Tag Archives: medical clinic

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.

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Beware of These Illegal Business Arrangements in Healthcare

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

Florida does not have a corporate practice of medicine prohibition like many other states do.  In other words, a physician is allowed to work as an employee or independent contractor of a corporation or other business entity owned by nonphysicians   However, there are a number of exceptions to this rule.

For dentists, optometrists and chiropractors there are specific statutory prohibitions on any member of that profession practicing his or her specialty while working for a group, practice or organization that is owned or controlled by one who is not a member of that profession.  These laws, a different one for each specialty, make it a felony to do so, as well as grounds for discipline against the professional’s license.  It is considered to be a separate felony offense for each day.

The main exceptions for these prohibitions include, for example, working for a hospital, working for a federal health care clinic, working for a not-for-profit charity health care clinic, and other limited exceptions.

There are All Treated the Same: Revoked License, Licensed in Another State But Not in Florida and Suspended License.

We have seen cases in which a dentist or chiropractor licensed in another state, but not in Florida, owned or operated a dental or chiropractic clinic in Florida.  This would be prohibited, of course.

In other cases, we have seen health professionals who have had their licenses revoked continue to own and operate or even “lease out” their practices to others.  The ownership or control of the practice by one with a revoked license would also be illegal.

We have seen cases in which a spouse or child of a deceased physician has continued to own and operate a clinic after the health professional died, when he or she was not a health professional.  This is illegal from the day the health professional died and there is no “grace period.”

In the Cases of Health Care Clinics and Pain Management Clinics…

In cases in which a member of the profession is allowed to work for a group, practice, clinic, corporation or other business entity that is not owned by health professionals, then that organization (again, with certain exceptions) is required to obtain a health care clinic license from the Agency for Health Care Administration (AHCA).  Professionals other than dentists, chiropractors and optometrists, could work, for example, for a corporation (corp.) or limited liability company (LLC) owned by an accountant and a businessman, as long as it had a valid health care clinic license.  Owning, operating or working for an unlicensed health care clinic which would be required by Florida law to be licensed, is a felony offense.

If you are a physician, nurse practitioner, other licensed health professional, you need to check the business’s licensure status with AHCA to make sure it is current and valid, before going to work there.

Additional situations include pain clinics and other types of health practices which constitute “risky” areas of practice.  If you are not aware of the almost daily occurrences of physicians getting busted, pharmacists getting arrested, and pharmacies and pain clinics being searched, closed and shuttered, you’re not reading the newspapers or watching TV.  Usually pain clinics are required to be licensed as health care clinics by AHCA and as pain medicine clinics by the Department of Health (DOH).  However, a regular medical practice is exempt from those requirements (with certain exceptions, of course).

We have encountered situations where a good physician is recruited into a very questionable practice setting by unscrupulous nonprofessionals who are merely using him or her.  Everything is placed in the physician’s name.  On paper it appears the physician is running a legitimate medical practice.  However, behind the scenes, the physician actually controls nothing.  It is clear that the whole setup is just a shell, a phony medical practice set up to skirt the law and avoid licensure.

We have seen medical practices and dental practices where a nonprofessional business person has control of all of the billings and collections, the employees, the bank accounts and all of the records.  The physician does not have control of anything, not even the practice’s bank account.  We have encountered several situations where the physician does not even have passwords to his/her own computers and software or keys to his/her own office.  We believe that such situations are sham operations set up to avoid statutory requirements.  A physician would be well warned to stay away from such situations.

Beware of Scams to Avoid the Law.

We have seen many cases where individuals, including lawyers and business people, have attempted to get creative to come up with schemes to try to get around the laws.  Often there may be a legal way to create an arrangement between licensed health professionals and unlicensed business people, to accomplish their goals, especially related to financial arrangements.

However, we have also seen many such schemes that were clearly illegal and meant to just put a facade on an obviously illegal arrangement.  When the criminal authorities start to investigate the behind-the-scenes people disappear, leaving the physician to pay the price. A physician or health care provider should have any such business arrangement reviewed in detail by a board certified health lawyer before he or she gets involved with it.  If you are thinking about investing in such a practice or arrangement, then we strongly recommend that you obtain an opinion letter from a board certified health lawyer as to the legality of the situation or arrangement.

Do Not Let Anyone Else Use Your Billing Number or Medicare Provider Number.

We have also been consulted on a number of occasions by physicians who were contacted by business people starting clinics allegedly seeking a “medical director” for their clinic, offering the physician a large amount of money without having to perform any real work.  However, they just need to use the physician’s Medicare number to bill with for a few months until their Medicare number is approved.  Such enterprises usually turn out to be Medicare billing fraud schemes.  The company uses the physician’s Medicare number to bill for hundreds or thousands of physician patient visits in patient’s homes, nursing homes or assisted living facilities (ALFs) that never occur.  When Medicare stops paying and starts investigating, the ones behind the scheme disappear and leave the physician holding the bag.

Avoid such schemes.  Avoid any situation where someone else “needs” to use your Medicare number for services that you are not actually performing yourself.  If the deal sounds too good to be true, it probably is.  You will wind up paying a heavy price later on if you fall for it,

There are Many Illegal Situations Which Carry Heavy Consequences.

Many of the above situations can result in criminal prosecutions.  In addition, these are also usually grounds for discipline on a health professional’s license.  In many cases, all fees collected while operating illegally must be refunded.  In the case where pain management is involved, the penalties are much higher than in other situations.  Where Medicare and Medicaid patients or billings may be involved, the risks of criminal prosecution and very large monetary penalties are much greater.

Contact a Health Care Attorney Experienced in Negotiating and Evaluating Physician and Health Professional’s Business Transactions.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider.

The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings.

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 about this blog? Please leave any thoughtful comments below.

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.

Kissimmee, Pine Hills Pain Clinics Investigated

Clinics in Kissimmee and Pine Hills are under investigation. A doctor involved with the clinics is accused of over-prescribing painkillers and other addictive medicine, according to the Orlando Sentinel.

Drug agents with the Metropolitan Bureau of Investigation collected evidence and talked to patients at the Miracle Health Center/Pine Hills Medical Center, and at the Keneday Medical Clinic.

This doctor has had previous complaints filed against him by The Department of Health (DOH), and he may now face an emergency suspension order (ESO).

Criminal charges have not yet been filed but are expected.

The doctor is under investigation for allegedly prescribing more than 800,000 oxycodone tablets to patients in the last two years.

According to DOH records, the doctor has previously been accused of improperly prescribing painkillers to patients, and the criminal investigation concerning his over-prescribing has been in the works for months.

This investigation and others across Florida are part of a statewide effort to curb Florida’s prescription drug problem. For more information about pain clinics and legal matters involving pain management, visit www.TheHealthLawFirm.com.