Dentist Defense attorney

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Dentists Smiling as $80 Million Settlement Reached in Dental Supply Price-Fixing Class Action Suit

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

On August 30, 2018, after two years of litigation, a group of dentists tentatively reached an $80 million settlement in a proposed class action accusing the country’s biggest dental supply companies of colluding to fix prices. The three dominant distributors, Henry Schein Inc., Patterson Cos. Inc. and Benco Dental Supply Co. Inc., allegedly artificially inflated prices on crowns, numbing agents, X-ray accessories and other products.

Artificially Inflating Prices.

In 2016, the three distributors were accused of artificially inflating prices on various dental supplies and equipment. Products at issue included supplies such as adhesives, implants, tooth brushes, pins and posts all the way to equipment such as imaging devices and dental chairs. Although there are hundreds of distributors and manufacturers of dental supplies and equipment, the defendants controlled approximately 80% of the market share. Click here to read my prior blog on this case and learn more.

The $80 million settlement comes roughly 30 months after the dentists first launched their lawsuits against the manufacturers. To learn more, click here to view the consolidated class action complaint  and the order in full.

Collusion?

In response to the suit, the three distributors accused the group of dentists of inaccurately portraying isolated actions as a nationwide conspiracy. However, a New York federal judge found reason to believe the distributors colluded to strong-arm lower cost rivals and boycott trade groups that worked with a newer distributor called SourceOne Dental Inc.

Despite reaching the settlement, the distributors deny any wrongdoing even though the Federal Trade Commission (FTC) also filed an administrative complaint against them in February 2018. In the complaint, the FTC accused the nation’s three largest dental supply companies of conspiring to refuse to provide discounts to buying groups representing small dental practitioners in violation of antitrust laws. To view the FTC’s press release, click here. Click here to view the FTC’s complaint.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals.

The Health Law Firm has attorneys who practice in the area of antitrust law and trade regulation. We have defended a hospital in federal court against allegations of violations of the antitrust laws, we routinely provide advice and opinion letters on antitrust and trade regulation matters, we have represented plaintiffs in law suits alleging anticompetitive behavior and violations of state and federal antitrust laws, we have given opinions on and been involved in litigation concerning the Lanham Act and the Robinson-Patman Amendments, and we routinely undertake litigation concerning restrictive covenants.

The attorneys of The Health Law Firm provide advice and representation concerning antitrust law, trade regulation, restraint of trade issues, and regarding deceptive and unfair trade practices. We routinely provide advice and analysis of proposed business ventures that include the foregoing. We have represented both plaintiffs and defendants in state court litigation and in federal court litigation in such matters.

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

Sources:

Overley, Jeff. “Dentists Get $80M From Supply Cos. To End Collusion Case.” Law360. (August 30, 2018). Web.

“Dentists Get $80M From Supply Cos. To End Collusion Case.” InfoTech Consulting. (September 5, 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.

NYC Doctor Gets Prison Term for Posing as Clinic Owner in $30 Million Fraud Scheme

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

On August 22, 2018, a doctor received a sentence of one year and a day in prison from a New York federal court for his part in a $30 million scheme to defraud Medicare and the state Medicaid program. The doctor admitted to posing as the owner of a medical clinic and falsely claiming to have seen hundreds of patients. He pled guilty on January 11, 2018, to health care fraud and conspiracy to commit health care fraud, mail fraud and wire fraud, the U.S. Attorney’s Office said.

Lies and Cover-ups.

The New York City doctor accepted responsibility for falsely posing as the owner of two medical clinics that were actually owned by a corrupt businessman, according to the U.S. Attorney’s Office for the Southern District of New York. Under New York state law, medical clinics must be owned and operated by a medical professional. The businessman was able to evade the requirements of the law by hiring doctors to pose as the owners of each clinic.

The corrupt businessman owned and operated six medical clinics in Brooklyn between 2007 and 2013 that fraudulently billed Medicare and Medicaid. Approximately $30 million was billed for services and supplies that were not provided, according to the indictment and other documents filed in federal court, as well as statements made during the doctor’s plea proceeding and sentencing.

