Health Care Fraud Puts Miami Man in Jail

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

4.5 Year Sentence for Role in Fraud.

A Miami Man voluntarily returned to Miami from Cuba and was immediately met with a 4.5-year long prison sentence.  Jose Gerardo Gonzalez, played a role in a scheme to defraud public schools and private health care insurers of $126 million.

Gonzalez allegedly created shell companies that submitted false health care claims. The private insurers were ultimately at lose for millions of dollars. Gonzalez fled to Cuba in 2015 after being charged with conspiracy and other charges. Upon voluntary return to Florida he is sentencing was reduced.
William Barzee, Gonzalez’s attorney, states its uncommon for fugitives to return once they flee to Cuba.  However, our experience has been just the opposite.  In our experience, quite a few individuals flee to Cuba, which has no extradition treaty with the U.S., after being notified of an investigation of Medicaid or Medicare fraud charges.

The Restitution.

The sentence included 4.5 years in prison and restitution of $13.9 million.  In addition, two properties owned by Gonzalez worth several hundreds of thousands of dollars were been seized.

Conspiracy lead remains in Cuba.

Reynaldo Castillo is considered the conspiracy’s leader “employing” several people. Gonzalez played a role in a scheme to target employers offering “administrative services only” insurance plans to their employees. Gonzalez, along with several other individuals, registered businesses in his or her name and opened bank accounts and cashed checks bilking insurers. Insurers that sustained losses include Cigna, Blue Cross Blue Shield, and United Healthcare.  Gonzalez and 15 other Miami residents were charged. But Reynaldo Castillo is still believed to be in Cuba, avoiding sentencing.

The conspirators submitted false claims to the insurers using medical director staffing companies to misappropriate doctors licensing information.  This is something we are constantly warning physicians against, allowing someone else to use and bill under their name and provider identification numbers.

Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses.  In many cases, those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter.  Individuals facing Medicare and Medicaid criminal charges should realize the severity of the offense.  Some may even decide not to spend the money required for a highly experienced health attorney as part of the legal team to help defend them.
The government is serious about combating health care fraud.  False claims are a growing problem in the program, costing the government billions of dollars each year.  Punishments for defrauding the system can be quite severe.

If you are accused of Medicaid or Medicare fraud, realize that you are in a fight for your life.  Your liberty, property/possessions and profession are all at stake.  Often a Medicaid Fraud investigation will begin with a notification from the investigator. From that point on, all action to obtain legal representation should be made. The investigator will use all information from that point on against you. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

To read further about the seriousness of health care fraud you can read additional blogs of mine here.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Sources:

Crosby, Christopher. “Miami Man In $126M Health Fraud Ring Gets 4.5 Years – Law360.”Law360 – The Newswire for Business Lawyers. LexisNexis, 13 June 2017. Web. 03 July 2017.

Keywords: Medicare Fraud, Medicaid Fraud, legal representation for fraud, False claims, legal representation, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense 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 © 2017 The Health Law Firm. All rights reserved.

 

 

 

 

Advertisements

Jury Awards $4.4 Million To Chicago Anesthesiologist Defrauded By Business Associate

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

On June 9, 2017, a jury in Illinois awarded a Chicago-area anesthesiologist nearly $4.4 million. The jury unanimously agreed that his business associate defrauded him on a revenue sharing agreement and fraudulently reported his earnings to the Internal Revenue Service (IRS).

The jury found that Dr. Martin R. Hall, owner of Keystone Orthopedic Specialists SC (Keystone), stuck Dr. Nicholas Angelopoulos with unwarranted expenses throughout the course of their business dealings. The jury ultimately agreed in favor of Dr. Angelopoulos on all five counts, including two breach of contract counts, breach of fiduciary duty, fraud and violation of IRS code.

 

A Sour Business Deal.

According to Dr. Angelopoulos, when he began to question Dr. Hall’s business expenditures, Dr. Hall would not provide sufficient documentation for the purchases. Dr. Angelopoulos also claimed he was not receiving credit for all of his billings. Additionally, over the course of their three-year working relationship, Dr. Angelopoulos claimed that Dr. Hall made payments to his family members, including his wife and his sister, without disclosing it to the other business associates.

