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Owner of Louisiana-Based Health Care Company Ordered To Pay Nearly $7 Million for 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, 2016, the owner of Louisiana-based Millennium Health Care Services (Millennium) was ordered to pay the state nearly $7 million in restitution and will spend 10 years behind bars for his role in a scheme to defraud the Medicaid system, according to Louisiana Attorney General Jeff Landry.

Millennium’s owner, Dwaine Woods, was ordered to pay $6,985,249 in restitution after his wife and the company were all found guilty of engaging in a criminal conspiracy to create multiple fake CPR cards for Millennium staff. The staff did not undergo training to be properly certified in CPR, Landry said.

The Dangerous Scheme.

Millennium operated from 2004 to 2010 and was solely funded by the government program Medicaid. According to Landry, the fake CPR card scheme was not only illegal but also extremely dangerous. “Instead of service workers learning necessary skills, they were fraudulently getting certifications without any training — greatly jeopardizing the health and safety of patients.”

Millennium was convicted of 19 counts of forgery, one count of theft by fraud, and one count of conspiracy to commit forgery. In addition to the restitution payment, the company was also ordered to pay $17,500 in fines.

Dynetta Woods was also convicted of 19 counts of forgery and one count of conspiracy to commit forgery. She was reportedly sentenced to five years of supervised probation and ordered to pay $54,730 in restitution and $5,000 in fines. Additionally, she is forever barred from doing business with the state of Louisiana, according to Landry. Dwaine Woods was convicted of theft by fraud.

To learn about a similar case of Medicaid fraud and the repercussions, click here to read one of my prior blogs.

Never Falsify Any Documents if You Are a Medicare or Medicaid Provider.

We have represented a number of owners of Medicare and Medicaid providers that were investigated, charged and convicted of fraud because they had falsified, forged, created or changed documents that were in their employees’ files. These have included items so simple as the expiration date on a CPR card, but have also included forging diplomas and other qualifying credentials. State Medicaid programs and the Medicare Program takes such matters very seriously. Often prison time will result for the owners of the company.

This can also be the basis for large recoveries under federal and state whistle blower (false claims act) laws. Submission of a false statement or false document to a federal official is a felony. Employees of Medicare and Medicaid providers who are aware that their employers have falsified documents can blow the whistle on them and collect large rewards under one of the applicable false claims acts (whistle blower laws).

Fraud Investigations Are a Very Serious Matter.

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 to retain the services of an experienced attorney to help 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.

Sources:

Kennedy, John. “La. Medicaid Fraudster Will Pay Nearly $7M In Restitution.” Law360. (December 20, 2016). Web.

Gyan, Joe. “Prairieville couple sentenced in $7 million Medicaid fraud scheme.” The Advocate. (December 20, 2016). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Medicaid fraud defense attorney, Medicaid investigation defense attorney, legal representation for conspiracy to commit Medicaid fraud, legal counsel for Medicaid audits, legal representation for Medicaid audits, health care fraud defense attorney, legal representation for Medicaid fraud, health care fraud investigation defense lawyer, legal representation for conspiracy for defraud the government, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida Medicaid Fraud defense attorney, Colorado Medicaid Fraud defense attorney, Louisiana Medicaid Fraud defense attorney, Kentucky Medicaid Fraud defense attorney, Virginia Medicaid Fraud defense attorney, District of Columbia (D.C.) Medicaid Fraud defense attorney, legal representation for whistleblower suits, whistleblower defense attorney, legal counsel for whistleblower, legal represenation for qui tam cases, qui tam defense attorney, legal representation for qui tam/whistblower investigations

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2017 The Health Law Firm. All rights reserved

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

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

On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care programs, by offering gift cards to pharmacy customers that exceeded legal limits. Roundy’s enacted a Script Saver Program that gave all customers “pharmacy club coupons” for pharmacy purchases. When they reached five of those coupons, they could be redeemed for a $10 gift card, the complaint states. At some stores, the number of coupons necessary for a gift card was lowered to three, Kotwica said.

