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Finding a Healthcare Providers Service Organization (HPSO) Insurance Attorney to Defend you in a Complaint Against Your Pharmacist or Pharmacy License

Carole C. SchrieferBy Carole C. Schriefer, J.D.
Many pharmacists or their pharmacies carry professional malpractice insurance through Healthcare Providers Service Organization (HPSO) or one of the other similar professional liability insurance companies. What they may not realize is that this insurance will pay for their legal defense expenses if there is a complaint filed against their pharmacist license or the pharmacy’s license. It will also pay for legal defense expenses if they receive a subpoena for records, if they are required to attend a deposition, or if they are accused of violating HIPAA or a client’s medical confidentiality.

Under this type of policy, the insurance company will pay the legal fees and other costs related to your defense or legal representation. However, you will be required to locate and retain the appropriate attorney to represent you in the matter.

What to Look For When Retaining an Attorney to Defend You.

1. The primary qualification for any attorney you hire to represent you should be his or her experience in working with health professionals in the same field. If the attorney is not familiar with your area of health practice, with the type of legal proceeding you have, or with your professional licensing board, it may be difficult for that attorney to represent you properly.

2. If consult with an attorney who states that she or he will help you make a statement to the investigator or assist you in the investigation, but will not agree to appear and represent you in hearings, then this is the wrong attorney. You need an attorney that can represent you from start to finish.

3. Seek and retain an attorney who accepts the insurance that you have, whether it is HPSO Insurance, CPH & Associates Insurance, Philadelphia Insurance, Pharmacist Mutual Insurance Company (PMIC), Trust Management Services, Philadelphia Insurance, Firemans Fund, or another national company. This will ensure that you have an attorney who will give you the lower rates the insurance company has negotiated and will have a good working relationship established with your insurance company. If an attorney with our firm cannot represent you, we will try to find you an attorney who will.

4. You also want to retain the services of an attorney who has appeared before your professional board or professional licensing authority in investigations and hearings, especially in formal administrative hearings.

5. Often you will come across an attorney who only wants you to accept a consent order, stipulation, or settlement agreement. Remember that these are all merely plea bargains and you will be pleading guilty to whatever offenses are charged. This is teh easy way out and often the easy way is not the right way. IF you plead guilty then, from that point on, you are guilty. In most cases, however, you will actually be innocent of the charges and will need a formal administrative hearing in order to prove this.

6. You don’t necessarily need an attorney who resides in your city, state, or location. Almost all the work on the case will be done by telephone and e-mail. You usually have only one meeting or hearing and, depending on what type of hearing it is, it could be located in many different locations. Our attorneys will travel to those locations for meetings and hearings.

7. Beware of attorneys who hold themselves out in Internet advertising as health attorneys or professional license defense attorneys but are really some other type of attorneys. We see this a lot from medical malpractice attorneys, criminal defense attorneys and attorneys who sue insurance companies. Be sure you get an attorney who concentrates his or her practice in defending those in the specialty of pharmacy and in board of pharmacy complaints, investigations, and hearings.

8. If you can’t find an attorney to meet your immediate needs through our firm or an Internet search, you may contact your insurance company or professional association and ask if they have a list of attorneys that can do the legal work you require.

For example, you may reach Healthcare Providers Service Organization (HPSO) at (800) 982-9491; you can reach Nurses Service Organization (NSO) at (800) 247-1500; you can reach CPH & Associates at (800) 875-1911 or (312) 987-9823; you can reach Pharmacists Mutual Insurance Company (PMIC) at (800) 247-5930.

Contact Health Law Attorneys Experienced Investigations of Pharmacists and Pharmacies.

The attorneys of The Health Law Firm provide legal representation to pharmacists, pharmacies, prescribing physicians, dispensing physicians and nurse practitioners, and other health providers in pharmacy board complaints and investigations, Department of Health (DOH) investigations, Colorado DORA investigations, Drug Enforcement Administration (DEA) investigations, Medicare and Medicaid audits, Medicaid Fraud Control Unit (MFCU) investigations, and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.

We also defend health professionals and health facilities in general litigation matters and business litigation 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: Carole C. Schriefer is an attorney and former registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

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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 © 2020 The Health Law Firm. All rights reserved.

