About The Health Law Firm

The Health Law Firm concentrates on representing health care providers. Our health law attorneys and paralegals have decades of experience in the legal and health care fields. Our health law attorneys include those Board Certified in Health Law, Masters degree trained, former hospital counsel and licensed health care professionals. Our clients include physicians, dentists, nurses, psychiatrists, psychologists, medical students, nursing homes, home health agencies, hospitals, health insurers, medical groups, durable medical equipment (DME) suppliers, and other health care providers.

Letter from the OIG Terminating You from the Medicare Program? What You Need to Do!

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

Have you received a letter from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) proposing to terminate you or exclude you from the Medicare Program? This is an extremely serious matter. You need to take action right away! For a physician or other health professional, this may be the most serious situation you have ever faced. Yes, even more serious than that jail sentence you just finished serving.

Do not let the time period to appeal or challenge this expire without filing an appeal with the appropriate official. Hire an experienced health law attorney to assist you with this right away. Make sure it gets done on time.

The Proposed Exclusion and Period of Exclusion May Not Be Appropriate in Your Case.

We often see letters from the OIG advising that the recipient healthcare professional is subject to a mandatory exclusion for a minimum of 20 years. This may not be accurate or correct.

Often a much shorter mandatory exclusion period of time is all that the law requires. By presenting the appropriate evidence at an appeal hearing, you can have the exclusion period reduced to a much shorter length of time.

Sometimes the OIG has initiated a mandatory exclusion when only a permissive exclusion (for a much shorter period of time than a mandatory exclusion) is authorized.

We have seen cases where a conviction of a criminal offense is not even one for which a Medicare exclusion is authorized at all. For example, a criminal action not involving theft, fraud or false claims and involving some technical violation of federal or state law, such as an immigration violation.

The only way to obtain relief when an inappropriate exclusion action is initiated by the OIG is to file a timely appeal and to have an appeal hearing before an administrative law judge. However, the appeal must be timely. It must be actually received by the appropriate official and agency by the deadline stated in the OIG’s letter. Not “mailed by,” not “filed by,” but “received by.”

Consequences of Medicare Termination or Exclusion from the Medicare Program Are Severe.

If you are terminated or excluded from the Medicare Program, you are automatically excluded from any state Medicaid Program. In many states, either of these are now grounds for revocation or non-renewal of a medical, nursing, dental, pharmacist, or psychotherapist license.

You will no longer be authorized to bill Medicare or Medicaid nor to order or prescribe an care or treatment paid for by Medicare or Medicaid. This means you will not be able to prescribe medications , order x-rays or lab test, or even order specialty consultations paid for by Medicare or Medicaid.

However, you will also be barred form any federal employment, contracting or subcontracting. You will be placed on the Office of Federal Contract Compliance Programs (OFCCP) Debarred List in the System for Award Management (SAM). This was previously called the “Debarred List” and was previously maintained by the General Services Administration.

SAM contains the electronic roster of debarred companies and individuals excluded from Federal procurement and non-procurement programs throughout the U.S. Government and from receiving Federal contracts or certain subcontracts and from certain types of Federal financial and nonfinancial assistance and benefits. The SAM system combines data from the Central Contractor Registration, Federal Register, Online Representations and Certification Applications, and the Excluded Parties List System.

You will be prohibited from working for or contracting with any company, organization or individual that receives any federal government funds from any source. You will be prohibited from being a shareholder, officer, employee, contractor or subcontractor of any company, organization or individual who receives any government funds from any source. This will prohibit you from almost any work for any health-related jobs, any insurance companies, any schools or colleges, any real estate agencies or brokers who are involved in any federally backed mortgages (VA or FHA), joining the military or public health service, and many, many other jobs.

Credentialing and certification organizations will revoke your credentials. Health insurance companies will terminate you from their provider panels.

Military service, forget it.

Work for the VA, forget it.

Contact an Experienced Health Lawyer to Help Eliminate or at Least Limit the Damage.

You need to immediately contact and retain an experienced health lawyer to fight this on the front end. You must try to reduce or prevent a lengthy exclusion period form being imposed from the very start. It will be too late to attempt to do this later.

You may have valid defenses to the exclusion, but only an experienced health lawyer is going to be able to assist you in finding these and effectively raising these in your defense. Don’t wait until it is too late!

Call The Health Law Firm! We area available to help you on these issues anywhere in the U.S.

Contact Health Law Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2024, George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder. The copyright holder reserves the exclusive right to have his name associated with this work.

What You Need to Know Right Now If the DEA is Knocking on Your Door!

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

Is the Drug Enforcement Administration (DEA) knocking at your door or, even worse, going through your files inside your office?

If so, this is what you need to know right now!

