Medicare Administrative Contractor and Other Contractors Continue to Discipline Medicare Providers Who Do Not Have Correct, Current Address Information on File; This Is One Thing You Definitely Want to Check up On!

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

We continue to receive calls from physicians and other Medicare providers who have had their Medicare billing privileges revoked or terminated because their address information is not up to date or is incomplete.  You must include a physical address at which your business operates so that if the Medicare Administrative Contractor (MAC), the Recovery Audit Contractor (RAC), or the Zone Program Integrity Contractor (ZPIC) attempts a site visit, they can find you and complete the site visit.  Leaving out a suite number, having the incorrect city or suite listed, having a locked entranceway or gate so that the auditors cannot get in, have all lead to revocation of Medicare billing privileges.  This can have devastating results to the business.

Often the physician or other Medicare Provider has recently relocated and the record has not been updated yet.  Other times, a post office box or other address is used instead of an actual physical address.  Often moving from one hospital to a different hospital leaves your information listed incorrectly.  Sometimes the street address is not complete or is incorrect.  Sometimes it is just a matter of a typographical error being made by whoever enters your addresses.

Just having a letter returned to the contractor because of an incorrect address can initiate this action.  You will be held individually responsible, regardless of this, even if you use an independent contractor or someone else to make your Medicare filings and keep them up to date.

The basis for the revocation is 42 CFR424.535(a)(5) and 424.535(a)(9) Medicare Provider is considered to be non-operational at the practice location on record with the Centers for Medicare and Medicaid Services (CMS).

You can easily check your own information to be sure it is correct, and you should do so.  Your addresses should be located online in the Provider Enrollment, Chain and Ownership System (PECOS). You can visit the website by clicking here.

Click here for more information.

You can also check online at the National Plan and Provider Enumeration System (NPPES) by clicking here.

Do this now!

If you receive a letter or any other indication that your Medicare billing privileges have been revoked or terminated, you must act immediately.  Contact an experienced health lawyer to assist you immediately.  Don’t wait, you will regret it if you do.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in  Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, 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.

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. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: termination of Medicare billing privileges, Medicare Administrative Contractor (MAC), Centers for Medicare and Medicaid Services (CMS), Zone Program Integrity Contractor (ZPIC), Recovery Audit Contractor (RAC), reviews of The Health Law Firm, Medicare Providers, ZPIC defense attorney, Medicare billing privileges, health law, revocation of Medicare billing privileges, ZPIC audit, Medicare defense attorney, legal representation for health care providers, Medicaid defense lawyer, Medicare audit, health law firm, Medicaid audit, The Health Law Firm reviews, Medicare billing privileges revoked, The Health Law Firm

“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 © 2016 The Health Law Firm. All rights reserved.

Arizona Appeals Court Affirms Dentist’s Suspension Over Questionable Prescriptions

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 December 13, 2016, an Arizona appeals court affirmed the suspension of a dentist who allegedly had a history of opioid addiction and who also allegedly wrote dozens of questionable prescriptions. The Arizona appeals court held that the state dental board didn’t violate his due process rights and had substantial evidence backing its decision that it wasn’t safe for him to practice.

The Arizona Court of Appeals, Division One, concluded that the Arizona State Board of Dental Examiners had acted within its authority by suspending Dr. Michael Wassef’s license to practice dentistry in the state. This was following Dr. Wassef’s refusal to submit to the dental board’s requests after it discovered evidence suggesting he had relapsed. The appeals court decision upheld a lower court’s decision affirming the dental board’s order.

History of Opioid Abuse?

Dr. Wassef’s possible relapse into opioid addiction reportedly first came to the attention of authorities in March 2014. This allegedly occurred when a pharmacist contacted the dental board to raise concerns about Dr. Wassef’s prescription-writing practices, according to the court’s decision. The board discovered that he had received prescriptions for controlled substances in increasing amounts over a six-year time period. Additionally, Dr. Wassef allegedly wrote 44 prescriptions in two years for the muscle relaxant Soma for his wife, his assistant and his assistant’s daughter, the opinion said.

After he tested positive for Soma and another medication, Dr. Wassef refused to submit to an assessment. As a result, the dental board issued an interim order that he obtain an inpatient substance-abuse evaluation, according to the opinion. He refused, and the dental board suspended his license in April 2014.

Arizona State Court Sides With Board.

Dr. Wassef contended that the board denied him due process by suspending his license without allowing him the opportunity to defend himself. Despite Wassef’s claims, the appeals court wasn’t swayed, explaining that the board didn’t have to give him a hearing before entering the interim order and can summarily suspend a licensee when it concludes.

