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Welcome to The Health Law Blog2019-02-15T20:02:56+00:00

Although the Law Stacks the Deck Against You, Leaving a Foreign Body in a Patient Doesn’t Always Mean Negligence or Discipline

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Leaving a foreign object (sometimes referred to as a “retained foreign body” or “RFB”) in a patient, such as a sponge, clamp, forceps, surgical needle, guide wire, part of a surgical instrument or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures, does not necessarily mean that the physician has committed an act of negligence or that the physician will be disciplined by the Board of Medicine (BOM) or Department of Health (DOH). There are many defenses in such a case and many incidents which do not constitute negligence. However, as a preliminary matter, the law does seem to stack the deck against the physician in such cases.

Medical Negligence Statutes.

Section 766.102(3)(b), Florida Statutes (previously Section 768.45, Florida Statutes),
states:

The existence of a medical injury does not create any inference or presumption of negligence against a health care provider, and the claimant must maintain the burden of proving that an injury was proximately caused by a breach of the prevailing professional standard of care by the health care provider. . . . However, the discovery of the presence of a foreign body, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or diagnostic procedures, shall be prima facie evidence of negligence on the part of the health care provider.

Grounds for Disciplinary Action Against a License.

Chapter 456, Florida Statutes, applies to all health professionals who are licensed by the Florida Department of Health (DOH). Section 456.072(1), Florida Statutes, which provides the grounds for possible discipline of any licensed health professional contains a subsection (cc), which provides the following as a basis for disciplinary action:

Leaving a foreign body in a patient, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures. For the purposes of this paragraph, it shall be legally presumed that retention of a foreign body is not in the best interest of the patient and is not within the standard of care of the profession, regardless of the intent of the professional.

Applicable to Others than Just Surgeons and Physicians.

We typically envision objects such as clamps or lap pads (“sponges”) being left in a patient after surgery. Note, however, these provisions of the law could apply equally to a nurse practitioner’s leaving a broken needle in a patient or a dentist’s leaving a burr or broken probe in a patient.

Res lpsa Loquitur.

Many surgeons and other physicians who are charged with such an allegation just give up, do not defend themselves, and agree to accept punishment from their professional board. The statutes quoted above are, basically, a restatement of the common law rule known as “res ipsa loquitur in medical malpractice cases.

The term “medical injury” in the statute refers to an injury sustained as a direct result of medical treatment or diagnosis, and does not encompass injuries totally unrelated thereto. Thus, when a plaintiff establishes that the injury is outside the scope of medical treatment or diagnosis, and the facts and circumstances attendant to the injury are such that, in light of past experience, negligence is the probable cause and the defendant is the probable actor, the doctrine of res ipsa loquitur is applicable.

In Florida, there is a Florida law that is set forth within Chapter 456, Florida Statutes. Chapter 456 of Florida Statutes applies to all health professionals who are licensed by the Florida Department of Health (DOH).

Many surgeons and other physicians who are charged with such an allegation just give up, do not defend themselves, and agree to accept punishment from their professional board.

Florida Cases on Retained Foreign Objects.

Archer v. Maddux, 645 So. 2d 544 (Fla. 1st DCA 1994) a surgeon left a tube in a patient after surgery by accident. The trial court dismissed the case because there was no affidavit from a medical expert corroborating that medical negligence had occurred that had been filed before the running of the statute of limitations. The Court of Appeal upheld the dismissal of the case.

DeAlmeida v. Graham, 524 So. 2d 666 (Fla. 4th DCA 1987), a surgeon left a Kelly clamp inside of a patient.

