Monthly Archives: May 2015

Andrew S. Feldman Moderated Health Care Fraud Panel

On May 13, 2015, Andrew S. Feldman moderated a health care fraud panel “Looking Ahead in 2015: Health Care Fraud and False Claims Act” as part of the ABA’s National Institute on Health Care Fraud.

Panelists included:

• Andrew S. Feldman, Moderator, Managing Member of Feldman Firm PLLC in Miami, Florida
• Daniel Bernstein, Deputy of Health Care Fraud Prosecutions for the U.S. Attorney’s Office for the Southern District of Florida;
• Susan Torres, Health Care Fraud Coordinator for the Civil Division of the U.S. Attorney’s Office for the Southern District of Florida;
• Franklin Monsour, Assistant U.S. Attorney in the Civil Division of the U.S. Attorney’s Office for the Southern District of Florida; and
• Marissel Descalzo, a partner at the Miami office of Carlton Fields Jorden Burt

During the panel, panelists addressed critically important issues related to health care fraud and the False Claims Act. The panelists underscored that the U.S. Attorney’s Office is focusing heavily on prosecutions related to Medicare D and managed care fraud (Medicare C). Indeed, “in Miami you might have a pharmacy the size of this conference room but they are billing more than the Walgreen’s down the street.” Panelists also agreed that there has been an increase in Anti-Kickback Statute prosecutions and that “juries understand kickbacks.”

In addition, panelists noted that there is enhanced coordination between the Civil and Criminal Division when a qui tam action is filed and highlighted that the Civil Investigative Demand statute permits the Civil Division to share materials obtained during a civil investigation with the Criminal Division. All of the government panelists also emphasized that voluntary disclosure, especially for the organization, is a good option which may greatly benefit an organization down the road. Finally, the panelists agreed that there has been a rise in prosecutions of physicians and a rise in prosecutions based on the “medical necessity” of a particular procedure or service.

Several of these themes were reaffirmed later in the conference. For example, Assistant Attorney General Leslie Caldwell highlighted that organizations should be willing to disclose information concerning the bad actors to obtain credit for cooperation. Ms. Caldwell also mentioned the Department’s focus on individual doctors, pharmacy owners, and individual suppliers. Furthermore, both Joyce Branda and Ms. Caldwell confirmed that the government is focusing on procedures that “compromise the well-being” of patients. On this note, Mrs. Branda referenced chiropractors, rehab therapy, and dental clinics. Procedures involving cardiac stents and spinal surgeries were also mentioned.

WASHINGTON, DC – The Financial Crimes Enforcement Network (FinCEN) issued a Geographic Targeting Order (GTO) today to about 700 Miami businesses to shed light on cash transactions that may be tied to trade-based money laundering schemes. These complex schemes are a primary method used by drug cartels, including the Sinaloa and Los Zetas, to launder their illicit proceeds. FinCEN’s order is aimed at disrupting the illicit financial infrastructure upon which these drug trafficking organizations rely.

FinCEN, in coordination with U.S. Immigration and Customs Enforcement’s Homeland Security Investigations (HSI) and Miami Dade State Attorney’s Office South Florida Money Laundering Strike Force, issued the GTO on electronics exporters located near Miami, Florida. Law enforcement investigations reveal that many of these businesses are exploited as part of sophisticated trade–based money laundering schemes in which drug proceeds in the United States are converted into goods that are shipped to South America and sold for local currency, which is ultimately transferred to drug cartels. This GTO enhances the transparency of the covered businesses’ transactions; it does not make any determination about their knowledge or lack thereof of the money laundering schemes.

In general, a nonfinancial trade or business that receives more than $10,000 in currency in a single transaction or multiple related transactions is required to file a Form 8300 with FinCEN. The GTO, which will be in effect for 180 days beginning on April 28, 2015, lowers the $10,000 reporting threshold to $3,000 for covered businesses. These businesses are required to report to FinCEN currency transactions over $3,000, and to include in those reports information about the transaction and the persons involved. Each business covered under this GTO has received notice of its obligations via personal service or by certified mail. Failure to comply could result in substantial criminal and civil penalties. The enhanced financial transparency provided by the GTO will bolster law enforcement’s ability to identify and prosecute the money launderers who service drug trafficking organizations and other criminal networks.

“When we issued a similar GTO in the Los Angeles area last year, many speculated about whether we’d be doing the same in other parts of the country,” said FinCEN Director Jennifer Shasky Calvery. “We are committed to shedding light on shady financial activity wherever we find it. We will continue issuing GTOs, as necessary, as well as exercising FinCEN’s other unique anti-money laundering authorities, to ensure a transparent financial system that impedes money launderers and other criminals from masking their identity and illicit activity.”

Executive Associate Director for Homeland Security Investigations, Peter Edge noted, “A GTO is one of many tools available in the fight against money laundering. Past successes show that GTOs can be effective in exposing criminal organizations using legitimate financial institutions and businesses to facilitate their illicit dealings. Homeland Security Investigations is dedicated to disrupting these activities and dismantling these organizations to protect the security of the nation’s financial infrastructure.”

Businesses covered by the GTO have been served a copy of the order and must begin complying on April 28, 2015. A copy of the order may be found here. Any questions about the order should be directed to the FinCEN Resource Center at 800–767–2825.