The state board had more than enough evidence to conclude that Dr. Wassef was unsafe to practice dentistry, the appeals court panel held. “Under these circumstances, the board was not required to accept Dr. Wassef’s explanations and Dr. Wassef did not disprove the board’s suspicions,” the panel held. “Thus, the dental board had reasonable grounds to take emergency action to prevent harm to the public.”

To read the decision on this matter, click here.

To read more on the repercussions of choices such as this, click here to read one of my prior blogs.

Serious Allegations Need Serious Legal Representation.

When a dentist, physician, nurse, psychologist, pharmacist, or other licensed health professional is accused of drug abuse or alcohol abuse, this is a very serious matter. As happened in this case, your license can be suspended putting you out of work and terminating your ability to pay for a legal defense.

Several things are a must. You must have good professional liability insurance that pays for the legal defense of complaints filed against your license, preferable with $50,000 or more of coverage for this type of event. Second, you must immediately retain experience health care legal counsel who deals with these types of cases routinely. Often there are options to such a harsh remedy as a suspension. Additionally, all the time spent from initial notification of the complaint, should be used in obtaining evidence to show that the dentist is not currently impaired. This can be routine random urinalysis testing, treatment with psychiatrist and certified addictions professionals, evaluation by special physicians health programs and other actions.

Usually, suspension is only appropriate when the physicians condition makes him an immediate threat to patient safety. Being able to prove that the physician is not a threat is te key to preventing a suspension. Also, using the time and money in appealing such a decision may, in may cases, be better used in requesting an emergency hearing and getting the evidence needed for that hearing.

Consult With An Attorney Experienced in the Representation of Dentists and Other Health Professionals.

The Health Law Firm routinely represents dentists, dental technicians, pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists and other health professionals in investigations and at Board of dentistry hearings and other legal matters. Call now or visit our website www.TheHealthLawFirm.com.

Sources:

Posses, Shayna. “Ariz. Court Backs Dentist’s Suspension Over Dubious Scripts.” Law360. (December 13, 2016). Web.

“Arizona Court Backs Dentist’s Suspension.” Lexis Nexis. (December 13, 2016). Web.

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 dentists, defense attorney for dentists, legal counsel for dentists and dental assistants, defense attorney for health care professionals, DEA investigation defense attorney, legal representation for DEA investigations, legal representation for board investigations, defense attorney for board of dentistry matters, reviews of The Health Law Firm, The Health Law Firm attorney reviews, dental board defense work, dental board investigations, impaired dentists, impaired professionals, physician health programs, administrative hearings, complaint investigation defense attorney for dentists, appeals (and variations on appeal ) of adverse license action, license revocation, emergency suspension orders, appeals of emergency suspension orders, Professionals Resources Network (PRN) attorney, Florida dentist defense attorney, Virginia dentist defense lawyer, Louisiana dentist defense legal counsel, Colorado dentist defense lawyer, Kentucky legal dentist defense counsel, District of Columbia dentist legal representation

“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 © 2016 The Health Law Firm. All rights reserved.

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

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 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care programs, by offering gift cards to pharmacy customers that exceeded legal limits. Roundy’s enacted a Script Saver Program that gave all customers “pharmacy club coupons” for pharmacy purchases. When they reached five of those coupons, they could be redeemed for a $10 gift card, the complaint states. At some stores, the number of coupons necessary for a gift card was lowered to three, Kotwica said.

Roundy’s has mounted a defense to these allegations. Despite that defense, the whistle blower maintains the gift cards were more than the legal nominal value allowed. The whistle blower claimed additionally that the “retailer reward exception” failed because the gift cards were tied to the services the government health care programs reimbursed and were meant to induce customers to transfer prescriptions to the store.

The pharmacist and whistle blower in the case, claimed that he heard corporate executives discussing having Medicare and Medicaid recipients excluded from the program because they were concerned their inclusion was illegal, but never acted on that concern. Therefore, Kotwica said that this shows that Roundy’s had the intent to violate the FCA. The whistle blower also claimed that the company retaliated against him for speaking out to the point where he resigned his position as a pharmacist with it.

The case was originally filed in June 2015. Like all federal False Claims Act (FCA) cases, it remained sealed until ordered unsealed by the court. It was unsealed in July 2016 after the U.S., and the states of Illinois, Minnesota and Wisconsin declined to intervene in the case. Click here to read the response in this case.

Fighting Government Fraud and Abuse.