Roundy’s has mounted a defense to these allegations. Despite that defense, the whistle blower maintains the gift cards were more than the legal nominal value allowed. The whistle blower claimed additionally that the “retailer reward exception” failed because the gift cards were tied to the services the government health care programs reimbursed and were meant to induce customers to transfer prescriptions to the store.

The pharmacist and whistle blower in the case, claimed that he heard corporate executives discussing having Medicare and Medicaid recipients excluded from the program because they were concerned their inclusion was illegal, but never acted on that concern. Therefore, Kotwica said that this shows that Roundy’s had the intent to violate the FCA. The whistle blower also claimed that the company retaliated against him for speaking out to the point where he resigned his position as a pharmacist with it.

The case was originally filed in June 2015. Like all federal False Claims Act (FCA) cases, it remained sealed until ordered unsealed by the court. It was unsealed in July 2016 after the U.S., and the states of Illinois, Minnesota and Wisconsin declined to intervene in the case. Click here to read the response in this case.

Fighting Government Fraud and Abuse.

This case was brought under the federal False Claims Act (FCA) or federal “whistle blower law.” This law contains standards for both civil and criminal penalties against those filing false claims for services paid for by the government. False Claims Act cases, such as this recent one, are typically filed in a qui tam (or whistle blower) proceeding. This type of action involves a private party filing a lawsuit on behalf of the government against a defendant who allegedly defrauded the government. The “whistle blower” receives a percentage of the money recovered by the government (if any), through any judgment or settlement of the case. Often the amounts awarded to the whistle blower are in the millions of dollars. Whistle blowers are often protected from receiving any potential civil liability or prosecution for their involvement in the matter.

Our firm has been on both sides of both federal and state whistle blower or qui tam cases. We have represented nurses, physicians, pharmacists and other health professionals in bringing such cases. We have also defended physicians, health care providers, medical groups and health facilities in such cases.

We have also represented relators or plaintiffs bringing such actions to recover money on behalf of the government. A qui tam relator can receive up to 30% of the amount recovered on behalf of the government. This means, for example, that of a defendant settles with the government paying back $5 million, the relator or whistle blower can receive up to $1.5 million, plus his attorney’s fees and costs. Usually, the biggest obstacle to bringing any such case is being able to show an actual false claim that was filed.

If you have information concerning health care fraud by overbilling federal health care programs such as Medicare or Medicaid, do not hesitate to take action. The government urges health care providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act provides a system of rewards that encourages whistle blowers to bring these issues to the government’s attention.

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, nurses, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in bringing or defending against False Claims Act, whistle blower or qui tam cases. We also defend health care providers in Medicare and Medicaid investigations, audits and recovery actions. We represent plaintiffs and defendants in complex health care litigation in state or federal courts.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistle blower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented number of doctors and other licensed health professionals as relators in bringing qui tam or whistle blower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistle blower cases.

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

Sources:

Kass, Dani. “Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Law360. (December 20, 2016). Web.

“Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Make Me Feed. (December 21, 2016). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, whistle blower defense attorney, qui tam defense attorney, legal representation for FCA claims, legal representation for qui tam cases, legal representation for whistle blower defense cases, Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for Medicare and Medicaid fraud investigation, Florida FCA defense attorney, Colorado FCA defense attorney, Kentucky FCA defense attorney, Louisiana FCA defense attorney, District of Columbia FCA defense attorney, Virginia FCA defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, complex health care litigation attorney, legal defense of complex health care business disputes, complex litigation defense counsel