By |2020-02-04T16:56:51-05:00February 4th, 2020|Categories: Colorado Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Nursing Student Claims Sexual Harassment, Retaliation in Lawsuit Filed Against North Carolina Lawsuit

Attorney Carole C. Schriefer Headshot By Carole C. Schriefer, R.N., J.D.
On November 29, 2019, a former University of North Carolina nursing student sued the school’s Greensboro campus, saying it improperly dismissed from her a program a month before graduation. She filed two separate suits. She claims she was forced to endure sexual harassment as a student for years. Then, when she accused a supervisor of misconduct, she was gradually pushed out of the nursing program, according to the lawsuit.

She is suing the University of North Carolina’s Greensboro nursing department in state court and UNC’s Board of Directors along with the Raleigh School of Nurse Anesthesia in federal court.

Lawsuit Describes Alleged Sexual Harassment, Retaliation.

According to the suit, the harassment began less than a year after she enrolled in the Doctor of Nursing Program at UNCG in August 2015, with hopes of becoming a nurse anesthesiologist. She was put under the supervision of a male certified registered nurse anesthetist, or CRNA. In her suit, she alleges that her supervisor began acting inappropriately almost immediately.

When she reported the harassment in July 2016, that’s when the retaliation started, claims the lawsuit. “They started trying to find things,” she reportedly said. She claims that one supervisor told her “If I can’t get you for this, I can get you for something else.” A few months later, on October 31, 2016, she states she was given additional clinical work and reassigned to work with the same CRNA she had previously reported for harassment, according to court documents.

In June 2018, a month before she was to graduate, she was dismissed from the program for what the school said were unsafe nursing practices. She appealed and UNCG allowed her to re-enroll in January 2019 for a tuition of $10,000. However, a month later, she was dismissed again for unsafe nursing practices. UNCG then refused any further appeals and upheld her dismissal in May 2019.

The nursing student is seeking unspecified damages, including loss of income and repayment of tuition, according to the lawsuit.

To read one of my prior blogs on a similar case dealing with a harassment lawsuit at Rutgers University, click here.

Contact Experienced Health Law Attorneys Representing Medical Students, Residents and Fellows.

The Health Law Firm routinely represents medical students, residents, and fellows who run into difficulties and have disputes with their medical schools or programs. We also represent other health providers in investigations, 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.

Sources:

“Lawsuit describes harassment, retaliation at UNCG nursing school.” Greensboro News & Record. (December 3, 2019). Web.

Waggoner, Martha. “Lawsuit describes harassment, retaliation at Nursing School.” The Washington Post. (December 3, 2019). Web.

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

KeyWords: Legal representation for nursing students, legal representation for nurse practice students, legal representation for nurse anesthetist students, nursing student attorney, nurse practice attorney, nurse anesthetist student attorney, nursing student legal counsel, nurse practice legal counsel, nurse anesthetist legal counsel, education law attorney for health professionals, education law legal counsel for health professional students, education law lawyer for health professional students academic review hearing attorney, nursing board defense attorney, nursing board defense legal representation, nursing school attorney, nursing school lawyer, nursing school legal counsel, nursing school legal defense counsel, legal dispute with nursing school, legal representation for CRNAs, attorney for CRNAs, lawyer for CRNAs, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, board of nursing legal defense counsel, board of nursing defense lawyer, board of nursing 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.
Copyright © 2020 The Health Law Firm. All rights reserved.

Finding an HPSO Attorney to Defend you in a Complaint Against Your Mental Health Counselor or Social Workers License

Attorney Carole C. Schriefer HeadshotBy Carole C. Schriefer, R.N., J.D.
Many licensed mental health counselors (LMHCs), licensed clinical social workers (LCSWs), Licensed Marriage and Family Therapists (LMFT), and other mental health professionals carry professional malpractice insurance through Healthcare Providers Service Organization (HPSO) or one of the many other insurance companies. What they may not realize is that their insurance will pay for their legal defense expenses if there is a complaint filed against their license, they receive a subpoena, or they are accused of violating HIPAA or a client’s medical confidentiality.

Under such policies, the insurance company will pay the legal fees and other costs related to your defense. However, you will be required to locate and retain the appropriate attorney to represent you in the matter.