Moreover, the provision of Fla. Stat. ch. 766.102(4) that discovery of a “foreign body” such as surgical paraphernalia is prima facie evidence of negligence, is clearly inapplicable in a case where the mesh was intentionally placed in patient’s body as part of her treatment, and like screws, plates, pacemakers, and/or artificial joints was intended to permanently remain in her body. (Kenyon v. Miller, 756 So. 2d 133 (Fla. 3d DCA 2000)

Smith v. Zeagler, 116 Fla. 628, 157 So. 328 (1934)
It is negligence per se for a surgeon to leave a sponge in an abdominal incision made in his patient in the course of his performance of a surgical operation upon such patient. The burden of showing due care is upon a surgeon who leaves a sponge enclosed in a wound after the performance of an operation, and he cannot relieve himself from liability unless the sponge was so concealed that reasonable care on his part would not have disclosed it, and conditions were such that, in his professional judgment, a special exploration for the sponge would have endangered the safety of the patient. Where a patient’s condition is critical and the paramount requirement is complete the operation in the shortest possible time, the failure to remove a sponge may be an accidental and excusable ship or inadvertence that is not actionable negligence, depending upon the circumstances of the case, the burden being on the physician to show to the satisfaction of the jury that the particular act was not blame-worthy because of the supervening necessity to complete the operation without delay.

The authorities are legion to the effect that it is negligence [***3] per se for a surgeon to leave a sponge in an abdominal incision made in his patient in the course of his performance of a surgical operation upon such patient. Ruth v. Johnson, 172 Fed. 191; Reeves v. Lutz, 179 Mo. App. 61, 162 S.W. Rep. 280; Rayburn v. Day, 126 Oregon 135, 268 Pac. Rep. 1002; Wynne
v. Harvey, 96 Wash. 379, 165 Pac. Rep. 67; Harris v. Fall, 177 Fed. 79, 27 L.R.A (N.S.) 1174; Moore v. Ivey (Texas Civ. App.), 264 S.W. Rep. 283; 21 R.C.L. 388.

The burden of showing due care is upon a surgeon who leaves a sponge enclosed in a wound after the performance of an operation, and he cannot relieve himself from liability unless the sponge was so concealed that reasonable care on his part would not have disclosed it, and conditions were such that, in his professional judgment, a special exploration [*631] for the sponge would have endangered the safety of the patient. Davis v. Kerr, 239 Pa. 351, 86 Atl. Rep. 1007, 46 L.R.A. (N.S.) 611.


Adverse Consequences of Accepting Discipline in a RFB Case.

Many health professionals agree to accept punishment from their professional board without realizing the harsh consequences. Any disciplinary action will be reported to the National Practitioner Data Bank (NPDB). If you are reported to the NPDB or another health care data base, you could have issues obtaining hospital privileges, state licenses, you may be excluded from the Medicare and Medicaid Programs, and it could also affect your ability to work in the health care field. Additionally, similar actions will be taken against any licenses you have in other states.

Shared Responsibility Between Surgeon and Hospital Staff.

Most hospitals have internal policies and procedures which make it a shared responsibility between the surgeon and the hospital’s staff (especially surgical technicians and operating room nurses) to safeguard against leaving foreign objects in patients.

The Health Law Firm has successfully defended physicians and other licensed health care professionals in administrative investigations and patients complaints relating to retained foreign bodies.

For more information on how we can help you in situations such as this, visit our Areas of Practice page on our website.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its 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.

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 licensed healthcare professionals, National Practitioner Data Bank, NPDB defense lawyer, NPDB representation, Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for 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.

Alaska Board Sends Contradictory Letter to Pharmacists Over Filling Opioid Prescriptions (Part 1)

Headshot of attorney George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The “Opioid Crisis” in the U.S.

We all know that there is an “opioid crisis” in the U.S. It is probably prevalent in every state. In Florida we have been suffering under it for the past ten to fifteen years. So it is nothing new to Florida. Government regulators including, but not limited to the Florida Department of Health (DOH), Florida Attorney General (AG), different State’s Attorneys’ (prosecutors) offices, multi-jurisdictional task forces, local law enforcement agencies, the U.S. Drug Enforcement Administration (DEA) and the Department of Justice (DOJ), along with federal prosecutors, have been involved in ongoing efforts in Florida for the past fifteen years or so, to shut down “pill mills” and attempt to eliminate the “opioid crisis.” Florida was, unfortunately, leading this trend.

