Blog Archive

December 2014
CMS Expands Medicare's Authority to Deny and Terminate Physicians and Other Providers-Why This Matters

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Stop me if you've heard this one before: the Centers for Medicare and Medicaid Services CMS recently increased Medicare's authority over physicians and other health care providers. On December 3, 2014, CMS released these new anti-fraud measures. This matters to physicians and health care providers because Medicare now maintains the authority to deny or revoke the enrollment of medical providers for man...

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12/11/2014

November 2014
Office of Inspector General Work Plan 2015: A Provider's Overview-Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law An ounce of prevention is worth a pound of cure. Through the 2015 Office of the Inspector General OIG Work Plan, the agency has revealed how it plans to carry out its mission to ensure the Medicare and Medicaid programs run more efficiently in the 2015 fiscal year. As a health care provider, knowing the ins and outs of...

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11/24/2014

Office of Inspector General Work Plan 2015: A Provider's Overview-Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law Each new fiscal year, the Office of the Inspector General OIG Department of Health and Human Services HHS releases its annual Work Plan. This Work Plan is the general overview of how the OIG intends to carry out its mission to make the Medicare and Medicaid programs run more smoothly and efficiently in the following ye...

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11/21/2014

IRS Beefs Up Whistle-blower Awards Program

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Internal Revenue Service IRS is hoping that a change in the law and the possibility of big payout will influence more whistle-blowers snitching to authorities. Few people are aware of this program. The IRS issued brand new regulations for its own whistle-blower program in August 2012. These were written to recruit more whistle-blowing moles to help flush out financial fraud. The biggest differences...

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11/17/2014

Failure to Comply With HIPAA Can Result in Both Civil and Criminal Penalties

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Even though a violation of the Health Insurance Portability and Accountability Act HIPAA Privacy and Security provisions do not allow a private civil cause of action, it does carry civil and criminal penalties. Anyone who is a health care professional or facility, or deals with a health care professional or facility, should be aware of these legal provisions. Criminal Penalties for HIPAA Violations. In...

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11/11/2014

October 2014
Medicare Providers: Make Sure Medicare Has Your Correct Address; Make Sure You Complete CMS Forms 855I Correctly

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We are constantly consulted by and retained to represent physicians, medical groups, pharmacies, Durable Medical Equipment DME distributors and other Medicare providers on issues relating to deficiencies from site visits and inspections from Medicare contractors and on notices of termination of Medicare billing privileges. Results of Termination from the Medicare Program. These are extremely serious is...

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10/29/2014

Supreme Court Scrutinizes Dentist Regulating Dentists - Ruling Could Affect Other Regulatory Boards

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The United States Supreme Court is currently hearing arguments in North Carolina Board of Dental Examiners v. Federal Trade Commission . The justices will determine whether professional regulatory boards should be exempt from federal antitrust laws and thus be allowed to eliminate low-cost competitors. This case will also decide whether U.S. states can delegate the regulation of professionals, such as ...

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10/22/2014

Baker Act Basics

By Lance O. Leider, J.D., The Health Law Firm The Florida Mental Health Act, more commonly known as the Baker Act, was passed to allow for the creation of programs designed to "reduce the occurrence, severity, duration, and disabling aspects of mental, emotional, and behavioral disorders." Section 394.453, Florida Statutes. The Baker Act contains a wide range of provisions ranging from screening to appointment of legal guardians. But what the Act is most known for are the involuntary evaluation ...

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10/20/2014

Reap the Benefits of Electronic Health Records, Not the Liabilities - Part 2

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm In part one, I discussed how the recent United States Ebola crisis in Texas appeared to bolster the argument for those wary of the implementation of electronic health records EHRs . To read that blog, click here . Health information technology health IT brings both opportunities and challenges for healthcare providers . EHRs are one of the most debated health IT developments. The intent of such an innovative system is to replace archaic paper...

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10/16/2014

The United States Ebola Case May Have Cast Doubt On The Use of Electronic Health Records - Part 1

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm The evolving world of electronic technology saturates every type of industry imaginable. Organizational communication and the resources utilized have come full circle; from paper and pens to iPads and keyboards. Healthcare is not excluded from this advancement. Conversion to electronic health records EHRs has been a hot topic in the healthcare world for years. At its inception, the intent of EHRs was to streamline procedures and improve the q...

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10/10/2014

Just What the Doctor Ordered: More Medicaid Reimbursements May Be On the Way For Florida Physicians

By Lance Leider, J.D., The Health Law Firm Taking Medicaid patients can be seen as a professional obligation for health care providers. In return, good deeds should not bankrupt a practice. There could soon be a resolution to a class-action lawsuit against Florida health and child-welfare officials that would adequately compensate physicians for treating children of poor families. According to the Miami Herald, the lawsuit was initially filed in 2005 by a group of pediatricians, dentists and nin...

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10/7/2014

What You Need to Know about the Rescheduling of Hydrocodone Combination Products

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm Physicians and pharmacists: mark your calendars. The Drug Enforcement Administration DEA is reclassifying "hydrocodone combination products" from Schedule III to the more-restrictive Schedule II under the Controlled Substances Act. The final regulation will take effect on October 6, 2014. Upon the effective date, this change will have a widespread impact on healthcare professionals, particularly physicians and pharmacists. This regulation was...

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10/2/2014

September 2014
Reinstatement After OIG Exclusion is Not Automatic

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An issue we frequently handle is Office of Inspector General OIG exclusion from the Medicare program following a conviction for a healthcare-related offense. An OIG exclusion blocks a healthcare provider from working for any individual or entity that contracts with federally funded programs in any capacity. For example, if a healthcare provider receives a five-year OIG exclusion, he or she cannot work ...

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9/10/2014

August 2014
The ABCs of IRBs

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm The field of scientific research presents many challenges to academics. When research is performed on human subjects in a health care setting, the stakes are even higher. Allegations of research misconduct can throw academic researchers into a tangled web of institutional and legal challenges. University policies, federal regulations, and legal concerns overlap in ways that may become quite frustrating for a health practitioner and researcher...

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8/25/2014

Has Healthcare Compliance Gone Too Far?

By Lance O. Leider, J.D., The Health Law Firm From large hospital systems to solo practitioners, there is no escaping healthcare compliance in the industry. The concept of compliance can spark different thoughts in different people. For example, some believe it is an unnecessary government intrusion, and others believe it's a way to improve the quality and costs of healthcare. No matter your thoughts on healthcare compliance and government oversight, regulation of the healthcare industry will ne...

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8/21/2014

Warning: Texting Patients' Sensitive Information Could Have Serious Consequences

By Lance O. Leider, J.D., The Health Law Firm I regularly lecture to residents and interns of local hospital residency programs. I like to discuss life skills for health care professionals that they may not learn in a classroom. At the end of the discussion, it never fails that I get at least one question regarding text messaging. For example, "Can I text another doctor about a patient?" or "Is text messaging an acceptable way to communicate with my patients?" These questions are not uncommon si...

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8/19/2014

As a Health Care Professional in Florida, You Need to Stay In the Know on Medical Marijuana

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law During the 2014 session, the Florida legislature passed Senate Bill 1030 or the Compassionate Medical Cannabis Act of 2014. The bill was signed into law by Florida Governor Rick Scott on June 16, 2014. The law makes it legal for qualified Florida patients to take low-THC cannabis in liquid form. The specific medical marijuana is approved to treat certain medical conditions such as epilepsy, muscle spas...

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8/12/2014


Stay Sharp and Aware: Employee Embezzlement in the Medical Field - Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Embezzlement should be a concern to all healthcare facilities , medical practices and business owners . Part one of my embezzlement blog discussed the extent of embezzlement in the medical field, financial indicators of fraud, and the office criteria that fosters fraudulent activities. To read part one, click here . Embezzlement is rarely always a complex crime. This type of fraud is actually quite sim...

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8/5/2014

July 2014
Don't Bury Your Head in the Sand: Embezzlement in the Medical Field - Part 1

When his American Express Platinum Card with an unlimited credit line was declined, a doctor in DeBary, Florida, realized he had a big problem. According to the Orlando Sentinel, the office manager of the doctor's medical practice allegedly embezzled more than $136,000. For more than two years, the middle-aged woman who managed the doctor's finances allegedly used the doctor's money and credit to support her lavish lifestyle. The accused fraudulent purchases include theme park visits, airfares, ...

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7/30/2014


Thinking About Contacting the Professionals Resource Network (PRN) or the Intervention Project for Nurses (IPN)? Read This
.

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Physicians, dentists, nurses and other health professionals, accused of wrongdoing, may be referred to or receive recommendations from colleagues to refer themselves to the Professionals Resource Network PRN or the Intervention Project for Nurses IPN. This is often done by someone who has absolutely no idea about these programs or what they require. An individual who does this may find himself or hers...

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7/28/2014

What You Need to Know About Florida's Baker Act - Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We are frequently consulted by family members of individuals who are erroneously confined under Florida's Baker Act, Section 394.451, Florida Statutes . An erroneous confinement under the Baker Act can occur for a number of different reasons. However, the result is that an independent citizen is confined in violation of his constitutional rights to liberty and privacy. There is a similar law that legal...

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7/21/2014

Science Journal Retracts Stem-Cell Research Studies; Head Researcher Held Accountable

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The scientific journal, Nature, retracted two high-profile stem-cell research studies due to signs of inadequate data and plagiarism. According to Tech Times, researchers from the RIKEN Center for Development Biology in Kobe, Japan, published results on January 30, 2014, claiming that scientists of the institute had successfully reprogrammed mature cells into young stem-cells. The stem-cells, a type of...

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7/15/2014

Limits on Number of Attempts and Time for Completion of USMLE Step Exams

By Catherine T. Hollis, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to the United States Medical Licensing Examination USMLE 2014 Bulletin of Information, individuals are permitted to attempt the same Step Exam or Step Exam Component a maximum of six times. All attempts, including incomplete attempts, are counted toward the limit, regardless of when they were taken. The USMLE Program itself does not limit the...

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7/11/2014

June 2014
Document Drop Off: Where One Health System Left Private Patient Medical Records

By Lenis L. Archer, J.D., M.P.H. A drop off of private patient files to a physician quickly turned into what may be one of the most expensive deliveries in healthcare regulatory history. In 2009, employees of Parkview Health System, a nonprofit organization with hospitals in Indiana and northwest Ohio, left 71 cardboard boxes of private patient medical records in the driveway of a retiring physician. Within 20 feet of the public road and in close proximity to a heavily trafficked shopping venue,...

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6/30/2014

Does the DEA Use Intimidation Tactics to Force Doctors and Pharmacists to Give up Their DEA Number
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Drug Enforcement Administration DEA continues to crackdown, at least in Florida, on physicians and pharmacists suspected of prescribing and dispensing narcotics. We believe this effort is a continuation of the campaign against "pill mills" and the pharmacies that fill prescriptions written by them. However, just because you are not a pain management physician or pharmacist and you don't write ...

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6/24/2014


Adventist Health System Self-Discloses Stark Law Violations

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law When I served with the federal government, a frequent saying used over and over was: "It's better to ask for forgiveness than to ask for permission." This may be what Adventist Health System is hoping for in making its latest self-disclosure to the Office of Inspector General OIG . Documents released on May 12, 2014, reveal that Adventist, which owns Florida Hospital and 44 other hospitals nationwide, ...

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6/20/2014

Outpatient Outsourcing: The Unconventional Methods of One Florida Urologist

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law "A menace to society," "board-certified in medical fraud," "one of the most dangerous doctors I've seen in a long time." These are some of the harsh words coming from the Florida Board of Medicine. The Board used those statements to describe a Sarasota, Florida, urologist who specializes in prostate problems. The urologist is accused of using unconventional diagnostic and treatment methods, even referr...

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6/18/2014

Halifax Health Back in the Hot Seat - Why the Hospital was Hit with Even More Sanctions

Always be wary of asking "could it get any worse?" Halifax Health Medical Center in Daytona Beach, Florida, is proof that a situation always has the possibility of taking a darker turn. On May 27, 2014, the federal judge overseeing the ongoing Halifax whistleblower/qui tam court cases ruled that the medical center wrongfully destroyed documents and files that were central to the upcoming trial. The trial, slated for July 2014, is the second part of a case against Halifax and will concern allegat...

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6/10/2014

How Tightened Controls on Prescribing for Medicare Part D Patients May Affect Health Care Providers-Part 2

By Lance O. Leider, J.D., The Health Law Firm Under a rule finalized by the Centers for Medicare and Medicaid Services CMS on May 19, 2014, doctors and other health care professionals will be required to enroll in the Medicare program, or have a valid opt-out affidavit on file, for prescriptions to be covered under Part D. The new requirement takes effect on June 1, 2015. To read more on the details of this rule and why CMS implemented it, click here for my previous blog. Through the rul...

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6/6/2014

How Tightened Controls on Prescribing for Medicare Part D Patients May Affect Health Care Providers-Part 1

By Lance O. Leider, J.D., The Health Law Firm On June 1, 2015, doctors and other health care providers will be under tighter restrictions when prescribing to Medicare Part D patients. A final rule released by the Centers for Medicare and Medicaid Services on May 19, 2014, requires health care providers to enroll in the Medicare program, or have a valid opt-out affidavit on file, for prescriptions to be covered under Part D. This requirement closes a loophole that previously allowed some practiti...

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6/4/2014


May 2014
Court Orders Florida Oncologist to Pay $89.6 Million After False Claims Act Judgment

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Talk about cracking down on Medicare fraud. On May 14, 2014, a Brevard County radiation oncologist received his final judgment in a whistleblower Medicare fraud case . The doctor, who owned the American Cancer Treatment Centers with offices in Titusville and Rockledge for nearly 20 years, was ordered to pay the United States $89.6 million. The doctor was charged with defrauding Medicare under the False...

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5/29/2014

Pain Management Physicians Beware: Your Practice is Under Scrutiny

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The practice of pain management remains under direct scrutiny here in Florida. The Orlando area recently entered the limelight again after federal agents raided a local pain clinic with heavy allegations against the owner and his sole practitioner. On May 8, 2014, Metropolitan Bureau of Investigation MBI agents and Florida Department of Health DOH officials raided the Pain Care Place of Central Florida...

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5/21/2014

Statistical Analysis, Often Performed on National Board Exams, May Result in Accusations of "Irregular Behavior" or Other Career-Killing Charges

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Before obtaining a professional license or degree, medical, dental, chiropractic and other professional students are subject to stringent testing. Students must take and pass the national board examinations. These examinations are usually administered by private companies, such as the National Board of Medical Examiners NBME , through the United States Medical Licensing Examination USMLE program, the N...

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5/13/2014

Medicare Providers and Suppliers Deemed "High Risk" Must Submit to Fingerprint-Based Background Checks

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services CMS is enforcing fingerprint-based background checks for Medicare suppliers and providers designated as "high risk." As a requirement of the Affordable Care Act ACA , CMS must improve the screening for those Medicare suppliers and providers. According to CMS, all newly enrolling home health agencies HHAs and durable medical equipment DME suppliers are high...

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5/9/2014

CRIMINAL LAW: Search and Seizure - Cell Phone

Our guest author of this is article is Doug Plank , a legal research attorney with National Legal Research Group in Charlottesville, Virginia. In the case of City of Ontario v. Quon , 560 U.S. 746 2010 , a police officer filed a civil rights action after his superiors disciplined him based on what they had discovered after searching the content of the texts on the wireless communication device that the police department had issued to him. The U.S. Supreme Court assumed, without deciding, that ci...

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5/1/2014

April 2014
CONSTITUTIONAL LAW: To Be "Clearly Established" or Not "Clearly Established": That Is the Question

Our guest author of this is article is Steve Friedman, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. The doctrine of qualified immunity shields governmental officials "from liability for civil damages insofar as their conduct does not violate clearly established statutory or constitutional rights." Harlow v. Fitzgerald , 457 U.S. 800, 818 1982 . For qualified immunity purposes, "clearly established" means that "[t]he contours of the right must be suff...

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4/22/2014

Physicians React to the Release of Medicare Reimbursements

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For years, the Centers for Medicare and Medicaid Services CMS kept private its records on Medicare reimbursement payments made to physicians, however, on April 9, 2014, that all changed. The government released records revealing unprecedented details about Medicare payments made to physicians, nurse practitioners NPs , physician assistants PAs and other health care providers. Many physicians resent bei...

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4/21/2014

CONTRACTS: Forum-Selection Clause—Enforcing by 28 U.S.C. § 1404(a) Motion to Transfer Venue

Our guest author of this is article is Charlene Hicks, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. Forum-selection clauses are commonly used in contracts to specify the location in which the parties agree to resolve any disputes that may arise between them. These clauses are important to businesses that wish to establish predictability and potential cost-savings in future litigation. Even so, until recently a split existed amongst the various federa...

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4/15/2014

Contracting 101: Tips for Physicians and Health Professionals-Part 12

By Christopher E. Brown, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Tip 28-Verify That the Relationship Between the Physician and the Employer is Legal. Our contracting blog series was created to identify and explain the different provisions of a physician's employment or independent contractor agreement. However, sometimes it's necessary to look beyond the written language of the contract and determine if the very re...

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4/14/2014

Texas Medicaid Settlement Raises Questions Among Health Care Providers

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On March 17, 2014, Carousel Pediatrics in Austin, Texas, agreed to pay the state a $3.75 million settlement, after an investigation by the Texas Health and Humans Services Commission Office of Inspector General OIG allegedly found a number of billing errors. According to a press release, the Texas OIG alleged the pediatric office charged for higher...

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4/8/2014

CMS Revises Emergency Preparedness Checklist

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm On February 28, 2014, the Centers for Medicare and Medicaid Services CMS issued its revised emergency preparedness checklist for health care facility planning. Updates to the checklist provide more detailed guidance about patient and resident tracking, supply management, and collaboration with local emergency management agencies and health care coalitions. According to the Survey and Certification Memorandum, the information is current policy...

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4/4/2014

Lost Thumb Drive at Arnold Palmer Medical Center Contains Information on 586 Child Patients

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An unencrypted flash drive containing limited information of 586 children treated at Orlando Health's Arnold Palmer Medical Center between 2009 and 2013, was misplaced, according to the hospital. The lost drive is being treated as a data security breach. However, there is no evidence that any of the information on the flash drive was accessed or used by any unauthorized individual. As a precaution, on ...

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4/2/2014

March 2014
New National Practitioner Data Bank (NPDB) Guidebook to be Available Soon

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law When faced with an issue or question about the National Practitioner Data Bank NPDB , most health care practitioners rely on the Data Bank Guidebook. Since September 2001, this Guidebook has been a reliable source to turn to for answers regarding reporting to and querying the NPDB. However, after twelve years, a new Guidebook will soon be released. In November 2013, the Health Resources and Services Ad...

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3/31/2014

Massachusetts Physicians Who Don't Meet Meaningful Use EHR Criteria Could Lose Their Medical Licenses in 2015

Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law Effective January 2015, Massachusetts physicians who wish to renew their licenses must demonstrate that they utilize electronic health records EHRs that meet the requirements of the federal government's meaningful use program. The purpose of the law was to improve the quality of healthcare provided to patients by Massachusetts doctors while reducing costs. However, the law had unintended consequences. It is estimate...

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3/26/2014

Equitable Tolling May Not Be Used To Save Late Hearing Request When It Could Have Been Easily Submitted on Time

The foregoing case summary was prepared by and appeared in DOAH case notes of the Administrative Law Section newsletter FACTS: The Department of Financial Services DFS resolves disputes over the costs of medical care provided to workers’ compensation claimants. On April 8, 2013, Florists Mutual Ins. Co. Florists receive notice of DFS’s determination that Florists owed $100,894.54 to the Kendall Regional Medical Center. The notice advised that a request for an administrative hearing h...

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3/24/2014

More Than 168,000 Patients' Information Stolen in Los Angeles County Computer Theft

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Around 168,500 patients of Los Angeles County medical facilities are receiving letters that their personal data was stolen. According to the Los Angeles Times, on February 5, 2014, an office of Sutherland Healthcare Solutions, which handles billing and collections for the county's Department of Health Services and Department of Public Health, was burglarized and computer equipment stolen. Click here to...

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3/21/2014

Professional Board Is Not Allowed to Ask About Misconduct Not Charged in Administrative Complaint at Informal Hearing

The foregoing case summary was prepared by Mary F. Smallwood, Esquire, of The Administrative Law Section of The Florida Bar. The Department of Health DOH filed an administrative complaint against Gonzalez, a licensed chiropractor, for alleged statutory and rule violations. The alleged violations involved recordkeeping practices and failure to provide records to a patient upon request. Gonzalez elected to have an informal hearing and did not dispute the findings of fact in the administrat...

