Massachusetts Mental Health Centers Submitted False Claims According to Suit

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 January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.

The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”

According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.

The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.

Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.

There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. 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 whistle blower 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.

Sources:

Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.

Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 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.

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The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2018 The Health Law Firm. All rights reserved

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Qui Tam Cases: If You Are Thinking About Blowing the Whistle, Follow These Tips

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

At The Health Law Firm, we have represented many clients that were involved in qui tam cases brought because of false claims under the Medicare False Claims Act (FCA).  We have defended health facilities and health professionals, but we have also brought whistle blower cases against health facilities and health professionals, representing the whistle blower.  If you are thinking about blowing the whistle on any type of fraud or unlawful conduct by your current or former employer, there are important facts that you should know.

Filing a qui tam (whistle blower) case can be complicated, complex, and time consuming.  It’s important to seek experienced legal counsel to guide you through the difficult process. It is crucial that a whistle blower’s attorney have a good working relationship with the U.S. Attorney’s Office and the State Attorney’s Office, as well.
Based on years of experience with these types of cases, from both sides, here are some key tips to remember if you are thinking about filing a qui tam or whistle blower suit:

1.     You Are Doing the Right Thing.  It is important to remember in qui tam cases that you are doing the right thing. Qui tam whistle blowers often save taxpayers millions of dollars and help the government recover stolen funds by coming forward with cases of fraud or unlawful conduct.  Additionally, they help to put an end to fraudulent activities and illegal conduct that may harm patients.

2.     Choose an Experienced Attorney.  Because filing a qui tam suit under the False Claims Act (FCA) can be a difficult and complicated task, choosing an attorney with the proper experience is very important. Litigation of whistle blower cases, either prosecuting them or defending them, is a highly complex, technical area of law and not all attorneys have the experience to make the process easier, let alone be successful.

3.     Don’t Drag Your Feet If You Have Evidence of Fraud.  Once you have evidence of fraud, you need to act quickly or you may lose your opportunity to receive a monetary award. The FCA limits the time in which a suit can be filed. Generally, a qui tam suit must be filed within six years of the date the fraud was committed. Most qui tam laws, including the FCA also have a “first to file” rule. This means that a qui tam whistle blower must be the first to file a case in order to be eligible to receive an award.  Additionally, if the fraud becomes public knowledge or the government discovers the fraud on its own, it is too late for the whistle blower.

4.     Whistleblowers Are Legally Protected from Retaliation by the False Claims Act.  One concern clients have when filing a qui tam suit, is the effect it might have on their future professional career as well as their personal life.
First, because the case is filed under seal, there is no record of any kind that even shows a case has been filed, much less the name of the person filing it.  The U.S. Attorney and its investigators (including the FBI and the OIG Special Agents) will know, but they ain’t telling.  It often takes several years before the court will order the case unsealed. Second, the False Claims Act contains a provision that prohibits any type of retaliation against the whistle blower. The act  makes it unlawful for any employer to retaliate against you for exercising your rights as a whistle blower.  Additionally, if it occurs, you will have a separate right to sue an employer just for the retaliation.  I saw a whistle blower case recently which the court dismissed because there wasn’t specific information contained in the complaint about any false claim being submitted.  However, because the employer had retaliated against the whistle blower, the court did not dismiss the whistle blower’s claim for wrongful retaliation against the employer.  This was a big mistake by the employer.

5.     Silence is Golden in Qui Tam Cases. Do not discuss your case with anyone but your lawyer. Do not tell your friends. Do not tell your family. Do not even disclose that you are thinking of filing a lawsuit. Public discussions can be detrimental to your case. Qui tam suits are filed under the “seal” provision of the FCA, which prohibits the disclosure of any aspect of the case to anyone without prior court approval.

6.    Most Important, Documentation of Actual False Claims is Required. Recent court cases have strictly emphasized the requirement that you must have documented proof of actual false claims being submitted to the government.  Whether these are copies of claims, copies of superbills, copies of explanations of benefits (EOBs), copies of ledgers, copies of book keeping documents or whatever, you must have several actual claims that are false that were submitted for payment.  You must be able to specifiy these by patient name, date of service, CPT code billed, amount billed, etc.  Internal memos, policies and procedures, billing guidance and instructions, medical record entries, and other documents that show the employer’s intent to defraud the government are useful in showing a conspiracy, or organized scheme to falsely bill. However, you must also have copies of false claims documentation, as well.

