Florida Dentist’s COVID-19 Business Interruption Insurance Claim Dismissed
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 3, 2020, a Florida federal judge dismissed a suit for business interruption insurance payments by a Florida dentist. The dentist claimed he sustained damages caused by the COVID-19 pandemic and related civil authority shutdowns of dental services. The dismissal freed Allied Insurance Company of America from having to pay the dentist’s for COVID-19 related losses, holding that the policy’s “virus exclusion” barred coverage of the insurance claim made.
Insurance Coverage for COVID-19 Related Losses.
The dentist sued his insurance carrier for damages that he argued were “caused by or result[ing] from a Covered Cause of Loss.” The causes of the alleged loss, he maintained, included the COVID-19 virus’s impact on his dental practice and the Florida governor’s emergency declaration that limited dental services during a period of time. Specifically, he claimed that he incurred costs to decontaminate his dental office and lost valuable income because of the governor’s dental services limitation. The dentist alleged that Allied breached the insurance contract by denying coverage in April.
Allied’s insurance policy provides coverage “for direct physical loss or damage to covered property at the [plaintiff’s] premises” that is “caused by or result[s] from any Covered Cause of Loss.” Allied argued that there was no direct physical loss or damage to covered property at the clinic due to appointment cancellations or the closure of the dental practice.
Dismissal of the Law Suit.
U.S. District Court Judge John Badalamenti, for the Middle District of Florida, dismissed the case. He found that the dental practice’s loss or damage asserted was “not due to a covered cause of loss.” More importantly, he found that the policy contained an exclusion for loss or damage caused “directly or indirectly,” by “[a]ny virus, bacterium or other microorganisms that induces or is capable of inducing physical distress, illness or disease.”
According to the judge’s order, in order for the insurer to provide coverage, losses from business suspension must be caused by direct physical loss or damage. He ruled that the dentist failed to demonstrate what the policy required in order to be a covered loss. To read the order in full, click here.
With such a specific exclusion as this policy contained, it was difficult for the judge in the case to rule any other way.
Litigation on Whether Insurance Policies Should Cover Losses Due to Coronavirus Closures.
This recent Florida dismissal is another in a string of cases where insurers have prevailed in Coronavirus business loss cases, because of similar exclusions in their policies. In a similar case, a Michigan federal judge sided with the insurance company saying it didn’t have to cover a chiropractic office’s COVID-19 claimed losses. Like the case above, the judge said the business failed to allege physical loss and, therefore, the policy’s virus exclusion barred coverage. Click here to read the judge’s order in this case.
According to insurance experts and regulators, most businesses and professionals will probably find it difficult to obtain an insurance payout because of policy changes made after the 2002-2003 SARS outbreak. SARS, which infected 8,000 people, led to millions of dollars in business-interruption insurance claims. As a result, many insurers added exclusions to standard commercial policies for virus losses. The added policy language potentially allows insurance companies to avoid hundreds of billions of dollars in business-interruption claims because of the Covid-19 pandemic.
Since a wide-scale virus outbreak is such a rare event, most policy purchasers overlooked this exception. There certainly wasn’t any concerted effort to make insureds aware of the exclusion nor to offer them the opportunity to purchase specific virus outbreak insurance coverage.
A global pandemic presents unique problems for insurance companies. After the SARS outbreak at the beginning of this millennium, many insurance companies realized they would not be able to cover such a broad-scale event causing massive losses. Such an event could have damages greater than those sustained in the largest hurricane to strike the U.S. The insurance industry argued to state regulators that such policy exclusions were necessary, considering the overwhelming number of claims that might arise from a single disease outbreak.
This foresight on the part of the insurance companies saved their shareholders billions, if not trillions, of dollars. Unfortunately business and professionals have had to shoulder the losses.
So, it begs the question: Did insurers actually know the potential damage a viral pandemic could wreak on businesses and, therefore, purposefully exclude coverage? Disputes over the precise wording of business insurance policies will most likely continue to generate court battles like those discussed above.
Read my prior blog on this subject to learn more.
Recommendation for the Future.
There are several options that businesses and state insurance regulators should consider to try to prevent such massive losses from going uncompensated in the future.
First would be to create and provide virus damage insurance similar to that provided for flood insurance by the National Flood Insurance Program (NFIP). The biggest problem would be that losses could easily exceed the largest hurricane that one could imagine. However, the NFIP has shown this type of plan works.