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3/19/2014

USMLE Hearing? Organization, Timing, and Evidence are Crucial-Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law If you are a physician, medical student, or medical resident accused of "irregular behavior" by the United States Medical Licensee Examination USMLE Secretariat/National Board of Medical Examiners NBME , you must challenge this accusation and defend yourself. You should request a hearing, plan on a personal appearance at the hearing before the Committee for Individualized Review CIR , and obtain and su...

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3/14/2014

USMLE Hearing? Organization, Timing, and Evidence are Crucial-Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law If you are a physician, medical student, or medical resident accused of "irregular behavior" by the United States Medical Licensee Examination USMLE Secretariat/National Board of Medical Examiners NBME , you must challenge this accusation and defend yourself. You should request a hearing, plan on a personal appearance at the hearing before the Committee for Individualized Review CIR , and obtain and su...

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3/12/2014

Halifax Health Reaches Record-Setting Settlement in Whistleblower/Qui Tam Fraud Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law At the eleventh hour Halifax Health Medical Center, a Daytona Beach hospital, agreed to pay a record-setting $85 million settlement in a whistleblower/qui tam lawsuit. The lawsuit alleged more than a decade of illegal compensation to doctors, violating the federal Stark Law, and Medicare fraud. According to the Orlando Sentinel, on March 3, 2014, Halifax and the U.S. Department of Justice DOJ reached t...

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3/10/2014

CMS Extends Ban on New Home Health Agencies and Ambulance Suppliers

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services CMS continues to stop fraudulent repayment claims before they happen. In an effort to do so, the agency is temporarily blocking several home health agencies HHAs and ground ambulance suppliers in fraud hot spots around the country from enrolling in and receiving reimbursements from Medicare, Medicaid and the Children’s Health Insurance Program CHIP p...

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3/6/2014

Mandatory Disqualification for Health License Because of Criminal Conviction? There May Still Be Hope

By Lance O. Leider, J.D., The Health Law Firm In 2009 the Florida Legislature passed a bill imposing severe restrictions on the professional boards regulating health care practitioners in Florida. These include the Board of Medicine, Board of Nursing, Board of Dentistry, Board of Massage Therapy, Board of Osteopathic Medicine, Board of Psychology and Board of Marriage and Family Therapy, among all others. These draconian measures were implemented in a supposed crackdown on healthcare fraud. Unfo...

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3/5/2014

Looking for Florida Advanced Practice Nurses to Have an Expanded Role? You May Have to Wait

By Joanne Kenna, R.N., J.D., The Health Law Firm Although there has been renewed interest and activity during the current legislative session to expand the roles of Florida advanced nursing practitioners, it seems unlikely that these efforts will result in any changes in the ways these nurses practice in the near future. A bill PCB SCHCWI 14-01 was recently passed by the House Select Committee on Health Care Workforce Innovation. It had bipartisan support. The bill proposed some significant chan...

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3/4/2014

February 2014
25 Arrested After Medicaid Fraud Round Up in Washington, D.C.

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In a citywide takedown, 25 people, including operators of home care agencies, operators of nurse staffing agencies, office workers and personal care assistants in Washington, D.C., were all arrested for alleged Medicare fraud schemes. According to the U.S. Attorney's Office, these individual scams involved at least $75 million in fraudulent Medicaid payments. On February 20, 2014, more than 200 law enf...

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2/27/2014

Florida Speech Therapist Arrested for Allegedly Defrauding Medicaid

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A licensed speech therapist faces up to five years in prison for allegedly defrauding Medicaid during the summer of 2013. According to the Florida Attorney General AG , the therapist was arrested on February 7, 2014, for allegedly using falsified records to collect payment for services never rendered. An investigation by the AG's Medicaid Fraud Control Unit MFCU and the Orange County Sheriff's Office r...

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2/21/2014

Florida Board of Pharmacy Recommends PRN Evaluation for all Applicants with History of Mental Problems or Substance Abuse

By Lance O. Leider, J.D., The Health Law Firm The Florida Board of Pharmacy made some rather concerning recommendations to present and future applicants at its February 12, 2014, meeting. During the portion of the agenda where the Board considers the approval of applicants for licensure with prior mental health or substance abuse related issues, some members of the Board expressed frustration with the fact that the applicants had not been evaluated by the Professionals Resource Network PRN prior...

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2/19/2014

Bipartisan Plan for SGR Repeal Released

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law After months of negotiations on how to revise Medicare's payment system for physicians, the bipartisan team of Senate and House committees have reach a deal on the policy. On February 6, 2014, lawmakers unveiled the agreement to repeal Medicare's sustainable growth rate SGR . The legislation replaces the SGR with a system that would provide stable payment ...

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2/14/2014

Appellate Court Rules Agency Personnel Should Not Have Ex Parte Contract With Hearing Officer on Case

The forgoing case summary was prepared by Mary F. Smallwood, Esquire, of the Administrative Law Section of The Florida Bar Taylor-Tillotson sought medical supplies and prescriptions, and the Agency for Health Care Administration AHCA denied that request. On appeal, AHCA filed a motion to dismiss. In its motion, AHCA stated that it believed Appellant should be entitled to a new hearing since an AHCA staff member had ex parte communications with the original hearing officer. While acknowledging th...

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2/12/2014

Florida Law Enforcement Chemist Allegedly Stole Pain Pills Jeopardizing Thousands of Drug Cases

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Florida Department of Law Enforcement FDLE is reviewing nearly 3,000 cases across Florida that were processed by a chemist in the FDLE's Pensacola Regional Crime Laboratory, according to a press release. It is alleged that for years the chemist stole pain pills from an evidence room in the Florida Panhandle, and therefore tainted thousands of criminal cases. To read the press release from the FDLE ...

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2/4/2014

January 2014
Sometimes You Get Involved in Litigation Whether You Want to or Not

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Sometimes, despite your best efforts and your best practices, you get involved in litigation. Employees and former employees sue your organization or your or both. Sometimes you are brought in as a witness in such litigation. Contractors and vendors sometimes may sue over contractual matters. If you are not a party to such an action, you still may be called as a witness. Sometimes there may be a disput...

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1/31/2014

Health Care Providers Must Wait for RAC Appeal Hearings While Medicare Beneficiaries Receive Top Priority

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In December 2013, the U.S. Department of Health and Human Services’ HHS Office of Medicare Hearings and Appeals OMHA notified hospitals, doctors, nursing homes and other health care providers that due to a backlog of Recovery Audit Contractor RAC appeals, the agency would be suspending acting on new requests for hearings filed. Health care providers were told they would not be able to submit any ...

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1/28/2014

Department of Justice Recovers $2.6 Billion from Healthcare Fraud Cases in FY 2013

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to a press release posted on December 20, 2013, the Department of Justice DOJ announced that it secured $2.6 billion in settlements and judgments from healthcare fraud in fiscal year 2013. That amount makes 2013 the fourth consecutive year that the DOJ has recovered more than $2 billion in healthcare fraud cases. Recoveries from healthcare fraud made up a majority of total recoveries under th...

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1/24/2014

USMLE Announces Increase to Minimum Passing Score for Step 1 Exam

By Catherine T. Hollis, J.D., The Health Law Firm and By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In September 2013, the United States Medical Licensee Examination USMLE announced that the Step 1 Committee would meet to review the minimum passing score for the USMLE Step 1 examination at its December meeting. On December 12, 2013, the USMLE announced that the Step 1 Committee had decided to raise the minimum passing score for the Step 1 examinat...

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1/22/2014

The Health Law Firm Attorneys Often Represent Physicians and Health Professionals in Last Minute Depositions and Hearings

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Our attorneys often receive calls from physicians and other health professionals regarding the possibility of representing them on short notice at a Board of Medicine or Board of Osteopathic Medicine hearing, or at a deposition related to a health care matter. Many Law Firms Refuse To Take Last Minute Cases. Many law firms refuse to represent a client at a hearing unless given plenty of advance notice ...

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1/20/2014

CRIMINAL LAW: Retroactivity of Supreme Court Decision in Padilla v. Kentucky and Possible Application for Health Professionals

Our guest author of this is article is Mark Rieber, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. In Padilla v. Kentucky , 559 U.S. 356 2010 , the Supreme Court held that the Sixth Amendment right to effective assistance of counsel requires an attorney for a criminal defendant to provide advice about the risk of deportation arising from a guilty plea. In Chaidez v. United States , 133 S. Ct. 1103 2013 , the Supreme Court held that Padilla announced a ...

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1/17/2014

Office of Medicare Hearings and Appeals Suspends Assignment of Appeal Requests Because of Large Backlog of RAC Appeals

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Appealing a bad decision by Medicare’s Recovery Audit Contractors RACs is taking longer than ever, according to an article on Modern Healthcare. The system is so overwhelmed by the number of appeals that some are calling it an administrative quagmire that is denying basic due process rights. In December 2013, the U.S. Department of Health and Human Services’ HHS Office of Medicare Hearings ...

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1/15/2014

CMS Announced Proposed Rule to Possibly Ban Providers Labeled as Harmful Medicare Part D Prescribers

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services CMS is proposing to exclude providers from Medicare if the government determines a pattern of abusive prescribing practices of Medicare Part D drugs. The agency also wants to prohibit doctors who are not enrolled in Medicare from prescribing drugs that are reimbursed by Pa...

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1/13/2014

Florida Department of Health Launches New System to Track Continuing Education Credits

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In July 2013, the Florida Department of Health DOH announced the launch of CE @ Renewal, a new system that verifies a practitioner’s required continuing education records at the time of licensure renewal. Currently the system requests health care practitioners to input their continuing education records in the electronic tracking system at the time of licensure renewal. Eventually the DOH will re...

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1/8/2014

CONTRACTS: Cyberlaw—Signed Email Constitutes Binding Legal Agreement

Our guest author of this is article is Charlene Hicks, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. Emails and other electronic communications are changing certain time-honored precepts of contract formation. Attorneys should be aware that what used to be considered standard negotiating procedures may now result in a contract binding upon their clients. This trend is illuminated in Forcelli v. Gelco Corp. , 109 A.D.3d 244, ___ N.Y.S.2d ___ 2013 , a r...

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1/6/2014

Congress Moves Closer to Permanent Repeal of Medicare’s SGR Formula

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 12, 2013, the U.S. House of Representatives passed a three-month patch to stabilize physicians’ Medicare payments, delaying a nearly twenty-four percent 24% cut in Medicare payments that was scheduled for physicians in 2014. The delay gives lawmakers time to consider two bills developed by the House Ways and Means Committee and the Senate...

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1/2/2014

December 2013
ESTATES: Estate Plan of James Gandolfini

Our guest author of this is article is Jim Witt, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. When Sopranos actor James Gandolfini died on June 19 of this year from a heart attack while he was on a vacation trip with his family in Italy, the media reported trivial facts surrounding his death, such as the details of his last meal and drinks. After a month or so had passed, however, attention turned to the details of Gandolfini's estate plan, with the ...

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12/17/2013

Orlando Health and Florida Blue Create Accountable Care Organization

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Lance O. Leider, J.D., The Health Law Firm On December 3, 2013, Orlando Health Physician Partners and Florida Blue announced the launch of an accountable care organization ACO . The purpose of the ACO is to encourage providers to reduce healthcare costs by grouping together and assuming responsibility for the care of a group of beneficiaries. According to a press release, the ACO between Orlando He...

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12/12/2013

Florida Board of Medicine Votes to Raise the Fees for Copies of Medical Records

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The cost of copying medical records is going up. On December 6, 2013, the Florida Board of Medicine voted unanimously to raise the cap on charges for copying medical records to $1 per page. Previously in Florida, physicians were allowed to charge up to $1 a page for the first 25 pages and 25 cents for every page after that. Under the new rule, for example, a physician could charge up to $1,000 for a co...

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12/10/2013

Halifax Health Whistleblower/Qui Tam Case Will Go To Trial

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Federal Judge Gregory A. Presnell has ruled that Halifax Health Medical Center, a Daytona Beach hospital, illegally compensated six 6 oncologists, violating the federal Stark Law. The case must still go to trial on the amount of damages and other legal issues. The Stark Law bars physicians from getting extra cash or benefits from patient referrals through kickbacks, split fees and other under-the-table...

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12/6/2013

November 2013
First Lady Challenges Florida Companies to Hire More Veterans

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On November 14, 2013, First Lady Michelle Obama attended and spoke at the first Veterans Institute Workshop, held at Disney World. This event encouraged companies from across the country to hire, train and support our nation’s military service members and their families as they transition into civilian life, according to the Orlando Sentinel. At the Veterans Institute Workshop, Mrs. Obama spoke a...

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11/25/2013

Despite Affordable Care Act Individual Mandate, Concierge Medicine on the Rise

By Lance O. Leider, J.D., The Health Law Firm Despite the Affordable Care Act's ACA mandate that individuals acquire healthcare coverage, concierge medicine is on the rise in recent years. Concierge medicine is a type of medicine where patients pay a physician practice a retainer or membership fee and then pay a la carte for discounted services offered by the physicians. In times past, concierge medicine was primarily for the wealthy with patients paying thousands of dollars a month for the "roy...

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11/21/2013

Purpose of Florida E-FORCSE Prescription Database Not for Disciplinary or Criminal Prosecution Purposes Against Physicians, Pharmacists or Other Health Professionals

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida now has an active prescription drug monitoring program PDMP . It is called the Electronic-Florida Online Reporting of Controlled Substances Evaluation or E-FORCSE. More often it is referred to simply as the prescription drug database by Florida physicians. The Florida Legislature adopted the E-FORCSE system in Florida by Section 893.055, Florida Statutes. Section 893.055 7 b , Flori...

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11/19/2013

October 2013
Hospice of the Comforter Settles Whistleblower/Qui Tam Lawsuit

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On October 28, 2013, a Florida federal judge approved a $3 million settlement in a False Claims Act lawsuit alleging Hospice of the Comforter Inc. HOTCI , defrauded Medicare. The judge shot down objections from the whistleblower sometimes called a relator or plaintiff who argued that the settlement amount is unfair, according to the Orlando Sentinel. Click here to read the entire article from the Orlan...

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10/31/2013

More Hospitals, Nursing Homes and Medical Facilities are Requiring Employees to Receive Flu Vaccine

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We’re coming up on that time of year when stuffy noses and scratchy throats turn into the full-blown influenza virus. According to the Centers for Disease Control and Prevention CDC , the flu season usually runs from November 1 through March 31. With the flu season comes the debate over the legality of mandatory flu shots for health care professionals. Many hospitals in Florida, and natio...

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10/23/2013

U.S. Food and Drug Administration Finalizes Rule on Codes that Will Track Medical Devices

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 20, 2013, the U.S. Food and Drug Administration FDA announced that companies will have to include unique device identification UDI codes on medical devices. These codes will provide a consistent way to identify medical devices, and therefore, should improve patient safety, according to the FDA. The codes allow regulators to track products, monitor them for safety and expedite recalls. The ...

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10/21/2013

Rule Raising the Cost for Copies of Medical Records to be Tabled Until Next Florida Board of Medicine Meeting

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The cost of copying medical records will stay where it is, for now. On October 3, 2013, the Florida Board of Medicine voted to not allow an increase to the cost of medical records requested by patients and others from physicians. The Board did vote to conduct research on the topic and discuss the issue again at the next Board meeting. There is a proposal to the current Florida Administrative Code Rule ...

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10/14/2013

Medicare Audit Claims University of Miami Hospital Owes Government $3.7 Million

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The University of Miami Hospital allegedly owes Medicare $3.7 million. This is according to an audit report of the hospital’s billing practices that found the hospital allegedly overbilled the health care program in 2009 and 2010. The report was released on October 8, 2013, by the U.S. Department of Health and Human Services HHS Office of Inspector General OIG . According to a letter from the Uni...

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10/9/2013

Winter Park Urology Settles Whistleblower/Qui Tam Lawsuit

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A federal whistleblower or qui tam lawsuit against a local physician group has been settled, according to the Orlando Business Journal OBJ on September 30, 2013. The providers were accused of fraudulently billing Medicare and TRICARE from 2007 until 2010. The allegations allegedly stem from radiation therapy used to treat cancer patients. According to the OBJ, the defendants include Winter Park Urology...

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10/2/2013

September 2013
What You Need to Know About the HIPAA Omnibus Final Rule-Part 3

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Health Insurance and Portability and Accountability Act HIPAA Privacy and Security Rules were amended by an Omnibus Final Rule published by the U.S. Department of Health and Human Services HHS in January 2013. The most significant changes involve business associates who are now directly subject to the mandates of the HIPAA Privacy and Security Rules and HIPAA enforcement. In addition, covered entit...

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9/26/2013

What You Need to Know About the HIPAA Omnibus Final Rule-Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Health Insurance and Portability and Accountability Act HIPAA Privacy and Security Rules were amended by an Omnibus Final Rule published by the U.S. Department of Health and Human Services HHS in January 2013. By September 23, 2013, hospitals, physicians, covered entities and business associates must comply with the new changes. The most significant changes involve business associates who are now d...

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9/25/2013

Join The Health Law Firm Attorneys for a Presentation on Medicare and Medicaid Audits

By Cori Powers, Marketing Director, The Health Law Firm Attorneys Christopher E. Brown and Lance O. Leider with The Health Law Firm will be giving a presentation on Thursday, September 26, 2013, to the members of the Medical Office Resources of Florida MOROF and attending health care providers. This presentation is called, Medicare and Medicaid Audits: Ready or Not, Here They Come. The lecture is open, but attendees must register. It will be held at the Howard Johnson Plaza in Altamonte Springs ...

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9/24/2013

What You Need to Know About the HIPAA Omnibus Final Rule-Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Health Insurance Portability and Accountability Act HIPAA Privacy and Security Rules were amended by an Omnibus Final Rule published by the U.S. Department of Health and Human Services HHS in January 2013. The Omnibus Final Rule marks the most significant changes to the HIPAA Privacy and Security Rules since they were first implemented. These changes greatly enhance a patient’s privacy rights...

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9/24/2013

Florida Oncologists Pay $3.5 Million to Settle Whistleblower/Qui Tam Fraud Claims

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A group of Florida radiation oncology service providers settled a whistleblower or qui tam lawsuit for $3.5 million, according to the Department of Justice DOJ on September 13, 2013. The providers were accused of defrauding Medicare, Medicaid and TRICARE by performing unnecessary and improperly supervised procedures from 2007 until 2011. According to the DOJ press release, the defendants include Gulf R...

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9/23/2013

Florida Home Health Care Company Settles with State Over Medicaid Fraud Charges

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Broward County, Florida, home health care company is accused of overbilling the Medicaid program for patient services by almost $500,000, according to the Sun Sentinel. This accusation comes after the Florida Agency for Health Care Administration AHCA conducted an audit of claims from July 2007 to March 2011. The audit allegedly found that the home health care company was overpaid for services that w...

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9/20/2013

ICD-10 Is Coming: Are You Ready for the Transition?

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The clock is ticking. It is just a little over a year away until the switch to ICD-10. If you are not already preparing for the fall 2014, implementation, you should be. ICD-9 codes will be replaced, after more than 30 years, with ICD-10 codes. The mandatory implementation date is October 1, 2014. This switch applies to all Health Insurance Portability Accountability Act HIPAA compliant health care pro...

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9/6/2013

CRIMINAL LAW: False Confessions—Admissibility of Expert Testimony

The author of this is article is Mark Rieber, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. A growing number of state courts have ruled that expert testimony concerning the phenomenon of false confessions may be admissible in a criminal trial. The Supreme Court of Michigan recently addressed this matter and held that while such expert testimony is potentially admissible, the expert testimony at issue before the court was based on unreliable research a...

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9/4/2013

Emory University Accused of Overbilling Medicare and Medicaid for Patients Enrolled in Clinical Trial Research-Whistleblower Filed First Claim

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Emory University in Atlanta, Georgia, will pay $1.5 million to settle claims it overbilled Medicare and Medicaid for cancer clinical trial services that were not permitted by the Medicare and Medicaid rules. This announcement from the Department of Justice DOJ was released on August 28, 2013. This case came from a whistleblower/qui tam lawsuit filed by a former research finance manager at Emory Univers...

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9/3/2013

August 2013
How 2014 IPPS Final Rule Impacts Physicians Admitting Patients to Hospitals

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 2, 2013, the Centers for Medicare and Medicaid Services CMS released the 2014 Inpatient Prospective Payment System IPPS Final Rule the 2014 IPPS Final Rule . The 2014 IPPS Final Rule substantially affects how hospitals will bill for observation stays, long outpatient stays and short inpatient stays. One of the most significant aspects of the 2014...