The “Opioid Crisis;” Nothing New in Florida.

During this same period of time, my firm and I have been involved in defending physicians and pharmacists in criminal, civil, and administrative actions seeking to prosecute them, revoke their licenses, revoke their DEA registrations, terminate them from Medicaid participation, levy fines on them and other punitive actions. Florida was also, unfortunately, leading this trend.

So our opinions and comments in this blog, Part 1, and its Part 2, Part 3, Part 4 and Part 5 are informed by long years of experience with something that is old news in Florida, but may be new news in other states.

Alaska Sends out its Warning to Pharmacists to Keep Filling Prescriptions for Opioids.

On January 23, 2019, the Chairman of the Alaska Board of Pharmacy sent out an open letter to Alaska pharmacists, discussing the negative effect on patient health that has arisen in response to the fact that many pharmacists have stopped filling prescriptions for opioids. From its tone, it warns pharmacists to keep filling such prescriptions under threat of possible disciplinary action against their licenses, at least that is my interpretation of it. Here is a copy you can read for yourself, click here.

The two-page letter begins by stating:
The [Alaska] Board of Pharmacy has had an influx of communication concerning patients not able to get controlled substance prescriptions filled for various reasons, even when signs of forgery or fraudulence were not presented.

The letter continues stating:
As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation. These laws are: AS [Alaska Statutes] 08.80.261 DISCIPLINARY ACTIONS.

It then continues, quoting and citing other statutes and administrative codes under which a pharmacist could be charged for refusing to fill an opioid prescription for a patient.

Chilling? Mixed Signals? You be the Judge!

The problem I have is where is the state board of pharmacy (in any state, not just Alaska), when the DEA comes in to the pharmacy with its search warrants and arrest warrants? Where is the state board of pharmacy when the raid by local police/sheriff/multi-jurisdictional task force comes into the pharmacy? Where is the state board of pharmacy when the U.S. Attorney’s Office indicts and prosecutes the pharmacist? Where is the state board of pharmacy when the DEA issues its Order to Show Cause (OTSC) why the pharmacy’s or pharmacist’s DEA registration should not be revoked.

The state board of pharmacy is usually the one providing the expert witnesses to testify against the pharmacist or pharmacy, that’s where. The state board of pharmacy is standing by ready to take disciplinary action against the pharmacist or pharmacy, after the other government agencies get finished.

If pharmacists and pharmacies are refusing to fill prescriptions for opioids, which is something that I advise my clients to do, if they can afford to do so, then that is a smart move, until state agencies, including the state boards of pharmacy, take action to help them out of this predicament. The pharmacists are caught on the horns of a dilemma: face federal and state criminal prosecutions and actions by the DEA for filling opioid prescriptions; or face possible administrative actions by the state board of pharmacy for not filling opioid prescriptions. My advice is to choose the latter as it is much easier to defend a state administrative action, especially if you are not trying to do so from a federal prison somewhere.

The cost of defending a DEA action to revoke a DEA registration is prohibitive if done correctly, even if the pharmacist is completely innocent of any wrongdoing. The goal of these proceedings, despite the innocence of the pharmacist or pharmacy, is to put them out of business, and it almost always succeeds! Click here to read one of my prior blogs about DEA investigations of health care professionals.

To read my additional opinions on the types of actions that can be taken by states and state agencies to address the issues which the Alaska Board letter attempts to address, please see Part 2 of this blog. Click here to read Part 3 of this blog series and stay tuned for Parts 4 and 5!

To learn more on administrative and informal hearings before the Florida Board of Pharmacy, 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 (whistle blower 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.

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, 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 over prescribing, 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.

Review Your Florida DOH Practitioner Profile or it Could Cost You!

