Health Care Lawyer Blog

Frank, Haron, Weiner and Navarro, in collaboration with the United States Attorneys Office for the Eastern District of Michigan, has settled a false claims suit against SCCI Hospitals of America,Inc. (SCCI), a provider of specialized long-term acute hospital care (an “LTACH”), to recover $830,166 in payments allegedly misappropriated from Medicare.

The lawsuit was filed on May 18, 2005 by the law firm under the qui tam provisions of the federal False Claims Act (31 U.S.C. 3729 et seq.) on behalf of Teri Hall-Dutts, R.N., Robert Kuzina and Donna Rudolph, R.N., in the U.S. District Court for the Eastern District of Michigan in Case No. 05-40351. On July 26, 2006, Christine Paulus and Angela DeGrez, represented by Patricia Stamler of the Bloomfield Hills, Michigan law firm, Hertz Schram, filed a similar lawsuit in Case No. 06-13393. The cases were consolidated in September, 2007 and the settlement announced here resolves both cases.

The settled law suits claimed that, between October 1, 2004 and September 30, 2005, SCCI submitted claims to the Medicare Program for services provided by SCCI Detroit which were not medically necessary because they were provided beyond the date when the patient should have been discharged, or because the patient did not meet admission criteria for an LTACH. SCCI, headquartered in Houston, Texas, operates Long-Term Acute Care Hospitals in several states but the subject matter of the lawsuits were the operations of its facility in Detroit, Michigan. SCCI previously settled another suit in 2007 for $75 million for conduct from 1996-1999 involving numerous Texas locations.

The Relators will share an award of 20.5 percent of the settlement or $170,184.11. The defendant also agreed to pay $107,983.89 for Relators’ expenses and attorney fees. In settling the suit the defendant neither admitted liability nor did the government conclude that the claims were not well founded.

After the jump - why the FCA is crucial to combating fraud

Continue reading "Detroit Long-Term Care Facility to Pay Back Over $800K in Medicare Fraud Settlement" »

The firm of Frank, Haron, Weiner and Navarro has collaborated with the United States and Michigan governments to settle a false claims suit against St. John Health System for $822,000.

The lawsuit was filed in 2008 by the law firm under the qui tam provisions of the federal False Claims Act, Title 31, United States Code, Section 3730 (b) –(h) on behalf of Maria Hoepner and Frank Pink, D.D.S.

The Act (and similar state Acts, such as the Michigan Medicaid False Claims Act) provides incentives to private citizens, called Relators, who discover fraud against the federal government and who bring their information to the government and help pursue the defrauding entities. The qui tam provisions allow Relators to represent the interest of the government for damages and civil penalties for a violation of law, and if the action is successful, a portion of the recovery is provided to the Relators.

Ms. Hoepner was formerly the Clinic Coordinator for a dental clinic operated jointly by St. John Health System and the University of Detroit at St. John Detroit Riverview Center. Dr. Pink was a supervising and billing dentist at the clinic. The law suit claimed St. Johns Health System submitted or caused to be submitted claims to the Medicaid program, for dental or oral/maxillofacial care on behalf of three health care professionals at St. John Riverview Center.

Continue reading "Michigan Health Care Fraud Case Settled for $800,000 Against St. John" »

Our firm published a series of articles in the Summer, 2008 edition of Michigan Medical Law Report.

Michigan Medical Law Report is published by Dolan Media Company. Frank, Haron, Weiner & Navarro was asked to contribute to this prestigious magazine sent to 20,000 practitioners.

Michelle Bayer's article on Internet pharmacies is entitled "They're efficient, but mail-order Internet pharmacies have intricate legal requirements."

Mercedes Varasteh's article entitled "Joint Commission standard fosters collaboration between medical staffs, hospitals" covered the application of MS 120.

Louis Szura wrote on revisions to Section 179 of the Internal Revenue Code in an article, "Economic Stimulus Act offers big tax breaks for health care providers."