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8/30/2013

Florida Therapy Staffing Company Owner and Patient Recruiter Plead Guilty to $7 Million Medicare Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A therapy staffing company owner and a patient recruiter pleaded guilty on August 21, 2013, to one count each of conspiracy to commit health care fraud in connection with a $7 million Medicare fraud scheme. The scheme allegedly involved a now defunct home health care agency, Anna Nursing Services Corp., in Miami Springs, Florida, according to the Department of Justice DOJ . The agency was supposed to p...

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8/29/2013

Bostwick Laboratories Settles Whistleblower Claim Involving Illegal Physician Inducements

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Bostwick Laboratories Bostwick will pay the government $503,668 to settle whistleblower allegations that the company made illegal payments to induce physicians to utilize Bostwick’s laboratory testing services, according to a press release from the Department of Justice DOJ on August 20, 2013. The government claims Bostwick would bill Medicare and Tricare for testing services were not medical...

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8/28/2013

Medicaid Fraud Control Unit Busts Florida Pharmacist in Alleged $600,000 Medicaid Fraud Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An investigation by the Florida Attorney General’s AG Medicaid Fraud Control Unit MFCU uncovered almost $600,000 in alleged Medicaid fraud. According to the AG, a pharmacist and owner of a Hialeah, Florida, pharmacy, was arrested on August 22, 2013. A press release from the AG stated that the pharmacist was charged with one count of first-degree Medicaid fraud. Click here to read the press releas...

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8/26/2013

Shands Healthcare to Pay $26 Million Settlement for Allegedly Submitting False Claims in Whistleblower/Qui Tam Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 19, 2013, Shands Healthcare agreed to pay $26 million to settle a lawsuit that stemmed from a whistleblower/qui tam claim. According to the settlement agreement, six of Shands’ Florida hospitals were accused of billing government health programs, such as Medicare and Medicaid, for inpatient claims that should have been coded as outpatient services for five years. Click here to read the ...

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8/21/2013

Planned Parenthood Pays $4.3 Million to Settle Allegations of Medicaid Fraud in Qui Tam/Whistleblower Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Planned Parenthood Gulf Coast recently paid $4.3 million to settle civil allegations under the False Claims Act, according to the Department of Justice DOJ on August 16, 2013. The nonprofit organization is accused of fraudulently billing Medicaid and other government programs for health services provided by some of its Texas clinics between 2003 and 2009, according to the DOJ. The settlement resolves a...

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8/19/2013

Daytona Beach Hospital Facing Recommendation for Medicare and Medicaid Termination After Wrong-Site Surgery

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It’s usually a nightmare for a physician who performs wrong-site surgery. However, that’s what one surgeon at Halifax Hospital in Daytona Beach, Florida, is accused of doing. The term wrong-site refers to the fact that the surgeon has operated on the wrong leg, arm, eye or other organ. According to the Daytona Beach News-Journal, the surgeon allegedly made an initial incision into a patient...

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8/16/2013

Consumer Reports Ranks Surgical Safety in Hospitals Throughout Florida and the U.S.

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For the first time, patients can view and compare surgery safety results at hospitals across the country. Consumer Reports recently rated nearly 2,500 hospitals in 50 states for surgical safety. This report measured infections, readmission rates, complications and adverse reactions such as a heart attack or death in patients after a surgery. The report was compiled using recently released Medicare data...

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8/15/2013

Osceola Regional Medical Center Approved for OB-GYN and Internal Medicine Residency Programs

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Beginning July 2014, Osceola Regional Medical Center will launch its Obstetrics and Gynecology OB-GYN Residency Program. Osceola Regional announced on July 16, 2013, that it has been approved by the American Osteopathic Association AOA for the program. The approval makes the hospital’s OB-GYN Residency Program the first approved by the AOA in the Southeastern area of the United States. The reside...

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8/5/2013

College Student Abandoned by DEA in Cell for Days to Receive $4.1 Million Settlement

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A California college student left in a small holding cell by the Drug Enforcement Administration DEA for five days without food, water, or a toilet has settled his claims for $4.1 million, according to a number of news sources. The student was taken by agents during a late April 2012, drug raid on his friend's house in which nine people were arrested. The engineering student at the University of Califo...

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8/1/2013

July 2013
Adverse Consequences of Settling a Malpractice Lawsuit Filed Against You-Part 1

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It is crucial to understand that settling a malpractice claim prior to trial, or even prior to a suit being filed, is not the end of the matter. As stressful as having a malpractice claim hanging over your head can be, it is important to know that settling it may only be the beginning of your legal problems. Be Familiar With These Adverse Legal Ramificatio...

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7/31/2013

Fake Department of Health Letters Continue to Pop Up-Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law There is an interesting phenomenon that pops up from time to time. It is the phony Department of Health letter. In 2008, we received information that letters, which appeared to be from the Maryland Department of Health DOH , were being mailed out. The letters were mailed to residents of that state, advising the person that he or she was a carrier of a sexually transmitted disease STD . The letters aske...

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7/30/2013

Bill to Repeal Medicare SGR Physician Payment Formula Moves Forward-What This Could Mean for Physicians’ Payments

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 23, 2013, the House Energy and Commerce Health Subcommittee approved a proposal to repeal Medicare’s sustainable growth rate SGR physician payment formula in lieu of a system that rewards doctors for high quality care. The Subcommittee on Health passed the bill, which could be the start of a permanent fix for physician payments, according to ...

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7/26/2013

California Medical Center Will Pay $275,000 to Settle Federal Patient Privacy Case

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Shasta Regional Medical Center in Redding, California, has agreed to pay $275,000 to settle a federal investigation concerning alleged violations of the Health Insurance Portability and Accountability Act HIPAA Privacy Rule. The settlement resolves allegations made by the U.S. Department of Health and Human Services HHS Office of Civil Rights OCR that the medical center shared a patient’s medical...

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7/23/2013

CERT Contractors Identifying Documentation Errors for Home Health Services

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law About a year ago we told you about one of the newest acronyms in the Medicare Program’s audit process, CERT which stands for the Medicare Comprehensive Error Rate Testing Program. The CERT Program is one way CMS is trying to improve the quality and accuracy of Medicare claim submissions and payments of those claims. Recently Medicare Contractors have reported seeing an increase in errors identifi...

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7/22/2013

Contracting 101: Tips for Physicians and Health Professionals - Part 11

By Christopher E. Brown, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We continue with our blog series on contracting tips for physicians and health professionals. Collectively these blogs are intended to provide a review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, alon...

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7/17/2013

Biopsy Self-referrals Draw Congressional Scrutiny

By Lance Leider, J.D., The Health Law Firm In a recently released report the Government Accountability Office GAO concludes that physicians who self-referred biopsy procedures cost Medicare approximately $69 million in potentially unnecessary services. To read the entire GAO report, click here . The report concludes that claims by physicians who self-referred the pathology procedures rose at a much faster rate than those made by physicians who do not self-refer. The report found that the increas...

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7/16/2013

What Does the Future Hold for Florida’s Prescription Drug Monitoring Program?

By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Officials with the Florida Department of Health DOH listened to suggestions on how to improve the security of its prescription drug monitoring database at a special meeting held on July 8, 2013, in Tallahassee, Florida. This comes after a slew of criticism over the monitoring system. Most recently, the prescription drug monitoring database came under fire ...

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7/10/2013

Florida Health Clinic Owner Arrested on Charges of $300,000 in Medicaid Fraud

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The owner of a Lake County, Florida, medical center was arrested by the Attorney General’s AG Medicaid Fraud Control Unit MFCU on June 27, 2013, for allegedly committing $300,000 in Medicaid fraud. According to the AG, the clinic owner allegedly billed Florida Medicaid for services never rendered and used the Medicaid provider number of a physician who was no longer employed at his facility. The ...

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7/8/2013

Contracting 101: Tips for Physicians and Health Professionals - Part 10

By Christopher E. Brown, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the tenth in a series intended to provide a review of contracting basics for physicians, nurse practitioners and health care professionals, primarily by discussing employment agreements. We will continue to highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in ou...

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7/5/2013

Franck’s Pharmacy Files Motion to Consolidate Brilliant Blue G Eye Surgery Dye Lawsuits

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law More on the Franck’s Pharmacy fungus cases. In the past couple of months, there have been an increasing number of people filing product liability lawsuits over Brilliant Blue G, an eye surgery dye made by Franck’s Compounding Pharmacy in Ocala, Florida. In response, on April 12, 2013, Franck’s filed a request to consolidate all claims pending in the federal court system before one jud...

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7/3/2013

Products Liability Lawsuits Filed Over Brilliant Blue G Surgical Dye Made By Franck’s Compounding Lab

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Franck’s Compounding Lab in Ocala, Florida, may be closed, but that isn’t stopping patients affected by the lab’s contaminated products from filing lawsuits against the compounding pharmacy. According to an article on About Lawsuits, at least four products liability lawsuits were filed against Franck’s just in March of 2013. All of the lawsuits allege that the plaintiffs suffere...

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7/1/2013

June 2013
Florida Prescription Drug Monitoring System Comes Under Fire After Privacy Breach

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida health officials are looking to step up security of the statewide prescription drug monitoring database to protect patients’ information. This comes after 3,300 Floridians’ names, addresses, phone numbers, pharmacies and drug dosages prescribed were leaked, according to an article in the Sun Sentinel, published on June 14, 2013. The information was allegedly being used as part of cr...

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6/24/2013

Fight Office of the Inspector General (OIG) Exclusion!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General OIG can have on the career and employment of a licensed health professional. Whether you are a physician, nurse, dentist, psychologist or other health professional, if you allow yourself to be excluded from the Medicare Program, devastating economic results may ...

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6/18/2013

PERSONAL INJURY: Tort of Malicious Prosecution Is Expanded in Hawaii

The author of this is article is Fred Shackelford, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. In many states, one of the elements of the tort of malicious prosecution is initiating or procuring the institution of a criminal proceeding. See generally Restatement Second of Torts § 653. This element focuses on whether the alleged tortfeasor had probable cause at the time he or she initiated or procured the criminal action against the plaintiff. W...

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6/17/2013

Walgreens Pays $80 Million to Settle Drug Enforcement Administration Painkiller Investigation

By Lance O. Leider, J.D., The Health Law Firm and Catherine T. Hollis, J.D., The Health Law Firm It seems the firefight between Walgreens and the Drug Enforcement Administration DEA has come to an end. On June 11, 2013, the DEA announced Walgreens agreed to pay $80 million to end an investigation into whether it violated rules on the distribution of prescription painkillers in Florida and throughout the country. According to the DEA, this is the largest settlement in its history. To read the pre...

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6/14/2013

Civil Forfeiture of Property and Money: A New Weapon in the Government’s Arsenal Against Health Fraud and Pill Mills

By Christopher E. Brown, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law More and more recently, we have seen government prosecutors and agencies, including the Medicaid Fraud Control Unit MFCU , the U.S. Attorney General’s AG Office, and local sheriff and police departments use the Civil Forfeiture Act against health professionals and health facilities in health-related cases. A prompt, aggressive defense to these ...

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6/13/2013

Technical Corrections to HIPAA Omnibus Rule Released

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Health and Human Services HHS acknowledged the need for technical corrections to a ruling published as part of the Health Insurance Portability and Accountability Act HIPAA omnibus rule on January 23, 2013, according to a final rule published on the Federal Registrar. According to the HHS, the errors necessitating technical corrections contained in January’s final rule fall shor...

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6/12/2013

A Finding of “Irregular Behavior” on Your U.S.M.L.E. Step Transcript Can Ruin Your Medical Career Before it Starts

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Many medical students and interns receive letters from the National Board of Medical Examiners NBME , United States Medical Licensee Examination USMLE Secretariat advising them that they are suspected of "irregular behavior" on a Step examination. Virtually any infraction of the USMLE rules contained in its Bulletin or the rules of the testing center can result in such an accusation. Although "irregula...

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6/10/2013

MRI May be Able to Detect Complications Related to Metal-on-Metal Hip Implants

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Patients with any metal-on-metal hip implant might want to discuss getting an MRI, even if they are not experiencing any discomfort. A medical study published in Journal of Bone & Joint Surgery suggests an MRI may be able to detect problems before any damage is caused from a hip implant. This can include hip implant failures and metallosis, or metal poisoning, from the chromium and cobalt ions in t...

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6/7/2013

Healthcare Integrity and Protection Data Bank Merger with National Practitioner Data Bank Completed

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Health Resources and Services Administration HRSA announced that on May 6, 2013, the Healthcare Integrity and Protection Data Bank HIPDB officially merged with the National Practitioner Data Bank NPDB . The two data banks are now known as the NPDB. The HRSA published the final rule to eliminate duplicate data reporting and access requirements. To read the full text of the final rule, click here . T...

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6/6/2013

Senate Committee Calls for Baker Act Study Instead of Expanding the Powers of Nurse Practitioners and Physician Assistants

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida’s nurse practitioners and physician assistants were hopeful the Senate would vote to allow them to have the authority to order the involuntary commitment of a patient for mental-health evaluation under the Baker Act. However, instead on April 15, 2013, the Children, Families and Elder Affairs Committee passed the formation of a work group to figure out how to improve the more than 40-year...

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6/5/2013

May 2013
Jury Awards Doctor $3.8 Million in Damages in Anthem Blue Cross Case

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On April 8, 2013, a Los Angeles jury awarded $3.8 million in compensatory damages to an urgent care and family practice physician who claimed he was wrongly excluded from Anthem Blue Cross’s provider network. Anthem Blue Cross is a unit of the insurance giant WellPoint Inc. It is expected that this rare verdict ...

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5/31/2013

Central Florida Undercover Detective Awarded Special Agent of the Year

By Catherine T. Hollis, J.D., The Health Law Firm The Orlando Sentinel reports that in April 2013 , the Florida Department of Law Enforcement FDLE named local undercover detective Billy Powell of the Metropolitan Bureau of Investigation MBI in Orlando as its Special Agent of the Year. Powell received this award for his outstanding efforts in pill mill investigations. To read the entire Orlando Sentinel Article on Powell’s award, click here . Powell was Instrumental in Local Pill Mill Busts...

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5/30/2013

Steroid Injections Compounded at Tennessee Pharmacy Recalled Due to Possible Contamination

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Food and Drug Administration FDA sent out a warning to health care professionals that steroid injections compounded by Main Street Family Pharmacy, LLC, in Tennessee, may be contaminated. The announcement came on May 24, 2013. So far, seven patients have allegedly suffered adverse reactions from the medications. The FDA says it is working with the Centers for Disease Control and Prevention CDC...

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5/28/2013

Mental Health Counselors, Psychologists, Social Workers and Family Therapists Should Be Sure They Carry Insurance to Cover Complaints Against Their Licenses

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law From our experience mental health counselors, psychologists, social workers and family therapists are at a high risk of having a client or patient file a complaint against them with their licensing board. Many of their clients/patients have mental health problems, emotional problems or personality disorders; this is why they are seeing a therapist to begin with. If there is a disagreement between the t...

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5/26/2013

DePuy Orthopaedics to Discontinue All Metal-on-Metal and Ceramic-on-Metal Hip Implants

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Johnson and Johnson’s DePuy Orthopaedics announced on May 16, 2013, that the company is phasing out all of its metal-on-metal and ceramic-on-metal hip replacements. As of August 31, 2013, these DePuy products will no longer be available worldwide. Click here to read the press release from DePuy Orthopaedics . This decision comes after DePuy recalled 93,000 ASR XL hip implants in August 2010. The ...

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5/23/2013

U.S. Department of Justice Files Two Lawsuits Against Novartis Pharmaceuticals Corporation Over Charges of Kickbacks

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Novartis Pharmaceuticals Corporation NPC is currently fielding two different lawsuits, filed just days apart from each other, by the U.S. Department of Justice DOJ . The first lawsuit was filed on April 23, 2013, alleging the company gave illegal kickbacks to pharmacists. A second lawsuit was filed on April 26, 2013, alleging illegal kickbacks were paid by NPC to health care providers. According to the...

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5/21/2013

Lawsuits Against Manufacturers of Metal-on-Metal Hip Implants: Things You Need to Know as an Implant Recipient-Part 3

By Carole C. Schriefer, R.N., J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Two nationwide recalls of metal-on-metal hip implants by Johnson and Johnson’s DePuy Orthopaedics and Stryker Orthopaedics has prompted The Health Law Firm to take on plaintiffs’ products liability cases against these manufacturers. In August 2010, DePuy recalled 93,000 ASR XL hip implants after a significant percentage failed within ...

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5/15/2013

Food and Drug Administration (FDA) Recalls Sterile Drugs from Florida Compounding Pharmacy

By Lance O. Leider, J.D., The Health Law Firm There’s been yet another recall from a compounding pharmacy. On May 8, 2013, the U.S. Food and Drug Administration FDA sent a warning to doctors and pharmacists to avoid drugs made by The Compounding Shop, based in St. Petersburg, Florida. The recall is due to potential safety concerns. Click here to read the press release from the FDA . This recall is part of a nationwide crackdown by the FDA and state agencies on compounding pharmacies, setti...

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5/14/2013

Home Health Care Company’s Patient Recruiter Sentenced to More Than Three Years in Prison for Medicare Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Miami patient recruiter will spend the next 37 months in prison for his part in a $20 million Medicare fraud scheme, according to the Department of Justice DOJ . Manuel Lozano was sentenced on May 6, 2013, in the Southern District of Florida. In addition to his prison sentence, Mr. Lozano will serve two years of supervised release and was ordered to pay more than $1,850,000 in restitution, jointly wi...

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5/10/2013

Lawsuits Against Manufacturers of Metal-on-Metal Hip Implants: Things You Need to Know as an Implant Recipient-Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm The Health Law Firm has recently undertaken plaintiffs’ products liability cases against the manufacturers of defective hip implants, including both Johnson and Johnson’s DePuy Orthopaedics and Stryker Orthopaedics implants. DePuy recalled 93,000 ASR XL hip implants in August 2010, after a significant percentage failed within five yea...

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5/9/2013

Lawmakers Vote to Fund Florida’s Prescription Drug Monitoring Program

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The future of Florida’s prescription drug monitoring program looked bleak going into the last day of the legislative session. However, on May 3, 2013, lawmakers voted to fund the prescription drug database for one year, according to the Orlando Sentinel. Law enforcement officials have said the program is essential to fighting the war on prescription drug abuse The database, which was previously f...

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5/7/2013

Lawsuits Against Manufacturers of Metal-on-Metal Hip Implants: Things You Need to Know as a Recipient-Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm In August 2010, Johnson and Johnson’s DePuy Orthopaedics recalled 93,000 ASR XL hip implants after a significant percentage failed within five years. Click here to read the press release from DePuy . In July 2012, Stryker Orthopaedics issued a voluntary recall of the Rejuvenate and ABG II modular-neck femoral hip systems. Click here to see ...

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5/1/2013

April 2013
New Details Emerge on Central Florida Woman’s $3 Million Medicaid Fraud Scheme at Mental Health Facility

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law As the investigation into a Central Florida mental health counselor continues, new details are emerging on the extent of the $3 million Medicaid fraud scheme. On March 27, 2013, I blogged about a registered mental health counselor arrested on charges of racketeering, Medicaid fraud and identity theft. The Medicaid scheme was through the mental health facility she owned. She is accused of using the publ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Often we learn after the fact that a health professional such as a mental health counselor, psychologist, or pharmacist has received Healthcare Providers Service Organization HPSO insurance, has had a legal problem, and has not been able to locate an attorney or law firm that accepts this type of insurance. We have offices in Florida and Colorado, but we have attorneys licensed in Florida, Colorado, Lo...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Some of the clients we are representing in hip implant cases against manufacturers DePuy owned by Johnson & Johnson and Howmedica Osteonics Corporations n/k/a Stryker Corporation , d/b/a Stryker Orthopaedics, have signs and symptoms of respiratory illnesses similar to chronic obstructive pulmonary disease COPD and other illnesses. Signs of this include general fatigue, persistent coughing, shortnes...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Lake Mary, Florida, compounding pharmacy recently recalled products due to concerns from the Food and Drug Administration FDA . The Balanced Solutions Compounding Pharmacy, LLC Balanced Solutions , a division of Axium Healthcare Pharmacy Inc., announced a voluntary recall of all lots of its sterile unexpired ophthalmic products on April 17, 2013. Click here to read the press release from Balanced Sol...

The author of this is article is Charlene Hicks, Senior Attorney with National Legal Research Group in Charlottesville, Virginia. One of the legal arenas in which individual rights are pitted directly against business interests comes into play when an individual employee signs an employment contract containing a covenant not to compete. Not surprisingly, state courts are often called upon to referee disputes concerning the enforceability of such contracts. In a recent proemployer decision, a Flo...

