Tag Archives: health care fraud

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

Patricia's Photos 013By 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 been conducted by the RACs and CMS desired to start over with a clean slate. Just saying!

What Does Limited Basis Mean?

According to CMS, current RACs will conduct a limited number of automated reviews and a small number of complex reviews on certain claims including, but not limited to:

- Spinal fusions;
- Outpatient therapy services;
- Durable medical equipment;
- Prosthetics;
- Orthotics; and
- Supplies and cosmetic procedures.

RACs will not conduct any inpatient hospital patient status reviews for now. In the past, short inpatient stays accounted for 91 percent of the money the program recovered for Medicare.

Controversial Program.

According to an article on HealthData Management, in February 2014, members of congress argued that parts of the RAC program are unfair and violate the way that the Medicare program was intended to operate by raising out-of-pocket costs for beneficiaries. To address this concern, CMS established a provider relations coordinator to increase program transparency. This was announced in June 2014, so it is too soon to determine if this position will help providers affected by the medical review process. Click here to read more from HealthData Management.

Healthcare providers have complained that they are fed up with Medicare recovery audits tying up crucial funds and physician time in endless appeals. Currently, appeals can take up to five years. There is also a two-year moratorium in place preventing new appeals from being filed. You may remember my previous blog on the enormous backlog of Medicare recovery audit appeals. Click here to read that post.

What Exactly is a RAC?

RACs are often referred to as “bounty hunters.” They are private companies contracted by CMS, used to identify Medicare overpayments and underpayments, and return Medicare overpayments to the Medicare Trust Fund. Since the program began in 2009, it has brought in more than $8 billion in allegedly fraudulent, wasteful and abusive payments to healthcare providers.

How to Prepare for a Medicare Recovery Audit.

There is no such thing as a routine Medicare audit. The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited.

I previously wrote a blog highlighting some of the actions we recommend you take in responding to a Medicare audit. The most important step you should take is to consult an experienced health law attorney early in the audit process to assist in preparing the response. Click here to read more on how to respond to a Medicare audit.

We Told You RACs Would Be Back.

RACs apparently caught $3.7 billion in allegedly wasteful payments that Medicare made to healthcare providers in 2013, and was allegedly on pace to bring back $5 billion this year. That’s why the government was eager to get RACs back to work.

It is extremely common for state and federal regulators to enforce even the smallest violations, resulting in investigations, monetary fines and penalties. If found in violation, you will not only have to pay fines and face disciplinary action, you will also lose revenue because you will have to spend time dealing with the investigation, instead of practicing medicine. Whether you are trying to prevent Medicare and Medicaid audits, Zone Program Integrity Contractor (ZPIC) audits, or any other kind of healthcare audits, there are steps you can implement in your practice today that may save you down the line. Click here to read more on self audits.

Comments?

What do you think about the return of Medicare recovery audits? What are you thoughts on Recovery Audit Contractors? Please leave any thoughtful comments below.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at http://www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Demko, Paul. “Controversial Medicare Recovery Audits Make Limited Return.” Modern Healthcare. (August 5, 2014). From: http://www.modernhealthcare.com/article/20140805/NEWS/308059962/controversial-medicare-recovery-audits-make-limited-return

Goedert, Joseph. “CMS Restarts Parts of the RAC Program.” HealthData Management. (August 5,2014). From: http://www.healthdatamanagement.com/news/CMS-Restarts-Parts-of-the-RAC-Program-48553-1.html

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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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 © 1996-2014 The Health Law Firm. All rights reserved.

Duke University Health System Pays $1 Million to Settle Allegations of False Claims in Whistleblower Lawsuit

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 21, 2014, Duke University Health System in Raleigh, North Carolina, settled a whistleblower/qui tam lawsuit, according to the Department of Justice (DOJ). The lawsuit, filed in 2012, stated that the three-hospital academic medical center is alleged to have fraudulently inflated its Medicare bills by unbundling a number of cardiac services and billing for physician assistants’ (PAs) time illegally. Duke University Health System agreed to pay $1 million to resolve these allegations.

Click here to read the press release from the DOJ.

Duke University Health System Accused of Submitting False Claims to Federal Health Care Programs.

