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

Miami Man to Remain Jailed for Trial in Nation’s Largest Medicare Fraud Case

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

On December 3, 2018, a Florida judge ruled that a Miami businessman who has been jailed for more than two years on $1 billion health care fraud charges, must remain in custody through his trial next year. U.S. District Judge Robert N. Scola Jr. found no violation of his due process rights and denied Philip Esformes’ motion to dismiss several money laundering charges.

Trial Date is Set.

A February 11, 2019, trial date has been set for one of the nation’s biggest Medicare fraud cases that Esformes allegedly orchestrated through nursing homes and assisted living facilities he owned. According to the government, the scheme resulted in $1 billion in false billing and at least $464 million in improper reimbursement payments from Medicare and Medicaid.

Esformes, has been in federal custody since his arrest in July 2016, and prosecutors voiced concerns early on about him being a risk for flight, possible witness tampering and his substantial resources enabling him to live comfortably overseas.

Judge Scola found that the bid for release deserved reconsideration, but ultimately found delays in the case were more attributable to giving the defense time to review the overwhelming quantity of evidence than time spent addressing the government’s conduct. He also agreed with the government that the duration of Esformes’ detention is not grounds for release under binding precedent.

Additionally, the judge rejected Esformes’ motion to dismiss nine counts of alleging money laundering concealment. Esformes had argued that the government improperly based transactions cited in other counts as alleged payments or receipts of kickbacks. You can read more about that here.

Despite problems with the conduct of prosecutors and agents, the judge is keeping the fraud case on track. The Miami businessman is charged with conspiracy, obstruction, money laundering and health care fraud. Click here to read the U.S. Department of Justice’s press release on this case.

Click here to read one of my prior blogs about a billion dollar fraud scheme in Florida.

Contact Health Law Attorneys Experienced in Handling Medicare Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S., as well as in civil and administrative litigation attempting to recoup claims that have been paid. 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 Medicare and Medicaid Program.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Hale, Nathan. “Miami Man To Remain Jailed For Trial In $1B Medicare Fraud.” Law360. (December 3, 2018). Web.

Weaver, Jay. “Miami federal judge keeps massive Medicare fraud case on track for trial in January.” Miami Herald. (November 14, 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: Medicare fraud defense representation attorney, legal representation for defense of Medicare fraud charges, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, Medicaid fraud defense attorney, legal representation for Medicaid fraud, audit defense lawyer, healthcare fraud representation, healthcare fraud lawyer, legal representation for Medicaid audit, Medicaid audit defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigations, DOJ representation, representation for DOJ investigations, licensure defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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Alaska Board of Pharmacy Sends Letter to its Pharmacists Sending Mixed Signals Over Filling Opioid Prescriptions (Part 1 of a 2 part series)

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, 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. To read more on pill mill cases in the state of Florida, click here.

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, Drug Enforcement Administration (DEA) hearing defense attorney, DEA investigation attorney, Drug Enforcement Administration (DEA) hearing legal representation, Drug Enforcement Administration (DEA) investigation legal defense attorney representation, representation for DEA investigations against pharmacists and physicians, legal representation for pill mill allegations, legal representation for allegations of over prescribing, lawyer providing representation for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, defense for Drug Enforcement Administration (DEA) Order to Show Cause (OTSC), responding to Drug Enforcement Administration (DEA) Order to Show Cause (OTSC), Drug Enforcement Administration (DEA) Order to Show Cause (OTSC) attorney and legal defense

“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.

Federal Court in Connecticut Rules Workers Can’t Be Denied Jobs for Medical Marijuana Use

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

On December 7, 2018, a federal judge in Connecticut ruled that a nursing home violated an anti-discrimination provision of the state’s medical marijuana law when it rescinded an employee’s job offer. It’s the latest in a series of similar clashes between federal and state laws around the country that came out in favor of medical marijuana users trying to keep or obtain jobs with drug-testing employers. The ruling provided clarification on medical marijuana use under the Connecticut Palliative Use of Marijuana Act (PUMA).
Advocates hope the new decisions are a sign of growing acceptance of marijuana’s medicinal value.

Background of the Case.

The plaintiff was a healthcare worker who was diagnosed with post-traumatic stress disorder (PTSD) in 2012 after being in a car accident. She notified a potential employer that she qualified under PUMA for her use of medical marijuana to cope with the effects of the accident. However, when a drug test came back positive for marijuana, the nursing home rescinded her job offer anyway, citing federal law which indicates marijuana is still illegal.