What to Look For When Retaining an Attorney to Defend You.

1. The primary qualification for any attorney you hire to represent you should be her experience in working with health professionals in the same field. If the attorney is not familiar with your area of health practice, it may be difficult for that attorney to get up to speed to represent you properly.

2. If you come across an attorney who states that he or she will help you make a statement or assist you in the investigation, but does not appear in hearings, then this is the wrong attorney. You need an attorney that can represent you from start to finish.

3. Seek and retain an attorney who accepts the insurance that you have, whether it is HPSO Insurance, CPH & Associates Insurance, Philadelphia Insurance, Trust Management Services, or another national company. This will ensure that you have an attorney who will give you the lower rates the insurance company had negotiated and will have a good working relationship established with your insurance company. If an attorney with our firm cannot represent you, we will try to find an attorney who will.

4. You also want to retain the services of an attorney who has appeared before your professional board or professional licensing authority in investigations and hearings, especially formal administrative hearings.

5. Often you will come across an attorney who only wants you to accept a consent order, stipulation, or settlement agreement. Remember that these are all merely plea bargains and you will be pleading guilty to whatever offenses are charged. In most cases, you will be innocent and need a formal administrative hearing in order to prove this.

6. You don’t necessarily need an attorney in your city, state, or location. Almost all the work on the case will be done by telephone and e-mail. You usually have only one meeting or hearing and, depending on what type of hearing it is, it could be located in many different locations. Our attorneys will travel to those locations for meetings and hearings.

7. Beware of attorneys who hold themselves out in Internet advertising as health attorneys or professional license defense attorneys but are really some other type of attorneys. We see this a lot from medical malpractice attorneys and criminal defense attorneys. Be sure you get an attorney that concentrates his or her practice in defending those in your specialty board complaints, investigations and hearings.

8. If you can’t find an attorney to meet your immediate needs through an Internet search, you may contact your insurance company or professional association and ask if they have a list of attorneys that can do the legal work you require.

For example, you may reach Healthcare Providers Service Organization at (800) 982-9491; you can reach Nurses Service Organization (NSO) at (800) 247-1500; you can reach CPH & Associates at (800) 875-1911 or (312) 987-9823. You can also access a list of professional license defense attorneys online at https://taana.org/referral/.

To learn more about finding an HPSO attorney to defend you in such matters, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers, and family therapists in Department of Health (DOH) investigations, FBI investigations and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.

We also defend health professionals and health facilities in general litigation matters and business litigation 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: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

KeyWords: Healthcare Providers Service Organization (HPSO) Insurance defense attorney, HPSO lawyer, representation for HPSO matters, representation for professional liability insurance cases, representation for licensed mental health counselors (LMHCs), mental health counselor defense lawyer, mental health counselor representation, social worker defense lawyer, representation for social workers, social worker defense attorney, social worker complaint cases, mental health counselor complaint cases, defense lawyer for psychologists, Florida health law defense attorney, medical license defense, Florida Department of Health (DOH) attorney, representation for DOH investigations, DOH defense lawyer, representation for Agency for Health Care Administration (AHCA) investigation, AHCA complaint defense, administrative complaint lawyer, administrative complaint defense, administrative hearings defense, representation for health care professionals, representation for doctors, representation for nurses, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm. All rights reserved.

Hospital Countersues FCA Whistleblower for Failing to Report Information Internally

Carole C. SchrieferBy Carole C. Schriefer, R.N., J.D.
On March 13, 2019, a West Virginia hospital facing a whistleblower lawsuit countersued a former employee who filed the False Claims Act (FCA) lawsuit against the health system. Wheeling Hospital alleges that the former executive, who is the whistleblower/relator in the lawsuit, breached his fiduciary duty to the company by failing to report the unlawful conduct internally, first. Instead, he used the information as the basis for his whistleblower claim. In the countersuit filed in the U.S. District Court for the Northern District of West Virginia, the Hospital accuses the former executive-turned-whistleblower of attempting to ‘extort a settlement’ and filing the FCA whistleblower suit as an act of revenge.

The Whistleblower’s Complaint.

