The Administrative Process to Challenge OIG Exclusion Actions
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.
The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation. Below are the steps in the process you must follow to protect your career and your livelihood.
How to Challenge OIG Exclusion Actions.
1. Notice of Intent (NOI) received: If the OIG is proposing to exclude a person or entity from Medicare, it will send out a letter called a “Notice of Intent” or “NOI.” This will contain the reasons for the exclusion and will detail hearing or appeal rights. It is very important to make sure that your state licensing board and Medicare have your correct current address on file because the address which Medicare has will be where the NOI is mailed. (Note: the OIG may not send a NOI for mandatory exclusions which carry a 5-year minimum exclusion period.) You will not have a second chance. Regardless, you usually only have 30 days to submit a written response requesting a hearing and containing information the OIG will consider in making its decision. In some cases, providers may have the opportunity to present oral arguments before OIG officials. You must make sure that your request is received by the deadline, not just mailed by the deadline. Send your request by a fast, reliable means (such as Federal Express or U.S. express mail) that you can track; or register for and file it electronically online. Read the instructions in the letter and follow them. Be sure you get a receipt when you file.
2. Notice of Exclusion (NOE): Sometimes the OIG will send a “Notice of Exclusion” or “NOE” if it decides to exclude a provider regardless of the response provided to a NOI or in certain cases of mandatory exclusions or certain permissive exclusions where no NOI is ever sent. Medicare exclusions usually take effect 20 days after the NOE is mailed. In cases involving fraud, kickbacks and other prohibited activities, a Notice of Proposal to Exclude or NOPE may be sent instead.
3. Administrative Law Judge (ALJ) Hearing: Providers have the right to appeal a proposed exclusion by requesting an administrative hearing (similar to a trial) before an “Administrative Law Judge” or “ALJ.” ALJ’s are part of the Department of Health and Human Services (HHS). If you wish to request an ALJ hearing, you must do so within 60 days of receiving the Notice of Exclusion (or according to the instructions), and you must be prepared to raise all of your arguments over issues regarding the decision itself, the proposed exclusion period, mitigating factors or other aspects of the action.
4. Department Appeals Board (DAB): If you disagree with the ALJ hearing decision, you can further appeal to the HHS “Departmental Appeals Board” or “DAB.” This is a written appeal which will be required to set forth legal errors which were made in the ALJ hearing.
5. Judicial Review: If you disagree with the decision made by the DAB, your only option is to challenge the final decision in a U.S. District Court.
MOST IMPORTANT, consult a health law attorney experienced in such matters. The consequences of Medicare exclusion, even a permissive exclusion for one year or three years, are severe. Most people do not realize this until it is too late; then it is too late (in many, but not all, cases).
To learn more about the consequences of OIG exclusion, click here to read one of my prior blogs.
Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program.
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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., 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, 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.
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Florida’s Prescription Drug Importation Plan Continues to Gain Support
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 12, 2019, the Florida House of Representatives’ Health Quality Subcommittee voted 15 to 2 to approve House Bill 19 (HB 19) that would implement one of Florida Gov. Ron DeSantis’ recently announced health care proposals. In February 2019, the new Florida governor, who was criticized for not having a health care platform while he campaigned, announced the proposal that Florida start importing drugs from Canada.
HB 19 -Prescription Drug Importation Programs.
HB 19 was created for the purpose of safely importing cost-effective prescription drugs from Canada and other foreign nations under specified conditions. The proposed program would go into effect on July 1, 2019.
HB 19 provides eligibility criteria for prescription drugs and program participants; provides distribution requirements; provides annual reporting requirements; provides application and permitting requirements for certain participating entities; and provides that implementation of International Prescription Drug Importation Program is contingent on federal arrangement or obtaining federal guidance. Click here for more information on HB 19.
Two Programs, One Goal – Lowering Prescription Drug Prices.
The program will offer access to FDA-approved prescription drugs imported from Canada, allowing the drugs to be sold to Floridians at a much lower cost than they could otherwise purchase them here. “One of the biggest drivers of this country’s out of control healthcare spending is the cost of prescription drugs,” said Governor DeSantis.
According to the bill, the U.S. spends 30 to 190% more than other developed countries on prescription drugs, and up to 174% more for the exact same for prescription drugs. The proposed bill aims to lower these unnecessary high costs by establishing two different drug importation programs.
The first program would allow the state to import prescription drugs from Canada for use by the Florida Medicaid Program and prison health care system. It would be known as the Canadian Drug Importation Program. It would be run by the Florida Agency for Health Care Administration (AHCA).