Second would be similar programs provided at the state level. At the present time, many states, have captive insurance companies to fund losses from wind damage caused by storms. In Florida, the Citizens Property Insurance Corporation (CPIC) provides such coverage.
The biggest problem I see with both of the above is that short-sighted and selfish people don’t want to purchase such insurance and, thereby, make it less expensive for all involved. They figure that the government will bail them out anyway in such an event, so why should they pay. Therefore, either making it paid for completely with taxpayer money or a requirement of obtaining a business license or professional license or some combination, may be a way to finance it.
Creating a trust fund with assessments to employers and employees, similar to what is currently done for social security, would be another option. Creating a large trust fund that could cover such tragic events might work best. However, this would have to be made “raider safe” so that Congress does not come back and raid these funds and use them for other purposes like it has done to the United States Postal Service (USPS).
At the very least, some type of universal virus pandemic business loss insurance should be mandated by law or, at least, partially funded by the government. Making it mandatory means making it cheaper and making it work.
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.ThehealthLawFirm.com
Sources:
Zhang, Daphne. “Fla. Dentist’s Bid For COVID-19 Loss Coverage Axed.” Law360. (September 3, 2020). Web.
Zhang, Daphne. “State Farm Needn’t Cover Chiropractor’s COVID-19 Losses.” Law360. (September 3, 2020). Web.
Frankel, Todd. “Insurers knew the damage a viral pandemic could wreak on businesses. So they excluded coverage.” The Washington Post. (April 2, 2020). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.
KeyWords: healthcare employment law representation, legal representation for physicians, doctor defense legal representation, legal representation for healthcare professionals, complex health care litigation attorney, complex civil litigation attorney, complex healthcare litigation lawyer, complex medical litigation lawyer, representation for complex medical litigation, representation for healthcare business litigation matters, business insurance representation, business interruption insurance claims defense, COVID-19 business insurance claim representation, The Health Law Firm, reviews of The Health Law Firm Attorneys, The Health Law Firm attorney reviews, legal representation for physicians and health care professionals, attorney for physician suits against insurers, complex medical business litigation against health insurers
“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.
OSHA Issues Series of Citations for COVID-19-Related PPE Violations
By Carole C. Schriefer, J.D.
On September 14, 2020, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a citation against a healthcare system in Louisiana. Christus Shreveport-Bossier Health System is facing fines for failing to safeguard its employees with the appropriate personal protective equipment (PPE) during the coronavirus pandemic. OSHA has proposed $13,494 in penalties, the maximum allowed by law.
OSHA’s Investigation for COVID-19 Exposure Risk.
After receiving reports of employee exposure, OSHA opened a coronavirus–related investigation. The agency found that the health system violated workplace safety protocols and put employees at risk of COVID-19 exposure.
In a press release, OSHA stated, “emergency facility employees often shared used protective gowns or did not have protective gowns to wear while treating patients.” Click here to read the press release in full.
Christus Health had 15 business days from receipt of the citation and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings. In a statement, Katy Kiser, a spokesperson for Christus Health, said, “We are actively contesting the citation and the penalty. We have worked hard to secure the PPE we have needed to get us through many phases of the pandemic and maintain a local contingency supply of at least ten days. To date, we have experienced no gaps in PPE supply during pandemic response.”
COVID-19 Citations for Several Different Health Systems.
After receiving criticism that it was not adequately investigating COVID-19 complaints, OSHA announced it would ramp up enforcement. As a result, the agency said it would also issue fines against New Jersey-based Bergen New Bridge Medical Center and Hackensack Meridian Health. The two healthcare systems were cited for failing to provide appropriately fit respirator masks to its home healthcare employees. Additionally, after providing respirators, they didn’t provide adequate training and compliant medical evaluations.
Click here for more on this story.
To read OSHA’s Enforcement Response Plan for Coronavirus Disease memo that was released in May, 2020, click here. For additional resources, visit OSHA’s COVID-19 response page on their website here.
Click here to read one of our recent blogs on this topic and learn more.
Health Care Providers Can and Should File Complaints with OSHA for Workplace Violations.