YES, you do have the right to call your attorney. Call your attorney right now. If you cannot, ask one of your employees or spouse to call your attorney. Get your attorney involved right now!

NO, do not sign a document to relinquish or voluntarily give up your DEA registration number. If you do so, this will probably be the biggest mistake you make in your life.

NO, do not sign a document waiving your right to a grand jury investigation before the DEA is authorized to charge you. Why would you voluntarily give up one of your most important constitutional rights?


Don’t Get Fooled By What the DEA Agents Tell You.

The DEA has the reputation (and, in my experience, deservedly so) of making false statements to individuals about what will happen to them or not happen to them if they do not “Cooperate” with the DEA by giving up their rights.

Often they will handcuff the pharmacist or the physician who is the subject of their raid, search warrant, or subpoena as a method of intimidating them. Then they will threaten the person by arresting them and jailing them immediately if they do not sign a “voluntary” relinquishment of their DEA registration. Yet once you do this, your DEA registration is gone, and you will most likely never get one again.

We have even had the report from a physician recently where the DEA agents, during executing a search warrant (not an arrest warrant, by the way), of having the doctor sign a document waiving her right to having a grand jury hearing on any charges she may have been facing. The threat was that she needed to waive her rights or be arrested on the spot and taken to jail. She signed without consulting an attorney.

If you are a pharmacist or pain management physician, or you own or operate a pain management practice, or if you prescribe or dispense opioids, you must have the name and phone number of a good health lawyer and a good criminal lawyer on hand and post at all times! It is only a matter of time before you need to use it.

Have this information in your wallet and taped to every telephone and computer in your office. But use it right away. Call your attorney right away. Your attorney will come over or brief you on what to do or not do.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH, and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections, and audits. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law, as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, call (407) 331-6620 or toll-free (888) 331-6620 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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620. Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2022 The Health Law Firm. All rights reserved.

By |2024-03-14T20:00:41-04:00March 16, 2024|Categories: Medical Education Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on What You Need to Know Right Now If the DEA is Knocking on Your Door!

Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

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

On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.

The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.

Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s office. In addition, a whistleblower who sued the company on behalf of the state will also receive $1 million. It is the second-largest Medicaid fraud settlement in Washington’s history.

An Investigation and a Whistleblower.

According to the press release, the Washington AG’s office began investigating pharmacy benefit managers in 2019 after a whistleblower said the company failed to disclose actual pharmacy benefits and service costs. Furthermore, Centene allegedly failed to pass on discounts it received to the state Medicaid program, causing inflated fees, according to the release.

Washington sued Centene in July 2022, alleging the company and a subsidiary, Coordinated Care of Washington, violated the state’s Medicaid False Claims Act. Coordinated Care of Washington contracts with Washington’s Health Care Authority to manage its Medicaid program, Apple Health.

Shelling Out Big Bucks For Settlements.

Centene did not admit to any wrongdoing in this case, as is usual with settlement agreements. “This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making healthcare delivery local, simple and transparent,” Centene’s spokesperson said.

But, while denying any wrongdoing, it has settled claims over similar alleged conduct in ten other states for more than $260 million. Additionally, it said last year that it was still in negotiations with more states and had set aside $1.25 billion to settle such claims. Click here to learn more. 

To view the settlement agreement in full, click here. 

Similar Patterns of Misconduct?

We need to ask: “Is this the business model of Centene and its different owned subsidiary companies?” We note that on March 22, 2022, the Centers for Medicare and Medicaid Services (CMS) assessed civil monetary penalties (CMP) against Centene Corporation for similar alleged wrongful activities involving the states of California, South Carolina, Texas, Ohio, Michigan, and others.  And in a letter dated March 11, 2022, the Florida Agency for Health Care Administration issued a $9.1 million fine over Centene/Sunshine Health’s improper failure to pay benefits to Florida’s neediest, sick children.  We have not found any report that Centene challenged or appealed either government penalty.

When multiple billions of dollars in government contracts are handed out to one contractor, and it is the subject of so many allegedly wrongful acts, one must ask if it is just treating such penalties and fines as the routine costs of doing business. Considering that $9.1 million is less than three (3) hundredths of a percent (.0003) of its $31 billion in contracts with the state of Florida, this cost may not even be significant enough for it to post on its profit ad loss statements.

Contact Health Law Attorneys Experienced with Medicare and Medicaid Audits, Healthcare Audits, and Insurance Payment Disputes.

The attorneys of The Health Law Firm represent counselors, therapists, physicians, healthcare providers and healthcare facilities in defense of Medicare and Medicaid audits, audits by insurance companies and managed care, and demands for repayment of overpayments. They represent healthcare providers in audits, audit appeals and repayment disputes against Centene Corporation and Sunshine Sate Health Plan d/b/a Sunshine Health. They also represent healthcare providers in defense against allegations of false billing, overbilling, False Claims Act violations and civil monetary penalties (CMP).