The plaintiff sued alleging the nursing home violated PUMA’s anti-discrimination provision. This provision of the law allows qualified patients to use marijuana and prohibits employers from taking adverse employment actions because of the individual’s qualifying status.

Court Grants Summary Judgment.

U.S. District Court Judge Jeffrey Meyer ruled the nursing home discriminated against her based solely on her medical marijuana use was in violation of state law. In doing so, the judge rejected the nursing home’s argument that the federal Drug Free Workplace Act (DFWA) required the nursing center to rescind the plaintiff’s job offer. The court also rejected the nursing home’s argument that the federal False Claims Act (FCA) bars the center from hiring the plaintiff because its employment of someone who uses medical marijuana in violation of federal law would amount to “defrauding of the federal government.” The court stated there is no federal law that bars the center from hiring the plaintiff on account of her medicinal marijuana use outside of work hours.
(We have seen these this type of creative argument made before by both plaintiffs and defendants in litigation arguing that certain actions constitute a violation of the False Claims Act when actually they do not; in this case, the judge failed to be suckered into agreeing with this argument.)

Significance of this Case.

This decision is significant for employers because it clarifies the relationship between federal and Connecticut state laws concerning marijuana use and provides guidelines for drug testing in the employment domain. It indicates that PUMA protects a qualifying patient’s medical marijuana use outside the realm of working hours. The case is now heading to a trial on whether the plaintiff should receive compensatory damages for lost wages from not getting the job.

In this case, there was a strong state law in favor of the employee which allowed the use of medical marijuana. The federal court gave deference to the state law.

Additionally, the decision will likely be used in arguments in similar cases across the county. As this area of the law continues to develop and change, employers should consider reviewing their own drug-related policies and adjust them as necessary.

To read about another case where an employee got fired for using marijuana outside of work, click here to read one of my prior blogs.

Contact Experienced Health Law Attorneys for Medical Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting and/or licensing, while complying with Florida law. We can also represent doctors, pharmacies and pharmacists facing proceedings brought by state regulators or agencies.

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

Sources:

“New rulings on medical marijuana use go against employers.” The Denver Channel. (December 5, 2018). Web.

Elser, Wilson. “New Ruling on Medical Marijuana in the Workplace Clarifies Connecticut’s PUMA Legislation.” The National Law Review. (December 7, 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.

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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.

Florida Pharmacy Hit With FCA Suit for Illegal Kickback Scheme Targeting Tricare

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

On October 19, 2018, the federal government filed suit against a Florida pharmacy for allegations of illegal kickback schemes involving industry marketers. The U.S. Attorney’s Office for the Middle District of Florida alleges that Oldsmar Pharmacy was involved in illegal schemes that resulted in the federal Tricare program paying more than $21 million in reimbursements for prescriptions and False Claims Act (FCA) violations.

Suit Filed on Behalf of The Defense Health Agency (DHA).

The federal government filed the suit on behalf of the U.S. Department of Defense, including its Defense Health Agency (DHA). The DHA administers the Tricare program, which provides health insurance for active duty military personnel, military retirees and their dependents.

The government is seeking treble damages, civil penalties and restitution, based on its claims that the pharmacy submitted claims to Tricare for reimbursement for prescriptions of costly compound medications. The government claims that they knew were fraudulent under the FCA because of the kickbacks paid to marketers.

On October 18, 2018, the U.S. Department of Justice (DOJ) released a press release announcing the involvement of three military members in the scheme as sales representatives for Centurion Compounding, Inc. All three were indicted for paying kickbacks to Tricare beneficiaries to obtain prescriptions for compounded medications. You can learn more about this in the section below.21

Click here to read the DOJ’s press release.

Former Whistleblower Suit.

The lawsuit against Oldsmar Pharmacy and company President, Larry Smith, stems from a whistleblower suit filed in 2015 by Jennifer Silva and Jessica Robertson, former employees, according to the complaint.

The schemes allegedly occurred between September 2014 and February 2015 by Smith and Oldsmar and different pharmacy services administration organizations.

Tricare Reimbursements and Kickback Schemes.