According to the complaint, the lawsuit was originally filed by a former health care bill coder and quality-control auditor for Duke’s revenue-cycle subsidiary, Duke Patient Revenue Management Organization. The former employee accused Duke University Health System of allegedly making false claims to Medicare, Medicaid and TRICARE by billing the government for services provided by PAs during coronary artery bypass surgeries when the PAs were acting as surgical assistants, which is not allowed. The whistleblower also alleged the medical center increased billing by unbundling claims when the unbundling was not appropriate. These unbundled claims were associated with cardiac and anesthesia services, according to the complaint.

To read the whistleblower’s complaint filed in December of 2012, click here.

According to the DOJ, the claims resolved by the settlement are allegations only, and there has been no determination of liability.

Whistleblowers Who Report Fraud and False Claims Against the Government Are Usually Employees.

Doctors, nurses or staff employees working for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. They are sometimes even asked to participate in it. In many cases the activity may amount to health care fraud.

It does not matter who you are. You may even be actively involved in the wrongdoing. This does not disqualify you from reporting the false claims activity or receiving a reward for doing so. In order to encourage employees with knowledge of fraudulent activity to come forward, the government will usually not seek to prosecute or punish that person in any way.

Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Of course, the larger the amount of money the government has been defrauded the more likely it will be that the government will be interested in pursuing the case and the larger the reward the whistleblower will receive if there is a recovery.

To read more on whistleblower cases, read my previous blogs. Click here for part one, and click here for part two.

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

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower 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.

Comments?

What do you think of this settlement? Do you think whistleblower lawsuits are becoming more common? Please leave any thoughtful comments below.

Sources:

Carlson, Joe. “Duke Pays $1 Million to Settle Whistle-Blower Case.” Modern Healthcare. (March 25, 2014). From: http://bit.ly/1g3W7yw

Department of Justice. “Duke University Health System, Inc. Agrees to Pay $1 Million For Alleged False Claims Submitted to Federal Health Care Programs.” Department of Justice. (March 21, 2014). From: http://www.justice.gov/usao/nce/press/2014/2014-mar-21.html

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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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 © 1996-2014 The Health Law Firm. All rights reserved.

Centers for Medicare and Medicaid Services Puts Recovery Audit Contractor Program on Hold

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 18, 2014, the Centers for Medicare and Medicaid Services (CMS) announced it is in the procurement process for the next round of Recovery Audit Program contracts. This means the program is, for the time being, on hold while CMS awards new contracts. According to CMS, it will select new vendors to continue the Recovery Audit Contractor (RAC) program, which is responsible for detecting improper Medicare payments. It is expected that this pause will also be used to refine and improve the RAC program. In the announcement it was not disclosed how long the program would be on hold.

Click here to read the announcement from CMS.

This news comes months after CMS revealed an enormous backlog of RAC appeals. The backup is so bad, providers are not able to submit new cases until the existing backlog clears, which could take two years or more.

Current Contracts Extended to Conclude Appeals.

According to Modern Healthcare, CMS extended its contracts with the four current vendors until December 31, 2015, for administrative and transition activities. These contracts were to end on February 7, 2014. The purpose of the extension is to allow the RACs to handle and wind down appeals. To read the entire article from Modern Healthcare, click here.

For providers this means a lull in additional documentation requests (ADRs), however it is important to remember RAC audits are not going away.

Dates to Remember.

Providers should note the important dates below:

- February 21, 2014, was the last day a Recovery Auditor could send a postpayment ADR;
- February 28, 2014, is the last day a Medicare Administrative Contractor (MAC) may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration; and
- June 1, 2014, is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment.

Backlog of RAC Appeals Worse Than Ever.

The RAC appeals process has become so overloaded that in December 2013, the U.S. Department of Health and Human Services’ (HHS) Office of Medicare Hearings and Appeals (OMHA) notified hospitals, doctors, nursing homes and other health care providers that the agency would be suspending acting on new requests for hearings. Health care providers were told they would not be able to submit any new appeals until the existing backlog clears, which could take two or more years. To read more on the backlog of RAC appeals, click here for my previous blog.

