IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT IN AND FOR LEON COUNTY, FLORIDA STATE OF FLORIDA, OFFICE OF THE ATTORNEY GENERAL, DEPARTMENT OF LEGAL AFFAIRS, vs. Plaintiff, Case No. Jury Trial Demanded DONALD E. BECKETT, D.P.M., and WOUND HEALING ASSOCIATES OF TAMPA, INC., a Florida corporation, Defendants. / COMPLAINT Plaintiff, STATE OF FLORIDA, OFFICE OF THE ATTORNEY GENERAL, DEPARTMENT OF LEGAL AFFAIRS, files this complaint against Defendants, DONALD E. BECKETT, D.P.M., and WOUND HEALING ASSOCIATES OF TAMPA, INC., a Florida corporation, and alleges: I. INTRODUCTION 1. This is a civil action to recover damages and civil penalties in excess of $360,083.34 from Defendants, DONALD E. BECKETT, D.P.M., and WOUND HEALING ASSOCIATES OF TAMPA, INC., jointly and severally, for causing false claims to be submitted to the State of Florida s Medicaid program during the period May 1, 2001, through September 15, 2004. 2. The State of Florida seeks recovery under the Florida False Claims Act, 68.081-.092, Florida Statutes, and the principles of common law. 3. This Court has jurisdiction of the causes of action set forth herein pursuant to the provisions of 68.083 and 26.012, Florida Statutes, and venue is proper in Leon County pursuant to 47.011 and 68.083, Florida Statutes.
II. PARTIES 4. Plaintiff, STATE OF FLORIDA, OFFICE OF THE ATTORNEY GENERAL, DEPARTMENT OF LEGAL AFFAIRS, (hereinafter thestate ),is Florida schief legal office and has the responsibility of protecting the State sproperty and revenue. The Office of Attorney General is acting through its Medicaid Fraud Control Unit( MFCU ),which is federally mandated to conduct[]a statewide program for the investigation and prosecution of violations of all applicable State laws regarding any and all aspects of fraud in the Medicaid program. See 42 U.S.C. 1396b(q)(3). The Attorney General is authorized to seek the remedies sought in this complaint pursuant to 409.920(8)(d), Florida Statutes. 5. Defendant, DONALD E. BECKETT, D.P.M., is a podiatrist enrolled in the Medicaid program and is assigned Medicaid individual provider number 340122700 and practices in Hillsborough County, Florida. BECKETT is the owner and president of Defendant WOUND HEALING ASSOCIATES OF TAMPA, INC. 6. Defendant, WOUND HEALING ASSOCIATES OF TAMPA, INC., is a Florida corporation which is owned in whole or in part by BECKETT and is assigned Medicaid pay-to provider number 340186300. All of the false claims alleged herein were submitted by BECKETT under the pay-to provider number of WOUND HEALING ASSOCIATES OF TAMPA, INC. During the time period involved in this complaint, it operated out of offices in Hillsborough County, Florida. 7. Defendant, WOUND HEALING ASSOCIATES OF TAMPA, INC., is the alter ego of BECKETT. BECKETT used the corporation and its assets for his personal benefit as well as to perpetuate a fraud on the Florida Medicaid program. For ease of reference, the two Defendants will 2
be refered to as BECKETT. III. THE FLORIDA MEDICAID PROGRAM 8. The Medicaid Program, enacted under title XIX of the Social Security Act of 1965, 42 U.S.C. 1396, et seq., provides funding for medical care for indigent individuals. The Medicaid program is a joint federal-state program in which the United States provides approximately one-half of the funding and the state provides the remaining one-half. See 42 U.S.C. 1396b. 9. The Florida Legislature has designated the Florida Agency for Health Care Administration( AHCA )as the single state agency authorized to make payments under the Medicaid program. See 409.902, Fla. Stat. A private corporation under contract with AHCA acts as the fiscal intermediary and is authorized to receive and proces Medicaid claims onbehalf of AHCA. To receive reimbursement for providing medical services to a Medicaid recipient, a Medicaid provider electronically or by paper transmits a claim requesting payment to the intermediary located in Tallahassee, Florida. Payment is made to the provider via electronic or paper warrant. 10. As a condition of receiving federal money to help fund the Medicaid program, each state is required by federal law (with narrow exceptions not relevant here) to operate a Medicaid Fraud Control Unit( MFCU ).See 42 U.S.C. 1396a(61). Each MFCU must conduct[] a statewide program for the investigation and prosecution of violations of all applicable State laws regarding any and all aspects of fraud in the Medicaid program. See 42 U.S.C. 1396b(q)(3); see also 409.920(7), Fla. Stat. In the state of Florida, the MFCU is primarily responsible for the investigation and control of Medicaid fraud, and its investigators who have been certified under 943.1395, Florida Statutes, are Florida law enforcement officers. See 409.910(17)(b), 409.9205, 3