What these cases show is that health professionals whose employers fail to provide proper safety equipment, PPE, and other job-related protections, can file OSHA complaints. OSHA’s main purpose for existing is to protect employees from unsafe working environments. Although the fines OSHA assesses may be small, if the employer is fined, this may provide the basis for a workers compensation claim, a law suit, a union complaint or all of three of these.
Furthermore, if the employer retaliates against the employee for filing an OSHA complaint, then the employee has a valid cause of action against the employer, regardless of any other rights, under OSHA’s “whistle blower protection” provisions.
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.
To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com
Sources:
Campbell, Braden. “OSHA Ramps Up Physical Inspections, COVID Case Reporting.” Law360. (May 19, 2020). Web.
Kutner, Max. “OSHA Fines La. Health System Over COVID-19 Violations.” (September 14, 2020). Web.
Shinkman, Ron. “OSHA fines 3 hospital systems for PPE violations.” Healthcare Dive. (September 15, 2020). Web.
About the Author: Carole C. Schriefer is an attorney and former registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456 or Toll-Free: (888) 331-6620. Its main office is in the Orlando, Florida area.
KeyWords: Health law defense lawyer, legal representation of health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Department of Health defense attorney, healthcare employment law representation, legal representation for physicians, nurse defense lawyer, nursing complaint defense attorneys, board of nursing defense attorney, nurse defense legal representation, legal representation for healthcare professionals, complex health care litigation attorney, complex civil litigation attorney, complex healthcare litigation lawyer, complex medical litigation lawyer, representation for complex medical litigation, representation for healthcare business litigation matters, representation for administrative hearing, representation for Department of Health (DOH) representation, DORA defense attorney, DOH defense attorney, representation for DOH hearings, representation for DOH investigations, representation for disciplinary charges, representation for disciplinary complaint
“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.
OSHA Issues Citations to Health Care Systems Over COVID-19 PPE Violations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 14, 2020, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a citation against a healthcare system in Louisiana. Christus Shreveport-Bossier Health System is facing fines for failing to safeguard its employees with the appropriate personal protective equipment (PPE) during the coronavirus pandemic. OSHA has proposed $13,494 in penalties, the maximum allowed by law.
OSHA’s Coronavirus-related Investigation.
After receiving reports of employee exposure, OSHA opened a coronavirus–related investigation. The agency found that the health system violated workplace safety protocols and put employees at risk of COVID-19 exposure.
In a press release, OSHA stated, “emergency facility employees often shared used protective gowns or did not have protective gowns to wear while treating patients.” Click here to read the press release in full.
Christus Health had 15 business days from receipt of the citation and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings. In a statement, Katy Kiser, a spokesperson for Christus Health, said, “We are actively contesting the citation and the penalty. We have worked hard to secure the PPE we have needed to get us through many phases of the pandemic and maintain a local contingency supply of at least ten days. To date, we have experienced no gaps in PPE supply during pandemic response.”
A Series of COVID-19 Citations for Different Health Systems.
After receiving criticism that it was not adequately investigating COVID-19 complaints, OSHA announced it would ramp up enforcement. As a result, the agency said it would also issue fines against New Jersey-based Bergen New Bridge Medical Center and Hackensack Meridian Health. The two healthcare systems were cited for failing to provide appropriately fit respirator masks to its home healthcare employees. Additionally, after providing respirators, they didn’t provide adequate training and compliant medical evaluations.
Click here for more on this story.
To read OSHA’s Enforcement Response Plan for Coronavirus Disease memo that was released in May 2020, click here. For additional resources, visit OSHA’s COVID-19 response page on their website here.
Click here to read one of our recent blogs on this topic and learn more.
Health Providers Can and Should File Complaints with OSHA.
What these cases show is that health professionals whose employers fail to provide proper safety equipment, PPE, and other job-related protections, can file OSHA complaints. OSHA’s main purpose for existing is to protect employees from unsafe working environments. Although the fines OSHA assesses may be small, if the employer is fined, this may provide the basis for a workers compensation claim, a lawsuit, a union complaint, or all of three of these.
Furthermore, if the employer retaliates against the employee for filing an OSHA complaint, then the employee has a valid cause of action against the employer, regardless of any other rights, under OSHA’s “whistleblower protection” provisions.
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.
To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com
Sources:
Campbell, Braden. “OSHA Ramps Up Physical Inspections, COVID Case Reporting.” Law360. (May 19, 2020). Web.
