Compliance Update

Florida Doctor Sentenced for Role in Sober Home Fraud

A Florida psychiatrist and medical director of two South Florida addiction treatment facilities was recently sentenced to four-and-a-half years in prison for his role in a fraud scheme in which he billed $112 million for services that were never provided or were medically unnecessary. After a 15-day trial in March, Jose Santiero of Miami Lakes was found guilty of conspiracy to commit healthcare...

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Physician Supervision of APRNs in Florida MedSpas

If you can’t make heads or tails out of Florida law on this topic, join the club! The law is clear as…mud. Simply put, ANY physician can provide the required indirect supervision of a mid-level practitioner at a MedSpa IF the physician’s primary practice location is the same one as the MedSpa. If the physician’s primary practice location is different from the MedSpa, then the supervising...

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Pharmacy Owner, Others Sentenced in $174M Telemedicine Pharmacy Fraud Scheme

A Florida pharmacy owner, his co-conspirators and seven related corporate entities recently were sentenced by a federal judge in Greenville Tenn. for their roles in a multimillion-dollar healthcare fraud scheme. It was alleged that they deceived pharmacy benefit managers (PBMs) such as Express Scripts and CVS Caremark. The PBMs processed and approved thousands of claims for prescription drugs on...

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Opioid Crackdown Nets 14, Including 12 Medical Professionals

The owner of a Boynton Beach pharmacy was among 14 people charged in connection with the unlawful distribution of opioids. Of them, twelve were medical professionals at the time of the alleged crime. According to the charges filed against Casey Kelleher, from February 2019 to August 2021, the owner of Neighborhood Pharmacy purchased large amounts of oxycodone and hydromorphone and sold most on...

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Pharmacy Fraud: Data Tells the Story

If a pharmacy is going to engage in nefarious activities, it should expect to get caught. Fraud in these cases is generally easy to prove. Simply verifying inventory, orders and dispensing records yields incredible data that when combined with comparative data from peer pharmacies can be used by law enforcement to establish that fraud has been committed. Latest Enforcement Activity On April 13,...

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Group Home Owners Convicted in $1M Fraud Scheme

A Texas couple who owned and operated group homes recently was found guilty of perpetrating a $1 million dollar scheme to defraud Medicare. Lindell King, 52, and his wife Ynedra Diggs, 44 were charged with sending their group home residents to Behavioral Medicine of Houston (BMH), in exchange for kickbacks. BMH was a community mental health center that purportedly provided partial...

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