Thinking About Contacting the PRN or IPN Programs? Read This First!
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Physicians, dentists, nurses, and other health professionals, accused of wrongdoing, may be referred to or receive recommendations from colleagues to refer themselves to the Professionals Resource Network (PRN) or the Intervention Project for Nurses (IPN). This is often done by someone who has little to no knowledge about these programs or what they require. An individual who does this may find himself or herself in a situation that they rapidly come to regret.
Both programs have done some wonderful things. They have saved the lives and careers of many health professionals who have issues with drugs and alcohol, or who suffer from mental illnesses. However, often a person may be accused of being an addict, alcoholic, serious substance abuser or having an uncontrolled mental illness when nothing is further from the truth. Then these programs may not be right for that individual.
Often we find that a physician may be referred to PRN if he or she is suspected of excess drinking if alcohol is smelled on that person’s breath, if the physician is suspected of using drugs, or if he/she exhibits behavior that is now being labeled as “disruptive.” To read a previous blog I have written about those accused of being “disruptive physicians,” click here.
Nurses are routinely instructed that they “must” report to IPN when there is some discrepancy in the narcotics count at a hospital or nursing home, someone makes an anonymous complaint (even a false one) about the nurse or the nurse is suspected (even wrongly) of diverting drugs. We have found that some hospitals and nursing homes routinely do this to their nurses without any consideration of whether the person is innocent.
Many health professionals are advised by their colleagues that they should falsely claim they are alcoholics or addicts to get into PRN or IPN to avoid disciplinary action against their licenses. For those afflicted with a serious substance abuse problem or a mental illness, this may be correct. However, if it is not the case, this advice is egregiously wrong.
PRN and IPN Are Not the “Easy Way Out.”
These organizations may be lifesavers for those who actually need them but may seem like punishment to those who do not. Either way, these programs are not the “easy way out” of legal problems.
For an example of one physician’s reported experiences with such a program, click here.
Although these articles are dated, we were recently contacted by a physician who disclosed a similar anecdote as reported in these articles.
If you are accused of wrongdoing, violating your practice act, or if you are threatened with being reported to the Department of Health (DOH) or your professional board, especially if you are being falsely accused, then it is much better to defend yourself and fight such charges instead of trying to “take the easy way out.”
Speak with an Attorney Immediately, at the Beginning and Prior to Making Any Decisions or Calls.
You should obtain information on the facts and alternatives immediately when accused and prior to making any such decision, calling anyone, or speaking with any investigator. Contact our firm to speak with an attorney who can provide information to you on your options.
Click here to read my prior blog on impaired practitioner programs and learn more valuable information.
You Must Carry Insurance Which Covers the Legal Fees For Defending a Complaint Against Your License.
We always recommend that all health professionals carry insurance that covers their attorney’s fees and their legal defense expenses when they are accused of an offense that may affect their licenses. Most physicians and dentists already have insurance that covers this. Nurses can buy insurance that covers this for less than ten dollars ($10) a month (note: available from Nurses Service Organization (NSO), CPH & Associates and other carriers). Other health professionals such as pharmacists, psychologists, mental health counselors, massage therapists, respiratory therapists, aids and technicians should either pay extra for such coverage on their existing policies or should buy a separate policy which covers this (note: available from Healthcare Providers Service Organization (HPSO), Lloyd’s of London and other carriers). The absolute minimum coverage you should have for this purpose is $25,000; if you don’t have this much coverage for professional license defense, purchase more.
Remember This Is My Opinion.
What I say in this blog is my opinion. There are those who may disagree with it. If so, tough! It is my experience as an attorney with more than 33 years of experience, and I’m sticking by it.
Contact Experienced Health Law Attorneys in Matters Involving PRN or IPN.
The Health Law Firm’s attorneys routinely represent physicians, dentists, nurses and other health professionals in matters involving PRN or IPN. Our attorneys also represent health providers in Department of Health investigations, before professional boards, in licensing matters, and in administrative hearings.