Our attorneys represent physicians, mental health counselors, behavior therapists, professional counselors, occupational therapists, social workers, medical groups, home health agencies, pharmacies, pharmacists, home nursing care providers, and other healthcare providers and institutions.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Redmond, Nell. “Centene to pay $33.3 million to settle Washington Medicaid fraud claims.” Reuters. (August 25, 2022). Web.

Elletson, Grace. “Centene Strikes $33M Deal To End Wash. Medicaid Fraud Suit.” Law360. (September 2, 2022). Web.

Health Law Weekly. “Centene Will Pay $19 Million to Resolve Medicaid Fraud Allegations.” AHLA. (September 2, 2022). 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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

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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 © 2022 The Health Law Firm. All rights reserved.

By |2024-03-14T09:59:09-04:00March 14, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

Many Adverse NPDB Actions Are Reported That Should Not Be;  Here Are Examples

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

We are constantly being contacted by physicians, nurse practitioners, and other licensed health professionals seeking to appeal adverse National Practitioner Data Bank (NPDB) reports.  Often, we find that an adverse report has been made when the matter should not have been.  Federal regulations and NPDB guidelines establish the types of incidents authorized to be reported to the NPDB.  When an employer or other organization makes an improper report, it should be challenged and removed.

Types of Matters That Are Not Authorized for NPDB Reports.

Following are some of the incidents for which we have seen adverse NPDB reports that were improperly made:
–Physician or nurse practitioner employed by hospital fired.
–Physician’s contract with a medical group or hospital terminated for cause.
–Hospital medical staff takes action against a physician or nurse practitioner requiring that individual to take continuing education courses on a certain subject.
–Physician’s clinical privileges are administratively suspended because of late medical records or notes.
–Physician or nurse practitioner has clinical privileges summarily suspended for less than 30 days while an investigation or inquiry occurs.
–Adverse action against or findings of substandard care made against an intern or resident physician are not reportable because they do not have clinical privileges.
–Withdrawal of an initial application for clinical privileges in order to avoid a denial (note: not a renewal application, an initial application).
–Adverse action a hospital takes based on the individual’s fees or advertising.
–Payment of a medical malpractice settlement because a hospital, nurse or different individual was negligent.
–Terminating clinical privileges because of inability to obtain board certification or failure to meet other eligibility criteria.
–Withdrawal of an initial application for a state license to avoid a denial (note: not a renewal application, an initial one).
–Resigning from or allowing membership in a professional association to expire before a final adverse decision by that association is made is not reportable (note:  this is unlike the situation from hospital clinical privileges or action by a state licensing board).
–Termination of clinical privileges or state license because of medical reasons.

There are many others. We see them all the time.

Improperly Reported to the NPDB?  Get a Lawyer and Challenge It!

If you are reported improperly to the NPDB, you must retain the services of a good health lawyer experienced with NPDB issues.  An adverse NPDB report can follow you for life and can make future employment very difficult.  An experienced health lawyer will know exactly what to do to have the improper report removed.

Click here to read one of my prior blogs on fighting against adverse NPDB reports.

Don’t Wait Until It’s Too Late, Contact Experienced Health Law Attorneys.

The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists, and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. 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 Toll-Free (888) 331-6620 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2024, George F. Indest III, The Health Law Firm. All rights reserved.
No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder.  The copyright holder reserves the exclusive right to have his name associated with this work.
By |2024-03-14T09:59:09-04:00March 12, 2024|Categories: Dental Law|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Many Adverse NPDB Actions Are Reported That Should Not Be;  Here Are Examples

Department of Health Quarterly Report Released Covering Through March 2021

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

The Florida Department of Health’s Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021.

Scope of the Florida Department of Health’s Control.

First, note that Florida’s Department of Health regulates 22 health care practitioner boards and four health professional councils. This makes it one of the largest such organizations in the country. Second, this also means that the practice of health care in Florida is one of the most heavily regulated anywhere in the U.S., with each professional board, as well as the Department of Health, having specific Florida statutes governing their professions, as well as the different boards each enacting different sets of administrative rules regulating those professions.

The Quarterly Performance Report contains financial and statistical information concerning licensed health professionals.

Key Emphasis on Unlicensed Practice of Health Care Professions.

The key emphasis of this report is the Department of Health’s ongoing efforts to reduce and eliminate the unlicensed practice (UP) of health care professions in the state. This is often referred to generically as the “unlicensed practice of medicine,” but it applies to any health profession for which a license in Florida is required, for example, massage therapy.

Large Number of Health Care Professionals in Florida.

The Report points out that the Department of Health issued 29,651 professional licenses to new applicants just in the Third Quarter of the fiscal year, from January 1, 2021, through March 31, 2021.