RAC Audits Will Be Back.

In the first three months of the fiscal year 2013, RACs recouped more than $2.2 billion from providers due to what the RACs deemed were overpayments. With money coming in, RAC audits are not going away. It has become common for state and federal regulators to enforce even the smallest violations, resulting in investigations, monetary fines and penalties. If found in violation, you will not only have to pay fines and face disciplinary action, you will also lose revenue because you will have to spend time dealing with the investigation, instead of practicing medicine. Whether you are trying to prevent Medicare and Medicaid audits, Zone Program Integrity Contractor (ZPIC) audits, or any other kind of healthcare audits, there are steps you can implement in your practice today that may save you down the line. Click here to read more on self audits.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think about the RAC program being put on hold? What do you think CMS should do to improve the program? Please leave any thoughtful comments below.

Sources:

Kutscher, Beth. “CMS Recovery Audits on Hold as Contractors Wrestle Big Backlog.” Modern Healthcare. (February 20, 2014). From: http://www.modernhealthcare.com/article/20140220/NEWS/302209968/cms-recovery-audits-on-hold-as-contractors-deal-with-big-backlog

Centers for Medicare and Medicaid Services. “Recent Updates.” Centers for Medicare and Medicaid Services. (February 18, 2014). From: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html

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.

 

“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 © 1996-2014 The Health Law Firm. All rights reserved.

Miami Medical Clinic Owner Pleads Guilty to $20 Million in Medicare Fraud

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The owner of a Miami-based medical clinic pleaded guilty on January 8, 2014, for her involvement in several health care fraud schemes that allegedly cost the Medicare program around $20 million. The schemes allegedly involved fraudulent billing for home health care services and therapy prescriptions to patients that may not have required them, according to the Associated Press. The owner operated Merfi Corp., a medical clinic that employed physicians, physician assistants and other medical professionals authorized to dispense prescriptions for home health care services.

Click here to read the Associated Press article.

The medical clinic owner faces up to 10 years in prison and is scheduled to be sentenced in March 2014.

Medicare Fraud Scheme Involved Kickbacks and Brides.

According to an article on Home Health Care News, through Merfi, the owner and her co-conspirators were allegedly given kickbacks and brides for providing fraudulent home health and therapy prescriptions and other medical documentation to owners and operators of other home health agencies and patient recruiters. The fraudulent documents were then used to bill Medicare.

To read the entire article from Home Health Care News, click here.

Case Investigated by Medicare Fraud Strike Task Force.

This case was investigated by the Medicare Fraud Strike Task Force. This task force has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion since the agency’s inception in March 2007. To learn more about the Medicare Fraud Strike Force’s anti-fraud efforts, click here to read a previous blog.

What You Need to Know about Medicare and Medicaid Audits.

I previously wrote a two-part blog on the increased number of Medicare and Medicaid audits being initiated against health professionals who treat home health care, assisted living facility (ALF) and skilled nursing facility (SNF) residents. This area of medical practice has been identified as one fraught with fraud and abuse. To learn more on the areas being targeted and how to respond to different types of audits click here for the first blog, and click here for the second.

Physicians, Nurse Practitioners and Physician Assistants Must Check Out Their Employers.

I have previously written blogs warning licensed health practitioners about illegal health care clinics. Often the individuals involved in fraudulent acts will use an unlicensed health clinic as a vehicle to process false claims. Licensed health professionals should jealously protect their Medicare and Medicaid provider numbers and make sure that they do not allow their name or numbers to be used in false billing activities. Check out any company or corporation that employs you to be sure it is properly licensed, as necessary. To read a previous blog I wrote on unlicensed health clinics, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Do you think similar schemes are fairly common? Do you think we will see more news stories like this with the increased anti-fraud efforts of the Medicare Fraud Strike Task Force? Please leave any thoughtful comments below.

