CMS Recovery Audit Prepayment Reviews Scheduled to Begin Summer 2012

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

The Centers for Medicare & Medicaid Services (CMS) Recovery Audit Prepayment Review (RAPR) Demonstration Project is scheduled to begin on [stat.] June 1, 2012. However, the project was originally scheduled to begin January 1, 2012.

Claims with High Rates of Improper Billing will be Reviewed by Recovery Audit Contractors (RACs).

The Recovery Audit Prepayment Review allows Recovery Audit Contractors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that have been found to result in high rates of improper payments.

Certain States will be the Focus of This Initial Launch of Recovery Audit Prepayment Reviews.

The Recovery Audit Prepayment Reviews will focus on seven states with high populations of fraud-prone and error-prone providers. These states are California, Florida, Illinois, Louisiana, Michigan, New York, and Texas. The Recovery Audit Prepayment Reviews will also include four states with high claims volumes of short inpatient hospital stays. These states are Missouri, North Carolina, Ohio, and Pennsylvania.

Recovery Audit Prepayment Review Demonstration May Include More States in the Future.

CMS is expecting that the prepayment reviews will help lower error rates by preventing improper payments instead of searching for improper payments after they occur. If these reviews are successful, other states will be included in subsequent roll-outs of the Recovery Audit Prepayment Review Demonstration.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid 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 http://www.thehealthlawfirm.com/.

Sources:

Reimbursement Management Consultants, Inc. "CMS Recovery Audit Prepayment Review Demonstration Project." Reimbursement Management Consultants, Inc. (Feb. 9, 2012). From:
http://rmcinc.org/word/?p=276

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

CMS Update on Electronic Funds Transfer (EFT) for all Existing Medicare Providers

The following information was released by the Centers for Medicare & Medicaid Services (CMS) on May 30, 2012, updating the original new flash from December 16, 2011:

Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through Electronic Funds Transfer (EFT). Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.

As part of CMS's revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official.

For more information about provider enrollment revalidation, click here to review the MLN Matters Special Edition Article SE1126, "Further Details on the Revalidation of Provider Enrollment Information."

For the reference source and further information, click here.

Contact Health Law Attorneys Experienced in Handling Medicare and Medicaid Fraud Cases.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge.

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

New York Doctors, Nurse Practitioner Arrested in Crackdown on Prescription Drug Abuse

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

A New York law enforcement crackdown on prescription drug abuse has resulted in the arrests of 98 people. Among those charged are two doctors and a nurse practitioner.

Brooklyn federal prosecutors joined with the Drug Enforcement Administration (DEA), district attorney's offices, and local law enforcement agencies, to carry out a series of raids that began June 5, 2012 and resulted in the arrests.

To view the DEA's press release concerning the raid, click here.

Doctors Involved in Crackdown Accused of Overprescribing.

One of the doctors is accused of conspiring to distribute oxycodone to patients that were not legitimate. Allegedly, the doctor surrendered his DEA registration. This terminated his authority to prescribe controlled substances such as oxycodone. However, he allegedly attempted to use other health care practitioners to continue to prescribe drugs, which the government contends is illegal.

Another doctor involved in the crackdown is charged with illegal distribution of oxycodone. During the execution of a federal search warrant at his offices on March 1, 2012, the doctor voluntarily surrendered his DEA registration. However, he allegedly continued to issue prescriptions to those whom he knew were not legitimate patients.

We continually warn against "voluntarily relinquishing" DEA registrations or medical licenses with any investigation pending as this is treated the same as a revocation in most cases. For an article we have written on this, click here.

Florida Has Recently Experienced Similar Prescription Drug Abuse Crackdowns.

Starting around two years ago, Florida health providers involved in narcotics precribing became routine targets for law enforcement. This was part of a concerted effort by state and federal officials to crackdown on "pill mill" operations. Regulations increased. Lawmakers enacted severe penalties for doctors and other health professionals accused of over-prescribing. Most physicians were banned from dispensing drugs in their offices. The governor created a Florida drug "strike force" with a mission to eliminate any pain clinics that were found to be breaking the law. The Florida Surgeon General and the Board of Medicine made announcements about the "crackdown" on "over-prescribing."

Since the implementation of the new pain management and prescribing laws, the Florida strike force has made thousands of arrests and seized millions of pills of narcotics. This has resulted in serious concerns by those in the pain management profession.

