Did You Lose Your ABIM Board Eligible Credentials?
We have been contacted by numerous physicians who had completed residency programs in internal medicine and only recently discovered that their time has now expired to become board certified. ABIM considers internal medicine and subspecialist physicians who had met the standards for Board Certification in general internal medicine or any subspecialties to be “Board Eligible” in the relevant specialty for seven (7) years.
Recently, many physicians who had previously been board eligible found out that they could no longer apply for the certification exam or become board certified.
The ABIM Changes the Rules.
In July 2012, The American Board of Internal Medicine (“ABIM”) changed its rules regarding the designation of “Board Eligible” and the qualifications to apply for a board certification exam.
The 2012 rule requires physicians who wish to become board certified in internal medicine, or any of the ABIM’s subspecialties, to register for and take the certification exam within seven (7) years of becoming Board Eligible. After seven (7) years, if the physician has not taken and passed the board certification exam, that physician loses their “Board Eligible” status and will not be allowed to take the board certification exam.
Requirements if the Time Limit has Expired.
A physician who is no longer “Board Eligible” because more than seven years has passed can only apply for the ABIM’s certification exams if the physician has:
1. completed one (1) year of retraining in the relevant specialty after the expiration of the physician’s period of Board Eligibility; and
2. the physician has met all other requirements for board certification in effect at that time.
This means that any physician who loses Board Eligibility and has not been board certified will be required to complete a one (1) year residency/fellowship in the applicable field before qualifying for the ABIM’s certification exams. The one (1) year residency/fellowship must be at an ACGME-accredited U.S. training program or an RCPSC-accredited Canadian training program. Additionally, the physician will need to obtain an attestation from the program which states that the physician has demonstrated the requisite competency for unsupervised practice.
Rule Change Limits How Many Times a Physician Can Take the ABIM’s Certification Exams.
In 2011, ABIM implemented a rule that prevents physicians from taking its certification exams more than three (3) times in a row. After a third failed attempt at a certification exam, the physician will be prevented from registering for an exam for a year. This means that if a physician fails a certification exam in 2017, 2018, and 2019, then that physician will be prevented from registering for an ABIM certification exam in 2020 and would have to wait till 2021 to re-apply.
This rule only puts a cap on three (3) failed attempts. If the physician fails twice in a row and then takes a year off, they can still register for an ABIM certification exam the following year. For example, if a physician fails an ABIM certification exam in 2017 and 2018 and then does not register for the 2019 exam, that physician can still register for the 2020 exam.
What Can Be Done to Obtain Authorization to Take Board Certification Exam if Your Time is Up?
What can be done to obtain authorization to take the ABIM board certification exam if your seven years has expired or you have exceeded the number of attempts allowed? We have prepared petitions for physicians who have been unable to take the examinations because of personal hardships or other mitigating factors. Although it is expected that approval of a request for additional time to take the exam or an additional attempt to take the exam may not be successful if sufficient hardship and mitigating facts are shown we expect that the ABIM may grant these requests. There is no guarantee and, as of yet, we have no indication this will work or what percentage may be granted or denied.
For more information, click here to read one of my prior blogs regarding ABIM matters.
Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in investigations and hearings of all types. This includes board certification hearings, medical board hearings, Drug Enforcement Administration (DEA) hearings, Food and Drug Administration (FDA) hearings, medical staff peer review and clinical privileges hearings, FBI Investigations, DOJ Investigations, Drug Enforcement Administration (DEA) investigations, Medicare and Medicaid overpayment demands and hearings, and other types of investigations of health professionals and providers. We also undertake civil litigation in the same types of cases.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law and Achal A. Aggarwal, J.D. Mr. Indest is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: American Board of Internal Medicine (ABIM), legal representation for ABIM investigations, legal representation for ABIM discipline, legal representation for ABIM certification, legal representation for Board representation, legal representation for Board investigations, defense attorney for Board investigations, attorney for Board representation, legal representation for medical students, legal representation for medical residents, legal representation for medical fellows, legal representation for physician employment agreement, physician employment contract attorney, legal representation for physician license revocation, licensure defense attorney, legal representation for health care professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews board certification hearings, medical board hearings, Drug Enforcement Administration (DEA) hearings, Food and Drug Administration (FDA) hearings, medical staff peer review and clinical privileges hearings, FBI Investigations, DOJ Investigations, Drug Enforcement Administration (DEA) investigations, Medicare and Medicaid overpayment demands and hearings, and other types of investigations of health professionals
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm. All rights reserved.