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In 1997, the Florida Legislature passed a statute that requires the Department of Health (DOH) maintain online practitioner profiles for certain health care professionals. Practitioner profiles are required for medical doctors, osteopathic physicians (DOs), chiropractors (DCs), advanced practice registered nurses (APRNs) and podiatric physicians. The statute specified the required information to be maintained, how it was to be reported, and other requirements dealing with compiling and updating the information in the profiles.

To visit the DOH’s website and learn more about these profiles, click here.

What Information Does the Practitioner Profile Include?

The profile contains required and optional information from the healthcare provider. Required
information includes:

1. education and training, including other health-related degrees, professional and post graduate training specialty
2. current practice and mailing addresses
3. staff privileges and faculty appointments
4. reported financial responsibility
5. legal actions taken against the practitioner
6. board final disciplinary action taken against the practitioner
7. any liability claims filed against podiatric physicians which exceed $5,000
8. any liability claims filed against M.D.s and osteopathic physicians which exceed
$100,000

Optional information may include committees/memberships, professional or community
service awards, and publications the practitioner has authored.

These profiles are published on the DOH’s website. They are freely accessible by the public and are frequently used by employers, medical staff committees, and insurance panels to verify information provided by applicants.

Be Sure to Check Your Own Profile for Accuracy.

If you are a licenced profiled health care practitioner, you should review your profile information frequently and report any corrections to the DOH immediately! By law, you are responsible for updating your profile information within 15 days after a change of an occurrence in each section of the profile.

Unfortunately, information on practitioner profiles is not always 100 percent correct. Oftentimes, the information in a profile is outdated or misreported. The majority of the information in a profile is supposed to be entered through the website by the practitioner personally; however, the DOH is free to add information on its own.

It’s important to note that not all of the information on the practitioner profile is verified by the DOH. To view which information is self-reported, as well as reported by the DOH, click here to view the DOH’s profile guide.

Recently, The Health Law Firm had a client whose employment contract was not renewed due to misreported criminal history information on the DOH practitioner profile. Most troubling was the fact that this information appeared on the profile suddenly; it had not been on the practitioner profile in the past. Furthermore, the information was decades old and had been posted in direct violation of a court order sealing the underlying records.

We have also had cases where information was incorrect, where the same information was repeated several times, or where the information on the profile did not meet basic requirements for reporting.

Fight Misreported Information on Your Practitioner Profile.

The Health Law Firm has been successful in having the DOH remove criminal history information and other incorrect information from a practitioner profile.

It is imperative that you check your practitioner profile regularly to ensure that it is accurate with respect to the information that you provided and that may have been provided by the DOH. If you find that confidential or incorrect information has been posted to your profile, contact an attorney experienced with dealing with these matters immediately. You never know when your employer, a business associate or potential patient will look up your information on your profile.

Contact Health Law Attorneys Experienced with Department of Health Matters and Investigations.

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 (DME) suppliers, medical students and interns, chiropractors, hospitals, ambulatory surgical centers, pain management clinics, nursing homes and any other health care provider

Our attorneys provide legal representation in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, Federal Bureau of Investigation (FBI) investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, healthcare license representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

Genetic Testing Scams Ripping off Government Programs for Millions, Part 1 of 2

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Several genetic testing companies have come into the spotlight for allegations of ripping off Medicare and False Claims Act (FCA) violations. Health care professionals need to be aware of these types of schemes and the dangers they may face if involved. In each of these cases, the companies agreed to a pay a settlement in the millions to resolve allegations they submitted claims for unnecessary genetic testing.

This is part one of a two part blog series. Click here for part two.

The Details.

On February 11, 2019, the Department of Justice (DOJ) announced that GenomeDx Biosciences Corp. (GenomeDx) agreed to pay $1.99 million to resolve FCA allegations. The false claims to Medicare were for a post-operative genetic test for prostate cancer patients. GenomeDx allegedly submitted claims for the genetic test to Medicare between September 2015 and June 2017. They were not medically reasonable nor necessary because the prostate cancer patients did not have risk factors necessitating the test. You can read the DOJ’s press release and learn more here.

