Tag Archives: pharmacist defense

Florida Pharmacy Owner Accused of Medicare Fraud

00011_RT8By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Drug Enforcement Administration (DEA) agents removed boxes of documents and computers from the pharmacy, according to Naples News. The pharmacy owner and his mother are allegedly being investigated by the U.S. Office of Inspector General (OIG) of the Department of Health and Human Services (HHS).

Click here to read the entire Naples News article.

Pharmacy Owner and Mother Allegedly Submitted False Claims to Medicare, Medicaid and Tricare.

According to NBC2, a South Florida television station, the pharmacy owner and his mother were both allegedly part of a scheme that defrauded Medicare. The family allegedly submitted claims to Medicare Part D after beneficiaries had died. This information came from a letter sent to Medicare Part D providers from the Centers for Medicare and Medicaid Services (CMS) on October 17, 2012. The letter was obtained by NBC2. The scheme allegedly also involved submitting false claims to Medicaid and Tricare.

Click here to watch the NBC2 news story.

Investigation is Ongoing.

The pharmacy that was raided is part of a chain of stores owned by the same family. So far, only the pharmacy located on Rattlesnake-Hammock Road in Naples is being investigated. That location is reportedly still closed, but the other pharmacy locations are open.

Neither the DEA nor the OIG of the HHS has released a press release on this investigation.

As in all media reports, please remember that all persons are presumed to be innocent until proven guilty in a court of law.

Pharmacies Are Being Raided and Shutdown  All Over the State.

If  you have watched the news at all lately or have been reading our blog, you can tell there have been an increased number of raids on pharmacies, arrests of pharmacists and emergency suspension orders issued from the Department of Health (DOH).

Recently, the DEA served a Walgreens distribution center in Florida with an immediate suspension order (click here to read more on this story), and pulled the controlled substance licenses from two Central Florida CVS Pharmacies (to learn more, click here).

In my personal opinion, the recent raids and investigations at pharmacies are especially hard on the independent operators. If the large retail giants can’t survive, the small independent pharmacies stand little chance.

Talk with an Experienced Health Law Attorney About Medicare, Medicaid and Tricare 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.

What Do You Think?

As a pharmacy owner, pharmacy employee or health care facility owner, what do you think of the increased effort to find fraud? Do you think all facilities, not just pharmacies, are under the microscope? Please leave any thoughtful comments below.

Sources:

Freeman, Liz. “Sunshine Pharmacy in East Naples Remains Close, Day After Federal Raid.” Naples News. (January 19, 2013). From: http://www.naplesnews.com/news/2013/jan/19/sunshine-pharmacy-east-remains-closed-raid-federal/

Ritter, Rick. “Naples Pharmacy Busted for Medicare Fraud.” NBC2. (January 20, 2013). From: http://www.nbc-2.com/story/20627104/detectives-investigating-medicare-fraud-at-naples-pharmacy

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.

New System for Patients to Report Medical Mistakes in the Works

By Danielle M. Murray, J.D.

According to the New York Times, the government wants to implement a new system that would allow patients to report medical mistakes and unsafe practices by health care providers to a central reporting organization. This includes doctors, hospitals, pharmacists, and all other professionals or entities that provide medical treatment. While it is only an idea at this point, the government envisions patients reporting problems through a website or a phone number by answering a short questionnaire.

Federal officials believe that medical mistakes frequently go unreported and patients could have useful information that could be used to identify health care providers and facilities where errors are made.

A Tool to Help Doctors and Hospitals Learn from Mistakes.

Hospitals and some doctors like the idea. They argue that it would allow them to better understand the prevalence and characteristics of medical errors and learn how to better prevent those errors.

However, some suggest that these reports need to be matched with a patient’s medical records and taken with a grain of salt. Health care providers believe patients may perceive something as an adverse event that is actually not a problem or is common with the procedure they received. The example used in the New York Times article is that a patient with a hip replacement surgery may report a dislocated hip when the patient hears or feels a popping sensation, but this is a normal sensation after this type of procedure.

System Will Monitor Quality.

Health care providers are already under scrutiny by the government through Medicare and Medicaid. This would be another tool used to monitor doctors’ ability to give care. It’s great for patients, but what will the effect be on providers? It’s too soon to say. The American Medical Association did not comment for the New York Times article, stating that it needed to study the details.

To read the New York Times article, click here.

Comments?

As a provider, do you agree with this proposed system? Leave a comment below.

How Patient Complaints Can Impact Your License.

As many health professionals are aware, patient complaints are a frequent cause of problems for your license. When a patient complains to the Department of Health (DOH), the DOH will hold a hearing, called a probable cause panel, to determine, based on the complaint, if there is enough information to proceed against your license. If there is, the DOH will file an administrative complaint against your license, and ask you to voluntarily relinquish your license.

When you receive the first correspondence from the DOH that there is a pending investigation, do not sit idly. Call an experienced health law attorney, such as those available at The Health Law Firm, to evaluate your case and let you know what your options are. Do not speak with any investigator or DOH representative, and do not voluntarily relinquish your license. Your career and livelihood are at stake.

For a list of the 25 biggest mistakes health professionals make when notified of a DOH investigation, click here.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH Cases.

The Health Law Firm 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.

If you are aware of an investigation of you or your practice, or if you have been contacted by DOH, contact an experienced health law attorney immediately.

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

Source:

Pear, Robert, “New System for Patients to Report Medical Mistakes.” The New York Times, (September 22, 2012). From: ttp://www.nytimes.com/2012/09/23/health/new-system-for-patients-to-report-medical-mistakes.html?emc=tnt&tntemail0=y&_r=1

 

About the Author: Danielle M. Murray 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

“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.