Justia Lawyer Rating
AV Preeminent
Super Lawyers
The Florida Bar
AVVO Reviews
AVVO Clients' Choice
AVVO Rating

Patient brokering is against the law.  Before you or someone you know enters into an arrangement to be paid for sending patients or residents for treatment, beware!  There are very specific laws prohibiting patient brokering and violating them can land someone in prison for a very long time!

Please be familiar with the Florida and federal statutes prohibiting patient brokering.  The Florida anti-patient brokering statute is below.  In a future post, I’ll share the federal statute.

Patient-Brokering_01-e1593038122280
Florida Statute §817.505. Patient brokering prohibited; exceptions; penalties

On June 4, 2020, an indictment was unsealed in Tampa at the U.S. District Court for the Middle District of Florida charging four Florida men with among other crimes, conspiracy to defraud the United States and paying or receiving health care kickbacks.

The charges arise out of the defendants’ participation in a multi-million dollar conspiracy aimed at defrauding TRICARE, the health care benefit program of the U.S. Department of Defense that provides health care coverage for active duty service members, the National Guard and Reserve members, retirees, their families and survivors.

compounding-service-940x600-1-300x191The indictment alleges that the co-conspirators owned and operated Florida Pharmacy Solutions Inc. (FPS) aimed at targeting TRICARE beneficiaries. Florida Pharmacy Solutions submitted claims to TRICARE for expensive prescription drugs that were specially compounded for beneficiaries, but were not prescribed legitimately, and were generated by paying illegal bribes and kickbacks.  The indictment alleges that the defendants submitted claims to TRICARE of more than $54 million for compounded drug prescriptions and that TRICARE paid out roughly $41 million to FPS.

telemed-300x167Having recently written here about “target letters,” I thought it would be helpful to discuss what happens in a fairly garden variety Medicare prosecution.  A few weeks back, a Florida man who the owner of a durable medical equipment company was charged in federal court in Savannah, Georgia, for his involvement in a Medicare kickback and telemedicine conspiracy.

Patrick Wolfe of Belleair Beach, FL, was accused in an information (a charging document that substitutes for a grand jury indictment) of conspiring to pay kickbacks for “leads,” which as it turns out were not actually “leads” at all.  The so-called “leads” were signed orders from nurse practitioners and doctors, which were then submitted to Medicare Part B and Medicare Part C for payment through Wolfe’s DME Georgia based company, Wilmington Island Medical Inc.  Reading the information lays out how the scheme operated.

Apparently, the feds have been on to Wolfe for a while.  In fact, Wolfe is the 25th defendant who has been charged in a far reaching telemedicine conspiracy arising out of “Operation Brace Yourself” and “Operation Double Helix” as part of the largest Medicare fraud ever prosecuted in the Southern District of Georgia.  As is so often the case, I would say that other defendants looking to cut a deal with prosecutors in hopes of lessening their sentence by way of earning a §5k1.1 motion for downward departure or a Rule 35 motion reduction of sentence probably fingered Wolfe as someone who was paying kickbacks for bogus leads.

Your day started out just like every other day.  You go through your typical daily routine.  Over a cup of coffee, you check the headlines for the latest news.  A plane has crashed leaving no survivors while expectant loved ones morn them when they learn of the tragedy.  The president tweeted something outlandish once again that makes you scratch your head that has drawn him yet another heavy dose of criticism.  Some famous Hollywood actor or producer has been accused of groping an up and coming starlet who is suing him for a small fortune.  A priest has been excommunicated after years of sexual abuse that the diocese claimed to not know about and tried to sweep it under the carpet.  A crazed husband commits a murder-suicide after being served with divorce papers.   You read through your email and reply as necessary.

Target-letter-2-300x188As the day rolls on, things are pretty predicable.  The mail gets delivered.  You throw away the junk mail, then you see it.  Your heart skips a beat.  It’s a letter from the local U.S. Attorney’s Office.  It’s addressed to you.  You start to shake and your hands tremble as you tear open the envelope and begin to read.

Dear Mr. / Ms. So & So:

BigStock_KickBackTypically, when I meet with clients for the first time, it never ceases to amaze me that they have little or no idea what constitutes Medicare fraud is and didn’t know they couldn’t be doing the things they were doing.  So, I decided to write this post to give a primer to explain: what is Medicare Fraud?

For those who are working in the medical field, whether they are doctors, corporate owners of medical practices, pharmacists, pharmacy owners, lab owners, durable medical equipment business owners, just to name a few, it can’t be overemphasized that it is essential to be familiar with the basics of Medicare fraud.

With this in mind, I want to make sure you are informed about how someone can get themselves in trouble. In general, Medicare fraud refers to submitting a false claim in a Medicare beneficiary’s name to a governmental sponsored health care program for reimbursement.

