Mentally Ill Inmate Gouges Out Own Eyes, Sues County for Negligence

7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 7, 2017, a mentally ill inmate in the Boulder, Colorado, jail sued Sheriff Joe Pelle in federal court, claiming that the jail staff failed to stop the man from using his fingers to gouge out his own eyes after several prior attempts to do so. Ryan Partridge sued Pelle and 21 other jail employees in U.S. District Court in Denver. He claimed that he blinded himself because they failed to heed warning signs to treat his mental illness, according to the civil lawsuit filed by Denver civil rights attorneys David Lane and Kathryn Stimson.

Inmate Negligence.

The inmate, who is now blind and suffers from deep, severe schizophrenic psychosis, is seeking monetary awards for negligence, including compensatory damages for physical and psychological injuries including pain and emotional distress and humiliation. He suffers from auditory and visual hallucinations, delusions and paranoia, according to the lawsuit.

On December 17, 2016, Partridge curled up in a ball in his cell with fingernails that hadn’t been cut for six weeks and plucked both of his eyes “completely out of his head,” the lawsuit says. The lawsuit also says jailers failed to respond to a series of precursor events in which the inmate said he would gouge his eyes out. In early 2016, he banged his head into his toilet, breaking seven teeth, the lawsuit says. Additionally, there were several prior attempts by the inmate to committed suicide.

Shane McGurk, the jail’s mental health program director, sought an emergency court order to get him psychiatric treatment. The judge ordered deputies to immediately take him to get psychiatric treatment. However, according to the lawsuit, the orders were ignored and the “Defendants’ willful and deliberate indifference to Mr. Partridge’s serious medical needs directly led to his self-mutilation, head and vertebrae injury, broken teeth and ultimately, to his permanent blindness.”

The jail failed to properly train officers in how to care for a mentally ill inmate, the lawsuit said.

This is not the first time an inmate or their families have sued for improper care during incarceration. Click here to read one of my prior blogs on a similar case.

It is an unfortunate reality that our society today tends to ignore citizens with true and severe mental health illnesses, choosing to treat them as criminals, instead. Instead of allocating funds for treatment, acting in a preventative manner, it prefers to spend the money for prisons and paying for incarceration. This is a complete shame. This poor, mentally ill individual suffers the consequences. Unfortunately, the officials who run our jails and prisons also suffer by being the treater of last resort, which is grossly unfair to them, as well. Our jail and prison officials should have a “safety relief valve” available to them where they can divert individuals who have been incarcerated because of their mental illnesses and obtain appropriate treatment for them.

Providing Representation For All Health Care Professionals.

Our firm has represented a number of nurses, physicians and other health care professionals who provide care in jails and prisons, as well as in other government facilities and institutions. We routinely represent physicians, nurses and advance practice nurses who work for the VA, the Department of Health, the county, the military, the Indian Health Service and other government agencies. Although government employees may have personal immunity from civil suits, they are not protected against termination and other employment actions, complaints against their professional license, National Practitioner Data Bank reports, and other types of administrative actions; our firm represents them in all of these. The government is not going to represent you in these. Call us at the first sign of a legal problem.

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

Sources:

Mitchell, Kirk. “Mentally Ill inmate sues for negligence.” The Denver Post. (December 8, 2017). Web.

Mitchell, Kirk. “Psychotic Boulder jail inmate gouges out own eyes, sues county for negligence.” The Denver Post. (December 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: Legal representation for government physicians, legal representation for government nurses, legal representation for mental health professionals, mental health defense attorney, legal representation of mental health counselors, mental health counselor defense attorney, legal defense of professional licensure cases, legal representation for Board of Nursing cases, legal representation for Board of Medicine cases, Board of Nursing investigation defense attorney, legal representation for peer review, legal representation for administrative actions, legal representation for health care professionals, legal representation for psychiatrists, psychiatrists defense attorney, defense counsel for mental health professionals, health care lawyer, The Health Law Firm 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.

