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.
Author: Andrew Feldman
Mr. Feldman represents professionals, corporations, health care providers, and health care marketers in government investigations and prosecutions throughout the United States. Mr. Feldman works tirelessly for his clients from the time an investigation begins until the time a jury renders a verdict.
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