Additionally, the doctor fabricated false medical records to support the fraudulent reimbursement claims and wrote prescriptions and referrals for medically unnecessary tests and supplies, the U.S. attorney’s office said.

The Punishment.

U.S. District Judge Lorna G. Schofield sentenced the doctor to three years of supervised release in addition to the prison term for his role in the scheme. He was also ordered to pay restitution of approximately $1.83 million and to forfeit $269,412 in unlawful gains. The three other defendants involved in this case, a doctor, a physical therapist and an occupational therapist, are scheduled to go to trial at a later date. Click here to learn more.

“The Medicare and Medicaid programs are intended to provide essential medical services to the elderly and the needy, not to enrich corrupt doctors and other fraudsters,” U.S. Attorney Geoffrey S. Berman said in a statement. “Today’s sentence sends a strong message that those who cheat Medicare and Medicaid, including physicians who abuse their licenses and professional oaths, will be held accountable.” You can view the U.S. Attorney’s press release here.

To read about a similar case of fraud, click here to read one of my prior blogs.

This is a Dangerous Pitfall of Which all Doctors and Dentists Must Be Aware.

This is the type of situation we often see in which a doctor or dentist is victimized by dishonest and corrupt scofflaws, especially here in Florida. Most often an older physician who is retired or semi-retired is asked to become the “medical director” or “dental director” of a clinic that is owned in whole or in part by someone else. The physician may not even know who its true owners are. Later the physician or dentist is asked to serve as the “president” or as a “director” of the company and his/her name is placed on all the corporate papers. The trouble really begins, however, when the true owner(s) places the physician’s or dentist’s name on corporate papers and licensing papers as an “owner,” “shareholder” or “member” of the business, when the physician has paid nothing for the business and is not truly the owner.

If a physician or dentist becomes aware of such a scheme and gets out of it as soon as she or her finds out, the physician or dentist may be able to avoid prosecution or liability. However, if the physician or dentist continues to do business with the true owners as an “owner on paper,” “shell owner,” or “sham owner,” (they all mean the same thing, “fraudulent owner”) then he or she can be in for some serious civil and criminal liability.

There can be serious criminal penalties, such as the one reported on in this blog. For example, in Florida, it is a felony for a non-dentist (meaning a dentist not licensed in Florida) to own or control a dental clinic in Florida. It is also a criminal offense for a layperson (or a business entity owned by lay persons), to own or control a medical clinic, unless it goes through the strict health care clinic license requirements that Florida law requires. If the clinic is owned or operated illegally (even if it’s “just on paper”), then all of the bills it issue are also illegal.

Contact Health Law Attorneys Experienced in Handling Medicare and Medicaid Fraud Cases.

The Health Law Firm’s attorneys 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.

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

Sources:

Hanson, Joyce. “Doc Gets Year In Prison For Role In $30M Medicare Fraud.” Law360. (August 22, 2018). Web.

“NYC Doctor Gets Prison Term for Role in $30M Fraud Scam.” Bloomberg Law. (August 22, 2018). Web.

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

KeyWords: Medicare and Medicaid fraud representation, false claims attorney, false claims representation, representation for overbilling, representation for DOJ investigations, fraud defense attorney, representation for medicare issues, representation for Medicaid issues, Medicare lawyer, Medicaid lawyer, health care fraud investigation representation, health care fraud defense representation, Medicare fraud representation, health care professional representation, representation for physicians, representation for physician reimbursement, licensure defense attorney, professional license representation, licensure defense representation, representation for health care professionals, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Florida health law defense lawyer, owner on paper, shell owner, or sham owner, paper owner, Florida dental clinic ownership, health care clinic license

“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.