The whistleblower, a former accountant, and senior executive at Wheeling Hospital, was discharged in August 2015. In December 2017, he filed a complaint under the qui tam provisions of the False Claims Act (FCA). He alleged the hospital violated the federal Anti-Kickback Statute (AKS) by paying kickbacks to physicians for patient referrals to the Hospital. Based on this, it is alleged, the claims for the services the hospital provided to the referred patients were false claims, subject to recoupment by the government.

The Hospital’s Countersuit.

In an unusual strategy, the Hospital filed a counter-suit against the whistleblower, alleging that he breached his fiduciary duty to the Hospital and abused the legal process. The Hospital’s case asserts that instead of carrying out his duty to the Hospital, instead, he capitalized on his alleged knowledge of the conduct to “extort a settlement” through a “false and frivolous” FCA suit as an act of revenge.

Additionally, the Hospital alleges that “at no time during his employment, or in his role as a partner at Deloitte, did he report any suspicions of fraud or violations of federal regulations to Wheeling Hospital’s compliance officer.”

You can read Wheeling Hospital’s countersuit against the whistleblower on our website in full.

The Significance of This Case: Unique Defense Strategy for Defending a Whistleblower Suit.

This case shows a unique, but legally valid, defense strategy that might be used in other future whistleblower cases. Often the information about false claims is produced by a high-ranking hospital or institutional employees whose job duties may have required them to report what they knew to the company as part of their job. The company should then have the opportunity to investigate and correct any improper billing or other misconduct that an errant employee might be carrying out on his own. By failing to do this, the employee may breach his duties to the company, may violate his employment contract, and may be subject to a suit or counter-suit over this. To the extent that the actions of the ex-employee cause the employer damages, the employer may be entitled to indemnification from the ex-employee.

However, the other side of the story is when an employee does make his or her superiors aware of suspected misconduct and false claims within the company and the company does nothing about it. This is often the case that we have when potential blowers contact us about filing a False Claims Act case. Often the whistleblower attempts to do the right thing by reporting it within the company and is stymied by his or her superiors. To us, this opens the door to legitimate whistleblower suits.

To read one of my prior blogs about South Florida Hospital reaching a settlement for similar FCA
claims, click here.

Click here to learn more about who can file a whistleblower/qui tam lawsuit and the reward programs for coming forward with a false claim.

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 (whistleblower or qui tam) case. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities that have been sued in False Claims Act (whistleblower 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 whistleblower 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:

Pearlman, Steve and Freeman, Meika. “Top 10 Whistleblowing And Retaliation Events Of The Year.” Law360. (December 20, 2019). Web.

Goldberg, Pinchos. “Hospital Sues Whistleblower for Failing to Report Information And Choosing Instead to Use As Basis for Claim.” JD Supra. (May 8, 2019). Web.

Commins, John. “HOSPITAL COUNTERSUES FALSE CLAIMS WHISTLEBLOWER.” Health Leaders. (May 9, 2019). Web.

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

Keywords: Florida health law attorney, whistleblower attorney, whistleblower defense lawyer, Florida health law defense attorney, whistleblower defense attorney, whistleblower defense legal counsel, legal representation for whistleblower cases, qui tam lawyer, health law attorney, qui tam defense lawyer, qui tam plaintiff lawyer, whistleblower legal representation, False Claims Act lawyer, False Claims Act attorney, False Claims Act legal counsel, The Health Law Firm, DOJ defense lawyer, Office of Inspector General (OIG) defense counsel, Office of Inspector General (OIG) defense attorney, Office of Inspector General (OIG) legal representation, medcila legal defense attorney, health care fraud attorney, health care fraud lawyer, attorney legal representation for qui tam cases, Anti-Kickback Statute (AKS) attorney, Anti-Kickback Statute (AKS) lawyer, Anti-Kickback Statute (AKS) defense counsel, Medicare fraud defense lawyer attorney, Medicare fraud legal representation, Medicaid fraud defense lawyer attorney, legal representation for Medicare and Medicaid fraud, legal representation for Stark Law violations, healthcare fraud defense attorney, whistle blower lawyer attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida qui tam whistle blower lawyer attorney, Colorado qui tam whistle blower lawyer attorney, Louisiana qui tam whistle blower lawyer attorney, Kentucky qui tam whistle blower lawyer attorney, Virginia qui tam whistle blower lawyer attorney, District of Columbia (D.C.) qui tam whistle blower lawyer attorney, civil monetary penalties lawyer attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer attorney legal counsel, Virginia False Claims Act (FCA) and civil monetary penalties lawyer attorney, Virginia whistleblower lawyer attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer attorney, civil monetary penalties lawyer attorney

