About thehealthlawfirm

The Health Law Firm was established in 1999, bringing together a team of top attorneys with decades of experience in the legal and healthcare fields. Based in Orlando, Florida, the firm provides legal representation for healthcare providers. The services we provide include reviewing and negotiating contracts, business transactions, defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, opinion letters, commercial litigation, covenants-not-to-compete, restrictive covenant litigation, incorporation, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, Board of Dentistry cases, Department of Health investigations, pain management and pain medicine physician defense, pain management clinic defense, Zone Program Integrity Contractor (ZPIC) audit defense, Recovery Audit Contractor (RAC) audit defense, Medicaid Fraud Control Unit (MFCU) defense, Medicaid Fraud Control Unit (MFCU) search warrant and subpoena defense, Department of Health (DOH) subpoena defense, representation in clinical privileges hearings, representation before the Education Commission for Foreign Medical Graduates (ECFMG), National Board of Medical Examiners (NBME) representation, United States Medical Licensing Examination (U.S.M.L.E.) challenges and representation, all types of commercial and business litigation, administrative hearings, negotiation of contracts and other matters of Health Law and legal representation of health care professionals.

Whistleblower Agrees To Split Fees In $785M Pfizer FCA Deal

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 29, 2016, Dr. William LaCorte, M.D., a whistleblowing physician in Metairie, Louisiana, helped win a $785 million False Claims Act settlement with Pfizer, Inc., one of the World’s largest pharmaceutical companies.  Dr. LaCorte agreed with his former lawyers on a split of attorney’s fees. This resolved one of many disputes about paying multiple attorneys.

An Agreement Was Reached.

U.S. District Senior Judge Douglas P. Woodlock signed off on the agreement between whistle blower Dr. LaCorte and the doctor’s attorneys at Boone & Stone and Vezina & Gattuso LLC, on November 29, 2016. This gives Dr. LaCorte 62 percent of the relator’s share and 38 percent to three law firms.

Lawsuit Was First Filed In 2002.

This lawsuit first started back in 2002 when whistle blower Dr. LaCorte filed a lawsuit against Wyeth, Inc. Wyeth had received millions of dollars from filing false-claims lawsuits against multiple health care companies in July 2014, or so it was alleged.

The lawsuit was first filed in 2002, before Pfizer had purchased Wyeth.  The case was consolidated with a lawsuit from another whistle blower, Lauren Kieff. The U.S. Department of Justice intervened in 2009. The dispute was recently settled in earlier 2016 without an admission of wrongdoing hy the pharmaceutical companies.

The DOJ said that the LaCorte and Kieff case focused on discounts that Wyeth offered to hospitals that purchased oral and intravenous versions of Protonix. Wyeth did not offer that same discounts to Medicaid, which violated the program’s “best price” provision requiring all suppliers to give the Medicaid Program the best price it gives to anyone else.

Dr. LaCorte, the qui tam plaintiff or “relator,” had alleged in his earlier lawsuit that Pfizer’s unit Wyeth, Inc., had overbilled Medicaid for Protonix, a heartburn medication.  Dr. LaCorte was offered a $64 million relator’s share, and the states offered him a $34 million relator’s share.

Boone & Stone and Vezina & Gattuso were looking to receive approximately 40 percent of the award, which is fairly standard in qui tam cases. They also wanted the award to be split equally between the two firms, as well as with the Sakla Law Firm.

Still Problems After The Settlement.

Even though a settlement was reached, it does not solve all of the disputes about the ten of millions of dollars that the attorneys will share as part of their contingency fee.  The Sakla Law Firm is currently disputing with Boone & Stone and Vezina & Gattuso about their own subdivision of the award. The dispute continues to play out in federal court.

The Sakla Firm, which routinely handles FCA cases argued in a different lawsuit that Boone & Stone and Vezina & Gattuso did not deserve any attorney’s fees because they did not do any of the “important” work. The Sakla Law Firm claims that it did 95 percent of the work in this case.

Disputes Over Legal Fees.

Dr. LaCorte has a separate dispute with Wyeth, Inc., about legal fees which he claims the company owes him from the FCA suit.  According to Dr. LaCorte, Wyeth owes him $7.7 million in legal fees, in addition to $300,000 in costs.  Judge Woodlock apparently indicated that the parties should mediate their dispute.