Owner of “Serenity Ranch Recovery” Found Guilty in $38 Million Fraud Scheme

PGPd-1-300x144Fort Lauderdale, Florida (March 2020) – After a six-week jury trial Sebastian Ahmed42, of Delray Beach, Florida, was convicted of conspiracy to commit health care fraud and wire fraud, five counts of health care fraud, conspiracy to commit money laundering, and eleven counts of money laundering.  According to the U.S. Attorney’s Office, the co-conspirators took advantage of and exploited vulnerable drug addicts, the most of whom were only 18 to 26 years old; falsified paperwork; and entered into various kickback arrangements, so that they could pocket millions of dollars of falsely and fraudulently obtain fund for their own personal use and benefit.  Out of all the co-conspirators, Sebastian Ahmed profited the most, netting more than $2.8 million in just less than a three year period.

Sentencing is scheduled for August 6, 2020.  As for the health care fraud and wire fraud conspiracy and money laundering conspiracy convictions, Amhed defendant faces a statutory maximum of 20 years in prison per count.  As to the health care fraud and money laundering convictions, Amhed faces an additional maximum statutory sentence of 10 years in prison.

Corrupt-doctorIn a nutshell, the federal Anti-Kickback Statute and Stark Law make it a crime with serious penalties for providers of medical services to pay or accept any form of remuneration such as kickbacks or anything of value in exchange for receiving referrals of patients who obtain medical treatment paid by government healthcare programs including Medicare and Medicaid, and from entering into certain kinds of financial relationships.

The Anti-Kickback Statute and the Stark Law are designed to keep medical treatment decisions independent from any influence of possible financial gain. The Anti-Kickback Law and the laws prohibiting other unlawful financial arrangements are designed to prevent healthcare providers from referring patients for healthcare services that are not medically necessary.

The Department of Justice has declared that, “[p]atients are entitled to be sure that the care they receive is based on their actual medical needs rather than the financial interests of their physician.”

TRENTON, NJ (Nov. 22, 2019) Kenneth Sun, M.D., 58, of Easton, PA, pleaded guilty to one count of conspiracy to defraud the United States and to pay and receive health care kickbacks in U.S. District for the District of New Jersey.

Subsys-300x300Sun admitted that from 2012 to 2016, he conspired to solicit and receive more than $140,000 in bribes and kickbacks from Insys Therapeutics, a pharmaceutical company headquartered in Arizona, in exchange for him prescribing more than 28 million micrograms of Subsys, a powerful opioid narcotic that is designed for rapid entry into a patient’s bloodstream by being sprayed under the tongue.

Subsys contains fentanyl, a synthetic opioid pain reliever that is approximately 50 to 100 times more potent than morphine.  The U.S. FDA approved Subsys solely for the “management of breakthrough pain in cancer patients who are already receiving and who are tolerant to around the clock therapy for their underlying persistent cancer pain.”  Dr. Sun admitted that he broke the law when he prescribed Subsys to patients for whom Subsys was completely medically unnecessary, not eligible for insurance reimbursement and unsafe.

Housecalls.jpgDETROIT, MI (March 5, 2014) – Jose Mercado-Francis, 60, a former Detroit-area physician pleaded guilty today in the U.S. District for the Eastern District of Michigan to one count of conspiracy to commit health care fraud in violation of 1371 for his role in an $11.5 million health care fraud scheme.

Even though Mercado-Francis’ medical license had been revoked and he was not licensed to practice medicine in Michigan, that didn’t stop him. Mercado-Francis admitted in his plea agreement that, from September 2009 and through February 2012, he held himself out to the public as a licensed medical doctor and claimed to provide physician home health services to Medicare beneficiaries.

Court documents allege that Mercado-Francis prepared medical documentation that licensed physicians signed as if they had actually provided services to Medicare beneficiaries, when, in fact, no such services were provided. The phony health services were then submitted to Medicare as if licensed physicians had performed them.

On December 16, 2014, a Houston psychiatrist was arrested on charges related to her alleged participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment.

Sharon Iglehart, 56, of Houston, was charged in the U.S. District Court for the Southern District of Texas by indictment with one count of conspiracy to commit health care fraud and four counts of health care fraud. According to preliminary calculations, the United States Sentencing Guidelines call for a sentence that is more than twice the maximum penalty of 10 years in prison that can be imposed on each count. Without taking Dr. Iglehart’s role in the conspiracy into consideration, the guidelines call for a sentence in the range of 235-293 months.

According to the indictment, Iglehart is alleged to have participated in a scheme to defraud Medicare that started in 2005 and continued until May 2012. Iglehart is accused of having caused the submission of false and fraudulent claims for partial hospitalization program (PHP) services to Medicare through Houston’s Riverside General Hospital. A PHP is a form of intensive outpatient treatment for severe mental illness.

Contact Information