Kutner, Max. “OSHA Fines La. Health System Over COVID-19 Violations.” (September 14, 2020). Web.
Shinkman, Ron. “OSHA fines 3 hospital systems for PPE violations.” Healthcare Dive. (September 15, 2020). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.
KeyWords: nurse defense lawyer, nursing complaint defense attorneys, board of nursing defense attorney, Health law defense lawyer, legal representation of health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Department of Health defense attorney, healthcare employment law representation, legal representation for physicians, nurse defense legal representation, legal representation for healthcare professionals, complex health care litigation attorney, complex civil litigation attorney, complex healthcare litigation lawyer, complex medical litigation lawyer, representation for complex medical litigation, representation for healthcare business litigation matters, representation for administrative hearing, representation for Department of Health (DOH) representation, DORA defense attorney, DOH defense attorney, representation for DOH hearings, representation for DOH investigations, representation for disciplinary charges, representation for disciplinary complaint
“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.
What Foreign Medical Graduates Need to Know Before Transferring Medical Schools
By Achal A. Aggarwal, M.B.A., J.D., and George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law
When medical school graduates who graduated from a medical school outside of the United States want to practice medicine in the United States, they register with the Educational Commission for Foreign Medical Graduates (“ECFMG”). The ECFMG issues certificates to foreign medical graduates to register for and take the United States Medical Licensing Examination (“USMLE”) Step exams. Medical graduates must take and pass all of the USMLE Step exams to practice medicine in the United States.
Guidelines for Medical School Transfers.
The ECFMG has several rules and procedures regarding a foreign medical graduate’s transfer between medical schools. Foreign medical graduates should keep up-to-date on these rules to not jeopardize their chances of becoming doctors in the United States.
Suppose a foreign medical graduate transferred credits to the medical school that awarded or will award their medical degree. In that case, the foreign medical graduate must disclose and document those credits when they apply to ECFMG for examination. This must be done regardless of when the credits were earned. For example, a student attends a medical school for one year and earns credits for 12 courses. The student transfers to another medical school, which accepts the credits for those 12 courses toward meeting its degree requirements. The credits for those 12 courses are then referred to as transfer credits.
Additionally, for ECFMG Certification, credits that are transferred to the medical school that awarded or will award your medical degree must meet all of the following criteria:
1. All credits must have been transferred from a medical school that is either:
A. located in the United States or Canada and listed in the World Directory of Medical Schools, or
B. listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements.
2. Credits must be for courses passed at the medical school at which the course was taken.
3. Credits may only be transferred from one medical school to the medical school that awards the final degree. This means that if a foreign medical graduate transfers medical schools more than once, the credits they obtained from their first medical school will not qualify for ECFMG certification.
What Happens If You Don’t Follow the Proper Procedures?
Suppose the foreign medical graduate’s transferred credits do not comply with these criteria. In that case, the foreign medical graduate will not meet the requirements to be registered by the ECFMG for examination, nor will the foreign medical graduate be certified by the ECFMG.
However, if a foreign medical graduate’s transferred credits do not meet all of the criteria listed above, they can request an exception from the ECFMG Medical Education Credentials Committee. We recommend that you find a Health Care Attorney Experienced in these matters. Click here to learn more and view a prior blog on this topic.
Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG)
The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”
To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 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; he is the President and Managing Partner of The Health Law Firm, and Achal A. Aggarwal, M.B.A., J.D. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com. The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Tolle-Free: (888) 331-6620.
KeyWords: Irregular behavior defense lawyer, irregular conduct legal representation, graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing
“The Health Law Firm” is a registered fictitious business name 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.
Woman Posing as Nurse For Six Years Sentenced to Prison For Health Care Fraud, Identity Theft, and Wire Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 23, 2020, a Tennessee woman who posed as a nurse working at several medical facilities was sentenced to more than four years in prison. In December 2019, she pled guilty to wire fraud, healthcare fraud, identity theft, and practicing nursing without a license.
How a Phony Nurse Gained Employment.
According to a news release from the U.S. Attorney’s Office, the woman posed as a registered nurse, despite not having a nursing degree or a nursing license, and having no nursing experience. To accomplish the fraud, she obtained the license numbers of real nurses with similar first names. She admitted to providing fraudulent information on job applications to gain employment. She was employed by at least eight different health care providers between September 2012 and November 2018. She also falsely claimed that she held nursing degrees from two educational institutions, Walters State College and Carson Newman University.
