According to the Tampa Bay Times, Rose Radiology Centers Inc. a Tampa Bay based diagnostic center, will pay the government $8.71 million to settle allegations that it violated the federal False Claims Act by billing federal health care programs for unnecessary radiology procedures.
Rose Radiology Centers Inc. operated approximately a dozen offices in the Tampa Bay area and is the official radiology practice for the Tampa Bay Rays and Tampa Bay Lightning.
The settlement deals with a lawsuit filed by two whistle-blowers under the federal False Claims Act, which allows private parties to bring suit on behalf of the government and to share in any recovery. The lawsuit stated that Rose Radiology Centers Inc. improperly billed for radiology procedures referred by chiropractors, which are not covered by Medicare. Rose Radiology bypassed this constraint when they accepted orders from chiropractors and billed for them as if the tests were actually ordered by a Rose Radiology-employed physician. The whistle-blowers will receive a combined $1.7 million as their share of the recovery from the case.
The radiology center is accused of performing and billing for radiology procedures that were never ordered by the patients’ treatment providers and of sending claims to Medicare for radiology services that were not performed at facilities authorized as Medicare providers, according to the article. In addition to the other allegations, the center is accused of giving kickbacks to referring physicians.
Shimon Richmond, special agent in charge for the Health and Human Service office of the Inspector General stated, “Not only do the kinds of frauds that were alleged in this case rob Medicare of needed funds, they threatened the health of elderly and disabled Americans.”
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In a January 5, 2016 press release, The Florida Division of Insurance Fraud (DIF) announced the arrest of Timothy T. Rush, 38 year-old, Bradenton-based insurance agent. Rush was arrested for allegedly stealing $224,600 from an unsuspecting Port Charlotte resident.
“In early 2015, the Manatee County Sheriff’s Office received a complaint regarding Timothy R. Rush after one of his clients suspected that the money he had been paid was not being used for the insurance annuities that Rush and his client had agreed upon,” according to DIF. After the complaint, DIF and Florida’s Division of Agents and Agency Services launched an investigation into the practices of Rush.
The investigation revealed that Rush was a licensed insurance agent in Florida and was authorized to sell Bankers Life annuities. Rush worked with a Port Charlotte resident to secure a Medicare insurance supplement and the client agreed to make payments on a Bankers Life annuity which Rush sold her. According to the investigators, Rush opened a fictitious corporation through Florida’s Division of Corporations that was used to open a separate bank account. Rush then illegally deposited the diverted annuity payments from the Port Charlotte resident totaling$224,600.
On December 30, 2015, Rush was arrested and booked into the Manatee County Jail with a bond of $100,000 and was charged with one count of an organized scheme to defraud, a felony of the first degree. This case will be prosecuted by the Office of Manatee State Attorney Ed Brodsky and if convicted, Rush will face up to 30 years in prison.
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Allstate Insurance Co. has asked the Florida Supreme Court to address the issue of reimbursement for medical services under the state’s No-Fault auto insurance system as a result of conflicting opinions in the lower courts. Allstate is looking to overturn a ruling in August 2015 by the 4th District Court of Appeal in favor of medical providers.
The 4th District Court of Appeal ruling addressed whether policies were clear that Allstate would reimburse the providers under a statutory fee schedule. The providers argued that the policies were “ambiguous” on the issue of whether such an election to pay at the fee schedule was made and the 4th District Court of Appeal agreed.
In the brief filed by Allstate to the Florida Supreme Court, Allstate argues that the August ruling conflicted with a decision by the 1st District Court of Appeal and that similar cases are currently pending in two other appellate courts. “Given that every Florida driver must carry PIP insurance, and the vast numbers of claims processed under such coverage, this conflict (between appeals courts) creates confusion and instability in the lower courts and impacts thousands of insureds and many other citizens and business in Florida”, according to the brief filed by Allstate.
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A Central Florida man has been arrested by State investigators for running an unlicensed medical clinic to rip off insurance companies for tens of thousands of dollars, according to a WFTC article.