Law Enforcement Continues to Pursue Physicians, Pharmacists, Nurses and Other Health Providers.

The recent raid in New York and ongoing actions in Florida demonstrate that law enforcement will continue to pursue health professionals who prescribe large amounts of narcotics.

Contact Health Law Attorneys Experienced with DEA Cases and Overprescribing Allegations.

The Health Law Firm represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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 Include:

Allen, Jonathon. "Doctors Arrested in New York Prescription Drug Crackdown." Reuters. (June 7, 2012). From
http://in.reuters.com/article/2012/06/06/usa-crime-painkillers-idINL1E8H6E3J20120606

CBS News. "98 Arrested in NY Prescription Drug Sweep." CBS News. (June 6, 2012). From
http://www.cbsnews.com/8301-201_162-57448268/dozens-arrested-in-ny-prescription-drug-bust/

McKenzie-Mulvey, Erin. "U.S. Attorney Lynch, District Attorneys, DEA, Other Law Enforcement Announce Prescription Drug Initiative." Drug Enforcement Administration. (June 7, 2012). Press Release. From:
http://www.justice.gov/dea/pubs/states/newsrel/2012/nyc060712a.html

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

Jury Convicts South Florida Doctors of Medicare Fraud

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

A federal jury convicted two South Florida doctors, one Miami-area therapist, and two other individuals for their involvement in a Medicare fraud scheme. The scheme allegedly involved more than $205 million in fraudulent billings by American Therapeutic Corporation (ATC), a corporation which provided mental health care services. The jury reached a decision on June 1, 2012.

To see the Department of Justice press release, click here.

The two doctors and the therapist were each found guilty of one count of conspiracy to commit health care fraud. The other two individuals were each found guilty of one count of health care kickbacks. Sentencing has not yet been scheduled. The maximum penalty for each conspiracy count and each count of health care fraud is ten years in prison plus a fine. The maximum penalty for each count of health care kickbacks is five years in prison plus a fine.

Doctors, Therapist, and Others at ATC Allegedly Created False Documents for Medicare Reimbursements.

One of the federal indictments charged more than 14 separate defendants with criminal violations. To see this indictment click here.

Allegedly, ATC billed Medicare for hundreds of millions of dollars in services, for thousands of patients who were not qualified. The charges alleged fraudulent documents were created by the doctors and others associated with ATC. The doctors allegedly would sign patient documents without having seen or treated the patients.

ATC operated partial hospitalization programs (PHPs) throughout Florida and would allegedly bill Medicare for PHP treatments for patients in the names of the doctors. Included in these submissions to Medicare were claims for patients who were allegedly ineligible for PHP treatments. ATC allegedly did not provide legitimate PHP treatment, but illegally changed patient medical records to justify claims that were submitted.

Contact Health Law Attorneys Experienced in Handling Medicare and Medicaid Fraud Cases.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge.

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 Include:

U.S. Department of Justice, Office of Public Affairs. "Doctors, Therapist, and Recruiters from Miami-Area Mental Health Care Corporation Convicted for Participating in $205 Million Medicare Fraud Scheme." FBI. (June 01, 2012). Press Release. From:
http://www.fbi.gov/miami/press-releases/2012/doctors-therapist-and-recruiters-from-miami-area-mental-health-care-corporation-convicted-for-participating-in-205-million-medicare-fraud-scheme

Weaver, Jay. "Two South Florida Doctors, 3 Others Convicted on Medicare Fraud Charge." Miami Herald. (June 01, 2012). From
http://www.miamiherald.com/2012/06/01/2827660/miami-medicare-fraud-jurors-tell.html#storylink=misearch/

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

Connecticut Attorney General Alleges Medicaid Fraud Scheme

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

Connecticut Attorney General George Jepsen alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. Jepsen filed a civil action  on May 31, 2012. It is the first case the state has initiated under the Connecticut False Claims Act. The Connecticut False Claims Act gives the state the ability to seek compensation for taxpayers from those who submit false claims for reimbursements they are not eligible to receive. To view the Connecticut False Claims Act, click here.

The complaint seeks restitution, treble damages and civil penalties as well as a permanent injunction against the unlawful acts and practices alleged in the complaint. To view the complaint, click here.

Despite Being Excluded from Medicare and Medicaid, Accused Individual Allegedly Found Ways to Bill Medicaid for Services.