Remember: Those who file qui tam cases under the FCA are valuable and important for our nation’s health care system. They help stop health care fraud and help the government recover billions of dollars. They prevent the theft or waste of millions of dollars that could be spent on actual, needed health care.  They also help prevent harm that may be caused to patients from receiving substandard treatment, unnecessary procedures and treatments or no treatment. Through qui tam lawsuits, whistle blowers have stopped harmful practices that endanger the health and lives of Medicare, Medicaid, Tricare and VA patients.

For more information, read my prior blog on whistleblowers who report fraud.

Contact an Experienced Health Law Attorney to Assist in Whistle blower/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 whistle blower/qui tam cases, in which we represent the person who files the claim.
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., 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, FCA defense attorney, legal representation for FCA violations, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, whistle blower attorney, complex health care litigation defense attorney, whistle blower defense attorney, whistle blower defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense lawyer, medical professionals defense counsel, medical professionals defense lawyer, medical professional defense 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 © 2018 The Health Law Firm. All rights reserved.

Broward Health Executives Charged for Conspiring to Get Rid of CEO

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

On December 12, 2017, five North Broward Health District executives were hit with criminal charges. A state attorney is alleging violations of Florida’s open government laws for supposedly holding secret meetings at which they decided to terminate the former interim chief executive.

The Broward County State Attorney’s Office served summons on Broward Health’s interim president and CEO Beverly Capasso, current and former board of commissioners members Rocky Rodriguez, Christopher T. Ure and Linda Robison, and general counsel Lynn Barrett. According to court records, a grand jury returned an indictment against them in state circuit court following an investigation.

Broward’s Bad Luck.

The new charges seem to be the latest chapter of a tumultuous past several years for leadership of North Broward Health. The four-count indictment stems from a prior investigation that followed the controversial December 2016 firing of interim CEO Pauline Grant for alleged kickback violations. For more information on this investigation, click here.

Government-in-the-Sunshine Law.

The indictment levies misdemeanor charges for alleged violations of the state’s public meetings law, also known as the Government-in-the-Sunshine Law. According to court documents, the four board members and Barrett conspired in late November and early December 2016 to hold secret meetings. They were conducted via phone in which they discussed a “reportable event” allegedly committed by Grant and decided upon her termination.

The meetings allegedly violated the law because they covered business or official acts of the district but were not publicly noticed. Therefore, they did not meet requirements to be open to the public at all times or give the public a reasonable opportunity to be heard on Grant’s termination, the indictment says.

Knowingly violating the Sunshine Law can result in removal from office and a criminal penalty of up to 60 days in jail and a maximum $500 fine, according to state records.

To read the indictment in full, click here.

To read more on Broward Health’s legal woes, click here to read a prior blog I wrote.

To learn more about how The Health Law Firm can assist you in matters of employment law, click here.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in defending allegations of employment discrimination and other complaints from employees and patients. We represent employers in unemployment compensation hearings, in defending against EEOC (discrimination) complaints, and in defending litigation involving wage and hour disputes, as well as other types of contract or employment litigation. We also can investigate such allegations and attempt to negotiate settlements where warranted. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

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

Sources:

Hale, Nathan. “Broward Health Execs Charged For Conspiring To Ax CEO.” Law360. (December 12, 2017). Web.

Fleshler, David. “Ousted Broward Health CEO files lawsuit.” Sun Sentinel. (December 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: employment issues attorney, employment law defense attorney, employment law attorney, legal representation for health care facilities, legal representation for health care professionals, Legal representation for workplace discrimination, workplace discrimination lawyer, legal representation for employee discrimination, defending litigation involving wage and hour disputes, legal representation for contract law, contract law attorney, legal representation for contract litigation, contract litigation attorney, employment litigation lawyer, legal representation for employment litigation, legal representation for labor relations, legal representation for employee relations, legal representation for conditions of employment, 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.

 

Trump Administration Reverses Guidelines for Penalties Against Nursing Homes

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

The Trump administration is actively reversing nursing home guidelines previously put in place under President Barack Obama. The current administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.

The change in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association (AHCA) has complained that under President Obama, inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve or prevent them.

Serious Violations.

Since 2013, federal records show that nearly 6,500 nursing homes have been cited at least once for a serious violation. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.

In 2017, the Centers for Medicare & Medicaid Services (CMS) discouraged its offices from imposing fines, even in the most serious health violations, if the error was a “one-time mistake.”

According to Dr. Kate Goodrich, director of clinical standards and quality at CMS, unnecessary regulation was the main concern that health care providers raised with officials. “Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.

Serious Penalties.

Medicare has various ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. It can deny payments for new admissions.

The average fine in recent years has been $33,453., but 531 nursing homes amassed combined federal fines above $100,000., records show. In 2016, Congress increased the fines to factor in several years of inflation that had not been accounted for previously.