David Haron instructed providers on the federal False Claims Act in "Exposing fraud and abuse--what a private citizen may do."

Finally, Melinda Balian and Ross Hammersley gave excellent employment related information in "Employees--your biggest risk and your biggest ally."

Louis Szura, an Associate Attorney at Frank, Haron, Weiner & Navarro, has been admitted, through waiver, to the State Bar of Michigan. Louis, a University of Michigan and Cornell Law School graduate and an attorney licensed, and who has practiced, in Ohio and Illinois, was approved by the Character and Fitness Committee and sworn in before the Honorable Shalina Kumar, Judge of the 6th Circuit in Michigan in Oakland County.

Louis will continue his practice in all aspects of litigation, including health care and complex business matters.

The Michigan Medicaid False Claims Act was amended effective January 1, 2006 through the efforts of Attorney General Mike Cox and Representative David Law (R., Commerce). I worked actively for passage of the amendment and testified before the Michigan House of Representative Judiciary committee, then chaired by Rep. Law.

The Amendment brought Michigan into line with 22 other progressive states by adding a Qui Tam provision to the existing Medicaid False Claims Act. According to Wallace Hart, an Assistant Attorney General, actively involved in fraud control, the amendments--giving private citizens the right to bring Qui Tam suits to recover fraudulent monies stolen from the taxpayers by providers treating the Medicaid program as their own private ATM machine--the amendment helped him reduce his in-box.

The Michigan Medicaid False Claims Act prohibits the presentment of any false or fraudulent claim for payment under the Social Welfare Act – namely, for Medicaid benefits. The law currently provides for the State to recover the full amount received by a Medicaid provider due to fraudulent conduct, plus triple the amount of damages suffered by the State as a result of the conduct.

HB 5757, a bill pending before the Michigan Senate after having passed the House in near unanimous fashion, would allow the State of Michigan to recoup extra funds from combined state/federal recoveries because of the provisions of the federal Deficit Reduction Act of 2005 ('DRA"). To explain, shortly after the the Michigan Medicaid False Claims Act amendment passed the Michigan Legislature and Governor Granholm signed the Act, the U.S. Congress passed the DRA providing for a 10% incentive to States which enacted a "compliant" Qui Tam statute addressing Medicaid fraud. Specifically, the Medicaid program is a joint federal/state program. Thus, in Michigan, the federal government pays about 56% and the state 44% of the costs of the Medicaid program and fraud recoveries are divided on the same percentage.

If the state has a "compliant" Qui Tam statute, the state receives an extra 10% of the recovery--that is, 54% in Michigan--of the recovery.

Continue reading "David Haron Testifies on Michigan Medicaid False Claims Act Revisions" »

My partner, Monica Navarro, and I recently returned from Chicago where we attended the American Bar Association Conference on "Physician-Legal Issues--Physicians Under Siege--What is their Future."

Although it was a long day for us--storms between Chicago and Detroit kept us on our Northwest Airlines plane for two hours before takeoff (fortunately in Business Class because of frequent-flyer updates, with free snacks and foot room)--we learned a lot and were able to interact with many health lawyers from around the country.

The Conference covered Fraud and Abuse Issues Impacting Physicians, CMS pressure on Medicare expenditures, Physician Joint Ventures and other Alternative Practice Strategies, such as, physician owned hospitals, ASCs, under arrangements, diagnostic and other ancillary enterprises, concierge medicine, insurance opt-out, managed care models and sales of health care products. Other topics included responses to marketplace demands that impact physician practice models, relationships with hospitals, employment models, etc.

Finally, a panel discussed the future FOR Physicians in the face of pressure on costs of and access to health care, demands by both Democrats and Republicans for "universal" health care, hospital mergers, productivity demands, hospital governance changes, increased regulatory demands and other negative influences on the profession--pointing out--as all physicians know--that the majority of physicians are unhappy, angry, resigned, scaling back expenditures and expectations and deeply concerned about the future.

