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.

 

 

Advertisements

Drug Enforcement Administration (DEA) Agents May Surprise You at Florida Board of Pharmacy Meeting

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 several recent Florida Board meetings, after hearings at which disciplinary cases were considered by the Board, Drug Enforcement Administration (DEA) agents approached the health professional. Even in instances where the pharmacist was represented by an attorney and the attorney was there, the DEA agents confronted the professional involved.

What Were the DEA Agents Trying to Do?

In the cases where The Health Law Firm’s attorneys were there representing clients, the professional received some type of discipline on his or her license. Some of these were Settlement Agreements. The DEA Agent approached the professional and urged the professional to sign a voluntary relinquishment of DEA registration.

It seems that this is happening to professionals where there is some type of serious or long-term discipline is being taken against their licenses, such as long-term probation, suspension or revocation. Also, if the charges against the health professional involved, drugs, over-prescribing, abuse of narcotics, operation of a “pill mill,” selling or illegally dispensing or prescribing narcotics, drug diversion or abuse, being impaired from use of drugs, and other similar misconduct. These are often grounds for the revocation, suspension or revocation of the DEA number.

This action by DEA agents has occurred at Board of Medicine meetings and hearings, Board of Osteopathic Medicine meetings and hearings, Board of Dentistry meetings and hearing and Board of Pharmacy meetings and hearings. If you are a professional who has a DEA registration and number, you are, apparently, fair game.

Don’t Be Surprised; Be Prepared and Don’t Make a Rash Decision.

It is unusual to see federal agents of this type “cruising” state professional board meetings like we have seen lately. But, it seems to make sense, from the DEA’s point of view. If you can take several minutes and convince, surprise or intimidate a health professional into relinquishing his or her DEA registration voluntarily, then you may save the government hundreds of hours of time and thousands of dollars in expenses in having to investigate and have a separate administrative hearing (which the health professional may win), if he or she voluntarily relinquishes the DEA registration.

Immediately consult with an experienced health law attorney who has dealt with the DEA before.

Remember Your Rights; Yes, You Have Rights!

Yes, you do have rights, Constitutional rights. Use them! That is what they are there for.

You have the right to consult with counsel before making a decision. Don’t believe it if a DEA agents tells you that you don’t.

You have the right not to sign any forms or make any statements. Don’t sign anything. Don’t make any statements except for getting the agent’s card and telling them you will have your attorney contact them.

You have the right to take time to consider the matter and consult with others. You do not have to make a decision right away.

The Consequences of Voluntary Relinquishment are Serious and Long-Lasting.

Your voluntary relinquishment are serious and long lasting. It will be treated the same as a revocation of your DEA number. We have consulted with physicians and pharmacists who have never been able to get it back after they relinquished it.

You will probably be terminated from any health insurance panels you are on if this happens.

You will probably have action taken against your clinical privileges if you have clinical privileges at any hospital, nursing home or ambulatory surgical center (ASC).

You may be terminated from the Medicare or Medicaid Program.

There are many other consequences that may result.

Therefore, you and your attorney should be aware that this may happen and you and your attorney should be prepared if it does happen.

For more tips on how to prepare, click here to read my prior blog.

Don’t Wait Too Late; Consult with an Experienced Health Law Attorney Early.

Do not wait until action has been taken against you to consult with an experienced attorney in these matters. Few cases are won on appeal. It is much easier to win your case when there is proper time to prepare and you have requested a formal hearing so that you may actually dispute the facts being alleged against you.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing pharmacists, pharmacies and pharmacy technicians in investigations and at Board of Pharmacy hearings. Call now or visit our website 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: Administrative hearing attorney, representation for administrative hearings, administrative complaint defense attorney, Board of Pharmacy representation, Board of Pharmacy attorney, Board of Pharmacy defense attorney, representation for Board of Pharmacy investigations, representation for Board of Pharmacy complaints, DEA hearing defense attoreny, DEA investigation attorney, DEA hearing representation, DEA investigation representation, pharmacist attorney, health care professional defense attorney, representation for health care professionals, professional licensure defense attorney, professional licensure representation, licensure defense attorney, representation for licensure issues, representation for pharmacists, representation for pharmacies, pharmacy attorney, review 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.

