Florida Federal Judge Clarifies Earlier Order Dismissing $320 Million Qui Tam/False Claims Act Suit

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

U.S. District Judge James S. Moody Jr. dismissed whistle blower Nancy Chase’s lawsuit against LifePath Hospice, Inc., and Good Shepherd Hospice, Inc., on September 22, 2016.  He found that Chase did not sufficiently plead fraud in her suit and called it“clearly frivolous,” dismissing it with prejudice.  The federal government and the state (Florida) had declined to intervene in Ms. Chase’s case.  However, now the federal government has now requested that Judge Moody to clarify his decision to state that the original dismissal was “without prejudice” to the U.S. to bring its own False Claims Act (FCA) case at a later date.

The judge clarified that his earlier dismissal of the whistle blower’s $320 million qui tam (or FCA) suit against the hospice care provider did not affect the government’s ability to file its own lawsuit.  This decision was entered on October 21, 2016.

Judge Granted the Government’s Request.

To see a copy of Judge Moody’s brief decision granting the government’s request, click here. In circumstances such as this, the government had argued, and Judge Moody agreed, the more appropriate decision would have been a dismissal without prejudice against the government. Regardless, Ms Chase’s case remained closed and permanently dismissed.

“That dismissal should not serve as precluding the United States from, at some point in the future, pursuing a claim against defendants for violations of the False Claims Act,” Judge Moody said. “This is because the dismissal against Chase was based on her failure to plead her claim with particularity and because the United States took no part in drafting the complaint.”

Chase’s Sealed Complaint.

Nancy Chase, a social worker who was employed at LifePath from 1992 through December 2012, filed her complaint under seal in 2010. She accused the hospice groups of conspiring with several doctors and assisted living facilities, in exchange for kickbacks. The alleged scheme involved certifying that patients had terminal conditions so they would qualify for hospice care; to bill health care programs for more expensive treatments than were actually necessary; and to establish a way to ensure patients could be recertified.

One complaint alleged more than $4.5 billion in false claims, but that number dropped to $20 million annually over a 16-year period, totaling $320 million in a subsequent complaint.

Judge Moody found that Chase had fallen “well short” of meeting pleading requirements regarding the alleged FCA violations. To read more on Nancy Chase’s suit, click here.

Click here to read one of my prior blogs on an alleged FCA Suit.

Contact Health Law Attorneys Experienced with Qui Tam, Whistleblower Cases and False Claims Act Violations.

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.

Source:

Kennedy, John. “US Given Chance to Refile $320M FCA Suit.” Law360. (October 21, 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 attorney, False Claims Act (FCA) defense attoreny, Anti-Kickback Statute attorney, legal representation for False Claims Act violation, legal representation for Anti-Kickback Statute, fraudulent practices of hospice care provider, whistleblower lawyer, FCA violations defense lawyer, financial interest in physician referrals, health law attorney, defense attorney, The Health Law Firm, health law firm, fraud investigations, qui tam attorney, AKS defense lawyer, Department of Justice defense attorney, DOJ settlement lawyer, illegal remunerations, federal health care programs, reviews of The Health Law Firm, The Health Law Firm attorney reviews, health care fraud scheme, The Health Law Firm

“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.

Community Health Exploring Options Including the Possible Sale of Its Business

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

On September 16, 2016, Community Health System Inc. (CHS), one of the largest U.S. hospital chains, announced that it is exploring the possibility of a deal to sell the company. The struggling Tennessee-based company announced “very preliminary” discussions with advisers to consider all of its options.

A Tough Sell.

Since its acquisition of 71 hospitals from Florida-based Health Management Associates Inc. (HMA) in 2014, CHS has struggled. Executives have said that the turn around of former HMA hospitals has been difficult. In August 2016, CHS posted a second-quarter net loss of $1.43 billion (that’s billion with a “B”) after writing down the value of its hospital assets. The company said at the time that it had overestimated the long-term fair value of its hospitals.