Fla. Stat. IV. FACTS 11. The State of Florida, acting through its MFCU, conducted an investigation of the Medicaid billing practices of BECKETT. Investigation found that BECKETT fraudulently used provider numbers of physicians to bill Medicaid at the physician rate for services that were not provided by a physician but were instead provided by nurses who were not under a physician sdirect supervision. Three of the physician provider numbers BECKETT used to submit false claims to Medicaid were used by BECKETT without the consent of those physicians. 12. BECKETT is a Medicaid-enrolled podiatrist and, at all material times, employed Advanced Registered Nurse Practitioners ( ARNPs ), registered nurses ( RNs ), and licensed practical nurses( LPNs )to allegedly provide debridement of wounds to Medicare and Medicaid recipients. 13. When billing Medicaid, or causing bills to be submitted to Medicaid, all Medicaid providers must comply with the Medicaid handbook applicable to their specialty. See Fla. Admin. Code r. 59G-4.220 (Podiatry Services); 59G-4.230 (Physician Services); and 59G-4.010 (ARNP Services). 14. The handbooks governing BECKETT spractice are the Podiatry Coverage and Limitations Handbook (hereinafter Podiatry Handbook ), the Physician s Coverage and Limitation Handbook (hereinafter PhysicianHandbook ),and the Advanced Registered Nurse Practitioner Coverage and Limitations Handbook ( ARNP Handbook ). 15. According to all three handbooks, when an ARNP is employed by a Medicaidenrolled podiatrist or physician, the podiatrist or physician must enroll as a group provider and the 4
ARNP must enroll as an individual treating provider within the group. See Podiatry Handbook at 1-4; Physician Handbook at 1-6; ARNP Handbook at 1-4. 16. Services provided by an ARNP in a group practice must be billed to Medicaid under the ARNP provider number and reimbursed by Medicaid at the ARNP rate, which is 80% of the physician rate. See 409.905(1), Fla. Stat.; Fla. Admin. Code r. 59G-6.050(3)(d). 17. An exception to the 80% rate is when the services are provided by the ARNP under the direct supervision of the physician. See ARNP Handbook at 1-5. All services (except certain services not relevant here) provided under directsupervision of the physician may be billed at the physician rate. Directsupervision means the physician is on the premises when the services are rendered and the physician reviews, signs and dates the medical record. See id. 18. Only two ARNPs inbeckett spractice were enrolled as Medicaid providers as part of the group. These ARNPs provided services to Medicaid recipients when a physician was not on the premises, and BECKETT fraudulently billed Medicaid under a physician streating provider number. Claims provided by these ARNPs were required to have been submited under the ARNPs treating provider number and reimbursed at 80% of the physician rate. 19. Several other ARNPs were associated with BECKETT spractice but they were not enrolled as Medicaid providers. These ARNPs provided services to Medicaid recipients when a physician was not on the premises, and BECKETT fraudulently billed Medicaid under a physician s treating provider number. 20. LPNs and RNs cannot enroll as Medicaid providers and cannot provide unsupervised services to Medicaid patients and bill Medicaid for those services under a physician snumber. Instead, services provided by an LPN or RN must be provided under the direct supervision of a 5