 

Connecticut Dentist Gets Drilled in Huge Medicaid Fraud Case

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A dentist and owner of a number of clinics in Connecticut is feeling the pain of justice. According to a number of news sources, Gary Anusavice will spend the next eight (8) years in prison for targeting poor patients, performing unnecessary dental procedures and collecting $21 million in fraudulent Medicaid claims. He was sentenced on October 9, 2013.

To read an article on the dentist’s sentencing from The Hartford Courant, click here.

Dentist Must Forfeit Luxury Items.

On top of prison time, the dentist will have to pay $3.3 million in restitution and $1.9 million to the Internal Revenue Service (IRS) as a result of his Medicaid fraud scheme, according to The Hartford Courant. He was also ordered to forfeit his mansion, a 2008 Mercedes-Benz, a yacht and more than $91,000 in cash that was found in his home.

According to news reports, this is far from the first time he has been accused of defrauding the Medicaid program.

Dentist Previously Barred from Practicing in Massachusetts and Rhode Island.

According to an article in the Connecticut Post, the dentist had previous run-ins with authorities in Massachusetts and Rhode Island involving health care fraud. Both states allegedly stripped him of his dental licenses. He was also allegedly barred from participating in Medicaid in those states.

Since the dentist could no longer practice in those states, in 2008, he opened three dental groups in Connecticut, according to the Connecticut Post. In these new practices, it’s alleged he hired other dentists and offered them commissions for performing expensive procedures, paid patient recruiters to solicit poor neighborhoods, and provided shuttle services for patients. In two years, his Connecticut clinics received $21 million in Medicaid payments, according to the Connecticut Post.

Click here to read the Connecticut Post article.

In June 2013, the dentist pleaded guilty to health care fraud and tax evasion.

Being Barred from the Medicare and Medicaid Program Can have Devastating Effects.

Few health care practitioners really understand the significance of being excluded from the Medicare or Medicaid programs. Exclusion usually occurs as a direct result of disciplinary action being taken by the state board of medicine, board of nursing, board of dentistry, board of pharmacy or other health care licensing entity. To read more on the effects of exclusion from the Medicare or Medicaid programs, click here.

Take Fraud Charges Seriously.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Often Fraud Claims Can Give Rise to Large Rewards Paid to Whistleblowers.

Practically every state now has statues which allow a monetary recovery to be a person bringing a claim on behalf of the state for false Medicaid payments. These are modeled after the federal False Claims Act, used to reward whistleblowers or qui tam relators for recovers in Medicaid fraud cases.

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

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

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

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

Comments?

Why was it so simple for the dentist to move to another state and continue to defraud Medicaid after being previously reprimanded for the same crime? Please leave any thoughtful comments below.

Sources:

Mahony, Edmund. “Dentist in Massive Medicaid Fraud Case Sentenced to 8 Years.” The Hartford Courant. (October 9, 2013). From: http://www.courant.com/health/connecticut/hc-medicaid-fraud-1010-20131009,0,1388813.story

Mayko, Michael. “Fraudulent Dentel-Group Owner Sentenced.” Connecticut Post. (October 9, 2013). From: http://www.ctpost.com/local/article/Fraudulent-dental-group-owner-sentenced-4883112.php
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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Florida Board of Dentistry Warns About Responding to or Consulting with Individuals Over Internet About Dental Issues

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At the Florida Board of Dentistry meeting held on November 15, 2013, one of the committee chairs discussed an issue that has arisen nationally that is causing dentists legal problems. The issue arises when individuals contact a dentist over the internet seeking “information” on a dental condition or problem, and possible actions or procedures that can resolve these issues.

The concern with this is that the dentist may actually be diagnosing a dental condition or problem the individual has. The bigger concern is that if the individual contacting the dentist for information is in a different state from the one in which the dentist is licensed. Then the dentist is actually practicing dentistry in the state in which the individual is located.

In this blog I will discuss some of the issues a dentist can encounter when diagnosing a condition or problem over the internet. I will also talk about ways a dentist can reduce his or her risk.

Issues Dentists Can Face When Diagnosing a Condition Over the Web.