The Biggest Healthcare Fraud Case Ever Prosecuted in 2019: Big Surprise! Florida Wins!
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds. Often joked and written about by Florida novelists such as Carl Hiassin and Tim Dorsey, this case serves to highlight why the “Debtor’s Haven” state often excels in cases of healthcare fraud.
In April 2019, after decades of alleged schemes, illegal kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid, Phillip Esformes was sentenced to 20 years in prison. He was also ordered to pay $44.2 million in money forfeitures and restitution, and forfeiture of his ownership interests in several skilled nursing homes.
A federal district judge sentenced the South Florida health care facility owner after he was found guilty in the largest health care fraud scheme ever charged by the U.S. Justice Department (DOJ).
A Case of “Epic” Fraud.
The nursing home mogul was accused of paying bribes and receiving kickbacks in a massive $1 billion Medicare fraud case touted by federal prosecutors as the largest in the nation. During an eight-week jury trial, prosecutors argued that Esformes himself made $38 million from Medicare and Medicaid payments between 2010 and 2016. Additionally, his South Florida network received more than $450 million through bribes and though services that weren’t medically necessary or which were never provided, according to the prosecution’s case.
To learn more about this case, click here to read one of my prior blogs.
Convicted, But Not of Healthcare Fraud.
The shocker, in this case, is that the federal jury convicted Esformes on 20 counts of conspiracy to defraud the taxpayer-funded Medicare program. The lack of a conviction for healthcare fraud itself was puzzling. Many of his alleged co-conspirators had already pled guilty to health care fraud and some had even testified against him at trial. To learn more, click here to read one of my prior blogs on another individual involved in the case.
Despite being billed as the largest healthcare fraud case prosecuted in U.S. history, it is also a stark reminder to prosecutors of how tricky it can be to secure a conviction on any particular charge.
To read the DOJ’s press release about this case in full, click here.
Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.
The attorneys of The Health Law Firm represent healthcare providers in Medicare and Medicaid audits, and in ZPIC and RAC audits throughout Florida and across the U.S. We also represent health providers in civil and administrative litigation by government agencies and insurance companies attempting to recoup claims that have been paid. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, recovery actions and administrative actions seeking termination from Medicare and Medicaid Programs.
The Health Law Firm’s attorneys routinely represent physicians, dentists, pharmacists, psychotherapists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Weaver, Jay. “Miami healthcare exec Esformes sentenced to 20 years in biggest Medicare fraud case.” Miami Herald. (September 12, 2019). Web.
Hale, Nathan. “The Biggest Stories In Florida Legal News Of 2019.” Law360. (December 20, 2019). Web.
Jackson, David. “Nursing home mogul Philip Esformes sentenced to 20 years for $1.3 billion Medicaid fraud.” Chicago Tribune. (September 13, 2019). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Keywords: Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud defense, Medicare and Medicaid fraud defense legal counsel, Medicare and Medicaid fraud defense lawyer, defense of Medicare and Medicaid fraud charges, CMS, ZPIC and RAC audit defense attorney, CMS, ZPIC and RAC audit defense lawyer, CMS, ZPIC and RAC audit legal representation, Medicaid Fraud Control Unit (MFCU) defense attorney, health care clinic fraud audit, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicaid Fraud Control Unit (MFCU) defense legal counsel, Medicaid Fraud Control Unit (MFCU) subpoena defense attorney, Medicaid Fraud Control Unit (MFCU) subpoena legal representation, Medicaid Fraud Control Unit (MFCU) subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense lawyer, OIG, HHS, DOJ and U.S. Attorney subpoena defense attorney, OIG, HHS, DOJ and U.S. Attorney subpoena legal representation, legal representation for allegations of Medicare fraud, legal representation for health care fraud, healthcare fraud defense attorney, healthcare fraud defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, healthcare fraud defense legal representation, legal representation for submitting false claims, false claims defense lawyer, false claims legal defense representation, false claims defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigation defnse, DOJ defense representation, False Claims Act (FCA) legal defense attorney lawyer, False Claims Act (FCA) defense legal representation counsel, Anti-Kickback Statute (AKS) defense attorney, AKS legal defense representation, AKS defense lawyer
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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Hospital Countersues Whistleblower for Failing to Report Conduct Internally First
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 13, 2019, a West Virginia hospital facing a whistleblower lawsuit countersued a former employee who filed the False Claims Act (FCA) lawsuit against the health system. Wheeling Hospital alleges that the former executive, who is the whistleblower/relator in the lawsuit, breached his fiduciary duty to the company by failing to report the unlawful conduct internally, first. Instead, he used the information as the basis for his whistleblower claim. In the countersuit filed in the U.S. District Court for the Northern District of West Virginia, the Hospital accuses the former executive-turned-whistleblower of attempting to ‘extort a settlement’ and filing the FCA whistleblower suit as an act of revenge.