A spokeswoman for Pfizer, Neha Wadhwa, stated in an e-mail dated November 29, 2016, “Given the limited role relator LaCorte and his counsel played in bringing about the ultimate settlement in this mater, and the deficient records supporting the latter’s fee request, as Pfizer indicated in its court papers, Pfizer believes his request is excessive and should be reduced.”

In motion papers in June 2016, Dr. LaCorte’s attorneys had said that $7.7 million was a reasonable amount under the law for a complex contingency case that required a vast amount of expenses.

Attorney’s Fees Reasonable or Not?

Knowing what goes into a major qui tam case, given the extremely large recovery for the government, it seems that $7.7 million is imminently reasonable.  This case extended over a 14 year period and.  I’m sure, the attorneys and their staffs did a tremendous amount of work on it.  In fact, I would query whether or not a Lode Star multiplier might be in order given the recovery made.

Contact Experienced Health Law Attorneys.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case.  This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities.  However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties.  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 doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:
Elfin, Dana. “Wyeth to Pay $785M to End Medicaid False Claims Case.” Bloomberg BNA. (February 7, 2016). Web.

Loftus, Peter. “Pfizer to Pay $785 Million to Settle Medicaid Claims.” The Wall Street Journal (February 16, 2016). Web.

Amaral, Brain. “Whistleblower In $785M Pfizer FCA Deal Agrees To Fees Split.” Law360. (November 29, 2016).Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA), overbilling Medicaid, The Health Law Firm reviews, False Claims Settlement, Medicaid fraud defense attorney, reviews of The Health Law Firm, False Claims Act defense lawyer, qui tam attorney, Medicaid false billing,False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, FCA original source requirement, AKS safe harbor, FCA subject matter jurisdiction, FCA first to claim requirement, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer

“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 © 2016 The Health Law Firm. All rights reserved.

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent 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 have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 2016). 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: False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation defense attorney, 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 © 2016 The Health Law Firm. All rights reserved.

South Florida Hospital Agrees To Pay $12 Million To Settle FCA Claims

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

On December 7, 2016, a Miami-area hospital will pay the federal government about $12 million to resolve allegations that it violated the False Claims Act (FCA) by submitting false claims to federal health care programs for medically unnecessary cardiac procedures, the U.S. Department of Justice (DOJ) said.

The Allegations.

The allegations against South Miami Hospital stem from procedures allegedly performed by Dr. John R. Dylewski while he worked for the hospital. “Performing medically unnecessary heart procedures is shocking to the conscience,” Shimon R. Richmond, the U.S. Health and Human Services’ (HHS) Office of Inspector General’s (OIG) special agent in charge, said in a statement. “Conducting cardiac catheterizations purely for profit, not patient care, seriously breaches the ‘do no harm’ commitment physicians pledge.”

Two Whistle Blowers Add to the Mix.

Two whistle blowers, Dr. James A. Burks and Dr. James D. Davenport, brought the suit to light and stand to receive about $2.75 million of the settlement. Dr. Burks is a vascular surgeon who started working at South Miami Hospital in 2003 and Dr. Davenport is a cardiologist who was active in various peer review committees at the hospital between 2010 and 2014.

Both whistle blowers claimed to have personal knowledge of Dr. Dylewski and the hospital performing a number of unnecessary cardiac procedures for the sole purpose of increasing the amount of reimbursements paid to the hospital and its doctors by Medicare the DOJ said. According to the two whistleblowers, the alleged wrongdoing was known throughout the hospitals’ corporate hierarchy, including top executives, department officers, medical division chiefs and members of peer review committees. Additionally, both whistleblowers claim to have witnessed “repeated and continuing instances” of the improper medical and billing practices.

Dr. Dylewski, who no longer works at the hospital, was not a party to the settlement. Click here to read the press release on the suit from the DOJ.

To learn more about FCA suit, click here to read one of my prior blogs on a similar case.

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

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. 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 doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:

Kennedy, John. “Florida Hospital To Pay $12M To Settle FCA Claims.” Law360. (December 7, 2016). Web.