This is a long time, six years, to get away with health fraud. Usually, we only see things like this in Florida. However, in the past few years, Florida seems to be seeing fewer and fewer fake doctors, nurses, and health professionals. Perhaps the crackdown by the Florida Department of Health on the unlicensed practice of health professions has had some impact on this.
Continuing Lies & Fraudulent Behavior.
While posing as a nurse, the fake R.N. worked in various medical settings, including nursing homes, rehabilitation and assisted living facilities, a doctor’s office, and home health agencies. She rendered nursing care to numerous patients, dispensed prescription medications, and gained access to patients’ sensitive and private medical information, the U.S. Attorney’s Office said. Furthermore, the woman made false entries in patients’ medical records and submitted or caused the submission of at least $500,000 in false claims to public and private health care benefit programs.
The phony nurse performed procedures that she was, of course, unqualified to perform. She failed to act or to notify others of the necessary procedures for patients and failed to chart and document patient care. According to the written plea agreement, at least one patient required re-admittance to the hospital and an additional three-day hospital stay due to her inept care.
The Tennessee Bureau of Investigation Director David Rausch is quoted in the media as having stated: “Our Medicaid Fraud Control Division remains committed to working with our federal partners to ensure healthcare fraud and identity theft cases like this one are addressed and investigated thoroughly.”
Judge Clifton L. Corker of the U.S. District Court for the Eastern District of Tennessee sentenced her to 51 months in prison, followed by three years of supervised release. She was also ordered to repay $700,000 in restitution to her employers.
To read the DOJ’s press release about this case in full, click here.
To read about a similar case in Florida, click here to view one of my prior blogs.
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 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 (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
“Morristown woman posed as nurse for 6 years at 8 health care providers.” ABC 6 Local News. (December 12, 2019). Web.
Starks, Ariel. “Fake nurse sentenced to 51 months in prison, ordered to repay employers $700,000.” WVLT 8 Local News. (September 23, 2020). Web.
Bonvissuto, Kimberly. “Nurse imposter who worked in assisted living sentenced for wire fraud, healthcare fraud, identity theft.” McKnight’s Senior Living. (September 25, 2020). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
KeyWords: nursing license defense attorney, legal representation for nursing license defense, legal representation for board of nursing complaints and investigations, unlicensed practice of medicine defense attorney, unlicensed practice of nursing defense lawyer, Department of Health defense attorney, DORA investigation defense lawyer, legal representation for DOH or DORA investigations, DOJ defense lawyer, legal representation for DOJ investigations, legal representation for nurses, health law attorney, nursing law attorney, health care fraud defense attorney, legal representation for health care fraud, legal representation for health care fraud investigations, health care fraud investigation representation, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation representation, Medicare fraud defense lawyer, Medicaid fraud defense attorney, representation for Medicare and Medicaid fraud, representation for false billing, representation for submitting false claims, False Claims Act (FCA) defense attorney, FCA legal representation, FCA investigation representation, representation for FCA investigations, review of The Health Law Firm attorneys, The Health Law Firm reviews, Medicaid Fraud Control Unit (MFCU) defense attorney
“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.
Judge Dismisses Florida Dentist’s COVID-19 Business Interruption Insurance Claim
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 3, 2020, a Florida federal judge dismissed a suit for business interruption insurance payments by a Florida dentist. The dentist claimed he sustained damages caused by the COVID-19 pandemic and related civil authority shutdowns of dental services. The dismissal freed Allied Insurance Company of America from having to pay the dentist’s for COVID-19 related losses, holding that the policy’s “virus exclusion” barred coverage of the insurance claim made.
Insurance Coverage for COVID-19 Related Losses.
The dentist sued his insurance carrier for damages that he argued were “caused by or result[ing] from a Covered Cause of Loss.” The causes of the alleged loss, he maintained, included the COVID-19 virus’s impact on his dental practice and the Florida governor’s emergency declaration that limited dental services during a period of time. Specifically, he claimed that he incurred costs to decontaminate his dental office and lost valuable income because of the governor’s dental services limitation. The dentist alleged that Allied breached the insurance contract by denying coverage in April.