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Massage Therapist Sued for $25 Million After Alleged Sexual Assault

2 Indest-2009-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A woman who claims she was assaulted at a Massage Envy location in the Northwest section of the District of Columbia (D.C.) filed a $25 million lawsuit against the company and the massage therapist who she said attacked her. The alleged victim, who is not identified in the suit, said the franchise owners never should have hired the alleged attacker, and that they knew he previously had been accused of assaulting women.

The Allegations.

According to the suit, the defendant removed a sheet that was covering the woman and made inappropriate oral sexual contact toward the end of her 90-minute massage at a Massage Envy location. The woman immediately pulled the sheet back up to cover herself and told him to leave.

The defendant has been accused in four separate reports of sexual misconduct at three different locations. Click here to read about all of the accusations against the defendant.

The woman who filed the suit is seeking $25 million from Massage Envy, the franchise owners and the defendant.

To learn about how to protect yourself as a massage therapist from situations like this and the repercussions, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in the Representation of Massage Therapists.

The attorneys of The Health Law Firm provide legal representation to massage therapists in Department of Health (DOH) investigations, licensing matters and other types of investigations of health professionals and providers. We have represented a number of massage therapists who have had summary actions initiated against their massage therapy licenses by the Department of Health (DOH).

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

Sources:

Segraves, Mark. “Woman Sues DC Massage Envy, Masseur for $25M After Alleged Assault.” NBC Washington. (October 14, 2017). Web.

Swalec, Andrea. “Massage Envy Worker Now Accused in 4th Sex Abuse Case.” NBC Washington. (September 21, 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: Legal representation for massage therapists, legal representation for Department of Health (DOH) Investigation, legal representation for Board of Massage Therapy investigations, Massage Therapy Licence defense attorney, massage therapy licensure attorney, licensure defense attorney, legal representation for massage therapy license investigation, massage therapy defense, legal representation for massage therapy regulations, legal representation for employee of massage establishment, legal representation for employer of massage establishment, massage therapist attorney, regulations of massage therapists, legal representation for health professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm attorneys, The Health Law Firm attorney reviews

 

“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 © 2018 The Health Law Firm. All rights reserved.

New DOJ Memo Shifting Government Policy in False Claims Act Cases Should make Healthcare Providers Happy!

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

On January 29, 2018, the U.S. Department of Justice (DOJ) released a new internal memorandum that we believe signals a backing-off of government support for False Claims Act cases. The memorandum sent by Associate Attorney General Rachel Brand, references “vast reams” of government agency guidance explaining the government’s views and interpretation of various laws. It includes laws related to requirements for accurate billing of Medicare and Medicaid by healthcare providers.

The “Brand Memorandum.”

In the memo, Brand said the DOJ “may not use its enforcement authority to effectively convert agency guidance documents into binding rules.” The memo is a product of Attorney General Jeff Sessions’ move in November 2017, to curtail “regulation by guidance.”

It states that it specifically applies to civil enforcement of laws, including the False Claims Act (FCA), that the Associate Attorney General oversees.

Click here to view the DOJ’s Brand Memorandum in full on our website.

Implications of the Brand Memorandum.

Brand’s memorandum stopped short of completely forbidding the use of agency guidance in support of DOJ cases. The memorandum indicates that, while violations of agency guidance can’t be used to prove violations of law, they can still be used “to help prove that the party had the requisite knowledge” of its legal obligations, Brand wrote.

FCA cases can be affected by many types of guidance. Medicare contractors provide guidance on billing when appropriate and the U.S. Food and Drug Administration (FDA) issues guidance on illicit off-label promotion. Additionally, the Office of the Inspector General (OIG) issues guidance and bulletins related to kickbacks and improper physician referrals.

To learn more about the DOJ’s role in health care fraud and compliance, click here to read one of my prior blogs.