The Medical Quality Assurance (MQA) division of the Department of Health issued 102 cease and desist orders to unlicensed individuals whose unregulated and illegal activities were reported to it. It referred 98 complaints to law enforcement agencies for potential criminal violations.

The unlicensed practice of a health profession in Florida is a felony.

It would be interesting to imagine how many additional applicants there might have been for licensed and how many additional complaints and prosecutions for unlicensed practice there might have been if the COVID-19 pandemic hadn’t been in full bloom. The QPR shows overall enforcement support down for the Fiscal Year 2020-2021, undoubtedly because of this.

Which Professions Have Most Unlicensed Violations?

Although the QPR does not discuss this, from my own personal experience, the ere are three top runners: massage therapy, nursing, and dentistry; note, however, that this is my opinion, only.

It seems to me that there are many cases of mistaken unlicensed practice brought against massage therapists because of mistakes in identity by investigators. We have experienced cases where investigators arrest several different individuals of foreign origin who happen to be present at a massage establishment and accuse them of practicing there without a license when that person was only there visiting a friend or relative and did not touch any client. Often the visitor and even the licensed professionals there will speak little or no English, therefore being unable to clear up any confusion.

Dentistry is another profession where there is a great deal of unlicensed practice. Often this arises when an individual was a dentist in a foreign county and relocates to the U.S., but is unable to obtain a license. They may set up shop in a home or garage and hold themselves out to a certain group speaking the same foreign language, as able to provide skilled dental services. To me, the number of unlicensed practice cases I have encountered in this profession is largely due to the absence of qualified licensed dentists providing care in our communities, especially to the indigent and immigrant communities.

Charges of unlicensed practice of nursing often arise because of nurses who may have been trained abroad failing to make sure that everyone they work with refers to them as “medical assistants” or whatever other role they are filling. It is very common in doctors’ offices and medical practices to refer to anyone who assists the doctor in any way as “the nurse.” One must be careful if one is not a licensed nurse to correct this mistitling whenever it occurs. We have had multiple cases of a doctor’s competitor or a disgruntled patient filing a complaint that the doctor’s medical assistant was holding himself out to be a nurse when they were not.

To Read the entire DOH Third Quarterly Performance Report for 2020-2021, click here:

http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/qpr3-2021.pdf

Remember the Mission of the Florida Department of Health; It is Not to Help YOU.

The QPR emphasizes the same thing you will hear at every professional board meeting if you attend it. That is, the mission of the Florida Department of Health is to protect, promote, and improve the health of all people in Florida and to protect the public. It is not to advocate for or help any individual licensed health professional.

That is one of the reasons I continually tell licensed health professionals that if you want advice on what to do or how to do it legally, don’t call and ask the Department of Health.

First, there is no individual who is authorized to give you advice on what to do or not to do on behalf of any profession, board, or council. Second, there is no individual who is authorized to make decisions on behalf of any professional board or council. A professional board speaks when it meets, discusses an issue, and votes on that issue. That is how decisions are made; not by what one employee may think.

You may send all of your complaints and other hate mail to me at one of the addresses given below.

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 Toll-Free (888) 331-6620 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 © 2021 The Health Law Firm. All rights reserved.

 

 

 

Supreme Court of Pennsylvania Says Serial Killer Cannot Sue Psychiatrist for Medical Malpractice

Author headshot standing in dark suit with red tie against a dark grey backgroundBy: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 22, 2023, the Supreme Court of Pennsylvania unanimously decided that a serial killer cannot sue his psychiatrist for gross negligence because the action is barred by the Pennsylvania state law that prohibits criminals from benefitting from their crimes.

The Murderer’s Mental Health History.

In February 2016, Cosmo DiNardo was diagnosed with a major depressive disorder. Three months later, DiNardo was in an ATV accident in which he sustained head injuries. His mother reported that he began acting bizarrely a month after the accident. Additionally, DiNardo was also diagnosed with bipolar disorder and schizophrenia. He was prescribed strong antidepressants and antipsychotics.

DiNardo also had a violent history. During his institutionalizations, he allegedly attacked his mother and father on multiple occasions, as well as hospital staff members. He was also allegedly banned from his high school campus and university due to behavioral issues. It is also reported that doctors reported that DiNardo had homicidal and suicidal tendencies.

The Murders and Mr. DiNardo’s Confession.

On July 5, 2017, Cosmo DiNardo lured a 19-year-old to his family’s farm and shot and killed him. The next night, he and his cousin lured three more young men to the property and killed them as well. DiNardo and his accomplice disposed of the bodies by burning and burying them on the property. DiNardo was arrested days later after police located the grave site on the farm. He confessed to the murders.