Lincoff, Nina. “BREAKING: South Miami Hospital to pay $12M to settle false claims allegations.” South Florida Business Journal. (December 7, 2016). 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: Florida health attorney, qui tam lawyer, health law attorney, Florida health lawyer, The Health Law Firm, health law defense lawyer, health care fraud attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, FCA original source requirement, AKS safe harbor, FCA subject matter jurisdiction, FCA first to claim requirement, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2016 The Health Law Firm. All rights reserved

Extensive Bribery Scheme At Dallas’ Forest Park Medical Center

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

Founders and investors of a physician-owned health care facility in Dallas, Texas, known as the Forest Park Medical Center, were charged on December 1, 2016, in a bribery and kickback scheme. The range of felony offenses stem from their payment or receipt of roughly $40 million in bribes and kickbacks for referring patients to Forest Park Medical Center (FPMC), according to a federal indictment in Texas federal court.

 


21 Took Part In Conspiracy Scheme.

The indictment was returned by a federal grand jury in November 2016, identifying 21 defendants including executives, physicians, surgeons and other individuals associated with FPMC who allegedly took part in a bribery scheme that cheated federally funded health care programs and other insurance plans for their personal financial gain.

The defendants named included, Forest Park co-founder of FPCM, CEO Alan Andrew Beauchamp, anesthesiologist and president of its board of directors Richard Ferdinand Toussaint, Jr., surgeon and board of directors member Wade Neal Baker, and Forest Park managing partner and investor Wilton McPherson Burt. However, there were many others involved in addition to these few.  It must be remembered that those named have been charged but have not been convicted in a court of law.  Often in this type of case, a defendant is acquitted or dismissed.

FPMC was an out-of-network hospital.  According to the indictment, the patients that were referred there were primarily ones with high reimbursing out-of-network private insurance benefits or benefits under certain federally-funded programs.  FPMC’s owners, managers, and employees also tried  to sell patients with lower reimbursing insurance coverage, namely Medicare and Medicaid beneficiaries, to other facilities in exchange for cash.

According to a press release from the U.S. Department of Justice, because FPMC is an out-of network hospital, it is free to set its own prices, resulting in a higher reimbursement rate than in-network providers.

Park Over Billed Patient’s Insurance Companies.

The indictment alleges that Forest Park billed patients’ insurance plans more than half a billion dollars and collected around $200 million in paid claims from 2009 to 2013 as a result of the bribes and kickbacks.

According to the DOJ, several co-defendants operated shell entities where the defendants funneled bribes and kickbacks payments though to surgeons in exchange for referrals.

“Medical providers who enrich themselves through bribes and kickbacks are not only perverting our critical health care systems, but they are committing a serious crime. Massive, multifaceted schemes such as this one, built on illegal financial relationships, drive up the cost of health care for everyone and must be stopped,” said U.S. Attorney John Parker of Texas’ Northern District in a statement.

FPCM Investors Referred Patients In Return For Kickbacks.

According to the indictment, primary care physicians who were investors in the facility and referred patients to FPCM for surgery and other specialized treatments received kickbacks ranging anywhere from $100,000 to $7 million. Those enriched funds where used to market their own personal medical practices or for personal goods and expenses.

There were several government health care programs that were affected by the alleged bribery scheme such as Tricare, The U.S Department of Labor’s FECA health care program, who was  billed $25 million; the U.S. Department of Defense’s health care program, who was billed over $10 million; and federal and retirees FEHBP health care program, who was billed over $60 million.

Each of the defendants have been charges with one count of conspiracy to pay and receive health care bribes and kickbacks. This gives the defendants a chance to be sentenced to five years in prison and a $250,00 fine.

Others involved in the scheme have been charged with violating the federal Travel Act and aiding and abetting a conspiracy to commit money laundering.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Sources:
Lee, Suevon. “21 At Texas Med. Center Charged In Massive Bribery Scheme.” Law360. (December 1, 2016). Web.

Krause, Kevin. “Doctor-owners, Execs of Bankrupt Forest Park Hospital Chain Indicted In Massive Kick-back Scheme.” Dallas News. (December 2, 2016). Web.

