About thehealthlawfirm

The Health Law Firm was established in 1999, bringing together a team of top attorneys with decades of experience in the legal and healthcare fields. Based in Orlando, Florida, the firm provides legal representation for healthcare providers. The services we provide include reviewing and negotiating contracts, business transactions, defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, opinion letters, commercial litigation, covenants-not-to-compete, restrictive covenant litigation, incorporation, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, Board of Dentistry cases, Department of Health investigations, pain management and pain medicine physician defense, pain management clinic defense, Zone Program Integrity Contractor (ZPIC) audit defense, Recovery Audit Contractor (RAC) audit defense, Medicaid Fraud Control Unit (MFCU) defense, Medicaid Fraud Control Unit (MFCU) search warrant and subpoena defense, Department of Health (DOH) subpoena defense, representation in clinical privileges hearings, representation before the Education Commission for Foreign Medical Graduates (ECFMG), National Board of Medical Examiners (NBME) representation, United States Medical Licensing Examination (U.S.M.L.E.) challenges and representation, all types of commercial and business litigation, administrative hearings, negotiation of contracts and other matters of Health Law and legal representation of health care professionals.

Former Pharmaceutical Sales Rep to Serve 70 Months in Prison for Part in $13M Oxycodone 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 March 24, 2017, a federal judge in the U.S. Southern District of Florida in Miami sentenced a former pharmaceutical salesman to nearly six years in prison for his part in a $13 million money laundering scheme. The scheme involved more than two million oxycodone pills, which the salesperson allegedly helped supply to pain clinics by falsely telling pharmaceutical wholesalers that the clinics weren’t “pill mills.”

U.S. District Judge Beth Bloom, sentenced Jonathan Sendor to 70 months in prison after he pled guilty in January 2017 to one count of conspiracy to commit money laundering. Sendor was essentially working as a broker between wholesale pharmaceutical suppliers and pain clinics attempting to procure a supply of oxycodone for patients of pill mills.
The Scheme.

According to prosecutors, Sendor and two co-conspirators operated six pain clinics in Florida between March 2010 and June 2011. The co-conspirators operated the clinics to ensure that the maximum amount of oxycodone would be prescribed without a legitimate medical need, and purely for the sake of profit. The six clinics dispensed and distributed more than two million oxycodone pills before they were caught and shut down in 2011. The clinics made roughly $13.5 million from the unlawful prescriptions, according to the U.S. Department of Justice.

Sendor helped the pain clinics receive a steady supply of the drug through the wholesalers, prosecutors alleged. For his part in the scheme, Sendor allegedly created multiple companies, building on the connections he had formed as a pharmaceutical salesman. He then proceeded to act as a “quasi-broker” between the doctors of the pain clinics needing the oxycodone and the wholesalers distributing the drug.

Sendor was able to mislead wholesale pharmaceutical companies and told them that he would function as an inspector. It is alleged that he conducted fake inspection visits to the pain clinics and required the clinics’ doctors to complete a survey. When the surveys were completed, he misrepresented the results and advised the doctors, pain clinic managers, owners and other co-conspirators to lie on the survey form.

In 2010, Florida Attorney General Pam Bondi helped pass legislation banning doctors from dispensing narcotic medications out of their office. After the law changed, Sendor then assisted in the opening of two pharmacies – one in Boca Raton and another in Orlando, Florida. Patients of the six pain clinics were then directed to these pharmacies for oxycodone.

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

To learn more about the pill mill problem in Florida, click here to read one of my prior blogs.

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, dentists, pharmacists, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, 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. 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.

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:

Lincoff, Nina. “South Florida pain clinics tied up in $13M money laundering conspiracy.” South Florida Business Journal. (January 17, 2017). Web.

Posses, Shayna. “Sales Rep To Serve 70 Months For $13M Oxycodone Scheme.” Law360. (March 24, 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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for prescription drug abuse, Drug Enforcement Administration (DEA) cases, legal representation for DEA investigations, Prescription Drug Monitoring Program, legal representation for schemes to over-prescribe narcotics, legal representation for schemes to traffic narcotics, pill mill defense attorney, legal representation for doctor shopping, legal representation for pill mills, legal representation for pharmacists, legal representation for pharmacies pharmacy defense attorney, pharmacist defense attorney, administrative hearing attorney, DEA defense attorney, Department of Health investigations, legal representation for DOH investigations, DOH investigation defense attorney, prescription drug crackdown, Florida prescription drug abuse, prescription drug trafficking, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

3 Sentenced in Florida for $175 Million Drug Compounding Fraud Scheme

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

On March 24, 2017, three participants were sentenced in Florida federal court, for a scheme that used call centers and kickbacks to generate fake prescriptions for compounding pharmacies. The scheme was able to scam the government and private insurers for $175 million.

U.S. District Judge Daniel T.K. Hurley, sentenced one of the defendants, Todd Stephens, to ten years. He sentenced Todd Hanson to eight years and one month. He sentenced Christopher Mucha to 30 months in prison. Each defendant also received three years of supervised release (probation) after they are released from prison.