physician and billed to Medicaid under that physician s treating provider number. See Physician Handbook at 1-7. 21. Several LPNs and RNs were associated with BECKETT Spractice. LPNs and RNs provided services to Medicaid patients when the physician was not on the premises, and BECKETT fraudulently billed Medicaid under a physician streating provider number and received payment as if a physician had done the service. 22. As a podiatrist, BECKETT is limited to providing medical, surgical, palliative, and mechanical treatment of ailments of the human foot and leg. The surgical treatment of ailments of the human foot and leg is limited anatomically to that part below the anterior tibial tubercle (basically, below the knee). See 461.003(5), Fla. Stat. 23. BECKETT did not limit his practice to wounds below the knee. Instead, BECKETT at all material times contracted with at least one medical doctor to become part of his group. BECKETT told these medical doctors that they would be consultants in the event a nurse needed advice or guidance while treating wounds above the knee. 24. In fact, however, BECKETT used these medical doctors Medicaid treating provider numbers without authorization to fraudulently bill Medicaid for services that the medical doctors did not provide but were instead rendered by nurses who were not under the doctors direct supervision. 25. BECKETT contracted with Sydel Legrande, M.D., and fraudulently billed Medicaid for services that Dr. Legrande did not provide from approximately June 2001 to October 2003; BECKETT contracted with Inderjit Bhullar, M.D., and fraudulently billed Medicaid for services that Dr. Bhullar did not provide during October 2003; and BECKETT contracted with Nkemdilim Uzo, M.D., and fraudulently billed Medicaid for services that Dr. Uzo did not provide from approximately 6
March 2004 through January 2005. 26. Attachment 1 to this Complaint is a list of the claims that the state of Florida asserts were fraudulently submitted by BECKETT. The spreadsheet identifies the recipients (by a unique number for privacy purposes), the date of service of the claim, the date paid, the paid amount, the procedure code billed, the physician name that BECKETT billed under, and the warrant number and remittance voucher number of the claims. 27. As shown in the spreadsheet, Defendant BECKETT falsely identified himself as the treating provider for 2,686 of the total false claims billed. BECKETT falsely identified Inderjit Bhullar, M.D., as the treating provider for 38 false claims. BECKETT falsely identified Nkemdilim Uzo, M.D., as the treating provider for 602 false claims. BECKETT falsely identified Sydel Legrande, M.D., as the treating provider for 2,780 false claims. BECKETT falsely identified Defendant WHAT, which is considered by Medicaid to be a physician provider, as the treating provider for 733 false claims. 28. For the services identified in Attachment 1, BECKETT caused claims for payment to be submitted to Medicaid as if a physician performed the work. The actual treating provider was, in fact, a nurse and the physician was not on the premises when the services were rendered. Moreover, Drs. Uzo, Bhullar, and Legrande did not authorize BECKETT to bill Medicaid using their treating provider numbers for the services rendered by nurses. 29. For the above-referenced services or procedures, BECKETT electronically or otherwise presented, or caused to be presented, a claim for payment to the Medicaid Program. 30. As a Medicaid provider, BECKETT had an afirmative duty to supervise the provision of, and be responsible for, goods and services claimed to have been provided, to supervise 7
and be responsible for preparation and submission of the claim, and to present a claim that is true and accurate and that is for goods and services that (a) Have actually been furnished to the recipient by the provider prior to submitting the claim.... and (e)are provided in accord with applicable provisions of all Medicaid rules, regulations, handbooks, and policies and in accordance with federal, state, and local law. See 409.913(7)(a) & (e), Fla. Stat.; see also Florida Medicaid Provider General Handbook, at page 5-4 (spelling out the same requirements as contained in the statute). 31. Each time BECKETT billed the Medicaid program or its designated intermediary, BECKETT represented to the State of Florida that he has complied with all federal and state laws governing the relevant program. 