According to the complaint, Centurion Compounding Inc., hired sales representatives as independent contractors who marketed costly compound medications to Tricare beneficiaries. Patients recruited by the sales reps were directed to send their prescriptions to Centurion, which then directed them to Oldsmar pharmacy.

From November 2014 to February 2015, Tricare paid about $18 million for approximately 4,000 claims for compound prescriptions as part of the kickback scheme, according to the federal government. Oldsmar paid Centurion more than $6.1 million in kickbacks, some of which was distributed to the individual sales representatives involved.

Additionally, prosecutors claim that pharmacy President, Larry Smith, entered into a second kickback scheme with several marketing companies. These companies published online advertisements offering free consultations for pain creams via telemedicine, without ever seeing a physician in person. In return, Oldsmar Pharmacy paid a 41 percent kickback to the marketers, the complaint alleges.

Click here to read the complaint in full.

The suit brings forward false or fraudulent claims; recovery of payments made by mistake by Tricare; and unjust enrichment. To learn more, click here to read one of my prior blogs on a similar case.

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.

Sources:

Hale. Nathan. “Fla. Pharmacy Hit With False Claims Suit Over Kickbacks.” Law360. (October 19, 2018). Web.

Stringini, Mary. “St. Pete doctor pleads guilty to receiving kickbacks, BMW in $5.3 million pharmacy conspiracy.” ABC Action News. (March 8, 2018). 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.

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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.

Walgreens Agrees to Pay $269 Million to Settle Two FCA Suits

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

On January 22, 2019, Walgreens agreed to pay more than $269 million to settle allegations of False Claims Act (FCA) violations for overbilling of various drugs. The deals are some of the largest pay-outs ever by a retail pharmacy, according to the United States Department of Justice (DOJ).

The Two Settlements.

There were two separate complaints involving Walgreens to settle federal and state lawsuits that accused the pharmacy of overbilling federal healthcare programs. Both were unsealed by U.S. District Court judges in Manhattan, according to the DOJ.

In the first settlement, Walgreens agreed to pay $209.2 million to the U.S. and several state governments for improperly billing Medicare, Medicaid and other federal healthcare programs. The pharmacy is accused of excessive dispensing of insulin pens to beneficiaries who didn’t need them, according to U.S. officials. It reaped improper payments by understating the amount of treatment days covered by supplies of insulin pens. That allowed it to bill for prescriptions that should have been denied as premature, the DOJ said. Click here to visit our website and read the complaint and the stipulation for the first settlement.

In the second settlement, Walgreens agreed to pay $60 million to settle claims of overbilling Medicaid programs through bogus Medicaid price reporting. The retail pharmacy never disclosed or charged the lower drug prices it offered the public through a pharmacy discount program.

According to the DOJ, Walgreens obtained inflated reimbursement amounts because it failed to disclose discounted drug prices in its “Prescription Savings Club.” However, federal prosecutors said Walgreens didn’t disclose the discounted drug price when filing for reimbursement from Medicaid. Click here to visit our website and read the complaint and stipulation for the second settlement.

There are two whistleblowers in the insulin pen case, they will receive a roughly 19 percent cut of the $41 million portion of the settlement that will go to state, a reward of close to $8 million for blowing the whistle. The whistleblower in the Medicaid price reporting case, will receive a $11.4 million reward, according to his attorney. Not bad for a days work!

Walgreens released a statement, saying it was glad to have the matters resolved but admitted to no wrongdoing.

This isn’t the first time Walgreens has been involved in an FCA lawsuit. Click here to read one of my prior blogs on a similar case.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:

Overley, Jeff. “Walgreens Pays $269M In Milestone FCA Deals.” Law360. (January 22, 2019). Web.

Thomas, Patrick. “Walgreens to Pay $269 Million on Claims It Overcharged Federal Programs.” WSJ. (January 22, 2019). Web.

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

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

The Most Common Cases The Health Law Firm Takes

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

One of the most common questions we get asked by doctors and lawyers alike, is about the types of cases our firm takes. They often mistake the practice of health law as medical malpractice defense. However, this is an incorrect assumption. Likewise, if we had a penny for every time we have heard “Yikes, an attorney! I hope I never need you,” we could close our doors and all retire.

As a general health law practice, we concentrate on both proactive and defensive legal issues and clients involved in the health care industry. To a certain extent our law firm does practically everything a physician, medical group, health facility or health care professional could need in the legal arena.