In 2008 after Dr. Angelopoulos left Keystone, Dr. Hall came to him with a hand-written tabulation of more than $150,000 Dr. Angelopoulos allegedly owed to Keystone. Dr. Angelopoulos rejected the amount saying it was false.

Fraudulent Reports to the IRS.

In response to the rejection, Dr. Hall then allegedly reported a payment of $159,577.45 to Dr. Angelopoulos in tax documents filed with the IRS. Dr. Hall claimed that it was for the alleged outstanding debt plus an alleged bonus, which Dr. Angelopoulos claimed he never received, according to court documents. Because of this, in 2011 the IRS came after Dr. Angelopoulos for taxes on Dr. Hall’s reported payment, settling the taxable amount at about $120,000.

In the end, jurors agreed with Dr. Angelopoulos that these numbers were inaccurately reported by Dr. Hill in the first place. Additionally, the jury rejected Dr. Hall’s counterclaim arguing that Dr. Angelopoulos still owed him the money.

To view the court document’s in this case, click here.

To read an article I wrote on how to prevent employee embezzlement which was featured in Medical Economics, click here.

To learn more about complex business litigation and examples of how The Health Law Firm can help you, click here.

 

Contact Health Law Attorneys Experienced in Business Transactions and Contracts.

At the Health Law Firm we provide legal services for physicians, dentists, and the owners of medical practices. We represent owners, shareholders and employees in shareholder disputes, contract litigation, complex healthcare transactions and complex business litigation. This includes 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 also represent health facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The services we provide include disputes with health insurers, defense of audits, litigation of overpayment demands, 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. Our attorneys litigate in state courts, federal courts, state administrative hearings and federal administrative hearings. We represent plaintiffs and defendants in complex litigation matters.

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

Source:

Simpson, Dave. “Jury Awards $4.4M To Doc Defrauded By Associate.” Law360. (June 7, 2017). 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 attorney, medical practice shareholder dispute lawyer, partnership break-up attorney, health law defense attorney, complex business litigation attorney, legal representation for contract negotiations, legal representation for health mergers and acquisitions, DOJ Antitrust Division lawyer, legal representation for complex business litigation, legal representation for contract disputes, legal representation for complex health care litigation, health care litigation attorney, complex litigation lawyer, medical practice ownership litigation, medical clinic employemnt dispute lawyer, legal counsel for health care business transactions, legal representation for health care contracts, contract negotiations lawyer, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“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 © 2017 The Health Law Firm. All rights reserved.

What You Need to Know About Preparing and Responding to an Initial Medicaid Audit Request

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

Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities.

The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicaid program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities.

Facts You Should Know About the Medicaid Audit Process.

Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. The most important thing to remember is that just because you are being audited, it does not mean that you or your business have done anything wrong. State and federal governments conduct audits for several different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing and complaints of possible fraud.

If You Are the Subject of an Audit.

A Medicaid audit will usually begin with the provider receiving an initial audit request, usually by letter or fax. This request will serve to notify the recipient that it is the subject of an audit. The initial letter will not always identify the reason for the audit. It will, however, contain a list of names and dates of service for which the auditors want to see copies of medical records and other documentation.

Once the records are compiled and sent to the auditor, the process shifts and you are now going to have to dispute the auditor’s findings in order to avoid overpayment.

The biggest mistake that someone who is the subject of an audit can make is to hastily copy only a portion of the available records and send them off for review. The temptation is to think that because the records make sense to you, they will make sense to the auditor. Remember, the auditor has never worked in your office and has no idea how the records are compiled and organized. This is why it is so important to compile a thorough set of records. The records should be presented in a clearly labeled and organized fashion that provide justification for every service or item billed.

Compiling a Response to an Initial Audit Request.

The following are steps that you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process:

1. Read the audit letter carefully and provide everything that it asks for. It’s always better to send too much documentation than too little.

2. If at all possible, compile the records yourself. If you can’t do this, have a compliance officer, experienced consultant, or experienced health attorney compile the records and handle any follow-up requests.

3. Pay attention to the deadlines. If a deadline is approaching and the records are not going to be ready, contact the auditor and request an extension before it is due. Do this by telephone and follow up with a letter (not an email). Send the letter before the deadline.

