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Miami-Dade County Pharmacy Charged With Healthcare Fraud

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According to reporting from the Miami Herald, Rx Health Pharmacy, a small medical practice based in West Miami, has been implicated in a $1.2 million health care fraud scheme. Federal prosecutors allege that the company, and several related individuals, defrauded both Medicare and Medicaid through the use of illegal cash kickbacks and billing for false prescriptions.

In recent years, federal regulators have become increasingly focused on healthcare industry billing compliance.  If you have any specific questions or concerns about healthcare fraud and anti-kickback laws, please contact our Miami physician practice management & litigation lawyers for immediate assistance.

Miami Pharmacy Allegedly Received Illegal Cash-Based Kickbacks 

Federal prosecutors contend that Elaine Hurtado, the co-owner and manager of Rx Health Pharmacy, submitted outright false claims to both Medicare and Medicaid. The criminal and civil healthcare fraud complaints state that Rx Health Pharmacy charged the federal health programs for prescription medication that was never actually provided to beneficiaries of these programs.

It is worth noting that the former corporate officer of Rx Health Pharmacy, a previously licensed medical professional named Mayrelis Lopez, was recently sentenced to federal prison for using the company to obtain financial kickbacks. At least three people connected to Rx Health Pharmacy have been charged with federal fraud crimes. In addition to Ms. Lopez, the husband of co-owner Elaine Hurtado was also implicated in the healthcare billing fraud. 

Strict Federal Regulations Prohibit Kickbacks and Self-Referrals  

While the healthcare fraud allegations in this case are especially egregious — and thus, resulted in  multiple criminal charges — all medical practitioners in Florida should be very careful to avoid any prohibited self-referrals and/or kickbacks when it comes to billing state or federal health programs. Indeed, there are very strict regulations that bar financially motivated decision-making in medical referrals. Any ‘quid pro quo’ arrangement that involves a medical referral should be avoided. To be clear, even on a purely civil level, self-referral violations are strictly punished. Medical practices that violate federal law can be:

  • Denied any payment for medical services provided;
  • Temporarily barred for participating in Medicare/Medicaid; and
  • Fine $15,000 — per legal violation.

In some cases, medical practices and medical professionals have even been permanently barred from Medicaid, Medicare, and other government health programs. Due to the total amount of patients in Florida who are covered, at least in part, by these programs, a ban from billing federal or state governments could potentially destroy the commercial viability of a medical professional’s business. If you have questions about self-referral laws, you should call a lawyer right away. 

Get Help From Our Miami, FL Medical Practice Business Attorneys Today

At Pike & Lustig, LLP, our Florida commercial law attorneys have the knowledge and experience to represent medical practitioners in matters of business management and litigation, including those involving self referral laws. To get a confidential review of your case, please call us now. From our law office locations in Miami and West Palm Beach, we represent medical practices throughout South Florida.

Resource:

miamiherald.com/news/local/community/miami-dade/west-miami-dade/article235118377.html

https://www.turnpikelaw.com/lawsuit-two-central-florida-medical-practices-accused-of-violating-anti-kickback-laws/

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