Illegal Enterprise.

Stephens, Hanson and Mucha were among 16 defendants the federal government charged in September 2016. The U.S. Department of Justice (DOJ) described an extensive enterprise that operated from 2013 to 2015. According to the DOJ, the enterprise controlled numerous stops along the supply chain, including the selection of ingredients for compounded drugs, solicitation of patients for unnecessary prescriptions, and funneling of kickbacks to “corrupt physicians.”

To learn more about the defendants being charged, click here.

According to prosecutors, the participants purchased pharmacies that functioned as fronts for the illegal conduct and held licenses that made the operation possible. Specific drugs were chosen and produced by the pharmacies based on the amount of money reimbursed by the military health care program TriCare, as well as other private insurers. More than $175 million was eventually paid out in false claims, prosecutors alleged.

Key Component of the Scheme.

The defendants used call centers as a major part of the scheme to generate bogus prescriptions. The call center staff obtained information on potential patients, including military veterans, who had previously been prescribed medications. They then proceeded to contact the patients to convince them to authorize the faxing of the medically unnecessary prescriptions to doctors’ offices.

A group of “corrupt” physicians would then issue prescriptions for compounded medications for the patients regardless of the absence of medical necessity. It was alleged that this was done in exchange for illegal compensation to the doctors such as cash, gift cards and free consulting. The defendants disguised the illegal payments as reimbursement for “data collection.” These were allegedly distributed through a phony software company called ClinicalCorp LLC, prosecutors said.

To read the sentencing memorandum in full, click here.

To read about a similar health care fraud case involving TRICARE, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Pharmacists, Pharmacies, and Other Health Care Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes pharmacists, pharmacies, physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

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

Sources:

Hale, Nathan. “3 Sentenced In Fla. For $175M Health Care Fraud Scheme.” Law360. (March 24, 2017). Web.

McMahon, Paula. “Feds charge 16 in massive $175M prescription cream fraud based in South Florida.” Sun-Sentinel. (September 1, 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 allegations of violating Anti-Kickback Statute, TRICARE false claims legal defense attorney, TRICARE physician representation, pharmaceutical fraud lawyer, compounding pharmacy attorney, legal representation for military physicians, fraudulent practices of pharmaceutical companies, financial interest in physician referrals, TRICARE fraud attorney, compounding pharmacy lawyer, 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, Health care fraud defense attorney, legal representation for health care fraud, legal counsel for allegations of health care fraud, AKS defense attorney, False Claims Act (FCA) defense attorney, legal representation for FCA claims, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for DOJ investigations, DOJ investigation defense attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Finding an Attorney/Lawyer Who Takes Healthcare Providers Service Organization (HPSO) Insurance for Pharmacists and Pharmacies

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

We often hear from callers and clients in professional licensing complaints, Department of Health investigations and Board of Pharmacy cases, that they had good insurance coverage with Healthcare Providers Service Organization (HPSO) Insurance, but could not find an attorney that would accept it. Often these professionals retain us after action has been taken to appeal or attempt to reverse an adverse disciplinary action taken against their license.

This should not be a difficult task. Our firm and its attorneys have accepted HPSO Insurance for over 25 years.

Our firm has attorneys that are licensed in and can defend pharmacies and pharmacists in Florida, Colorado, Louisiana, Virginia and the District of Columbia. Additionally, there are many states, such as Tennessee, Georgia, Oregon, Pennsylvania, New York, Delaware, and others, which allow us to appear before their boards and represent clients in these state under their “multi-jurisdictional practice” rules, because this is an area in which we routinely practice.

Legal areas in which we can represent an HPSO insured that HPSO will pay for include: administrative hearings, complaints against a professional license, an investigation of a complaint made against your professional license, a deposition you may be subpoenaed for, a complaint made for violation of HIPAA or patient privacy, and many others.

Regardless of the state, contact us at:

The Health Law Firm, Main Office
1101 Douglas Ave.
ALtamonte Springs, FL 32714
Phone: (407) 331-6620
Fax: (407) 331-3030
Website: http://www.TheHealthLawFirm.com
Internet Contact: http://www.TheHealthLawFirm.com/contact-us/

One last word, regardless of whether you are covered by HPSO Insurance or not, if an investigator contacts you to obtain a statement from you, whether orally or in writing, always, always, always, consult with an experienced attorney in this area BEFORE giving any statement or talking to the investigator about anything.

Contact Health Law Attorneys Experienced in Representing Pharmacists, Pharmacies, and Other Health Care Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes pharmacists, pharmacies, physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

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: Legal representation for pharmacists, legal representation for pharmacies, Board of Pharmacy investigation defense attorney, pharmacy and pharmacist defense attorney, legal counsel for Board of Pharmacy investigations and hearings, health care professional defense attorney, legal representation for medical professionals, Florida HPSO health law attorneys, legal representation for cases dealing with HPSO insurance, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida health law attorney, legal represenation for administrative hearings, legal representation for complaints against a professional license, licensure defense attorney, legal representation for a complaint made for violation of HIPAA or patient privacy

“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

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.

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