MFCU Investigation Leads to $100K+ Recovery for Fla. Medicaid

TALLAHASSEE, Fla.—Attorney General Ashley Moody, working with federal partners, is recovering thousands of dollars for Florida’s Medicaid program. The recovery follows an investigation into an Ocala neurologist allegedly submitting false claims for medically unnecessary and unreasonable prescription drugs. As a result of the joint state and federal investigation, Florida Neurological Center, LLC and its owner, Dr. Lance Kim, have agreed to pay $800,000 to resolve allegations that Dr. Kim fraudulently prescribed drugs.

One drug that Dr. Kim allegedly falsely prescribed is Acthar Gel®, which cost government health care programs more than $32,000 each time Dr. Kim prescribed a five-day supply. Pursuant to the agreement, the Florida Medicaid program will receive more than $113,000 in restitution.

Attorney General Ashley Moody said, “Defrauding Florida’s Medicaid program is not a victimless crime, it harms the taxpayers of our great state. My Medicaid Fraud Control Unit investigators work hard to protect taxpayers by identifying, investigating and stopping fraud exploiting this taxpayer-funded health care program—and recovering lost funds whenever possible.”

According to the joint investigation, the defendants allegedly submitted, or caused to be submitted, false claims to Medicare and Medicaid from January 2013 through July 2020.

The settlement agreement following the investigation partially resolves claims brought under the qui tam or whistleblower provisions of the Federal False Claims Act and Florida False Claims Act statutes. Under those provisions, a private party can file an action on behalf of the U.S. and/or the state of Florida and receive a portion of any recovery. The suit, filed in the Middle District of Florida, is captioned United States ex rel. Singbush v. Florida Neurological Center, LLC, Case No. 5:19-cv-603-Oc-GPB-PRL (M.D. Fla.).

As part of the agreement, the agreed claims remain allegations only and there is no determination of liability.
 
The Florida Medicaid Fraud Control Unit is funded through a grant totaling $26,329,510 for Federal Fiscal Year 2021, from the U.S. Department of Health and Human Services Office of Inspector General. The Federal Share of these funds is 75% totaling $19,747,136. The State Matching Share of these funds is 25% totaling $6,582,374 and is funded by Florida.

The Florida Attorney General’s Medicaid Fraud Control Unit investigates and prosecutes providers that intentionally defraud the state’s Medicaid program through fraudulent billing practices. Medicaid fraud essentially steals from Florida’s taxpayers. From January 2019 to the present, Attorney General Moody’s MFCU has obtained more than $70 million in settlements and judgments.