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2019/2020 The Health Law Firm. All rights reserved

By |2019-12-30T20:53:58-05:00December 30th, 2019|Categories: Colorado Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Doc Charged in Largest Medicare Scheme Ever Reported Involving Genetic Testing

By Carole C. Schriefer, R.N., J.D.
On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Alleged Fraudulent Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

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

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, 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.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistleblower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. 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 several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

KeyWords: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

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

By |2019-12-05T20:30:00-05:00December 5th, 2019|Categories: Colorado Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Doctor Sentenced to 40 Years For Alleged Interstate Pill Mill

By Carole C. Schriefer, R.N., J.D.

On October 2, 2019, a physician in Virginia received a 40-year prison sentence for illegally prescribing more than half a million opioid pills over 19 months. The U.S. District Court for the Western District of Virginia handed down the sentence to Joel Smithers, who reportedly operated a “pill mill” out of Virginia, according to authorities. In addition to prison time, he was given an $86,000 fine and will serve three years of supervised release upon the completion of his prison time, according to court documents.

The sentence is lighter than it could have been. He was facing up to life in prison and a fine of more than $200 million, according to officials at the U.S. Justice Department (DOJ). Click here to view the court’s sentencing document in full.

The Alleged Interstate Pill Mill Operation.

In May 2019, Smithers was convicted by a jury on more than 859 federal drug charges, including one count of possessing with the intent to distribute controlled substances and one count of maintaining a place for the purpose of unlawfully distributing controlled substances. Additionally, he was convicted on hundreds of counts of unlawfully distributing a controlled substance without a legitimate medical purpose or beyond the bounds of medical practice.

When he opened his Virginia practice in 2015, officials said he prescribed controlled substances to “every patient in his practice, resulting in over 500,000 Schedule II controlled substances being distributed.” Authorities say that he allegedly ran an operation that was less a medical practice and more an interstate drug distribution network.

Smithers was able to rake in over $700,000 in cash and credit card payments before the search warrant was executed at his office on March 7, 2017. Click here to read the press release issued by the U.S. Attorney’s Office in the Western District of Virginia.

To learn about a similar case involving two Florida doctors, click here.


The Problems I See in This Case.

I tell you that I take issue with many of the cases of this sort. I do not know enough about the actual facts of this physician’s case, but I can comment generally based on other similar cases I have had in the past. The government, both state and federal, has come down like a hammer on individual physicians and pharmacists in its over-zealous campaign to crack down on opioids. Many physicians and pharmacists, just trying to do a good job and legitimately treat their patients, are being caught up and persecuted. Chronic pain patients, many of whom are disabled veterans or people injured on the job, are unable to find physicians to treat them anymore or, if they can, any pharmacists willing to fill their prescriptions.

All sorts of under-handed techniques are used to try to make a case against conscientious health professionals who are merely trying to do their jobs. These do include the tactic seen in the case we are reporting on, which I call “bean counting.” The government comes in and, instead of proving how many allegedly illegal prescriptions were written or how many patients the physician gave the prescriptions to, breaks these out into the number of pills. This greatly exaggerates the case and these large numbers alone make it look like the doctor (or pharmacist) is doing something wrong or extremely way out of the norm.

For example, if a patient was receiving a low dose of a pain killer, say 10 mg Oxycodone every 4 to 6 hours, prescribed for four times a day, the ordinary monthly prescription for this medication alone (and such patients rarely receive one type of medication alone) this equates to 120 pills per month. If 10 mg pills are not available and/or the prescription is filled with 5 mg pills, instead, this is 240 pills a month. A years’ worth is 1,440 pills or 2,880 pills for just one patient. If the physician has 50 similar patients, this is 72,000 pills or 144,000 pills a year that the physician is writing and a pharmacy or pharmacies are filling.