Allied’s insurance policy provides coverage “for direct physical loss or damage to covered property at the [plaintiff’s] premises” that is “caused by or result[s] from any Covered Cause of Loss.” Allied argued that there was no direct physical loss or damage to covered property at the clinic due to appointment cancellations or the closure of the dental practice.
Dismissal of the Law Suit.
U.S. District Court Judge John Badalamenti, for the Middle District of Florida, dismissed the case. He found that the dental practice’s loss or damage asserted was “not due to a covered cause of loss.” More importantly, he found that the policy contained an exclusion for loss or damage caused “directly or indirectly,” by “[a]ny virus, bacterium or other microorganisms that induces or is capable of inducing physical distress, illness or disease.”
According to the judge’s order, in order for the insurer to provide coverage, losses from business suspension must be caused by direct physical loss or damage. He ruled that the dentist failed to demonstrate what the policy required in order to be a covered loss. To read the order in full, click here.
With such a specific exclusion as this policy contained, it was difficult for the judge in the case to rule any other way.
Litigation on Whether Insurance Policies Should Cover Losses Due to Coronavirus Closures.
This recent Florida dismissal is another in a string of cases where insurers have prevailed in Coronavirus business loss cases, because of similar exclusions in their policies. In a similar case, a Michigan federal judge sided with the insurance company saying it didn’t have to cover a chiropractic office’s COVID-19 claimed losses. Like the case above, the judge said the business failed to allege physical loss and, therefore, the policy’s virus exclusion barred coverage. Click here to read the judge’s order in this case.
According to insurance experts and regulators, most businesses and professionals will probably find it difficult to obtain an insurance payout because of policy changes made after the 2002-2003 SARS outbreak. SARS, which infected 8,000 people, led to millions of dollars in business-interruption insurance claims. As a result, many insurers added exclusions to standard commercial policies for virus losses. The added policy language potentially allows insurance companies to avoid hundreds of billions of dollars in business-interruption claims because of the Covid-19 pandemic.
Since a wide-scale virus outbreak is such a rare event, most policy purchasers overlooked this exception. There certainly wasn’t any concerted effort to make insureds aware of the exclusion nor to offer them the opportunity to purchase specific virus outbreak insurance coverage.
A global pandemic presents unique problems for insurance companies. After the SARS outbreak at the beginning of this millennium, many insurance companies realized they would not be able to cover such a broad-scale event causing massive losses. Such an event could have damages greater than those sustained in the largest hurricane to strike the U.S. The insurance industry argued to state regulators that such policy exclusions were necessary, considering the overwhelming number of claims that might arise from a single disease outbreak.
This foresight on the part of the insurance companies saved their shareholders billions, if not trillions, of dollars. Unfortunately business and professionals have had to shoulder the losses.
So, it begs the question: Did insurers actually know the potential damage a viral pandemic could wreak on businesses and, therefore, purposefully exclude coverage? Disputes over the precise wording of business insurance policies will most likely continue to generate court battles like those discussed above.
Read my prior blog on this subject to learn more.
Recommendation for the Future.
There are several options that businesses and state insurance regulators should consider to try to prevent such massive losses from going uncompensated in the future.
First would be to create and provide virus damage insurance similar to that provided for flood insurance by the National Flood Insurance Program (NFIP). The biggest problem would be that losses could easily exceed the largest hurricane that one could imagine. However, the NFIP has shown this type of plan works.
Second would be similar programs provided at the state level. At the present time, many states, have captive insurance companies to fund losses from wind damage caused by storms. In Florida, the Citizens Property Insurance Corporation (CPIC) provides such coverage.
The biggest problem I see with both of the above is that short-sighted and selfish people don’t want to purchase such insurance and, thereby, make it less expensive for all involved. They figure that the government will bail them out anyway in such an event, so why should they pay. Therefore, either making it paid for completely with taxpayer money or a requirement of obtaining a business license or professional license or some combination, may be a way to finance it.
Creating a trust fund with assessments to employers and employees, similar to what is currently done for social security, would be another option. Creating a large trust fund that could cover such tragic events might work best. However, this would have to be made “raider safe” so that Congress does not come back and raid these funds and use them for other purposes like it has done to the United States Postal Service (USPS).