Sources:

Associated Press. “South Florida Woman Guilty in $20M Medicare Fraud Scheme.” Miami Herald. (January 8, 2014.) From: http://www.miamiherald.com/2014/01/08/3858269/fla-woman-guilty-in-20m-medicare.html

Oliva, Jason. “Miami Clinic Owner Pleads Guilty to $20 Million Home Health Fraud.” Home Health Care News. (January 8, 2013). From: http://bit.ly/1h87Xv4

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Miami “Rock Doc” Arrested on Medicare Fraud Charges

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

An osteopathic physician in Miami, Florida, dubbed the “Rock Doc,” was arrested on September 30, 2013. He is charged with twelve (12) counts of health care fraud, according to the Department of Justice (DOJ). The “Rock Doc” is accused of falsely billing the Medicare program for physical therapy procedures, such as massages and electrical stimulation, which were not necessary. If convicted the doctor faces up to ten (10) years in prison and a $250,000 fine.

Click here to read the press release from the DOJ.

In 2010, this osteopathic physician was the feature of a Wall Street Journal article called “Confidentiality Cloaks Medicare Abuse.” The article looked into the billing practices of the “Rock Doc” and many other doctors performing physical therapy and reaping the reimbursements from Medicare.

The physician’s nickname, “Rock Doc,” stems from his appearance of spiked, punk-styled hair, along with accessories of chains, bangles and leather bracelets.

Indictment Accuses Doctor of Spending Reimbursements on Himself.

According to the indictment, the “Rock Doc” is accused of falsely and fraudulently representing that his physical therapy treatments and services were medically necessary and had been provided to Medicare beneficiaries between December 2007 and August 2009. The indictment also alleges that he used the Medicare payments on himself or others.

To read the indictment against the osteopathic “Rock Doc” physician, click here.

Medicare regulations require that physical therapists billing under a physician must have completed an accredited physical-therapy education program. However, in the Wall Street Journal article, the “Rock Doc” said that he trained his “office girls” to do the work because hiring a physical therapist was too expensive.

Wall Street Journal Article Highlighted Physician’s High Medicare Reimbursements.

According to the Wall Street Journal article released in 2010, the “Rock Doc” admitted to receiving more than $2.6 million from Medicare between 2007 and 2009. His gross payments were allegedly more than 24 times the Medicare income of the average family doctor.

In 2009, Medicare administrators caught onto the doctor’s billing activity and began scrutinizing his bills. That increased oversight led him to sell his business.

According to the Miami Herald, the doctor was currently working at a hospital in Larkin County, Florida, when he was arrested.

To read the Miami Herald article, click here.

Fraud Charges Must Be Taken Seriously.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. There are many times audit investigators must make a judgment on whether overcharges are simply an honest mistake or fraud. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Do you think that being the subject of the Wall Street Journal article back in 2010, the “Rock Doc” basically alerted the government to his fraudulent billing practices? Please leave any thoughtful comments below.

Sources:

Weaver, Jay. “Miami Beach’s ‘Rock Doc’ Busted on Medicare Fraud Charges.” Miami Herald. (September 30, 2013). From: http://www.miamiherald.com/2013/09/30/3660611/miami-beachs-rock-doc-busted-on.html

Department of Justice. “Miami Physician Indicted in Medicare Fraud Scheme.” Department of Justice. (September 30, 2013). From: http://www.justice.gov/usao/fls/PressReleases/130930-01.html

United States of America vs. Christopher Gregory Wayne. Case Number 13-206912. Indictment. (September 30, 2013). From: http://www.thehealthlawfirm.com/uploads/RockDoc.Indictment.pdf

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.

 

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Hawaii Hospital to Pay More Than $451,000 to Resolve Whistleblower/Qui Tam Allegation of Improper Claims

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Wahiawa General Hospital in Honolulu, Hawaii, agreed to pay $451,428 to settle two lawsuits alleging that the hospital improperly billed Medicare, Medicaid and Tricare. The settlement stemmed from a civil whistleblower/qui tam lawsuit. The lawsuit was filed by a doctor who allegedly worked at an outpatient clinic operated by Wahiawa General Hospital, according to the Department of Justice (DOJ). Wahiawa General Hospital signed the settlement agreement on August 29, 2013.

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

Whistleblower Receives Money in Settlement and Attorneys’ Fees Paid by Hospital.

