In the News | The Health Law Firm Blog

New Details Released on Drug Enforcement Administration’s Investigation of Central Florida Pain Management Clinic

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

The Drug Enforcement Administration’s (DEA) investigation into a Longwood, Florida, pain management clinic continues. More details are being revealed about the case. DEA agents along with local police and sheriffs’ deputies raided the pain management clinic on June 14, 2013. Agents believe the evidence they have gathered suggests the clinic was operating as a “pill mill,” according to the Orlando Sentinel. Officials allegedly seized evidence at the clinic associated with at least ten (10) doctors and other clinic employees. No one has been arrested yet, but documents filed in federal court in Orlando […]

By The Health Law Firm|2024-03-14T10:00:49-04:00June 1, 2018|DEA, Health Care Industry, In the News, Pain Management, Pharmaceutical Drugs, Pharmacy, The Health Law Firm Blog|

Fifty-Five Hospitals Around the Country to Pay the Government $34 Million Settlement for False Claims Allegations

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

Fifty-five (55) hospitals in twenty-one (21) states have agreed to pay the Department of Justice (DOJ) more than $34 million to settle allegations of Medicare fraud in a whistleblower case, according to the DOJ on July 2, 2013. The false claims allegations involve a back procedure called a kyphoplasty. The kyphoplasty can be performed safely and effectively as an outpatient procedure. However, it is alleged that hospitals were using more expensive, inpatient procedures to increase Medicare billings.

To read the press release from the DOJ, click here.

A kyphoplasty is used to treat spinal fractures […]

By The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|In the News, Medicare, Medicare Fraud, The Health Law Firm Blog, Whistleblower|

CMS Fights Medicare Fraud With Ban on New Home Health Agencies and Ambulance Suppliers in Three Cities

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

The Centers for Medicare and Medicaid Services (CMS) announced it will temporarily ban new home health providers and ambulance suppliers from enrolling in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in three fraud “hot spots.” According to CMS, the six-month moratorium begins July 30, 2013. It applies to newly enrolling home health agencies (HHAs) in Miami, Florida, and Chicago, Illinois. It also applies to newly enrolling ambulance suppliers in Houston, Texas. Existing providers and suppliers can continue to deliver and bill […]

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Affordable Care Act, In the Know, In the News, Medicare, Medicare Fraud, The Health Law Firm Blog|

Orlando Health’s Restructuring Efforts Might Mean Pay Cuts and Layoffs for Employees

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

Many employees at Orlando Health might be getting hit hard in the wallet with pay cuts schedule for later this year. According to the Orlando Sentinel, the eight-hospital health system notified its night-shift workers that their differential pay would be trimmed by several dollars an hour. For some employees that could be a twenty percent (20%) reduction in salary. The differential pay cuts are scheduled to take effect on September 8, 2013.

Meanwhile the hospital allegedly raised prices in the cafeteria, reduced the tuition reimbursement benefit, cut some workers hours and made a number of […]

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Health Care Industry, In the Know, In the News, The Health Law Firm Blog|

Oncologist Accused of Billing Medicare for Unnecessary Chemotherapy-Employee Whistleblowers Filed First Claim

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

A Michigan oncologist is accused of deliberately misdiagnosing patients with cancer so he could allegedly administer chemotherapy treatments and bill the government for those treatments, according to the Department of Justice (DOJ). For more than two years the oncologist allegedly billed Medicare for $35 million in fraudulent claims. The oncologist was charged on August 19, 2013, with one count of Medicare fraud, according to the DOJ.

On top of submitting false claims to Medicare, a criminal complaint alleges a number of other serious charges. These include hiring doctors who may not have been properly […]

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|In the News, Medicare, Medicare Fraud, The Health Law Firm Blog, Whistleblower|

Grace Period Included in the Affordable Care Act Could Pose Financial Risk to Healthcare Professionals and Providers

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A little known rule published by CMS to implement the Affordable Care Act (ACA) could pose a significant financial risk for doctors, hospitals and other healthcare providers. The rule requires health plans participating in the exchanges to provide individuals purchasing insurance through the exchanges a grace period before terminating the coverage for non payment of the premiums. Doctors and other healthcare providers will continue to provide care during the grace period, but the insurance plan will […]

By The Health Law Firm|2024-03-14T10:00:53-04:00June 1, 2018|In the News, The Health Law Firm Blog|

Fake Doctor in Texas Accused of Injecting Patients with Silicone Instead of Botox

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

A South Texas woman was charged on October 31, 2013, for allegedly injecting people with silicone, that she claimed was Botox. The phony health professional, described in some media reports as an “unlicensed plastic surgeon,” has been charged with practicing medicine without a license. According to Reuters, the unlicensed health professional could also be facing charges of manslaughter if investigators confirm that a woman’s death was related to treatments received from the imposter.

Click here to read the entire article from Reuters.

If convicted, the fake health care professional could spend up to […]

By The Health Law Firm|2024-03-14T10:00:53-04:00June 1, 2018|Fake Health Care Professionals, In the News, The Health Law Firm Blog|

Fake Surgeon in Florida Accused of Performing Liposuction Without a License

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

A Kissimmee, Florida, man was arrested on December 18, 2013, on charges that he has been allegedly performing liposuction without a medical license in a Central Florida clinic. According to the Orlando Sentinel, the Metropolitan Bureau of Investigation (MBI) began investigating the phony surgeon about a year ago, after Florida Department of Health (DOH) received a complaint about the clinic in which the phony doctor worked. The clinic was called “Sculptural Orlando.”

Click here to read the article from the Orlando Sentinel.

Investigators Looking for More Victims.

According to the Orlando Sentinel, it is […]

By The Health Law Firm|2024-03-14T10:00:53-04:00June 1, 2018|Fake Health Care Professionals, In the News, The Health Law Firm Blog|

Say Goodbye to Physicians United Plan and Hello to Changes

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

As of July 1, 2014, at 12:01 a.m., Physicians United Plan (PUP) will be liquidated. The insurance company was declared insolvent by a Florida circuit judge in Tallahassee on June 9, 2013. The judge turned the company over to the Florida Chief Financial Officer for immediate control of the company’s property and assets.

PUP is a Medicare Advantage plan, which is a private insurance company that insures Medicare patients. The Orlando, Florida-based company reports having 38,000 insurance subscribers. Those members have been switched back to original Medicare and a Part D prescription drug plan to avoid losing coverage […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|In the News, The Health Law Firm Blog|

CMS in the Hot Seat for Lax Oversight of Medicaid Managed Care Organizations

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

For years, each state has kept an eye on its own Medicaid managed care plans, while the Centers for Medicare and Medicaid Services (CMS) is required to monitor how well each individual state is doing. However, a recent Government Accountability Office (GAO) report claims CMS is sleeping on the job. The report, released on June 20, 2014, stresses the need for more federal oversight of these plans.

With the implementation of the Affordable Care Act (ACA), the Medicaid program is expected to expand significantly. Most of the new beneficiaries enrolled in managed care are covered almost entirely by federal […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Department of Health and Human Services, GAO, Government Accountability Office, Health Care Industry, HHS, In the Know, In the News, MCO, Medicaid, Medicaid managed care, Medicare, The Health Law Firm Blog|