The second program would be known as the International Drug Importation Program. It would be run by the Florida Department of Business and Professional Regulation and would be available to individual residents.
Despite gaining house support, both programs would still need approval from the federal government before they could be implemented in Florida.
To learn more about Gov. DeSantis’ proposal, click here to read his press release.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.
The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Sexton, Christine. “DeSantis prescription drug savings plan gets early House support.” Orlando Sentinel. (March 12, 2019). Web.
News Service of Florida. “DeSantis Drug Importation Plan Wins House Support.” Sunshine State News. (March 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., 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.
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Former UCLA Phlebotomist Awarded Nearly $1.6 Million in Harassment Suit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 7, 2019, a jury awarded almost $1.6 million to a woman who alleged she was fired for complaining about coworker’s subjecting her to racial insults and discriminatory comments at her job. Nicole Birden claimed that UCLA Medical Center, Santa Monica, failed to investigate when supervisors harassed and insulted her and several other African-American employees. Additionally, she alleged that she was fired from her job as a phlebotomist after raising concerns about the issue, according to the verdict filed in Los Angeles Superior Court.
Alleged Hostile Work Environment.
According to Birdnne’s complaint, she began working at UCLA Medical Center Santa Monica, as a phlebotomist in 2015. Shortly after, she claims coworkers made disparaging remarks about the color of her skin and racially stereotyped her in Spanish. In June of 2016, the UC Board of Regents abruptly terminated her employment despite the fact that she had never previously received any kind of disciplinary action against her.
Following her termination she filed a complaint in 2017, alleging that the UCLA Health created a hostile work environment. Additionally, she alleges that the University of California Board of Regents violated California’s Fair Employment and Housing Act for harassment, race and age discrimination, and retaliation, according to the complaint.
To read the verdict for this case in full, click here.
Click here to read one of my prior blogs that also deals with discrimination in the workplace.
Contact Health Attorneys Experienced in Health Law and Employment Law.
The Health Law Firm represents both employers and employees in the health care industry in defending allegations of employment discrimination and other complaints from employees and patients. We represent employers and employees in unemployment compensation hearings, in defending against EEOC (discrimination) complaints, and in defending litigation involving wage and hour disputes, as well as other types of contract or employment litigation. We also can investigate such allegations and attempt to negotiate settlements where warranted. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.
To contact The Health Law Firm please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
“UC Regents to Pay $1.5 Million in Hostile Work Environment Case.” Associated Press. (August 7, 2019). Web.
Stawiki. Kevin. “Ex-UCLA Blood Tech Wins $1.6M In Racial Harassment Suit.” Law360. (August 7, 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., 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 The Health Law Firm. All rights reserved.
Here Are Some Common Sense Tips for Taking Your USMLE Step Exams and Scoring Higher
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Here are some common-sense tips you should be sure you follow that may help you to reduce stress and score higher when you take your United States Medical Licensing Examination (USMLE) Step examinations. You should be doing everything within your control to minimize your stress and the risk of being late for the examination. Again, these are common sense and if you have taken a lot of standardized examinations, you may already be aware of these.
1. Do not plan on driving to the test site from your home the morning of the examination even if you leave in the same city as the testing center.
a. Unexpected car problems could occur.
b. Traffic backups and delays always occur.
c. Accidents always happen.
d. Road problems, construction delays, and detours are common.
Eliminate these unnecessary risks.
2. Find the hotel closest to the testing center and stay there the night before the test. Hopefully, this will be within walking distance of the test site if it is necessary to walk there.
3. Read all of the applicable testing procedures, the applicable USMLE and/or Educational Commission for Foreign Medical Graduates ( ECFMG) Handbook, Guidelines and Procedures again the day before the examination you are taking. You signed an agreement to be bound by these and you are expected to know these for the examination. Be sure you understand how scheduled and unscheduled breaks work, how the time is accounted and what you are allowed to do and prohibited from doing on breaks.
4. Make sure you know ahead of time exactly how much time you will be given for each part of the examination and for breaks, Be sure you have calculated how much time you have for each question on each section of the examination, answer within the times you have calculated and move on through the examination in a timely manner.