This does not seem extreme or unusual to me, at all, and these amounts are on the low side. Yet just as government agencies love to inflate the “street value” or contraband drugs they seize, they love to break down the number of opioids a physician writes so it seems to a layperson to be extraordinarily large. Furthermore, a pain management physician or any other kind of physician cannot survive with just 50 patients a month. It is far more likely for a physician to have a thousand (1,000) or more patients a month. I call this type of numerical exaggeration “bean counting.” But it has put a number of physicians and pharmacists in jail.

Judges should not allow such exaggerated numbers to be introduced into evidence in the absence of further information that places them in context. It is unfairly prejudicial to the defendant to do so.


Contact Health Law Attorneys Experienced with DEA Cases.

The attorneys of The Health Law Firm are experienced in handling Drug Enforcement Administration (DEA) cases, board of medicine cases and board of pharmacy cases regarding allegations of over-prescribing and illegal prescribing. If you are currently being investigated or facing other adverse actions by the DEA contact one of our attorneys by calling (407) 331-6620 or (850) 439-1001. You can also visit our website for more information at www.TheHealthLawFirm.com.

Sources:

Booker, Brakkton. “Doctor Gets 40 Years For Illegally Prescribing More Than Half A Million Opioid Doses.” NPR. (October 2, 2019). Web.

“Virginia doctor could get life in prison today for prescribing 500,000 opioid pills.” RTV6. (October 2, 2019). Web.

Almasy, Steve. “Virginia doctor who illegally prescribed 500,000 opioid pills sentenced to 40 years in prison.” CNN. (October 2, 2019). Web.

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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How Criminal Charges Can Affect Your Professional Medical License

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

Every health care provider knows that their license to practice can be disciplined for misconduct on the job. However, many are surprised to learn that they can also be disciplined for actions including criminal charges that occur outside their professional lives.  A criminal conviction for a felony or misdemeanor that is not directly related to their profession can still result in discipline.

Criminal Charges Do Impact Professional Licenses.

Licensing authorities are charged with protecting the general public, not the individuals they regulate. Most health care practitioner practice acts include criminal convictions as one of the grounds for the denial or discipline of a professional license. Some of those acts (for example, Florida) allow the disciplinary authority to impose discipline upon a conviction even when adjudication is withheld.

These authorities can and do impose discipline based upon the facts underlying a conviction, even when the conviction itself is not directly related to the practice of a profession.  For example, a conviction for driving under the influence (DUI) or reckless driving can raise the question of whether the practitioner could be impaired or reckless while providing patient care.  The licensing authority will most likely investigate these matters and the facts underlying the offense to determine if the practitioner poses a threat to the public.

Therefore, if you have been arrested for DUI, disorderly conduct, assault, or any other misdemeanor, you can anticipate that the state, the Department of Health (DOH) or the Department of Licensing and Regulatory Affairs will start an investigation. It is imperative that you retain an attorney who can immediately defend your freedom during your criminal case and also protect your livelihood during licensing proceedings.


Conviction of Felony or Misdemeanor Charges May Lead to Suspension of Professional License.

In the event of a conviction, in many cases, this may trigger a report to the state licensing board.  In Florida, for example, a physician or other licensed health professional who is required to have a practitioner profile must update that profile with the information about the conviction within 15 days.  In Florida, a physician or other licensed health professional must also notify his or her licensing board for the Department of Health (when there is no board), in writing, within 30 days.

If you are facing felony or misdemeanor charges, it is imperative that you seek the advice and experience of an attorney who can navigate the criminal and administrative courts and get you the best possible result to protect your freedom and livelihood. Remember, your profession is often your only means of support.

Practitioners who have been arrested generally want their criminal cases resolved as quickly and quietly as possible.  Unfortunately, they may inadvertently accept a plea arrangement that results in severe discipline or revocation of their license.  All health care providers and their criminal attorneys should consider the consequences to the practitioner’s license before accepting a plea arrangement and should consult with an experienced health law attorney. Click here to read one of our prior blogs for more information on this.

Contact Health Law Attorneys Experienced in Handling Licensure Matter and Disciplinary Matters.

If you have been arrested, it is strongly recommended that you retain an experienced health care attorney who can advise you and your criminal counsel as to the effects a potential outcome could have on your license.