This can cause a myriad of different problems for the dentist involved in these situations:

1.  By diagnosing in a state in which the dentist is not licensed, he or she is engaging in the unlicensed practice of dentistry in that state. This can lead to criminal charges in that state and disciplinary actions in the state where the dentist is licensed.

2.  Cases have arisen where incorrect diagnoses have been rendered because the individual failed to provide complete information and the dentist failed to physically examine the individual or follow other procedures normally followed.

3.  There have been instances where such individuals have filed complaints or claims against dentists for providing them information upon which they relied.

4.  In most cases, a dentist’s professional liability (dental malpractice) insurance will not cover professional negligence in another state.

Recommendations to Reduce Risk.

I recommend that dentists take the following steps to help reduce risk if involved in providing information to non-patients over the internet or in the media (radio, television, newspaper, etc.):

1.  Make sure that you have proper warnings and disclaimers that are included in every such e-mail communication or listserv communication you make. Include:

A.  Include the state in which the dentist is licensed/practicing and state that the communication is not considered to be diagnosing, prescribing, treating or practicing any profession in any other state or jurisdiction.

B.  Include a disclaimer or statement in every e-mail listserv or other communication with non-patients that you are providing general information for educational purposes only and the individual must see and follow the advice of a dentist in his or her geographic area to make any diagnoses.

C.  Include that the person receiving the information cannot rely on it for treatment purposes since an actual physical examination must take place before any reliable information/recommendations can be made in any individual’s case.

2.  Inquire with your professional liability insurer or agent to ask about “broad form coverage” and attempt to obtain coverage that includes educational activities, marketing activities and other similar activities. Make sure the broad form coverage also covers these activities in different states.

3.  Make sure your professional liability insurance provides coverage for legal expenses involved in defending against administrative complaints and investigations initiated by any state or federal agency that could result in disciplinary action against you or your license. You probably need at least $25,000 in coverage for this. However, $50,000 or $75,000 in coverage for such matters is preferred. Buy this coverage separately if necessary. Lloyd’s of London provides such coverage separately.

4.  Find out where the individual contacting you resides or is communicating from. Require complete information, including complete name, address and telephone numbers.

5.  Be extremely reluctant to criticize care, services, procedures, materials or appliances used or prescribed by other dentists.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry 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.

Comments?

Have you ever been asked to consult with a patient over the internet? Did you know all of these issues could up? Please leave any thoughtful comments below.

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Phony Dentist Charged with Child Abuse After Injuring Teen During Procedures

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

A Miami man, his wife and their daughter have been charged with child abuse following two alleged dental procedures that left a 14-year-old girl permanently disfigured. According to a number of sources, the three were arrested on September 12, 2012, at their home-operated dental office.

Click here to see the man’s arrest affidavit from the Miami Police Department.

14-Year-Old Patient Left in Pain and Disfigured.

According to the Miami Herald, when the 14-year-old girl broke a front tooth, she and her mother went to the man, who claimed to be a dentist when he lived in Cuba. He offered to perform the dental work in the back room of his home office for $500. Instead of fixing the tooth, the article states the man filed all four of the girl’s front teeth down to the gums. He then allegedly fit her with a permanent bridge, which the mother described as an “iron bridge painted white with the form of teeth.”

The victim was allegedly left with swollen and blackened gums, according to the Miami Herald. She is now under the care of a licensed dentist at the University of Miami.

To read the entire article from the Miami Herald, click here.

All Three Family Members Face Charges of Child Abuse.

The fake dentist and his wife, who apparently witnessed the procedures, face charges of child abuse, child negligence and performing dental services without a license. The couple’s daughter faces a charge of child negligence.

The license status of almost all health care professionals can easily be checked online. In Florida, license verification for all health care professionals can be checked on the Florida Department of Health (DOH) website. Hint: If they don’t have a license, they ain’t a legitimate health professional.