5. Do not let other occurrences and disturbances in the testing center upset you or distract you.
6. If some extremely disruptive event occurs, for example, fire alarms and evacuations taking place, other examination takers having seizures and being removed by paramedics, etc., consider leaving and taking an incomplete on this examination. Be sure to ask the test center monitors/proctors to file an incident report on what occurred at the test center, Then, within 24 hours, write to the USMLE and ECFMG and advise the organization of exactly what happened and why you had to leave.
7. Bring your own lunch, snacks, and beverages, including something like energy bars or chocolate bars, to provide needed sustenance. Do not leave the testing center for lunch unless you absolutely have to, and then, stay local and on foot. Do not take the risk of driving someplace and back.
8. If a certain testing center has a bad reputation for being a poor testing site or having frequent computer failures, schedule to take the test at a site in another city or state. Travel there and stay at a hotel within walking distance of the test site, perhaps a few days before the examination date. You can then use the additional time and isolation for additional studying and test preparation.
9. Do not refer to or use any cell phone, tablet or personal device while the test is still underway. Be sure you are familiar with all test-taking procedures.
10. To avoid any risks of misunderstandings, do not write down anything during the examination or about the examination at the testing center. Outside during lunch, may be okay; otherwise, wait till you get back home.
Although common sense, you would be surprised at how many test-takers violate these common-sense tips and then suffer from the consequences.
Plan for and have as stress-free of an examination as you can. Control the controllable.
For more helpful tips and to learn more about examples of “Irregular Behavior,” click here to read my prior blog.
Additionally, click here to view one of our blogs on our experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”
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 fo 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 in 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 (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
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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 The Health Law Firm. All rights reserved.
Steps to Challenge OIG Exclusion Action from Medicare Program
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.
The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation. Below are the steps in the process you must follow to protect your career and your livelihood.
The Administrative Process to Challenge OIG Exclusion Actions.
1. Notice of Intent (NOI) received: If the OIG is proposing to exclude a person or entity from Medicare, it will send out a letter called a “Notice of Intent” or “NOI.” This will contain the reasons for the exclusion and will detail hearing or appeal rights. It is very important to make sure that your state licensing board and Medicare have your correct current address on file because the address which Medicare has will be where the NOI is mailed. (Note: the OIG may not send a NOI for mandatory exclusions which carry a 5-year minimum exclusion period.) You will not have a second chance. Regardless, you usually only have 30 days to submit a written response requesting a hearing and containing information the OIG will consider in making its decision. In some cases, providers may have the opportunity to present oral arguments before OIG officials. You must make sure that your request is received by the deadline, not just mailed by the deadline. Send your request by a fast, reliable means (such as Federal Express or U.S. express mail) that you can track; or register for and file it electronically online. Read the instructions in the letter and follow them. Be sure you get a receipt when you file.
2. Notice of Exclusion (NOE): Sometimes the OIG will send a “Notice of Exclusion” or “NOE” if it decides to exclude a provider regardless of the response provided to a NOI or in certain cases of mandatory exclusions or certain permissive exclusions where no NOI is ever sent. Medicare exclusions usually take effect 20 days after the NOE is mailed. In cases involving fraud, kickbacks and other prohibited activities, a Notice of Proposal to Exclude or NOPE may be sent instead.
3. Administrative Law Judge (ALJ) Hearing: Providers have the right to appeal a proposed exclusion by requesting an administrative hearing (similar to a trial) before an “Administrative Law Judge” or “ALJ.” ALJ’s are part of the Department of Health and Human Services (HHS). If you wish to request an ALJ hearing, you must do so within 60 days of receiving the Notice of Exclusion (or according to the instructions), and you must be prepared to raise all of your arguments over issues regarding the decision itself, the proposed exclusion period, mitigating factors or other aspects of the action.
4. Department Appeals Board (DAB): If you disagree with the ALJ hearing decision, you can further appeal to the HHS “Departmental Appeals Board” or “DAB.” This is a written appeal which will be required to set forth legal errors which were made in the ALJ hearing.
5. Judicial Review: If you disagree with the decision made by the DAB, your only option is to challenge the final decision in a U.S. District Court.
MOST IMPORTANT, consult a health law attorney experienced in such matters. The consequences of Medicare exclusion, even a permissive exclusion for one year or three years, are severe. Most people do not realize this until it is too late; then it is too late (in many, but not all, cases).
To learn more about the consequences of OIG exclusion, click here to read one of my prior blogs.
Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program.
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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., 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 The Health Law Firm. All rights reserved.
Neurosurgeon Keeps $17.5 Million Award, Despite Arrest for Soliciting Prostitute
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On June 25, 2019, a Washington state appeals court sided with an arbitrator’s decision to award $17.5 million to a neurosurgeon who was fired after he didn’t disclose his arrest for soliciting prostitute.