The types of cases we most commonly see are the following:

1. Sales, mergers and acquisitions of medical practices, health care clinics, and health facilities. We represent buyers, sellers and lenders at any stage of the process.

2. Contracts for medical and health care transactions. We prepare contracts, review contracts, negotiate contracts, help to terminate or break contracts, and we litigate contracts. We can be on either side of these transactions. Our litigation can take place in state court or federal court. We review and analyze quite a few employment contracts for medical residents and fellows going to new positions.

3. We research and prepare complex legal opinion letters on proposed health care transactions. The health care industry is the most regulated industry in the United States. There are complex layers of both federal and state laws and regulations as well as numerous federal and state agencies regulating it. Often, legal opinion letters are sought by purchasers and lenders for healthcare transactions for these reasons. We have several board certified health lawyers in our firm who have written dozens of these.

4. We represent health professionals and health facilities in Medicare audits, including fraud audits by the Zone Program Integrity Contractors (ZPICs) and by Recovery Audit Contractors (RACs). This includes representation in the appellate process, including requests for reconsideration, request for redetermination, and federal administrative law judge hearings. Preparation of the response to the audit request, completion of the audit questionnaire, response to the preliminary audit report (PAR), and defense of any repayments demanded, through administrative hearings before federal administrative law judges and appeals if necessary.

5. We represent health professionals and health facilities in Medicaid audits, including fraud audits by the zone program integrity contractors (ZPICs). This includes preparation of the initial response to the audit request, completion of the audit questionnaire, response to the preliminary audit report (PAR), and defense of any repayments demanded, through administrative hearings and appeals if necessary.

6. If there has been an action by the Centers for Medicare & Medicaid Services (CMS) to terminate the Medicare provider’s billing privileges, we aggressively represent them to have the decision reversed and have them reinstated. This includes filing requests for reconsideration and corrective action plans (CAPs). We have been very successful in obtaining relief for our clients.

7. We have represented a number of clinical investigators, primarily physicians, and defensive charges of research fraud, misconduct in science, manipulation of data, manipulating outcomes, in research investigations, and other similar proceedings brought by their institutions or and investigation review board. Whether it is at the initiation of such an investigation or in later hearings and appeals, we have navigated a number of principal investigators through these processes.

8. Our firm has represented a number of medical students, residents and fellow, including foreign medical graduates, in cases brought by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE), and the Educational Commission for Foreign Medical Graduates (ECFMG) in cases where there is an allegation of “irregular behavior” and rules violations through the hearing process and in appeals as necessary.

9. We represent physicians and other health professionals in hospital medical staff peer review proceedings and hearings. Whether it’s the initial application for clinical privileges and medical staff membership or action being taken to revoke or limit clinical privileges, we have been involved representing physicians and other health professionals at all levels. We have also done similar work for physicians in actions initiated by HMOs, professional associations, certification bodies, and other organizations. This is an area where a physician truly needs a health lawyer experienced in this type of proceeding.
10. “Disruptive physician” defense is another area where a doctor really needs an attorney who knows what he or she is doing. When your hospital or medical staff is attempting to place the label on you “disruptive physician,” you are really in trouble. This is an area in which careful navigation is required to prevent actions that result in such a label. Other wise, the physician can be pigeon-holed for life, placed into disruptive physician programs requiring years, if not a lifetime, of close monitoring and can even have discipline commenced against his or her medical license. We can assist you in taking actions to avoid having this happen.

11. When you receive a Medicare, Department of Health and Human Services (HHS), or Office of the Inspector General (OIG) subpoena or civil investigative demand (CID), you know there is serious trouble for someone in the works. We help you to respond promptly and professionally and attempt to keep you from becoming the target of serious federal investigations.

12. We represent physicians, nurses, dentists, psychologists and other licensed health professionals in responding to Department of Health (DOH) letters of investigation. Many physicians, nurses, dentists and other licensed health professionals do not understand that when they receive a letter from the Department of Health complaints advising them that they are under investigation for a complaint that is been made against them, this is a very serious matter. There is nothing that is “routine” about this. This means that there is an investigation that has been opened against your license that could ultimately result in disciplinary action being taken against you. Any disciplinary action taken against you will be on your license forever. This is the time to obtain an attorney. This is not a time to attempt to represent yourself. You should not ever speak with the investigator or provide a statement to the investigator; this is something only your attorney should do and only if it is determined to be advisable considering the facts of the case. We have represented hundreds of licensed health professionals in such investigations and in subsequent disciplinary hearings.