At the very least, some type of universal virus pandemic business loss insurance should be mandated by law or, at least, partially funded by the government. Making it mandatory means making it cheaper and making it work.
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.ThehealthLawFirm.com
Sources:
Zhang, Daphne. “Fla. Dentist’s Bid For COVID-19 Loss Coverage Axed.” Law360. (September 3, 2020). Web.
Zhang, Daphne. “State Farm Needn’t Cover Chiropractor’s COVID-19 Losses.” Law360. (September 3, 2020). Web.
Frankel, Todd. “Insurers knew the damage a viral pandemic could wreak on businesses. So they excluded coverage.” The Washington Post. (April 2, 2020). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.
KeyWords: healthcare employment law representation, legal representation for physicians, doctor defense legal representation, legal representation for healthcare professionals, complex health care litigation attorney, complex civil litigation attorney, complex healthcare litigation lawyer, complex medical litigation lawyer, representation for complex medical litigation, representation for healthcare business litigation matters, business insurance representation, business interruption insurance claims defense, COVID-19 business insurance claim representation, The Health Law Firm, reviews of The Health Law Firm Attorneys, The Health Law Firm attorney reviews, legal representation for physicians and health care professionals, attorney for physician suits against insurers, complex medical business litigation against health insurers
“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.
Florida Senate Passes New Legislature to Fix Patient Brokering Act
By Amanda I. Forbes, J.D.
A new act (SB 1120) was recently passed by the Florida Senate and enacted on June 18, 2020, with an effective date of July 1, 2020. SB1120 restored the Florida Patient Brokering Act to its original wording to correct a big glitch made when the Legislature previously amended it. On June 27, 2019, there was an amendment enacted by the Florida Legislature that changed the Florida Patient Brokering Act, Section 817.505, Florida Statutes. It became effective on July 1, 2019. The amendment changed Section 817.505(3)(a), Florida Statutes.
The original wording of the statute stated:
(3) This section shall not apply to the following payment practices:
(a) Any discount, payment, waiver of payment,
or payment practice not prohibited
by 42 U.S.C. s. 1320a-7b(b) or
regulations promulgated thereunder.”
Section 817.503(3)(a). (Emphasis added).
The new amendment to the Florida Patient Brokering Act stated:
(3) This section shall not apply to the following payment practices:
(a) Any discount, payment, waiver of
payment, or payment practice expressly
authorized by” 42 U.S.C. s. 1320a-7b(b)(3) or
regulations adopted thereunder.”
Section 817.505(3)(a). (Emphasis added)
This Federal law exemption had previously been relied on to avoid the Florida statute’s criminal prohibitions, particularly, by health law attorneys advising their clients on proposed business ventures. The most immediate problem with the amendment was that there are no “discounts, payments waivers of payment or payment practices” that are “specifically approved” by the federal statute.
Rather than provide clarification, the amendment only created confusion. The Federal Anti-Kickback Statute (42 U.S.C. Section 1320a-7b(b)) does not “expressly authorize” any exception or safe harbor. The amended language caused confusion regarding whether an arrangement must qualify for safe harbor protection under the Federal anti-kickback statute in order to be legal under Florida law. Therefore, the amendment went from a state law that was similar to and cohesive with the federal statute to one which was much stricter than the federal law and prohibited many current business arrangements.
When there is no safe harbor, the arrangement is evaluated by its intent. The Florida Fourth District Court of Appeal recently confirmed that the Patient Brokering Act is a “general intent” statute. This means that an individual only needs to intend to commit the act prohibited by the statute (e.g. paying for referrals), as opposed to intending to specifically violate the Patient Brokering Act. See State v. Kigar, 279 So. 3d 217 (Fla. 4th DCA 2019)
The bill (SB1120) was passed by the Florida Senate and enacted on June 19, 2020, with an effective date of July 1, 2020. SB1120 restored the Florida Patient Brokering Act to its original wording.
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.
To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com
About the Author: Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com. The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or toll-free: (888) 331-6620.
KeyWords: Representation for healthcare professionals, representation for healthcare compliance, representation for healthcare facilities, healthcare facility defense lawyer, healthcare compliance defense attorney, healthcare license defense attorney, Complex Healthcare Litigation, complex healthcare litigation defense lawyer, Complex Business Litigation, Complex Commercial Litigation, Class Action Litigation, medical regulatory defense lawyer, 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.