In May 2018, DiNardo pleaded guilty to four counts of first-degree murder. He is serving four consecutive life sentences.

The Complaint Against the Psychiatrist.

DiNardo’s mother filed a complaint on DiNardo’s behalf that claimed his criminal conduct was the result of grossly negligent psychiatric treatment. In early 2017, the treating psychiatrist is alleged to have deemed DiNardo to be in remission from his bipolar disorder and reduced his medication dosage.

On July 6, 2017, the day after he murdered his first victim, DiNardo had an appointment with the psychiatrist. The psychiatrist continued to believe that DiNardo was not a risk to himself or others and advised him to cease his medication intake. That night, he murdered three more people.

The complaint claimed that if it were not for the psychiatrist’s grossly negligent failure to assess DiNardo’s risk for violence, then he would not have been involved in the murders. The complaint sought compensation for the emotional distress and pain DiNardo endured because he murdered four people and will live the rest of his life in prison.

Pennsylvania’s No Felony Conviction Recovery Rule.

The no felony conviction recovery rule is a Pennsylvania state law that prohibits convicted felons from profiting or benefitting from their criminal conduct. This law barred DiNardo’s mother’s complaint against the psychiatrist.

DiNardo pleaded guilty to four counts of first-degree murder. He did not plead insanity or guilty but mentally ill. He pleaded guilty and thus accepted full responsibility as an active participant in the murders. Therefore he must bear the losses sustained from his criminal actions.

The Supreme Court of Pennsylvania unanimously decided that the no felony conviction recovery rule barred the complaint because the compensation sought would benefit DiNardo for his criminal conduct.

Although the outcome of this case turned on an idiosyncracy in Pennsylvania law, it is doubtful that the case would have ever made it beyond the summary judgment stage anyway. There are no facts showing hope the psychiatrist would have had any way of knowing facts other than what the patient reported to her. There was no evidence that the parents had attempted to take any action to have DiNardo involuntarily confined or treated of mental illness, filed for a guardianship, attended sessions with the psychiatrist, or anything else. Perhaps they should have.

This modern trend of blaming others for our own shortcomings (and those of our children, needs to stop.

Psychiatrists are not miracle workers. They cannot read people’s minds. They cannot predict the future.

Furthermore, it is common knowledge (thanks in part to the HBO series “The Sopranos” and its storyline of Tony Soprano’s sessions with his psychiatrist, that there have been journal articles reporting that psychopaths and serial killers may use sessions with psychiatrists as a tool to sharpen their skills at deception and learn how to avoid getting caught and convicted.) (I don’t usually quote fictitious medical studies articles from fictitious TV series and movies, but actor Peter Bogdanovich, playing psychiatrist Elliot Kupferberg, was pretty convincing on this issue.)

The precedential case on the liability of psychiatrists for misdiagnosing murderers is, of course, Tarasoff vs. Board of Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976). This cases is a must for the reading and education of all psychiatrists, psychologists and psychotherapists.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This representation includes psychiatrists, mental health counselors, social workers, psychologists, physicians, nurses, dentists, psychologists, medical students and interns, as well as other health care providers.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in civil litigation in state and federal courts. We represent physicians and other health professionals in cases before medical boards, before state licensing agencies, and in National Practitioner Data Bank (NPDB) disputes. We represent physicians accused of wrongdoing, in patient complaint investigations and in Department of Health and in board licensing investigations in other states investigations.

To contact The Health Law Firm, please call (407) 331-6620 or toll free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Cipriano, Ralph. “The Untold Tale of Cosmo DiNardo’s Descent Into Murder and Madness.” Philadelphia City Life. (25 February 2020) https://www.phillymag.com/news/2020/02/25/cosmo-dinardo/

Dinardo v. Kohler No. J-8A-B-2023 (E.D. Pa. November 22, 2023)

D’Annunzio, P.J.. “Pa. Murderer Can’t Sue Doctors For Psychiatric Malpractice.” Law360. (27 November 2023) https://www.law360.com/health/articles/1769646?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-11-28&read_main=1&nlsidx=0&nlaidx=13

Henry, Tanya Albert. “He killed 4 men. Now he seeks compensation from his care team.” American Medical Association. (9 December 2022) https://www.ama-assn.org/practice-management/sustainability/he-killed-4-men-now-he-seeks-compensation-his-care-team

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Hartley Brooks is a law clerk with The Health Law Firm. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“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 © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

Male Surgeon Wins $15 Million Verdict in Suit Based on “Reverse Discrimination” and Anti-Male Bias; Hospital Requests New Trial