The Whistleblower’s Complaint.
The whistleblower, a former accountant, and senior executive at Wheeling Hospital, was discharged in August 2015. In December 2017, he filed a complaint under the qui tam provisions of the False Claims Act (FCA). He alleged the hospital violated the federal Anti-Kickback Statute (AKS) by paying kickbacks to physicians for patient referrals to the Hospital. Based on this, it is alleged, the claims for the services the hospital provided to the referred patients were false claims, subject to recoupment by the government.
The Hospital’s Countersuit.
In an unusual strategy, the Hospital filed a counter-suit against the whistleblower, alleging that he breached his fiduciary duty to the Hospital and abused the legal process. The Hospital’s case asserts that instead of carrying out his duty to the Hospital, instead, he capitalized on his alleged knowledge of the conduct to “extort a settlement” through a “false and frivolous” FCA suit as an act of revenge.
Additionally, the Hospital alleges that “at no time during his employment, or in his role as a partner at Deloitte, did he report any suspicions of fraud or violations of federal regulations to Wheeling Hospital’s compliance officer.”
You can read Wheeling Hospital’s countersuit against the whistleblower on our website in full.
The Significance of This Case: Unique Defense Strategy for Defending a Whistleblower Suit.
This case shows a unique, but legally valid, defense strategy that might be used in other future whistleblower cases. Often the information about false claims is produced by a high-ranking hospital or institutional employees whose job duties may have required them to report what they knew to the company as part of their job. The company should then have the opportunity to investigate and correct any improper billing or other misconduct that an errant employee might be carrying out on his own. By failing to do this, the employee may breach his duties to the company, may violate his employment contract, and may be subject to a suit or counter-suit over this. To the extent that the actions of the ex-employee cause the employer damages, the employer may be entitled to indemnification from the ex-employee.
However, the other side of the story is when an employee does make his or her superiors aware of suspected misconduct and false claims within the company and the company does nothing about it. This is often the case that we have when potential blowers contact us about filing a False Claims Act case. Often the whistleblower attempts to do the right thing by reporting it within the company and is stymied by his or her superiors. To us, this opens the door to legitimate whistleblower suits.
To read one of my prior blogs about South Florida Hospital reaching a settlement for similar FCA
claims, click here.
Click here to learn more about who can file a whistleblower/qui tam lawsuit and the reward programs for coming forward with a false claim.
Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.
Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities that have been sued in False Claims Act (whistleblower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Pearlman, Steve and Freeman, Meika. “Top 10 Whistleblowing And Retaliation Events Of The Year.” Law360. (December 20, 2019). Web.
Goldberg, Pinchos. “Hospital Sues Whistleblower for Failing to Report Information And Choosing Instead to Use As Basis for Claim.” JD Supra. (May 8, 2019). Web.