“Executives, Surgeons, Physicians and Others Affiliated with Forest Park Medical Center (FPMC) in Dallas Indicted in Massive Conspiracy.” United Stated Department of Justices. (December 2, 2016). web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: The Health Law Firm reviews, health care fraud audit. Medicare audit defense attorney, reviews of The Health Law Firm, health care fraud scheme, Medicare fraud defense lawyer, health law criminal defense attorney, Medicaid audit defense attorney, health law, health law criminal representation, Forest Park Medical Center (FPMC), Medicaid fraud defense attorney, Tricare, U.S. Department of Defense, health care programs, U.S. Department of Labor, The Health Law firm, conspritator in health care fraud scheme, Florida physician defense attorney, Colorado physician defense lawyer, Kentucky doctor defense legal counsel, Louisiana physician defense attorney, District of Columbia (D.C.) doctor defense lawyer

“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 © 2016 The Health Law Firm. All rights reserved.

DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

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

Attorneys with The Health Law Firm also represent 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 have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 2016). 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: Florida health law defense attorney, qui tam defense lawyer, legal representation for allegations of health care fraud, legal representation for health care fraud investigations, health care fraud defense attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud investigation defense attorney, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, The Health Law Firm reviews, Reviews of The Health Law Firm attorneys, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer
“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 © 2016 The Health Law Firm. All rights reserved.

East Texas Lab Agrees to Pay $3.75 Million to Settle False Claims Suit

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, owners of an East Texas clinical laboratory who overcharged Medicare for falsified driving mileage bills have agreed to pay the U.S. government $3.75 million to settle a whistle blower’s False Claims Act (FCA) lawsuit. The suit was brought by a former employee, the U.S. attorney’s office announced.

Submitting False Claims.

Texas-based Elite Lab Services LLC (Elite) and its owners, Gerard and Suzanne Dengler, reportedly settled claims brought under the False Claims Act (FCA) by plaintiff Karen Malcolm. The Denglers admitted that from approximately 2010 to 2014 they submitted inflated employee mileage claims to Medicare and billed the government health agency knowing it does not pay for mileage claims in excess of actual miles driven.

According to court documents, the defendants employed phlebotomists who traveled around East Texas to collect blood samples and transport those samples back to Elite for lab services. For several years, the defendants at Elite knowingly submitted or caused to be submitted inflated mileage calculations beyond the actual distances driven by the employees.

The Whistle Blower.

In 2014, the whistle blower Malcolm, filed the suit alleging that Elite had defrauded Medicare. She claimed that she approached the Denglers in the spring of that year to voice concerns about the billing practices, but the issue was not corrected. She then resigned from the company as a result. The U.S. Attorney’s Office revealed that the government intervened in the suit for purposes of the settlement.

In an agreed final judgment, the parties said that the defendants relinquished and waived all right and title to more than $2.5 million in cash held in a collection of several financial accounts and sales of real property that they owned to satisfy the settlement in the instant case.

As a result of the deal, Malcolm will receive a 21 percent share of the recovery, totaling $787,500, authorities said.

Medicare and Medicaid fraud cases brought on by whistleblowers are unfortunately becoming more common. To read about the serious repercussions of cases like this, click here to read one of my prior blogs.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim, as well as in defending them in certain cases.

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

Sources:

Wolf, Alex. “East Texas Lab Pays $3.75M For Falsified Medicare Billing.” Law360. (December 14, 2016). Web.

“Tyler lab, owners to pay $3.75 million for filing false Medicare claims.” Longview Business Journal. (December 14, 2016). Web.

“East Texas lab company, owners to pay $3.75M for false Medicare claims.” KLTV-ABC. (December 14, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with 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 Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) attorney, legal representation for submitting false claims to the government, defense attorney, Medicare false claims defense lawyer, allegations of false billing, Medicare and Medicare fraud investigation defense attorney, consumer reports of false claims, Medicare audit defense lawyer, health care fraud defense attorney, whistle blower attorney, qui tam defense lawyer, legal representation for whistle blower suits, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, qui tam relator’s attorney, qui tam defense attorney, Florida whistle blower case, Virginia Whistle blower case, Colorado whistle blower case, Louisianan Whistle blower case, complex healthcare litigation attorney
“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 © 2016 The Health Law Firm. All rights reserved.

