reviews for The Health Law Firm | The Health Law Firm Blog

Supreme Court Rules FCA Case Liability Requires Defendants’ Subjective Belief

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

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

The case before the Supreme Court […]

Supreme Court Says FCA Case Liability Requires Defendants’ Subjective Belief

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

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

The case before the Supreme Court […]

Court Assesses $170 Million in Fines Against Two Texas Ophthalmologists For False Claims

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

On November 18, 2021, the Justice Department announced that two Texas ophthalmologists and their eye clinic must pay millions of dollars in penalties for fraudulently billing Medicare. The penalties were assessed in connection with their evaluation and treatment of glaucoma.

U.S. District Judge Lynn Hughes assessed $170 million in penalties against the ophthalmologists and their eye clinic in Houston, Outreach Diagnostic Clinic.

A Former Employee Blew the Whistle.

According to the U.S. Department of Justice (DOJ), the action resulted from a False Claims Act (FCA) or “qui tam” suit. The whistleblower was a former employee of the clinic. The suit alleged that between February 2006 and December 2011, the two ophthalmologists fraudulently billed the Medicare Program for single eye pressure measurement tests […]

Former Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000

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

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

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

The Fraudulent Billing Scheme.

Through the dental practice, she and the dentist allegedly both participated to defraud the D.C. Medicaid Program. As part of the scheme, both the dentist and the office manager allegedly […]

By The Health Law Firm|2024-03-14T09:59:30-04:00May 12, 2023|Categories: Dental Law Blog|Tags: board of dentistry defense attorney, civil monetary penalty defense counsel, Civil Monetary Penalty defense lawyer, civil monetary penalty litigation defense attorney, defense for overbilling Medicare, dental baord dfense legal counsel, dental insurance audit defense attorney, dental license defense lawyer, dentist defense attorney, Department of Health investigation defense attorney, False Claims Act attorney, false healthcare billing attorney, health fraud defense legal representation, health professional license defense attorney, healthcare fraud defense lawyer, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for Medicare and Medicaid audits, Medicaid audit defense attorney, Medicaid audit defense legal counsel, Medicaid exclusion defense counsel, Medicaid fraud defense attorney, Medicaid fraud defense counsel, Medicaid fraud defense lawyer representation, Medicaid/Medicare audit defense attorney, Medicare and Medicaid defense lawyer, Office of Inspector General (OIG) defense counsel, Office of Inspector General (OIG) Medicaid/Medicare defense attorney, Office of Inspector General (OIG) Medicaid/Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for medical overbilling, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

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

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

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

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

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As […]

By The Health Law Firm|2024-03-14T09:59:33-04:00February 25, 2023|Categories: Health Facilities Law Blog|Tags: allegations of healthcare fraud, allegations of overbilling Medicaid, attorney for dentists, Centers for Medicare and Medicaid (CMS), civil monetary penalty defense counsel, Civil Monetary Penalty defense lawyer, civil monetary penalty litigation defense attorney, defense attorney for dental practice, dental practice legal defense representation, dentist legal defense counsel, dentist legal representation, False Claims attorney, FCA attorney, FCA defense lawyer, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud defense lawyer, healthcare fraud representation, legal counsel for dentists, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for medical overbilling, legal representation for Medicare and Medicaid audits, Medicaid administrative law judge hearing defense attorney, Medicaid administrative law judge hearing legal representation, Medicaid and Medicare audit defense attorney, Medicaid audit defense attorney, Medicaid audit defense legal counsel, Medicaid exclusion hearing defense attorney, medical overbilling, Medicare Medicaid defense lawyer, Medicare Medicaid fraud defense attorney, Medicare Medicaid fraud defense counsel, Medicare Medicaid fraud defense legal representation, Office of Inspector General (OIG) Medicaid exclusion attorney, Office of Inspector General (OIG) Medicaid exclusion defense counsel, Office of Inspector General (OIG) Medicaid exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for healthcare investigations, representation for overbilling Medicare, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

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

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

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

The Fraudulent Billing Scheme.

Both the office manager and the dentist were alleged to have participated in a scheme to defraud the D.C. Medicaid Program through their operation of the dental practice. The dentist was a Medicaid provider. As […]

How Can I Be Sure I Don’t Have Employees, Contractors Who Are on Medicare’s Exclusion List?