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: Legal representation for impaired physicians, legal representation for Department of Health (DOH) investigations, Intervention Project for Nurses (IPN) defense attorney, Professionals Resource Network (PRN) defense legal counsel, DOH investigation defense attorney, legal representation for investigations against health care professionals, legal representation for Florida DOH investigations, Florida DOH representation, DOH complaint defense, legal representation for DOH complaint, Florida impaired practitioners program, legal representation for PRN matters, legal representation for IPN matters, legal representation for disruptive physician issues, health law defense attorney, legal representation for health care professionals, changes to Florida impaired practitioners program, legal representation for health care investigations, The Health Law Firm reviews, reviews of The Health Law Firm attorneys
“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.
Need Last Minute Deposition or Hearing Representation? Call The Health Law Firm
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Our office often takes phone calls from pharmacies and pharmacists needing short-notice representation at a Board of Pharmacy hearing or at a deposition related to a health care matter.
In our experience, many other law firms refuse to represent clients at hearings unless the firm is given plenty of advance notice. We always prefer to have sufficient time to obtain documents, review files, interview witnesses, conduct research and prepare, in order to provide the best possible representation to our client. However, we realize that in certain cases, the alternative is that the client either gets legal representation on little or no advance notice or has to suffer the consequences of having no legal representation.
Administrative Proceedings Can be Complex.
In some cases, individuals may be fooled into believing that they can effectively represent themselves. They later find out that they have gotten in over their heads. Laypersons (meaning, in this case, nonlawyers) who are not aware of such complex matters as the Administrative Procedure Act, the Rules of Civil Procedure, the Rules of Evidence, the Florida Administrative Code (F.A.C.) Rules which the Board of Pharmacy and the Department of Health (DOH) have enacted, may quickly be confused.
The inexperienced individual, or even the inexperienced attorney, in these matters, can fall into a number of procedural traps that damage an effective defense. This can be advising the individual to talk to the DOH investigator, filing an unnecessary answer to an Administrative Complaint, forgetting or not knowing that the client’s right to be free of self-incrimination applies in this type of case and many, many others.
Procedural Mistakes Can Be Damaging To Your Legal Defense.
Often you will find that merely having an experienced attorney to represent you at a hearing or Board meeting will assist you in avoiding mistakes that damage your case and assist you in preserving your rights for an appeal. In other cases, it may even be possible to obtain a change in the forum to obtain a better result. For example, many laypersons do not know that if you elect an informal hearing before the Board of Pharmacy, you have waived your right to prove you are innocent by contesting the facts alleged against you.
What few know or think of in the heat of the moment is that you can ask at the informal hearing before the Board of Pharmacy to contest the facts, to prove you are not guilty of the charges, and to have the hearing converted to a formal hearing. A formal hearing will be in front of a neutral Administrative Law Judge (ALJ), and you have a great many more procedural rights than you have at an informal hearing. However, we still recommend that you have an experienced health lawyer represent you at a formal hearing.
Professional Liability Insurance May Pay Legal Fees for Deposition Coverage.
If you are a pharmacist or pharmacy that has professional liability insurance, these often provide legal coverage for depositions. This is primarily because the outcome of the deposition may include having you named as a defendant in a professional liability or negligence lawsuit or having disciplinary charges filed against you.
One of the first things you should do if you receive a subpoena or a notice of a deposition is to contact your professional liability insurance carrier and see if it will pay for an attorney to represent you. For example, Healthcare Providers Service Organization (HPSO), CPH & Associates, Nurses Service Organization (NSO), Dentists Advantage and many other malpractice insurance companies provide excellent deposition coverage.
The second thing you should do is to call an experienced attorney and schedule a consultation. Even if you cannot afford to retain the services of the attorney for the actual deposition, a consultation may assist you in properly preparing. Click here to read our blog on this matter and learn more.
Consult With A Health Law Attorney Experienced in the Representation of Pharmacists and Pharmacies.
We routinely provide deposition coverage to pharmacists, pharmacies and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.