Do You Know What A Compromised Physician or Health Care Provider Is?

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

What is a “compromised physician” or “compromised health provider”?  It may not be what you think it is.

This term is used from time to time to refer to health professionals, physicians and health facilities whose identities and billing numbers have been stolen and crooks are utilizing them to falsely bill Medicaid, Medicare, Tricare and health care insurance programs for services that were never performed.

Stolen Medical Identities

Every now and then, these “compromised healthcare providers” have their identifying information ordered into lists which are sold or exchanged from one criminal to the next. This may wind up causing thousands of false claims to be submitted using their identification.  This could cause millions of dollars in taxpayer money or in health insurance proceeds to be paid out to thieves.

The Centers for Medicare and Medicaid Services (CMS) maintains a list of compromised providers that is used to screen for any claim submitted under that providers identification, including prescriptions, orders for durable medical equipment, orders for home health services, orders for diagnostic tests and other services paid by a third party payer.  CMS estimates that there are approximately 5,000 providers whose medical identities have been stolen and used to submit false claims.  A physician may be on this list and not even know it until his or her claims start being denied.

In 2011, Cybil G. Roehrenbeck of the American Medical Association wrote a good article explaining the entire problem in detail.  I highly recommend that you review it and you can do so by clicking here.

Helpful Resources

CMS has published a “Fraud, Waste and Abuse Toolkit” to help physicians and other health care providers prevent the false use of their billing information.  It is titled:  “Health Care Fraud and Program Integrity: An Overview for Providers.”  It also has several other informational publications on how physicians and other health professionals can avoid identity theft.  You can access these publications by clicking here:


Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Sources:
Roehrenbeck, Cybil. “Physician Identity Theft.” ABA Health eSource. (October 2011). Web.

“Fraud, Waste, and Abuse Toolkit.” Centers For Medicare and Medicaid Services.(July 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: health care fraud defense attorney, compromised physician list, compromised health provider attorney, The Health Law Firm reviews, The Florida Bar in Health Law, Medicare fraud defense attorney, The Health Law Firm, Medicaid fraud defense attorney, consumer reports of Medicare fraud, Centers for Medicare and Medicaid Services (CMS) audit attorney, Medicaid investigation defense lawyer, Medicare investigation defense lawyer, reviews of The Health Law Firm, legal representation for health care fraud charges, false claims act case legal representation, whistle blower claims attorney

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 2016 The Health Law Firm. All rights reserved.

 

Nursing Home and Hospital Accussed For Woman’s Death

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

The family of a mentally ill woman, Diane Rimert, who died of pneumonia, urged a Texas jury on December 1, 2016 to find a nursing home and a hospital liable for her death. The family alleged that the nursing home neglected her and that the hospital wrongfully recognized a do-not-resuscitate document that she signed while unable to care for herself.

The Patient Suffered From A Mental Illness.

Rimert lived with severe bipolar disorder and delusions. She lived the last years of her life in a Pennsylvania rehabilitation nursing home after she was arrested and involuntarily committed to a mental hospital.

Rimert Living In Poor Conditions In The Nursing Home.

Jeffrey D. Antonson of Adkerson Hauder & Benzey PC, an attorney for Rimert’s three adult children, told jurors in Dallas County that Rimert developed severe bedsores in her feet and lower half of her body, stating that this confirmed she had been neglected. The attorney claimed there was also proof that Rimert was left in her own excrement until her flesh began to decay and this took away her body’s ability to fend off pneumonia, he said.

Final Days.

Rimert was taken to Texas Health Harris Methodist Hospital, where she was left to die because she had signed what appeared to be a valid legal documents concerning her end-of-life decisions. She signed the documents when she first arrived at the nursing home when, it is alleged, she was mentally ill. The document stated that she did not want to be rescuscitated and gave her medical power of attorney to her neighbor rather than her children. She died in February 2012.

Attorney Anderson stated: “What makes sense here? Is a mentally ill woman — bipolar disorder, with psychosis, a woman who had delusions that she was different people — is she responsible for her own suffering and for her own death? Or is there one or more of the defendants sitting before you that is responsible for her suffering and her death?”