Community Health’s shares reportedly plunged 75% in the past 12 months; however, they rose 16% after the news of a possible sale.

Who Will Want to Buy It?

The high level of debt, combined with a slew of operational issues facing the company, could limit the number of potential buyers. The two other biggest hospital chains, HCA Holdings Inc. and Tenet Healthcare Corp., may view CHS’s debt load as too much of an obstacle. Sheryl Skolnick, an analyst with Mizuho Securities, said “Tenet would have to use stock (and put its stock at risk) and we doubt that its new board would risk the new strategy for such a disruptive transaction,” Skolnick said in a note to clients. “We don’t think it gets sold in whole, but it might get sold in part.”

CHS said in a news release that it had no timetable for its talks with advisors. It also added that it had “no certainty that the exploration will result in any kind of transaction.”

To read the press release from CHS in full, click here.

To read one of my prior blogs on how the merging and acquisition of hospital companies affects the health care industry, click here.

Contact Health Law Attorneys Experienced in Business Transactions and Contracts.

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, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, 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.

Sources:

Evans, Melanie. “Hospital Operator Explores A Deal.” The Wall Street Journal. (September 16, 2016). Print.

Hammond, Ed. “Community Health Said to Explore Options Including Sale.” Bloomberg. (September 16, 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: Hospital acquisitions and mergers, legal representation for reviewing and negotiating healthcare contracts, medical business transaction attorneys, legal representation for individual and facility contracts, legal representation for facilities and institutions in contracts, attorneys for sale and merger of medical practices, attorneys for sale and merger of healthcare facilities, legal review of health facility contracts, contract review attorney, business transaction attorney, review of The Health Law Firm attorneys, The Health Law Firm reviews, The Health Law Firm, legal opinion letter for complex business transactions, legal opinions on healthcare transactions, legal opinions on healthcare purchases and transactions, The Health Law Firm, health law transactional attorneys

“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.

 

CMS’s Pre-Claim Review Project for Home Health Agencies Delayed Indefinitely For Florida

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

The Centers for Medicare & Medicaid Services (CMS) is implementing a three-year Medicare Pre-Claim Review Demonstration for Home Health Services in the states of Illinois, Florida, and Texas Michigan and Massachusetts.

The CMS Pre-Claim Review Demonstration officially began in Illinois on August 3, 2016, however, early information received from Illinois, has caused a change of plans. CMS now believes that additional education efforts will be beneficial before expansion of the demonstration to other states. Therefore, on September 20, 2016, CMS announced it will not move forward with initiating the demonstration in Florida in October of 2016, as originally planned.

Indefinite Delay.

CMS views these additional educational efforts as crucial to the long-term success of the demonstration for beneficiaries, providers, and the Medicare program. CMS will therefore, take additional time prior to expanding to other states. The start dates for Florida, Texas, Michigan, and Massachusetts have not been announced; however, CMS stated that it will provide at least 30 days’ notice on its website prior to beginning in any state. CMS continues to expect a scattered start, beginning with Florida.

To visit the CMS website to learn more or to stay up to date, click 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 www.TheHealthLawFirm.com.

Source:

“Pre-Claim Review Demonstration for Home Health Services.” CMS.gov. (September 20, 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: Centers for Medicare and Medicaid Services (CMS) Pre-Claim Review Demonstration for Home Health Services, delayed expansion on the pre-claim review demonstration, three-year Medicare pre-claim demonstration, Medicare and Medicaid defense lawyer, Medicare audit defense attorney, False Claims Act defense lawyer, Medicare fraud defense attorney, legal representation for Home Health Agencies (HHAs), HHA defense lawyer, health care defense attorney, reviews for The Health Law Firm, reviews of The Health Law Firm attorneys, The Health Law Firm

“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.

 

New Florida Rules Shorten Required Hours For Community Pharmacies and Change Start of Business Requirements

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

The Florida Board of Pharmacy (BOP) amended its rules regarding community pharmacies following a request for relief by industry health care professionals. The amended rules include shortening community pharmacy hours of operation from 40 to 20 hours per week, pharmacy delays to open business after the receipt of a permit and changes regarding ownership. Rules promulgated by The Florida BOP are published in the Florida Administrative Code (FAC).