The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing physicians, physician assistants and other health professionals in investigations and at Board of Pharmacy hearings. Call now or visit our website 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: Florida Board of Pharmacy, Legal Defense for Pharmacists, Pharmacist, Pharmacy and tagged Administrative Law Judge, administrative procedure act, administrative proceeding, ALJ, Board of Pharmacy, Board of Pharmacy hearing, defense attorney, defense lawyer, Department of Health, deposition coverage, disciplinary charges, disciplinary complaint, FAC, final hearing, Florida Administrative Code, formal hearing, health law firm, health professional, hearing representation, Informal hearing, last-minute deposition coverage, legal representation, legal representation for pharmacist, legal representation for pharmacy, local deposition coverage, negligence lawsuit, noticed of a deposition, pharmacist, pharmacy, professional liability insurance, rights for an appeal, Rules of Civil Procedure, Rules of Evidence, short notice of representation of pharmacy, short notice representation of pharmacist, subpoena, 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.
Common Errors We See in Pharmacy Inspections and How to Avoid Them
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm
Pharmacies and pharmacists are subject to many types of inspections. These inspections are necessary to determine whether the business and its employees are complying with state and federal laws and regulations. Administrative agencies, such as the Drug Enforcement Administration (DEA), Food and Drug Administration (FDA) and the Department of Health (DOH), have the authority to inspect pharmacies.
Inspections may be routine and simply to confirm compliance with the law. Annual inspections by the Florida DOH are examples of these. However, inspections can also be triggered by a fear of imminent danger to the public health, safety, and welfare; a formal complaint; or the belief that a specific violation of law by the pharmacy or pharmacist has occurred or may occur.
Common Errors Found During Inspections.
With our experience working with pharmacists and pharmacies we’ve seen a number of different inspection deficiencies. These errors may result in a complaint being filed and the beginning of the administrative law process regarding investigations and hearings.
Here are some common deficiencies often found during pharmacy inspections:
1. Pharmacy technicians not properly identified with name tags and identified as
pharmacy technicians (as opposed to pharmacists);2. Pharmacy technicians not supervised by pharmacist;
3. Medication on shelves not properly labeled (including exact number of pills remaining in bottle);
4. Controlled substances not accurately recorded on appropriate forms;
5. Not keeping schedule II inventory and dispensing records separate from schedule III-V records;
6. Failure to maintain a biennial inventory;
7. Controlled substance records (including invoices, inventories and logs) not properly maintained for required number of years;
8. Not having an accurate count for all controlled substances on hand;
9. Required DEA forms not maintained, accurate or complete;
10. Inadequate security measures (cameras, alarms, etc.);
11. Failure to control access to secured areas;
12. Proper pre-hire screenings not in place (background checks, references, etc.);
13. Proper computer security measures not in place;
14. Not properly identifying suspect controlled substance prescriptions;
15. No corrective measures in place to ensure legitimacy of a controlled substance
prescription;16. Not knowing the requirements for filling a legitimate controlled substance
prescription;17. Refrigerator not being maintained at the appropriate temperature; and
18. Food or other non medications (e.g., lab samples) being kept in refrigerator with medications.
Be Aware: All Pharmacies Are Subject to Inspections.
We are constantly writing blogs on pharmacies that, after inspections, get served with immediate suspension orders (ISO), emergency suspension orders (ESO), or have their controlled substance registrations revoked. This is not happening to just the smaller independent stores, but to the big chain pharmacies as well.
In a prior case, the DEA revoked the controlled substance licenses from two CVS pharmacies in Sanford, Florida. (Click here to read that blog.) This is why it is imperative for all pharmacies and pharmacists to know the state and federal laws and regulations.
Your Best Defense.
In our opinion, your best defenses are the following:
1. Know the laws and rules and be sure they are fully implemented and followed, always, by everyone in the store.2. Maintain good professional liability insurance that includes coverage for legal defense of administrative complaints and complaints against your pharmacy license and your pharmacist license. Cover should be at least $25,000 for legal defense expenses at the very minimum. Contact Lloyd’s of London or Healthcare Providers Service Organization (HPSO) if your agent can’t locate this insurance for you.3. Contract with a good pharmacy consultant and have him/her make frequent visits and “mock investigations.”
