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South Florida Pharmacy Owner Pleads Guilty to $23 Million Health Care Fraud Scheme

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

A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks, according to a Department of Justice (DOJ) press release.

Click here to read the entire press release from the DOJ.

Pharmacy Owner Used Kickbacks and Referrals to Allegedly Scam Medicare and Medicaid.

According to […]

By The Health Law Firm|2024-03-14T10:00:41-04:00June 1, 2018|Assisted Living Facilities, Medicaid, Medicare, Medicare Fraud, The Health Law Firm Blog|

Tennessee-Based Nursing Care Company Being Investigated for Medicare Fraud

By Danielle M. Murray, J.D.

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer’s centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal.

Click here to read the entire article from the Wall Street Journal.

Therapists Allegedly Encouraged to Perform Unnecessary and Costly […]

By The Health Law Firm|2024-03-14T10:00:42-04:00June 1, 2018|Assisted Living Facilities, Home health care facility, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog, Whistleblower|

Occupational Therapists, Podiatrists, Psychologists and Optometrists Being Scrutinized in Medicare Audits

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

Our firm has recently seen an increase in the number of occupational therapists (OTs), speech therapists (STs), podiatrists, psychologists, optometrists and other licensed health professionals being scrutinized in Medicare audits and recovery actions. Often these result from claims submitted for evaluation or treatment entered in nursing homes or assisted living facilities (ALFs).

You Must Provide Complete and Detailed Documentation of Care Rendered.

In many cases, the provider may not have complete documentation of the care rendered because it has been placed in the patient’s record at the facility. Unfortunately, Medicare does not see this as an excuse […]

By The Health Law Firm|2024-03-14T10:00:45-04:00June 1, 2018|Assisted Living Facilities, Health Care Industry, Home health care facility, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

Major Medicare Offender Sentenced to Prison for Multi-Million Dollar Health Care Fraud Scheme

By Lance O. Leider, J.D., The Health Law Firm

The former owner of four mental health facilities in South Florida and North Carolina was sentenced to fourteen (14) years in federal prison on February 25, 2013. The former business owner pleaded guilty to defrauding Medicare out of tens of millions of dollars from 2004 through 2011, according to the Department of Justice (DOJ). He had previously been convicted of cocaine trafficking but decided to move to Medicare fraud supposedly because he thought it would be safer. In total the former mental health facility owner was indicted for defrauding the government of nearly $63 million. As part of his plea, he […]

By The Health Law Firm|2024-03-14T10:00:45-04:00June 1, 2018|Assisted Living Facilities, In the News, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

A New Year Means New Audits and Site Visits for Assisted Living Facilities – Protect Yourself Now

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

For Assisted Living Facilities (ALFs) in Florida, it’s time to do a little brushing up on your compliance material.

Beginning in January 2015, the Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid Program Integrity (MPI), will conduct site visits to determine compliance with the Florida Medicaid Provider General Handbook and the Assistive Care Services Coverage and Limitations Handbook. This is just one of several initiatives aimed at ALFs to curtail fraud, waste, and abuse in the Florida Medicaid program.

Be Prepared.

The goal of a site visit is to determine if providers […]

By The Health Law Firm|2024-03-14T10:00:58-04:00June 1, 2018|Assisted Living Facilities, Medicaid, Medicaid audit, Office of Inspector General, The Health Law Firm Blog|

Preparing for a Florida Board of Medicine Informal Hearing

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

If you are scheduled to appear for an informal hearing before the Florida Board of Medicine, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them.

Limited Circumstances for Informal Administrative Hearing

First, you should understand that you will only be at an informal hearing in which you appear before the Board of Medicine itself for a very limited number of reasons. These will include the following:

If you completed an election of rights (EOR) form and agreed that you did not intend to dispute any material facts alleged against you from […]

By The Health Law Firm|2024-03-14T10:00:29-04:00June 1, 2018|Board of Medicine, Department of Health, Health Care Industry, Informal Hearings, The Health Law Firm Blog|

Orlando Physician To Pay $10,000 Fine for Prescribing Painkillers to Undercover Agents

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

On January 24, 2013, an Orlando physician pleaded no contest to racketeering charges for allegedly prescribing pain pills to undercover agents who did not need them. The physician was fined $10,000 and placed on 20 years of probation.

Physician Was One of the First Arrested in Florida’s Prescription-Abuse Crackdown.

According to the DOH complaint, between 2008 and 2009, the physician allegedly saw two undercover agents six times. Each agent complained about minor pain. Both agents were allegedly prescribed pain medication by the physician.

The complaint states that each office visit between the physician and undercover agents was […]

By The Health Law Firm|2024-03-14T10:00:44-04:00June 1, 2018|Board of Medicine, Department of Health, The Health Law Firm Blog|

Doctor Sentenced to Almost 27 Years in Prison for Pill Mill Charges

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

A doctor was sentenced to almost 27 years in prison on July 24, 2013, according to the Sun Sentinel. The former doctor, Sergio Rodriguez, had worked as a pediatrician at Children Plus Health Center near Palm Beach County, Florida. He was charged with operating a pill mill out of his office. He pleaded guilty to four counts of manslaughter, four counts of conspiracy to traffic oxycodone, one count of racketeering and one count of money laundering.

Click here to read the entire Sun Sentinel article.

Doctor Prescribed Pain Pills to Undercover Detectives.

Dr. Rodriguez is accused […]

By The Health Law Firm|2024-03-14T10:00:51-04:00June 1, 2018|Board of Medicine, Civil Forfeiture, Pain Management, The Health Law Firm Blog|

Will Florida Board of Medicine Follow Board of Pharmacy’s Lead and Recommend PRN Evaluations for Applicants Before Application is Considered?

By Lance Leider, J.D., The Health Law Firm

At the February 12, 2014, Florida Board of Pharmacy meeting, some board members expressed frustration with the fact that applicants for licensure with prior mental health or substance abuse related issues had not been evaluated by the Professionals Resource Network (PRN) prior to the consideration of their applications by the Board. The applications were scheduled for consideration, but applicants were told to come back after they had PRN evaluations. This recommendation by the Board of Pharmacy could have potentially serious consequences for applicants.

So far, the Board of Pharmacy is the only Board we are aware of to make such a recommendation. We […]

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|Board of Medicine, IPN and PRN, The Health Law Firm Blog|

The RACs, They’re Back! The Return of Medicare Recovery Audits

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

All good things must come to an end. This includes the two-month hiatus from Recovery Audit Contractors (RACs) that healthcare professionals enjoyed. The Centers for Medicare and Medicaid Services (CMS) is restarting audits of Medicare fee-for-service claims on a limited basis. The program has been suspended since June 1, 2014, due to expired contracts.

CMS announced the return of RACs on August 4, 2014.

Click here to read the latest announcements on Medicare recovery audits from CMS.

From what we have heard, there were serious problems with some of the audits that had […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Centers for Medicare and Medicaid Services, Medicare, Medicare Audit, The Health Law Firm Blog|