Tag Archives: Health care

Miami Man Charged with Conspiracy to Commit Health Care Fraud

On November 17, 2016, Satellite Press Releases and News reported the arrest of 21-year-old Eduardo Arango Chongo in connection with the arrests of 31-year-old Osmaro Ruiz and 25-year-old Raymel Betancourt for conspiracy to commit health care fraud.

According to the complaint, the co-conspirators had established fake medical facilities in Union County, New Jersey and were fraudulently billing insurance companies for services that were never rendered. The “phantom providers” allegedly submitted false claims for services worth more than $6 million, raking in hundreds of thousands of dollars from insurance companies. The defendants also utilized an electronic healthcare network used by medical practices to access the health insurance information of individuals who were not aware of their fraudulent activities.

The defendants could face up to 10 years in prison and a $250,000 fine if found guilty of the crimes they were accused of. U.S. Attorney Paul J. Fishman credits special agents of the U.S. Postal Inspection Service and special agents of the FBI with the investigation leading to the charges.

Click here to view the full story.

Comments Off on Miami Man Charged with Conspiracy to Commit Health Care Fraud

Filed under Healthcare

Federal Appeals Court Reinstates PIP Claims Suit Against HCA

A federal appeals court has revived a lawsuit against HCA Holdings charging that HCA and three of its Florida hospitals violated Florida’s Deceptive and Unfair Practices Act.

The U.S. Court of Appeals for the Eleventh Circuit’s April 26 ruling overturned a February 2015 federal court decision in the Middle District of Florida that dismissed the class action. That suit accused three HCA hospitals—Memorial Hospital Jacksonville, North Florida Regional Medical Center of Gainesville and JFK Medical Center in Atlantis—of charging unreasonably high fees for emergency radiological services covered by Florida’s Personal Injury Protection (PIP) insurance.

The four Florida residents who filed the complaint received emergency radiological services after motor vehicle accidents. They said they were billed more than other patients who received the same services. “In fact, these fees are up to 65 times higher than the usual and customary fees charged to non-PIP patients for similar radiological services,” according to the complaint.

In one example, the court’s opinion said the hospitals charged between $5,900 and $6,965 for spinal CT scans on the plaintiffs. The ruling said Medicare rates for spinal CT scans are between $213 and $220, and rates for uninsured patients go up to $3,454.

The complaint said the exorbitant rates caused the residents’ $10,000 PIP coverage to be exhausted prematurely. The complaint also accuses HCA of breach of contract as the four Floridians entered into a Condition of Admission contract that required their accounts to be paid at the hospitals’ price lists. All four plaintiffs said they weren’t provided such a price list at the time of their treatments.

Only one of the four plaintiffs was allowed to go forward with a suit against a single hospital in the 2015 ruling by U.S. District Judge James Moody in the Middle District of Florida. Moody’s ruling was overturned by a unanimous Eleventh Circuit panel consisting of Judges Beverly B. Martin, Julie E. Carnes and Senior Judge R. Lanier Anderson III. The suit was originally filed July 2014 in the Southern District of Florida.

 

Comments Off on Federal Appeals Court Reinstates PIP Claims Suit Against HCA

Filed under Uncategorized

Roig Lawyers Attorneys Present on Regulatory Compliance

Roig Lawyers, a minority-owned, multi-practice litigation law firm dedicated to serving clients across six offices throughout Florida, is pleased to announce that Jessica Z. Martin, Partner (Deerfield Beach), and Dennis LaRosa, Healthcare Policy Advisor (Tallahassee), will present a program on August 11, 2015 to a national insurance carrier’s SIU Team in Orlando covering regulatory compliance as it relates to insurance defense.

“At Roig Lawyers we believe that continually updating and educating our lawyers is one of the most important aspects of a comprehensive PIP defense.  It is even more important that SIU’s stay on the cutting edge of new and innovative issues so that cases that come to defense counsel utilize the most current thought in the industry,” said Martin.

The presentation will cover specific topics such as medical director responsibilities and the implications of clinic licensing, and exemptions under current and newly enacted legislation together with innovative ideas in defending insurance law suits.  In recent years, regulatory compliance has become a significant tool for auto insurers in fighting personal injury protection fraud and abuse. It will also cover recent case law regarding Section 627.736(6)(b) requests for pre-suit discovery, and other investigative tools to obtain information regarding whether a clinic is operating lawfully.

Martin has been practicing since 2006 defending Personal Injury Protection (PIP)/No-Fault, bodily injury and uninsured/underinsured litigation and aiding insurance carriers with fraud (SIU) investigations, through Examinations Under Oath (EUO), Section 627.736(6)(c) Petitions/Motions for Discovery, and leading affirmative litigation against fraudulent medical providers. Martin is a skilled trial attorney and is also experienced in the use of alternative dispute resolution techniques, including mediation and arbitration, as a means of litigation avoidance. Martin joined the firm in 2002, became a licensed attorney in 2006, and the first female partner in the firm in 2009.

LaRosa has over 40 years experience in state licensing, including 10 years as a supervisor at the Agency for Health Care Administration implementing and overseeing health care clinic licensure and exemptions. LaRosa is a sought after speaker in discussing the relationship between state licensing and automobile insurance having made presentations to the Florida Bar, National Insurance Crime Bureau, the International Association of Special Investigative Units, attorneys and judges and has been a witness in numerous federal criminal and civil cases dealing with this subject.  While a practicing attorney, he prosecuted scores of administrative law cases, appeals, and represented the State of Florida in both state and federal courts on diverse issues ranging from taxation, state licensing, and environmental law to admiralty.  He has been a healthcare policy advisor with Roig Lawyers for the past two years.

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, community association law, corporate law, real estate, banking and finance, immigration, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit www.roiglawyers.com.

Comments Off on Roig Lawyers Attorneys Present on Regulatory Compliance

Filed under Healthcare