According to the complaint, one of the individuals involved in the alleged fraud scheme was previously convicted of a felony in another state for submitting false health care claims. He was then permanently excluded by the U.S. Department of Health and Human Services (DHHS) from participation in Medicare and Medicaid, as a result of his conviction. Any entity with which he serves as an employee, administrator, operator or in any other capacity, were also excluded from state healthcare programs. The state alleges that, despite the exclusion, he established a number of dental practices in Connecticut that were operated by practicing dentists who billed Medicaid for services.

Allegedly, the excluded individual was actively involved in managing the practices and received millions of dollars in Medicaid reimbursements. The dental providers allegedly knew of the exclusion and did not disclose it on enrollment and re-enrollment forms for the Connecticut Medical Assistance Program.

Florida Has Similar False Claims Act.

Florida has a Medicaid False Claims Act similar to the one that Connecticut has. Florida's Medicaid False Claims Act can be found here. However, in Florida, a separate provision of the state's Medicaid law provides an award to a whistle-blower of up to 25% of any recovery. This is in Section 409.9203, Florida Statutes. In addition, Florida has a law that allows civil recovery for criminal acts such as Medicaid fraud, which is sometimes used by the Florida Attorney General and private individuals to recover money lost as a result of certain criminal conduct. For the Florida Civil Remedies for Criminal Actions law, click here.

As a general rule state false claims acts are modeled after the federal False Claims Act used to pursue Medicare fraud. For the federal Medicare Fraud False Claims Act, 31 U.S.C. § 3729, click here.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Fraud Cases.
The Health Law Firm's attorneys routinely represent physicians, dentists, nurses, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits, hearings and recovery actions. In addition The Health Law Firm represents health providers in Medicare exclusion actions and in being reinstated to the Medicare Program or being removed from the exclusion list.

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:
Rees, Nick. "Jepsen alleges $24M Medicaid fraud." Legal Newsline. (June 4, 2012). From:
http://www.legalnewsline.com/news/contentview.asp?c=236342

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

Franck's Pharmacy Announces Sterile Compounding Service Shutdown; Recalls Compunding Prescriptions

Franck's Pharmacy, Inc. located in Ocala, Florida, recently issued a recall for its compounded prescriptions. The prescriptions impacted by this recall include all sterile human and veterinary compounded prescriptions distributed by Franck’s Pharmacy from November 21, 2011 to May 21, 2012. Franck's Pharmacy made the announcement on the company's website on May 24, 2012. To see the recall click here.
Recall Based on FDA Findings of Fungal Growth in Pharmacy's Clean Room.
The recall was allegedly prompted by action by the U.S. Food and Drug Administration (FDA). The FDA notified Franck's Pharmacy that environmental sampling of the pharmacy's clean room revealed the presence of microorganisms and fungal growth. Because of the FDA's findings, Franck's Pharmacy decided to recall its sterile compounds to prevent any possible risk of infection to patients.
Franck's Pharmacy Urges Physicians to Assist in Recall Efforts.
Franck's Pharmacy is seeking the assistance of physicians in alerting patients who may be impacted by the recall. Franck's Pharmacy is also advising physicians to review and evaluate patient records to determine if any adverse events may have resulted from use of the recalled products. Any adverse events should be reported to Franck’s Pharmacy and the FDA’s MedWatch program.
Franck's Pharmacy Ceases Production of Sterile Compounds.
Franck's Pharmacy also announced that it will stop producing sterile compounds at its Ocala lab facility for the present. Franck's Pharmacy made the announcement via e-mail on May 23, 2012. The e-mail also confirmed that several employees had been laid off. Allegedly, these employees were terminated due to the sterile compounding shutdown. Franck's Pharmacy will continue to compound non-sterile human and veterinary medicine.
Franck's Pharmacy Recently Linked to Eye Infection Outbreak.
Franck's Pharmacy decided to cease sterile compounding after the Centers for Disease Control and Prevention (CDC) issued a warning urging physicians not to use sterile products made by Franck's Pharmacy. The warning was issued after the CDC traced a rare fungal eye infection back to the pharmacy. The infection impacted at least 30 patients who allegedly had undergone some type of eye procedure in which Franck's Pharmacy products were used. For additional information on this, click here.
Prior Deaths of 30 Polo Ponies.
In an earlier unfortunate incident in 2009, Franck's Pharmacy's compounding of veterinarian prescriptions allegedly led to the deaths of approximately 30 expensive polo ponies here in Florida. Click here for details. In the aftermath of that case, the FDA attempted to prevent Franck's Pharmacy from any further compounding of pharmaceuticals for veterinary purposes. The FDA eventually lost the case heard by the U.S. District Court, Middle District of Florida, which ruled in favor of Franck's Pharmacy. The decision can be seen here.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.
The Health Law Firm represents pharmacists and pharmacies in investigations, regulatory matters, licensing issues, litigation, inspections and audits. The firm's attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
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 Include:
Franck, Paul. "Urgent: Compounding Prescriptions Recall." Franck's Pharmacy. Press Release. (May 23, 2012). From
http://www.francks.com/
Medina, Carlos E. "Franck's Ceases Sterile Compounding Service." Ocala.com. (May 23, 2012) From
http://www.ocala.com/article/20120523/ARTICLES/120529872/-1/entertainment02?template/

