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OB/GYN Fraud Alert – State and Federal Authorities Prosecuting Physicians For Claims Related To Non US FDA Mirena IUDs

In 2009 and Arkansas physician, and just last month a physician in Jacksonville, Florida, were indicted for Health Care Fraud related to claims submitted to Federal Health Care Programs for Bayer manufactured intra-uterine devices sold under the Mirena name.  Apparently there are also a number of such investigations currently under way related to such purchases.   The fraud, as alleged by authorities, relates to the use of Non-FDA approved devices, which can be purchased from Canadian and other internet pharmacies at nearly half the cost of the products in the United States.

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Pharmacy – The Next Wave of Enforcement

The first wave of enforcement in the quest by the State of Florida and the DEA to alleviate the problem of prescription drug abuse has focused largely on physicians.  Now, although the physician “pill mill” problem still receives a lot of attention, the State and DEA (while not doing victory laps yet) have cut substantially into the problem. Either by stopping or scaring out of business a large number of rouge pain management practices.

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Too Big To Prosecute?

Occasionally you can see large dollar figures attached to settlements between the United States and certain providers. This leads to the question, “why didn’t anyone go to jail for this?”  In many cases smaller providers have and would for much less; but the simple fact is that smaller providers are easier to prosecute; there is a guy to point at and call evil.  It is easier to target an individual who owns a smaller business than individuals in a large business with multiple layers.  The simple answer is that it is too much work, so the government generally extracts a price and moves on.

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50 And 35 Year Prison Sentences Handed Out In Medicare Fraud Case

A Judge in Miami has sentenced two former officers of a Miami based mental health therapy company to 50 ane 35 years in prison; making the sentences two of the largest ever for Medicare Fraud. The sentences reflect a trend of increasingly strong punishment for Medicare Fraud; however it also may reflect how treacherous guilty pleas can be in federal court.

In this case, the two defendants pled guilty without a trial and without a plea agreement with the government.  In federal criminal prosecutions, defendants who plead guilty generally do so through plea agreements with prosecutors.  However, there are occasions where such an agreement waives appeal rights or commits a defendant to agree to facts they may not be comfortable with, including in many cases, the level of involvement in the crime or the amount of money at issue.

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Court Issues Preliminary Injunction in Physician Gun Gag Law Case

In 2011, the Florida Legislature passed a law which prohibited physicians from inquiring into gun ownership. The law, “Firearm Owners’ Privacy Act”  Fla. Stats. §§ 790.338, 381.026, 456.072, 395.1055).  Under the law, licensed health care practitioners  may not (i) intentionally record any disclosed information concerning firearm ownership in a patient’s medical record if the practitioner knows the information is not relevant to the patient’s medical care or safety, or the safety of others (the “record-keeping provision”); (ii) ask a patient whether she owns a firearm unless the practitioner in good faith believes the information is relevant to the patient’s medical care or safety, or the safety of others (the “inquiry restrictionprovision”); (iii) discriminate against a patient based solely on firearm ownership. or (iv) unnecessarily harass a patient about firearm ownership.

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Physicians Make Pledge To Stop Prescribing Oxycodone

In West Virginia, two physicians have started an advocacy grouptargeting physicians to pledge that their practices, in treating pain management, would not prescribe oxycodone in the course

of treatment. Citing the addiction potential for the drug and highlighting some of the more egregious cases of abusive prescribing, the physician’s pledge presents an interesting quandary.  The problem of oxycodone addiction in states like West Virginia are longstanding and well documented; in 2004, Purdue Pharma, the manufacturer of Oxycontin, settled a lawsuit with the State to settle claims that the company negligently marketed the drug, causing substantial addiction in the State.

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Most Doctors Will Face Malpractice Suit During Careers, Study Finds

Most doctors will face a malpractice lawsuit at some point in their careers, a new study published in The New England Journal of Medicine found. The threat of being sued creates a “tangible fear” that can lead physicians to practice costly “defensive medicine,” the researchers concluded. Despite recurring calls for medical malpractice reform, the study found doctors in virtually all fields face a high risk of ending up in court. The study looked at malpractice data from 1991 to 2005 across nearly 41,000 physicians covered by an unnamed national insurer. 

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Federal Judge Strikes State Drug Trafficking Law

In a decision that shows that sometimes the knee jerk reaction of the legislature can do more harm than good, a Federal judge in Orlando issued a decision finding that Florida’s drug trafficking law. F.S. 893.13 as amended by F.S. 893.101 is unconstitutional.  The Florida Supreme Court found that to convict an individual for drug trafficking, the law required that the person charged actually know that he or she was in possession of an illegal drug.  The Florida legislature passed F.S. 893.101,  in 2002 in reaction to the Florida Supreme Court which provided, in part:

“(2)  The Legislature finds that knowledge of the illicit nature of a controlled substance is not an element of any offense under this chapter. Lack of knowledge of the illicit nature of a controlled substance is an affirmative defense to the offenses of this chapter.”

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Physician Acquitted in Fraud Case Regarding Submission of Claims For Another Physician’s Services

A Clearwater Physician was charged in a federal indictment for submitting false claims to the Medicare Program for services actually performed by another physician.  That other physician had been excluded from the Medicare Program.  Since the other physician was barred from submitting claims for his services, the indictment charged that claims submitted by the physician who had a valid provider number were false claims.

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Florida Prescription Drug Monitoring Program Reporting Begins September 1, 2011

Beginning September 1, 2011 reporting for the much disputed and the long awaited Florida Prescription Drug Monitoring Program (PDMP) will go into effect; registration for the PDMP begins August 1, 2011.  On September 1, providers who dispense controlled substances will be required to electronically report prescription information within seven (7) days of dispensing any controlled substances.

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