Community Pharmacies May Delay Opening After Application is Approved.

The rule changes allow community pharmacies to delay the opening of business after receipt of the pharmacy permit. The BOP acknowledged that a delay may exist between the time a pharmacy receives a permit and when the pharmacy commences operations. For example, the delay in receiving the Drug Enforcement Administration (DEA) registration would make it difficult to structure an asset purchase. Ordinarily the pharmacy would have to obtain a new pharmacy permit and then obtain its DEA registration in an asset purchase transaction. Once the pharmacy permit has been received under prior rules, the pharmacy had to start operations (then 40 hours a week), but could not dispense controlled substances or obtain insurance contracts without the DEA registration.

Under the new rules, the BOP must be given notice (within 15 days) if the pharmacy is delaying its opening and give its reason. When it does open for business, the Board must be notified within two days. If the permittee delays commencement of operations, it must:

Display a sign in block letters not less than one inch in height at the main entrance of the establishment stating that the pharmacy is not yet open for business and that medicinal drugs may not be dispensed or sold nor prescriptions filled or dispensed; and

Within two business days of commencement of operations the permittee must notify the Board in writing that the permittee has commenced to operate and the date of such commencement.

Additionally, it is important to know that any pharmacy which does not commence operations within six months of the date of receipt of its permit, must provide a written statement to the Board that includes the reason(s) that the pharmacy has failed to commence operations, the efforts the pharmacy has made to commence to operate, the exact date the pharmacy expects to commence operations.

Changes in Ownership.

The BOP also amended the rules regarding changes of ownership and clarified that transfers of ownership in business entities (i.e., a corporation, limited liability company, limited partnership, etc.) holding pharmacy permits do not constitute “changes of ownership” when such entity continues to hold the permit without change in identity (purchase of stock or membership interests for example). Upon the transfer of ownership interests in the business entity, the following steps must also be taken:

Within fifteen days of closing the transfer, the permittee must notify the BOP of the transfer of ownership; and

All persons, members, partners, officers, directors, and agents having an ownership or other financial interest of greater than five percent and all persons who directly or indirectly manage, oversee, or control the operation of the business entity must file their fingerprints with the BOP.

The rule amendments, especially the reduction in community pharmacy operating hours from 40 per week to 20 per week, may give pharmacies the leeway for new opportunities and to try new business ventures, without incurring the expense of having to pay a full-time pharmacist.

Whether opening a new establishment, changing locations or changing owners, it is important to be aware of the licensing requirements and rules, process, fees and statutes.

A pharmacy permit is required prior to operating in the State of Florida. To learn about the changes and important information on obtaining a community pharmacy permit, click here to visit the Florida Board of Pharmacy.

To learn more on how we can help you or your practice if such a situation arises, click here to read one of my prior blogs.

Consult With A Health Law Attorney Experienced in the Representation of Pharmacists and Pharmacies.

We routinely provide deposition coverage to pharmacists, pharmacies and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing physicians, physician assistants and other health professionals in investigations and at Board of Pharmacy hearings. Call now or visit our website www.TheHealthLawFirm.com.

Source:

Akerman LLP. “The Board of Pharmacy’s 40 Hour Rule is Dead! Long live the 20 Hour Rule! Community Pharmacy Ownership Rule Change Creates new Opportunities.” Lexology. (August 30, 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: The Florida Board of Pharmacy (BOP) attorneys, pharmacy hours of operation, reduced daily operating hours for pharmacies, community pharmacies may delay opening of business after receipt of permit, Drug Enforcement Administration (DEA) registration lawyers, community pharmacy permit, legal representation of pharmacies and pharmacists, pharmacy and pharmacist defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm attorneys, The Health Law Firm, pharmacy law attorney, change in ownership application

“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.