Visit our website to find out how The Health Law Firm can assist you with Medicaid fraud defense, Medicare fraud defense and False Claims Act defense cases.

What Will the Long Term Effects Be?

We see these latest actions by the DOJ to announce a policy of allowing big corporations unbridled discretion to steal from the tax payers. We believe it signals a change to discouraging False Claims Act cases from being brought. It is difficult to see why DOJ is easing off of matters that help the prosecution of False Claims Act cases, especially those by individual relators (whistle blowers). Whistle blower or qui tam cases brought by hundreds of individual whistle blowers are now recovering billions of dollars each year in Medicare and Medicaid fraud. Why would anyone want to stifle such a successful program?

It is argued by DOJ that the DOJ’s budget is limited and U.S. Attorneys need to be freed up to go after serious crime, but that is exactly why the False Claims Act was passed in the first place. If the government doesn’t have the resources, personnel or, more importantly, the interest in pursuing those who files false claims and state form the tax payer, then private whistle blowers or relators are authorized to do this. All the government has to do is to decline to intervene in the case and then the relator can go ahead and pursue the case on its own, without costing the government anything. It was because of war profiteers’ treating the U.S. treasury as a piggy bank, to be looted anytime they felt like it, that caused the False Claims Act’s passage in the Civil War era.

There is also a big concern that if there is less guidance on such complex topics as how to properly document valid medical services and procedures delivered to patients, then how can busy doctors, health care professionals and health facilities hope to understand what is require of them. It is my understanding that such “guidance” is for just such a purpose, to guide those who are trying to comply.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent health care 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.

Sources:

Overley, Jeff. “New DOJ Memo Will Make Waves In Fraud Cases.” Law360. (January 29, 2018). Web.

“New DOJ Memo Will Make Waves In Fraud Cases.” Institute for Legal Reform. (January 29, 2018). 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: Fraudulent billing defense attorney, fraudulent billing representation, Medicare fraud defense attorney, Medicaid fraud defense attorney, representation for health care fraud, representation for Medicare fraud, representation for Medicaid fraud, False Claims Act (FCA) attorney, FCA defense attorney, FCA representation, false filling representation, false billing defense attorney, health care fraud defense attorney, U.S. Department of Justice (DOJ) guidance representation, DOJ investigation representation, DOJ defense attorney, DOJ investigation defense attorney, OIG investigation representation, OIG defense attorney, health care professional defense attorney, health care professional representation, health care compliance representation, health care compliance attorney, 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 © 2018 The Health Law Firm. All rights reserved.

 

Florida Massage Therapist Charged in Sexual Battery Case Following Several Complaints

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 June 24, 2016, a South Florida massage therapist was charged with sexual battery after being accused of assaulting a client during a session in February 2016. The therapist who allegedly worked at Chi Spa in Pompano Beach, Florida, pleaded not guilty on charges of sexual battery on a person older than 18 without violence.

The Complaints.

According to police reports, at least three women claimed to have been inappropriately touched during massage appointments at Chi Spa. Police said the spa’s owner said she was aware of one incident because the woman called to ask for her money back and complained about “too much touching.”

To learn about how to protect yourself as a massage therapist from situations like this and the repercussions, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in the Representation of Massage Therapists.

The attorneys of The Health Law Firm provide legal representation to massage therapists in Department of Health (DOH) investigations, licensing matters and other types of investigations of health professionals and providers. We have represented a number of massage therapists who have had summary actions initiated against their massage therapy licenses by the Department of Health (DOH).

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

Sources:

Batchelor, Samantha. “South Florida massage therapist accused of touching clients’ breasts, genitals.” Local 10 News. (June 25, 2016). Web.

Geggis, Anne. “Massage therapist charged in sexual battery case.” Orlando Sentienl. (June 25, 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: Department of Health Investigation, Florida Board of Massage Therapy, Massage Therapy Licence, criminal background screening, Florida Department of Law Enforcement, Florida massage therapist, license disciplined, license investigation, license revoked, licensure defense coverage, massage therapy defense, massage therapy regulations, employee of massage establishment, employer of massage establishment, massage therapist attorney, massage therapist lawyer, regulations of massage therapists, regulations of professionals and occupations, The Health Law Firm, Health Law

“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.