“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 © 2016 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:23-04:00May 15, 2018|Categories: Health Facilities Law Blog|Tags: Colorado FCA defense attorney, complex health care litigation attorney, complex litigation defense counsel, District of Columbia FCA defense attorney, False Claims Act (FCA) defense attorney, Florida FCA defense attorney, health care fraud defense lawyer, health care fraud scheme, Kentucky FCA defense attorney, legal defense of complex health care business disputes, legal representation for FCA claims, legal representation for illegal kickback schemes, legal representation for Medicare and Medicaid fraud, legal representation for Medicare and Medicaid fraud investigation, legal representation for qui tam cases, legal representation for whistle blower defense cases, Louisiana FCA defense attorney, Medicare and Medicaid fraud defense attorney, qui tam defense attorney, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, Virginia FCA defense attorney, whistle blower defense attorney|Comments Off

Kmart Agrees to Pay $32.3 million to Settle Whistle Blower’s False Claims Act Suit

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

On December 22, 2017, Kmart Corporation agreed to pay $32.3 million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

The Whistle Blower False Claims Act (FCA) Suit.

The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). This provision permits private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.

The 2008 lawsuit, which was filed by a former Kmart pharmacist, alleged that Kmart pharmacies offered discounted generic drug prices to cash paying customers through various club programs. The pharmacies then knowingly failed to disclose those prices when reporting to federal health programs. According to the suit, in one case, Kmart had sold a 30-day supply of a generic version of a prescription drug for $5 to customers of its discount program, but then filed for reimbursement from the government for $152 for that same drug for its Medicare customers.
To read more on the 2008 suit, click here.

The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The former pharmacist will receive a whistle blower award of $9.3 million. The case was heard in the U.S. District Court in the Southern District of Illinois.

To read the DOJ’s press release on this case in full, click here.

To read about a similar case of a pharmacy inflating prices to government health care programs, click here to read one of my prior blogs.

Who Knew Medicare Part D Claims Could Yield Such Big Whistle Blower Settlements?

Who knew Medicare part D claims could yield such big whistle blower settlements? I know I didn’t. I didn’t even think about such claims until I read this case. This could mean some serious compliance issues for big chain stores that have pharmacies (note that I said “could”). Walmart, Publix, Albertsons, Costco, Sam’s Club, Winn Dixie, Engel’s, and every other chain that owns and operates pharmacies, may be in jeopardy.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim (the whistle blower). We have also defended health professionals and institutions in litigation of whistle blower complaints filed against them.

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

Sources:

McCausland, Phil. “Kmart to pay $32.3M to settle health care-related whistleblower case.” NBC News. (December 22, 2017). Web.

The Associated Press. “Kmart to pay $32.3 million to settle prescription drugs case.” ABC News. (December 22, 2017). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, pharmacy defense attorney, pharmacist defense attorney, pharmacy defense lawyer, pharmacist defense lawyer, pharmacy defense counsel, pharmacist defense counsel, Board of Pharmacy license defense attorney, Board of Pharmacy license defense lawyer, Board of Pharmacy license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel

“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 2018 The Health Law Firm. All rights reserved.

Owner of Louisiana Health Care Company To Pay Nearly $7 Million for 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, 2016, the owner of Louisiana-based Millennium Health Care Services (Millennium) must pay the state nearly $7 million in restitution and will spend 10 years behind bars for his role in a scheme to defraud the Medicaid system, according to Louisiana Attorney General Jeff Landry.

Millennium’s owner, Dwaine Woods, was ordered to pay $6,985,249 in restitution after his wife and the company were all found guilty of engaging in a criminal conspiracy to create multiple fake CPR cards for Millennium staff. The staff did not undergo training to be properly certified in CPR, Landry said.

The Dangerous Scheme.

Millennium operated from 2004 to 2010 and was solely funded by the government program Medicaid. According to Landry, the fake CPR card scheme was not only illegal but also extremely dangerous. “Instead of service workers learning necessary skills, they were fraudulently getting certifications without any training — greatly jeopardizing the health and safety of patients.”

Millennium was convicted of 19 counts of forgery, one count of theft by fraud, and one count of conspiracy to commit forgery. In addition to the restitution payment, the company was also ordered to pay $17,500 in fines.