Talk to an Experienced Attorney Before You Talk to an Investigator.
In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to DOH investigators, DEA special agents, police officers, sheriffs’ deputies or criminal investigators of any type. Our advice is to always contact an experienced health law attorney before making a statement to an investigator. Click here to read a previous blog on the best practice tips for dealing with investigators.
Never voluntary relinquish your DEA registration or your pharmacy license without speaking to an experienced health law attorney first. Click here to read a blog on why this is so important.
Contact Health Law Attorneys Experienced with Investigations of Pharmacies and Pharmacists.
The attorneys of The Health Law Firm provide legal representation to pharmacies, pharmacists 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 (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. 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.
Carole C. Schriefer is an attorney with 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 Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
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12 Tips on Protecting Your Rights and Defending Yourself Against Irregular Behavior Charges from the USMLE
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
If you are one of those unlucky individuals who have been accused of irregular behavior by the United States Medical Licensing Examination (USMLE) Secretariat, then it is extremely important for you to know this information.
USMLE hearings on irregular behavior are almost always held in Philadelphia, Pennsylvania, before a large committee the committee on individual review or “CIR,” appointed to hear such cases. The committee is composed of medical school professors, doctors, medical school administrators, members of various medical specialty associations, and others. The hearings are held in one of the conference rooms of the National Board of Medical Examiners (NBME) Building in Philadelphia.
We routinely represent medical students and graduates who have taken the USMLE Step exams and have later been accused of irregular behavior. This includes hearings, appeals and other legal matters involving the Step Exams, credentials, responding to inquiries about the misconduct of school officials and related matters.
What is Irregular Behavior?
Irregular behavior can include many different types of action. We have seen cases in which someone set the test center building on fire in order to have the test (which was ongoing) canceled with irregular behavior because they wrote on their hand or their arm or ankle during the examination. We have seen individuals charged with irregular behavior because they had handwriting on the bottom of a flip flop or a sheet of toilet paper; we have seen individuals charged with irregular behavior because they used their iPhone during a break or they were not still in medical school on the day the Step exam was given. We have seen those charged with irregular behavior for altering their test scores on their test transcripts, even though they received a passing grade and because they posted “Me too” on a website where someone had asked if anyone had copies of “The Houston Cases” or wanted them.
We have seen those charged with irregular behavior because they posted information on an Internet website that the USMLE thought was too similar to actual test materials. We have seen individuals charged because they used forged documents to obtain access to the test or to apply to monitor’s instructions at the test center. We have seen individuals charged with irregular behavior for sending forged test scores to their medical school. We have seen applicants charged with irregular behavior for not following the monitor’s directions at the test center. We have represented test-takers who were accused of irregular behavior because their test answers were too “statistically similar” to those of another test taker who took the test at a different location and date.
We have represented medical students charged with irregular behavior because they had completed their USMLE applications incorrectly, using the information that their medical school officials had told them to place on the forms. We have represented medical school students charged with irregular behavior because their medical schools had placed the wrong information on their cation forms (note: later the medical school itself was found to have been guilty of irregular behavior by the organization.)
However, allegations of irregular behavior can usually be easily overcome with an explanation of the truth. It is up to you (and us, if you hire us) to present the truth as to what really happened and why it happened.
Although it is our best advice that you retain the services of an experienced health lawyer, specifically one experienced in dealing with the USMLE and in representing applicants in USMLEor
Tips for Preparing for a Hearing Before the Committee on Individual Review of the USMLE.
Following are several of the most important tips we can present on how to best prepare for a hearing before the Committee on Individual Review of charges of Irregular Behavior.
1. Be sure to request a complete copy of the USMLE’s file and work case, including any investigation, incident reports, videos, or other materials, before you file a response, in writing.