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are often consulted by companies in the health care industry and by health professionals after they receive a subpoena or audit regarding their employing or contracting with an individual or business that is on the Office of the Inspector General’s (OIG’s) List of Excluded Individuals and Entities (LEIE), who are prohibited from contracting with Medicare. This can cause devastating consequences since the law prohibits this by anyone contracting with the government or receiving any payments from any government healthcare program from dealing with these persons. This includes anyone contracting with or receiving payment from Medicare, Medicaid, Tricare, the Veterans Administration, and the military, among others. It can also lead to a demand for […]

By The Health Law Firm|2024-03-14T10:00:03-04:00March 13, 2020|Categories: Health Facilities Law Blog|Tags: allegations of healthcare fraud, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Medicare reinstatement attorney, Medicare Reinstatement representation, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

Mental Health Professionals: You Must Challenge Overpayment Demands from Medicare and Medicaid Audits

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We have gotten calls from many mental health professionals who have been placed on prepayment review after failing to challenge Medicare or Medicaid audit results. Once placed on prepayment review, the payments are held up for many months. Some providers are even forced out of business as a result.

Failing to challenge, follow-up on, and appeal any adverse audit results can be very detrimental. An error rate above 15% will usually result in the provider being placed on prepayment review.

What Happens During Prepayment Review.

While on prepayment review, the provider will be required to submit documentation for medical records by mail to support each claim submitted. Additionally, they must have those claims and supporting documentation audited, before any […]

Dentists: Challenge Overpayment Demands from Medicare, Medicaid Audits!

During our years of experience, we have gotten many calls from dentists who have been placed on prepayment review after failing to challenge the results of Medicare and Medicaid audits. Once placed on prepayment review, the payments are held up for many months. Some providers are even forced out of business as a result.

Failing to challenge, follow-up on, and appeal any adverse results of Medicare and Medicaid audits can be very detrimental. An error rate above 15% will usually result in the provider being placed on prepayment review.

What Happens During Prepayment Review.

While on prepayment review, the dentist or provider will be required to submit documentation for medical records by mail to support each claim submitted. Additionally, they must have those claims and supporting documentation audited, before any […]

By The Health Law Firm|2024-03-14T10:00:09-04:00November 6, 2019|Categories: Dental Law Blog|Tags: allegations of healthcare fraud, allegations of overbilling Medicaid, attorney legal representation for OIG notice of intent to exclude, Centers for Medicare and Medicaid (CMS), False Claims attorney, FCA attorney, FCA defense lawyer, FCA lawyer, health care fraud defense attorney, health care professional defense attorney, healthcare fraud defense lawyer, healthcare fraud representation, legal representation for CMS investigations, legal representation for fraud investigations, legal representation for health care fraud, legal representation for health care professionals, legal representation for Medicare and Medicaid audits, medical overbilling, Medicare administrative law judge hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare and Medicaid audit defense attorney, Medicare audit defense attorney, Medicare audit defense legal counsel, Medicare exclusion hearing defense attorney, Office of Inspector General (OIG) Medicare exclusion attorney, Office of Inspector General (OIG) Medicare exclusion defense counsel, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, OIG exclusion defense attorney, OIG exclusion defense lawyer, OIG investigation legal defense representation, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, representation for overbilling Medicare, representation for submitting false claims, reviews for The Health Law Firm, The Health Law Firm attorney reviews|Comments Off

CMS Announces Final Rule to Reduce Criminal Behavior in Medicare, Medicaid

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

On September 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the ability to stop fraud and abuse before it happens. The “Program Integrity Enhancements to the Provider Enrollment Process” goes into effect on November 4, 2019, and will help keep untrustworthy providers out of federal health insurance. The new affiliations provision will allow CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse and repeat offenders.

Details on the Rule.

The final rule, (CMS-6058-FC), creates several new revocation and denial authorities to enhance CMS’ efforts to stop fraud and abuse.

Similar to the affiliations component, these authorities provide a basis for administrative action to revoke or deny, as applicable, Medicare enrollment if:

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