matter and conducted settlement negotiations with the defendants. Florida’s civil investigation was handled by the Attorney General’s Complex Civil Enforcement Bureau, which is part of the Medicaid Fraud Control Unit.

Contact Health Law Attorneys Experienced in Healthcare Fraud Cases.

The Health Law Firm represents physicians, medical practices, pharmacists, pharmacies, and other health providers in healthcare fraud cases, including investigations, regulatory matters, litigation, and audits involving government health programs (Medicare, Medicaid, TRICARE).

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

Sources Include:

Meale, Jenn. “Attorney General Bondi’s Office Reaches Historic Healthcare Fraud Settlement.” Florida Office of the Attorney General. (July 2, 2012). Press Release. From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/E494FDADFF113AC885257A2F0068F790

Schmidt, Michael S. and Katie Thomas. “GlaxoSmithKline Agrees to Pay $3 Billion in Fraud Settlement.” New York Times. (July 2, 2012). From: http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay-3-billion-in-fraud-settlement.html?pagewanted=all

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 Firm2012-07-09T18:25:50-04:00June 1st, 2018|Categories: In the News, The Health Law Firm Blog|Tags: Attorney General, audit, false claims act, FDA, florida, Florida Medicaid, fraud defense attorneys, fraud schemes, GlaxoSmithKline, GSK, healthcare fraud, medicaid, medicaid fraud control unit, medicare, mfcu, qui tam, realtor, settlement, whistleblower|0 Comments

Florida Respiratory Therapist Arrested for Alleged Elder Abuse

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

A Lee County, Florida, registered respiratory therapist at HealthPark Medical Center in Fort Myers, Florida, was arrested and charged with battery on an elderly patient. The respiratory therapist was arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU). The arrest was announced by the AG on February 14, 2014.

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

Respiratory Therapist Accused of Fracturing Patient’s Hand.

According to the AG, the respiratory therapist allegedly abused a 68-year-old intensive care unit patient by severely bending his fingers back resulting in a bone fracture in the patient’s hand, while the man’s arms were restrained.

The respiratory therapist is charged with battery on a person over the age of 65, which is a third-degree felony. If convicted, the alleged abuser faces a minimum sentence of three years in prison and up to $10,000 in fines.

MFCU Conducted Investigation.

The MFCU’s investigation led to the MFCU issuing a warrant for the respiratory therapist’s arrest. The case will be prosecuted by the Lee County State Attorney’s Office.

According to the AG, in addition to Medicaid fraud, the MFCU investigates abuse, neglect and exploitation of elderly or disabled people in health care facilities.

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 Health Care 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 speech therapists, occupational therapists, vocational therapists, therapy groups, 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 these charges? Please leave any thoughtful comments below.

Source:

Florida Attorney General. “Lee County Man Arrested for Elder Abuse.” My Florida Legal. (February 14, 2014). From: http://bit.ly/1o6vq0J

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 © 1996-2014 The Health Law Firm. All rights reserved.

Florida Attorney General Targets Targeted Case Management Fraud

By Christopher E. Brown, J.D., The Health Law Firm

Due to increased fraud throughout the system, the Florida Attorney General (AG), through the Medicaid Fraud Control Unit (MFCU), is focusing its attention on Medicaid targeted case management (TCM) services.

TCM services were created to assist children with documented mental health conditions in gaining access to medical, social, educational, and other support services. To be eligible for such services a child must meet very strict criteria.

Eligibility Criteria for Children’s Mental Health TCM Services:

1. Must be enrolled in a Department of Children and Families (DCF) children’s mental health target population (birth through 17 years);
2. Has a mental health disability (i.e., serious emotional disturbance) that requires advocacy for and coordination of services to maintain or improve level of functioning;
3. Requires services to assist in attaining self sufficiency and satisfaction in the living, learning, work, and social environments of choice;
4. Lacks a natural support system for accessing needed medical, social, educational, and other services;
5. Requires ongoing assistance to access or maintain needed care consistently within the service delivery system;
6. Has a mental health disability (i.e., serious emotional disturbance) that, based upon professional judgment, will last for a minimum of one year;
7. Is in out-of-home mental health placement or at documented risk of out-of-home mental health treatment placement; and
8. Is not receiving duplicate case management services from another provider.

Unfortunately, many of the children TCM providers assist and bill Medicaid for do not meet these criteria. In addition, a lack of oversight by the Medicaid program has led to numerous improper and fraudulent payments to TCM providers.

Florida TCM Fraud Cases.

Improper and fraudulent payments are often related to TCM providers billing for services that were never performed and paying kickbacks for client referrals.