State insurance fraud investigators stated that the clinic on Pine Hills road was a front for Yves Joseph’s lavish lifestyle. He was running an unlicensed medical clinic in Orange County and had millions of dollars moving through his accounts. As a result of his bank records, the Florida Division of Insurance Fraud was able to detect the fraud.
Investigator stated that Joseph’s office first opened in 2006, and that he would hire medical doctors and chiropractors to pose as the owners of the clinic in order to make the medical clinic appear legitimate. Joseph however, was the real owner of the clinic and managed the clinic. According to investigators, Joseph billed more than $158,000 to several insurance companies that they currently know of. During the investigation, investigators found that from 2011 to 2014 there was more than $1.7 million in credits and $1.2 million was withdrawn from bank accounts in cash.
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On December 3, 2015, the Florida Department of Economic Opportunity (DEO) determined that Uber drivers in Florida will be considered independent contractors rather than employees. This reverses an earlier state decision and shows the State’s position in a countrywide debate regarding the classification of Uber drivers.
Executive Director of the DEO, Jesse Panuccio, stated in his decision that “Technology is allowing hundreds of thousands of people to go into business for themselves. Those in business for themselves may not have the same guarantees and benefits of those in the employ of others, but there are many other benefits of being your own boss. …Technological advances are opening up that dream to many more people, and we should not malign (or perhaps misclassify) that trend as worker misclassification.” This decision means that the San Francisco-based company can avoid paying drivers’ unemployment benefits, workers’ compensation and other employee-related costs.
This decision follows Uber’s appeal of a prior state revenue department decision in May, which dealt with the classification of former Uber drivers Darrin McGillis and Melissa Ewers as company employees, entitling them to unemployment benefits after Uber dismissed them from the service. Darrin McGillis states that he is planning to appeal the decision to the District Court of Appeals.
Click here to Daily Business Review article. (Subscription required)
On November 18,2015, a Miami widow of a car crash victim sued Lyft for alleged negligence leading to the wrongful death of a motorcyclist. The widow is alleging that the ride-hailing company failed to properly train the driver that caused the fatal accident.
Poliana Perez, whose husband Loinier Perez was killed while riding his motorcycle on October 31, believes that Lyft Florida Inc. is liable for the crash caused by driver Pirooz Pakdel. Pakdel was carrying a pair of Lyft passengers when he allegedly made an improper left-hand turn and rammed into Loinier Perez.
Perez’s attorney, Ervin Gonzalez of Colson Hicks Eidson, stated that “Lyft, which isn’t even authorized to operate in Miami-Dade County, fell far short of its obligation to act in the best interests of public safety and an innocent life was taken.” The suit alleges that Lyft knew or should have known that Pakdel was not properly trained or suited for the job. The San Franciso-based Lyft allows passengers to use a smartphone app to hail rides from drivers in their personal cars.
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On October 5, 2015, GEICO filed a lawsuit in federal court against Boston-based Big City Chiropractic & Sports Injury Clinic, according to a Law360 article. GEICO claims that Big City created a scheme to defraud the company out of, up to $1.1 million by overbilling for insurance payments and paying kickbacks to patients for cooperating with the scheme.
In the lawsuit, GEICO alleges that Dr. Brian Elias, Florida-based founder of Big City Chiropractic, and Karen Davis and Dr. Megan Bratton of Massachusetts were involved in the scheme to defraud GEICO. GEICO alleges that the trio earned substantial profits by using unskilled services and staff at their clinic while billing them as services performed by licensed staff. The lawsuit claims that that the trio overused chiropractic practices and submitted inflated demands for insurance payments based on false and deceptive bills and records.
GEICO states in the complaint, that it has already paid at least $110,000 of about $517,000 in submitted bills to Big City. The clinic has billed GEICO so far this year at an estimated annual rate of $600,000.
Big City Chiropractic & Sports Injury is the Massachusetts-based arm of an interstate network of chiropractic clinics operated by Elias.
GEICO is seeking damages including the money unfairly paid to Big City, the costs of handling the investigation, and treble damages under the Racketeer Influenced and Corrupt Organizations Act and Massachusetts consumer protection law.
Click here to read Law360 article (subscription required).