By Lance O. Leider, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Edna Lorraine Watkins, the owner of Homecare Unlimited, LLC, in Jacksonville, Florida, has been sentenced to six years in prison for defrauding Medicaid, according to the Florida Office of the Attorney General AG . She made more than $400,000 in false claims between January 2008 and June 2011. Ms. Watkins was sentenced on April 2, 2013. Click here to read...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm On April 16, 2013, a Chicago jury found in favor of Johnson and Johnson’s DePuy Orthopaedics, according to Reuters. The plaintiff was a nurse who had the DePuy ASR XL hip implant in her in 2008. It was replaced three years later. The plaintiff was requesting $5 million in damages. The 12-person jury deliberated for a little more than a day ...

By George F. Indest, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Lake Mary, Florida, pain management doctor was ordered by a judge to spend 25 years in prison and to pay a $500,000 fine. Dr. Ronald Lynch, who operated Integrated Medicine, was sentenced on April 15, 2013, for charges of drug trafficking, according to the Florida Office of the Attorney General AG . Click here to read a press release from the AG . Writing Prescriptions with a Revoked Drug Enforcement Adm...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm Choosing one hip replacement over another is one of the most important decisions a patient and a surgeon can make together. In the last ten years, there have been many types of artificial hip implants approved for use in the U.S. These options include metal-on-metal, ceramic-on-ceramic or advanced plastics such as cross-linked polyethylene, just ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to The Physicians Foundation, a nonprofit organization that seeks to advance the work of physicians, one of the biggest concerns of practicing doctors is the continuing acquisition of small practices by hospitals and medical groups. On April 4, 2013, a new group called the Association of Independent Doctors met for the first time in Orlando, Florida. The group is made up of 80 independent Flo...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm Currently jurors in Circuit Court of Cook County, Chicago are hearing the second trial against Johnson and Johnson’s DePuy Orthopaedics. According to Public Health Watchdog, a former DePuy employee testified on March 26, 2013, that the company knew the ASR XL hip implant’s design was defective a year prior to issuing the recall. In Au...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Orange-Osceola chief medical examiner ruled on April 5, 2013 , that a 17-year-old teen died as the result of an accidental apparent overdose on bath salts, according to the Orlando Sentinel. Four teens altogether were found unconscious in an Orange County, Florida, home in February 2013. All the teens reportedly snorted the same bath salts off a $10 bill and all were hospitalized. Although the drug...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm Stryker Orthopaedics is already facing more than 80 lawsuits from patients alleging injuries due to the recalled Stryker Rejuvenate and ABG II hip systems. As that number grows, plaintiffs are requesting that the cases be moved to a central federal court. You may remember, in July 2012, Stryker issued a voluntary recall of the Rejuvenate and ABG ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We frequently receive calls for consultations from students who receive a letter from the National Board of Medical Examiners NBME accusing the medical student or medical resident of "Irregular Behavior" on the United States Medical Licensing Examination USMLE . In many cases these are graduates of foreign medical schools who have applied through the Examination Committee for Foreign Medical Graduates ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The unsanitary practices of an Oklahoma dentist may have exposed more than 7,000 patients to HIV and hepatitis, according to a number of media sources and the Oklahoma Department of Health DOH . Currently officials with the Oklahoma DOH are contacting all of the dentist’s patients since 2007, and urging them to get tested for blood-borne diseases. Since the news broke on March 28, 2013, the denti...

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4/1/2013

March 2013
Florida Cardiologist Sentenced to Six Years in Prison for Fen-Phen Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A 79-year-old Florida cardiologist was sentenced to six years in prison on March 26, 2013. He’s accused of participating in a fraud scheme involving a trust fund set up to compensate victims of the diet drug Fen-Phen. According to media reports, the cardiologist took fees for examining patients who suspected heart damage from taking Fen-Phen. He diagnosed heart damage in a majority of patients, e...

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3/29/2013

Supreme Court Hears Arguments Over the Liability of Generic Drug Makers

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On March 19, 2013, the Supreme Court justices discussed whether makers of generic drugs already approved by the Food and Drug Administration FDA can be held liable under state law for claims of design defects. According to the Los Angeles Times, nearly eighty percent 80% of prescriptions that Americans fill are for generic drugs. The high court finds itself at a crossroads on how to resolve claims from...

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3/28/2013

Corporate Responsibility- Did DePuy Fail to Alert the Public of Mounting Hip Implant Failures?

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm According to USA Today, in 2001 Johnson and Johnson’s DePuy set out to create a new metal hip implant that offered stability and longevity to patients. In 2005, the company introduced the ASR XL hip implant. According to reports in the media, a couple of years after launching the hip implant, a substantial amount of evidence began to appear...

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3/26/2013

George F. Indest III Named Contributor on Westlaw Insider’s Health Care Law Blog

By Cori Powers, Marketing Director, The Health Law Firm George F. Indest III, President and Managing Partner of The Health Law Firm, was recently added as a contributor to the Westlaw Insider Health Care Law Blog. According to Westlaw, its blog authors are a community of thought leaders who are contributing to the Westlaw tradition of excellence in legal writing. They provide expert analysis and cutting-edge practice advice. Sign Up for Mr. Indest’s Blog. Throughout the course of this blog...

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3/25/2013

Common Deficiencies We See in Pharmacy Inspections

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm Pharmacies and pharmacists are subject to many types of inspections. These inspections are necessary to determine whether the business and its employees are complying with state and federal laws and regulations. Administrative agencies, such as the Drug Enforcement Administration DEA , Food and Drug Administration FDA and the Department of Health...

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3/21/2013

Food and Drug Administration (FDA) Updates Safety Concerns on Metal-on-Metal Hip Implants After Two Wide-Spread Recalls

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm On January 17, 2013, the Food and Drug Administration FDA issued an updated public health communication about hip replacement components that have both a metal ball and a metal socket, or metal-on-metal hip devices. This comes after two recent hip replacement recalls that are sparking thousands of lawsuits. Click here to read the FDA communicatio...

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3/20/2013

Contracting 101: Tips for Physicians and Health Professionals - Part 9

By Christopher E. Brown, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the ninth in a series intended to provide a review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the ...

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3/19/2013

Recovery Audit Contractor (RAC) Activity Up in Hospitals Across the Country

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Hospitals across the country are being hammered by Recovery Audit Contractors RACs . According to a survey by the American Hospital Association, RAC activity soared during the fourth quarter of 2012. The March 8, 2013, report explores the impact of the RAC program on the 1,233 hospitals that participated in the survey, according to an article on Healthcare IT News. Click here to read the article from H...

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3/18/2013

Choosing Wisely Campaign Expands List of Overused and Unnecessary Medical Tests and Procedures

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This year, seventeen 17 medical specialty societies added their names and recommendations to a list of medical procedures that are overused and often unnecessary. This updated list was released in February 2013, and includes ninety 90 new tests and procedures. The first version of the list was released in April 2012, with recommendations from nine 9 leading medical groups. It was created as part of the...

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3/15/2013

Jury Awards Plaintiff $8.3 Million in First Trial Over DePuy Hip Implants

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm On March 8, 2013, a California jury ruled that Johnson and Johnson’s DePuy unit designed a defective metal-on-metal ASR XL hip implant and was negligent, according to Bloomberg News. The plaintiff in this case was awarded $8.3 million in compensation damages, after the jury found that the design of the hip implant was the reason behind the ...

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3/14/2013

Whistleblowers Who Report Fraud and False Claims Against the Government Stand to Receive Large Rewards - Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. This is the second blog in a two-part series on whistleblower/qui tam lawsuits. In the first blog I explained...

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3/14/2013

Whistleblowers Who Report Fraud and False Claims Against the Government Stand to Receive Large Rewards - Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Individuals working in the health care industry, whether for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. This is the first blog of a two-part series. Throughout these two blogs, I will explain types of false claims...

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3/13/2013

Central Florida Chiropractor Convicted in False Claims Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Central Florida chiropractor was convicted of conspiracy to commit health care fraud by a federal jury on March 1, 2013. Since 2009, the chiropractor fraudulently claimed to own a rehabilitation center in Cape Coral, Florida. According to the Department of Justice DOJ , in March 2012, the chiropractor and several co-conspirators were formally charged with conspiracy to commit health care fraud, consp...

By Christopher E. Brown, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the eighth in a series intended to provide a review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law As of February 2013, more than 80 lawsuits have been consolidated into multicounty litigation MCL in the Superior Court in New Jersey against Stryker Orthopaedics. Patients are claiming the company’s Rejuvenate and ABG II modular-neck femoral hip systems are defective, according to a number of news sources. The case is on track to becoming one of the largest mass-tort litigations in the country. ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law AdvanceMed Corporation, an NCI company, was named the Zone 5 Program Integrity Contractor ZPIC for the Medicare and Medicaid programs, in December 16, 2009. As the ZPIC for Zone 5, AdvanceMed has been performing benefit integrity activities aimed to reduce fraud, waste and abuse in Medicare and Medicaid data matching programs. A ZPIC is a business entity that contract with Medicare and Medicaid and wor...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Most Medicare and Medicaid auditors are cracking down on occupation therapists OTs , physical therapists PTs , speech therapists STs and rehabilitation therapists RTs . We have recently been consulted by a number of large therapy groups and small therapy providers undergoing or who have recently undergone Medicare or Medicaid audits. In too many circumstances the audit agency has come back with a 100 p...

By Christopher E. Brown, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the seventh in a series intended to provide a review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By th...

By Lance O. Leider, J.D., The Health Law Firm A report released by the Government Accountability Office GAO on February 27, 2013, announced that Medicare will remain a "high-risk" program with respect to its fraud and waste vulnerability. The GAO cites the Center for Medicare and Medicaid Services CMS inability to reduce the rate of improper payments released by the agency as the reason for its ruling. Click here to view the full report from the GAO . Auditors Will Now Be Working Overtime. In 20...

By Lance O. Leider, J.D., The Health Law Firm According to the American Society of Interventional Pain Physicians ASIPP , Americans consume nearly eighty percent 80% of the world's opioid supply and ninety-nine percent 99% of the world's hydrocodone supply. Click here to see the ASIPP’s fact sheet on prescription drug abuse . The scariest part of these numbers is that the United States comprises about five percent 5% of the world's population. Food and Drug Administration Could Tighten Con...

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3/1/2013

February 2013

The author of this is article is Fred Shackelford, Senior Attorney with National Legal Research Group in Charlottesville, Virginia. In a case of first impression, the Montana Supreme Court has joined courts from many other states in recognizing a cause of action for negligent credentialing of a physician. In Brookins v. Mote , 2012 MT 283, ___ P.3d ___ not yet released for publication , an expectant mother hired an obstetrician who maintained a practice in his home. The obstetrician "Dr. Mote" h...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Our firm has been consulted recently by owners of different health care entities, including assisted living facilities, group homes, home health agencies and even medical groups that had received Medicaid overpayment demands. Instead of requesting a formal administrative hearing to contest the overpayment assessment, they had failed to respond or only requested an informal hearing. This resulted in a M...

The author of this is article is Paul Ferrer, Senior Attorney with National Legal Research Group in Charlottesville, Virginia. Parties who secure a favorable judgment in federal court may be happy with the outcome but should not forgo seeking their recoverable costs as well. The Federal Rules of Civil Procedure specifically provide that "[u]nless a federal statute, these rules, or a court order provides otherwise, costs—other than attorney's fees—should be allowed to the prevailing p...

By Christopher E. Brown, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the sixth in a series intended to provide a review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The victims and survivors of the meningitis outbreak are now filing lawsuits against the physicians and clinics that administered the tainted steroids. According to an article in The Tennessean, on January 29, 2013, a husband who lost his wife to fungal meningitis filed the first lawsuit against a Nashville outpatient clinic. It’s believed hundreds of people were injected at the same clinic with ...

By George F. Indest, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Winter Park, Florida, doctor pleaded no contest on February 11, 2012, to a racketeering charge. The charge stems from his arrest in a pill-mill probe in June 2010. The doctor’s arrest was one of the first in the Central Florida area relating to improper prescribing practices. Click here to see the complaint against the doctor . Since the doctor’s arrest, Florida law enforcement including the ...

By George F. Indest, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Sanford-Burnham Medical Research Institute announced on January 14, 2013, that John C. Reed, M.D., Ph.D., has resigned as Chief Executive Officer CEO . According to a press release from Sanford-Burnham, Dr. Reed accepted the position of Head of Roche Pharma Research and Early Development and member of the Corporate Executive Committee. Kristiina Vuori, M.D., Ph.D., president of Sanford-Burnham, will lead i...

By George F. Indest, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law As of February 2013, there are 537 cases listed on the Office for Civil Rights’ OCR Wall of Shame. These are breaches of unsecured health information affecting 500 or more individuals. The reports of these breaches of patient confidentiality are required by the Health Information Technology for Economic and Clinical Health HITECH Act. The OCR continuously updates this list of breaches on its website....

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2/8/2013

January 2013

By Lance O. Leider, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Food and Drug Administration FDA advisory committee voted 19 to 10 in favor of moving hydrocodone combination drugs from schedule III into the more restrictive schedule II category of controlled substances. According to a number of different sources, on January 25, 2013, the committee presented this recommendation to the FDA. If approved, hydrocodone co...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Lance O. Leider, J.D., The Health Law Firm With the popularity of electronic health records EHRs , social media and everything in between, the U.S. Department of Health and Human Services HHS has released stronger rules and protections governing patient privacy. On January 17, 2013, the HHS announced the omnibus rule to strengthen the privacy and security protection established under the Health In...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Drug Enforcement Administration DEA agents removed boxes of documents and computers from the pharmacy, according to Naples News. The pharmacy owner and his mother are alleg...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I have represented physicians, psychologists, nurse practitioners, nurses and other health professionals working in Veterans Administration VA medical centers and clinics throughout the United States. My representation has included personnel and employment issues, disciplinary actions, investigations, peer review investigations, clinical privileges actions, fair hearings, National Practitioner Data Ban...

By Thu Pham, O.D., Law Clerk, The Health Law Firm Relocating your practice can be stressful. There are many things that you need to do such as physically moving all of your equipment, moving your utility services, notifying your insurance companies, notifying the Department of Health DOH , notifying Medicare and Medicaid and, most important, notifying your patients. Optometrists sometimes forget that they should also notify their patients of the move. Florida Regulations. Rule 64B13-3.002 2 , Fl...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It’s no surprise to anyone that Medicare is cracking down on hospices around the country. According to a report by the Office of Inspector General OIG , eighty-two percent 82% of hospices’ claims did not meet Medicare coverage requirements. That is why Medicare is investigating the industry as a whole. Specific details on what Medicare is looking for can be found in the 2013 OIG Work Plan. ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I have been pleasantly surprised recently to discover that several professional liability insurance companies have raised their coverage amounts and added coverage in areas sorely needed by health professionals. I'm referring to coverage for incidents not necessarily related to malpractice or professional liability. I do note that Healthcare Providers Service Organization HPSO Insurance has increased i...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Health care providers beware, there is a scam making its rounds in Central Florida. Con men are telephoning citizens, including physicians, and pretending to be Drug Enforcement Administration DEA agents in the hope of extorting money from them. It’s a scam we first told you about in December 2012, but have since learned more. Click here to read my first blog on this nationwide telephone scam . H...

By Lance O. Leider, J.D., The Health Law Firm A former Florida Hospital employee, who admitted to stealing confidential patient information, was sentenced to spend one year and one day in federal prison on January 14, 2013. He pleaded guilty in October 2012, to one count of conspiracy and one count of wrongful disclosure of health information, according to the Orlando Sentinel. You may remember the news story about the privacy breach at Florida Hospital back in October 2011. The breach involved ...

By Lance O. Leider, J.D., Attorney, The Health Law Firm A group of doctors accused of performing an unusually high number of heart procedures on patients at an Ohio hospital has settled a whistleblower lawsuit, according to the Department of Justice DOJ . The settlement agreement covers accusations that the doctors and the hospital billed Medicare for unnecessary cardiac procedures from 2001 to 2006. Click here to read the press release from the DOJ . The Ohio hospital agreed to pay the U.S. gov...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We are sometimes told by the health professionals we represent especially pharmacists, licensed mental health counselors LMHCs , advanced registered nurse practitioners ARNPs , massage therapists and physical therapists that after they received a complaint regarding their license from the Florida Department of Health DOH they had difficulty finding an experienced attorney in Florida who would accept th...

By Thu Pham, O.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Optometrists' scope of practice has expanded significantly in the last 10 years. With that expansion has come a more complicated medical billing process. Inappropriate billing could result in an audit by insurance companies, the state Medicaid program, the Medicare program or other third party payors, and a request for repayment of the amount of money paid due to the inappropriate b...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Whether you’re an independent contractor, an employee of a chiropractor, physician or spa, or you travel to clients’ homes, insurance is essential for all massage therapists. Not only can professional liability insurance protect you in the event of a lawsuit, but it may also pay your legal defenses in the event of a complaint against your license to practice or for other legal problems. In ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The warnings have been loud and clear from the Centers for Disease Control and Prevention CDC . This influenza season is off to an early and serious start. With that in mind, a number of states are requiring all health professionals in the state to receive the flu vaccination. Some of those opposed to getting vaccinated are being handed fired by hospitals and health facilities. Because of this, a contr...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Central Florida nurse is in trouble with the law for allegedly writing fake prescriptions and illegally obtaining painkillers for herself, according to the Orlando NBC affiliate, WESH television. The nurse was allegedly arrested during the week of December 31, 2012. She is accused of trafficking in oxycodone and trying to fill forged prescriptions. Click here to read the WESH article . Phony Prescrip...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I am often asked about the burden of proof that must be met by the state Department of Health DOH in professional licensing disciplinary cases. This could be a complaint against a physician, dentists, mental health counselor, nurse, psychologist, pharmacist or anyone else. It also includes, for example, engineers, general contractors, school teachers, architects, cosmetologists, or any other profession...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Those who are licensed by the Department of Health DOH must be sure they are maintaining their continuing education requirements by taking the required courses in a timely manner. We have attended at least one professional board meeting recently where there was concern expressed about licensees failing to meet their continuing education requirements. One estimate was that approximately sixty percent 60...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I am often asked about the burden of proof that must be met by the state Department of Health DOH in professional licensing disciplinary cases. This could be a complaint against a physician, dentists, mental health counselor, nurse, psychologist, pharmacist or anyone else. It also includes, for example, engineers, general contractors, school teachers, architects, cosmetologists, or any other profession...

By Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Justice DOJ announced on December 27, 2012, that a specialty pharmacy, based in San Diego, California, has agreed to pay a $11.4 million settlement. That payment is to resolve allegations that the company used kickbacks to persuade doctors to write prescription for its products. The allegations came from a whistleblower lawsuit filed by a former employee. Cl...

By Danielle M. Murray, J.D. To combat the nationwide shortage of primary care physicians and the increase in student debt, several medical schools around the country are offering the chance for students to finish school in three years, instead of four. According to a number of news articles, these programs are geared specifically toward medical students looking to practice primary care. The hope is that these programs will be cost less for students and add more primary care physicians to under-s...

By Danielle M. Murray, J.D. The Office of Inspector General OIG of the U.S. Department of Health and Human Services HHS is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes SNFs , assisted living facilities ALFs , retirement living communities, home care services, and Alzheimer's centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments fro...