The Health Law Firm routinely represents physicians, pharmacists, nurses, and other healthcare practitioners in licensure matters.  We frequently consult with criminal defense attorneys regarding defense strategies tailored to minimizing criminal sanctions while at the same time preserving the practitioner’s license.

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 George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 2018 The Health Law Firm. All rights reserved.

Dental Clinic Owners Found Guilty of $1 Million Medicaid, Tax Scheme

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

On February 21, 2019, a federal jury found the owners of several dental clinics in Missouri guilty of a $1 million scheme to defraud the government. The owners of All About Smiles LLC, were convicted of submitting false claims to Medicaid for dentures and other services and payroll tax fraud, according to prosecutors.

Submitting False Claims.

Prosecutors alleged that the couple that owned the practice ran several schemes through the dental clinics from 2010 to 2015, including conspiring to defraud Medicaid. A main part of the scheme was to provide dentures and other services to adults who didn’t qualify for Medicaid. They would then bill the Medicaid program anyway, receiving more than $720,000, according to the DOJ.

The pair also allegedly ran a similar scheme with orthodontic equipment, racking up an estimated 241 false claims, said prosecutors. All About Smiles was paid approximately $165,700 during the the duration of the scheme.

Payroll Problems.

In addition to the fraud, the owners allegedly failed to forward payroll taxes to the Internal Revenue Service (IRS) even though the money was withheld from employee paychecks. Instead, the married pair used the almost $195,000 to cover lavish personal expenses and make payments on a variety of vehicles, said the DOJ.

Not Smiling Anymore.

Jurors found the couple guilty on all charges detailed in a 40-count indictment accusing them of fraudulently operating three All About Smiles LLC dental clinics, said the DOJ. Additionally, their legal woes continued to stack up as each was also convicted on a count of theft of public money for collecting unemployment benefits while working.

The female owner faces up to 10 years in prison on every count besides the payroll tax conspiracy charge, which comes with a maximum penalty of five years. The husband owner could get up to a decade for obtaining unemployment benefits and five years for each additional charge, prosecutors said.

Click here to read the DOJ’s press release.

To read one of my prior blogs on a similar case about a dentist defrauding medicaid, click here.

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

The attorneys of The Health Law Firm represent dentists, oral surgeons, and other health care providers in Medicaid audits, Medicare audits, insurance billing audits, ZPIC audits, RAC audits, administrative litigation and civil litigation throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in licensure complaints and investigations, DEA investigations, Medicare and Medicaid fraud investigations, audits, recovery actions and terminations from the Medicare or Medicaid Program.

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

Sources:

“All About Smiles Owners Convicted of Fraud.” Ozark Independent. (February 21, 2019). Web.
Posses, Shayna. “Couple Found Guilty Of $1M Medicaid, Payroll Tax Scheme.” Law360. (February 21, 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.

By |2019-04-18T18:44:05-04:00April 18th, 2019|Categories: Centers for Medicare and Medicaid Services, Dental Law Blog, Dentist Defense attorney, Health Care Fraud, Health care Law, Medicaid Fraud, Medicaid fraud|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Colorado Jury Rules in Favor of Marijuana Grow Business in Federal RICO Lawsuit

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

On November 14, 2018, a federal jury in Denver rejected claims involving the odor that was allegedly coming from a pot farm. This was a case that was being closely watched by the marijuana industry. The marijuana business had been sued for damages to neighboring property value under anti-racketeering laws.

A Closely Watched Lawsuit.

This was an important suit for the marijuana industry because it was the first federal suit brought under federal anti-racketeering laws. If the lawsuit had been successful, it could have created a new blueprint for opponents of marijuana legalization to dismantle the industry through civil cases under RICO laws.

The couple who own and live on land adjacent to the grow facility said the facility damaged their property values because of noise and odor. Because it harmed their views, and because no one wants to live near illegal activity, they claimed damages of $1 million.

The grow facility argued during trial that it didn’t cause any odor; its odor-control system doesn’t vent outdoors.

After a short deliberation, the jury ruled in favor of the marijuana grow facility and found it was not responsible for any of the alleged damages. Attorneys that represent similar marijuana facilities said proving property damages in cases like these are very difficult and hope the outcome of this case will deter others from trying the same. Click here to read more on this case.

