Florida Gov. Rick Scott Makes Changes to Florida Impaired Practitioners Program

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On May 31, 2017, Florida Governor, Rick Scott, signed into law House Bill 229 (Ch. 2017-41, Laws of Florida), which made changes to the statutory basis for Florida’s impaired practitioner programs. The impaired practitioner program for nurses in Florida is the Intervention Project for Nurses (IPN), which is a for-profit corporation, The impaired practitioner program for doctors, dentists, pharmacists, optometrists, and all other licensed health professionals is the Professionals Resource Network (PRN), a non-profit corporation.

The program, as envisioned in the statute, is designed to assist health care practitioners who are impaired as a result of the misuse or abuse of alcohol or drugs, or of a mental or physical condition, which could affect the ability to practice with skill and safety.

Revisions to the Program.

The new law requires DOH to establish terms and conditions of the program by contract, provides contract terms, requires DOH to refer practitioners to consultants and revises grounds for refusing to issue or renew license, certificate, or registration in health care professions.

A significant change in the program involved a licensee’s duty to report colleagues that have or are suspected of having an impairment. The new law creates an exception to the mandatory reporting of an impairment to the DOH. The new revision will allow a licensee who knows that a person is unable to practice with reasonable skill and safety due to an impairment, to report such information to the consultant, rather than DOH. Both the core licensure statute and individual practice acts are amended to include this language.

Be sure to check Florida’s DOH website regularly for news and updates, here.

To learn more about how The Health Law Firm can help you with matters involving the DOH, click here.

If You Are Instructed to Contact IPN or PRN, Call an Attorney First.

If you are ever instructed by your employer or anyone else to report yourself to the Intervention Project for Nurses (IPN) or to the Professionals Resource Network (PRN), consult with an experienced health law attorney first. There are many problems that you can avoid by having good legal advice before you make a stupid mistake. We are often consulted and retained by clients when after they have made mistakes in talking to the wrong people about the wrong things and are in a situation they could have avoided.

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, 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 impaired physicians and other health professionals in Professional Resource Network (PRN) and disruptive physician matters.

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

“Changes to Florida Reporting for Impaired Practitioners.” Holland & Knight LLP. (June 7, 2017). Web.

Mckown, Mia. “Changes to Florida Reporting for Impaired Practitioners.” Lexology. (June 7, 2017). Web.

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

KeyWords: Legal representation for impaired physicians, Legal representation for Department of Health (DOH) investigations, Intervention Project for Nurses (IPN) attorney, Professionals Resource Network (PRN) defense legal counsel, DOH investigation defense attorney, legal representation for investigations against health care professionals, legal representation for Florida DOH investigations, Florida DOH representation, DOH complaint defense, legal representation for DOH complaint, Florida impaired practitioners program, legal representation for PRN matters, legal representation for IPN matters, legal representation for disruptive physician issues, health law defense attorney, legal representation for health care professionals, changes to Florida impaired practitioners program, legal representation for health care investigations, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, 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.

 

Medical Students, Interns & Residents Beware: A Finding of “Irregular Behavior” Can Ruin Your Medical Career Before it Starts

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

A medical student, intern or resident may receive a letter from the National Board of Medical Examiners (NBME), United States Medical Licensee Examination (USMLE) Secretariat advising them that they are suspected of “irregular behavior” on a Step examination. In the case of graduates of foreign medical schools, this will be a letter from the Educational Commission for Foreign Medical Graduates (ECFMG). Although “irregular behavior” is not the same thing as “cheating,” it is often thought of as the same by medical school officials and residency program directors.

A notice of irregular behavior may delay your entry into a residency program, your graduation from medical school and your potential job opportunities. Your examination scores will be held up while the matter is investigated until a Committee review or hearing can be held.

It is imperative that anyone accused of irregular behavior immediately consult with legal counsel experienced in such matters. At The Health Law Firm, we have represented a number of medical students, interns and residents in hearings on irregular behavior and we have consulted with many before on these matters.

Don’t Listen to Bad Advice.

The following are examples of erroneous advice we have heard was given to those accused of irregular behavior:

1. You shouldn’t have a lawyer represent you in such matters because this will make the Committee angry at you.

2. You don’t need a lawyer because you can just explain it yourself.

3. You just write a statement and explain it; the Committee will understand and find in your favor.

4. You do not need to request a hearing on it because if you submit documents, the Committee will review them, find in your favor and no hearing will be necessary.

5. If you request a hearing on the matter, you do not need to attend it in person.

6. If you request a hearing, an attorney is not allowed to represent you at the hearing.

7. You should not worry about the Committee finding against you because you can always appeal the finding or sue in court.

The above advice is wrong. The only advice you should listen to is the advice of an attorney who is experienced in handling matters of irregular behavior.

The Importance of Retaining Experienced Legal Defense.