In a similar case, on March 8, 2018, the U.S. Attorney announced a settlement with a California genetics testing company, Natera, Inc. The company agreed to pay $11 million to resolve FCA allegations for improperly billing TRICARE for non-invasive prenatal testing. According to the government, Natera improperly billed for genetic screenings to test a baby’s risk for certain disorders and syndromes. Natera allegedly used an improper billing code to misrepresent the services and screened patients with low-risk pregnancies who did not need it, according to the government.  The suit was initiated by a pair of whistleblowers under the qui tam provisions of the FCA.

Click here to read the press release in full.


Consequences of These Types of Scams.

In both cases, the message is clear, “if you take advantage of programs like Medicare, you will be held accountable,” according to the government. Companies and providers who file false claims to generate more revenue are stealing from the taxpayers and those who rely on those federally funded programs.

Don’t allow your name, provider number and NPI to be used for ordering illegal medically unnecessary tests, procedures or treatments. If you do, you may very well find yourself caught up in a similar FCA or other government investigation. These hefty settlements send a message that pursuing healthcare fraud is a priority to the DOJ. In 2018, it recovered more than $2.8 billion from FCA cases alone. Click here to learn more.

Be sure to continue with part two of this blog series to learn more about these types of fraud scams.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent physicians, clinics, health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We also represent doctors, nurses and others as relators (whistle blowers) in bringing qui tam or whistle blower cases, as well.  We represent health professionals and health facilities in complex litigation involving medical issues in state and federal courts.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

“Genetic Testing Company Settles Whistleblower Suit for $11.4M.” Constantine Cannon Lawyer Group. (March 14, 2018). Web.

“Whistleblower Suit Over Falsified Prenatal Test Billing Settles.” Allison Legal Law Firm. (March 11, 2018). Web.

Raymond, Nate. “Natera settles U.S. billing probe over prenatal gene tests for $11.4 mln.” Reuters. (March 12, 2018). 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: Whistle blower plaintiff-relator attorney, qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid  Fraud Control Unit (MFCU) defense attorney, Medicaid  Fraud Control Unit (MFCU) defense legal representation, Medicaid  Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview 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 © 2019 The Health Law Firm. All rights reserved.

One in Four Florida Healthcare Providers Skipped Required Opioid Prescribing Class

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 5, 2019, state officials announced that about one in four Florida health care providers failed to take a required two-hour continuing education (CE) course on prescribing controlled substances.  The deadline for the mandated course was January 31, 2019. The Florida Department of Health (DOH) is now preparing to send non-compliance letters advising the providers that they have 15 days to take the mandated course or face disciplinary action, said DOH agency spokesman Brad Dalton.

“If the department does not receive a response within 15 days from receipt of the notice, a formal complaint will be initiated,” he said.


New Standards for Prescribing Controlled Substances.

A law in 2018 required all health care providers registered with the DEA and authorized to prescribe controlled substances to take a CE course.  The course covers the current standards for prescribing controlled substances, particularly opiates.

Click here to read our prior blog and learn more about House Bill 21, the Controlled Substances Bill.

In in the of Florida, nurses, dentists physicians, podiatrists, physician assistants and advanced practice registered nurses practitioners (APRNs) can prescribe controlled substances for pain. Prior to the passage of this law in 2018, only physician assistants and APRNs were required to take CE courses on controlled substances as part of licensure requirements.

The new mandate impacts an estimated 114,000 Florida healthcare providers including all dentists, according to the DOH.

Click here to read one of our prior blogs on the importance of health care compliance for all health care providers.

We have seen firsthand the kinds of problems that can arise when licensed health professionals do not follow up on continuing education requirements.  Click here to read one of my prior blogs and learn more.