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
In a massive jury verdict awarding a male attending physician more than he requested, a jury found that a hospital demonstrated reverse discrimination and an anti-mail bias in how it handled a female resident physician’s complaint against him.
On January 8, 2024, Thomas Jefferson University Hospital urged a Pennsylvania Federal court to reverse a $15 million judgment against it over its handling of a sexual assault investigation in a gender bias case. In December 2023, a federal jury in the U.S. District Court for the Eastern District of Pennsylvania found that there was proof that the hospital exhibited anti-male bias and violated a male orthopedic surgeon’s civil rights when it investigated allegations that he sexually assaulted a medical resident.  Thomas Jefferson University Hospital claimed the court unfairly excluded key evidence that would have countered the surgeon’s claims that the female medical resident was actually the aggressor.
The Initial Incident. 
In 2018, Plaintiff John Abraham, a male orthopedic surgeon at Thomas Jefferson University Hospital, alleged that a female resident physician attended a pool party at his residence and engaged in sexually aggressive behavior towards him without his consent.  According to the law suit, he reported the female resident’s conduct to the hospital.
Dr. Abraham later learned that the female resident had already filed a complaint against him, resulting in an investigation into his behavior.  No charges against him aver resulted from the hospital’s investigation or a related criminal investigation.
The Alleged Gender Discrimination. 
Dr. Abraham sued Thomas Jefferson University Hospital, accusing it of practicing discrimination against men during its investigation of the sexual assault allegations.  According to him, the hospital demonstrated gender bias by disregarding his allegation that he was assaulted by the female and pressuring him to take a leave of absence.  This was compounded by its failure to take any action against the alleged female aggressor about whom he complained.  The investigation was eventually terminated with no findings after Dr. Abraham relinquished his privileges at the hospital.
In the suit Dr. Abraham sought $5 million in compensatory damages.  However, after the four-day civil trial, the federal jury awarded him $11 million in compensatory damages and $4 million in punitive damages.
The Hospital’s Request for a New Trial.
Thomas Jefferson University Hospital requested a new trial after the jury handed down the verdict. The hospital claimed that the court excluded critical evidence that it would have used on cross-examination of Dr. Abraham to help it win its case.  The excluded evidence included texts stating Dr. Abraham was not drunk at the party and that he intended to have sex with the female resident even though he knew it was unethical because she was his student.
The hospital also argued that the court gave incorrect jury instructions about the difference between anti-male discrimination and anti-respondent discrimination in a sexual assault investigation. According to the hospital’s motion, taking “risk minimization measures” against someone accused of sexual assault, like placing them on a leave of absence, is not cause for a Title IX gender discrimination lawsuit. Additionally, the hospital claims, not specifying this difference to the jury incorrectly led the jury to believe that anti-respondent bias was, in fact, anti-male bias.
The judge has not yet ruled on the hospital’s request.
To read two recent blogs I wrote about Title IX and its applications to resident physicians and fellows, click here and here
Contact Experienced Health Law Attorneys Representing Health Care Professionals, Medical Students, Residents, and Fellows.
The Health Law Firm routinely represents students, including medical students, dental students, nursing students, pharmacy students, resident physicians, and fellows, who have legal problems with their schools or programs. We also represent students, residents, and fellows in investigations, academic probation and suspensions, disciplinary hearings, clinical competence committee (CCC) hearings, and appeals of adverse actions taken against them. The Health Law 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.
Our firm also specializes in providing legal representation to a wide range of healthcare professionals, including pharmacists, massage therapists, mental health counselors, registered nurses, and more.
To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Abraham v. Thomas Jefferson University No. 2:20-cv-02967-MMB (E.D. PA. January 8, 2024)
Abraham v. Thomas Jefferson University No. 2:20-cv-02967-MMB (E.D. PA. June 19, 2020)
D’Annunzio, P.J.. “Info Kept From Jury In $15M Gender Bias Case, Pa. Court Told.” Law360. (9 January 2024) https://www.law360.com/articles/1783770
Rock, Amy. “Thomas Jefferson University to Pay $15 Million to Male Surgeon for Gender-Biased Rape Investigation.” Campus Safety Magazine. (15 December 2023) https://www.campussafetymagazine.com/university/thomas-jefferson-university-to-pay-15-million-to-male-surgeon-for-gender-biased-rape-investigation/
Ruderman, Wendy. “Former Rothman orthopedic surgeon takes on Jefferson in federal court over sexual assault allegations.” The Philadelphia Inquirer. (5 December 2023) https://www.inquirer.com/health/john-abraham-rothman-jefferson-sex-discrimination-case-jury-federal-20231205.html
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice.
Hartley Brooks is a law clerk with The Health Law Firm. Its main office is in the Orlando, Florida area.
The Health Law Firm can be visited at:  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“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 © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.
By |2024-03-14T09:59:10-04:00March 6, 2024|Categories: Medical Education Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Male Surgeon Wins $15 Million Verdict in Suit Based on “Reverse Discrimination” and Anti-Male Bias; Hospital Requests New Trial