This case was brought under the federal False Claims Act (FCA) or federal “whistle blower law.” This law contains standards for both civil and criminal penalties against those filing false claims for services paid for by the government. False Claims Act cases, such as this recent one, are typically filed in a qui tam (or whistle blower) proceeding. This type of action involves a private party filing a lawsuit on behalf of the government against a defendant who allegedly defrauded the government. The “whistle blower” receives a percentage of the money recovered by the government (if any), through any judgment or settlement of the case. Often the amounts awarded to the whistle blower are in the millions of dollars. Whistle blowers are often protected from receiving any potential civil liability or prosecution for their involvement in the matter.

Our firm has been on both sides of both federal and state whistle blower or qui tam cases. We have represented nurses, physicians, pharmacists and other health professionals in bringing such cases. We have also defended physicians, health care providers, medical groups and health facilities in such cases.

We have also represented relators or plaintiffs bringing such actions to recover money on behalf of the government. A qui tam relator can receive up to 30% of the amount recovered on behalf of the government. This means, for example, that of a defendant settles with the government paying back $5 million, the relator or whistle blower can receive up to $1.5 million, plus his attorney’s fees and costs. Usually, the biggest obstacle to bringing any such case is being able to show an actual false claim that was filed.

If you have information concerning health care fraud by overbilling federal health care programs such as Medicare or Medicaid, do not hesitate to take action. The government urges health care providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act provides a system of rewards that encourages whistle blowers to bring these issues to the government’s attention.

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

The Health Law Firm’s attorneys routinely represent physicians, nurses, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in bringing or defending against False Claims Act, whistle blower or qui tam cases. We also defend health care providers in Medicare and Medicaid investigations, audits and recovery actions. We represent plaintiffs and defendants in complex health care litigation in state or federal courts.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistle blower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. 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 number of doctors and other licensed health professionals as relators in bringing qui tam or whistle blower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistle blower cases.

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

Sources:

Kass, Dani. “Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Law360. (December 20, 2016). Web.

“Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Make Me Feed. (December 21, 2016). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA) defense attorney, whistle blower defense attorney, qui tam defense attorney, legal representation for FCA claims, legal representation for qui tam cases, legal representation for whistle blower defense cases, Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for Medicare and Medicaid fraud investigation, Florida FCA defense attorney, Colorado FCA defense attorney, Kentucky FCA defense attorney, Louisiana FCA defense attorney, District of Columbia FCA defense attorney, Virginia FCA defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, complex health care litigation attorney, legal defense of complex health care business disputes, complex litigation defense 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 © 2016 The Health Law Firm. All rights reserved.

$785M Pfizer FCA Deal: Whistleblowing Doctor Agrees To Split Fees

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

Dr. William LaCorte, M.D., a whistleblowing physician in Metairie, Louisiana, helped win a $785 million False Claims Act settlement on November 29, 2016, with Pfizer, Inc., one of the World’s largest pharmaceutical companies.  Dr. LaCorte agreed with his former lawyers on a split of attorney’s fees, which resolves one of the several disputes about paying multiple attorneys.

An Agreement Was Reached.

U.S. District Senior Judge Douglas P. Woodlock signed off on the agreement between whistle blower Dr. LaCorte and the doctor’s attorneys at Boone & Stone and Vezina & Gattuso LLC, on November 29, 2016. This gives Dr. LaCorte 62 percent of the relator’s share and 38 percent to three law firms.

Lawsuit Was First Filed In 2002.

This lawsuit first started back in 2002 when whistle blower Dr. LaCorte filed a lawsuit against Wyeth, Inc. Wyeth had received millions of dollars from filing false-claims lawsuits against multiple health care companies in July 2014, or so it was alleged.

The lawsuit was first filed in 2002, before Pfizer had purchased Wyeth.  The case was consolidated with a lawsuit from another whistle blower, Lauren Kieff. The U.S. Department of Justice intervened in 2009. The dispute was recently settled in earlier 2016 without an admission of wrongdoing hy the pharmaceutical companies.

The DOJ said that the LaCorte and Kieff case focused on discounts that Wyeth offered to hospitals that purchased oral and intravenous versions of Protonix. Wyeth did not offer that same discounts to Medicaid, which violated the program’s “best price” provision requiring all suppliers to give the Medicaid Program the best price it gives to anyone else.

Dr. LaCorte, the qui tam plaintiff or “relator,” had alleged in his earlier lawsuit that Pfizer’s unit Wyeth, Inc., had overbilled Medicaid for Protonix, a heartburn medication.  Dr. LaCorte was offered a $64 million relator’s share, and the states offered him a $34 million relator’s share.