How a Disciplinary Action May Affect Your Healthcare License.

It is important that health care providers understand how this could impact your professional license and professional reputation. Failing to obtain the required CE during the time period set forth by state and board regulation can result in disciplinary action being taken against a licensee. Disciplinary action in one state can lead to disciplinary action commenced against a license held in another state, if the licensee holds multiple licenses.

Often consulting an experienced health law attorney on such matters can save a great deal of turmoil, mental anguish, cost and damage. Click here to read one of our prior blogs and learn more.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Pharmacists, Pharmacies and Other Healthcare 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 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.

Sources:

“A Quarter Of Florida Docs, Dentists Skip Required Opioid Training.” Health New Florida. (February 5, 2019). Web.

Sexton, Christine. “Thousands of Florida doctors, dentists skip required opioid training.” Orlando Sentinel. (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 Department of Health (DOH) investigations, legal representation for DOH complaints, licensure defense attorney, DOH defense attorney, health law defense attorney, legal representation for health care professionals, legal representation for disciplinary actions against your license, non-compliance representation, non-compliance defense attorney, healthcare compliance attorney, healthcare compliance representation, representation for non-compliance allegations, legal representation for license revocation, healthcare license defense attorney, administrative complaint attorney, legal representation for administrative complaints, Board of Medicine representation, pharmacy law attorney, legal counsel for Board representation, The Health Law Firm, health law defense attorney, Florida health law attorney, reviews of The Health Law Firm, The Health Law Firm attorneys review

“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.

DOH: Thousands of Florida Dentists Skipped Required Opioid Training

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 5, 2019, state officials announced that about one in four Florida health care providers failed to take a required two-hour continuing education (CE) course on prescribing controlled substances.  The deadline for the mandated course was January 31, 2019. The Florida Department of Health (DOH) is now preparing to send non-compliance letters advising the providers that they have 15 days to take the mandated course or face disciplinary action, said DOH agency spokesman Brad Dalton.

“If the department does not receive a response within 15 days from receipt of the notice, a formal complaint will be initiated,” he said.


New Standards for Prescribing Controlled Substances.

A law in 2018 required all health care providers registered with the DEA and authorized to prescribe controlled substances to take a CE course.  The course covers the current standards for prescribing controlled substances, particularly opiates.

Click here to read our prior blog and learn more about House Bill 21, the Controlled Substances Bill.

In in the of Florida, dentists physicians, podiatrists, physician assistants and advanced practice registered nurses practitioners (APRNs) can prescribe controlled substances for pain. Prior to the passage of this law in 2018, only physician assistants and APRNs were required to take CE courses on controlled substances as part of licensure requirements.

The new mandate impacts an estimated 114,000 Florida healthcare providers including all dentists, according to the DOH.

Click here to read one of our prior blogs on the importance of health care compliance for all health care providers.

We have seen firsthand the kinds of problems that can arise when licensed health professionals do not follow up on continuing education requirements.  Click here to read one of my prior blogs and learn more.


How a Disciplinary Action May Affect Your Dental License.

It is important that health care providers understand how this could impact your professional license and professional reputation. Failing to obtain the required CE during the time period set forth by state and board regulation can result in disciplinary action being taken against a licensee. Disciplinary action in one state can lead to disciplinary action commenced against a license held in another state, if the licensee holds multiple licenses.

Often consulting an experienced health law attorney on such matters can save a great deal of turmoil, mental anguish, cost and damage. Click here to read one of our prior blogs and learn more.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Dentists and Other Healthcare 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 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.

Sources:

“A Quarter Of Florida Docs, Dentists Skip Required Opioid Training.” Health New Florida. (February 5, 2019). Web.