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1/2/2013

December 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It’s been a long time since most of us have seen a report card, but hospitals all over the nation received their safety grades on November 28, 2012. Leapfrog, a national group that advocates for safer health care, determined the grades. According to the Orlando Sentinel, Florida hospitals ranked well. Overall, 39 percent 39% of the 156 hospitals graded received A’s, earning the Sunshine Sta...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In light of some recently passed laws around the country, the American College of Physicians ACP took a stance against government involvement in the doctor-patient relationship. The ACP released a statement in July of 2012, outlining the role of government regulation in health care. In an American Medical News article, the president of the ACP stated this document needs to be taken into consideration w...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For years providing health care to patients has been at a location that is convenient to the health provider. With emerging trends in telemedicine and upcoming healthcare reforms, recently enacted, patients may begin to enjoy the convenience of medical evaluation and follow-up by video, telephone and computer. The biggest bar to this to date has been the refusal of Medicare, Medicaid and insurers to pa...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Consumers have a new online tool to see which nursing homes are being hit with fines for poor quality, safety or maintenance. Nursing Home Inspect 2.0 is a free database that assists users in evaluating nursing homes across the country. The database was first introduced by ProPublica, a nonprofit investigative news organization, in August 2012. On December 17, 2012, the same organization introduced the...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A sting on a prescription fraud ring netted 29 arrests in Osceola County, Florida. On December 13, 2012. Osceola County Investigative Bureau OCIB agents, along with the Osceola County Sheriff’s Office, Kissimmee Police Department and St. Cloud Police Department conducted an operation nicknamed Rx Printshop, according to a press release from the Osceola County Sheriff’s Department. Click her...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 11, 2012, Attorney General AG Pam Bondi filed an emergency rule outlawing 22 new synthetic drugs, commonly known as bath salts, K2, and Spice. This emergency rule modifies Section 893.03 1 c , Florida Statutes, by expanding the list of synthetic drugs in Schedule I of controlled substances of the Florida Comprehensive Abuse Prevention and Control Act. Click here to view a copy of the emerge...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The investigation of a complaint which could lead to the revocation of a respiratory therapist's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health DOH . This is a very serious legal matter and it should be treated as such by the respiratory therapist who receives it. Yet, in many cases, attorneys are consul...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks, according to a Department of Justice DOJ press relea...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Doctors and hospitals around the country seem to be butting heads. In the past month, an article in The New York Times and a segment on the television magazine show 60 Minutes shed light on some questionable practices being enforced by hospitals on physicians working for them. I previously wrote a blog on this structural shift in the practice of medicine. Click here to read that blog . The effects of t...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A raid by the Drug Enforcement Administration DEA on November 27, 2012, at a New York home led to the arrest of an emergency room ER doctor, according to a number of sources. Once inside, agents allegedly found crack cocaine, crack pipes, needles and other drug paraphernalia belonging to the doctor. It’s reported by The Buffalo News that the raid came just as the alleged drug abuser was getting r...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Drug Enforcement Administration DEA is warning the public to be aware of a prescription drug scam. This telephone scheme is extorting money from people all over the country. On November 28, 2012, the DEA released a press release explaining the details of the scam. Don’t Give Money to Criminals Posing as DEA Agents Over the Phone. The scam starts with criminals posing as DEA agents calling vic...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A former Daytona Beach chiropractor will spend more than 15 years in federal prison for an alleged health care fraud scheme and illegally prescribing pills, according to the Federal Bureau of Investigation FBI , Jacksonville Division. He was also ordered to pay more than $2 million in restitution to his victims. The former chiropractor was sentenced on November 29, 2012, by a United States District Jud...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Detroit-area registered nurse was sentenced on November 19, 2012, to 30 months in federal prison for his alleged part in a nearly $13.8 million Medicare fraud scheme. According to a Department of Justice DOJ press release, he will serve probation after being released from prison. He was also ordered to pay more than $450,000 in restitution, together with his co-defendants. Click here to read the enti...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Debary, Florida, dentist has been served with an emergency suspension order ESO by the Florida Department of Health DOH for allegedly inhaling nitrous oxide or laughing gas in front of patients. The administrative complaint filed against the dentist on November 2, 2012, by the Florida DOH stated a department-approved evaluator deemed the dentist unfit to practice dentistry and was recommended to unde...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Sex, prescription drugs and money - sounds like the next big rock ‘n’ roll song, doesn’t it? According to a number of news sources, the owner of an Avalon Park-area pharmacist was allegedly knowingly filling phony prescriptions for painkillers. The pharmacist is also accused of exchanging sex for drugs with at least one woman, according to the Orlando Sentinel. This investigation was ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Seminole County, Florida, is the latest county to adopt tightened regulations for pain management clinics. On November 13, 2012, County Commissioners unanimously voted to adopt the ordinance enacting Chapter 186 of the Seminole County Code to establish regulations regarding pain management clinics. Click here to read the entire Seminole County ordinance . County Commissioners hope these new regulations...

By Lance O. Leider, J.D. The federal government has several tools in its toolbox to combat Medicare fraud. Among those are the Stark Act, Anti-Kickback laws, and Civil Monetary Penalty Laws. Each of these typically focuses on a particular type of behavior that is prone to abuse by healthcare providers. The following focuses on the Stark law and what is prohibited by it. Primarily, the Stark laws exist to combat the problems that can arise from physician self-referrals. Self-referrals are cases i...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Massage therapists, I beseech you: please do not talk to a Department of Health DOH investigator until you have talked to a health lawyer who is experienced with DOH investigations and board licensing complaints. Do not answer or respond to even the most basic questions about where you work now, what your address is or if you know patient x, until consulting with counsel. Admitting to the Simplest Fact...

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12/3/2012

November 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Who can forget the infamous cannibalism attack in Miami that sparked the threat of zombies, or the Sons of Anarchy actor killing his landlady and falling to his death? These are just a few of the more publicized incidents where synthetic drugs are thought to be the cause of erratic behavior. Click here to read a previous blog on the Miami cannibal and Florida’s Legislation to ban synthetic drugs ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On November 2, 2012, a former Altamonte Springs resident was sentenced to three and a half years in federal prison for fraudulently working as a Central Florida pharmacist from 2000 to 2009, according to the Department of Justice DOJ . Click here to read the press release from the DOJ . I previously blogged about this story when the fake pharmacist pleaded guilty. Click here to read that blog . Man Wor...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Kissimmee, Florida, teen found guilty in August 2012 for impersonating a physician assistant P.A. faced up to 20 years in prison for two counts of impersonation and two counts of practicing without a license. On November 14, 2012, the teen was sentenced to one year in jail by an Osceola County judge. The phony P.A. was given credit for his 264 days already served in jail, so he will only have to sp...

By Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law As if being faced with the consequences of criminal charges wasn't frightening enough, physicians, nurses, dentists, psychologists and other health professionals have the added danger of having their licenses disciplined or revoked if they plead nolo contendere or guilty to a criminal charge. Whether you are applying for a new license to practice or have been practicing for y...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Florida Department of Health DOH confirmed another case of fungal meningitis in Florida on November 19, 2012. A 56-year-old man allegedly received a contaminated steroid injection at Florida Pain Clinic in Marion County, Florida. This brings the state’s total number of fungal meningitis cases up to 24, including three deaths. To read the entire press release from the Florida DOH, click here ....

By Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law For three years, hundreds of life-saving cancer drugs disappeared from the shelves of the University of Miami’s UM Sylvester Comprehensive Cancer Center. A pharmacy technician at the center was arrested in connection to the thefts in May of 2011, and is accused of stealing more than $14 million in cancer drugs, according to the Miami Herald. The pharmacy tech faces four counts of grand theft, two counts of ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law You are already aware of Floridians’ fear of zombies, as shown by recent legislation against bath salts. Despite this, there continue to be reports of rampant zombie outbreaks across the Sunshine State. The zombie apocalypse has hit Central Florida, hard. As a citizen of Florida, you know you are not safe; not from zombies, not from British tourists, not from inability to count notes in an electi...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law There’s a structural shift that is sweeping the health care system - hospitals are acquiring private physician practices. It is happening all over the U.S., including right here in Central Florida. On December 31, 2012, Orlando Health - a nonprofit, multi-hospital system that owns Orlando Regional Medical Center and eight other hospitals - will allegedly merge with Physician Associates - Central ...

By Christopher E. Brown, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the fifth in a series intended to provide an introductory review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the end of ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Hundreds of Georgia health providers are without a professional license to practice, because a new immigration law is causing massive backups in paperwork, according to a number of sources. The Illegal Immigration Reform and Enforcement Act of 2011 or House Bill 87 went into effect on January 1, 2012, and requires every person to prove his or her citizenship or legal residency when the individual renew...

By Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On October 22, 2012, a former Florida Hospital employee admitted to stealing patient information that was used to target customers for lawyers and chiropractors, according to a number of sources. The man allegedly pleaded guilty in Orlando federal court to one count of conspiracy and one count of wrongful disclosure of health information, according to the Department of Justic...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In September 2012, the Drug Enforcement Administration DEA revoked the controlled substance licenses from two CVS pharmacies in Sanford, Florida. Details into the investigation were made public on October 12, 2012, in a final order released by the DEA. The order explains how the stores operated, whom they prescribed painkillers such as oxycodone to, and identified Central Florida’s top-prescribin...

By Christopher E. Brown, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the fourth in a series intended to provide an introductory review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the end of...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On October 26, 2012, the Florida Department of Health DOH issued an emergency suspension order ESO against a Boca Raton compounding pharmacy, according to a number of sources. The DOH in a press release called the conditions in the pharmacy so deplorable that nothing short of immediately shutting down the pharmacy would suffice. Click here to read the press release from the DOH . Compounding Pharmacy F...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On November 1, 2012, the American Hospital Association AHA filed a lawsuit against the U.S. Department of Health and Human Services HHS claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources. The AHA is seeking a court order declaring the practice invalid, saying it ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Office of Inspector General OIG for the U.S. Department of Health and Human Services HHS has reportedly launched an investigation into CVS’ practice for refilling prescriptions. According to an article in the Los Angeles Times, authorities are looking into reports that CVS has been refilling prescriptions and submitting insurance claims without patients’ permission. The Los Angeles Time...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law America’s deadliest drug doesn’t come from Columbia and isn’t smuggled in from Mexico. It is sold legally at the most frequently visited pharmacies. Overdosing on prescription painkillers, or opioids, kills more than 15,000 people a year in the U.S., according to an article in the Wall Street Journal. The war on prescription drugs is different than fighting cocaine and heroin, because...

By Danielle M. Murray, J.D. The Florida Prescription Drug Monitoring Program is apparently collecting dust as physicians are choosing not to use it. The Tampa Bay Times reported on October 5, 2012, that as few as one in twelve doctors have ever used the database. That is about eight percent 8% of all physicians. Approximately fourteen percent 14% of physicians are registered for the database. Click here to read the entire story from the Tampa Bay Times . Database Use Not Mandatory. Physicians in...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Kissimmee, Florida, man is accused of posing as an occupational therapist OT and working at various health care facilities in Central Florida, according to the Department of Justice DOJ . On October 16, 2012, the DOJ announced that the phony OT was charged with three counts of mail fraud, five counts of wire fraud, and one count of aggravated identity theft. Click here to see the press release from t...

By Danielle M. Murray, J.D. As a health care provider or owner of a health facility, you know about the Health Insurance Portability and Accountability Act HIPAA of 1996. You know that you must safeguard and protect confidential patient medical information to avoid civil and criminal penalties against you and your practice. Did you know that you may need a HIPAA Risk Assessment? All Health Care Providers Face a Real Audit Risk. The Office for Civil Rights OCR is stepping up enforcement around th...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The claims were almost all for expensive, high-end power wheelchairs. The man was sentenced on October 5, 2012. To see the press release from the Department of Justice DOJ , click here . Man Used Kickbacks and Illegally Solicited Medicare Beneficiaries in Scheme....

By Danielle M. Murray, J.D. Law enforcement has been working hard to bust pill mills and stop prescription drug abuse. Pharmacists and pain management doctors are under intense scrutiny by various law enforcement agencies, including the Drug Enforcement Administration DEA and the Department of Health DOH , for their role in giving out controlled substances. "Doctor shopping" is a common phrase used to describe patients who see multiple doctors in a short period of time in an attempt to dupe ...

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11/1/2012

October 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On October 8, 2012, the Osceola County, Florida, Commissioners unanimously approved an ordinance that will regulate pain management clinics, according to the Orlando Sentinel. The ordinance will take effect on October 31, 2012, and will be in effect for 10 years. Click here to see the ordinance passed at the Osceola County Commissioner’s meeting . This is part of the continuing efforts by l...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A report released by the Department of Health and Human Services HHS Office of Inspector General OIG on October 5, 2012, found that nineteen percent 19% of long-term care nurse aides who were found guilty of on-the-job abuse, neglect or property theft in 2010 had prior criminal records that would have showed up on a background check. Click here to read the entire report from the HHS OIG . Repo...

By Danielle M. Murray, J.D. According to the Orlando Sentinel, a study published in the Annals of Internal Medicine shows that patients like to read their doctors’ notes. In the study, published in April of 2012, doctors put their notes online, and gave patients online access to the file. While some patients had privacy concerns, ninety-nine percent 99% of them requested to keep access to the file after the study was over. To read the entire article from the Orlando Sentinel, click her...

George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law There’s a new task force riding into Texas. According to The Texas Tribune, the Texas Attorney General’s AG Office and the Office of Inspector General OIG at the Health and Human Services Commission HHSC have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children. The article, published on October 10, 2012, states the creation of the Medicaid an...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Two South Florida doctors, both former medical directors at the mental health care company American Therapeutic Corporation ATC , will spend 10 years in prison for their part in a $205 million Medicare fraud scheme. A U.S. district judge handed down the sentence on October 1, 2012. Click here to see the press release on the sentencing from the Department of Justice DOJ . I previously wrote a blog on th...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Physicians who run into difficulty in obtaining certification by the American Board of Internal Medicine ABIM need to act to ensure that they properly exercise their rights to hearings and appeals. Because of the extremely serious repercussions adverse action by the ABIM might have on a physician's career and livelihood, it is critical to approach this from an educated perspective. Competent, experienc...

By Dr. Thu Pham, O.D., Law Clerk On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. Payment of bribes and kickbacks, as well as payments to patient recruiters were an issue in this investigation. To read the entire article from the Miami Herald, click here . Arrests Part of a Nationwide Initiative. These arrests are part of a nationwide initiative to crack down on theft committed by individuals agai...

By Danielle M. Murray, J.D. On September 27, 2012, Public Citizen, a watchdog group, reported whistleblowers have initiated $6.6 billion in penalties against drug manufacturers in 2012. Most of these penalties are for fraudulently overcharging government programs. The report names a small Key West, Florida, pharmacy as one of the top whistleblowers in the country. The pharmacy noticed and reported that drug manufacturers were charging highly inflated prices to Medicaid. To read the entire report...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. To see that blog, click here . In October of 2012, the Centers for Medicare and Medicaid Services CMS announced it has discovered errors in its initial calculations. This means, 1,422 hospitals with high readmission rates will lose s...

By Thu Pham, O.D., Law Clerk, The Health Law Firm On August 9, 2012, the United States Court of Appeals for the Fifth Circuit, located in New Orleans, Louisianna, affirmed the conviction of a patient recruiter in Texas for Medicare Fraud committed after Hurricane Katrina. To read the court's decision, click here . The Recruiter's Charges. The patient recruiter was charged with conspiracy to defraud Medicare. Starting in 2007, the recruiter solicited potential beneficiaries and gathered informati...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law There’s a firefight brewing between Walgreens and the Drug Enforcement Administration DEA . On October 10, 2012, Walgreens filed a petition asking a federal judge to lift the Immediate Suspension Order ISO that bans its distribution center in Jupiter, Florida, from shipping controlled substances to its stores in Florida and on the East Coast. Back on September 14, 2012, the DEA issued an ISO on t...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The compounding pharmacy behind the meningitis outbreak was allegedly not following the requirements of its state license, according to the Massachusetts Department of Health DOH in a released statement on October 10, 2012. To read the entire statement from the Massachusetts DOH, click here . The New England Compounding Center NECC shipped more than 17,000 vials of a steroid to pain clinics in 23 state...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida does not have a corporate practice of medicine prohibition like many other states do. In other words, a physician is allowed to work as an employee or independent contractor of a corporation or other business entity owned by nonphsyicians. However, there are a number of exceptions to this rule. For dentists, optometrists and chiropractors there are specific statutory prohibitions on any member ...

By Danielle M. Murray, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law By now, you have heard stories of fake doctors and dentists in South Florida working on patients and causing severe injuries. Usually, these are solo efforts. However, according to CBS Miami, a couple was arrested back in August of 2011, for practicing medicine without a license. The wife owned a clinic where the husband treated patients. The majority of the patients were ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Another pharmacist was led away in handcuffs during a September 25, 2012, raid on an Orlando-area pharmacy, according to a number of sources. The pharmacist is accused of filling prescriptions for oxycodone, even though he allegedly knew the prescriptions were not legitimate. Click here to see video of the arrest from WFTV in Orlando . The Raid and Arrest Were Part of an Ongoing Investigation. In Decem...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Many massage therapists are unaware of the drastic long-term effects that discipline on their massage therapist license could have. This includes submitting a voluntary relinquishment of the massage therapist's license while there is an investigation pending or while there are charges pending. Although this particular article is being prepared specifically for massage therapists, similar principles app...

By: Lance O. Leider, J.D. and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The recently enacted Medicare Shared Savings Program MSSP has created a new form of healthcare delivery system, the Accountable Care Organization ACO . The purpose of the ACO is to encourage providers to reduce healthcare costs by grouping together and assuming responsibility for the care of a group of beneficiaries. In order to accomplish this goal, ACOs have been provided w...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney A Tennessee ambulance company and the U.S. Department of Health and Human Services DHHS announced a settlement in a case over a post payment audit for more than two million dollars in May 2012. Back in March of 2010, the Nashville ambulance company sued the DHHS after being sent a $2.65 million overpayment demand, according to the Nashvill...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals. I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility ALF and skilled nursing facility SNF residents. Most often these are audits by the Medicare Administr...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In September 2012, the Centers for Medicare and Medicaid Services CMS made the decision to allow Recovery Audit Contractors RACs to begin reviewing the billing codes for office visits for healthcare providers. Those at issue are the codes referred to as evaluation and management E&M codes. These claims had previously been off-limits to RACS. Connolly, Inc., the contractor for RAC audit services for...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law At least 105 people in nine states, including Florida, have contracted meningitis. The outbreak is allegedly due to contaminated epidural spinal injections of methylprednisolone linked to New England Compounding Center NECC in Framingham, Massachusetts. The manufacturing center is now closed, and the company has issued a voluntary recall of all products distributed since January 2012. Click here to see...

By Lance O. Leider, J.D. Personnel files contain many different kinds of potentially harmful information. Not only is there a tremendous amount of personal information that could be misused, but also information that could be harmful to future employment prospects and potential license discipline. Fortunately, healthcare providers in Florida have a strong right to privacy in the information contained in their personnel records. The greatest potential danger in these records is that they typicall...

By Danielle M. Murray, J.D. According to the New York Times, the government wants to implement a new system that would allow patients to report medical mistakes and unsafe practices by health care providers to a central reporting organization. This includes doctors, hospitals, pharmacists, and all other professionals or entities that provide medical treatment. While it is only an idea at this point, the government envisions patients reporting problems through a website or a phone number by answe...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In previous blogs we’ve mentioned that Florida Governor Rick Scott signed House Bill 1175 on March 23, 2012. This bill outlawed more than 90 new forms of synthetic drugs and included bath salts , among others. It modifies Section 893.03 1 c , Florida Statutes, by expanding the list of banned hallucinogenic substances in Schedule I of the Florida Comprehensive Abuse Prevention and Control Act . To...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A whistleblower lawsuit against Blackstone Medical, Inc., alleging Medicare fraud against Parrish Medical Center, was dismissed by a U.S. District Judge in Tampa, Florida, on August 15, 2012. According to Orthopedics This Week, the case was unsealed on August 8, 2012, but dismissed without prejudice, all pending motions were denied as moot, and the clerk was directed to close the case, just one week af...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices PMDs Demonstration at a Senate Special Committee on Aging. Durable Medical Equipment Suppliers DMES protested the program because it requires the permission of a Medicare Administrative Contractor MAC prior to the delivery of a power wheelchair to the consumer. To see ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals. I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility ALF and skilled nursing facility SNF residents. Most often these are audits by the Medicare Administr...

By Lance O. Leider, J.D. If you are a doctor, nurse, dentist, psychologist, pharmacist, massage therapist or other licensed health professional whose license has been recently revoked or suspended, there may still be hope. Ordinarily, you must immediately stop practicing or you risk being prosecuted for unlicensed practice, a felony. Although this blog deals with Florida law, similar relief may be available in other states, too. One of the hardest things about having a license suspended or revok...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I receive many questions and e-mails about possible violations of the Health Insurance Portability and Accountability Act's HIPAA Privacy Regulations and Security Regulations, and breaches of confidentiality of medical records and medical information. More detailed information on HIPAA Privacy Regulations and Security Regulations, can be found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/inde...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Florida Secretary of Health announced on September 27, 2012, that he has now signed 161 emergency suspension orders ESOs for massage therapists in Florida. The suspension orders are aimed at massage therapists who allegedly obtained their licenses to practice through a transcript-buying scandal at the Florida College of Natural Health. Officials believe the scheme could be linked to human trafficki...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 6, 2012, the Department of Justice DOJ announced it will join in a whistleblower lawsuit alleging false Medicare billings against Hospice of the Comforter Inc., HOTCI . The hospice is located in Altamonte Springs, a suburb of the Orlando area, and provides hospice services to local patients. To read the entire whistleblower complaint filed, click here . Allegations Against HOTCI. According...