4. Send a cover letter with the requested documents and records explaining what is included and how it is organized as well as who to contact if the auditors have any questions.

5. Number every page of the records sent from the first page to the last page of documents.

6. Make a copy of everything you send exactly as it is sent. This way there are no valid questions later on as to whether a particular document was forwarded to the auditors.

7. Send the response package using some form of package tracking or delivery confirmation to arrive before the deadline.

Compiling all of the necessary documentation in a useful manner can be an arduous task. If you find that you cannot do it on your own, or that there are serious deficiencies in record keeping, it is recommended that you reach out to an attorney with experience in Medicaid auditing to assist you in the process.

To learn how The Health Law Firm can assist you with a Medicaid audit, click here.

If you have been accused of Medicaid fraud and need to prepare for an audit, click here to watch our informational video blog.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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: 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: Medicaid fraud defense attorney, Medicaid audit defense attorney, legal representation for false billing, legal representation for Medicaid overpayment, legal representation for Medicaid audit, legal representation for Medicaid investigation, health care fraud defense attorney, Medicaid fraud attorney, Centers for Medicare & Medicaid Services (CMS) , legal representation for allegations of overbilling, audit defense attorney, ZPIC audit defense attorney, legal counsel for responding to Medicaid audits, legal representation for Medicaid fraud allegations, legal counsel for Medicaid audits, 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 © 2017 The Health Law Firm. All rights reserved.

Rutgers University Faces Lawsuit Over Anesthesia Residency Program Head’s Alleged Sexual Harassment

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 May 8, 2017, Rutgers University was hit with a lawsuit in New Jersey state court from former and current school employees. The suit alleges that the university failed to prevent, stop and remedy sexual harassment and retaliation by the director of its anesthesia residency program. Additionally, the suit also alleges that Rutgers “fostered a harassing and discriminatory atmosphere.”

What must be remembered is that residents, interns and fellows fill dual roles. They are employees as well as “students”or graduate medical education (GME) program participants. Therefore, they have the same rights as any other hospital or institution employee.

According to the plaintiffs, they reported their claims to the university in August 2016 and provided ample evidence. Rutgers then followed with an internal probe and issued reports that the allegations were erroneously found. In the report, Rutgers stated that Dr. Jean Daniel Eloy had not violated either the state’s law against discrimination or the university’s policies on sexual harassment.

The Alleged Misconduct.

The lawsuit was filed on behalf of current Rutgers University employee Melinda Ball and former employees Rebecca Scholl and Sam Nia. The alleged misconduct occurred when all three plaintiffs were residents in the program that was overseen by Dr. Eloy.

Melinda Ball and Rebecca Scholl claim Dr. Eloy repeatedly sexually harassed them, and retaliated against them because they snubbed his sexual advances, according to the complaint. Dr. Eloy allegedly retaliated against Scholl in various ways, including falsely stating in her semi-annual review that she was “disrespectful, lazy and unprofessional,” the complaint states. Dr. Eloy also allegedly retaliated against Sam Nia, because she attempted to protect Scholl from the sexual harassment and retaliation.

Ball, Scholl and Nia have accused Rutgers of “failing to conduct an adequate investigation into plaintiffs’ complaints of discrimination, harassment and retaliation; and failing to take appropriate disciplinary action against defendant’s supervisors, managers, agents and employees who discriminated and retaliated against plaintiffs and created a hostile work environment for them,” the complaint states.

To read the complaint filed April 27 in Essex County Superior Court in full, click here.

To read a blog on a similar case of harassment, click here.

Discrimination in Gme Programs More Common than You Think.

Unfortunately, from what our clients have told us, discrimination in different forms is not uncommon in many graduate medical education programs. Although it may be sexually based, as in this case, it may also be based upon an illness or medical condition, sexual persuasion race or national origin. It is illegal to discriminate based on these grounds or even the perception of these grounds when they do not actually exist and most institutions have written policies and standards that prohibit it. Discrimination and harassment can make a residency or other learning experience intolerable and lead to poor performance and failure.

Students, residents, interns and fellows may be reluctant to report incidents of discrimination or harassment because of fears of reprisal. However, you should always report it. You are doing no favors to your self, your peers or the program itself when you fail to report it.

