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

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

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

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

Their Playbook Included False Claims and Deception.

Allegedly, the defendants provided ‘fake invoices’ for medical and dental services that were never delivered. Each person attempted to claim somewhere between $65,000 and $420,000 in alleged fraudulent claims. When all was said and done, the total ended up being about $3.9 million, from which the defendants got about $2.5 million in illicit proceeds, the indictment alleges.

Flagrant Foul For Violation of Health Care Fraud Laws.

The scheme was discovered partly because of sloppy work by the defendants themselves. Several of the fake invoices and medical forms raised red flags because “they are not on letterhead, they contain unusual formatting, they have grammatical errors,” authorities said. These types of errors are the ones typically seen in the fraudulent e-mails received from Nigerian princes trying to recover their frozen bank accounts and scam e-mails sent to us attorneys trying to phish us into phony attorney’s fees scams.

Additionally, travel records, e-mails, GPS data, and other records showed that the players in question were often nowhere near the location of the health care providers when they claimed to have been treated or used their services, according to the indictment. (I wonder how many Facebook postings also showed this.)

All 19 defendants are charged with conspiracy to commit health care fraud and wire fraud. If convicted, they face up to 20 years in prison. To read the indictment in full, click here.

Read the DOJ’s press release on the case here.


Fraud is Fraud; Dishonesty is Dishonesty.

The problem here is, of course, a lack of integrity. Once you cheat or steal, even if it is just for a small amount of money, you are a thief. These guys sacrificed successful careers, stardom, prestige, and freedom, for a little bit of money.

Contact Health Law Attorneys Experienced with Health Care Fraud, False Claims Act Violations, and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of accusations of medical billing fraud, health insurance audits, alleged overbilling, Medicare audits, ZPIC audits and RAC audits, False Claims Act cases, and whistleblower/qui tam cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid Program.

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

Sources:

Dienst, Jonathan. “18 former NBA players arrested by federal authorities in alleged health care scam.” NBC News. (October 7, 2021). Web.

Zaggar, Zachary. “18 Ex-NBA Players Indicted For Alleged $4M Health Plan Fraud.” (October 7, 2021). Web.

D’Angelo, Bob. “18 former NBA players charged in $4M insurance fraud scheme.” Kiro7 News. (October 7, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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

 

Doctors Beware: Genetic Testing Scams Rip off Government Payers for Hundreds of Millions – Part 1 of 2

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

Several genetic testing companies have come into the spotlight for allegations of ripping off Medicare and False Claims Act (FCA) violations. Health care professionals need to be aware of these types of schemes and the dangers they may face if involved. In each of these cases, the companies agreed to pay a settlement in the millions to resolve allegations they submitted claims for unnecessary genetic testing.

This is part one of a two-part blog series. Click here for part two!

The Details.

On February 11, 2019, the Department of Justice (DOJ) announced that GenomeDx Biosciences Corp. (GenomeDx) agreed to pay $1.99 million to resolve FCA allegations. The false claims to Medicare were for a post-operative genetic test for prostate cancer patients. GenomeDx allegedly submitted claims for the genetic test to Medicare between September 2015 and June 2017. They were not medically reasonable nor necessary because the prostate cancer patients did not have risk factors necessitating the test. You can read the DOJ’s press release and learn more here.

In a similar case, on March 8, 2018, the U.S. Attorney announced a settlement with a California genetics testing company, Natera, Inc. The company agreed to pay $11 million to resolve FCA allegations for improperly billing TRICARE for non-invasive prenatal testing. According to the government, Natera improperly billed for genetic screenings to test a baby’s risk for certain disorders and syndromes. Natera allegedly used an improper billing code to misrepresent the services and screened patients with low-risk pregnancies who did not need it, according to the government. The suit was initiated by a pair of whistleblowers under the qui tam provisions of the FCA.

Click here to read the press release in full.

Consequences of These Types of Scams.

In both cases, the message is clear, “if you take advantage of programs like Medicare, you will be held accountable,” according to the government. Companies and providers who file false claims to generate more revenue are stealing from the taxpayers and those who rely on those federally funded programs.

Don’t allow your name, provider number, and NPI to be used for ordering illegal medically unnecessary tests, procedures or treatments. If you do, you may very well find yourself caught up in a similar FCA or other government investigation. These hefty settlements send a message that pursuing healthcare fraud is a priority to the DOJ. In 2018, it recovered more than $2.8 billion from FCA cases alone. Click here to learn more.