Boone & Stone and Vezina & Gattuso were looking to receive approximately 40 percent of the award, which is fairly standard in qui tam cases. They also wanted the award to be split equally between the two firms, as well as with the Sakla Law Firm.

Still Problems After The Settlement.

Even though a settlement was reached, it does not solve all of the disputes about the ten of millions of dollars that the attorneys will share as part of their contingency fee.  The Sakla Law Firm is currently disputing with Boone & Stone and Vezina & Gattuso about their own subdivision of the award. The dispute continues to play out in federal court.

The Sakla Firm, which routinely handles FCA cases argued in a different lawsuit that Boone & Stone and Vezina & Gattuso did not deserve any attorney’s fees because they did not do any of the “important” work. The Sakla Law Firm claims that it did 95 percent of the work in this case.

Disputes Over Legal Fees.

Dr. LaCorte has a separate dispute with Wyeth, Inc., about legal fees which he claims the company owes him from the FCA suit.  According to Dr. LaCorte, Wyeth owes him $7.7 million in legal fees, in addition to $300,000 in costs.  Judge Woodlock apparently indicated that the parties should mediate their dispute.

A spokeswoman for Pfizer, Neha Wadhwa, stated in an e-mail dated November 29, 2016, “Given the limited role relator LaCorte and his counsel played in bringing about the ultimate settlement in this mater, and the deficient records supporting the latter’s fee request, as Pfizer indicated in its court papers, Pfizer believes his request is excessive and should be reduced.”

In motion papers in June 2016, Dr. LaCorte’s attorneys had said that $7.7 million was a reasonable amount under the law for a complex contingency case that required a vast amount of expenses.

Attorney’s Fees Reasonable or Not?

Knowing what goes into a major qui tam case, given the extremely large recovery for the government, it seems that $7.7 million is imminently reasonable.  This case extended over a 14 year period and.  I’m sure, the attorneys and their staffs did a tremendous amount of work on it.  In fact, I would query whether or not a Lode Star multiplier might be in order given the recovery made.

Contact Experienced Health Law Attorneys.

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 http://www.TheHealthLawFirm.com.

Sources:
Elfin, Dana. “Wyeth to Pay $785M to End Medicaid False Claims Case.” Bloomberg BNA. (February 7, 2016). Web.

Loftus, Peter. “Pfizer to Pay $785 Million to Settle Medicaid Claims.” The Wall Street Journal (February 16, 2016). Web.

Amaral, Brain. “Whistleblower In $785M Pfizer FCA Deal Agrees To Fees Split.” Law360. (November 29, 2016).Web.

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. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA), overbilling Medicaid, The Health Law Firm reviews, False Claims Settlement, Medicaid fraud defense attorney, reviews of The Health Law Firm, False Claims Act defense lawyer, qui tam attorney, Medicaid false billing,False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, FCA original source requirement, AKS safe harbor, FCA subject matter jurisdiction, FCA first to claim requirement, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties 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 © 2016 The Health Law Firm. All rights reserved.

East Texas Lab Agrees to Pay $3.75 Million to Settle False Claims Suit

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, owners of an East Texas clinical laboratory who overcharged Medicare for falsified driving mileage bills have agreed to pay the U.S. government $3.75 million to settle a whistle blower’s False Claims Act (FCA) lawsuit. The suit was brought by a former employee, the U.S. attorney’s office announced.

Submitting False Claims.

Texas-based Elite Lab Services LLC (Elite) and its owners, Gerard and Suzanne Dengler, reportedly settled claims brought under the False Claims Act (FCA) by plaintiff Karen Malcolm. The Denglers admitted that from approximately 2010 to 2014 they submitted inflated employee mileage claims to Medicare and billed the government health agency knowing it does not pay for mileage claims in excess of actual miles driven.

According to court documents, the defendants employed phlebotomists who traveled around East Texas to collect blood samples and transport those samples back to Elite for lab services. For several years, the defendants at Elite knowingly submitted or caused to be submitted inflated mileage calculations beyond the actual distances driven by the employees.

The Whistle Blower.

In 2014, the whistle blower Malcolm, filed the suit alleging that Elite had defrauded Medicare. She claimed that she approached the Denglers in the spring of that year to voice concerns about the billing practices, but the issue was not corrected. She then resigned from the company as a result. The U.S. Attorney’s Office revealed that the government intervened in the suit for purposes of the settlement.

In an agreed final judgment, the parties said that the defendants relinquished and waived all right and title to more than $2.5 million in cash held in a collection of several financial accounts and sales of real property that they owned to satisfy the settlement in the instant case.