Sexton, Christine. “Thousands of Florida doctors, dentists skip required opioid training.” Orlando Sentinel. (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 Department of Health (DOH) investigations, legal representation for DOH complaints, licensure defense attorney, DOH defense attorney, health law defense attorney, legal representation for health care professionals, legal representation for disciplinary actions against your license, non-compliance representation, non-compliance defense attorney, healthcare compliance attorney, healthcare compliance representation, representation for non-compliance allegations, legal representation for license revocation, healthcare license defense attorney, administrative complaint attorney, legal representation for administrative complaints, Board of Medicine representation, pharmacy law attorney, legal counsel for Board representation, The Health Law Firm, health law defense attorney, Florida health law attorney, reviews of The Health Law Firm, The Health Law Firm attorneys review

“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.

So, the ZPIC Medicare Auditor Wants to Talk to You? What You Should Expect

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

You are a physician, nurse or other health care provider who bills Medicare. You have received that dreaded letter from the Zone Program Integrity Contractor (ZPIC) for Medicare advising you that it is auditing you for the Centers for Medicare and Medicaid Services (CMS). You know that the words “Program Integrity” by themselves mean that possible fraud is being investigated, at least that is the suspicion giving rise to this particular audit.

To read an earlier blog which I wrote on tips for responding to ZPIC audits, click here.

You have dutifully contacted an experienced health law attorney to aid you in responding to the ZPIC’ s request for records and information. You have obtained all of the requested medical records documentation, authoritative medical journal articles and other information that may be useful in supporting the care you delivered and for which you billed, added explanatory notes (clearly and contemporaneously dated, of course) where necessary or where records were missing, and done all you can to fully and completely respond to the audit.

After the Initial Audit Response and Site Visit.

Now, several weeks later, the ZPIC auditor/investigator contacts you and advises you that he would like you to come to his office to answer a few questions. The ZPIC auditor/investigator states that this is “just routine” and should only take approximately 20 minutes.

After discussing this with your attorney, knowing that you have committed no fraud and that your medical records are in pretty good shape to support your billing, you decide to go to the ZPIC office for the interview. (Note: I know that many attorneys would recommend against this action, but often we advise a client, with the right set of facts, of course, to do this.) What should you expect?

What to Expect When You Show up to Be Interviewed by the ZPIC Auditor.

Although we cannot guarantee you that you will experience the same as we have in the past, this is what happened often enough with us where it seems to be somewhat common practice in such audits.

1. Expect the ZPIC office to be in a building with good security, including magnetic/electronic scanning for guns and weapons, like at the airport or court house. Do not attempt to take any type of weapon inside the building, including pen knives on key chains and tear gas or pepper spray canisters.

2. Bring a valid government identification card with your photograph. If you are with an attorney or a consultant, that person will also need one. One of the first things that will happen is that you will be asked to show your identification cards to prove you are who you say you are.

3. Be sure you have your correct office address on file with Medicare. If the auditors show up at an address you have listed and your practice is not there, you will either get a letter automatically terminating your Medicare billing privileges or you will be called down for this interrogation by the ZPIC. This is a primary reason for such ZPIC interrogations. Be sure your physical office address, including suite number, apartment number, office number, etc., are correctly reflected in the Provider Enrollment and Chain/Ownership System (PECOS), the electronic portal through which Medicare providers enroll in Medicare.

4. You aren’t going to be interviewed by just one person and it isn’t going to be just “20 minutes.”

5. In most cases, there will be three or more auditors/investigators involved in the interview with you. This is why it is a good idea to bring your attorney and her paralegal so that you also have some support, as well. The least number of auditor/investigators that we have ever seen involved in such interviews is two. Don’t be surprised if there are three or four.

6. The questioning and interviewing will take much longer than you expected. Plan on taking the rest of the day off so that you are not rushed and do not feel pressured to get it over with fast. It is not going to be over with fast.

7. Don’t joke around with the ZPIC auditors. This is a very serious matter. Many talented government investigators will attempt to joke and make light of things in order to get you to let your guard down. Do not play into this. Be serious and act seriously at all times.