Contact Experienced Health Law Attorneys Representing Medical Students, Residents and Fellows.

The Health Law Firm routinely represents medical students, residents and fellows who run into difficulties and have disputes with their medical schools or programs. We also represent 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.

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: Legal representation for medical students, legal representation for residents, legal representation for fellows, legal representation for disputes with medical programs and institutions, legal representation for discrimination, bullying and sexual harassment in the workplace attorneys, intentional infliction of emotional distress lawyers, academic review hearing, legal representation for physicians accused of wrongdoing, medical graduate defense attorney, defense lawyer for doctors, legal representation fro physicians, residents and intern legal representation, medical student attorney, medical resident lawyer, medical intern lawyer, civil proceeding, criminal proceeding, administrative proceeding, medical administrative hearings, administrative law, medical student legal defense counsel, medical resident lawyer, medical resident defense attorney, medical intern lawyer, medical intern attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“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 © 2017 The Health Law Firm. All rights reserved.

Florida Doctors and Pharmacists Beware: Gov. Scott Declares State of Emergency for Opioid Abuse Crisis

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

On May 3, 2017, Florida Gov. Rick Scott declared a state of emergency to combat Florida’s opioid-addiction epidemic. According to the governor, the number of overdose deaths has reached epidemic proportions. This declaration will allow nearly $30 million in federal funding to be spent for treatment and prevention services.

Given past state actions taken to attempt to eliminate prescription pain medication abuse, physicians writing such prescriptions and pharmacies filling such prescriptions should beware. Get prepared, not only through having a good compliance program, but by contacting and having a good attorney on retainer in the event of a subpoena, raid, search warrant or arrest warrant. Additionally, always talk to your lawyer before speaking with any investigator or special agent about anything.

The Emergency Declaration.

An emergency declaration gives Governor Scott the power to spend immediately without the Legislature’s approval. Therefore, public health officials can move quickly to respond to a crisis. Additionally, the emergency declaration will free up nearly $30 million in federal funds for prevention, treatment and recovery services. These services include workshops focused on addressing the major opioid abuse problem in Florida’s areas hit hardest with this crisis.

The Opioid Epidemic.

According to the Center for Disease Control and Prevention (CDC), in 2015 nearly 3,900 people died across the state of Florida as a direct result of opioid abuse. Governor Scott’s emergency declaration has strengthened the Florida Legislature’s effort this year to address the opioid abuse crisis in several additional proposals.

Among the additional measures state legislators are considering one that rewrites Florida’s drug trafficking statute. The new measure would create tougher penalties for dealers and users, specifically those caught with fentanyl. Fentanyl is a synthetic drug that can be 100 times more potent than morphine.

For more information and statistics on the opioid epidemic in Florida, click here.

To read one of my prior blogs for physicians prescribing pain medication, click here.

Contact Experienced Health Law Attorneys for Opioid Abuse Concerns.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in opioid abuse investigations, drug diversion, regulatory matters, licensing issues, litigation, 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.

Sources:

Auslen, Michael. “Gov. Scott declares public health emergency over opioid crisis.” Miami Herald. (May 4, 2017).

Ceballos, Ana. “Florida Bolsters Response to Opioid-Addiction Crisis.” Associated Press. (May 4, 2017). 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’s opioid abuse crisis, legal representation for opioid prescribing, legal representation for physicians prescribing opioids, Drug Enforcement Administration (DEA) defense lawyer, legal representation for over-prescribing pain medication, Board of Medicine hearing attorney, Board of Pharmacy hearing attorney, Florida prescription drug crackdown, health care defense attorney, legal representation for drug diversion, drug diversion defense attorney, legal representation for health care professionals, health care professional defense attorney, Board of Medicine defense counsel, Board of Pharmacy defense lawyer, Florida health care defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm, attorneys for physicians, pharmacist legal defense attorney, Board of Medicine defense lawyer, Department of Health defense counsel, Drug Enforcement Administration (DEA) Order to Show Cause (OTSC) attorney, Drug Enforcement Administration (DEA) hearing 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 © 2017 The Health Law Firm. All rights reserved.