Commins, John. “HOSPITAL COUNTERSUES FALSE CLAIMS WHISTLEBLOWER.” Health Leaders. (May 9, 2019). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Keywords: Florida health law attorney, whistleblower attorney, whistleblower defense lawyer, Florida health law defense attorney, whistleblower defense attorney, whistleblower defense legal counsel, legal representation for whistleblower cases, qui tam lawyer, health law attorney, qui tam defense lawyer, qui tam plaintiff lawyer, whistleblower legal representation, False Claims Act lawyer, False Claims Act attorney, False Claims Act legal counsel, The Health Law Firm, DOJ defense lawyer, Office of Inspector General (OIG) defense counsel, Office of Inspector General (OIG) defense attorney, Office of Inspector General (OIG) legal representation, medcila legal defense attorney, health care fraud attorney, health care fraud lawyer, attorney legal representation for qui tam cases, Anti-Kickback Statute (AKS) attorney, Anti-Kickback Statute (AKS) lawyer, Anti-Kickback Statute (AKS) defense counsel, Medicare fraud defense lawyer attorney, Medicare fraud legal representation, Medicaid fraud defense lawyer attorney, legal representation for Medicare and Medicaid fraud, legal representation for Stark Law violations, healthcare fraud defense attorney, whistle blower lawyer attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida qui tam whistle blower lawyer attorney, Colorado qui tam whistle blower lawyer attorney, Louisiana qui tam whistle blower lawyer attorney, Kentucky qui tam whistle blower lawyer attorney, Virginia qui tam whistle blower lawyer attorney, District of Columbia (D.C.) qui tam whistle blower lawyer attorney, civil monetary penalties lawyer attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer attorney legal counsel, Virginia False Claims Act (FCA) and civil monetary penalties lawyer attorney, Virginia whistleblower lawyer attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer attorney, civil monetary penalties lawyer attorney
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How Can I Be Sure I Don’t Have Employees, Contractors Who Are on Medicare’s Exclusion List?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are often consulted by companies in the health care industry and by health professionals after they receive a subpoena or audit regarding their employing or contracting with an individual or business that is on the Office of the Inspector General’s (OIG’s) List of Excluded Individuals and Entities (LEIE), who are prohibited from contracting with Medicare. This can cause devastating consequences since the law prohibits this by anyone contracting with the government or receiving any payments from any government healthcare program from dealing with these persons. This includes anyone contracting with or receiving payment from Medicare, Medicaid, Tricare, the Veterans Administration, and the military, among others. It can also lead to a demand for repayment of claims for services or products provided, as well as civil monetary penalties, fines, and other adverse actions.
To ensure that you do not violate the federal laws and regulations involved, you should check the OIG’s online LEIE for every new employee or contractor with whom you deal.
Be sure that you also check for any other names (maiden names, married names, fictitious business names) and the names of the officers, directors, shareholders, and owners of any business entities.
This should be on your new employee checklist (kept in the personnel file) and your contracting checklist for new contracts.
If you have not previously done this, have your administrator, human relations (HR) director or contracting officer do this right now and place the results in the personnel file or contracting file for each one checked.
You might also adopt a form similar to this and have it completed by all new employees or contractors as a part of the new employee check-in process. You are still responsible for verifying non-exclusion for all contractors and employees, but this form may help eliminate some problems from the outset and will educate all of your employees and contractors to the requirements.
Visit our website and view an example form.
To learn more about how OIG exclusion can affect you, click here to read of our prior blogs.
Don’t let Medicare or Medicaid exclusion ruin your professional career. Click here to learn how The Health Law Firm and help you if you find yourself on the OIG list.
Contact Health Law Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.
The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: Office of Inspector General (OIG) Medicare exclusion attorney, OIG investigation legal defense representation, OIG exclusion defense attorney, OIG exclusion defense lawyer, Medicare audit defense legal counsel, Office of Inspector General (OIG) Medicare exclusion defense counsel, Medicare audit defense attorney, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, attorney legal representation for OIG notice of intent to exclude, Medicare exclusion hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare administrative law judge hearing defense attorney, Medicare and Medicaid audit defense attorney, legal representation for Medicare and Medicaid audits, Medicare reinstatement attorney, Medicare reinstatement representation, health care fraud defense attorney, legal representation for health care fraud, Centers for Medicare and Medicaid (CMS), legal representation for CMS investigations, health care professional defense attorney, legal representation for health care professionals, legal representation for fraud investigations, reviews for The Health Law Firm, The Health Law Firm attorney reviews, healthcare fraud representation, allegations of healthcare fraud, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, False Claims attorney, FCA lawyer, FCA attorney, representation for submitting False Claims
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020. The Health Law Firm. All rights reserved.
Take this Quick and Easy Quiz to See If You Might Be a “Disruptive Physician”
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
I often have consultations with and represent physicians from across the country who are in trouble with their hospital medical staff or their licensing board because a complaint has been filed against them alleging they are a “disruptive physician.” This is often the result of an alienated member of the nursing staff or even an economic competitor trying to make trouble for or get rid of the physician.
A disruptive physician is one whose “obnoxious” behavior upsets patients or other staff members. The American Medical Association defines this in its Code of Medical Ethics as “personal conduct, whether verbal or physical, that negatively affects or that potentially may affect patient care.” This type of behavior is disfavored in hospitals and health systems because it is thought to negatively affect patient care by decreasing morale, teamwork, collaboration and communication among health professionals.
The Joint Commission Gets Involved.
Starting in 2008 the Joint Commission began urging hospitals to incorporate provisions to rein in disruptive behavior in the hospitals by physicians. The Joint Commission started requiring hospitals in 2009 to have a written code of conduct addressing the issue. This code of conduct must define acceptable, disruptive, and unacceptable behavior in the workplace, the latter two of which are usually lumped together.
