Medicaid | The Health Law Firm Blog

August 27, 2012, Marks the Start Date of the CMS Recovery Audit Prepayment Review (RAPR)

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

On July 31, 2012, the Centers for Medicare and Medicaid Services (CMS) announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012.

The CMS originally announced the Recovery Audit Prepayment Review (RAPR) Demonstration Project in November of 2011 for a January 1, 2012 start date, then delayed it to June 1, 2012, then again to, “summer of 2012.”

To see the official announcement from the CMS, click here.

Recovery Audit Contractors (RACs) will Review Claims with High Rates of Improper Billing.

[…]

By The Health Law Firm|2024-03-14T10:00:34-04:00June 1, 2018|In the Know, In the News, Medicaid, Medicaid audit, Medicare, Medicare Audit, The Health Law Firm Blog|

Be Prepared for a Medicaid Audit Request

By Lance O. Leider, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law

Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country. The reason is that Florida has become synonymous with healthcare fraud. As a result, auditing and subsequent overpayment demands are some very real possibilities.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that […]

By The Health Law Firm|2024-03-14T10:00:33-04:00June 1, 2018|Medicaid, Medicaid audit, The Health Law Firm Blog|

WellCare Health Plans Reaches Settlement in False Claims Act Case

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

WellCare Health Plans Inc.(WellCare) has reached a $137.5 million settlement with the federal government and nine states. The settlement resolves four lawsuits alleging violations of the False Claims Act.

WellCare is based in Tampa, Florida. The company provides managed health care services for approximately 2.6 million Medicare and Medicaid beneficiaries across the United States.

Lawsuits Allege WellCare Submitted False Claims to Medicare, Medicaid Programs.

The lawsuits allege that WellCare submitted false claims to Medicare and Medicaid programs. WellCare allegedly falsely inflated the amount it claimed to be spending on medical care. Allegedly, this was done in order […]

By The Health Law Firm|2024-03-14T10:00:32-04:00June 1, 2018|Medicaid, Medicare, The Health Law Firm Blog|

Walgreens Reaches Settlement in False Claims Act Case

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

Walgreens has reached a $7.9 million settlement with the United States and participating states that resolves allegations that Walgreens violated the False Claims Act. The DOJ announced the settlement on April 20, 2012. To view the DOJ’s press release concerning the settlement with Walgreens, click here. To view the False Claims Act, click here.

Walgreens Allegedly Offered Illegal Inducements to Medicare and Medicaid Beneficiaries.

The settlement was reached after Walgreens was accused of offering illegal inducements to beneficiaries of government health programs (Medicare, Medicaid, the Federal […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|Medicaid, Medicare, The Health Law Firm Blog|

$24 Million Medicaid Fraud Scheme Alleged by Connecticut Attorney General

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

Connecticut’s Attorney General, George Jepsen, alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. He filed a civil action on May 31, 2012. It is the first case the state has initiated under the Connecticut False Claims Act. The Connecticut False Claims Act gives the state the ability to seek compensation for taxpayers from those who submit false claims for reimbursements they are not eligible to receive. To view the Connecticut False Claims Act, click here.

The complaint seeks restitution, […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|Medicaid, The Health Law Firm Blog|

Medicare Fraud Initiative Leads to Arrests of Over 100 Health Professionals

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

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

This multi-agency attack on medical professionals and health care providers was a joint effort between law enforcement agents from the Federal Bureau of Investigation (FBI), Department of Health and Human Services-Office of Inspector General (HHS-OIG), Medicaid Fraud Control Units (MFCU) and other state and local law enforcement agencies. In addition to arresting over 100 medical professionals, […]

By The Health Law Firm|2024-03-14T10:00:30-04:00June 1, 2018|Health Care Industry, In the News, Medicaid, Medicare, The Health Law Firm Blog|

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

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

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

The Medicaid Fraud Control Unit does not issue a subpoena without reason. An investigation by the Medicaid Fraud Control Unit is a […]

By The Health Law Firm|2024-03-14T10:00:29-04:00June 1, 2018|Medicaid, The Health Law Firm Blog|

Halifax Whistleblower Claims Hospital Overbilled Medicare

The U.S. Department of Justice has joined a whistleblower suit filed against Halifax Hospital by the hospital’s director of physician services, according to the Daytona Beach News-Journal.

The U.S. Department of Justice filed its part of the lawsuit on Friday. It claims that Halifax Health defrauded the federal government by submitting thousands of false claims for Medicare and Medicaid payments worth millions of dollars. By filing, the U.S. Department of Justice hopes to recover millions of dollars in Medicare and Medicaid payments that it says were made in error to Halifax.

Elin Baklid-Kunz filed a lawsuit against Halifax in 2009. As a whistleblower, he could be awarded a percentage of whatever the government recovers. […]

By The Health Law Firm|2024-03-14T10:00:27-04:00June 1, 2018|Health Care Industry, In the News, Medicaid, Medicare, The Health Law Firm Blog|

Doctor or Nurse, Please, Please, Please: Talk to an Attorney Before You Talk to an Investigator

Despite mailing out hundreds of thousands of postcards and letters to physicians, nurses, dentists, pharmacists, and psychologists throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Department of Health (DOH) investigators (who are sometimes titled “Medical Quality Assurance Investigators” or “Medical Malpractice Investigators“), Drug Enforcement Administration (DEA) special agents, police officers, sheriff’s deputies, or criminal investigators of any type.

Let me state this as succinctly and clearly […]

By The Health Law Firm|2024-03-14T10:00:27-04:00June 1, 2018|Department of Health, Health Care Industry, Medicaid, Medicare, Nurses, The Health Law Firm Blog|

Emergency Suspension Orders and Medicaid Fraud

In the recent case of Mendelsohn v. State of Florida Department of Health, Mendelsohn’s license to practice medicine was suspended under an Emergency Suspension Order (ESO).

According to the ESO, Mendelsohn is licensed to practice medicine in Florida pursuant to the provisions of chapter 458, Florida Statutes. On December 9, 2010, he entered a plea of nolo contendere in federal court to a charge of conspiracy to commit fraud upon the United States in violation of 18 U.S.C. § 371. As a result of his conviction, the Florida Department of Health immediately suspended his medical license without a hearing pursuant to section 456.074(1), Florida Statutes (2010), which states:

(1) The department shall issue an emergency […]

By The Health Law Firm|2024-03-14T10:00:27-04:00June 1, 2018|Department of Health, Health Care Industry, Medicaid, The Health Law Firm Blog|