The biggest problem faced by an individual accused of irregular behavior who does have a valid defense is to concisely and adequately explain the situation. Additionally, you must produce evidence that supports what you are saying.

Someone who is not trained in the legal profession and who is not familiar with such hearings will be unfamiliar with the process even though such hearings are not as formal as court hearings. Additionally, it is easy for a non-lawyer who is not familiar with the rules of the USMLE to fail to address those concerns and get side tracked on irrelevant matters.

Additionally, documents, statements, affidavits, expert witness reports and other documents presented to the Committee as evidence should be well organized, indexed, with a table of contents, pages numbered and summarized. This will better present an organized, easily understood defense. Sending in a few stray documents with no organization or explanation how the documents relate to the issues can be far less than effective.
Consequences of an Irregular Behavior Finding.

If a finding of irregular behavior is made against you, then this usually means that your best score is voided and you must retake it. The Committee may require you to wait a year or more to retake the examination. This can prevent you from obtaining or entering a residency program or it may delay you from graduating. Furthermore, the notation that you were found to have committed irregular behavior will be placed on your Step exam transcript. This will be reported out when your test scores are reported.

As indicated above, many medical decision makers view this as similar to cheating. It may disqualify you for many jobs or residency programs that you would otherwise be considered for.

If the time and money you have spent on your medical career is valued by you, you will act promptly to retain legal counsel experienced in USMLE hearings and procedures to represent you. You wouldn’t perform surgery on yourself. You shouldn’t attempt to represent yourself in such legal matters.

The takeaway message is that retaining an attorney to represent you against irregular behavior allegations could be the difference between a clear record and a mark that will follow you for the rest of your career. Don’t risk jeopardizing your future as a healthcare practitioner. Consult with an attorney as soon as you receive notice of allegations against you regarding irregular behavior.

To learn more on the repercussions of findings of irregular behavior, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Matters of Irregular Behavior Today.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in irregular behavior allegations, USMLE issues, academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

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

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

KeyWords: Legal representation for allegations of irregular behavior, legal representation for USMLE investigations, National Board of Medical Examiners (NBME), irregular behavior defense attorney, legal representation for medical students, legal representation for medical residents, United States Medical Licensing Examination (USMLE), Educational Commission for Foreign Medical Graduates (ECFMG), legal representation for USMLE hearings , legal counsel for USMLE appeals, health law defense attorney, ECFMG defense counsel, ECFMG legal representation, ECFMG hearing attorney, medical student attorney, medical resident lawyer, medical intern attorney, legal representation for civil proceeding, legal representation for criminal proceeding, legal representation for administrative proceeding, medical administrative hearings defense attorney, The Health Law Firm, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, USMLE Committee for Individualized Review (CIR) hearing attorney, ECFMG Committee for Individualized Review (CIR) hearing lawyer

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

Jury Convicts Doctor and Medical Billing Company Owner for $28 Million Medicare Fraud Scheme

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 May 1, 2017, a federal jury in Michigan found a Detroit-area doctor and owner of a medical billing company guilty of perpetrating a $28 million health care fraud scheme. The scheme involved billing Medicare for pain treatments that weren’t actually provided, the U.S. Department of Justice (DOJ) said.

Health Care Fraud Scheme.

Dr. Johnny Trotter and Elaine Lovett were both convicted after a four-week jury trial on one count of conspiracy to commit health care and wire fraud and three counts of health care fraud. In addition to the fraud scheme, both Trotter and Lovett also worked to dodge Medicare’s investigation into Trotter, according to the DOJ.

Evidence at the trial showed that between May 2008 and May 2014, both Trotter and Lovett fraudulently billed for services that were never provided. These services were predominantly nerve block injections, which treat pain by numbing groups of nerves.

In 2009, Medicare grew suspicious and began to require that claims submitted by Trotter satisfy a medical review prior to payment pre-payment review). As a result, both Trotter and Lovett conspired to dodge this investigation by starting fake medical centers, according to the prosecution said.

Trotter and Lovett attempted to hide their involvement by recruiting family members and employees to serve as “straw owners” of the companies. Meanwhile, the two fraudsters continued receiving payment for services that weren’t provided, the government said.

To learn more about health care fraud and the repercussions of Medicare fraud, click here to read one of my prior blogs.

Watch our short video blog on Medicare fraud and the audit process here.

Contact a Health Care Attorney Experienced in the Representation of Medicare and Medicaid Fraud.

The Health Law Firm and its attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicare and Medicare investigations, audits and recovery actions.

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. “Jury Convicts 2 Over $28M Medicare Pain Treatment Fraud.” Law360. (May 1, 2017). Web.

