A Florida man, 71, was sentenced on March 6, 2024, to one year and one day in federal prison for unlawful drug distribution, false statements relating to healthcare matters, and Paycheck Protection Program fraud. He was also ordered to pay restitution in the amount of $35,319.23 to the Small Business Administration and $8,466.56 to Medicare.
According to court documents, the defendant was a Florida-licensed physician and Drug Enforcement Administration registrant. On May 30, 2019, the Florida Board of Medicine suspended him from the practice of medicine for two years, which made him ineligible to lawfully prescribe controlled substances. However, he continued to issue controlled-substance prescriptions after his medical license was suspended. Furthermore, he concealed the fact that he was not authorized to issue prescriptions from Medicare in connection with the submission to Medicare of the prescriptions for payment. He eventually closed his medical business in November 2019.
Between April 2020 and May 2020, the defendant used his closed business to fraudulently obtain a federal Paycheck Protection Program (PPP) loan in the amount of $33,034. He submitted an application that contained multiple fraudulent representations, including stating average monthly payroll suggesting he actively operated a medical business; stating he employed six employees; and certifying that loan proceeds would be used for business-related purposes.
Compliance Perspective
Issue
Professional licenses should be verified upon hire, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) should be checked monthly to ensure no current employees are on the list. Professional license active status should also be tracked regularly. Anyone who hires or partners with an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds. The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act, and in promoting quality of care. Routine audits should be conducted at each facility on monetary transactions and the results of the audits should be reported to the compliance and ethics committee and to the governing body.
Discussion Points
- Review policies and procedures for verifying the status of professional licenses, including confirming that they are not included on a state or OIG exclusion list. Also review your policies and procedures for operating an effective compliance and ethics program. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train appropriate staff to follow protocols for verification of licenses and certifications of employees at the time of hire and on an ongoing basis to ensure that those licenses remain up-to-date and are unencumbered. Ensure that training is provided to licensed personnel about their responsibility to maintain an active license and to notify administration should their license be suspended, expire, or if they are added to the OIG’s LEIE or a state exclusion list. Also train all staff on your compliance and ethics policies and procedures upon hire and at least annually, including their responsibility to identify and report any concerns of fraud, waste, or abuse of government funds in a timely manner.
- Periodically audit to verify that the licensing and certifications of employees are valid and up to date. Immediately address any negative findings. Also periodically perform audits to ensure all staff are aware of the importance of identifying compliance and ethics concerns and their responsibility to report them to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