Be sure to continue with part two of this blog series to learn more about these types of fraud scams. Click here to read.

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

Attorneys with The Health Law Firm also represent physicians, clinics, 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 also represent doctors, nurses, and others as relators (whistleblowers) in bringing qui tam or whistleblower cases, as well. We represent health professionals and health facilities in complex litigation involving medical issues in state and federal courts.

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

Sources:

“Genetic Testing Company Settles Whistleblower Suit for $11.4M.” Constantine Cannon Lawyer Group. (March 14, 2018). Web.

“Whistleblower Suit Over Falsified Prenatal Test Billing Settles.” Allison Legal Law Firm. (March 11, 2018). Web.

Raymond, Nate. “Natera settles U.S. billing probe over prenatal gene tests for $11.4 mln.” Reuters. (March 12, 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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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

By |2021-03-25T17:22:06-04:00March 25th, 2021|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

HHS Announces Proposed Rules to Reform Stark Law and AKS Regulations

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued two proposed rules to reform the federal Stark Law (dealing with prohibited self-referrals) and Anti-Kickback Statute (AKS) (addressing giving or receiving any thing of value in exchange for a patient referral) regulations.

The long-awaited proposed rules aim to “modernize and clarify” federal laws relevant to value-based and patient coordinated care programs. The proposals would ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.

The Proposed Stark Rule.

The proposed rule that would further implement and clarify the Stark Law, “Modernizing and Clarifying the Physician Self-Referral” would, if finalized, create new exceptions to the existing Stark Law for value-based arrangements, according to CMS. These exceptions would apply broadly to care provided to all patients, not just Medicare beneficiaries, CMS said. The proposed rule also includes additional clarifications and guidance on key statutory terms and other technical compliance requirements.

For more info, click here to view the Stark proposed rule’s fact sheet issued by CMS.

The Proposed AKS Rule.

The proposed rule to further implement and clarify the AKS, “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements” would make several changes to the AKS and beneficiary inducement provisions of the Civil Monetary Penalties Law (CMP). These changes would include the addition of several new AKS safe harbors for certain remuneration exchanged between or among eligible participants.

The new AKS safe harbors include care coordination arrangements aimed at improving quality and outcomes; value-based arrangements with substantial downside financial risk; and value-based arrangements with full financial risk, according to OIG.

Click here to view the fact sheet issued by CMS to learn more about the proposed rule.

To view the press release issued by the HHS in full, click here.

Contact Health Law Attorneys Experienced in Handling Stark Law and Anti-Kickback Statute Compliance.

If you are involved in referring or providing DHS, your arrangements must be reviewed for compliance with Stark and other anti-fraud laws. Violations of these laws can carry severe financial and criminal penalties. One of the best ways to avoid these sanctions is to have your current or potential arrangement reviewed by an attorney who is experienced in these matters.

The Health Law Firm routinely advises healthcare providers on Stark compliance issues for practitioners and providers of all types of DHS. We can advise you on the legality of a particular arrangement and can assist with remedying any perceived compliance issues. Our attorneys also represent providers in cases of medical billing fraud, overbilling, Medicare audits, ZPIC audits and RAC audits, False Claims Act cases, and whistleblower/qui tam cases throughout Florida and across the United States.

They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

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

Sources:

Kearbey, Amy. “CMS Publishes Proposed Amendments To Stark Law Advisory Opinion Regulations.” The National Law Review. (October 9, 2019). Web.

HHS Press Office. “HHS Proposes Stark Law and Anti-Kickback Statute Reforms to Support Value-Based and Coordinated Care.” HHS.gov, U.S. Department of Health & Human Services. (October 9, 2019). Web.

“CMS, OIG Release Long-Awaited Stark, AKS Proposed Rules.”AHLA. (October 9, 2019). 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: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Stark Law defense, Stark Law representation, Anti-Kickback Statute (AKS) representation, AKS defense, AKS lawyer, AKS representation, Centers for Medicare & Medicaid Services (CMS), CMS representation, CMS defense attorney, CMS lawyer, representation for CMS investigation, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, 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 © 2019 The Health Law Firm. All rights reserved.