“Jury Convicts 2 Over $28M Medicare Pain Treatment Fraud.” Lexis Nexis. (May 1. 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: Medicare audit defense attorney, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare fraud investigation, Medicare Strike Force, legal representation for fraudulent claims, prepayment review attorneys, legal representation for submitting false claims, Medicare overbilling defense attorney, Medicare audit defense lawyer, legal representation for allegations of Medicare fraud, health care fraud defense attorney, Medicare fraud defense attorney, legal representation for Medicare termination, Medicarelegal representation for Medicare exclusion, OIG exclusion defense attorney, The Health Law Firm, 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.

Florida’s Baker Act: What You Need to Know – Part 1

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

At The Health Law Firm, we are frequently consulted by family members of individuals who are erroneously held under Florida’s Baker Act. An erroneous confinement under the Baker Act can occur for a number of different reasons. However, the result is that an independent citizen is confined in violation of his/her constitutional rights to liberty, privacy and the pursuit of happiness.

The Baker Act allows a licensed health professional to order an individual who is a threat to themselves or others because of a mental illness to be involuntarily held. The individual may then be held in certain designated health facilities for up to 72 hours for an initial psychiatric evaluation.

If the psychiatrist examining the confined individual feels that he or she should be held for further evaluation, then he or she can be held up to a week.

 

When to Call a Baker Act Attorney.

Over-cautious physicians, emergency room personnel, school officials, nursing home staff and other authorities may call upon the Baker Act to have those that they suspect may be a danger and have a mental problem involuntarily confined. If they are believed to be a threat, usually that individual may be legally involuntarily confined under the Baker Act. Seniors living on their own and teenagers are often the “victims” of this process.

If the individual being held under the Baker Act is not really a threat to themselves or others and the facility will not agree to release them, this is the time to call an attorney. Mistakes often occur as health personnel, school administrators and law enforcement personnel do not want to take the chance of someone committing suicide or killing others.

Factors that may indicate the person should not be held under the Baker Act include:

1. No prior history of mental illness or Baker Acts.
2. Supportive family/friends in the immediate area.
3. Acts/statements made not truly a threat to self or others.
4. Regular treating physician or health care personnel in area.
5. No current signs of mental illness.

 

Examples of abuses of the Baker Act that can occur:

1. Individuals who do not have a mental condition and do not meet the basic criteria for the Baker Act may be involuntarily confined and deprived of their freedom.

2. Children are involuntarily confined at facilities that are not really set up to take care of the medical and mental health needs of children.

3. Because of overcrowding, the person is taken to or transferred to a facility far away from his or her home, family and friends.

4. A person who has other medical problems or chronic medical problems (especially true with the elderly) is confined in a Baker Act facility and is unable to receive regular medical care or attend scheduled appointments with their regular treating physicians.

5. A person who is taking one or more prescriptions for medical problems will not be allowed to take them while confined in the Baker Act facility. This can lead to a deterioration of the person’s medical condition.

6. If the person has a regular psychiatrist or therapist, that person is not allowed to see or treat the person where he or she is confined because the therapist is not on the medical staff of the Baker Act facility.

7. If the person has a regular psychiatrist or therapist, that psychotherapist is, most often, not spoken to or consulted by the psychiatrist or staff of the Baker Act facility, even though the regular treating psychotherapist may know far more about the confined patients condition than anyone else.

8. An individual may be confined in a facility in which one or more dangerous patients are also confined. Our clients have reported assaults and sexual molestation which have occurred at such facilities when they were confined involuntarily under the Baker Act.

9. It has been reported to us by our clients that it seems if they have good health insurance (or Medicare) then they are kept longer because the insurance company (or Medicare) is paying the hospital for the inpatient stay, which can be a large amount of money.

10. Sometimes the family is located in another state and merely wants to have the person released so he or she can be taken where they are so the family is better able to support their needs.

Examples of How The Health Law Firm Can Help.

We often receive calls from the husband, wife, parents, children or friends of individuals who have been confined involuntarily to a mental facility. Often, we are called on to respond urgently to obtain the release of someone who may have been incorrectly confined to a mental institution without their consent.

Occasionally, we assist in cases in which the family may be located in another state and the patient is located here in Florida. Often, we are able to obtain a prompt release of the confined person in cases in which the basic requirements for an involuntary confinement under Florida Law do not exist and the patient should not have been confined.

We have been involved in working on an expedited basis with the hospital, mental institution or court to obtain the release of individuals who should not be confined or who desire to be released into the custody and care of their family or back to their own independence.

For a sample of an Emergency Petition for Write of Habeas Corpus we prepared with its supporting documentation, and which contains citations to the appropriate legal authorities, click here.  A Memorandum of Law (legal brief) in support of the Petition for Writ of Habeas Corpus is also included with it.

The Baker Act Is Not a Bad Thing.