Dynetta Woods was also convicted of 19 counts of forgery and one count of conspiracy to commit forgery. She was reportedly sentenced to five years of supervised probation and ordered to pay $54,730 in restitution and $5,000 in fines. Additionally, she is forever barred from doing business with the state of Louisiana, according to Landry. Dwaine Woods was convicted of theft by fraud.

To learn about a similar case of Medicaid fraud and the repercussions, click here to read one of my prior blogs.

Never Falsify Any Documents if You Are a Medicare or Medicaid Provider.

We have represented a number of owners of Medicare and Medicaid providers that were investigated, charged and convicted of fraud because they had falsified, forged, created or changed documents that were in their employees’ files. These have included items so simple as the expiration date on a CPR card, but have also included forging diplomas and other qualifying credentials. State Medicaid programs and the Medicare Program takes such matters very seriously. Often prison time will result for the owners of the company.

This can also be the basis for large recoveries under federal and state whistle blower (false claims act) laws. Submission of a false statement or false document to a federal official is a felony. Employees of Medicare and Medicaid providers who are aware that their employers have falsified documents can blow the whistle on them and collect large rewards under one of the applicable false claims acts (whistle blower laws).

Fraud Investigations Are a Very Serious Matter.

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 to retain the services of an experienced attorney to help 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.

Sources:

Kennedy, John. “La. Medicaid Fraudster Will Pay Nearly $7M In Restitution.” Law360. (December 20, 2016). Web.

Gyan, Joe. “Prairieville couple sentenced in $7 million Medicaid fraud scheme.” The Advocate. (December 20, 2016). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Medicaid fraud defense attorney, Medicaid investigation defense attorney, legal representation for conspiracy to commit Medicaid fraud, legal counsel for Medicaid audits, legal representation for Medicaid audits, health care fraud defense attorney, legal representation for Medicaid fraud, health care fraud investigation defense lawyer, legal representation for conspiracy for defraud the government, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida Medicaid Fraud defense attorney, Colorado Medicaid Fraud defense attorney, Louisiana Medicaid Fraud defense attorney, Kentucky Medicaid Fraud defense attorney, Virginia Medicaid Fraud defense attorney, District of Columbia (D.C.) Medicaid Fraud defense attorney, legal representation for whistleblower suits, whistleblower defense attorney, legal counsel for whistleblower, legal represenation for qui tam cases, qui tam defense attorney, legal representation for qui tam/whistblower investigations

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2017 The Health Law Firm. All rights reserved

By The Health Law Firm|2024-03-14T10:01:23-04:00May 15, 2018|Categories: Health Facilities Law Blog|Tags: Colorado Medicaid Fraud defense attorney, District of Columbia (D.C.) Medicaid Fraud defense attorney, Florida Medicaid Fraud defense attorney, health care fraud defense attorney, health care fraud investigation defense lawyer, Kentucky Medicaid Fraud defense attorney, legal counsel for Medicaid audits, legal counsel for whistleblower, legal represenation for qui tam cases, legal representation for conspiracy for defraud the government, legal representation for conspiracy to commit Medicaid fraud, legal representation for Medicaid audits, legal representation for Medicaid fraud, legal representation for qui tam/whistblower investigations, legal representation for whistleblower suits, Louisiana Medicaid Fraud defense attorney, Medicaid fraud defense attorney, Medicaid investigation defense attorney, qui tam defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Virginia Medicaid Fraud defense attorney, whistleblower defense attorney|Comments Off

East Texas Lab Agrees to Pay $3.75 Million to Settle False Claims Suit

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

On December 14, 2016, owners of an East Texas clinical laboratory who overcharged Medicare for falsified driving mileage bills have agreed to pay the U.S. government $3.75 million to settle a whistle blower’s False Claims Act (FCA) lawsuit. The suit was brought by a former employee, the U.S. attorney’s office announced.

Submitting False Claims.