Attorney George Michael Stewart of Stewart Wiegand & Owens, PC, representing the nursing home, argued that Rimert was generally an uncooperative patient and although she was mentally ill, she was deemed competent when she signed the do-not-resuscitate and medical power-of-attorney documents. “Every patient in this country has the right to refuse treatment, mentally ill or not,” he said. “The reality is, this was her choice. She decided long ago that, ‘I didn’t want to be rescuscitated, I didn’t want feeding tubes’ … even if it wasn’t a rational decision for her, it was her right to make that decision.”

Stewart also stated that Rimert’s children, who are seeking compensation for the loss of their mother, had suffered serious abuse at her hand since they were small and were mostly estranged from her. Rimert always became violent and enraged in the presence of one of her sons, and she had last seen her daughter in 1996, he said.

Stewart said they lost their mother a long time ago to the mental illness, not pneumonia.


Comment by Editor

This is certainly a tragic case. And Ms. Rimert, if she really understood what she was signing at the time (and that is a big problem if counselors and intake coordinators in these institutions are not adequately explaining end-of-life decision documents to their new residents), it was her right to make the decision. The law presumes every person is competent until a court declares her to be mentally incompetent. But as ill as she apparently was, this seems to be a real question.


Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Source :

Lowery, Brandon. “Nursing Home, Hospital Caused Woman’s Death, Jury Told.” Law360. (Dec. 1, 2016). Web.

About the Author:
George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

 
KeyWords: reviews of The Health Law Firm, health care lawyer, representation for mental health professionals, The Health Law Firm reviews, health law attorney, legal representation for health care professionals, health care provider defense attorney, The Health Law Firm, mental health counselor defense attorney, psychologist defense attorney, legal advice for skilled nursing facilities, nursing home defense counsel, board of mental health counselors defense lawyer, board of psychology defense attorney, complex mental health litigation attorney, psychiatrist defense counsel, complex litigation on health care issues

“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 © 2016 The Health Law Firm. All rights reserved.

News For Nursing Homes: Federal Government’s Attempt to Ban Nursing Home Arbitration Blocked

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

On November 7, 2016, a Mississippi federal judge temporarily blocked enforcement of the federal government’s proposed ban on mandatory arbitration in cases involving nursing homes. The order from U.S. District Judge Michael P. Mills granted a preliminary injunction sought by the American Health Care Association (AHCA) and prevents the ban from taking effect on Nov. 28.

The proposed rule, released by the Centers for Medicare & Medicaid Services (CMS), bans so-called pre-dispute binding arbitration clauses in nursing home contracts, which require patients and families to settle any dispute over care in arbitration, rather than through the court system.

To learn more about the rule, click here.

Click here to read the final rule issued by CMS.

Not Everyone Agrees With The Rule.

In Judge Mills’s order, he wrote that the CMS “does not have the authority to ban nursing home arbitration on general policy grounds,” even if the goal of protecting elderly Americans is a worthy one.

Additionally, Judge Mills added that CMS could conceivably justify the ban by citing its authority to protect the health and safety of nursing home residents. But, that would require “an exceedingly broad understanding of agency authority.”

Click here to read Judge Mill’s order in full.

AHCA, a top trade group for nursing homes, shared their disapproval of the ban and stated that they are happy with the outcome. “We believe federal law plainly prohibits CMS from issuing this arbitration regulation, and this injunction will halt implementation of the final rule until the court can consider the merits of the case,” the association said.

Contact Health Law Attorneys Experienced with Nursing Home Cases.

The Health Law Firm and its attorneys represent nursing homes and nursing home employees in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

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

Sources:

Overley, Jeff. “BREAKING: Feds’ Ban On Nursing Home Arbitration Blocked.” Law360. (November 7, 2016). Web.