According to the Florida AG, the three owners of Destiny TCM Corporation in Central Florida were arrested by the MFCU for $27,000 worth of Medicaid fraud. The corporation is accused of falsely billing the Medicaid program for illegitimate targeted case management services and bribing individuals in order to obtain Medicaid recipient numbers. Click here to read the press release from the AG.
In another similar case, the owners of Kingdom Builders Ministries in Lake County, Florida, were also arrested for allegedly defrauding Florida Medicaid out of $80,000. The MFCU revealed that the two owners allegedly directed employees to bill for an entire family when only one member received services. Employees were also allegedly instructed to bill for unauthorized expenses, such as travel time, employee staff meetings and phone calls. Additionally, records indicate that Kingdom Builders Ministries received payment for services allegedly provided to young children who did not have any documented mental health condition and continued to submit invoices months after terminating services. Click here to read more from the AG.

Tips for Responding to a Medicaid Fraud Control Unit Investigative Subpoena.

The MFCU has become aware of these improper payments and has begun to investigate TCM providers, aggressively. The MFCU 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 practice tips on how to properly respond to an MFCU subpoena.

Defend Yourself from Fraud Charges.

We have been consulted by many individuals similar to the subjects of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have in order to avoid a conviction.

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 Health Care 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 speech therapists, occupational therapists, vocational therapists, therapy groups, 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?

Did you know the eligibility criteria for children’s mental health TCM services? Were you aware that the AG is targeting these services? Please leave any thoughtful comments below.

About the Author: Christopher E. Brown, J.D., 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.

Apopka Woman to Serve 18-Month Prison Sentence After $47K Medicaid Scam

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

An Apopka businesswoman was recently sentenced to 18 months in prison after she was found guilty of a Medicaid scam. According to the Florida Attorney General’s Office, Shanqual Marshall-Gunn was arrested in September on suspicion of submitting more than $47,000 in fraudulent Medicaid claims.

Company Provided Targeted Case Management Services (TCMs).

Marshall-Gunn owned Second Chances TCM, Inc. TCMs are intended to provide Medicaid recipients who have mental-health disorders with connections to resources in their community, and to assist them in leading a more normal life. Prosecutors said Marshall-Gunn gave employees and clients kickbacks when they submitted referrals to her company.

Three of her employees were also arrested in September 2014 for billing Medicaid for targeted case management services that were fraudulent or not authorized.

Marshall-Gunn Entered a No Contest Plea.

Media reported that court records show Marshall-Gunn entered a no contest (or “nolo contendere”) plea and was found guilty of Medicare fraud, a second-degree felony. Circuit Court Judge Jenifer Davis sentenced Marshall-Gunn on July 2. Davis also ordered Marshall-Gunn to serve five years of probation.

In addition, she cannot work for any Medicaid provider and must pay more than $47,000 in restitution.

The Investigation Was Conducted by the Medicaid Fraud Control Unit.

The investigation was conducted by Attorney General Pam Bondi’s Medicaid Fraud Control Unit (MFCU). And it was prosecuted by the Attorney General’s Office of Statewide Prosecution.

Bondi’s MFCU investigates and prosecutes providers that intentionally defraud Florida’s Medicaid program. According to Bondi’s MFCU press release in this case: “From January 2011 to August 2014, Attorney General Bondi’s MFCU has obtained more than $460 million in settlements and judgments.”

To read the press release, click here.

To read more about the MFCU, click here.

Comments?

Have you ever been a victim or suspect of Medicaid fraud? Please leave any thoughtful comments below.

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 Health Care 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 (ALFs), 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 and visit our website at www.TheHealthLawFirm.com.

Sources:

Attorney General’s Press Office. “Four Central Florida Residents Arrested for Medicaid Fraud.” (Sept. 5, 2014). WCTV. From: http://www.wctv.tv/home/headlines/Four-Central-Florida-Residents-Arrested-for-Medicaid-Fraud-274154191.html

Connolly, Kevin P. “Apopka woman sentenced to prison for 18 months after Medicaid scam.” Orlando Sentinel. Print.

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.

KeyWords: Medicaid, Medicaid fraud, defense attorney, Medicaid investigation, defense lawyer, defense counsel, Medicaid claims, fraudulent claims, home health care, criminal defense, health law criminal defense, health law criminal representation, criminal representation, Medicaid Fraud Control Unit, MFCU, targeted case management provider, TCM, Florida’s Medicaid program, overbill Medicaid, Medicaid scam, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicare, Medicare fraud, Medicare Investigation, overbill Medicare, health care fraud, Florida Attorney General, The Health Law Firm

“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 © 1996-2015 The Health Law firm. All rights reserved.

Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000

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

The two owners of a Minneola, Florida, ministry that helps provide counseling therapy and case management for children and families, each face up to 15 years in prison for allegedly defrauding Medicaid. According to the Florida Attorney General (AG), the pair was arrested on December 11, 2013. The owners were arrested after an investigation by the AG’s Medicaid Fraud Control Unit (MFCU) revealed that they allegedly bilked the Medicaid program out of $80,000.

Click here to read the press release from the AG.

Pair Charged With Participating in an Organized Scheme to Defraud Medicaid.

According to a Daily Commercial article, the two owners ran a counseling center that was suppose to link Medicaid recipients with a mental health condition to state-approved mental health counseling centers in the community. However, the MFCU’s investigation uncovered that the owners allegedly billed Medicaid for services that were never rendered. According to the investigation, the duo also instructed their employees to bill for entire families when only one family member received services. Employees of the ministry also allegedly billed for unauthorized expenses. Additionally, it is alleged the ministry received reimbursements for services provided to children who did not have any documented mental health condition.

The two owners are both charged with one count of participating in an organized scheme to defraud Medicaid, according to the Daily Commercial. If convicted, they each face up to 15 years in prison, up to $10,000 in fines, and restitution. Click here to read the article from the Daily Commercial.

Responding to a MFCU Investigative Subpoena.

The MFCU 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 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 practice tips on how to properly respond to a subpoena.

Take Fraud Charges Seriously.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

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 Health Care 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?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Ray, Whitney. “Attorney General Bondi’s Office Announces Arrest of Lake County Couple for Nearly $80,000 Medicaid Fraud.” Florida Attorney General. (December 11, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/7BAB936C94315B3885257C3E006F8895

Daily Commercial. “Ministry Owners Charged with Medicaid Fraud.” Daily Commercial. (December 12, 2013). From: http://www.dailycommercial.com/news/article_cc247b13-5771-5da4-9cab-545c5614aa91.html

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.

New Hampshire Dentist Indicted on 189 Counts of Medicaid Fraud

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

On December 20, 2013, a New Hampshire dentist was indicted on 189 counts of Medicaid fraud, according to a number of news sources. The dentist is alleged to have made false claims to the New Hampshire Medicaid office for procedures such as oral exams, X-rays, tooth extractions and orthopedic treatments performed between 2008 and 2013. According to the Concord Monitor, the dentist faces a maximum sentence of 1,323 years in prison. However, it is unlikely the dentist will receive such a long sentence. It is even more unlikely that he will serve the entire sentence, even if he does receive the maximum.

To read an article from the Concord Monitor, click here.

Medicaid Fraud Control Unit of the New Hampshire Attorney General’s Office Brought Charges.

According to an article in the Union Leader, the Medicaid Fraud Control Unit (MFCU) of the state Attorney General’s (AG) Office handed down the charges against the dentist. Most of the indictment alleges that the claims made by the dentist were unjustified based on treatment records. The dentist is also accused of billing the Medicaid program for individual services he was already being reimbursed for under a lump-sum treatment plan.

The dentist was also allegedly indicted on nearly 30 counts of falsifying evidence. According to the Union Leader, once the dentist found out he was being investigated, the dentist allegedly attempted to alter his medical records.

According to his attorney the dentist plans to plead not guilty at his arraignment on January 15, 2014.

Click here to read the entire Union Leader article.

Poor Documentation or Fraud?

When we look at cases of this nature, we always ask was this just a case of poor documentation or was it intentional fraud? Was this a case of an incompetent biller or was it intentional submission of false claims? In many cases, poor administration or poor documentation can explain what may look like fraud to a regulator or prosecutor.

Tips for Responding to a MFCU Investigative Subpoena.

The MFCU 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 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 practice tips on how to properly respond to a subpoena.

Fraud Charges Should be Taken Seriously.

We have been consulted by many individuals similar to the subject of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in Medicare and Medicaid 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 http://www.TheHealthLawFirm.com.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Blackman, Jeremy. “Manchester Dentist Faces 1,300 Years in Medicaid Fraud Scheme.” Concord Monitor. (December 30, 2013). From: http://www.concordmonitor.com/home/10005460-95/manchester-dentist-faces-1300-years-in-medicaid-fraud-case

Siefer, Ted. “Manchester Dentist Indicted on 189 Counts of Medicaid Fraud.” Union Leader. (January 1, 2014). From: http://www.unionleader.com/article/20140101/NEWS03/140109940

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.

Mother and Daughter-In-Law Arrested for Allegedly Defrauding Medicaid Out of More Than $70,000

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

A mother and daughter-in-law duo each face up to 30 years in prison for allegedly defrauding the Florida Medicaid program out of more than $70,000. According to a press release from the Florida Attorney General (AG), released February 20, 2014, the pair was arrested for allegedly running a scheme that involved billing the Medicaid program for services never rendered.