Texas-based Elite Lab Services LLC (Elite) and its owners, Gerard and Suzanne Dengler, reportedly settled claims brought under the False Claims Act (FCA) by plaintiff Karen Malcolm. The Denglers admitted that from approximately 2010 to 2014 they submitted inflated employee mileage claims to Medicare and billed the government health agency knowing it does not pay for mileage claims in excess of actual miles driven.

According to court documents, the defendants employed phlebotomists who traveled around East Texas to collect blood samples and transport those samples back to Elite for lab services. For several years, the defendants at Elite knowingly submitted or caused to be submitted inflated mileage calculations beyond the actual distances driven by the employees.

The Whistle Blower.

In 2014, the whistle blower Malcolm, filed the suit alleging that Elite had defrauded Medicare. She claimed that she approached the Denglers in the spring of that year to voice concerns about the billing practices, but the issue was not corrected. She then resigned from the company as a result. The U.S. Attorney’s Office revealed that the government intervened in the suit for purposes of the settlement.

In an agreed final judgment, the parties said that the defendants relinquished and waived all right and title to more than $2.5 million in cash held in a collection of several financial accounts and sales of real property that they owned to satisfy the settlement in the instant case.

As a result of the deal, Malcolm will receive a 21 percent share of the recovery, totaling $787,500, authorities said.

Medicare and Medicaid fraud cases brought on by whistleblowers are unfortunately becoming more common. To read about the serious repercussions of cases like this, click here to read one of my prior blogs.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim, as well as in defending them in certain cases.

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

Sources:

Wolf, Alex. “East Texas Lab Pays $3.75M For Falsified Medicare Billing.” Law360. (December 14, 2016). Web.

“Tyler lab, owners to pay $3.75 million for filing false Medicare claims.” Longview Business Journal. (December 14, 2016). Web.

“East Texas lab company, owners to pay $3.75M for false Medicare claims.” KLTV-ABC. (December 14, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) attorney, legal representation for submitting false claims to the government, defense attorney, Medicare false claims defense lawyer, allegations of false billing, Medicare and Medicare fraud investigation defense attorney, consumer reports of false claims, Medicare audit defense lawyer, health care fraud defense attorney, whistle blower attorney, qui tam defense lawyer, legal representation for whistle blower suits, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, qui tam relator’s attorney, qui tam defense attorney, Florida whistle blower case, Virginia Whistle blower case, Colorado whistle blower case, Louisianan Whistle blower case, complex healthcare litigation attorney
“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 © 2016 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:26-04:00May 15, 2018|Categories: Pharmacy Law Blog|Tags: allegations of false billing, Colorado whistle blower case, complex healthcare litigation attorney, consumer reports of false claims, defense attorney, False Claims Act (FCA) attorney, Florida whistle blower case, health care fraud defense attorney, legal representation for submitting false claims to the government, legal representation for whistle blower suits, Louisianan Whistle blower case, Medicare and Medicare fraud investigation defense attorney, Medicare audit defense lawyer, Medicare false claims defense lawyer, qui tam defense attorney, qui tam defense lawyer, qui tam relator's attorney, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, Virginia Whistle blower case, whistle blower attorney|Comments Off

Massachusetts Mental Health Centers Submitted False Claims According to Suit

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

On January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.

The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”

According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.

The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.

Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.

There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:

Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.

Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 2018). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2018 The Health Law Firm. All rights reserved

U.S. Court in Florida Dismisses Whistleblower’s Complaint Against Nuclear Pharmacy

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

On September 28, 2017, the U.S. District Court for the Middle District of Florida dismissed a relator’s (whistle blower’s) False Claims Act (FCA) complaint against a nuclear pharmacy in Tampa. The court found that the relator failed to plead fraud with the required amount of specificity that the law requires. The case awas filed against GE Healthcare, Inc.’s nuclear pharmacy.

The Allegations.

GE Healthcare operates 31 nuclear pharmacies in the United States, where it produces radiopharmaceuticals through a process of compounding drugs. The relator was a board-certified nuclear pharmacist who formerly worked at GE Healthcare, Inc.’s nuclear pharmacy in Tampa, Florida. The relator’s allegations included the manner in which GE compounded and labeled radiopharmaceuticals. More specifically, the whistle blower claimed that GE sold diluted and expired drugs. Additionally, the whistle blower alleged that GE falsely inflated the reimbursement rate for certain drugs by providing false sales data to Medicare.