Dr. David Gifford, AHCA’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.

The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.

In November 2017, CMS terminated a Florida Nursing from the Medicare program home after 14 patients died during a hurricane.  You can learn more about this incident and CMS sanctions by clicking the link above.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

If you receive any notice related to any audit, overpayment or action to terminate you or your company, take immediate action. 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.

We also represent physicians, medical groups, pharmacies. health facilities and therapists in notices of termination of Medicare billing privileges, corrective action plans (CAPs), OIG exclusion hearings, Medicaid hearings and applications for removal from the List of Excluded Individuals and Entities (LEIE).

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Rau, Jordan. “Trump Administration Relaxes Financial Penalties Against Nursing Homes.” Kaiser Health News (KHN). (December 31, 2017). Web.

“Trump Administration Relaxes Financial Penalties Against Nursing Homes.” The Washington Post. (December 31, 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 Medicare investigations, legal representation for Medicare exclusion, Medicare attorney, Medicare defense attorney, OIG exclusion, legal representation for nursing home compliance, legal representation for nursing home regulations, Centers for Medicare and Medicaid Services (CMS), legal representation for CMS investigations, legal representation for Medicare providers, nursing facility license defense, legal attorney for health facilities, nursing home and skilled nursing facility (SNF) defense attorney, nursing home and skilled nursing facility (SNF) defense lawyer, nursing home and skilled nursing facility (SNF) defense legal counsel, CMS termination of Medicare provider status, legal representation for Medicare reinstatement, legal representation for AHCA investigations and surveys, legal representation for health care compliance, legal representation for health care professionals, health law defense attorney, The Health Law Firm, 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 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.

Appeals Court Affirms Discipline for Doctor Who Sold Prescriptions at Bar

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 December 15, 2017, a physician who sold painkiller prescriptions to patients at a bar and restaurant, had his two-year probation for unprofessional conduct upheld by a Maryland appeals court. The court upheld the decision after it found that the evidence supported the state board’s disciplinary decision.

Unprofessional Conduct Alleged.

The Court of Special Appeals affirmed the ruling by the Maryland State Board of Physicians (Board) to reprimand Dr. Walter Kozachuk and place him on probation for a minimum of two years for unprofessional conduct in the practice of medicine. The Board claimed he would routinely meet with patients at a restaurant and bar and give them prescriptions for painkillers and anti-anxiety drugs in exchange for $100 per prescription. Additionally, on at least one occasion, he allegedly gave a patient a prescription in a parking lot.

The appeals court determined that there was substantial evidence supporting the board’s determination that the doctor’s sale of prescriptions in a non-office setting constituted unprofessional conduct. To read the court’s opinion in full, click here.

How You Can Avoid Legal Issues.

As a physician, you should be proactive in avoiding drug seeking patients and illicit clinic owners or coworkers. With the power of prescribing comes a great responsibility. Don’t find yourself behind bars when it can all be prevented. Here are some tips to learn from the recent pain management clinic raids.

1.    Avoid working for practices or clinics that have reputations as pill mills.

2.    Most physicians subject of investigations, such as the one written about here, are typically the sole physician in the clinic. Join a team setting in a group practice with other full-time physicians.

3.    Document everything. Make sure all medical records meet the requirements of state and federal laws. Verify all patients’ identities and be sensitive to possible false identifications.

4.    Make sure you know about everything going on in your office. Maintain a loyal and trustworthy staff who will report irregular behavior to you as physician. Have a zero tolerance for staff violations.

5.    Do NOT ever allow a lay person or non-physician to control your office. Do not give anyone like this sole access to medical records, billings, bank accounts or scheduling. Make sure that you are the one in control of these, that you have the passwords and access numbers, and that your constantly review these. You will be held accountable for this so you should remain in control.

To read more physician tips on protecting yourself and your license, click here.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, pain management doctors, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.  We represent physicians in complaints against their medical licenses.  We also handle appeals of board of medicine cases.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Source:

Kang, Peter. “Md. Court Affirms Discipline For Doc Who Sold Scrips At Bar.” Law360. (December 15, 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 health care professionals, health law defense attorney, legal representation for unprofessional conduct, legal representation for employment issues, legal representation for pill mill allegations, doctor defense attorney, Board of Medicine defense counsel, medical board defense attorney, professional license defense lawyer, legal representation for prescription drug trafficking, pill mill laws, legal representation for prescribing controlled substances, pain management doctor, legal representation for pain management physicians, legal defense for pain management professionals, legal defense for doctors, legal representation for prescription drug crackdown, legal representation for prescription drug abuse, legal representation for Drug Enforcement Administration (DEA)investigations, legal representation for Federal Bureau of Investigation (FBI) investigations, legal representation for Department of Health (DOH) investigations, DOH defense 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 © 2017 The Health Law Firm. All rights reserved.