Swedish Health Services had appealed the original arbitration ruling, arguing that the neurosurgeon violated the terms of his employment contract when he failed to notify the employer that he had been arrested in a prostitution sting. However, according to the reports, the neurosurgeon claimed that in 2017 Swedish Health Services actually fired him after he complained of the practices of a different doctor. The arbitral ruled in favor of the neurosurgeon and made the monetary award. Click here to read more.
Swedish Health Services argued that the arbitrator unfairly limited how much it could cross-examine the fired neurosurgeon about his “illicit behaviors” before he was fired. However, the court rejected arguments that Swedish Health Services didn’t get a fair shake at the arbitration hearing. The court affirmed that his sexual activities were irrelevant to the claims about the cause of the termination.
To read the court’s opinion in full, click here.
Click here to read one of my prior blogs about a wrongful termination case involving a health care facility and a former employee and whistleblower.
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,
Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical
centers, pain management clinics, nursing homes, and any other healthcare provider. We represent
facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.
The lawyers of The Health Law Firm are experienced in both formal and informal administrative
hearings and in representing physicians in investigations and at Board of Medicine and Board of
Osteopathic Medicine hearings. We represent physicians accused of wrongdoing, in patient complaints and in Department of Health investigations.
To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.ThehealthLawFirm.com.
Sources:
Lidgett, Adam. “Doc Who Solicited Prostitute Sees $17.5M Arbitral Win Upheld.” Law360. (June 25, 2019). Web.
Baker, Mike. “Judge confirms $17.5M award for fired Swedish Health neurosurgeon.” Seattle Times. (October 23, 2017). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: Representation for health care professionals, legal representation for alternative dispute resolution (ADRS) proceedings, legal representation for arbitration for health providers, physician arbitration mediation legal counsel, physician mediation-arbitration attorney, legal representation for mediation-arbitration for health providers, complex health care litigation attorney, complex medical litigation legal counsel, complex medical business litigation attorney, physician employment legal representation, physician employment attorney, physician employment dispute lawyer, wrongful termination of health professionals legal representation, medical employment contract lawyer, medical employment contact representation, breach of physician employment contract lawyer, breach of physician contract representation, representation for healthcare whistleblowers, whistleblower defense lawyer, qui tam defense lawyer, representation for qui tam cases, The Health Law Firm reviews, reviews of The Health Law Firm
“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 The Health Law Firm. All rights reserved.
New Changes to Florida’s Certificate of Need Law Eliminate CONs for Hospitals
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On June 3, 2019, Tallahassee healthcare regulators began the complex process of reshaping the state’s certificate of need (CON) program. Florida regulators are moving ahead to eliminate the certificate of need program for hospitals and to focus it on nursing homes, hospices, and institutions for individuals with developmental disabilities.
The Proposed Changes to the CON Laws.
In May 2019, the Florida Legislature eliminated certificate of need program requirements for general acute care hospitals and tertiary services. The new law keeps CON requirements for specialty hospitals in place only until July 1, 2021. Click here to read more.
Rules being proposed to implement the legislative changes would maintain the four review cycles but split them into two different categories. One category would deal with applications for hospital facilities and hospices. The other category would be dedicated to nursing homes and intermediate-care facilities for individuals with disabilities.
Florida’s Certificate of Needs Programs.
Opponents of the CON program argue that it limits the ability to create new healthcare services and to build new facilities (in other words, “competition is good”). Advocates for CONs have argued that geographic areas where hospital and other health facilities are overbuilt can actually lead to increased healthcare costs and reduced services (in other words, “competition is bad”).
Critics of CONs argue that they limit the free market and, because CONs stifle competition, lead to increased costs. They have long argued that the requirements to maintain CONs can be shifted from certificates of need to simple licensing requirements.
To read my prior blog dealing with a certificate of needs case, click here.
Consult With A Health Law Attorney Experienced in the Representation Health Care Professionals.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in academic disputes, contract negotiations, license applications, board certification applications, credential hearings and civil and administrative litigations and hearings. We also have experience in representation for health care investigations by the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS).
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Sexton, Christine. “Florida regulators float new rules in hospital wars.” Sun-Sentinel. (July 5, 2019). Web.
“State Regulators Float New Rules in Hospital War Battles.” Law.com. (July 6, 2019). Web.
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, 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.
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