According to the DOJ, the federal and state governments alleged that Wahiawa General Hospital wrongfully submitted claims to Medicare, Medicaid and Tricare from April 2008 through March 2011. The investigation was initiated after a doctor alleged the hospital submitted bills for services provided by resident doctors without the level of supervision required by law.

On top of the more than $451,000 settlement, Wahiawa General Hospital agreed to pay $75,000 in attorneys’ fees and costs to the attorneys who represented the doctor. The doctor will also receive more than $84,600 as part of the settlement, under the False Claims Act. To learn more on whistleblower/qui tam cases, read our two-part blog. Click here for part one, and click here for part two.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of whistleblower/qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

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

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower 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.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Associated Press. “Wahiawa General Hospital to Pay $450K Settlement.” Star Advertiser. (August 30, 2013). From: http://www.staradvertiser.com/news/breaking/221856781.html

Department of Justice. “Community Hospital Pays $451,428 to Resolve Allegation of Improper Claims.” Department of Justice. (August 30, 2013). From: http://www.justice.gov/usao/hi/news/1308wgh.html

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Central Florida Pain Management Clinic Falls Victim to Civil Forfeiture

DPP_12By Christopher E. Brown, J.D., The Health Law Firm

On June 14, 2013, Drug Enforcement Administration (DEA) agents, along with local police and sheriffs’ deputies raided a Longwood, Florida, pain management clinic. In addition to criminal charges, the physicians and employees associated with this clinic face another lesser known threat,  the civil forfeiture of their money and property. During the raid agents took everything from the clinic that could help them build a criminal prosecution. This included paper records, computer equipment and prescription drugs. In addition to the Longwood pain management clinic, DEA agents also searched homes in Brevard County, Florida, where associates of the Longwood clinic allegedly live. To read more on the raid, click here.

This is just one example. Recently we’ve noticed that it is becoming more common for government prosecutors and agencies, including the Medicaid Fraud Control Unit (MFCU), the U.S. Attorney’s Office, and local sheriff and police departments to use the Florida Contraband Forfeiture Act against health professionals and health facilities in health-related cases.

The Difference Between Criminal and Civil Forfeiture Laws.

There are two types of forfeiture laws, criminal and civil.  Criminal forfeiture laws allow the seizure of property only after a conviction beyond a reasonable doubt. On the other hand, civil forfeiture laws allow the government to gain possession of a person’s property immediately and without any determination of guilt.

Property is Subject to Forfeiture if Criminally Derived.

Under the idea that the property is itself guilty by association, federal and local law enforcement authorities may take your property without convicting or arresting you, putting the burden on you to prove that property was not associated with a criminal enterprise.  The property seized does not have to belong to the alleged bad actor or criminal.  This can occur because civil forfeiture is a civil lawsuit against property. The legal action has less to do with a person’s guilt and more to do with the property’s use as an instrumentality in a crime.  If the property has been used in association with or to aid criminal acts, the property is subject to civil forfeiture proceedings.

This is what the physicians and employees of the Longwood clinic are now facing.  While these individuals’ homes and property may not be directly associated with criminal activity, the government is still arguing that the property is subject to forfeiture because the money used to buy it was “criminally derived.”

Fighting Civil Forfeiture.

We believe the main purpose in the government’s use of civil forfeitures is to shut down the alleged criminal and make it so he or she cannot hire an attorney to defend the person(s) accused. This does, unfortunately, often work. However, a prompt, aggressive defense to these actions may recover the property or funds seized and, more importantly, a good defense can be used to help resolve any pending criminal charges.

The key to success in civil forfeiture actions is to immediately consult with an experienced attorney after the property has been seized.  Your best defense is to act as quickly as possible. To read more what defenses can be used to fight civil forfeiture, click here for a previous blog.

Contact Health Law Attorneys Experienced in Civil Forfeiture Cases.

The Health Law Firm routinely represents physicians, nurses, pharmacists, dentists, mental health counselors and other health providers in investigations, regulatory matters, licensing issues, litigation, civil forfeitures, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), 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 www.TheHealthLawFirm.com.

Comments?

What do you think of the Civil Forfeiture Act being used against health care professionals and health facilities? Please leave any thoughtful comments below.

About the Author: Christopher E. Brown, J.D., 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 Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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.
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