This case was investigated by the Miami Police Department, the DOH and a Miami-Dade County team that fights pharmaceutical crime. Detectives suspect more victims will soon come forward.

Miami Seems to Be a Hot Spot for Phony Health Care Professionals.

We have seen many reports on phony doctors, dentists, nurse practitioners and others practicing in the Miami area over the past decade. Many of these operate surreptitiously and prey on immigrants and foreign nationals. Others operate blatantly and publicly advertise.

Plastic surgery and cosmetic procedures appear to be the most likely area to be “practiced” by the imposters. We have seen or heard reports of physicians performing surgery in hotel rooms. We have read reports of walk-in plastic surgery offices where animal sedatives were used to sedate the patient and plastic knee replacements were used as breast implants.

More Stories on Fake Physicians and Other Health Professionals to Come.

In the near future on this blog, we will include additional articles on fake doctors and health professionals, some old, some new.

To see a recent blog on a Florida teen impersonating a physician’s assistant (PA), click here. You can also read the story of a fake plastic surgeon in New York by clicking here.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH Cases.

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

If you are aware of an investigation of you or your practice, or if you have been contacted by the DEA or DOH, contact an experienced health law attorney immediately.

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

Sources:

Sanchez, Melissa. “Little Havana Man Accused of Injuring Girl with Illegal Dental Work.” Miami Herald. (September 12, 2012). From: http://www.miamiherald.com/2012/09/12/2999610/little-havana-man-accused-of-injuring.html

CBS Miami. “Girl Leaves Dental Dungeon With Mangled Teeth; 3 Charged With Child Abuse.” CBS Miami. (September 12, 2012). From: http://miami.cbslocal.com/2012/09/12/girl-leaves-dental-clinic-with-disfigured-teeth-3-charged-with-child-abuse/

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.

 

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Dentists: Call The Health Law Firm Attorneys From Representation in Short-Notice Depositions and Hearings

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Our attorneys often receive calls from dentists and other health professionals regarding the possibility of representing them on short notice at a Board of Dentistry hearing, or at a deposition related to a health care matter.

We Take Last Minute Cases.

Some law firms may refuse to represent a client at a hearing unless given advance notice. In a perfect world, we would prefer to have a sufficient amount of time to prepare for a case in order to provide our clients with the best representation. However, we know the alternative is that the client either gets legal representation with little advance notice or has to go without having legal representation and suffer the consequences.

We may have to refuse a case as well. For instance, if we believe the case is too complex for us to represent you effectively or that any legal representation would be completely futile. This situation does not happen often.

Trust an Experienced Health Law Attorney in Administrative Proceedings.

We’ve heard of some dentists trying to represent themselves. Laypersons, meaning nonlawyer, unaware of such complex matters as the Administrative Procedure Act, the Rules of Civil Procedure, the Rules of Evidence, the Florida Administrative Code (F.A.C.) Rules which the Board of Dentistry and the Department of Health (DOH) have enacted may quickly be overwhelmed. Often the individual may only figure this out days or weeks before the final hearing.

The inexperienced individual, or even the inexperienced attorney, in these matters can fall into a number of procedural traps that damage an effective defense. This can be advising the individual to talk to the DOH investigator, filing an unnecessary answer to an Administrative Complaint, forgetting or not knowing that the client’s right to be free of self-incrimination applies in this type of case and many, many others.

Procedural Mistakes Can Hurt Your Defense.

Simply having an experienced attorney representing you at a hearing or Board of Dentistry meeting will help you to avoid mistakes that damage your case and assist in preserving your rights for an appeal. In some cases, it may even be possible to obtain a change in forum to obtain a better result. For example, many laypersons do not know that if you elect an informal hearing before the Board of Dentistry, you have waived your right to prove you are innocent by contesting the facts alleged against you.

What few people know is that you can ask at the informal hearing before the Board of Dentistry to contest the facts, to prove you are not guilty of the charges, and to have the hearing converted to a formal hearing. A formal hearing will be in front of a neutral Administrative Law Judge (ALJ) and you have a great many more procedural rights than you have at an informal hearing. However, we still recommend that you have an experienced health lawyer represent you at a formal hearing.