 

 

 

 

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.

Key Words: Medical and recreational marijuana use, legal counsel for medical marijuana, medical marijuana defense attorney, legal representation for medical marijuana growers and distributors, expanding marijuana industry in Florida, medical marijuana growers and distributors, expanding marijuana industry in Florida, medical marijuana dispensary defense attorney, The Health Law Firm Reviews, lawyer for medical marijuana growers and distributors, health lawyers for marijuana distributors, medical marijuana lawyer, legal counsel for marijuana industry, approval of Florida Constitution Amendment 2, The Health Law Firm attorney reviews, 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 2017 The Health Law Firm. All rights reserved.

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

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

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

The Whistle Blower False Claims Act (FCA) Suit.

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

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

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

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

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

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

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

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

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

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

Sources:

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

The Associated Press. “Kmart to pay $32.3 million to settle prescription drugs case.” ABC News. (December 22, 2017). Web.

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

KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, pharmacy defense attorney, pharmacist defense attorney, pharmacy defense lawyer, pharmacist defense lawyer, pharmacy defense counsel, pharmacist defense counsel, Board of Pharmacy license defense attorney, Board of Pharmacy license defense lawyer, Board of Pharmacy license defense counsel, FCA defense attorney, 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, complex health care litigation defense attorney, 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 counsel, 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

 

“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.

Mother Files Suit Against Walgreens Over Prescription That Killed Her Son

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 October 31, 2017, an Illinois woman filed suit against Walgreens with a state court suit claiming store personnel gave her incorrect instructions for handling the anti-rejection drugs prescribed to her 3-year-old son. The medication was prescribed to the boy after his heart transplant, and Tatiana Lowe claims Walgreens pharmacy’s error resulted in his death.

The Lawsuit.

Lowe alleged that Walgreens employees insisted on the incorrect instructions even after she said they contradicted previous instructions she’d been given for the drug. Therefore, the drugs did not have their proper effect and her son who went into heart failure and died.

She claimed she and her mother, who was also caring for the boy, were told by both Walgreens employees and the label the employees placed on the medication that tacrolimus was to be kept refrigerated. Additionally, she claims that she questioned the directions and informed the staff that previous tacrolimus prescriptions had come with warnings not to refrigerate it, but that the staff “carelessly and negligently rebuked and misled” her and her mother.

Lowe claimed she followed the directions given by the Walgreen employees, but that because of the refrigeration the drug had “sub-therapeutic and unreasonably dangerous effects,” resulting in heart failure.

At said time, Walgreens knew or should have known that tacrolimus must be mixed with the proper ingredients and stored at room temperature in order to provide the anticipated efficacy and beneficial anti-rejection effects to organ transplant patients such as Albert Dobbins,” the complaint said.

To read the complaint filed in this case, click here.

To learn more and read about another case of pharmacy negligence that lead to a patient’s death, 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.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing physicians in investigations and at Board of Medicine and Board of Osteopathic Medicine hearings. We represent physicians accused of wrongdoing, in patient complaints and in Department of Health investigations.

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

Sources:

Archer, Rick. “Walgreens Hit With Suit Over Prescription That Killed Child.” Law360. (October 31, 2017). Web.

Grossman, Dan. “Family sues Swedish Medical over death of son.” 9 News. (December 22, 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: Medical negligence lawsuit, wrongful death lawsuit, medical negligence defense attorney, wrongful death defense lawyer, legal representation for medical negligence, legal representation for wrongful death lawsuits, legal representation for pharmacists, legal representation for pharmacies, defense attorney for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Louisiana Board of Pharmacy attorney, Colorado Board of Pharmacy defense legal counsel, Virginia Board of Pharmacy defense lawyer, Kentucky Board of Pharmacy defense attorney, District of Columbia (D.C.) Board of Pharmacy lawyer, Louisiana pharmacist attorney, Colorado pharmacist defense legal counsel, Virginia pharmacist defense lawyer, Kentucky pharmacist defense attorney, District of Columbia (D.C.) pharmacist 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

 

U.S. Court in Florida Dismisses Whistleblower’s Complaint Against Nuclear Pharmacy

PS 4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On September 28, 2017, the U.S. District Court for the Middle District of Florida dismissed a relator’s (whistle blower’s) False Claims Act (FCA) complaint against a nuclear pharmacy in Tampa. The court found that the relator failed to plead fraud with the required amount of specificity that the law requires.  The case awas filed against GE Healthcare, Inc.’s nuclear pharmacy.