13. We also represent health professionals and others who have been excluded from the Medicare program and placed on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE). We have represented a number of healthcare professionals in completing and submitting applications to be removed from the LEIE and reinstated to the Medicare program.

14. We routinely counsel and represent physicians, dentists, psychologists, mental health counselors, and other health professionals in referrals to the Professionals Resource Network (PRN) for evaluation. We have found that often the health professional will not actually have any type of substance abuse problem or mental health issue. However, one referred for an evaluation to the PRN can wind up in a five year contract or even a lifetime contract for monitoring containing many mandatory requirements in order to continue practicing his/her profession and a lot of expenses associated with meeting such requirements.

15. We also routinely counsel and represent nurses and nurse practitioners (ARNPs), including certified registered nurse anesthetists (CRNAs) in similar referrals to the Intervention Project for Nurses (IPN). We have found that often the nurse will not actually have any type of substance abuse problem or mental health issue. However, one referred for an evaluation to the IPN can wind up in a five year contract or even a lifetime monitoring contract containing many mandatory requirements in order to continue practicing his/her profession and a lot of expenses associated with meeting such requirements.

16. We have been involved in a number of qui tam or whistle blower cases, either representing the whistle blower or representing an employer or institution that is being accused of wrongdoing. Whether this is pursuant to the Federal False Claims Act (FCA), a state false claims act or a private whistle blower act, we are experienced in investigating, prosecuting, defending, and litigating such cases in state or federal court.

17. Our firm represents physicians, pharmacists, health professionals and health facilities in administrative litigation against the Drug Enforcement Administration (DEA), the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), the Agency for Health Care Administration (AHCA) and the Department of Health, among other agencies. Whether the government agency is seeking to recover civil monetary penalties (CMP), attempting to recover large Medicare overpayments, seeking to revoke your DEA registration or seeking to discipline your medical license, we have experience in litigating such matters in these administrative tribunals. This can make the difference between a favorable outcome or a devastating outcome.

18. We represent Veterans Administration (VA) physicians, Army physicians, Navy physicians, Air Force physicians, and Indian Health Service physicians, in employment disputes, peer review investigations and hearings, clinical privileging investigations and hearings, and decisions to report to the National Practitioner Data Bank (NPDB).

19. Reporting a conviction for Driving under the influence (DUI) or some other criminal offense is required by most state licensing agencies. We are experienced in making such reports when required and in such a manner that a subsequent investigation and discipline on the professional license is often avoided.

20. Complex litigation involving health professionals is another area in which we routinely practice. Whether the matter involves a dispute between the shareholders of a medical clinic or practice, restraints on trade, allegations of false claims and fraud, the enforcement or avoidance of restrictive covenants (or covenants-not-to-compete), employment, pay and bonus disputes, ownership of practices or facilities, or any other of a number of different situations, we represent either side in state court or federal court.

21. Because of our experience in mental health law, we have come to represent individuals who have been incorrectly confined in mental health facilities in Florida because of allegations of impairment, drug abuse, mental health issues and other issues in which the person is initially though to be a threat to himself or to others. Both law enforcement authorities and medical personnel are being trained to take fewer chances with an individual acting unusual who may tend to hurt herself or someone else. They often tend to err to the side of ordering confinement under the Florida Mental Health Act (also known as the “Baker Act”). When this happens, the individual may be set for a long stay unless he or she has assistance in navigating the way out. We help doing this as quickly and expeditiously as possible.
22. We routinely representing physicians, pharmacists, nurses, dentists and other licensed health professionals in attempting to avoid or in disputing or in appealing adverse National Practitioner Data Bank (NPDB) Reports. There are only limited grounds for doing this so the professional needs to obtain counsel as early in the process as possible.

23. Any type of subpoena or search warrant from a government agency or law enforcement organization seeking your patient records can herald an investigation into false claims, over-prescribing, or other serious possible charges, criminal, civil or administrative. Our representation seeks to determine the reasons for this as early in the process as feasible and to protect your rights and limit your exposure as much as possible.

24. There are many, many other types of cases which we have experience with. To see some of these others, please visit our website.

As the business of health care grows, our law firm also grows. We are always seeking to expand our areas of practice within the health law field. Be sure to check back regularly for updates.