Professional Liability Insurance Might Even Pay for Your Legal Fees.

If you are a dentist who has a professional liability insurance policy, especially one with the larger national companies, these often provide legal coverage for depositions. This is primarily because the outcome of the deposition may include having you named as a defendant in a professional liability or negligence law suit or having disciplinary charges filed against you.

One of the first things you should do if you receive a subpoena or a notice of a deposition is to contact your professional liability insurance carrier and see if it will pay for an attorney to represent you. For example, Healthcare Providers Service Organization (HPSO), CPH & Associates, Dentists Advantage and many other malpractice insurance companies provide excellent deposition coverage.

The second thing you should do is to call an experienced attorney and schedule a consultation. Even if you cannot afford to retain the services of the attorney for the actual deposition, a consultation may assist you in properly preparing.

Consult With An Attorney Experienced in the Representation of Dentists.

We routinely provide deposition coverage to dentists, dental hygienists and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists and other health professionals in investigations and at Board of Dentistry hearings. Call now or visit our website www.TheHealthLawFirm.com.

Comments?

Have you ever had an informal or formal hearing before the Board of Dentistry? What was the experience like? Please leave any thoughtful comments below.

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Debary Dentist Served with Emergency Suspension Order for Allegedly Inhaling Laughing Gas

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

A Debary, Florida, dentist has been served with an emergency suspension order (ESO) by the Florida Department of Health (DOH) for allegedly inhaling nitrous oxide or laughing gas in front of patients. The administrative complaint filed against the dentist on November 2, 2012, by the Florida DOH stated a department-approved evaluator deemed the dentist unfit to practice dentistry and was recommended to undergo residential treatment.

Click here to read the full administrative complaint against the dentist.

We want to point out that these are just allegations made against the dentist at this point in time and have not been proven by the state.

Dentist Allegedly Did Not Finish Rehabilitation.

In June 2012, the Florida DOH ordered the dentist to be treated for alcohol and inhalant dependence. However, while in rehabilitation, she allegedly failed drug tests for alcohol, opiates and hydrocodone. She was then later reportedly caught inhaling laughing gas again.

The dentist allegedly refused another treatment plan by writing on it that she was going to drink champagne on holidays and special occasions.

The Office May Still Be Open.

On November 27, 2012, WFTV in Orlando reported a woman that looked to be the suspended dentist drove up to the Debary office and posted a handwritten sign on the front door that read, “Office is open.”

To see the story from WFTV, click here.

The Florida DOH states that when a licensee is served with an ESO that person may not practice in Florida while his or her license is suspended. Click here to see the status of the dentist’s license from the DOH.

The Dentist’s Options – Formal Hearing or Hearing Before the Board of Dentistry.

The dentist may elect to have a formal hearing contesting the facts with the Division of Administrative Hearings (DOAH). She also may waive this right and not dispute the facts and have an informal hearing before the Board of Dentistry. The Board will then make a final decision concerning the dentist’s license and her future working in dentistry. Be sure to check this blog for updates.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) 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.

Comments?

What do you think of this dentist’s story? Does she deserve another chance? Please leave any thoughtful comments below.

Sources:

Walsh, Michael. “Dentist Gassing Up on Nitrous Oxide No Laughing Matter.” New York Daily News. (November 27, 2012). From: http://www.nydailynews.com/news/national/dentist-gassing-nitrous-oxide-laughing-matter-article-1.1209081?print

Barber, Tim. “Dentist Accused of Using Laughing Gas on Self While Working on Patients.” WFTV. (November 27, 2012). From: http://www.wftv.com/news/news/local/dentist-accused-using-laughing-gas-while-operating/nTGJd/