2. Be sure that you file your statement, explanation, or other appropriate documents (depending on the facts and circumstances of your case) prior to the deadline given in the initial letter to you. Document its transmission to and receipt by the USMLE.
3. If you need an extension of time, request this in writing prior to the expiration of the deadline given to you in the original letter. Do this in writing and keep a copy.
4. Be sure that you request in writing a hearing and to appear in person at the hearing prior to the deadline given in the initial letter to you. (Note: if are already going to appear at the same hearing meeting, we can give you a discount from our normal legal fees for this representation. Ask about this.)
5. If you are unable to appear in person at the hearing in Philadelphia, Pennsylvania, on the date provided in the initial letter, ask that your hearing be postponed until the next available date, and provide good, sufficient reasons why you are unable to attend on the original date given.
6. Be very careful and deliberate about what you state in writing. Any statement you make should be well-organized, professionally prepared, and supported by adequate, relevant, affidavits and documents. This is another reason why you should have an attorney preparing and submitting this for you.
7. In some cases, we recommend hiring an expert to review the case and provide us an expert affidavit to submit. This may be the case when confronted with charges based on statistical analysis, computer systems issue, testing procedures, questionable documents, or other technical matters.
8. Your statement and presentation should directly address the allegations made against you. You are strongly encouraged to review the blog I previously wrote on preparing professional correspondence here.
9. Never lie or submit any false information or documents. The USMLE will thoroughly investigate any suspicious or questionable facts or materials you submit. This can extend to the use of private investigators to locate and interview witnesses, forged documents, or questioned document examiners to analyze documents submitted, and other such methods. Submitting any false information can lead to vastly more severe actions against you.
10. Get prepared for your hearing. Think about and rehearse what you will say. You will be under a lot of stress, in front of about 20 people, most of whom will be asking questions to you. If you are not ready for this, it will be to your detriment.
11. Expect the usual questions. But then, also expect the unusual questions that you may be asked. Plan for what questions may be asked by the Committee members. We always prepare our clients to testify and to be prepared to answer various questions that we know are likely to be asked.
12. Remember that you will be in an unusual, stressful, situation, one which you have probably never experienced before. Plan for this. Obtain as much information about the situation as you can. If you are not used to attending contentious hearings and being cross-examined and interrogated (which 99.9% of doctors are not), then you need to have an experienced attorney sitting next to you.
These are important matters that will affect your future career as a physician. Consider how much in time you have spent and how much in tuition, fees and student loans you have incurred to get this far. Is it smart to scrimp at this point in time and take the cheap way out by either trying to represent yourself or finding a cheap, inexperienced attorney to represent you?
Click here to read one of my prior blogs on the consequences of 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 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 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
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 © 2019 The Health Law Firm. All rights reserved.
Compounding Pharmacy Agrees to Pay $21 Million to End FCA Kickback Suit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 19, 2019, a Florida compounding pharmacy reached a $21.4 million settlement with the U.S. Department of Justice (DOJ) in the Southern District of Florida to resolve claims they orchestrated a $70 million kickback scheme. Diabetic Care Rx LLC, which does business as Patient Care America, and private equity firm Riordan Lewis & Haden Inc. agreed to pay to bring the False Claims Act (FCA) lawsuit to a close.
According to the DOJ, the Florida pharmacy, two executives and the private equity firm schemed to recruit beneficiaries of Tricare for medically unnecessary prescriptions such as expensive pain creams.
Details of the Case.
The DOJ claimed PCA used marketers to help recruit beneficiaries of Tricare. They allegedly paid kickbacks to solicit medically unnecessary prescriptions for expensive compounded drugs that were filled by the pharmacy and then charged to Tricare.
As a result, the pharmacy allegedly billed Tricare about $68 million for compounded drugs over eight months in 2014 and 2015.
For more information, click here to read the press release issued by the DOJ.
The lawsuit resolved by the settlement was originally filed under the whistleblower (or “qui tam”) provisions of the False Claims Act by two former employees of PCA. To learn more about whistleblower or qui tam cases, click here to read one of my prior blogs.