Florida Woman Lands Herself 6.5 Years in Prison, Owes $45 Million for Medicare Fraud Scheme

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 November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets.

Sila Luis received an 80-month prison sentence in addition to being ordered to pay $45 million in restitution.  This came after a 2016 guilty plea to a charge of conspiracy to commit health care fraud. Her case continued in 2017 following a 5-3 ruling by the Supreme Court holding that the government could not freeze assets belonging to her that were not tied to the alleged fraud scheme.  This decision has the effect of making it more difficult for law enforcement authorities to swoop in and seize all assets of a suspect, effectively depriving them of the resources to even hire an attorney (which is a common tactic in such cases).

“Innocent” Property Can’t Be Seized.

In the 2016 Supreme Court decision, Chief Justice John Roberts and Justices Stephen Breyer, Ruth Bader Ginsburg and Sonia Sotomayor, voted to overturn the Eleventh Circuit Court of Appeals decision that the government could freeze Luis’ “innocent” assets as well as the ones directly traceable to the Medicaid fraud funds.  Justice Clarence Thomas concurred in a separate opinion.

“We conclude that the defendant in this case has a Sixth Amendment right to use her own ‘innocent’ property to pay a reasonable fee for the assistance of counsel,” Justice Breyer wrote for the plurality. “On the assumptions made here, the district court’s order prevents Luis from exercising that right.”

Under federal statute, the government is allowed to freeze some assets before trial in criminal cases alleging federal health care or banking violations, according to the ruling. However, the Justices agreed with the defendant that the freeze o f all her assets kept her from paying her attorney.  This by itself will usually force a guilty plea even from someone who may be innocent.

Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients.  She allegedly paid the patients to use one of her home health companies so that she could bill the government for unnecessary or unprovided services.  To read more on the U.S. Supreme Court’s decision, click here.

To read the judgement of the case in full, click here.

To read about another case of Medicare fraud in Florida, click here to read one of my prior blogs.

My Observations on this Case.

The power of pretrial seizure of assets is a very heavy handed tactic that I have seen used a number of times by law enforcement authorities, often, in my opinion, completely wrongfully.  In some cases it is used as a hammer to try to bludgeon the suspect to death.  In others it may be motivated by something as simple as a sheriff’s deputy deciding he really liked the defendant’s car and wanted to seize it.  I have seen the bank accounts of minor children sized when all they contained was what the child had worked for at a part time job to help pay for college.  I have seen an annuity fund seized which had been paid for ten years before any of the criminal activity allegedly took place.  I have seen cash taken from a mother (the wife of the alleged suspect) going into the delivery room at a hospital to give birth, when the cash had just been given to her by her mother to pay the hospital bill. I have seen law enforcement hold out in negotiations to return wrongfully seized property because what they really wanted was the suspect’s new Cadillac to use. Pre-trial seizure is an extremely powerful tool that can be easily misused.

So I can understand the U.S. Supreme Court’s decision in this case. On a slightly different topic however, I never cease to wonder at the small (relatively speaking) sentences that are given to the largest crooks.  I have seen poor people who could not feed their families sentenced to similar prison terms for merely a few thousand dollars in Medicaid or food stamp fraud.  Yet here someone bilks us, the taxpayers, out of $45 million and only gets only 80 months?  Let’s see.  That’s getting paid $562,500 per month for every month in jail.  Gosh, I bet there are some pretty rich people around who don’t make $562,500 a month. Typically, we find out that these people have their millions stashed overseas in secret foreign bank accounts.  Do several years in prison, get out, and then vanish overseas to Cuba or elsewhere and live like a king (or queen) for the rest of their lives.  The story seems to happen over and over again.

Maybe the key should be to make the sentencing guidelines give one month of prison times for every one hundred thousand dollars stolen.  Then reduce that prison time by one month for every one hundred thousand dollars that is paid back in restitution.  This promotes prompt restitution while ensuring that the convicted defendant does not get out only to flee somewhere to enjoy their stash of hidden funds.  This means, of course, that the Bernie Maddofs never get out (as should be the case), but at least the smaller offenders are nor being punished disproportionately to the larger ones.

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 Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter.  Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding Medicare audits.

The government is serious about combating health care fraud.  It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs.  False claims are a growing problem in the program, costing the government billions of dollars each year.  Accordingly, punishments for defrauding the system can be quite severe.