The conference presentations were at a very high level and highlighted the need for physicians and other health care entities to be proactive and to consider their legal and professional relationships before they experience a crisis. While specialists and others in unique and specific practice niches may not have experienced significant reductions in income, most internists, family practice and pediatricians, among others, have and all are certainly aware of the pressures that have been building in the industry. Comfort today can turn into difficulty tomorrow in the face of hospital mergers and acquisitions, exclusive arrangements forcing out smaller practices and entities, "sham privileging" schemes, increasing employment of Hospitalists, and unfair payer practices.

Consultation with legal and professional experts prior to eruption of credentialing confrontations and issues, unfair competition or payer practices and regulatory activities and suspensions can--and will--reduce future costs, aggravation--or worse.

The tone of the sessions--and especially the luncheon address by Catherine I. Hanson, Vice-President and director of the AMA's Private Sector Advocacy and the Advocacy Resource Center on unfair payer practices and the AMA' s 1% Campaign to reduce payer's improper rejections to 1% of billings--presented a somewhat dismal picture of practice and a real need for increased physician organization and participation in the debate.

Nevertheless, Monica and I returned with a renewed interest in assisting our health care clients and in working with them to develop workable practice models in line with the most cutting-edge--and compliant--practice models in operation and contemplated across the country and globe.

Recently I acted as moderator and presenter for an ABA Business Law Section Teleconference discussing “Qui Tam: What Business Lawyers Need to Know.”

Federal and state False Claims Acts allow a private person to file a qui tam suit to recover monies wrongfully paid to providers by federal or state governments as a result of false claims the defendant made to the government. For example, if a physician practice group is overcharging Medicare, a person can file a sealed qui tam lawsuit that will trigger an investigation, allow the government to recover up to triple damages, as well as fines and penalties, and potentially, receive a substantial reward.

The teleconference I participated in covered:

Bringing a Qui Tam suit.
Avoiding a suit through the use of compliance mechanisms.
Reacting to internal complaints made by whistleblowers.
The employment status of whistleblowers.
Internal investigations, releases, confidentiality and severance agreements.
Do your knees knock when the FBI comes calling.

We are one of the leading Qui Tam firms in the nation, but through the knowledge gained in such representation, we counsel employers and providers in compliance matters and in the implementation of procedures and policies designed to avoid such actions.

My partner, Monica Navarro, and I taught Health law at Cooley Law School last semester. The 14 week class covered all aspects of health law--from the definition of disease, through credentialing, practice formation and operation, antitrust and fraud and abuse.

The class was so well received and we enjoyed teaching it to such a degree, that we decided to institute an in-house continuing education class in Frank, Haron, Weiner & Navarro designed to bring the latest knowledge, cases and news to our attorneys and strengthen their health law skills. the attorneys are all experienced in all aspects of health law and regularly serve our growing base of clients in credentialing, regulatory, transactional and litigation matters; however, our recent experiences will permit us to keep them sharp in cutting-edge practice methods and issues.

I just returned from my Sunday morning Weight Watcher's weigh-in. I reached my "10% Goal" and have lost 10% of the weight I was at when I began the program--this time--in October, 2007. I am looking at another 5% loss within a few months to reach my goal and begin a program of lifetime maintenance. In addition, I am starting an extensive exercise program with a "platoon" type trainer as soon as I pass a stress test ordered by my cardiologist (I had a "minor" heart-attack two years ago so the trainer wants to make certain I am good to go (I know I am, but why take any chances)).

Since I became a weight watcher, I have lost about 6 inches on my waist and many of the clothes I had relegated to the spare closet fit and look terrific. I am finally ready to start shopping again. I also feel much more energetic.

When I started my new program, I issued a challenge to our staff. most are pretty fit and pay attention to what they eat and how they live. We also offered a monetary incentive. We do not have a lot of food and snacks floating around (I used to peek in drawers every afternoon looking for them) but some were unhappy with their appearance. Since my challenge more than one has lost significant weight and we all feel pretty good.