We realize that the Baker Act is a good thing. Many people who may have serious mental health issues and fail to obtain treatment, should be involuntarily confined under the Baker Act. Sometimes this is the only way they will ever be treated correctly. Additionally, it is also a good thing that police, deputy sheriffs and other law enforcement officers are receiving training which is now resulting in more Baker Act hospitalizations and fewer arrests. This helps an individual to avoid a serious arrest and possible conviction of a serious offense (giving them a criminal record forever) when they may need only medical treatment for a mental condition.

Check this blog regularly for more on Florida’s Baker Act and the Marchman Act.

Contact Health Law Attorneys Experienced in Handling Victims of Involuntary Confinement Through the Baker Act and Marchman Act.

The Health Law Firm represents individuals, families and friends in challenges to and hearings related to the Florida Baker Act and Marchman Act, when the basic criteria for confinement are not met and there is no medical necessity for further confinement.

Our firm has a process we follow to make sure that a person who should not be held under the Baker Act may be released in a very short time. If the basic criteria for a Baker Act confinement are not present, the person is not required to be held and should be released. If the person has been living independently for decades, has family and a support system available, and has had no prior mental health problems, the odds are he or she should not be involuntarily confined. We act immediately to begin our representation, to make the hospital and its physicians aware that we are representing you, and to take measures to obtain release. If required, we are prepared to file an emergency Petition for Writ of Habeas Corpus with the local Circuit Court to have you brought before the judge for an emergency release hearing. These cases can be time intensive, require a great deal of immediate work, but can yield fast results in most cases.

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

 

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: Baker Act defense attorney, legal representation for Baker Act cases, legal representation for involuntary Baker Act confinement, legal representation for involuntary confinement in hospital, mental health confinement defense attorney, petition for Writ of Habeas Corpus, Baker Act attorney, Baker Act defense lawyer, legal representation for Florida Baker Act, Florida Marchman Act defense attorney, legal representation for Baker Act law, The Health Law Firm, reviews of The Health Law Firm attorneys, The Health Law Firm reviews

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

It is Always a Bad Idea for a Doctor, Nurse or Health Professional to . . . .

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

My experience in representing doctors, nurses and other licensed health professionals in disciplinary cases has lead me to conclude, us to conclude, its is always a bad idea for them to:

1. Write a prescription for any medication for yourself.

2. Start a romantic relationship with a patient.

3. Take someone else’s prescription medication, ever.

4. Write a prescription for or treat a patient, especially a family member, for a condition outside the scope of his specialty (e.g., a dentist prescribing antibiotics to her children to treat a cold; a pediatrician prescribing pain medications for an adult; a dentist writing a prescription for pain medications for a patient’s back paid; an OB/GYN prescribing antidepressants for a male).

5. Write any prescription for or treat any patient who is in another state when the physician is not licensed in that state.

6. Treat or prescribe for any spouse, other family member, friend or colleague, without opening a medical record and fully documenting the treatment or prescription, as you would for any other patient.

7. Hire a patient to work for you in your office or, especially, allow a patient to “volunteer” to work in your office.

8. Pre-sign blank prescriptions for your Physician Assistant, ARNP, Medical Assistant, receptionist, or anyone else, to complete later, or have pre-signed blank prescriptions in your office.

9. Seek psychotherapy or drug/alcohol abuse treatment with a physician or HCP health professional in your own medical group, institution or the staff of your own hospital.

10. Add to, alter or change any medical/dental record entry after you know there may be a claim, investigation or litigation involving it.

11. For a mental health professional (psychiatrist, psychologist, mental health counselor, social worker, psychiatric nurse practitioner) to have any type of social relationship with a current patient.

12. Take and use your own drug samples provided by pharmaceutical companies.

13. Go into a hospital where you do not have clinical privileges and treat or “assist” in treating a patient there, even if it is your own patient.

14. Have a sexual relationship ( including “sexting” or “telephone sex”) with a patient or patient’s immediate family member.

These are actual examples from cases in which I have had to represent licensed health professionals in defending their licenses and attempting to keep their jobs. For each of the above, there have been more than one.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents 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. We represent medical students, interns, residents, and fellows in disputes with their graduate medical education (GME) programs. We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters and other disputes with their employers. We often act as the physician’s personal counsel in medical malpractice litigation.

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

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 health professionals, legal representation for doctors, health law defense attorney, Florida health law defense attorney, Legal counsel for licensure issues, licensure defense attorney, legal representation for suspended or revoked license, legal representation for adverse disciplinary actions, administrative defense attorney, legal representation for investigations and complaints, legal representation for administrative hearings, complaint investigation defense attorney for health care professionals, appeals (and variations on appeal ) of adverse license action, Virginia health law defense lawyer, Louisiana health law defense legal counsel, legal representation for physicians, legal representation for mental health professionals. Colorado health professional defense lawyer, Virginia health law defense counsel, District of Columbia health law legal representation, The Health Law Firm reviews, reviews of 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.

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.

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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.

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.

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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.