Take This Quiz to See if You Are a “Disruptive Physician.”
Having represented physicians in hearings before medical staff peer review committees, resident physicians before academic conduct committees and appeal review committees, and physicians in hearings before the board of medicine, I have put together the following quiz from the types of misconduct such bodies use to denote a “disruptive physician.”
DISRUPTIVE PHYSICIAN QUIZ
Check “Yes” or “No” for each statement or question. Each “Yes” answer counts for one (1) point.
Add up all your “yes” answers above and see where you fall on the following chart:
SCORE
0 to 1 You are not a disruptive physician. You may be dead, however.
2 to 32 You may be a disruptive physician.
Although the quiz above is tongue-in-cheek, all of the questions or statements on it come from actual cases where a physician had to defend himself or herself against charges that they were a “disruptive physician.”
Legal Defenses To Disruptive Physician Charges.
Allegations against a physician for “disruptive behavior” are often vague and impossible to properly defend. It is imperative that if such charges are made against you, you obtain legal counsel who can get involved right away. Such vague, subjective allegations often are relatively easy to defend against, when the true facts are ascertained.
In the case of Fahlen v. Sutter Central Valley Hosp., 58 Cal. 4th 655 (2014), the physician’s hospital clinical privileges were terminated because of a claim of disruptive behavior. The California Supreme Court reversed the hospital’s decision and allowed the physician the right to proceed with a whistleblower case alleging substandard nursing care by the hospital’s nursing staff and the presence of risk to patient safety. In effect, the Court ruled that the doctor was merely a valid whistleblower complaining about quality of care issues. There are similar cases from other jurisdictions.
One can defend such a case by showing that the doctor’s actions are objectively reasonable under the circumstances. Other times you may have a defense you can show because an economic competitor is filing complaints or causing them to be filed against you. Sometimes complaints are generated by hospital staff as a result of a physician’s complaining about incompetent nursing staff or lack of proper equipment. In some cases, we have seen a single nurse generate enough animosity towards a physician so as to have charged with being disruptive.
Read one of my past blogs titled, “Disruptive Physicians: Nobody Likes a Nuisance” to learn more about this topic.
Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: Physician representation, hospital, and medical staff peer review hearings, representation for medical staff fair hearings, medical board representation, Professionals Resource Network (PRN) legal representation, “physician health program” and peer assistance representation, PRN attorney, representation for peer review hearings, disruptive physician representation, disruptive physician defense lawyer, peer review defense attorney, Board of Nursing representation, Board of Pharmacy representation, Board of Medicine representation, Board of Medicine defense lawyer, representation for board matters, healthcare board representation, representation for healthcare professionals, physician defense lawyer, medical license defense, healthcare license defense, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm. All rights reserved.
Taking a Look at 2019’s Largest Healthcare Fraud Case Ever Prosecuted
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
For years, Florida has topped the lists with the highest rates of Medicare and Medicaid fraud and abuse. But even by the standards of Florida’s rampant healthcare fraud, this 2019 case stands out for its sheer size, making Florida, once again, the leader in fakes and frauds. Often joked and written about by Florida novelists such as Carl Hiassin and Tim Dorsey, this case serves to highlight why the “Debtor’s Haven” state often excels in cases of healthcare fraud.
In April 2019, after decades of alleged schemes, illegal kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid, Phillip Esformes was sentenced to 20 years in prison. He was also ordered to pay $44.2 million in money forfeitures and restitution, and forfeiture of his ownership interests in several skilled nursing homes.
A federal district judge sentenced the South Florida health care facility owner after he was found guilty in the largest health care fraud scheme ever charged by the U.S. Justice Department (DOJ).
A Case of “Epic” Fraud.
The nursing home mogul was accused of paying bribes and receiving kickbacks in a massive $1 billion Medicare fraud case touted by federal prosecutors as the largest in the nation. During an eight-week jury trial, prosecutors argued that Esformes himself made $38 million from Medicare and Medicaid payments between 2010 and 2016. Additionally, his South Florida network received more than $450 million through bribes and though services that weren’t medically necessary or which were never provided, according to the prosecution’s case.
To learn more about this case, click here to read one of my prior blogs.
Convicted, But Not of Healthcare Fraud.