If you have assets seized by state or federal law enforcement authorities, you must act immediately to start the proceedings to have them released or you may forfeit them.  There are often a number of valid defenses to have your property released.  The Health Law Firm represents individuals, spouses and families in obtaining the release of “forfeitures” and seized property and funds.

If you are accused of Medicare or Medicaid fraud, realize that you are in a fight for your life.  Your liberty, property/possessions and profession are all at stake.  Often it is possible to settle allegations of Medicare fraud by agreeing to pay civil monetary penalties and fines.  If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison.  Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare 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.

Sources:

Macagnone, Michael. “Fla. Woman Gets 6.5 Years, Owes $45M For Medicare Fraud.” Law360. (November 22, 2017). Web.

Koenig, Bryan. “High Court Determines ‘Untainted’ Assets Can’t Be Frozen.” Law360. (March 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: Legal representation for Medicare fraud, legal representation for health care fraud, legal representation for Medicare audits, Medicare audit defense, legal representation for Medicare billing, health care clinic fraud audit, Medicare fraud defense attorney, health care fraud defense lawyer, health care fraud scheme, Medicare fraud scheme, civil forfeiture defense attorney, The Health Law Firm, legal representation for Medicare fraud investigation, civil forfeiture defense lawyer, legal representation for fraudulent billing, legal representation for improper billing, restitution for health care fraud offense, Medicare reimbursement claims, improper Medicare billing claims, false claims defense attorney, legal representation for Anti-Kickback Statute (AKS), AKS defense attorney, legal representation for accepting kickbacks, The Health Law firm attorney reviews, reviews of 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 © 2017 The Health Law Firm. All rights reserved.

 

 

State of Florida Sued as DOH Fails to Grant New Pot Licenses

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 November 22, 2017, a plant nursery and a man who has epilepsy, filed suit alleging that it’s “high time” for the Florida Department of Health (DOH) to comply with a Florida constitutional amendment and its implementing legislation. The constitutional amendment requires the DOH to license more medical marijuana treatment centers. According to the suit that has been filed, DOH’s failure to do so is depriving patients of medication that they really need.

The Number of Licenced Treatment Centers.

Bill’s Nursery, Inc., and Michael Bowen filed suit accusing the DOH of failing to meet an October 2017 deadline to expand the number of licensed treatment centers in the state by an additional ten as it is being argued, is required by The Florida Medical Marijuana Legalization Initiative. The initiative, known as Amendment 2, was passed in November 2016. Click here to learn more.

Bill’s Nursery previously applied unsuccessfully to become a medical marijuana dispensary in the state of Florida and now wants to apply to be a medical marijuana treatment center. In his suit Bowen claims he relies on medical marijuana to prevent and treat his epileptic seizures.

Treatment Center Licenses.

Despite passage of Amendment 2, the DOH has only given licenses to six additional treatment centers and is refusing to accept and consider additional applications. According to the complaint, this defies the Florida Legislature and threatens the ability of patients to access lifesaving medication. Patients and advocates for medical marijuana claim that the few that have been approved are simply not enough to provide what is needed. During a late October 2017 hearing before the Florida Senate Health Committee, Christian Bax, director of the DOH’s Office of Medical Marijuana Use, made it clear that the agency wouldn’t issue the additional licenses until pending litigation challenging a provision of the law is resolved.

According to the suit, the DOH’s refusal to license more businesses is harming competition, preventing companies like Bill’s Nursery from entering the market and strengthening the monopoly hold enjoyed by the seven current treatment centers. Additionally, in the process, the agency and officials are harming patients like Bowen, who says his life is at risk without adequate access to medicinal marijuana, the complaint says.

Click here to read the complaint in full.

To read a previous blog I wrote on the current legislation of Florida’s medical marijuana, click here.

Contact Experienced Health Law Attorneys for Medical Marijuana Concerns.

The Health Law Firm’s attorneys can assist health care providers and facilities, such as doctors, pharmacists and pharmacies, wanting to participate in the medical marijuana industry. We can assist in preparing and completing applications for registration, permitting and or licensing. We can also represent doctors, dispensaries, pharmacies, and pharmacists facing proceedings brought by state regulators or agencies.

Call now or visit our website www.TheHealthLawFirm.com.

Sources:

Posses, Shayna. “Florida Sued For Dragging Feet On Medical Pot Licenses.” Law360. (November 22, 2017). Web.

Kam, Dara. “Medical marijuana license delays challenged in lawsuit.” Sun Sentinel. (November 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 2017 The Health Law Firm. All rights reserved.