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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

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.

Health Care Fraud Playing the CardsIt never ceases to amaze me when I am hired to represent a client at sentencing who has just been found guilty of Medicare fraud when they say to me, “You know Mr. Malove, I just didn’t see this coming.”

I don’t know what to tell these clients. At this stage of the game, I must admit that in my mind I wonder how they didn’t at least consider the possibility that a jury wouldn’t believe their version. Almost always I know their trial attorneys, who are among the best of the best. I am sure that these fine lawyers reviewed all of the government’s evidence with their clients and fully laid out the government’s theory of the case.

Yet, despite their attorney’s unequivocal advice to enter into a plea bargain with the government, you have got to wonder why most of these clients went to trial? Was it because the client was so much in denial (not the river in Eqypt) that they simply couldn’t grasp what the government was prepared to prove? Or that that they just couldn’t bring themselves to admit to themselves or to their families that they had fraudulently obtained money from the government that they didn’t legitimately earn? Is it more than just denial? Bravado? Machismo? Whatever it is, one thing for certain – the decision to go to trial in many, if not most, of these cases flies in the face of the statistics. We’ve all heard it before: numbers don’t lie!

TAMPA —

Originally from: http://www2.tbo.com/news/news/2011/oct/28/2/attorney-general-to-speak-on-efforts-to-battle-pre-ar-298876/

Nine doctors and two pharmacists were among 22 people caught in a federal drug sweep today Friday accusing them of illegally peddling prescription drugs.

Criminal Defense and Health Care Fraud Attorney Robert Malove is referenced in this October 16th article that appeared in the Louisville, KY Courier-Journal. Below is an excerpt from that article. Read more below.

Kentucky addicts who travel to Florida for easy access to prescription painkillers are facing new roadblocks — laws targeting rogue pain clinics, a prescription-drug monitoring system and tougher police enforcement.

And while ending Florida’s reign as the unofficial pain-pill capital of America is an uphill fight that is far from won, there are signs of progress. Registered pain clinics in Florida have dropped from 930 last year to 736 now as the state begins to crack down.

Stories Like this Illustrate Why You need a Medicare Fraud Attorney familiar with health care fraud and abuse on YOUR side!

Robert Malove P.A. puts great emphasis on legal issues relating to white collar crime defense and the delivery of professional advice and counsel to health care providers, DMEs, and corporate compliance programs with a clear understanding of the applicable sentencing guidelines for which his Health Care Fraud Blog has received widespread recognition.

With the government dedicating the necessary financial and human resources to prosecuting these types of crimes, you need a Medicare Fraud Attorney familiar with health care fraud and abuse on your side. From his law offices in Ft. Lauderdale and Miami, Florida, Robert Malove provides legal representation to doctors, medical clinics, hospitals, DME providers and other health care companies.

thumb-print.jpgMIAMI, FL – Defendant Ramon Moreira, 82, of Miami, pled guilty today to one count of health care fraud, in violation of Title 18, USC, § 1347. Sentencing has been scheduled for May 17, 2011.
According to court records, the fraud involved false billing of durable medical equipment to the Medicare Program. In March 2007, Moreira became the president of J&G Health Care, Inc., a Miami-Dade County DME company. From February through May 2007, Moreira’s company submitted more than $5 million in false claims to Medicare for, among other items, urinary leg bags. Medicare paid approximately $1 million on these false billings.
Moreira was indicted in 2007 and subsequently fled the U. S. After he found out about the health care fraud charges. He was taken into custody attempting to re-enter the United States at the Port of Miami in late last year.

ekg.jpgThe Associated Press reports that on August 12, Sushil Sheth, a suburban Chicago cardiologist was sentenced to five years in prison for bilking Medicare and insurance companies out of more than $13 million for care never provided.

The 5-year sentence falls short of the 94 – 121 month advisory sentence called for by the United States Sentencing Guidelines, for losses that exceed $7M but are less than $20M, by a perpetrator with a special skill who was a leader or organizer of a criminal enterprise.

U.S. attorney’s office says used the proceeds to purchase a mansion, property in Arizona, luxury automobiles, and to invest in various venture capital opportunities.

infusion.1.jpgOn July 21, 2010, Raul S. Ramirez, 55, of Miami Gardens, FL, was convicted of one count of conspiracy to commit health care fraud, twelve counts of health care fraud, and three counts of money laundering.

According to the evidence presented at trial, the fraud involved purported treatment of HIV- positive Medicare beneficiaries at RA Medical Center, 2455 W. Flagler St., Miami, Florida. Ramirez paid Medicare beneficiaries to sign papers as though they had received treatment and to allow their Medicare numbers to be used to bill Medicare.

According to the evidence presented at trial, the billings were mostly for expensive drug infusion treatments for blood disorders that were claimed to be complications of the beneficiaries’ HIV condition. To justify the treatments, Ramirez caused the falsification of medical records showing severe symptoms such as spontaneous bleeding. Also, the blood samples from Ramirez’ clinic were found to be fraudulent. Blood tests from the same Medicare beneficiaries at legitimate hospitals did not show the purported blood disorders.

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