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10/1/2012

September 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Christopher E. Brown, J.D. On September 19, 2012, Florida state authorities announced the suspension of more than 80 massage therapists’ licenses. They are accused of fraudulently obtaining their licenses based on fake documentation obtained from a staff member at the Florida College of Natural Health, in Pompano Beach, Florida. On September 20, 2012, one massage therapist, whose license was...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I receive many questions and e-mails about possible violations of the Health Insurance Portability and Accountability Act's HIPAA Privacy Regulations and Security Regulations, and breaches of confidentiality of medical records and medical information. I will attempt to explain and clarify this issue a little in this short blog. More detailed information on HIPAA Privacy Regulations and Security Regulat...

George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Miami man, his wife and their daughter have been charged with child abuse following two alleged dental procedures that left a 14-year-old girl permanently disfigured. According to a number of sources, the three were arrested on September 12, 2012, at their home-operated dental office. Click here to see the man’s arrest affidavit from the Miami Police Department . Dental Procedures Left 14-Year-Old...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Polk County Sheriff’s Office issued 25 arrest warrants in connection to an ongoing pill mill investigation involving a medical clinic in Winter Haven, Florida. On September 19, 2012, the sheriff’s office announced that ten suspects in the case have been arrested, and 15 suspects with arrest warrants remain at large. Click here to see the press release from the Polk County Sheriff’...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This is the second blog dedicated to physicians who are accused of being a disruptive. To read part 1 on the types of conduct that might make you a "disruptive physician," click here . Consequences of Disruptive Physician Behavior. According to one article on the subject by a physician leader, the consequences of disruptive behavior by a physician in a hospital are as follows: Disruptive physicians und...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A fake New York plastic surgeon was convicted on September 7, 2012, for performing cosmetic surgeries between April 2011 and December 2011, without a medical license. He’s also accused of completing the surgeries without general anesthesia and permanently disfiguring his patients. This is all according to the New York Attorney General’s AG Office. To see the entire press release on this arr...

George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly obtained at least $6.1 million in fraudulent reimbursement payments, according to the Federal Bureau of Investigation FBI . Click here to see the press release from the F...

By Joanne Kenna, J.D., R.N., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to a number of sources, state authorities have announced the suspension of more than 80 massage therapists’ licenses, who appear to have fraudulently obtained their licenses with the help of a Florida massage school employee. On September 19, 2012, 81 emergency suspension orders ESOs were signed, suspending the licenses of massage therapists who are part of...

By Christopher E. Brown, J.D. and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the third in a series intended to provide an introductory review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the end of t...

By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A former employee of an organization that provides services to developmentally disabled adults in Alachua County, Florida, was arrested on June 15, 2012, according to the Attorney General’s AG Office. The woman was arrested for allegedly stealing money from 11 clients in 2010 and 2011. To see the press release from the AG, click here...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 14, 2012, the Drug Enforcement Agency DEA blocked the Walgreens distribution center in Jupiter, Florida, from shipping oxycodone and other controlled drugs to its pharmacies in Florida and the East Coast with an immediate suspension order, according to the DEA. In the press release, the DEA called the Walgreens distribution facility an "imminent danger" to the public. To see the entire pre...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I have never read a Jeff Foxworthy book, and I have never watched more than a minute or two of one of his comedy routines, so my apologies to him in advance. However, I find his comedy routine about rednecks or what I know of the little bit I have heard to be a good vehicle for conveying what might be a joke to many, but should be taken very seriously, especially by one accused of being a disruptive ph...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Many massage therapists, when confronted with an investigation against their license, do not fight the charges, sometimes they decide it is cheaper and easier just to give up their license. Either choice is likely to be a mistake. A charge can be filed causing an investigation to be opened against a massage therapist by many different sources and often without any supporting evidence. If challenged and...

By Christopher E. Brown, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the second in a series intended to provide an introductory review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the end of...

By Danielle M. Murray, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Lakeland Ledger reports that Polk County Sheriff’s Detectives arrested a dentist and two pharmacists on September 5, 2012, in three unrelated cases dealing with illegally prescribing and dispensing painkillers. The sheriff’s office said the three arrests are part of its efforts to target prescription drug abuse. To read the entire Lakeland Ledger article, c...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Drug Enforcement Administration DEA revoked the registrations controlled substance licenses from two CVS pharmacies in Sanford, Florida, on September 12, 2012, according to a number of sources. The two pharmacies will no longer be able to fill prescriptions for drugs such as oxycodone, Dilaudid, Vicodin, Ritalin and Xanax. This decision is in response to a government crackdown on the distribut...

By Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 16, 2012, the Office of Inspector General OIG released a report on questionable billing by mental health centers. The report focuses on the nation’s mental health clinics that overbilled Medicare in 2010, some by tens of millions of dollars. The majority of these clinics were located in South Florida, Texas and Louisiana. To see the full report from the OIG, c...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A former medical examiner, who is accused of keeping the body parts of more than 100 people in his Pensacola storage facility, was arrested September 7, 2012. He now faces a felony charge of improper storage of hazardous waste, a misdemeanor charge of nuisance injurious to public health and driving with a suspended license, according to a number of sources. To see the case against the former medical ex...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The investigation of a complaint which could lead to the revocation of a massage therapist's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health DOH . This is a very serious legal matter and it should be treated as such by the massage therapist who receives it. Yet, in many cases, attorneys are consulted by massage therapists after the entire investigation is over, and they ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An 18-year-old Florida teenager was found guilty on August 30, 2012, of impersonating a physician’s assistant PA and practicing medicine without a license. According to the court case, he will be sentenced on November 14, 2012, and faces up to 25 years in prison on the felony counts. To view the court records from this case, click here . Teen Allegedly Treated ER Patients at a Central Florida Hos...

By: Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Federal court records from August 13, 2012, show that a former Florida Hospital employee faces fraud-conspiracy charges after he illegally accessed patient records in a solicitation scheme, according to the Orlando Sentinel. The breach in patient information was first thought to involve 2,000 patients, but according to a Federal Bureau of Investigation FBI affidavit, more th...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law As a participant in many listservs, including those of the American Health Lawyers Association AHLA , I had always been warned to watch what I said online as the OIG, the FBI and other law enforcement authorities and regulators monitored these. Not that I really believed this, and this was unnecessary, because who would be dumb enough to say anything that might cause problems for himself or herself or ...

By Christopher E. Brown, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This blog is the first in a series intended to provide an introductory review of the basics of contracting for physicians and health professionals, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice. By the end of ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The director of a center for developmentally challenged adults in Okaloosa County, Florida, was arrested on August 16, 2012, for allegedly fraudulently billing Medicaid for more than $270,000 for services under the Medicaid Developmentally Disabled Waiver Program, according to the Attorney General’s AG office. To read the entire press release from the AG’s office, click here . Medicaid Frau...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For Medicare providers, being notified of an impending audit is not welcome news. Being notified of a prepayment review is even worse. In a prepayment review, the health care provider must submit documentation to the Centers for Medicare & Medicaid Services CMS contractor before ever receiving payment. The health care provider will only receive payment typically months later if the contractor is sa...

By Christopher E. Brown, J.D. In Florida, You DO NOT Have to Speak to an Investigator! Despite mailing out hundreds of thousands of postcards and letters to pharmacists, throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Depar...

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9/4/2012

August 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Justice DOJ announced that a Daytona Beach chiropractor pleaded guilty to health care fraud, conspiracy to illegally distribute prescription drugs and money laundering on August 28, 2012. An article in the Daytona Beach News Journal states that he is facing a penalty of 30 years in federal prison. Click here to read the entire press release from the DOJ . Chiropractor Submitted Inflat...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An investigation led by the Attorney General’s Medicaid Fraud Control Unit MFCU ended with an arrest of a north Florida registered nurse RN , in Suwannee County. The arrest was based on allegations of failing to assess and monitor a 94-year-old patient’s condition. The patient fell and broke her hip and shoulder, and later died. Click here to see the full press release from the Attorney Gen...

By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney General Pam Bondi along with special agent Mark R. Trouville of the Drug Enforcement Administration DEA and Longwood Police Chief Troy Hickson announced, on June 20, 2012, the execution of 37 arrest warrants stemming from state drug charges. The defendants all reside in Central Florida. Click here t o read the entire press release from the Florida Attorney General . The Defendants’ Charges Varied. The charges for the defendants...

By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm A Palm Beach, Florida, speech pathologist has allegedly been charged with Medicaid fraud and grand theft by the Attorney General’s AG Office of Statewide Prosecution. According to the press release posted on June 29, 2012, from the AG’s office, the speech pathologists is accused of attempting to defraud Medicaid out of more than $459,000. To read the entire press release from the Florida Attorney General, click here . Assistants P...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Joanne Kenna, J.D., R.N. MedVance Institute, which is a healthcare training school with four Florida campuses, reached an agreement with the Florida Office of the Attorney General AG on June 13, 2012. MedVance was alleged to have made misleading marketing claims to students. Under the agreement, the for-profit college is required to offer retraining to eligible students who attended specific progra...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A whistleblower lawsuit based on information from a former Florida Hospital Orlando billing employee and a former staff physician alleges that seven of Adventist’s Florida hospitals overbilled the federal government between 1995 and 2009, resulting in tens of millions of dollars in false or padded medical claims, according to an article in the Orlando Sentinel and other sources. To read the entir...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Christopher E. Brown, J.D. The Medicaid Fraud Control Unit MFCU is a division of the Florida Office of Attorney General. It is in charge of investigating and prosecuting health care providers suspected of defrauding the state's Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records. Th...

By Christopher E. Brown, J.D. Nurses, did you know the National Council of State Boards of Nursing NCSBN maintains a database of all state disciplinary actions? This database, called Licensure QuickConfirm, lists all disciplinary actions from the Florida Board of Nursing and forty-six 46 other state boards. It is frequently used by hospitals and medical groups to screen potential employees. To search the Licensure QuickConfirm list, click here . Where the Information Comes From. According to the...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law July 31, 2012, marked the end of an era for Franck’s Pharmacy in Ocala, Florida, as the retail location closed its doors for good. According to an Ocala Star-Banner article, in July 2012, Franck’s Compounding Lab, which was one of the largest compounding labs in the country, was bought by Wells Pharmacy Network. The deal included Franck’s Lifestyles, which sells supplements and wellne...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Recently, courts in both California and Colorado ruled that Certified Registered Nurse Anesthetists CRNAs are now allowed to independently administer anesthesia to patients without the supervision of a physician. In California, the decision came from the First District Court of Appeals on March 15, 2012. In Colorado, an appeals court allowed the same practice on July 19, 2012. A recent article in Ameri...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida. This is allegedly due to excessive readmission rates in these hospitals between July 2008 and June 2011, according to the Centers for Medicare and Medicaid Services CMS . This story was originally reported by Kaiser Health News on August 13, 2012, and by other sources. To r...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Doctors, nurses, dentists, health professionals, and health facilities often face legal challenges from many different sources, including federal and state regulators, medical malpractice trial lawyers, hospitals, clinics and colleagues. When faced with a legal problem, the first person they should turn to should be an attorney who is Board Certified by The Florida Bar in Health Law. A Board Certified ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On Monday, August 6, 2012, a New York Times article revealed that cardiology services at some Florida HCA hospitals are under investigation by the U.S. Department of Justice DOJ for allegedly performing unnecessary procedures to increase profits. Click here to see the entire New York Times article posted August 6, 2012 . I previously blogged about and published an article on how a number of medical spe...

By Danielle M. Murray, J.D., Attorney, The Health Law Firm A doctor in Polk County, Florida, has lost his license to practice medicine. Rather than risk having his license revoked in an administrative proceeding, the now former doctor offered to voluntarily relinquish his license. The Florida Board of Medicine voted to accept the voluntary relinquishment on Friday, August 3, 2012, according to a Lakeland Leger article. Click here to read the entire Lakeland Leger article . Doctor Nabbed for Alle...

By Cori Pope, The Health Law Firm The July 25, 2012, issue of Medical Economics features an article written by George F. Indest III, President and Managing Partner of The Health Law Firm . The article, Beware Legal Ramifications of Unnecessary Tests, discusses lists that were recently released by nine medical specialty societies on medical tests and procedures patients and physicians should question or avoid. What These Lists Mean for Patients and Doctors. In the article Mr. Indest provides his ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The owner and operator of a Miami home health care agency pleaded guilty for his part in a $42 million home health Medicare fraud scheme, according to the Department of Justice DOJ , the FBI and the Department of Health and Human Services DHHS . The 43 year-old man pleaded guilty before a U.S. district court judge to one count of conspiracy to commit health care fraud on August 2, 2012. To see the enti...

The author of this is article is John Stone, Senior Attorney with National Legal Research Group in Charlottesville, VA. Police arrested Christina outside Chicago's Midway Airport. She had purchased a ticket from Southwest Airlines but was behaving so oddly while waiting to board the airplane that agents called the police, who escorted her from the airport. Christina walked to the rail and bus terminal of the Chicago Transit Authority, immediately outside the airport, where she started singing lo...

By Christopher E. Brown, J.D. The investigation of a complaint which could lead to the revocation of an osteopathic physician's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health DOH . This is a very serious legal matter and it should be treated as such by the osteopathic physician who receives it. Yet, in many cases, attorneys are consulted by osteopathic physicians after the entire investigation is ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 31, 2012, the Centers for Medicare and Medicaid Services CMS announced on its website that hospitals should brace themselves for prepayment audits beginning August 27, 2012. The CMS originally announced the Recovery Audit Prepayment Review RAPR Demonstration Project in November of 2011 for a January 1, 2012 start date, then delayed it to June 1, 2012, then again to, summer of 2012. To see the o...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The North Carolina Department of Health and Human Services DHHS announced on July 25, 2012, in a press release, that it investigated 75 cases for potential Medicaid billing fraud. The DHHS has already referred 35 cases totaling $21 million to the special Medicaid Investigations Unit of the North Carolina Attorney General’s office. Investigators Used Data Analytics Software to Detect Questionable ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response AMR , after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article . AMR Allegedly Incorrectly Billed 323 Ambulance Trips. According to the report, an in-house audit by the city showed that 323 ambulance trips out of nearly 5...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law and Medical Medical and clinical researchers, whether in an academic community or in a practice setting, spend years on clinical trials and investigations in hopes of contributing to their perspective fields. Many of these researchers, however, find themselves defending their reputation after being accused of research ...

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8/1/2012

July 2012

By Michael L. Smith, J.D., R.R.T. In Florida, You DO NOT Have to Speak to an Investigator! Despite mailing out hundreds of thousands of postcards and letters to respiratory therapists, throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This e...

By Miles Indest China's increasing health concerns for its aging population, combined with the government's proposed health care reform, has generated much optimism in multi-national corporations concerning the future of China's health care industry. Many U.S. health care providers are already reaping the rewards of participating in China's health care investments, preparing for the promising boom that is sure to come. Any U.S. health provider that is serious about expanding internationally and ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 24, 2012, a 49-year-old man from Ruskin in South Fla., pleaded guilty in federal court to fraudulently working as a Central Florida pharmacist from 2000 to 2009, according to the Department of Justice DOJ in a press release. Man was Working at Central Florida Pharmacies. Prosecutors said this man worked at pharmacies throughout Central Florida, including CVS pharmacy and Walgreens. According to...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 2, 2012 the Officer of Inspector General OIG released its Medicare compliance review of West Florida Hospital in Pensacola. According to the audit, the hospital complied with Medicare billing requirements for the documentation majority of inpatient and outpatient claims. However, the overpayments for the years 2009 and 2010 totaled up to $173,000. Official Break Down of the Audit. West Florida ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The investigation of a complaint which could lead to the revocation of a dentist's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health DOH . This is a very serious legal matter and it should be treated as such by the dentist who receives it. Yet, in many cases, attorneys are consulted by dentists after the...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An Orlando and Jacksonville physician have been linked to a statewide pill-mill operation that brought in millions of dollars to pain clinic owners and doctors, according to the Orlando Sentinel . On June 27, 2012 seven doctors and seven pain clinic owners were arrested in the raid that was dubbed "Operation Pill Street Blues. The two-year, multiagency investigation into the pill-mill operation spanned...

By Lance Leider, J.D. In Florida, You DO NOT Have to Speak to an Investigator! Despite mailing out hundreds of thousands of postcards and letters to nurses throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Department of Healt...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida Governor Rick Scott signed House Bill 1175 on March 23, 2012. This bill outlaws over 90 new forms of synthetic drugs. It modifies Section 893.03 1 c , Florida Statutes , by expanding the list of banned hallucinogenic substances in Schedule I of the Florida Comprehensive Abuse Prevention and Control Act . To view Florida HB 1175, click here . Florida's Synthetic Drug Legislation Imposes Restrict...

By Lance O. Leider, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with healthcare fraud. As a result, auditing and subsequent overpayment demands are some very real possibilities. Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state M...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida Governor Rick Scott signed House Bill 1175 on March 23, 2012. This bill outlaws over 90 new forms of synthetic drugs. It modifies Section 893.03 1 c , Florida Statutes , by expanding the list of banned hallucinogenic substances in Schedule I of the Florida Comprehensive Abuse Prevention and Control Act . To view Florida HB 1175 , click here . Florida's Synthetic Drug Legislation Imposes Restric...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We have recently experienced an alarming increase in the number of Medicare providers receiving notices that their Medicare billing privileges are being terminated. These include home health agencies HHAs , independent diagnostic testing facilities IDTFs , ambulance and emergency transport providers, physicians, pharmacies, durable medical equipment DME providers, medical groups, physical therapists an...

The Health Law Firm is pleased to announce that Lance O. Leider has joined the firm as an attorney at the firm's Altamonte Springs office. His practice will focus on the representation of health providers in litigation, licensing and disciplinary issues, contracts, appeals, administrative hearings, regulatory matters, and Medicare and Medicaid defense. Mr. Leider earned his Juris Doctor J.D. summa cum laude from Barry University's Dwayne O. Andreas School of Law in December 2011. He was the vale...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A licensed practical nurse LPN at Florida State Hospital has been arrested and charged with one count of abuse of a disabled adult at the hospital. The nurse was arrested on a felony warrant by the Attorney General’s Medicaid Fraud Control Unit MFCU . The arrest was announced by the Florida Attorney General on June 29, 2012. Abuse Allegedly Occurred During Medication Administration. The nurse all...

By Miles Indest Maury Regional Hospital, located in Columbia, Tennesse, has agreed to pay the federal government over $3.5 million to settle False Claims Act allegations that occurred between 2004 and 2009. Maury Regional submitted a voluntary self-disclosure to the U.S. Attorney's Office and the Department of Health and Human Services DHHS Office of Inspector General OIG . Hospital Self-Reported After Compliance Program Revealed Billing Errors. The hospital self-reported after its own complianc...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law GlaxoSmithKline GSK , a prescription drug manufacturer, has agreed to pay $3 billion in fines to resolve healthcare fraud allegations. The settlement was announced by federal prosecutors on July 1, 2012, and in a press release from the Florida Attorney General on July 2, 2012. This is the largest healthcare fraud settlement in U.S. history. Settlement Resolves List of Allegations Related to Healthcare ...

By Miles Indest A Pennsylvania man has been charged in a 23-count indictment in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. The charges were announced by the Department of Justice DOJ on June 29, 2012. "Straw" Owner Allegedly Used to Start Ambulance Company. The indictment alleges that the man used a "straw" owner someone who was not actually the owner to fraudulently open Starcare Ambulance because he was otherwise ineligible to own the compan...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A recent case involving the Florida Department of Business and Professional Regulation DBPR demonstrates how important it is for all professional licensees, including Department of Health DOH licensees, to immediately update their addresses with the licensing agency when there is change. Appellant Sought to Reverse Revocation of Two Licenses. In Griffis v. Department of Business and Professional Regula...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The First District Court of Appeal has ruled that the Agency for Health Care Administration AHCA had substantial justification to withdraw a home health agency's application for licensure in a recent case. To view the opinion, click here . Home Health Agency Challenged AHCA's Decision to Withdraw Application. AHCA withdrew the home health care facility's license application because the application alle...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Two Orlando assisted living facilities ALFs won a case against the Agency for Health Care Administration AHCA on appeal. The First District Court of Appeal heard the case and filed an opinion in favor of the ALFs on November 30, 2011. To view the opinion, click here . Appeals Court Dismissed Three Complaints Made by AHCA Due to Uncorroborated Hearsay Evidence. On appeal, the ALFs challenged a final ord...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Office for Civil Rights OCR has released an audit protocol for audits of Health Insurance Portability and Accountability Act HIPAA covered entities. The audit protocol covers audit procedures and requirements for assessing compliance with HIPAA's Privacy Rule, Security Rule, and Breach Notification Rule. This information is extremely valuable for covered entities. Covered entities can use the audit...