For more information on various health law topics and how The Health Law Firm can help you, visit our YouTube page to watch our video blogs.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, 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., 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 clients involved in the health care industry, legal representation for health care professionals, defense attorney for health care professionals, health law attorney, legal representation for sales, mergers and acquisitions of medical practices and facilities, physician contract lawyer, legal representation for contracts for medical and health care transactions, Medicare and Medicaid fraud defense attorney, representation for Medicare, Medicare defense lawyer, representation for Medicaid, Medicaid attorney, Medicare audit defense lawyer, Medicaid audit defense lawyer, healthcare fraud representation, healthcare fraud defense lawyer, clinical research defense attorney, legal representation for medical students, USMLE defense lawyer, representation for irregular behavior, irregular behavior defense attorney, medical education law representation, legal counsel for peer reviews, mental health law attorney, peer review defense lawyer, representation for DOH investigations, Department of Health (DOH) investigation defense attorney, legal representation for mental health counselors and professionals, Qui Tam/Whistleblower defense attorney, representation for qui tam cases, qui tam lawyer, whistleblower defense lawyer, representation for whistblower cases, baker act lawyer, complex litigation defense attorney, licensure defense attorney, representation for licensure defense, healthcare license defense attorney, False Claims Act (FCA) attorney, FCA defense lawyer, Baker Act defense attorney, representation for OIG exclusion, representation for DOH investigations, DOH defense lawyer, nurse attorney, representation for nurses, pharmacy representation, pharmacist representation, dentist attorney, representation for dentists, representation for healthcare professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, 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.

Cheating, Irregular Behavior and Other Challenges Facing Medical Students and Graduates

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

The road to becoming a physician is paved with many unique challenges. The long, exhausting journey begins and students are faced with the first battle: rigorous undergraduate course work, followed by the MCAT and medical school applications. During medical school, and for some, after graduation, the USMLE (United States Medical Licensing Examination) and its STEP 1, STEP 2 and STEP 3 exams provide another hurdle in the uphill battle. At any of these stages, medical students can face a gauntlet of accusations including cheating, misrepresentation, falsification of information, unfair advantages and the many faces under the general label of “irregular behavior.”

Challenges Prior to Entering Medical School.

Prior to medical school, pre-med students must be ambitious, inquisitive and extra cautious about any disciplinary action. A minor blemish on a pre-med student’s academic record (from academic dishonesty or other accusations), will become a major red flag once that student begins applying. Not only will any kind of discipline record hinder a student’s chances of acceptance, an infraction can also ruin that student’s reputation as they apply for residency and beyond.

Because the process of becoming a physician is difficult without having a discipline record, any charge against a pre-med student must be taken with the upmost seriousness. Don’t raise a white flag early on in the uphill battle!

Challenges After Medical School.

The battle continues for medical students; medical school courses and clinical rotations will be rigorous and challenging, calling on every neuron you possess to fire efficiently. You will be tested, in more ways than one. You will forget the term “MCAT” and substitute for it a new acronym–“USMLE” which stands for United States Medical Licensing Examination.

The USMLE is a four stage examination required for medical licensure in the United States. Because the USMLE is the barrier between you and your medical license, it is an extremely important component of your medical education.

One such issue is being accused of “irregular behavior.” This broad label includes anything from cheating to disruptions during testing or soliciting information on actual examination content. In the event that your test score is held up or invalidated due to irregular behavior you will want to correct the situation immediately, or you may be prohibited from taking future exams (meaning you won’t be able to obtain your license or a residency in the U.S.). If you are accused of irregular behavior or if you feel that you were faced with inadequate testing conditions, resolving the issue may be as simple as requesting a rescoring of the examination or a retest. Sometimes, because of problems at a test site or because of technical problems, retesting is an option.

The National Board of Medical Examiners and the USMLE take all such matters concerning the administration and the security of the test contents extremely seriously. In ceratin cases, they have sued those they believe may have compromised actual test contents. Click here to read more about the case.

After years of schooling, don’t allow an allegation of irregular behavior to mark your test transcripts and prevent you from attaining your goals and reaping the benefits of your hard work.

To learn more about USMLE, irregular behavior and how we can help you, click here to read one of my prior blogs.  Check our Medical Education Law Blog Regularly to stay on top of news and tips!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

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.

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

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

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

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