Professor Appeals DEA's Medical Marijuana Research Ban

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

A University of Massachusetts-Amherst professor is appealing a final order issued by the Drug Enforcement Administration (DEA) that has stopped him from growing marijuana for medical research purposes.

Appeals Court Hears Oral Arguments in Medical Marijuana Research Case.

The U.S. Court of Appeals for the First Circuit heard oral arguments in the case on May 11, 2012. During the hearing the DEA attempted to get the case thrown out by claiming that the court has no jurisdiction over the issue. The court’s ruling should come in about three months.

To hear the oral arguments presented in this case, click here.

DEA's Final Order Rejected Administrative Law Judge Recommendation.

The DEA issued a final order to the professor in August 2011. The order rejected a 2007 recommendation by a DEA Administrative Law Judge (ALJ) which stated that it was in the public interest to grant the professor's research license. To view the DEA's Final Order, click here. There is already one lab or research facility that is doing something similar to this.

Professor Has Waited Over a Decade for DEA License.

The professor first applied for a DEA license in June 2001. He intended to start a marijuana production facility at the University of Massachusetts-Amherst under contract to the Multidisciplinary Association for Psychedelic Studies (MAPS). MAPS is a non-profit research and educational organization that hopes to develop marijuana into an FDA approved prescription medicine.

Appeals Court Ruling Could End the Monopoly on Medical Marijuana Research Supply.

Both the professor and MAPS have been struggling with the DEA to obtain permission to grow marijuana for FDA-approved research since 2001. The appeals court decision in this case could conclude the eleven year battle and possibly end the National Institute on Drug Abuse (NIDA) monopoly on the supply of marijuana for research. A University of Mississippi laboratory funded by NIDA is currently the only facility in the United States permitted to grow marijuana for research (but we can't reveal where it is).

Contact Health Law Attorneys Experienced with DEA Cases.

The attorneys of The Health Law Firm are experienced in handling all types of DEA cases, including final orders, investigations, DEA registration number revocations and more. If you are currently facing adverse action by the DEA contact one of our attorneys by calling (407) 331-6620 or (850) 439-1001. You can also visit our website for more information at http://www.thehealthlawfirm.com/.

Sources: Elliot, Steve. "Appeals Court Accepts Challenge of DEA's Marijuana Research Denial." Toke of the Town. (May 10, 2012). From: http://www.tokeofthetown.com/2012/05/appeals_court_accepts_challenge_of_deas_marijuana.php

MAPS. "MAPS Efforts to Obtain a DEA License for a Medical Marijuana Production Facility." Multidisciplinary Association for Psychedelic Studies. (2012). From: http://www.maps.org/research/mmj/

MAPS. "U.S. Appeals Court To Hear Oral Arguments In Case Challenging DEA's Denial Of License For Medical Marijuana Production Facility." PR Newswire. (May 10, 2012). From: http://www.marketwatch.com/story/us-appeals-court-to-hear-oral-arguments-in-case-challenging-deas-denial-of-license-for-medical-marijuana-production-facility-2012-05-10

Smoker, Jay. "Federal Appeals Court Will Hear Case Against DEA For Denying Medical Marijuana Research." The Weed Blog. (May 11, 2012). From: http://www.theweedblog.com/federal-appeals-court-will-hear-case-against-dea-for-denying-medical-marijuana-research/

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