Corkery, Michael. “U.S. Just Made It A lot More Easier To Sue Nursing Homes.” The New York Times. (September 29, 2016). 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: Nursing home arbitration cases, U.S. ban on mandatory arbitration for nursing homes, legal representation for American Health Care Association (AHCA) investigations, Centers for Medicare & Medicaid Services (CMS), legal representation for nursing homes, CMS investigation defense lawyer, Medicare and Medicaid defense attorney, reviews for The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Healthcare Providers Service Organization (HPSO) Insurance: Finding What’s Right For You

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

There have been multiple times when we have been told by the health professionals we represent, especially  advanced registered nurse practitioners (ARNPs), pharmacists, licensed mental health counselors (LMHCs), massage therapists and physical therapists that after they received a complaint regarding their license from the Florida Department of Health (DOH) they had a hard time trying to find an experienced attorney in Florida who would accept their professional liability insurance.  In this case, I am talking specifically about Healthcare Providers Service Organization (HPSO) Insurance.

HPSO Insurance Helps With Expensive Legal Fees.

The healthcare professionals who are covered by HPSO Insurance have wonderful insurance coverage.  HPSO Insurance provides professional liability coverage that protects in the event of a lawsuit or negligence claim.  However, many times the professional receives a notice of an investigation, a subpoena for a deposition in someone else’s case, a demand because of an allegation of sexual harassment or sexual impropriety, a complaint because of a breach of medical records confidentiality or Health Insurance Portability and Accountability Act (HIPAA) Privacy complaint, or some other administrative type of action.

HPSO provides great coverage for these.  For example, HPSO currently reimburses up to $10,000 in legal fees and expenses just for representation of you at depositions.  HPSO currently reimburses up to $25,000 in legal fees and expenses for your defense in a DOH or Agency for Health Care Administration (AHCA) notice of investigation or complaint.  HPSO currently reimburses up to $25,000 in legal fees and expenses for your legal representation in defense of a complaint or investigation regarding breach of medical confidentiality.

Get Insurance Now.

It is very important for every health professional to carry insurance that covers any investigation, complaint or administrative hearing that might be filed or opened against your license.  You may think that you are covered for this by your employer, but you are not.  If your employer contradicts this, ask for a statement in writing that your employer will pay for your legal defense for any such matter arising during your employment.

What typically happens, especially in the case of a hospital employee, nursing home employee, pharmacy employee or corporate employee, is that the employer is the one who terminates the employee and then files a complaint with the DOH.  The DOH then opens an investigation against the health professional.  The employer is not going to pay your legal defense costs if the employer has reported you.

You may very well be out of work, out of money and face an investigation and complaint that could terminate your professional license and career.  You should not take this chance.  Insurance such as HPSO Insurance is inexpensive and reliable.  Buy it while you can afford it. After the actions have occurred, it is too late.

Connect an Experienced Health Law Attorney if You are Contacted by an Investigator.

Also, you should immediately contact an experienced health law attorney if you are telephoned or visited by any investigator, or if you receive a letter advising you that an investigation has been opened regarding your care.  Call immediately for advice before you speak with an investigator or provide any documents or statements of any kind.

You cannot and should not seek “legal advice” on what to do from the investigator, from a DOH employee, from your professional board or from any attorney representing any of them.  They are not your friends.  They are on the side against you. You should definitely not take any advice from them.

Be Cautious of Cheap Insurance Policies.

If you have good insurance, it will pay for your legal expenses from the very beginning, so use it.  However, beware of cheap insurance policies from professional associations that do not provide any coverage for disciplinary complaints and licensure investigations.  Always check to be sure this is covered.  Get it in writing.  With some companies you have to pay an extra premium to obtain this coverage.  With some insurers, they do not offer it, and you have to purchase a completely separate policy covering just this.  It is worth it!  Do it!

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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

About the Author: About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Healthcare Providers Service Organization (HPSO) Insurance, professional liability insurance, health professionals, doctors, nurses, advanced registered nurse practitioners (ARNPs), massage therapists, licensed mental health counselors (LMHCs), social worker, assisted living facility (ALF), physical therapists, psychologists, defense attorney, defense lawyer, Florida defense attorney, experienced health lawyer Florida, experienced health attorney Florida, Florida defense lawyer, health facilities, Florida license defense, Florida Department of Health (DOH), DOH investigation, Agency for Health Care Administration (AHCA) investigation, AHCA complaint, administrative lawyer, administrative complaint, administrative hearings, administrative attorney

“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 © 2016 The Health Law Firm. All rights reserved.