The shocker, in this case, is that the federal jury convicted Esformes on 20 counts of conspiracy to defraud the taxpayer-funded Medicare program. The lack of a conviction for healthcare fraud itself was puzzling. Many of his alleged co-conspirators had already pled guilty to health care fraud and some had even testified against him at trial. To learn more, click here to read one of my prior blogs on another individual involved in the case.
Despite being billed as the largest healthcare fraud case prosecuted in U.S. history, it is also a stark reminder to prosecutors of how tricky it can be to secure a conviction on any particular charge.
To read the DOJ’s press release about this case in full, click here.
Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.
The attorneys of The Health Law Firm represent healthcare providers in Medicare and Medicaid audits, and in ZPIC and RAC audits throughout Florida and across the U.S. We also represent health providers in civil and administrative litigation by government agencies and insurance companies attempting to recoup claims that have been paid. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, recovery actions and administrative actions seeking termination from Medicare and Medicaid Programs.
The Health Law Firm’s attorneys routinely represent physicians, dentists, pharmacists, psychotherapists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Weaver, Jay. “Miami healthcare exec Esformes sentenced to 20 years in biggest Medicare fraud case.” Miami Herald. (September 12, 2019). Web.
Hale, Nathan. “The Biggest Stories In Florida Legal News Of 2019.” Law360. (December 20, 2019). Web.
Jackson, David. “Nursing home mogul Philip Esformes sentenced to 20 years for $1.3 billion Medicaid fraud.” Chicago Tribune. (September 13, 2019). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019/2020 The Health Law Firm. All rights reserved.
Florida DOH Issues Emergency Rules for Medical Marijuana Treatment Centers
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Effective December 10, 2019, emergency rules for the regulation of medical marijuana treatment centers (MMTCs) were issued by the Florida Department of Health (DOH). Also issued were notices of proposed rules to provide further regulation for background screening and renewal applications.
Emergency Rules.
In Florida, emergency rules may be adopted if an administrative agency finds there is an immediate danger to the public health, safety, or welfare. Such rules are effective for 90 days while an agency undertakes the formal rulemaking process. Agency rulemaking is subject to challenge under Florida’s Administrative Procedures Act (APA), which allows those who have a substantial interest in the prosed rules to challenge them. This means implementation could be delayed.
Rule 64ER19-7, Florida Administrative Code–Background Screenings for MMTCs.
The new Florida administrative rule, Rule 64ER19-7 of the Florida Administrative Code (FAC) requires MMTCs to ensure that all employees, owners, and managers of an MMTC pass a background screening check before being allowed to serve in such a role at the MMTC. The rule also includes extensive background and record-keeping requirements for MMTCs.
Under the rule, MMTCs have an ongoing obligation to report certain arrests of any employee, owner, or manager to DOH within 48 hours of becoming aware of the arrest. MMTCs failing to meet these requirements will be subject to discipline. Click here to view the rule in full.
Rule 64ER19-8–Renewal Applications for MMTCs.
The second rule, 64ER19-8, FAC, concerns renewal applications for MMTCs. Each MMTC is required to submit a renewal application, along with a renewal fee. Those initially licensed between July 31, 2017, and October 31, 2017, must submit a renewal application. The renewal application must be received no later than February 28, 2020. After submission of these applications, the renewals are then biennial.
All other MMTCs shall submit a renewal application biennially, which must be received by the DOH at least 30 days, but not more than 60 days before the license expires. Renewal applications that are not received by the DOH on or before the deadline will not be considered. It is crucial that all MMTCs be aware of these deadlines, calendar these deadlines and be sure there is an action taken on such renewals. Click here to view the rule in full.
For more information and to view the complete list of proposed rules and rule development, visit the Florida DOH website here.
To stay on top of medical marijuana legislation in Florida, read my prior blog here and be sure to visit our Marijuana Law Blog regularly.
Contact Experienced Health Law Attorneys for Medical and Recreational Marijuana Concerns.
The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists, and pharmacies, wanting to participate in the medical marijuana industry. We can properly help to complete and submit the applications for renewals, registration, permitting and/or licensing, complying with Florida law. We also represent health facilities, health clinics, and pharmacies facing proceedings brought by state regulators or agencies.
To contact The Health Law Firm please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Stanfield, Timothy. “Florida’s Department of Health/Office of Medical Marijuana Use Issues Emergency Rules and Notices of Rulemaking.” National Law Review. (January 8, 2020). Web.
Newlon, Amanda. “Client Alert: Florida Issues Emergency Rules and Notice of Rulemaking for MMTCs.” JD Supra. (January 22, 2020). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm. All rights reserved.
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