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 also represents both plaintiffs (whistle blowers or relators) and defendants in False Claims Act (whistleblower or qui tam) cases. 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:
Stawiki, Steve. “Pharmacy, PE Fund Ink $21M Deal To End FCA Kickback Suit.” Law360. (September 20, 2019). Web.
Bolado, Carolina. “Pharmacy, PE Fund Near Deal To End Feds’ FCA Kickback Suit.” Law360. (July 1, 2019). Web.
“Compounding Pharmacy, Two of Its Executives, and Private Equity Firm Agree to Pay $21.36 Million to Resolve False Claims Act Allegations.” Florida Record. (September 24, 2019). 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 the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
KeyWords: legal representation for pharmacists, legal representation for pharmacies, pharmacy defense attorney, pharmacist defense lawyer, representation for False Claims Act investigation, False Claims Act representation, FCA defense lawyer, board representation for pharmacists, board representation for pharmacies, board representation for physicians, Board of Pharmacy investigation representation, legal representation for board investigations, administrative hearing defense attorney, representation for administrative hearings, administrative complaint representation, Board of Medicine representation, Board of Medicine attorney, Board of Medicine defense attorney, representation for Board of Medicine investigations, representation for Board of Medicine complaints, DEA hearing defense attorney, DEA investigation attorney, DEA hearing representation, DEA investigation representation, representation for DEA investigations against physicians, representation for pill mill allegations, representation for allegations of overprescribing, representation for overbilling, DOJ defense lawyer, representation for DOJ investigations, representation for health care professionals, 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 © 2019 The Health Law Firm. All rights reserved.
CMS Announces Final Rule to Reduce Criminal Behavior in Medicare, Medicaid
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the ability to stop fraud and abuse before it happens. The “Program Integrity Enhancements to the Provider Enrollment Process” goes into effect on November 4, 2019, and will help keep untrustworthy providers out of federal health insurance. The new affiliations provision will allow CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse and repeat offenders.
Details on the Rule.
The final rule, (CMS-6058-FC), creates several new revocation and denial authorities to enhance CMS’ efforts to stop fraud and abuse.
Similar to the affiliations component, these authorities provide a basis for administrative action to revoke or deny, as applicable, Medicare enrollment if:
• A provider or supplier circumvents program rules by coming back into the program, or attempting to come back in, under a different name (e.g. the provider attempts to “reinvent” itself);
• A provider or supplier bills for services/items from non-compliant locations;
• A provider or supplier exhibits a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs; or
• A provider or supplier has an outstanding debt to CMS from an overpayment that was referred to the Treasury Department.
Additionally, the rule gives CMS the ability to prevent applicants from enrolling in the program for up to three years if found to have submitted false or misleading information in its initial enrollment application.
Furthermore, the new rule expands the re-enrollment bar that prevents fraudulent or otherwise problematic providers from re-entering the Medicare program. CMS can now block providers and suppliers who are revoked from re-entering the Medicare program for up to 10 years. Previously, revoked providers could only be prevented from re-enrolling for up to three years.
Additionally, if a healthcare provider or supplier is revoked from Medicare for a second time, CMS can now block him/her from re-entering the program for up to 20 years. These new authorities and restrictions are effective on November 4, 2019.
For more information, click here to view the final rule with comment.
To learn more about the Medicare enrollment application process, click here to read my prior blog.
Don’t Wait Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.
Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.
Sources:
Kacik, Alex. “CMS targets healthcare providers’ affiliates in new rule.” Modern Healthcare. (September 5, 2019). Web.
“CMS Announces New Enforcement Authorities to Reduce Criminal Behavior in Medicare, Medicaid, and CHIP.” Orlando Medical News. (September 5, 2019). Web.
“CMS takes action to keep fraudsters out of Medicare and Medicaid.” CMS.gov. (September 5, 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 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 Awarded $17.5 Million, 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.
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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.