GE argued that the realtor’s claims should be dismissed pursuant to the FCA’s public disclosure bar because the allegations overlapped with an action filed by a different relator, James Wagel, in 2006. To read about this FCA case, click here.

The Court’s Decision.

The court found that Sunil Patel’s allegations were not “based on” or “substantially the same as” the allegations in the prior public disclosures. However, the court dismissed the realtor’s claims on another ground: failing to plead the allegedly fraudulent claims with sufficient particularity. According to the court, the allegations that defendant “presented or caused to be presented” a false claim fell “well short of alleging ‘exact billing data.'” In other words, the relator failed to plead one or more false claims by giving the specifics, such as date, amount, patient, billing code, amount paid by the government, etc. The court found that the relator identified no “particular facts about the ‘who,’ ‘what,’ ‘where,’ ‘when,’ and ‘how’ of fraudulent submissions to the government.”

The case is United States ex rel. Patel v. GE Healthcare Inc., No. 8:14-cv-120-T-33TGW (M.D. Fla. Sept. 28, 2017).

Click here to read one of my prior blogs on a similar FCA case involving a pharmaceutical company.

Specifics of the False Claims Are Required for Any Qui Tam Whistle Blower’s Case.

This is one of the biggest short comings we see in potential clients who contact us with information about false claims being submitted by their employers or other healthcare providers. They do not have the specifics of any single false claim. Yet the law requires this or a whistle blower’s case can get dismissed by the court outright. You can do an awful lot of work investigating, pleading and litigating a whistle blower’s case only to have the court dismiss it without its ever getting anywhere near a trial. Even if a scheme or system is inherently fraudulent, you must be able to show one or more claims that were submitted were actually false claims.

We advise health care professionals who consult us with possible False Claims Act/whistle blowers cases, be sure you have the details, and preferably copies of the documents, that show a false bill was submitted to the government. This can be a CMS Form 1500 or an explanation of benefits that the patient and the insurer or facility receives back. Sometimes you can get these form the patient if you do not have access to these from the employer. But without a false claim and, preferably, a number of false claims, you don’t really have a False Claims Act suit.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Sources:

Fraud and Compliance. “U.S. Court in Florida Dismisses Whistleblower Action Against Nuclear Pharmacy.” AHLA Weekly. (October 6, 2017). Web.

Mayo, Rebecca. “Evidence of likely submission not enough to prove FCA violation.” Wolters Kluwer Health Law Daily. (October 2, 2017). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Health care fraud defense attorney, legal representation for allegations of health care fraud, False Claims Act (FCA) attorney, FCA defense attorney, False Claims attorney, legal representation for FCA investigations, legal representation for FCA complaints, Whistleblower attorney, Whistleblower defense attorney, legal representation for Whistleblower investigations, legal representation for Whistleblower complaints, qui tam attorney, qui tam defense attorney, legal representation for qui tam cases, legal representation for qui tam investigations, FCA legal representation, relator attorney, relator defense attorney, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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 © 2017 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:31-04:00May 15, 2018|Categories: Health Facilities Law Blog|Tags: False Claims Act (FCA) attorney, False Claims attorney, FCA defense attorney, FCA legal representation, health care fraud defense attorney, health law defense attorney, legal representation for allegations of health care fraud, legal representation for FCA complaints, legal representation for FCA investigations, legal representation for qui tam cases, legal representation for qui tam investigations, legal representation for Whistleblower complaints, legal representation for Whistleblower investigations, qui tam attorney, qui tam defense attorney, relator attorney, relator defense attorney, reviews of The Health Law Firm, the health law firm, The Health Law Firm attorney reviews, whistleblower attorney, whistleblower defense attorney|Comments Off