By Miles Indest and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A recent "whistle-blower case" filed under the False Claims Act FCA has emphasized the indispensability of fact verification when submitting claims, grant applications or other information to the federal government. Health care providers may face FCA liability for false records or mediocre research methods when seeking research grants from a federal agency. Click here to view the False...

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7/2/2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Drug Enforcement Administration DEA and Florida law enforcement announced a statewide pill mill bust that spanned several cities in Florida on June 27, 2012. Seven doctors and seven pain clinic owners were arrested. The raid has been dubbed "Operation Pill Street Blues" by the DEA. To view the DEA's press release concerning the raid, click here . Charges Against the Doctors and Pain Clinic Owners I...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law New information is available regarding the Office for Civil Rights’ OCR initial round of mandated audits of Health Insurance Portability and Accountability Act HIPAA covered entities. The OCR announced official details concerning the audits at an OCR and National Institute of Standards and Technology NIST conference held June 6, 2012. Initial HIPAA Audits Began November 2011. As required by the H...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Often a business obtains faulty legal advice that it can treat its employees as "independent contractors" and avoid a number of mandatory costs associated with hiring an actual employee. These may include, for example, paying social security, Medicare and other mandatory assessments. Additionally, the employer may believe that it can avoid expenses, such as workers' compensation insurance coverage, tha...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law WellCare Health Plans Inc. WellCare will pay $137.5 million to the federal government and nine states to settle four lawsuits alleging violations of the False Claims Act. WellCare is based in Tampa, Florida. The company provides managed health care services for approximately 2.6 million Medicare and Medicaid beneficiaries across the United States. Lawsuits Allege WellCare Submitted False Claims to Medi...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Eighth Circuit Court of Appeals ruled that investors can continue to bring claims against KV Pharmaceutical Co. KV for making false or misleading statements to the U.S. Food and Drug Administration FDA . The ruling was reached on June 4, 2012. To view the appeals court ruling in Public Pension Fund Group v. KV Pharmaceutical Company, click here . Appeals Court Ruling Revives Securities Fraud C...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Medicare providers are now able to submit medical documents to the Centers for Medicare & Medicaid Services CMS review contractors electronically for almost all of them. This includes the Medicare Administrative Contractors MACs , Recovery Audit Contractors RACs and will soon include several Zone Program Integrity Contractors ZPICs . For a list of review contractors currently accepting electronic r...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Health and Human Services DHHS Office of the Inspector General OIG posted an advisory opinion on June 1, 2012. In the advisory opinion the OIG concluded that two different arrangements between an ambulatory surgical center ASC and anesthesia services provider could result in prohibited remuneration under the federal anti-kickback statute and lead to administrative sanctions and crimin...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida law and regulations currently allow an assisted living facility ALF to relocate or terminate a resident for almost any reason. However, the administrator must provide a 45-day notice and document the reason for termination or relocation. Section 429.28 k , Florida Statutes 2011 , states that an ALF resident must receive: At least 45 days' notice of relocation or termination of residency from th...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Walgreens has reached a $7.9 million settlement with the United States and participating states. The settlement resolves allegations that Walgreens violated the False Claims Act. The DOJ announced the settlement on April 20, 2012. To view the DOJ's press release concerning the settlement with Walgreens, click here . To view the False Claims Act, click here . Walgreens Allegedly Offered Inducements to M...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A New York law enforcement crackdown on prescription drug abuse has resulted in the arrests of 98 people. Among those charged are two doctors and a nurse practitioner. Brooklyn federal prosecutors joined with the Drug Enforcement Administration DEA , district attorney's offices, and local law enforcement agencies, to carry out a series of raids that began June 5, 2012 and resulted in the arrests. To vi...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The medical use of marijuana is now legal in Connecticut. The state's governor signed into law HB 5389 on May 31, 2012, which allows licensed physicians to certify a patient's use of marijuana for medical purposes. Connecticut is the 17th state to legalize marijuana for medical use. To view Connecticut HB 5389, click here . Connecticut's Medical Marijuana Legislation Imposes Restrictions on Patients. T...

The following recent update was released by the Centers for Medicare & Medicaid Services CMS on May 30, 2012, updating the original from December 16, 2011: Existing regulations at 42 CFR 424.510 e 1 2 require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through Electronic Funds Transfer EFT . Section 1104 of the Affordable Care...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A federal jury convicted two South Florida doctors, one Miami-area therapist, and two other individuals for their participation in a Medicare fraud scheme. The scheme allegedly involved more than $205 million in fraudulent billings by American Therapeutic Corporation ATC , a corporation which provided mental health care services. The jury reached a decision on June 1, 2012. To see the Department of Jus...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida Attorney General Pam Bondi announced that her office has reached a settlement with 411-PAIN. The settlement requires 411-PAIN to pay $550,000 and change its advertising practices for allegedly making misrepresentations to consumers. 411-PAIN is a Florida-based attorney and chiropractic referral service. Lawyer Referral Service Allegedly Misrepresented Consumer Entitlements. The Attorney General...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Connecticut Attorney General George Jepsen alleges that 28 individuals, dental practices and corporations were involved in a $24 million Medicaid fraud scheme. Jepsen filed a civil action on May 31, 2012. It is the first case the state has initiated under the Connecticut False Claims Act. The Connecticut False Claims Act gives the state the ability to seek compensation for taxpayers from those who subm...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Centers for Medicare & Medicaid Services CMS is planning to move forward with the Recovery Audit Prepayment Review RAPR Demonstration Project on [stat.] June 1, 2012. It was originally scheduled to begin January 1, 2012. Recovery Audit Contractors RACs will Review Claims with High Rates of Improper Billing. The Recovery Audit Prepayment Review allows Recovery Audit Contractors RACs to review cl...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law There are many benefits to operating a business in a corporate form. These may include favorable income tax treatment and immunity from certain types of liability. A physician who practices under the structure of a sole proprietorship or a partnership mayor may not be able to enjoy similar advantages. Practice of Medicine May Be Heading Towards Corporate Environment. The practice of medicine appears to...

by George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law If you are scheduled to appear for an informal hearing before the Florida Board of Massage Therapy, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them. Limited Circumstances for Informal Administrative Hearing First, you should understand that you will only be at an informal hearing in which you appear before the Board of Massage...

Beleaguered Franck's Pharmacy, Inc. located in Ocala, Florida, has issued a recall for its compounded prescriptions. The prescriptions impacted by this recall include all sterile human and veterinary compounded prescriptions distributed by Franck’s Pharmacy from November 21, 2011 to May 21, 2012. Franck's Pharmacy made the announcement on the company's website on May 24, 2012. To see the recall click here . Recall Based on FDA Findings of Fungal Growth in Pharmacy's Clean Room. The recall ...

I am sad to announce that we have lost a great legal mind and friend with the passing of Joseph DuRocher on May 19, 2012. A fellow Naval aviator, Joe served in the early Viet Nam war era, through 1965. Joe later went on to pursue a career as an attorney after leaving the Navy. He served as the Public Defender for the Ninth Judicial Circuit Court for Orange and Osceola Counties, for 20 years, through 2001, perhaps the most important role an attorney can have in our legal system. He also shared hi...

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6/1/2012

Attorneys from The Health Law Firm delivered a third seminar to Florida Hospital's family medicine residents and medical students. The lecture took place on Wednesday, May 23, 2012 at Florida Hospital East Orlando. The topic focused on Florida Department of Health DOH disciplinary actions. This seminar was part of a series of lectures presented to Florida Hospital's Family Medicine Department by The Health Law Firm's attorneys. In previous lectures, the attorneys discussed physician employment c...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A professor at the University of Massachusetts-Amherst is appealing a final order issued by the Drug Enforcement Administration DEA that prohibits him from growing marijuana for medical research purposes. Appeals Court Hears Oral Arguments in Medical Marijuana Research Case. The U.S. Court of Appeals for the First Circuit heard oral arguments in the case on May 11, 2012. During the hearing the DEA atte...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Florida cardiologist recently had his medical license emergently suspended by the Florida Department of Health DOH for performing stem cell treatments. According to the emergency suspension order ESO , the DOH had previously warned the doctor to stop performing these treatments in 2011. Now, his license is at risk of being revoked. To view the ESO click here. DOH Suspends Cardiologist's License Beca...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Cardinal Health has reached a settlement with the Drug Enforcement Administration DEA . The settlement suspends Cardinal Health's ability to ship controlled substances from its Florida distribution facility for two years. The company will now supply controlled substances from its distribution center in Jackson, Mississippi. Cardinal Health's Settlement Does Not Prevent the DEA from Pursuing Civil Penal...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Registered nurses at ten HCA hospitals in Florida have reached a collective bargaining agreement with the hospital chain. After negotiating for over a year, National Nurses United--a union for registered nurses--announced that it finalized the agreement with HCA on May 7, 2012. The agreement affects over 3,000 Florida registered nurses at HCA hospitals. It will be effective for three years. According t...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Did you know that the Drug Enforcement Administration DEA has a public list of physicians with DEA registrations that have been arrested and prosecuted? On the DEA's website, there is a list of all investigations of physician registrants in which the DEA was involved that resulted in the arrest and prosecution of the registrant which was updated and released on April 3, 2012. The list includes: ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A California college student was left in a small holding cell by the Drug Enforcement Administration DEA for five days without food, water, or a toilet. He believes that the DEA forgot about him. He was taken by agents during a late April 2012 drug raid on his friend's house in which nine people were arrested. The engineering student at the University of California, San Diego, was not arrested or charg...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law If you are contacted by a Florida Department of Health investigator, did you know that you cannot be required to make a statement or give information that can be used against you? If you are being investigated you have a right to refuse to speak with an investigator pursuant to the Fifth Amendment of the U.S. Constitution and the equivalent rights given by the Florida Constitution, Article 1, Section 9...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In Florida, You DO NOT Have to Speak to an Investigator! Despite mailing out hundreds of thousands of postcards and letters to physicians, nurses, dentists, pharmacists, and psychologists throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Flo...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law When Was the Last Time You Checked Your Addresses on File with CMS/Medicare? When was the last time you checked all four of the addresses you should have on file for any individual or any group/company Medicare number you may have? The consequences of not doing so can be severe. In addition to your mailing or correspondence address , and your billing address, you also should have a physical address tha...

by George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law If you are scheduled to appear for an informal hearing before the Florida Board of Clinical Social Work, Marriage & Family Therapy & Mental Health Counseling, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them. Limited Circumstances for Informal Administrative Hearing First, you should understand that you will only be at ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Internal Revenue Service IRS is now alerting hospitals that it has completed the review of their medical resident Federal Insurance Contributions Act FICA refund claims. The first hospitals to be notified may receive their FICA refund checks as early as May 2012. FICA deductions are a percentage of the employee's wages that are withheld to help fund both the Social Security and the Medicare Program...

by George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law If you are scheduled to appear for an informal hearing before the Florida Board of Pharmacy, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them. Limited Circumstances for Informal Administrative Hearing. First, you should understand that you will only be at an informal hearing in which you appear before the Board of Pharmacy itsel...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The United States Department of Health and Human Services HHS Office for Civil Rights OCR has reached a settlement with Phoenix Cardiac Surgery PSC over alleged Health Insurance Portability and Accountability Act of 1996 HIPAA violations. The settlement was reached on April 17, 2012 and requires PSC to pay OCR $100,000 and enter into a one-year corrective action plan CAP . The Resolution Agreement and ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Three U.S. Senators have teamed up to request an evaluation of state medical boards. This bipartisan effort was initiated at the end of February 2012 when Senators Charles Grassley R-Iowa , Orrin Hatch R-Utah and Max Baucus D-Mont. sent a letter to the director of the Office of the Inspector General OIG for the Department of Health and Human Services HHS . In the letter the senators ask the OIG to laun...

by George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law If you are scheduled to appear for an informal hearing before the Florida Board of Dentistry, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them. Limited Circumstances for Informal Administrative Hearing. First, you should understand that you will only be at an informal hearing in which you appear before the Board of Denstistry it...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Over 100 doctors, nurses and other health professionals were arrested on charges relating to Medicare fraud by federal agents on May 2, 2012. The arrests were made in seven cities nationwide, but more than half took place in South Florida. This was a multi-agency attack on health providers involving law enforcement agents from the Federal Bureau of Investigation FBI , Department of Health and Human Ser...

According to media reports, the Centers for Disease Control CDC has traced a rare fungal infection to a Central Florida pharmacy. As reported, Franck's Compounding Lab, located in Ocala, Florida, is believed to be at least partially responsible for spreading a rare fungal eye infection to over 30 patients across the U.S. The CDC reports that eye drops and injections traced back to the lab caused the infections. These ophthalmic products contained multiple fungal and bacterial species, according ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In the last century, major changes in health care and technology, as well as simple progress in such innocuous conveniences such as public water fountains, have dramatically improved the quality of life. These have increased the average life expectancy in the United States from 47 years in 1900 to 78 years in 2011 almost doubling life expectancies. Health advances achieved throughout the 20th century a...

by George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law If you are scheduled to appear for an informal hearing before the Florida Board of Nursing, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them. Limited Circumstances for Informal Administrative Hearing. First, you should understand that you will only be at an informal hearing in which you appear before the Board of Nursing itself ...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In the last century, major changes in health care and technology, as well as simple progress in such innocuous conveniences such as public water fountains, have dramatically improved the quality of life. These have increased the average life expectancy in the United States from 47 years in 1900 to 78 years in 2011 almost doubling life expectancies. Health advances achieved throughout the 20th century a...

by George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law If you are scheduled to appear for an informal hearing before the Florida Board of Medicine, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them. Limited Circumstances for Informal Administrative Hearing. First, you should understand that you will only be at an informal hearing in which you appear before the Board of Medicine itsel...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We have recently received notice from the Florida Department of Health DOH that Florida pharmacies have been receiving fraudulent letters from someone claiming to be from "DOH Investigative Services." These fake letters contain numerous errors including poor grammar, incorrect letterhead and an incorrect phone number. The notice from the DOH regarding these forged letters, as well as a redacted example...

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5/2/2012

April 2012
The Greatest Health Advances that Changed our Lives in the Past Century: Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In the last century, major changes in health care and technology, as well as simple progress in such innocuous conveniences such as public water fountains, have dramatically improved the quality of life. These have increased the average life expectancy in the United States from 47 years in 1900 to 78 years in 2011 almost doubling life expectancies. Health advances achieved throughout the 20th century a...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In the last century, major changes in health care and technology, as well as simple progress in such innocuous conveniences such as public water fountains, have dramatically improved the quality of life. These have increased the average life expectancy in the United States from 47 years in 1900 to 78 years in 2011 almost doubling life expectancies. Health advances achieved throughout the 20th century a...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On April 4, 2012, nine different medical specialty groups each released its list of the top five medical tests and procedures that are overused and often unnecessary. Each list also includes information about when a test or treatment may be appropriate based on clinical evidence and guidelines. The lists cover a wide range of tests, procedures and treatments including stress tests, nonsteroidal anti-in...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Tuomey Reversed On March 30, 2012, the 4th U.S. Circuit Court of Appeals overturned a federal district judge's 2010 decision for Tuomey Healthcare System. U.S. ex rel. Drakeford v. Tuomey Health. Sys., Inc. , 4th Cir., No. 10-1819 Mar. 30, 2012 The lower court's decision ordered Toumey Healthcare System to pay $44.9 million for allegedly violating the Stark Law. 42 U.S.C. § 1395nn The appeals cour...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Few health care practitioners really understand the significance that being excluded from the Medicare Program may have. Exclusion usually occurs as a direct result of disciplinary action being taken by the state board of medicine, board of nursing, board of psychology, board of pharmacy or other health care licensing entity. If revocation, suspension, restriction or limitation of a license occurs, thi...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Pinellas County has started a new billboard campaign aimed at curbing prescription drug abuse. The billboard message reads, "We're shutting down Pill Mills in Pinellas County." The first two billboards were erected on April 1, 2012. Several smaller boards will be put up in the next few weeks, with even more planned for the future. This continues the long-standing battle by Pinellas County law enforceme...

On April 9, 2012, Gwynne A. Young, President-Elect of The Florida Bar, announced that George F. Indest III, President and Managing Partner of The Health Law Firm, has been appointed to serve on The Florida Bar's Health Law Certification Committee. Mr. Indest will begin his three year term on July 1, 2012. The Florida Bar's Health Law Certification Committee is responsible for overseeing the board certification process for all health law attorneys. Appointments to this standing committee are made...

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Diversified Service Options DSO acquired Highmark Medicare Services Highmark on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. BCBS Florida . Highmark had the contract with the Centers for Medicare & Medicaid Services CMS to be the Medicare Administrative Contractor MAC , formerly known as a "Carrier" or "Fiscal Intermediary," ...

There are important distinctions in the licensure requirements, the insurance requirements and the types of services that can be provided by home health agencies, nurse registries and homemaker and companion organizations in Florida. The owners and operators of such businesses must should be aware of these. Diligence must be taken to ensure that employees of one type of provider do not deliver services to clients/patients that are not authorized by the company's license. When applying for a lice...

The U.S. Drug Enforcement Administration DEA is continuing to attack pharmacies, including the largest pharmacy chains, with the recent investigation of a Walgreens distribution center and six Walgreens pharmacy stores in Florida. On Wednesday, April 4, 2012, the DEA issued inspection warrants to the Florida Walgreens distribution center and six pharmacies. According to the warrant, the DEA is investigating these Walgreens pharmacies in Florida to determine if the pharmacies are dispensing contr...

In today's heavily regulated health care environment there seems to be little room for the time-honored tradition of professional courtesy. Practiced for hundreds of years, professional courtesy originally referred to the provision of health care to physician colleagues or their families free of charge or at a reduced rate. Many argue, rightfully so, that the Hippocratic Oath even requires this for the patient who is a physician and his or her family. More recently the scope of professional cour...

When a physician, medical group or other healthcare provider receives a notice of an audit and site visit from Medicare, the Medicare Administrative Carrier MAC or the Zone Program Integrity Contractor ZPIC , things happen fast with little opportunity to prepare. Hopefully this checklist will help you to prepare for the on-site visit that will shortly follow. Many items on this checklist may seem common sense to the reader; however, they would not be on here if I did not encounter them as proble...

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4/4/2012

March 2012
Dissecting Clinical Research Misconduct and Fraud

Medical and clinical researchers, whether in an academic community or in a practice setting, spend years on clinical trials and investigations in hopes of contributing to the field of medicine. However, many of these researchers instead find themselves defending their reputation after being accused of research misconduct or research fraud. One of the most notorious recent cases of research misconduct involved a South Korean stem cell researcher who claimed to have cloned human embryonic stem cel...

In a recent blog post, we discussed the precedent set by Meyers v. Columbia/HCA Healthcare Corp. in determining court review standards for clinical privileges and peer review actions. Although Meyers is one of the major cases concerning peer review and termination of hospital privileges, there have been other recent clinical privileges cases that are important for physicians to be aware of when facing a peer review action. This is especially true if the physician is being accused of disruptive b...

When a physician, medical group or other healthcare provider receives a notice of an audit and site visit from Medicare, the Medicare Administrative Carrier MAC or the Zone Program Integrity Contractor ZPIC , things happen fast with little opportunity to prepare. Hopefully this checklist will help you to prepare for the on-site visit that will shortly follow. Many items on this checklist may seem common sense to the reader; however, they would not be on here if I did not encounter them as proble...

Pain management clinics in Orange County, Florida can expect to face more regulations in upcoming months. As of March 19, 2012, county lawmakers are planning to make major changes to the way pain management clinics operate in this Central Florida County, in order to minimize prescription drug abuse, according to the Orlando Sentinel . Some of the proposed regulations include: Pain management clinics will be required to provide Orange County with monthly business records documenting the...

Despite the passage of Florida's Health Care Clinic Act over nine years ago, there are apparently still many health practices which are violating it. Unfortunately, the violation of the Health Care Clinic Act can have extremely serious repercussions, including conviction of a felony, loss of all fees collected, and disciplinary/licensure action against any physicians, nurses or other licensed health professionals working there. Over the past three years we have seen the following scenarios or o...