There has been a global movement to '"Wellness Programs" in the workplace (Weight Watchers International and local chapters are available to help organize such endeavors.)

According to the Society for Human Resource Management, wellness programs are a tool to reduce health care costs and disability- and illness-related absences, or and a tactic to attract talent.

Wellness programs are most prevalent in the United States where they’re seen (as our firm has found) as a way to reduce health care costs by making workers more aware of healthy behaviors and encouraging them and their families to adopt healthier lifestyles..

Whether you institute a formal program through an organization such as Weight Watchers or some other professional program, encourage your staff to try something like Weight Loss Wars , create a self-designed pool or contest, or just bring in a healthy lunch now and then, you will see increased productivity, less absenteeism and happier employees.

We are pleased to announce that Frank, Haron, Weiner & Navarro recently joined forces with several professional service firms to launch a new business advisory group, The Alliance. The Alliance was formed to answer the need for expert business analysis and guidance that can be critical to a company’s success in identifying and meeting both short and long term business goals. The Alliance offers a team of established experts that provide clients a single source for addressing their specific business challenges.

The Alliance team includes:
• Frank, Haron, Weiner & Navarro
• Colburn Group
• BBK
• Huffmaster
• StaffPro America, Inc.
• CERB Associates

Clients of The Alliance will benefit from a holistic approach of considering all areas of a business that are integral to its success. Instead of hiring internal experts or researching, interviewing, and contracting several individual consultants, clients can now have an integrated team with best-in-class expertise in a range of fields:
• Law
• Property and Casualty Insurance
• Employee Benefits
• Financial Systems & Operational Performance Efficiencies
• SecurPlace™ (risk and legal management, security and operations) for real estate
• Recruitment Management
• Communications, Marketing, Advertising
• Human Resource Solutions
• Wealth Management

The group is very excited to launch The Alliance, as it is a natural evolution of what each Alliance member has experienced in its collective 150+ year history of providing custom solutions to clients. In today’s world, clients need business guidance in many different areas and, with the launch of The Alliance, we are able to offer one source to whom they can go to solve their business challenges and achieve their goals.

Utilizing a proprietary assessment process, The Alliance provides free initial services customized for each client. Based on the client’s individual needs, a unique Alliance team is created to analyze the business and develop strategies to impact the business’ short-term profitability and long-term viability. The key focus is to offer not only an integrated strategy, but also to provide ongoing support by helping implement and measure the strategies developed.

We look forward to discussing the opportunities The Alliance offers.

I would like to introduce myself and my new HEALTH CARE LAWYER BLOG. I have been practicing business and health related transactional, regulatory and litigation law since 1969 when I graduated from the University of Michigan Law School and joined a firm in Detroit (after a stint as law clerk to the Chief Judge of the Michigan Court of Appeals). Presently, I am a Principal Member of Frank, Haron, Weiner and Navarro, P.L.C., a boutique law firm in Troy, Michigan, a northern suburb of Detroit. I have been named a Super Lawyer for 2007 by Law & Politics Magazine and am active in the community and the Bar Association.

Health Care is the number one industry in the United States and certainly in Michigan where most other industries are in the doldrums. There is more construction in Michigan in the health care field than any other (except, perhaps, casinos!) and the issues -- regulatory and transactional-are immense. Recently, my partner, Monica Navarro, and I taught a Health Care Law Class at Cooley Law School in Auburn Hills, Michigan. The subject, taught from a 1400 page text book covered everything from the definition of disease to the drug industry to antitrust considerations to death and dying. The students were fascinated by the breadth and scope of the subject--as were we when we looked at the text book. Given the attention the "health care crisis" is receiving in the current political campaign and the rising cost of health care in America and throughout the world, the subject--and this Blog--will have a long life.

Plese return often for insight into the area, information on subjects new to you and for detailed information in areas that will be of assistance to medical practitioners, attorneys and the general public.