32. BECKETT submitted claims to Medicaid electronically. Any provider who utilizes the electronic funds transfer system is certifying with each use of the electronic funds transfer system that the claim(s) for which the provider is being paid is in compliance with all federal and state laws and the provisions found on the back of the paper claim form, which states, in pertinent part: I certify that the services listed above were medically indicated and necessary to the health of this patient and were personaly furnished by me or my employee under my personal direction. 33. The back of the paper claim form also contains the following language: NOTICE: This is to certify that the foregoing information is true, accurate and complete. I understand that payment and satisfaction of this claim will be from Federal and State funds, and that any false claims, statements, or documents, or concealment of a material fact, may be prosecuted under applicable Federal or State laws. 34. BECKETT ignored the billing criteria set forth by the Florida Medicaid Program and knowingly engaged in a pattern of submitting improper claims to Medicaid. 8
35. As a result of the false or fraudulent claims presented or caused to be presented, the Medicaid program suffered least $120,027.78 in actual damages. 36. Additionally, the State of Florida has identified at least 6,839 false claims submitted to the Florida Medicaid program for the period under review. As investigation continues, the number of false claims identified by the state may increase and the State reserves its right to allege additional false claims and submit evidence of those false claims at the trial in this matter. COUNT I VIOLATION OF THE FLORIDA FALSE CLAIMS ACT FLA. STAT. 68.081-.092 37. The State of Florida realleges and incorporates by reference paragraphs 1 through 36 as though fully set forth herein. 38. BECKETT knowingly presented, or caused to be presented, false or fraudulent claims for payment to the Florida Medicaid Program. 39. As a result of BECKETT sconduct set forth in this count, the State of Florida suffered actual damages in excess of $120,027.78. COUNT II PAYMENT BY MISTAKE OF FACT 40. The State of Florida realleges and incorporates by reference paragraphs 1 through 36 as though fully set forth herein. 41. Had the Florida Medicaid Program known that BECKETT improperly billed the Florida Medicaid Program for services not provided, the Florida Medicaid Program would not have paid BECKETT for the claims submitted. 42. As a result of the improper conduct, the Florida Medicaid Program or its 9
intermediary, paid monies to BECKETT by mistake of fact and has been damaged by an amount in excess of $120,027.78. COUNT III UNJUST ENRICHMENT 43. The State of Florida realleges and incorporates by reference paragraphs 1 through 36 as though fully set forth herein. 44. As a result of the conduct described herein, BECKETT was paid Medicaid funds to which he was not entitled. 45. As a consequence of the acts set forth above, BECKETT was unjustly enriched at the expense of the State of Florida in an amount in excess of $120,027.78. 46. In equity and good conscience, BECKETT should not be permitted to retain the monies wrongfully received. PRAYER FOR RELIEF WHEREFORE, Plaintiff demands that judgment be entered in favor of the State of Florida against the BECKETT, jointly and severally, as follows: a. On Count I, for treble the amount of the State of Florida s damages plus civil penalties of $10,000.00 for each false claim submitted;for reasonable atorney s fees and costs of this civil action; and for such other and further relief as the Court deems just and equitable; b. On Counts II and III, return of all funds paid by the Florida Medicaid Program or its intermediary to BECKETT as a result of the improper billing submissions, prejudgment interest, costs, and for such other and further relief as the Court deems just and equitable; and c. On all counts, for such other and further relief as the Court deems just and equitable. 10
DEMAND FOR JURY TRIAL The STATE OF FLORIDA respectfully demands trial by jury of all issues so triable. Respectfully submitted this day of, 2005. CHARLES J. CRIST, JR. ATTORNEY GENERAL SCOTT J. FLINT ASSISTANT ATTORNEY GENERAL Florida Bar No. 0085073 3507 Frontage Road, Suite 325 Tampa, Florida 33607 (813) 287-7226 (813) 281-5513 (telecopier) 11