Federal Judge Refuses to Dismiss Florida Compounding Pharmacy’s FCA Suit

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 4, 2017, a Florida federal judge refused to dismiss the federal government’s False Claims Act (FCA) suit against a compounding pharmacy. RS Compounding LLC and its owner, Renier Gobea, are accused of overbilling Tricare for prescriptions. The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner.

Judge Finds Claims Are Sufficiently Stated.

According to U.S. District Judge Virginia M. Hernandez Covington, the government adequately pled its claims that RS and Gobea had knowingly charged Tricare prices well in excess of what it charged cash payors for substantially the same drugs. “The United States’ amended complaint in partial intervention sufficiently states claims for unjust enrichment and violation of the FCA,” the judge said.

The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Additionally, Judge Covington rejected the owner’s argument that claims against him personally should be dropped from the case pointing to his “extensive involvement” in RS’s operations and his profit-taking from the company.

The Relator’s FCA Suit.

The relator McKenzie Stepe, a former RS sales representative, originally filed her complaint in December 2013. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. Those drugs, all mixtures containing the anesthetic ketamine, were charged to the government at prices of between $400 and $3,000 per bottle when the equivalent rate for an uninsured cash payer was between $15 and $45 a bottle.

The relator’s complaint was dismissed in November 2017, based on what Judge Covington said was a lack of firsthand knowledge to support her claims, but with leave to file an amended complaint by December 7, 2017.

To read the court’s order in full, click here.

To learn about a similar case involving a Florida compounding pharmacy, click here to read one of my prior blogs.

 

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s 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:

Wilson, Daniel. “Fla. Compounding Pharmacy Can’t Escape Tricare FCA Suit.” Law360. (December 4, 2017). Web.

Raymond, Nate. “Florida compounding pharmacy must face U.S. fraud suit – judge.” Reuters. (December 4, 2017). Web.

KeyWords: False Claims Act defense attorney, FCA legal counsel, TRICARE false claims legal defense attorney, TRICARE physician representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, whistle blower lawyer, FCA violations, fraud detection, financial interest in physician referrals, TRICARE fraud attorney, health attorney, defense attorney, The Health Law Firm, health law firm, fraud investigations, consumer reports of health care fraud, conflict of interest in physician referrals, compound medication prescriptions, compounding pharmacy lawyer, prescription reimbursement, legal defense of military physicians, legal defense of TRICARE providers, attorney reviews of The Health Law Firm, Veterans Administration (VA) physician defense attorney, The Health Law Firm attorney reviews, legal representation for pharmacies, legal representation for pharmacists, health law defense attorney, legal representation for health care professionals

“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 © 2018 The Health Law Firm. All rights reserved.

 

Alabama Doctor and 3 Nurse Practitioners Charged With Running Fraudulent Pill Mill

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

On December 6, 2017, three nurse practitioners and a doctor were arrested following an Alabama federal grand jury indictment accusing them of operating a “pill mill.” According to the U.S. Department of Justice (DOJ), all four allegedly dispensed controlled substances inappropriately, unlawfully and for non-medical reasons.

The Alleged Pill Mill.

The nurse practitioners and physician allegedly prescribed opioids including fentanyl, hydrocodone, oxycodone, methadone and hydromorphone on a monthly basis for years, according to the indictment. They then allegedly billed health care providers for related unnecessary patient examinations.

“[The four defendants] did knowingly and intentionally conspire to distribute and dispense and cause to be distributed and dispensed mixtures and substances containing detectable amounts of controlled substances by issuing and causing prescriptions for those substances outside the usual course of professional medical practice and for no legitimate medical purposes, through the operation of a pill mill,” the indictment stated.