8. You are not in an endurance contest. Ask for bathroom breaks, water breaks or just a break to talk with your attorney, as many times as you desire. Do this at least once each hour. This will help to keep your blood circulating and keep you alert.

9. You will be confronted with what the ZPIC auditors believe they have found that violates Medicare regulations. This may include, for example, billing services for patients who were dead at the time, billing for services on dates after the patient was no longer qualified to receive them, billing for services that were billed by another provider, etc. Do not guess at why this happened if you did not know for a fact. You can advise the investigator that you will take down the investigation, look into it and provide the information to him or her at a later date.

10. Don’t be surprised if the ZPIC auditor has incorrect information. Often the ZPIC will have confused information on two different Medicare beneficiaries with the same names or whose Medicare numbers were incorrectly recorded. For example, in one recent ZPIC investigator interview with my client, the investigator accused the physician of billing for services provided to a patient who had been deceased for two years. The physician had just seen the patient on a follow-up visit a month prior to the interview. The ZPIC had confused a dead patient who had the same name with the live patient. This is not uncommon.

11. Don’t be surprised if the ZPIC auditor asks you about other Medicare provider’s billings for the same patient. This also happened to a client of mine in a recent case. The ZPIC investigator questioned why the XYZ company would have billed for the same services as those provided by my client, a solo practitioner. My client did not know. He correctly told the auditor that he did not know why the other party had billed Medicare for the same services, but he had provided the services to his patient and he had billed for the services. He could not know whey someone else did something.

12. If there have been intervening factors affecting your billing practices, disclose these to the investigator. In one case, my client had changed software for her electronic health records and billing. One of the reasons this was necessary was because of bugs that made the billings sometimes unreliable. Records more than four (4) years old were no longer available. The client disclosed this.

13. Be sure you are able to reconcile the number of patients seen per day, the number of hours the CPT codes billed to Medicare are supposed to reflect, and that these seem reasonable. If you are billing time-based CPT codes for patients that it would take you 27 hours to see in a day, you are in trouble. You must know this ahead of time and either have a reasonable answer to address the problem (e.g., an incorrect date entry in the billing software caused two days worth of services to accidentally be billed for the same date of service) or correct the over-billing error.

14. Know what rules, regulations and guidelines apply to the billings for the CPT codes you are billing. Check to see if there are local coverage decisions (LCDs) from your area Medicare Administrative Carrier (MAC) or National Coverage Decisions (NCDs) from CMS and know them. Be sure you have followed them and are following them.

15. Know the licensure rules and regulations for your profession, as well as the Medicare guidelines for billing for your profession. Sometimes billing for what an assistant, trainee, or ancillary provider does is allowed, and sometimes it isn’t. If you bill for what an assistant does, be sure you know the rules and are properly billing. The ZPIC investigator certainly will ask questions about this.

16. Your health record entries, assessments, evaluations, progress notes, etc., are required to be made contemporaneously with your delivery of the services. This generally means within 24 hours, as a rule of thumb. Records made a week or a month later are not considered to be reliable or accurate. So be sure you have made and are making your records contemporaneously with seeing the patient or providing the services.

17. Check the location code for the claims you have submitted. Make sure they reflect the correct site that the services were delivered. There could be differences in payments based on the site/location code. You will be asked about this if there are discrepancies.

18. If you identify problems and issues when preparing for your ZPIC interview, go ahead and correct them. This way you will be able to show you have made an honest mistake, have changed your procedures and the mistake(s) will not happen again in the future. Sometimes this may require terminating your billing company, purchasing new software, retaining a professional consultant, asking for an educational site visit from the MAC, and obtaining additional continuing education on billing practices and procedures for you and your staff (some of which CMS offers online).

We have many helpful resources on our webpage and YouTube page. Click here to view our video Q&A on ZPIC audits for more information.

To read an additional blog I wrote on preparing for an audit, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

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.

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