Recently in Tennessee Health Care Fraud Category

Tennessee Doctor Sentenced to 2 Years in Prison for Providing Unapproved Foreign Medication

June 12, 2013, by The McKellar Law Firm, PLLC

While most health care fraud cases deal with drug diversion, improper billing, and fraudulent insurance claims, there are other potential pitfalls for medical providers which are less common. One such pitfall is violating the Food, Drug, and Cosmetics Act (21 U.S.C. § 301, et al.).

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According to a press release from the U.S. Attorney's Office, Johnson City, Tennessee physician William Kincaid, was sentenced to 2 years in federal prison earlier this week for violating the Food, Drug, and Cosmetic Act. Kincaid was a doctor with East Tennessee Hematology-Oncology Associates, P.C., d/b/a McLeod Cancer and Blood Center.

Kincaid entered into a plea agreement, wherein he admitted that he had been obtaining unapproved drugs from a Canadian business, Quality Specialty Products, beginning in 2007. Such unapproved drugs are often referred to as "misbranded" drugs. These misbranded drugs included chemotherapy medications and were administered at Kincaid's medical clinic.

Greeneville Federal Court Judge J. Ronnie Greer sentenced Kindcaid, and the Judge declared that Kincaid's actions were "about greed" and the "motivation was to make more money." Judge Greer also pointed out that, although it was impossible to know which patients had received the unapproved drugs, the "emotional harm" to patients from not knowing whether they had received unapproved drugs contributed to the seriousness of the offense.

Kincaid's attorney informed the Court that his client had entered into an agreement with the United States and the State of Tennessee to pay $2.55 million in settlement of civil claims under the False Claims Act for false and fraudulent claims submitted to Medicare and TennCare.

Tennessee Hospital Pays $883k to Settle False Claims Act Violations

January 18, 2013, by The McKellar Law Firm, PLLC

The Nashville Business Journal reports that Tennessee-based Wayne Medical Center has entered into an agreement with the Federal Government to settle False Claims Act allegations, which were actually self-reported by Wayne Medical Center. Wayne Medical Center has agreed to pay $883,451 as part of the settlement. The improper claims relate to ambulance services of the hospital, and include providing medically unnecessary services, improperly documented services, and lack of the requisite signatures.

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As I have written about previously, the False Claims Act [FCA] (31 U.S.C § 3729 et seq.) penalizes those who defraud the government. For example, the FCA imposes civil penalties for making false claims for payments to the government, using false records to support a false claim, or receiving compensation from the government but delivering less than the proper amount to the intended recipient.

The penalties under the FCA are severe, and a civil penalty up to $11,000 may be assessed for each false claim. The government may also seek treble damages for each violation. The Justice Department has increasingly used the FCA to recover large sums of money. In Nashville, which is part of the Middle District of Tennessee, the the Middle Tennessee office for the U.S. Attorney secured more than $100 million in recoveries or settlements from health care fraud actions in 2011.

As an added punishment, violators of the FCA may be excluded altogether from federal health care programs such as Medicare and Medicaid. (42 U.S.C. § 1320a-7(b)).

Tennessee Physical Therapy Assistant Pleads Guilty to Health Care Fraud

September 19, 2012, by The McKellar Law Firm, PLLC

According to 18 USC § 1347, anyone convicted of defrauding, or attempting to defraud, a health care benefit program faces fines and possible incarceration, which could even result in a life sentence if death resulted from the deception. Former physical therapist assistant Patricia J. Boshears of Knoxville, Tennessee recently pled guilty to violating this statute, according to a press release from the U.S. District Attorney's Office.

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The press release states that Boshears formerly owned, managed, and worked as a physical therapy assistant at Total Rehab, Inc. in Knoxville, Tennessee. After an investigation by the Office of Inspector General, Health and Human Services Division, Boshears acknowledged deliberately filing false claims in an attempt defraud Medicare for patient services that did not qualify for reimbursement. In order for claims to qualify for Medicare reimbursement, all patient services must be provided by either a licensed physical therapist or under the direct supervision of a licensed physical therapist. However, from June 2009 to October 2010, Boshears and other Total Rehab, Inc. employees operated unlicensed and without supervision resulting in Medicare incurring losses of $68,096.27.

Boshears now faces a possible 10-year prison sentence as well as financial liability for restitution, forfeiture, and other fines. Her sentencing hearing is scheduled for December 17, 2012 before the Honorable Thomas W. Phillips.

Chattanooga-Area Doctor Sentenced to 70 Months Incarceration for Writing Improper Prescriptions

March 10, 2011, by The McKellar Law Firm, PLLC

Federal and state prosecutions have been steadily increasing for medical doctors who issue medically unnecessary prescriptions, usually in the form of pain pills. The latest doctor in East Tennessee to be punished for such activities is Elizabeth Reimers of Winchester, Tennessee, who, according to a press release from the U.S. Attorney's Office for the Eastern District of Tennessee, was sentenced yesterday to 70 months incarceration in the Eastern District of Tennessee at Chattanooga by the Honorable Harry S. Mattice, Jr., United States District Judge.

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According to the press release, Reimers first came to the attention of law enforcement by a citizen who reported that Reimers was inappropriately prescribing addictive pain medication to drug-seeking patients without medical justification. Reimers allegedly prescribed pain-killers and other addictive substances even after her patients had overdosed on those medications or had been treated for addiction to them. Additionally, pharmacy records disclosed an abnormally high rate and amount of prescriptions issued by Dr. Reimers of pain medications.

The Government eventually set up an undercover sting operation, wherein an agent posed as a drug-seeking patient and was able to obtain addictive medications without any appropriate medical examination or justification. The press release reports that the undercover agent was even able to obtain such prescriptions for his fictional "brother" who Dr. Reimers never saw at all, and in whose existence she voiced disbelief.

United States Attorney Bill Killian stated what every prosecutor would echo:

I hope that this prosecution helps sound the alarm that we are experiencing a epidemic of prescription pill abuse in East Tennessee. Anyone, including a licensed doctor, who unlawfully distributes these pills will face substantial penalties. Dr. Reimers chose to ignore the oath all physicians take to "do no harm." Her actions had a devastating effect on several of her patients and the community at large. Our office will continue to target and prosecute those individuals who are responsible for illegally putting these powerful drugs on our streets.