By |2019-12-05T20:42:16-05:00December 5th, 2019|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Doc Charged in Largest Medicare Scheme Ever Reported Involving Genetic Testing

By Carole C. Schriefer, R.N., J.D.
On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Alleged Fraudulent Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

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

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, 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.

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 whistleblower 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 several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

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

KeyWords: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, 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 © 2019 The Health Law Firm. All rights reserved.

By |2019-12-05T20:30:00-05:00December 5th, 2019|Categories: Colorado Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Doctor Charged for $2.1 Billion Medicare Fraud; Largest Healthcare Fraud Scheme Ever Reported

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Alleged Fraudulent Orders for Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

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

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, 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.

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 whistleblower 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 several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

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: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, 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 © 2019 The Health Law Firm. All rights reserved.

By |2019-12-05T20:22:56-05:00December 5th, 2019|Categories: Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Doctor Charged in Largest Medicare Fraud Scheme Ever Reported

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

On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Fraudulent Orders for Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

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

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, 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.

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 whistleblower 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 several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

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 and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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Genetic Testing Scams Ripping off Government Programs for Millions, Part 1 of 2

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

Several genetic testing companies have come into the spotlight for allegations of ripping off Medicare and False Claims Act (FCA) violations. Health care professionals need to be aware of these types of schemes and the dangers they may face if involved. In each of these cases, the companies agreed to a pay a settlement in the millions to resolve allegations they submitted claims for unnecessary genetic testing.

This is part one of a two part blog series. Click here for part two.

The Details.

On February 11, 2019, the Department of Justice (DOJ) announced that GenomeDx Biosciences Corp. (GenomeDx) agreed to pay $1.99 million to resolve FCA allegations. The false claims to Medicare were for a post-operative genetic test for prostate cancer patients. GenomeDx allegedly submitted claims for the genetic test to Medicare between September 2015 and June 2017. They were not medically reasonable nor necessary because the prostate cancer patients did not have risk factors necessitating the test. You can read the DOJ’s press release and learn more here.

In a similar case, on March 8, 2018, the U.S. Attorney announced a settlement with a California genetics testing company, Natera, Inc. The company agreed to pay $11 million to resolve FCA allegations for improperly billing TRICARE for non-invasive prenatal testing. According to the government, Natera improperly billed for genetic screenings to test a baby’s risk for certain disorders and syndromes. Natera allegedly used an improper billing code to misrepresent the services and screened patients with low-risk pregnancies who did not need it, according to the government.  The suit was initiated by a pair of whistleblowers under the qui tam provisions of the FCA.

Click here to read the press release in full.


Consequences of These Types of Scams.

In both cases, the message is clear, “if you take advantage of programs like Medicare, you will be held accountable,” according to the government. Companies and providers who file false claims to generate more revenue are stealing from the taxpayers and those who rely on those federally funded programs.

Don’t allow your name, provider number and NPI to be used for ordering illegal medically unnecessary tests, procedures or treatments. If you do, you may very well find yourself caught up in a similar FCA or other government investigation. These hefty settlements send a message that pursuing healthcare fraud is a priority to the DOJ. In 2018, it recovered more than $2.8 billion from FCA cases alone. Click here to learn more.

Be sure to continue with part two of this blog series to learn more about these types of fraud scams.

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

Attorneys with The Health Law Firm also represent physicians, clinics, health care professionals and health facilities in qui tam or whistle blower 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 also represent doctors, nurses and others as relators (whistle blowers) in bringing qui tam or whistle blower cases, as well.  We represent health professionals and health facilities in complex litigation involving medical issues in state and federal courts.

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

Sources:

“Genetic Testing Company Settles Whistleblower Suit for $11.4M.” Constantine Cannon Lawyer Group. (March 14, 2018). Web.

“Whistleblower Suit Over Falsified Prenatal Test Billing Settles.” Allison Legal Law Firm. (March 11, 2018). Web.

Raymond, Nate. “Natera settles U.S. billing probe over prenatal gene tests for $11.4 mln.” Reuters. (March 12, 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.

KeyWords: Whistle blower plaintiff-relator attorney, qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid  Fraud Control Unit (MFCU) defense attorney, Medicaid  Fraud Control Unit (MFCU) defense legal representation, Medicaid  Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, 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 © 2019 The Health Law Firm. All rights reserved.

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