As a result of the deal, Malcolm will receive a 21 percent share of the recovery, totaling $787,500, authorities said.

Medicare and Medicaid fraud cases brought on by whistleblowers are unfortunately becoming more common. To read about the serious repercussions of cases like this, click here to read one of my prior blogs.

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 whistle blower/qui tam cases, in which we represent the person who files the claim, as well as in defending them in certain cases.

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

Sources:

Wolf, Alex. “East Texas Lab Pays $3.75M For Falsified Medicare Billing.” Law360. (December 14, 2016). Web.

“Tyler lab, owners to pay $3.75 million for filing false Medicare claims.” Longview Business Journal. (December 14, 2016). Web.

“East Texas lab company, owners to pay $3.75M for false Medicare claims.” KLTV-ABC. (December 14, 2016). Web.

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: False Claims Act (FCA) attorney, legal representation for submitting false claims to the government, defense attorney, Medicare false claims defense lawyer, allegations of false billing, Medicare and Medicare fraud investigation defense attorney, consumer reports of false claims, Medicare audit defense lawyer, health care fraud defense attorney, whistle blower attorney, qui tam defense lawyer, legal representation for whistle blower suits, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, qui tam relator’s attorney, qui tam defense attorney, Florida whistle blower case, Virginia Whistle blower case, Colorado whistle blower case, Louisianan Whistle blower case, complex healthcare litigation 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 © 2016 The Health Law Firm. All rights reserved.



DOJ Releases 2016 False Claims Act Recovery Statistics: Third Highest Annual Recovery Ever

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, the U. S. Department of Justice (DOJ) released its annual False Claims Act (FCA) recovery statistics. It revealed that the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2016. What this indicates to me is that, if all of these cases had been brought by individual relators, those relators could have shared in as much as $1.41 billion as their personal reward for the relator’s part of the recoveries. A whistle blower can receive up to 30 percent of the amount warded to the government, plus all attorney’s fees and costs, for bringing a successful False Claims Act case.

The Third Highest Annual Recovery.

Based on these statistics, 2016 took its place as the third highest annual recovery since the FCA was established in the 1800s. The fiscal year average jumps to nearly $4 billion since fiscal year 2009, and the total recovery during that period to $31.3 billion.

“Congress amended the False Claims Act 30 years ago to give the government a more effective tool against false and fraudulent claims against federal programs,” said Mizer. “An astonishing 60 percent of those recoveries were obtained in the last eight years. The beneficiaries of these efforts include veterans, the elderly, and low-income families who are insured by federal health care programs; families and students who are able to afford homes and go to college thanks to federally insured loans; and all of us who are protected by the government’s investment in national security and defense. In short, Americans across the country are healthier, enjoy a better quality of life, and are safer because of our continuing success in protecting taxpayer funds from misuse.”

Fraud in the Health Care Industry.

The DOJ recovered $19.3 billion in health care fraud claims from January 2009 to the end of fiscal year 2016. Additionally, 57 percent of the health care fraud dollars recovered in the 30 years since the 1986 amendments to FCA claims. Most of the false claims actions are filed under those whistle blower, or qui tam, provisions. Whistle blowers filed 702 qui tam suits in fiscal year 2016, and the DOJ recovered $2.9 billion in these and earlier filed suits in 2016. The government awarded the whistle blowers a total of $519 million during the same time period.

Click here to read the DOJ’s press release in full.

These DOJ fraud recoveries restore valuable assets to federally funded programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families.

To read more on the importance of preventing health care fraud, click here to read one of my prior blogs.

If you find yourself at the center on an audit or investigation for health care fraud, don’t wait until it’s too late. Contact an experienced health law attorney. To find out how The Health Law Firm can help you, click here.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or 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:

Richardson, Kalie. “DOJ Announces $4.7 billion in False Claims Act Collections – $2.5 billion in Health Care Alone.” AHLA Weekly. (December 15, 2016). Web.

Sheppard Mullin Richter & Hampton LLP. “DOJ Releases its 2016 False Claims Act Recovery Statistics.” The National Law Review. (December 15, 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: Florida health law defense attorney, qui tam defense lawyer, legal representation for allegations of health care fraud, legal representation for health care fraud investigations, health care fraud defense attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud investigation defense attorney, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA suit, legal representation for submitting false claims to the government, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, The Health Law Firm reviews, Reviews of The Health Law Firm attorneys, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties 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 © 2016 The Health Law Firm. All rights reserved.

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

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 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

 

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Sources:

Kennedy, John. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 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.

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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 © 2016 The Health Law Firm. All rights reserved.