Click here to read one of my prior blogs on this case.

It is unclear to me why the Plaintiffs in this case prosecuted the case under a RICO theory since such a cause of action is usually very difficult to prove. However, I am not aware of all the facts of the case. It seems to me that a simple suit for nuisance against the marijuana grow farm would have been easier to prove and obtain an injunction on.

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:

Foody, Kathleen. “Colorado Lawsuit Could Ripple Through US Cannabis Industry.” Health News Florida. (October 30, 2018). Web.

Ingold, John. “Jury finds in favor of Colorado marijuana grow in closely watched federal lawsuit.” The Colorado Sun. (November 18, 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 © 2018 The Health Law Firm. All rights reserved.

ECFMG Affidavit to Complete? Attending a Caribbean Medical School? Being Investigated for Irregular behavior by the ECFMG or USMLE? You need Legal Advice! Your Residency Matching Might Now Be at Issue, as Well!

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

Have you recently unexpectedly received an affidavit from the Educational Commission for Foreign Medical Graduates (ECFMG or the United States Medical Licensing Examination (USMLE) Secretariat? Are you attending or have you graduated from a Caribbean medical School such as the University of Science, Art and Technology (USAT), Faculty of Medicine, in Montserrat, or the Atlantic University School of Medicine (AUSOM) in St. Lucia? Then you are probably, unknowingly, being investigated for misconduct, improprieties in your medical school attendance or other “irregular behavior.” You need to consult with a lawyer and specifically a lawyer who knows and understands the processes followed by the ECFMG and the USMLE.

Large Number of Legal Inquiries Being Received from Current Students and Graduates of USAT.

A year ago, our firm was receiving a large number of calls from students and graduates of the Atlantic University School of Medicine (AUSOM) concerning inquiries and letters they were receiving from the ECFMG and/or the USMLE. However, over the past several months, we have now received an even larger number of inquiries from students and alumni of the University of Arts, Technology and Sciences (USAT) Faculty of Medicine in Montserrat. We have now seen several different affidavits which the ECF image he has sent to students and graduates of USAT which request some very specific and detailed information about their course attendance and experience as students at USAT.

Each inquiry we have received from students and graduates of USAT has disclosed facts and circumstances that are slightly different from the other. From these we have been able to piece together a fairly comprehensive picture of what is probably going on. To summarize, it appears that you SAT is under investigation by the ECF image he for the various irregularities that our clients have disclosed have occurred in the past.

Affidavits from the ECFMG and the USMLE Should Be Taken Very Seriously. They Should Be Answered Truthfully and Must Be Returned Promptly.

The Handbook and Guidelines published by the ECFMG and the USMLE, require that any student or graduate who applies for their services must promptly respond to requests for information. This would include responding to the affidavits (which are really questionnaires to be completed under oath). Otherwise, the applicant can be charged by the ECFMG or the USMLE with “irregular behavior” in accordance with the Handbook and Guidelines that they previously agreed to follow when initially applying.

We hear from our callers, clients, and potential clients that they may have received instructions from their schools or from other sources that they do not have to do send these affidavits back in or respond to these requests for information. We do not believe that this is correct and vice. If confronted by having been sent such an inquiry or affidavit by the USEMLE or ECFMG, you should immediately contact competent, experienced, legal counsel to advise you on the exact issues and facts of the situation. You will only receive advice that takes your own personal interests into consideration from your own personal attorney; you are not likely to receive it from anyone else.

View Our Other Blogs on Our Experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Our law firm is had a great deal of experience representing students and graduates in disputes with and defending charges of “irregular behavior” against the USMLE, ECFMG and he NBME. To review a few of these please see:
What to Do If You Receive an Inquiry From the USMLE, ECFMG, or NBME
GOING TO TAKE THE USMLE STEP EXAMS? BEWARE OF ACTIONS THAT CAN BE CALLED “IRREGULAR BEHAVIOR”-PART 1, and
Accused of Irregular Behavior on the USMLE? Here’s What You Will Do Wrong.

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 © 2018 The Health Law Firm. All rights reserved.

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