Click here to read the press release from the AG.

Mother and Daughter-In-Law Claimed to Provide Services to Developmentally Disabled Child.

According to the AG, the mother and daughter-in-law allegedly ran a scheme that involved billing the Medicaid program for services that were not actually provided to the mother’s developmentally disabled son. It’s alleged the mother submitted timesheets for work that was not provided. The press release did not state how the daughter-in-law was specifically involved in the scheme.

The mother and daughter-in-law are each charged with one count of Medicaid fraud, which is a first-degree felony. If convicted, the pair could face up to 30 years in prison and up to $10,000 in fines and restitution. Additionally, if convicted, this would be a crime of health care fraud. The collateral consequences could be devastating.

According to the AG, the Florida Medicaid Fraud Control Unit (MFCU) and the Tampa Police Department arrested the mother of the child, and the Chesterfield County Sheriff’s Department in South Carolina arrested the daughter-in-law.

When the MFCU is Involved, the Investigation is Serious.

The MFCU 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 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 practice tips on how to properly respond to a subpoena.

Medicare and Medicaid Audits Should Not Be Dismissed.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

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 Health Care 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 speech therapists, occupational therapists, vocational therapists, therapy groups, 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?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Source:

Jenn, Meale. “Attorney General Pam Bondi’s Office Announces the Arrest of Mother and Daughter-in-Law Duo for More Than $70,000 of Medicaid Fraud.” My Florida Legal. (February 20, 2014). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/5A11AC9DE5E6269A85257C85006D7EE3

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 © 1996-2014 The Health Law Firm. All rights reserved.

Florida Woman Uses Forged License to Practice Nursing

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

A Florida woman allegedly used a fake state nursing license to pose as a nurse and then treat patients at their homes, according to the Lake County, Florida, Sheriff’s Office. The woman is accused of treating patients at least seven times, but the sheriff’s office stated there may be more victims. The fake nurse was arrested on September 27, 2013. She faces charges of working as a nurse without a license and using a forged state document.

To read the Orlando Sentinel article, click here.

This is not the woman’s first time in trouble with law enforcement. Earlier this year she was allegedly arrested for running an unlicensed assisted living facility (ALF), according to WFTV, the ABC affiliate in Orlando, Florida.

Used Another Nurse’s License Number to Dupe Employer.

According to the Orlando Sentinel, the fake nurse was hired at TLC Home Care Facilities in Leesburg, Florida, in May 2013, after presenting the forged nurse license to her employer. Part of the phony nurse’s job was to treat patients at their home, including administering blood pressure checks and dispensing medications.

An audit of TLC Home Care facilities by the Department of Health (DOH) uncovered that the phony nurse was allegedly using the same nursing license number as a woman with a similar name. The legitimate nurse actually works at St. Petersburg General Hospital.

Fake Nurse Previously Arrested for Similar Charges.

In December 2012, the same woman was arrested for scheming to defraud and criminal use of personal information, according to WFTV.

Then in March 2013, the Florida Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) arrested her again for running an unlicensed ALF. According to WFTV, the woman billed residents for more than $55,000 worth of services in spite of the fact she was operating a facility without a state-required license.

Click here to watch WFTV’s report.

More Stories on Fake Physicians and Other Fraudulent Professionals to Come.

In the near future on this blog we will include additional articles on fake doctors and health professionals.

To see a recent blog a fake Florida pharmacist sentenced to prison, click here. To read a blog on a phony dentist in Miami, click here. You can also read the blog on a fake plastic surgeon in New York by clicking here.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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 it is too easy to forge a health care professional’s license? Should the home health facility be punished for not doing a thorough background check? Please leave any thoughtful comments below.

Sources:

Comas, Martin. “Woman Used Forged Documents to Work as a Nurse, Deputies Say.” Orlando Sentinel. (September 27, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-woman-assumed-nurse-identity-20130927,0,395526.story

Hughes, Ryan. “Deputies: Woman Pretending to be Nurse has been in Trouble Before.” WFTV. (September 27, 2013). From: http://www.wftv.com/videos/news/deputies-woman-pretending-to-be-nurse-has-been-in/vCDXSX/
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.

The Health Law Firm2013-10-02T08:45:40-04:00May 15th, 2018|Categories: Nurse License, Patient Care|Tags: AG, Attorney General, defense attorney, defense lawyer, department of health, doh, fake nurse, forged nurse license, licensed practical nurse, LPN, medicaid fraud control unit, mfcu, nurse, nurse attorney, nurse identity, Nurse lawyer, nurse license, phony nurse, the health law firm|0 Comments