The Allegations.

GE Healthcare operates 31 nuclear pharmacies in the United States, where it produces radiopharmaceuticals through a process of compounding drugs.  The relator was a board-certified nuclear pharmacist who formerly worked at GE Healthcare, Inc.’s nuclear pharmacy in Tampa, Florida. The relator’s allegations included the manner in which GE compounded and labeled radiopharmaceuticals. More specifically, the whistle blower claimed that GE sold diluted and expired drugs. Additionally, the whistle blower alleged that GE falsely inflated the reimbursement rate for certain drugs by providing false sales data to Medicare.

GE argued that the realtor’s claims should be dismissed pursuant to the FCA’s public disclosure bar because the allegations overlapped with an action filed by a different relator, James Wagel, in 2006. To read about this FCA case, click here.

The Court’s Decision. 

The court found that Sunil Patel’s allegations were not “based on” or “substantially the same as” the allegations in the prior public disclosures. However, the court dismissed the realtor’s claims on another ground:  failing to plead the allegedly fraudulent claims with sufficient particularity. According to the court, the allegations that defendant “presented or caused to be presented” a false claim fell “well short of alleging ‘exact billing data.'”  In other words, the relator failed to plead one or more false claims by giving the specifics, such as date, amount, patient, billing code, amount paid by the government, etc.  The court found that the relator identified no “particular facts about the ‘who,’ ‘what,’ ‘where,’ ‘when,’ and ‘how’ of fraudulent submissions to the government.”

The case is United States ex rel. Patel v. GE Healthcare Inc., No. 8:14-cv-120-T-33TGW (M.D. Fla. Sept. 28, 2017).

Click here to read one of my prior blogs on a similar FCA case involving a pharmaceutical company.

Specifics of the False Claims Are Required for Any Qui Tam Whistle Blower’s Case.

This is one of the biggest short comings we see in potential clients who contact us with information about false claims being submitted by their employers or other healthcare providers.  They do not have the specifics of any single false claim.  Yet the law requires this or a whistle blower’s case can get dismissed by the court outright.  You can do an awful lot of work investigating, pleading and litigating a whistle blower’s case only to have the court dismiss it without its ever getting anywhere near a trial.  Even if a scheme or system is inherently fraudulent, you must be able to show one or more claims that were submitted were actually false claims.

We advise health care professionals who consult us with possible False Claims Act/whistle blowers cases, be sure you have the details, and preferably copies of the documents, that show a false bill was submitted to the government.  This can be a CMS Form 1500 or an explanation of benefits that the patient and the insurer or facility receives back.  Sometimes you can get these form the patient if you do not have access to these from the employer.  But without a false claim and, preferably, a number of false claims, you don’t really have a False Claims Act suit.

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 whistleblower 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 http://www.TheHealthLawFirm.com

Sources:

Fraud and Compliance. “U.S. Court in Florida Dismisses Whistleblower Action Against Nuclear Pharmacy.” AHLA Weekly. (October 6, 2017). Web.

Mayo, Rebecca. “Evidence of likely submission not enough to prove FCA violation.” Wolters Kluwer Health Law Daily. (October 2, 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: Health care fraud defense attorney, legal representation for allegations of health care fraud, False Claims Act (FCA) attorney, FCA defense attorney, False Claims attorney, legal representation for FCA investigations, legal representation for FCA complaints, Whistleblower attorney, Whistleblower defense attorney, legal representation for Whistleblower investigations, legal representation for Whistleblower complaints, qui tam attorney, qui tam defense attorney, legal representation for qui tam cases, legal representation for qui tam investigations, FCA legal representation, relator attorney, relator defense attorney, health law defense attorney, The Health Law Firm, 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.