Under Medical Peer Review from the Military or the VA? Get Experienced Legal Representation Now

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Our firm is often consulted by military physicians, Veterans Administration (VA) physicians, and former military and VA physicians concerning matters involving peer reviews of their care. In the military, whether Army, Navy, or Air Force, peer review for all physicians is now governed by one general department. The Department of Defense (DOD) Regulation, that is, Defense Health Agency Procedures Manual (abbreviated DHA PM) 6025.13, became effective October 1, 2019. VA physicians have different, but somewhat similar regulations that apply to them.
We are often consulted by these physicians, who no longer serve with those agencies, or after action has already been taken to report them to the National Practitioner Data Bank (NPDB) for allegedly substandard care. Such reports go into the NPDB for fifty (50) years and are reported to all state licensing boards and to the Federation of State Medical Boards (FSMB).
They can haunt a physician’s career for life.
What Should You Do When Notified of a Claim, Investigation, Peer Review Action, or Quality Assurance Investigation (QAI)?
When you first notice that you are the subject of or named in a Federal Tort Claims Act (FTCA) claim or any type of inquiry or investigation related to your care, you should consult with a healthcare attorney with experience in such matters. We are few and far between, but you can find us if you look for us.
You will usually have at least two opportunities to provide input into such matters, but you need to take advantage of the earliest opportunity to influence the outcome.
1.You must obtain and review a copy of the medical record.
2.You need to have an expert in your medical field review the case for you.
3.You can request an extension of time if needed.
What Are Questions I Should Ask of an Attorney with Whom I Consult?
These are the questions that I suggest you ask any attorney you consult with:
1.What is your experience dealing with the military or VA medical system?
2.How many similar matters of this nature have you handled?
3.Are you familiar with National Practitioner Data Bank (NPDB) reports, challenges and appeals?
4.How many NPDB matters have you handled?
5.How many cases have you handled in which you assisted in making statements for input into such investigations or inquiries?
6.Are you familiar with the Memorandum of Understanding (MOU) between the DOD and the Department of Health and Human Services (DHHS) taking DOD NPDB reports out from under the regular NPDB procedures?
7.How many military or VA quality assurance investigations have you represented physicians?
8.How many VA and military peer review/clinical privileges hearings have you done?
9.How familiar are you with hospitals and health systems?
10.How familiar are you with the military medical system, the roles of the Surgeons General, and the Department of Defense Division of Health Affairs (DOD HA)?
11.How familiar are you with DOD PM 6025.13?
12.How familiar are you with:  VHA Directive 1190 (Peer Review for Quality Management), VHA Handbook 1050.01 (VHA National Patient Safety Improvement Handbook), VHA Handbook 1100.17 (National Practitioner Data Bank (NPDB) Reports), VHA Handbook 1100.19 (Credentialing and Privileging), VHA Directive 2008-077 (Quality Management (QM) and Patient Safety Activities . . . ), VHA Directive 1026 (VHA Enterprise Framework for Quality, Safety and Management), and VA Handbook 5120/14 (Employee/Management Relations)?
Don’t Wait Until After the Decision to Report You Has Been Made.
Don’t wait until the final decision has been made to report you to obtain experienced legal counsel to represent you in defending yourself against allegations of substandard care. Avail yourself of any and all opportunities to provide your concise, objective, and well-reasoned medical rationale for your care at the earliest stage you are allowed to do so.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620
Attorney Positions with The Health Law Firm.  The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
“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 © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are constantly being contacted by physicians, nurse practitioners and other licensed health professionals seeking to appeal adverse National Practitioner Data Bank (NPDB) reports.  Often, we find that an adverse report has been made when the matter should not have been.  Federal regulations and NPDB guidelines establish the types of incidents that are authorized to be reported to the NPDB.  When an employer or other organization makes an improper report, it should be challenged and removed.
Types of Matters That Are Not Authorized for NPDB Reports.
Following are some of the incidents for which we have seen adverse NPDB reports that were improperly made:
–Physician or nurse practitioner employed by hospital fired.
–Physician’s contract with a medical group or hospital terminated for cause.
–Hospital medical staff takes action against a physician or nurse practitioner requiring that individual to take continuing education courses on a certain subject.
–Physician’s clinical privileges are administratively suspended because of late medical records or notes.
–Physician or nurse practitioner has clinical privileges summarily suspended for less than 30 days while an investigation or inquiry occurs.
–Adverse action against or findings of substandard care made against an intern or resident physician are not reportable because they do not have clinical privileges.
–Withdrawal of an initial application for clinical privileges in order to avoid a denial (note: not a renewal application, an initial application).
–Adverse action a hospital takes based on the individual’s fees or advertising.
–Payment of a medical malpractice settlement because a hospital, nurse or different individual was negligent.
–Termination of clinical privileges because of inability to obtain board certification or failure to meet other eligibility criteria.
–Withdrawal of an initial application for a state license to avoid a denial (note: not a renewal application, an initial one).
–Resigning from or allowing membership in a professional association to expire before a final adverse decision by that association is made is not reportable (note:  this is unlike the situation from hospital clinical privileges or action by a state licensing board).
–Termination of clinical privileges or state license because of medical reasons.
There are many others. We see them all the time.
Improperly Reported to the NPDB?  Get a Lawyer and Challenge It!
If you are reported improperly to the NPDB, you need to retain the services of a good health lawyer experienced with NPDB issues.  An adverse NPDB report can follow you for life and can make future employment very difficult.  An experienced health lawyer will know exactly what to do to have the improper report removed.
Click here to read one of my prior blogs on how to fight back against adverse NPDB reports.
Don’t Wait Until It’s Too Late, Contact Experienced Health Law Attorneys.
The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. 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 Toll-Free (888) 331-6620 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“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 © 2024, George F. Indest III, The Health Law Firm. All rights reserved.
No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder.  The copyright holder reserves the exclusive right to have his name associated with this work.
By |2024-03-14T09:59:10-04:00March 4, 2024|Categories: Massage Law Blog, Nursing Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples

Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements will fall by 3.4 percent under the PFS in 2024.

However, in a piece of good news, the 2024 final rule allows marriage and family therapists and mental health counselors, including addiction counselors, to enroll in Medicare and bill the program, for the first time ever.

Telehealth Expansions.

The PFS 2024 final rule expanded telemedicine and established that telehealth providers will be paid the non-facility rate for telehealth services. Under the rule, CMS will temporarily add health and well-being coaching services to the Medicare Telehealth Services List in 2024. Social Determinants of Health Risk Assessments will also be permanently added to the Telehealth Services List. The final rule also expanded the types of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists, and audiologists.

The final rule allows all diabetes self-management training services via telehealth. It also enables teaching physicians to be present using telecommunications when a resident furnishes telehealth services.

Finally, the rule established that rural health clinics and federally qualified health centers will continue receiving payment for telehealth services.

Outpatient Program Payment Increases.

CMS increased Medicare payments for hospital outpatient departments and ambulatory surgical centers by 3.1 percent for 2024. Stipulations in the Outpatient Prospective Payment Program final rule require hospitals to display standard charge information that conforms to a CMS template. Hospitals have been required to post the prices of services online since 2021, but compliance could be better.

Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll free at (888) 331-6620 and visit our website at www.ThehealthLawFirm.com.

Sources:

“Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule.” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule

“CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC).” CMS.gov Newsroom. (2 November 2023) https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

“CMS issues CY 2024 physician fee schedule final rule.” American Hospital Association. (2 November 2023) https://www.aha.org/news/headline/2023-11-02-cms-issues-cy-2024-physician-fee-schedule-final-rule

“CMS Issues Physician Fee Schedule Final Rule with Payment Rate Cut.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/e144866d-b571-4b10-98d0-530c46f3f5e7/CMS-Issues-Physician-Fee-Schedule-Proposed-Rule-wi?Token=fe443b47-6081-4bae-bc4a-936ffe203608

HHS Press Office. “CMS Finalizes Physician Payment Rules that Advances Health Equity.” United States Department of Health and Human Services. (2 November 2023) https://www.hhs.gov/about/news/2023/11/02/cms-finalizes-physician-payment-rule-advances-health-equity.html

“Medicare Payments for Hospital Outpatient Services to Increase 3.1% in 2024.” American Health Law Association Health Law Weekly. (3 November 2023) https://www.americanhealthlaw.org/content-library/health-law-weekly/article/dcc44d7b-c122-49fd-9e5a-9918549f2c44/Medicare-Payments-for-Hospital-Outpatient-Services

Pifer, Rebecca. “CMS finalizes 2024 Medicare hospital, doctor payments, 340B fix and price transparency requirements.” Healthcare Dive. (3 November 2023) https://www.healthcaredive.com/news/cms-medicare-hospital-doctor-rates-2024-340b-transparency/698706/

Vaidya, Anuja. “New PFS Rule Includes Telehealth Payment, Address Reporting Wins.” mHealth Intelligence Healthcare Media. (3 November 2023) https://mhealthintelligence.com/news/new-pfs-rule-includes-telehealth-payment-address-reporting-wins

About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice.

Hartley Brooks is a law clerk with The Health Law Firm.

The Health Law Firm’s main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced by anyone in any medium without the author’s express written permission. The author reserves the right to have his name associated with this work at all times.

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