The Florida Legislature unanimously passed HB 653 which relaxes some of the draconian exclusions enacted under SB 1986, which went into effect on July 1, 2009. SB 1986, which added provisions to Chapter 456, Florida Statutes, among others, prevented numerous healthcare providers from obtaining or renewing licenses based on prior criminal convictions, which could have occurred decades earlier. As of this writing March 16, 2012 , HB 653 has been passed unanimously by the Florida Legislature, but a...

About a year ago, Florida pain clinics began to really feel the impact of becoming law enforcement's newest target. This was based in part on televison "magazine" shows and investigative reporters' shows and articles publicizing many abuses by patients who were "doctor shopping" and physicians who were allegedly "over-prescribing." Regulations increased, and lawmakers enacted severe penalties for doctors accused of over-prescribing, including prison sentences. Most physicians were banned from di...

Defamatory attacks against doctors have become increasingly prevalent as more and more review sites join the world wide web, allowing patients to post virtually anything they want - good or bad - about a physician or any professional. With more physicians becoming employees of hospital systems or large healthcare institutions, adverse surveys, reports or reviews can affect advancement, bonuses and basic income. Internet ratings on review sites like Vitals.com and Yelp.com can range from snide co...

If you are a physician with hospital privileges, one of the most important cases for you to be aware of concerning "disruptive physician" actions is Meyers v. Columbia/HCA Healthcare Corp. , which was finally decided in 2003. In ruling on disruptive physician cases, courts almost always rely on Meyers , and it has been cited repeatedly in other disruptive physician cases to justify a hospital or medical staff's peer review actions disciplining the physician. In this case, Dr. Meyers, an orthoped...

Previously, I have written articles and blogs on why a physician, dentist, pharmacist, nurse, psychologist, mental health counselor or other licensed health professional should never agree to voluntarily relinquish his or her license after any notice of a possible investigation being opened. This is treated the same as if the state licensing agency had revoked that license for cause. This applies even if the license is in another state, is inactive, or has expired. The consequences of this inclu...

Orlando, Fla. - March 15, 2012 - George F. Indest III, President and Managing Partner of The Health Law Firm, shares his knowledge of health law in the March 14 issue of Medical Economics . Mr. Indest was interviewed and quoted for an article concerning legal advice for primary care physicians who prescribe painkillers. In the article he provided information based on his experience in defending physicians charged with over-prescribing with the DEA and Florida DOH, Board of Medicine. The article,...

One of the newest acronyms we have encountered in the Medicare Program's audit process is the Medicare Comprehensive Error Rate Testing program audit or CERT audit. It could be that we just haven't had clients who had problems with this in the past, as we have seen plenty of Zone Program Integrity Contractor ZPIC audits, Medicare Administrative Contractor MAC audits and actions, Medicaid Fraud Control Unit MFCU audits, etc. However, we did have a client recently who was being audited by a CERT c...

For those Medicare providers who had their Medicare numbers terminated by the Medicare Administrative Contractor MAC formerly called the "carrier" or "fiscal intermediary" , you can actually check the status of a corrective action plan CAP you submitted timely. If you go to the following: http://medicare.fcso.com/Enrollment/PEStatus.asp you should be able to view the status. Note that the date that will be listed as being received will probably be days, if not weeks after you sent it. That is wh...

Many nonphysician providers work in family practices, including nurses, medical assistants, clinical nurse specialists, nurse practitioners, psychologists, respiratory therapists, physician assistants, physical therapists, social workers and laboratory technicians, among others. These nonphysician healthcare providers not only assist with patients, they often see patients in the physician’s absence. One way Medicare recognizes these individuals for payment purposes is by claims coding that...

The American Board of Medical Specialities ABMS recently announced that it has adopted a new policy that will require doctors to attain board certification within three 3 to seven 7 years after finishing residency. Prior to the establishment of this new rule, the period between training and board certification was undefined, and physician's had an indefinite amount of time to become board certified. This new policy was created in order to diminish confusion created by the term "board eligible." ...

On Friday, March 2, 2012, a judge ordered that the temporary restraining order entered on behalf of CVS Pharmacy against the Drug Enforcement Administration DEA will remain in effect until March 13. This temporary restraining order prohibits the DEA from banning two Sanford CVS pharmacies from filling prescriptions for controlled substances like oxycodone and hydrocodone. CVS Pharmacy filed a request with the court for the temporary restraining order in early February 2012, after the DEA issued ...

The Agency for Health Care Administration AHCA , Office of Inspector General, Bureau of Medicaid Program Integrity, is the Florida agency responsible for routine audits of Medicaid health care providers to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited. These include pediatricians, Ob/Gyns, family practice physicians and dentists. The Medicaid audit usual...

The Medicaid Fraud Control Unit is a division of the Florida Office of the Attorney General charged with investigating and prosecuting health care providers suspected of defrauding the state's Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records. The practice tips below were prepared to assist a health care provider in properly responding to and defending against such a subpoena. ...

Have you received a notice of termination of your Medicare provider number? Medicare has been revoking the Medicare provider numbers of many different Medicare providers including physicians, medical groups, home health agencies HHAs , pharmacies, and durable medical equipment DME providers, based on returned mail sent to old addresses which have not been updated or based on inspection team site visits to old addresses. Often the termination is retroactive to a much earlier date the change or mo...

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3/1/2012

February 2012

Earlier in February 2012, the DEA accused both CVS Pharmacy, one of the nation's largest drug store chains, and Cardinal Health, one of the nation's largest legitimate distributors of pharmaceuticals, of endangering the public by selling excessive amounts of oxycodone to four Florida pharmacies. For Cardinal Health, the charges came in an immediate suspension order served Feb. 3, 2012, when the DEA suspended Cardinal's license to distribute controlled substances from its Lakeland, Florida locati...

According to the Orlando Sentinel , some of the worst alleged pill mills in Florida are located in Orlando. At a small pain clinic near downtown Orlando and an affiliated office, one doctor prescribed more oxycodone during a three-month period in 2010 than all doctors in the state of California combined. Details about the clinic from former employees span a nearly 200-page affidavit filed in Orange County Circuit Court in the racketeering case against doctors and management of this pain clinic. ...

In the current state of the economy, consumers are relying on new discount programs to help fund everything from ice cream outings to laser tag adventures to liposuction. Groupon and similar sites like Living Social offer subscribers daily deals for local products, services and businesses ranging from 20% to 90% off the original price. These virtual coupon inspired sites allow consumers to afford experiences they wouldn't be able to fund otherwise, and also send high-volume traffic to businesses...

CVS Asking Judge to Prevent DEA Ban CVS/pharmacy has asked a federal judge for a temporary restraining order to prevent the U.S. Drug Enforcement Administration DEA from banning two of its Florida stores in Sanford from selling controlled substances, according to the Orlando Sentinel . The DEA raided the two Sanford CVS stores on February 4, calling the CVS pharmacies on Orlando Drive and West First Street an "imminent danger" to the public. Each location was also served with an immediate suspen...

Healthcare audits are now occurring frequently. It has become common for state and federal regulators to enforce even the smallest violations, resulting in investigations and monetary fines and penalties. If found in violation, you will not only have to pay fines and face disciplinary action, you will also lose revenue because you will have to spend time dealing with the investigation, instead of practicing medicine. The adage 'prevention is worth a pound of cure' is definitely true when it come...

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2/1/2012

January 2012

Back in November, some Florida doctors received an unsigned letter from CVS/pharmacy telling them that the company's pharmacists would no longer fill prescriptions they write for painkillers and other powerful drugs. Community members against pill mills and overprescribing doctors are thrilled with the actions taken by CVS. The company is being praised for taking proactive steps at a time when prescription drug abuse has become out of control in Florida. However, the letter has also been called ...

Florida lawmakers are currently proposing one of the toughest laws in the nation against assisted living facilities. Specifically targeting abusive care, lawmakers are demanding for homes to be shut down when residents die from poor care. This is one of the biggest changes in Florida law since the creation of assisted living facilities, according to the Tampa Bay Tribune . Two Senate committees unveiled the dual bills in January after months of reports by the Miami Herald that showed facility re...

A new bill aimed at giving the Surgeon General more power to stop doctors who over-prescribe narcotics has passed its first House panel. The bill would allow the Surgeon General to issue an emergency order restricting a practitioner from prescribing controlled drugs if a case is pending, according to Health News Florida . However, the emergency order will not suspend the doctor from practice. Additionally, a probable-cause panel from a professional licensing board will have 20 days to uphold the...

The term "fair hearing" is used by different individuals and different organizations to refer to an administrative hearing or a private hearing in a hospital or professional association. There are a number of different types of proceedings that are often referred to as "fair hearings," including clinical privileges or peer review hearings, which allow a physician who has had his or her clinical privileges revoked to be reviewed. This type of hearing can also be referred to as: • Privileges...

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1/4/2012

December 2011
What Does Proposed Liposuction Bill Mean For Florida Plastic Surgeons?

A new Florida bill aimed at making liposuction procedures safer is making its way through the Senate in Tallahassee. The bill was created as a result of the deaths of four South Florida mothers in their 30s during liposuction procedures, according to the Orlando Sentinel. Present state rules say physician surgery offices must be inspected by the state Department of Health or accrediting organizations, unless the doctor performs procedures using only local sedatives that leave the patient awake. ...

If you are a pain management physician, it is important for you to be aware of changes in the laws governing the practice of pain management. The following laws were updated this summer, so the Florida Department of Health DOH will be enforcing these changes, including new penalities for inappropriate prescribing and new regulations for prescribing controlled substances. Minimum penalties for inappropriate prescribing for licensed health professionals - six 6 month suspension and $10,000 fine pe...

Florida is reported to have one of the worst prescription drug abuse problems in the country. Because of this issue, pain management physicians have been under increasing scrutiny and attack by federal and state agencies. If you are a pain management physician or you work in a pain a management clinic, you need to be aware of the measures that state and federal agencies are taking against doctors who practice pain management and the owners of pain management clinics. A news release sent out by t...

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act PPACA . This legislation made many reforms to the American health care system and with it came many changes that will affect both health care providers and consumers alike. One such change brought about by this legislation was the elimination of the independent Health Integrity and Protection Data Bank HIPDB , and its merger with the National Practitioner Data Bank NPDB . This will not affect...

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12/18/2011
November 2011

The crack down on Florida pill mills continues with CVS pharmacies notifying some doctors that they no longer will fill their prescriptions for certain narcotic medications. According to Health News Florida , this new policy appears to be limited to Florida, but CVS has not clearly stated what is being used to determine which doctors can have their prescriptions filled for which drugs though oxycodone definitely appears to be a target . The Florida Academy of Pain Management, released a letter v...

Three patients died in an unapproved medical trial conducted between 2003 and 2004. Now, the executives of Snythes Inc., a medical-device company, are awaiting sentencing this week after pleading guilty to a misdemeanor as "responsible corporate officers," according to Business Week. The Synthes officials allegedly bypassed FDA protocol to have surgeons test bone cement in people with spine fractures. The product was not approved for that use, and three people died in the operating room in 2003 ...

In an industry so concerned with serving others, physicians and other health professionals sometimes find that they are the ones being pushed towards a treatment program. According to a recent study , alcohol abuse is the most common reason for enrolling in a physician health program. Other reasons for treatment included opioid, stimulant and sedative abuse. However, not all physicians and health professionals that are referred to a health program are in need of rehabilitation services. The Flor...

Applying for a Florida medical license ? Read this now, so you don't have to wait later. What are the most common problems that hinder an application for a medical license or other health professional license in Florida? Still waiting for your Florida medical license or other health professional license? Here are some reasons why it may be taking so long. According to the Florida Board of Medicine 's website on May 17, 2011: NOT BEING COMPLETELY CANDID ABOUT YOUR HISTORY AND EDUCATION is the < ...

From George Indest’s Nursing Law Manual The advanced nurse is a registered nurse RN who has completed some form of advanced nursing education and training. Two types of advanced nurses are the advanced registered nurse practitioner ARNP and the certified nurse specialist. In Florida, there are three types of certified nurse specialists: certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners. The potential risk of liability for an advanced nurse is as rea...

Last week, the DEA announced the results of enforcement efforts directed at Florida's illegal prescription drug distributors. According to the DEA, more than 100 individuals have been arrested in operations targeting pill mills in Florida, and the DEA, as well as Florida law enforcement, will continue to investigate and prosecute pain clinics, pharmacies and physicians who are contributing to Florida's prescription drug trafficking epidemic. Operation Pill Nation I, initiated in February 2011 in...

The Office for Civil Rights OCR of the U.S. Department of Health and Human Services HHS is launching a pilot program this month to make sure covered entities are in compliance with HIPAA privacy and security rules and breach notification standards, according to the OCR . The OCR will perform up to 150 audits to assess HIPAA compliance . The HITECH Act requires HHS to perform periodic audits to check for HIPAA compliance. The audits will be conducted from November 2011 through December 2012. Init...

In light of the DEA's recent focus on Florida's prescription drug trafficking problem, we wanted to discuss a former case in which the DEA's actions resulted in a favorable outcome for alleged drug dealers. According to the Daily Journal, in 2004, U.S. District Judge Florence-Marie Cooper dismissed charges against three alleged methamphetamine dealers after an attorney to one of the defendants argued that the informant improperly relied on a "subinformant" to set up drug transactions in order fo...

The U.S. Department of Justice has joined a whistleblower suit filed against Halifax Hospital by the hospital's director of physician services, according to the Daytona Beach News-Journal . The U.S. Department of Justice filed its part of the lawsuit on Friday. It claims that Halifax Health defrauded the federal government by submitting thousands of false claims for Medicare and Medicaid payments worth millions of dollars. By filing, the U.S. Department of Justice hopes to recover millions of do...

Clinics in Kissimmee and Pine Hills are under investigation. A doctor involved with the clinics is accused of over-prescribing painkillers and other addictive medicine, according to the Orlando Sentinel . Drug agents with the Metropolitan Bureau of Investigation collected evidence and talked to patients at the Miracle Health Center/Pine Hills Medical Center, and at the Keneday Medical Clinic. This doctor has had previous complaints filed against him by The Department of Health DOH , and he may n...

From George Indest's Nursing Law Manual Nurses face a busy schedule often including a long list of patients and extensive work hours. As a result, they can become overworked and overtired, which may lead to mistakes when carrying out essential job duties like administering medication. An Institute of Medicine IOM report titled To Err is Human: Building a Safer Health System IOM, Dec. 1999 states the deaths from medication errors that take place both in and out of hospitals, more than 7,000 annua...

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11/11/2011 

Though many nurses pursue a career in nursing hoping that they will never face disciplinary charges, any number of events not in a nurse's control can lead to an investigation or administrative action . Nurses need to make sure they are covered if this ever occurs, with appropriate insurance . The primary reason that a nurse should purchase a professional liability insurance policy is that this type of insurance usually includes coverage for legal defense of licensing and disciplinary action com...

According to ABC News , Scott Tidwell, a former West Texas county attorney, will serve four months in jail and 10 years of probation for retaliating against two nurses . The nurses filed an anonymous complaint to state medical regulators against a doctor who used herbal remedies and hospital supplies to perform at-home procedures. The doctor then ordered a friend, a county sheriff at the time, to investigate the complaint, which resulted in the nurses being fired from their jobs and charged with...

In the recent case of Mendelsohn v. State of Florida Department of Health , Mendelsohn's license to practice medicine was suspended under an Emergency Suspension Order ESO . According to the ESO, Mendelsohn is licensed to practice medicine in Florida pursuant to the provisions of chapter 458, Florida Statutes. On December 9, 2010, he entered a plea of nolo contendere in federal court to a charge of conspiracy to commit fraud upon the United States in violation of 18 U.S.C. § 371. As a resul...

The road to becoming a physician is paved with many unique challenges. The uphill battle begins with rigorous undergraduate course work, followed by the MCAT and medical school applications. Upon acceptance into medical school, you are faced with the USMLE United States Medical Licensing Examination and its STEP 1 and STEP 2 exams. At any of these stages, a student can be accused of numerous faults including cheating, misrepresentation, falsification of information, unfair advantages and the man...

Supervised by the Board of Psychology and the Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, psychologists, Licensed Mental Health Counselors, Clinical Social Workers and Licensed Marriage and Family Therapists are responsible for an important component of patient care: mental health. Insuring the mental health of a patient does not come without risks. For this reason, every mental health professional should carry professional liability insurance that in...

Every health profession has its own set of rules and regulations. This week, we're examining Florida laws under which pain management clinics operate. Because Florida has one of the worst drug trafficking problems in the country, law enforcement is making sure that punishments for any violations are severe. For example, if a patient dies of drug overdose and the prescriber is found to be responsible, he or she can be charged with homicide, which was the case for a Palm Beach County pain manageme...

Another South Florida pill mill was busted by federal agents this month, adding to Florida's increasingly negative reputation as one of the worst drug trafficking states. According to the Miami Herald , 24 people were indicted on charges of defrauding Medicare while distributing oxycodone and oxymorphone across Miami-Dade and Broward counties. These healthcare providers were involved in a distribution network allegedly worth $40 million. Five pain management clinics in Miami, Hialeah and Plantat...

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11/1/2011

October 2011

Drug trafficking charges against a medical doctor are not a new concept, especially in Florida. Recent pill mill busts throughout the state have resulted in an omnipresent DEA, always on the lookout for illegal drug sales by pharmacies, pharmacists, pain management clinics and physicians. However, the recent arrest of a Central Florida doctor extends beyond the run of the mill "pill mill" bust, as the accusations in this case involve sex with a minor and delivering a controlled substance to a mi...

The road to becoming a physician is paved with many unique challenges. The uphill battle begins with rigorous undergraduate course work, followed by the MCAT and medical school applications. Upon acceptance into medical school, the USMLE United States Medical Licensing Examination and its STEP 1 and STEP 2 exams provide another hurdle. At any of these stages, a student can be accused of numerous faults including cheating, misrepresentation, falsification of information, unfair advantages and the...

Although you may speak of a "routine" Medicare audit, there is really no such creature. This is like saying you have a "routine IRS audit." The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited. Having too many claims for level five CPT codes might, for example, cause you to be audited. Having multiple claims submitted for the same date of service, may cause yo...

Criminal charges against a health care professional can have serious consequences. This post will discuss the impact of a criminal charge on a Florida licensed health professional. What is the Effect of a Plea of Nolo Contendere for a Florida Licensed Health Professional? Pursuant to the general chapter of Florida Statutes applicable to all licensed health professionals Chapter 456 , a plea of nolo contendere is treated the same as a plea of guilty for all purposes. Additionally the chapter of F...

The investigation of a complaint which could lead to the revocation of a physician's license to practice medicine and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health DOH . This is a very serious legal matter and it should be treated as such by the physician who receives it. Yet, in many cases, attorneys are consulted by physicians after the entire investigation is over, and they have attempted to represent themselves thro...

Recently, Florida pharmacists, physicians and pain management clinics have received negative attention over frequent Drug Enforcement Administration DEA raids. Now, Florida is once again in the spotlight as the state has launched a drug database in an attempt to reduce drug abuse perpetuated by visits to the doctor. According to the Orlando Sentinel , this database will allow physicians and pharmacists to review a patient's prescription history before issuing prescriptions for painkillers like O...

After a patient privacy breach at Florida Hospital a few weeks ago, another patient records scare has hit Florida - this time at Nemours. According to the Orlando Sentinel , information belonging to Central Florida patients of Nemours Children's Health System has gone missing. Computer back-up tapes containing old patient billing information have disappeared from the Wilmington, Del., office of Nemours. These tapes were not password protected and stored in a locked cabinet. Company officials bel...

Within the last few years, raids on pain management clinics, as well as pharmacies, have been increasingly commonplace. The doctors, pharmacists, nurses and other health care professionals involved are carted away in handcuffs and must defend their practice. According to the St. Petersburg Times , a South Florida pain management clinic has recently been shut down under emergency action by the Florida Department of Health DOH . Several health care professionals at the clinic were arrested, their ...

As a health care provider, keeping patient medical records confidential is a fundamental aspect of the job description. Within those records, the most private details of a person's life are revealed, details, that if leaked, may ruin the reputation of the patient and the health care provider. According to the Orlando Sentinel , Florida Hospital is currently trying to recover from the damaging effects of a breach of its medical electronic records. Three employees were to blame for "inappropriate ...

According to Institute of Medicine statistics , approximately 98,000 Americans die each year as a result of medical errors that could have been prevented. This is an example of 'wrongful death,' a term recognizable to many. However, the term 'wrongful birth' may not provide the same familiarity, but is causing just as much commotion in the legal arena. In 2007, the Tampa Tribune provided details of such a case involving a University of South Florida doctor. This doctor told Daniel and Amara Estr...

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10/12/2011