Department of Health v. Sharon Ann Day-Osteen, D.D.S. Case Number 2012-13461. Administrative Complaint to the Board of Dentistry. (November 2, 2012). From: http://www.thehealthlawfirm.com/uploads/doh%20v%20Day-Osteen.pdf

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

New Hampshire Dentist Indicted on 189 Counts of Medicaid Fraud

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 20, 2013, a New Hampshire dentist was indicted on 189 counts of Medicaid fraud, according to a number of news sources. The dentist is alleged to have made false claims to the New Hampshire Medicaid office for procedures such as oral exams, X-rays, tooth extractions and orthopedic treatments performed between 2008 and 2013. According to the Concord Monitor, the dentist faces a maximum sentence of 1,323 years in prison. However, it is unlikely the dentist will receive such a long sentence. It is even more unlikely that he will serve the entire sentence, even if he does receive the maximum.

To read an article from the Concord Monitor, click here.

Medicaid Fraud Control Unit of the New Hampshire Attorney General’s Office Brought Charges.

According to an article in the Union Leader, the Medicaid Fraud Control Unit (MFCU) of the state Attorney General’s (AG) Office handed down the charges against the dentist. Most of the indictment alleges that the claims made by the dentist were unjustified based on treatment records. The dentist is also accused of billing the Medicaid program for individual services he was already being reimbursed for under a lump-sum treatment plan.

The dentist was also allegedly indicted on nearly 30 counts of falsifying evidence. According to the Union Leader, once the dentist found out he was being investigated, the dentist allegedly attempted to alter his medical records.

According to his attorney the dentist plans to plead not guilty at his arraignment on January 15, 2014.

Click here to read the entire Union Leader article.

Poor Documentation or Fraud?

When we look at cases of this nature, we always ask was this just a case of poor documentation or was it intentional fraud? Was this a case of an incompetent biller or was it intentional submission of false claims? In many cases, poor administration or poor documentation can explain what may look like fraud to a regulator or prosecutor.

Tips for Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Fraud Charges Should be Taken Seriously.

We have been consulted by many individuals similar to the subject of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in Medicare and Medicaid investigations, audits and recovery actions.

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

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Blackman, Jeremy. “Manchester Dentist Faces 1,300 Years in Medicaid Fraud Scheme.” Concord Monitor. (December 30, 2013). From: http://www.concordmonitor.com/home/10005460-95/manchester-dentist-faces-1300-years-in-medicaid-fraud-case

Siefer, Ted. “Manchester Dentist Indicted on 189 Counts of Medicaid Fraud.” Union Leader. (January 1, 2014). From: http://www.unionleader.com/article/20140101/NEWS03/140109940

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

By |2014-01-23T09:00:16+00:00May 15th, 2018|Dentist Defense attorney, Dentists|0 Comments

Dentists: Beware of Nationwide Telephone Prescription Drug Scam – Callers Claim to be DEA Agents

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

The Drug Enforcement Administration (DEA) is warning dentists to be aware of a prescription drug scam. This telephone scheme is extorting money from people all over the country. On November 28, 2012, the DEA released a press release explaining the details of the scam.

Be Wary of Criminals Asking for Money Over the Phone.

The scam starts with criminals posing as DEA agents calling victims by telephone. Frequently the victims will have recently purchased prescription drugs over the internet or by phone. The imposters tell the victims that purchasing the drugs in that manner is illegal, and that they must pay a fine. If the victims refuse to send money, the phony DEA agents threaten to arrest the victims or search their property. Some of the victims have also reported unauthorized use of their credit cards after purchasing the prescription drugs.

Click here to read more on this scam from a DEA press release.

The DEA wants to remind dentists that no DEA agent will ever contact a person by telephone. They might show up at your house early in the morning or while you are eating dinner, however. Also, agents never request money or any other form of payment.

What Dentists Need to Know About Purchasing Drugs Over the Phone or On the Internet.

Many times it may be illegal to purchase controlled drugs by phone or over the internet. That’s why you should go to Canada to do it. There are direct flights from Orlando. However, some pharmacies that meet stringent requirements and are registered by the DEA are allowed to sell drugs over the internet or by phone. So don’t be fooled by this telephone scam.