Prosecutors alleged the medical personnel diagnosed patients at the Alabama practice with “vague, unsubstantiated medical conditions,” and prescribed controlled substances in 30-day quantities.

Additionally, prosecutors allege that they required the patients to have a follow-up appointment involving a physical examination that was “medically unnecessary.” They would then bill health care benefit programs for the patients’ visits, usually in the amount of $75, under allegedly false and fraudulent pretenses.

The alleged scheme earned the defendants more than $10,000. If convicted, each defendant faces a maximum sentence of 20 years in prison on the drug conspiracy and distribution counts. They face maximum sentences of 10 years in prison on the health care fraud counts.

To read the indictment in full, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.

According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions, including Show Cause Orders (SCOs) . 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. It includes defense in federal or state court and defense in federal or state 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:

Robinson, Carol. “Alabama doctor, 3 nurse practitioners federally indicted in pill mill case.” AL.com (Alabama News). (December 5, 2017). Web.

Narea, Nicole. “Doctor, 3 Nurse Practitioners Charged With Running ‘Pill Mill’.” Law360. (December 5, 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: Legal representation for pain management clinic, pain management clinic defense attorney, Show Cause Order (SCO) defense attorney, Show Cause Order (SCO) defense legal counsel, Show Cause Order (SCO) defense lawyer, legal representation for over-billing, legal representation for submitting false claims, False Claims Act (FCA) defense attorney, medical license defense attorney, nursing license defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) defense counsel, Drug Enforcement Administration (DEA) defense lawyer, board of medicine attorney, board of pharmacy attorney, legal representation for Department of Health investigations, legal representation for allegations of over-prescribing, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm, The Health Law Firm attorney reviews, formal and informal administrative hearing defense attorney, formal and informal administrative hearing defense lawyer, formal and informal administrative hearing defense legal counsel

“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 © 2018 The Health Law Firm. All rights reserved.

 

Kmart Agrees to Pay $32.3 million to Settle Whistle Blower’s False Claims Act Suit

PS 3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 22, 2017, Kmart Corporation agreed to pay $32.3 million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

The Whistle Blower False Claims Act (FCA) Suit.

The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). This provision permits private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.

The 2008 lawsuit, which was filed by a former Kmart pharmacist, alleged that Kmart pharmacies offered discounted generic drug prices to cash paying customers through various club programs. The pharmacies then knowingly failed to disclose those prices when reporting to federal health programs. According to the suit, in one case, Kmart had sold a 30-day supply of a generic version of a prescription drug for $5 to customers of its discount program, but then filed for reimbursement from the government for $152 for that same drug for its Medicare customers.
To read more on the 2008 suit, click here.

The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The former pharmacist will receive a whistle blower award of $9.3 million. The case was heard in the U.S. District Court in the Southern District of Illinois.

To read the DOJ’s press release on this case in full, click here.

To read about a similar case of a pharmacy inflating prices to government health care programs, click here to read one of my prior blogs.

Who Knew Medicare Part D Claims Could Yield Such Big Whistle Blower Settlements?

Who knew Medicare part D claims could yield such big whistle blower settlements? I know I didn’t. I didn’t even think about such claims until I read this case. This could mean some serious compliance issues for big chain stores that have pharmacies (note that I said “could”). Walmart, Publix, Albertsons, Costco, Sam’s Club, Winn Dixie, Engel’s, and every other chain that owns and operates pharmacies, may be in jeopardy.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim (the whistle blower). We have also defended health professionals and institutions in litigation of whistle blower complaints filed against them.

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

Sources:

McCausland, Phil. “Kmart to pay $32.3M to settle health care-related whistleblower case.” NBC News. (December 22, 2017). Web.

The Associated Press. “Kmart to pay $32.3 million to settle prescription drugs case.” ABC News. (December 22, 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.

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“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 2018 The Health Law Firm. All rights reserved.