Where Does this Information Come From?

The scammers are counting on the fact that if you have done this, you will get scared, as a dentist, and believe their accusations. Many people have no idea whether such conduct is legal or illegal. These imposters are banking on your ignorance and fear of losing your license. They are also banking on the fact you won’t report this to the real police.

Where do they get this information? Chances are, they are just “cold-calling” people. There are bound to be a certain number of people they reach who have done this. However, if they seem to have your personal information (or credit card number) report this to the police right away. Be sure to obtain a written police report. Also, you should file a HIPAA Privacy Complaint with the Office of Civil Rights (OCR) to begin an investigation if you believe your personal information has been stolen by or given to someone else to use.

Are Strict Regulations and Restrictions Causing Patients to Turn to Shady Pharmacies for Drugs?

It is no surprise that the DEA, along with other law enforcement agencies, has stepped up its efforts to cut down on overprescribing. To see examples of what I am talking about read my past blogs: Walgreens fights the Drug Enforcement Administration’s (DEA) immediate suspension order and Drug Enforcement Administration (DEA) pulls controlled substance licenses from two Sanford, Florida, CVS pharmacies.

If the largest, legitimate pharmacy chains in the state and nation are not allowed to fill these prescriptions, where will chronic-pain patients turn? Are these actions driving our citizens into the hands of shady pharmacies that have fewer safeguards and less accountability, such as online pharmacies? Are these actions driving our citizens to seek out illegal drug dealers and turn to illegal drugs to cope with their legitimate medical problems? That is just one opinion. Tell us yours below.

Contact Health Law Attorneys Experienced with Investigations of Dentists.


The attorneys of The Health Law Firm provide legal representation to dentists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

Comments?

As a dentist, have you been contacted by these phony DEA agents? Please leave any thoughtful comments below.

Sources:

Pavuk, Amy. “DEA Warns of Prescription-Drug Scam.” Orlando Sentinel. (November 29,2012). From: http://www.orlandosentinel.com/news/local/breakingnews/os-dea-warns-scam-internet-20121128,0,5800536.story

Drug Enforcement Administration. “DEA Scam Alert – Extortion Scheme.” DEA. (November 28, 2012). From: http://www.justice.gov/dea/divisions/mia/2012/mia112812a.shtml

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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

Florida Medicaid Audits Dental Claims

MLS02PJGBy Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations Handbook. AHCA’s audits are focused on claims that are billed too frequently, claims that are billed on the same date of service as a redundant code, and claims that have been unbundled when they should have been billed as part of a comprehensive code.

Specific Dental Codes Being Audited.

Dental providers that are the subject of these audits may not learn of the audit until they receive the Preliminary Audit Report. It is extremely important to immediately retain experienced health care counsel if you receive a Preliminary Audit Report so that a timely rebuttal with additional documents can be submitted. The audits are performed by the AHCA based entirely on the claims submitted by the provider.

Some of the specific procedure codes included in the audits are:

– D0120,
– D0272,
– D1110,
– D1120,
– D1203,
– D1330,
– D0150,
– D0210,
– D0330,
– D4355, and
– D4341.

Take Preliminary Audit Reports Seriously.

Every dental provider that receives a Preliminary Audit Report from AHCA has a limited time to respond to the audit. AHCA may also impose sanctions and assess costs against dental providers in these audits. Any dental provider that receives notice of an audit by the Agency should contact legal counsel experienced in these matters without delay.

Click here for a previous blog on tips for responding to an AHCA audit.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in AHCA investigations, audits and recovery actions, as well as Medicare and Medicaid investigations, audits and recovery actions.

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

Comments?

Have you ever received a Preliminary Audit Report from the AHCA? Did you know how to respond? Please leave any thoughtful comments below.

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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 © 1996-2014 The Health Law Firm. All rights reserved.

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