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CMS Memorandum for Texting Patient Information Among Healthcare Providers

George F. Indest III headshot

June 21, 2018

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

The Centers for Medicare & Medicaid Services (CMS) released a Memorandum in an effort to clarify their stance and guidelines on texting between healthcare providers and staff.

Texting Patient Orders is Not Permitted.

CMS does not permit  health care providers to text patient orders to a care team member on any platform. Therefore, texting patient orders from a health care provider is not in compliance with the Conditions of Participation (CoPs) or Conditions for Coverage (CfCs).

Texting Patient Information on Secure Platforms.

Patient information that is sent via text messages  is permissible if accomplished through a secure platform only. However, Computerized Provider Order Entry (CPOE) is the preferred method of order entry. CMS holds to the long-standing practice that a physician should enter patient orders into the medical record via a hand written order or CPOE.

Compliance Plans.

Furthermore, in order to be compliant, all healthcare providers must utilize and maintain platforms that are secure, encrypted, and minimize the risks to patient privacy. It is expected that providers/organizations will implement procedures that routinely assess the security and integrity of the texting platforms that are being utilized. This is to ensure patient confidentiality and to avoid negative outcomes that could compromise the overall care of patients.

Using secure texting platforms, has the potential for healthcare organizations to streamline contact and improve patient outcomes. Click here to visit our website and read the CMS Memorandum in full.

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001. Be sure to check The Health Law Firm Blog for regular updates.

Source: Center for Clinical Standards and Quality/Survey & Certification Group . “Texting of Patient Information among Healthcare Providers.” Centers for Medicare and Medicaid Services (CMS). (December 28, 2017). 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: Centers for Medicare and Medicaid Services (CMS), representation for CMS matters, CMS attorney, representation for health care investigations, representation for patient privacy issues, HIPAA lawyer, HIPAA representation, representation for health care compliance, health care compliance lawyer, CMS investigation representation, cyber-security representation, cyber-security attorney, data breach representation, HIPPA violation representation, HIPAA violation attorney, Medicare attorney, Medicaid attorney, representation for health care professionals, representation for health care facilities, 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 © 2018 The Health Law Firm. All rights reserved.

Administrative Final Orders Must State Findings of Fact Based on the Evidence Presented

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

Following is a summary of a recent appellate case on an issue relevant to health law:

Borges v. Dep’t of Health, 143 So. 3d 1185 (Fla. 3d DCA 2014).
Gustavo Borges (Borges) appealed a final order of the Florida Board of Dentistry that revoked his license to practice dentistry based on a conviction of the knowing receipt of child pornography under a federal statute.

At hearing, eight lay witnesses and four expert witnesses testified. In the recommended order’s discussion of the evidence presented, which was the basis for the Board’s final order, the administrative law judge (ALJ) discussed the testimony of only one witness-Borges-after concluding that a statement by Borges constituted a concession that established that his conviction was related to his ability to practice dentistry. No other testimony was discussed in the order, or even acknowledged.

On appeal, the appellate court concluded that the ALJ’s recommended order adopted by the Board did not comply with one of the requirements of section 120.57, Florida Statutes-that an ALJ’s order must contain “express findings of fact.” The court was quick to point out that, while the findings of fact did not have to address the testimony of every witness (i.e., all twelve here), the order must at least address the factual controversies at issue to the extent they are relevant to the disposition, or address why the testimony is irrelevant. Having failed to do so in this case, the appellate court reversed and remanded.

The case summary above was originally published in the Administrative Law Section Newsletter, Vol. 34, No. 2 (Dec. 2014), a publication of The Administrative Law Section of The Florida Bar.

Editor’s Comments on Case Summary.

This case demonstrates an important concept in administrative law. This is, an administrative law judge is required to discuss the evidence presented at the hearing and make specific findings of fact based on that evidence. Failing to do this in the recommended order (RO) can lead to reversal by an appellate court.


Comments?

Do you think the appellate court should have reversed? Do you think it was important to discuss all testimonies in this case? Please leave any thoughtful comments below.


Contact Health Law Attorneys Experienced in Handling Licensure Matters.

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

The attorneys of The Health Law Firm routinely represent 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 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.

KeyWords: Criminal law, license, defense attorney, health law, health care attorney, health care lawyer, health investigation, medical license, conviction, desntist, dentist criminal charges, Department of Health, DOH, professional license, federal statutes, license disciplined, license revoked, health attorney, finding of guilt, adjudication withheld, diversion program, DOH conviction, adjudication, discipline, criminal trial, defense lawyer, ALJ, administrative law judge, administrative law, appellate court, administrative orders, Florida Board of Dentistry, Board of Dentistry, dentistry, statutes, testimony

“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 © 1996-2015 The Health Law Firm. All rights reserved.

Overcoming License Suspension and Revocation Pending Appeal

By: Lance O. Leider, J.D.

If you are a dentist or other licensed health professional whose license has been recently revoked or suspended, there may still be hope. Ordinarily, you must immediately stop practicing or you risk being prosecuted for unlicensed practice, a felony. Although this blog deals with Florida law, similar relief may be available in other states, too.

One of the hardest things about having a license suspended or revoked is that it immediately cuts off the licensee’s sole source of income. If you have a thriving practice, this will usually destroy any value your business has. Without income, paying your bills will be a challenge, much less the cost to fight the legal action or to appeal.

Even if you appeal the decision and win the appeal, you will be out of practice for many months, often more than a year, before your license is reinstated. You still have all the lost income and business, and you never get this time and money back.

Fortunately, Florida law provides an avenue for temporary relief from the adverse decision, so that you may retain your license and practice your profession pending appeal of your case. This legal process is called a writ of supersedeas.

What is Supersedeas Relief?

Supersedeas relief is a form of relief granted by a reviewing court (court of appeal) that suspends the enforcement of the judgement of the lower court (or agency) while the underlying issues are decided on appeal. What this means is that you can have the action to revoke or suspend your license put on hold while you appeal the decision of the Department of Health (DOH).

This relief is authorized in two separate places in Florida law: Section 120.68(3), Florida Statutes, and Rule 9.190(e)(2)(C), Florida Rules of Appellate Procedure. Both of these provisions state that a reviewing court can grant a stay of enforcement of the revocation or suspension of a license pending review.

The relief is not automatic, however. Both provisions specifically prevent supersedeas from being granted if the licensee poses a probable threat to the health, safety or welfare of the state. Fortunately, it is the burden of the agency whose order is being reviewed to prove that there is a danger to the public.

Additionally, the Appellate Rule permits you to ask for expedited review. (Which of course is recommended because you want to be back to work as quickly as possible, right?) This means that the agency only has ten (10) days to file its opposition. This shortened time period may make it difficult for an overworked government attorney to file on time or to produce quality opposition.

Steps to Seeking Supersedeas Relief.

1. File an appeal of the Final Order revoking or suspending your license with the appropriate agency and a copy to the appellate court. Be sure to follow all appellate rules and instructions.

2. File a Petition for Expedited Supersedeas Relief with the appellate court at the same time.

3. If you receive a favorable ruling from the court, deliver that order to the licensing agency (in this case, the DOH) and request that your license be reinstated immediately.

Other Considerations.

It is important to note that this form of relief will not make the underlying action disappear. Your return to practice will only be temporary, unless you win the appeal. You will still have to show the licensing agency did something contrary to law when it imposed the discipline in order for the appellate court to overturn the decision. This is not often an easy task. Furthermore, the law only permits a thirty (30) day window in which to appeal the agency’s decision, after which your rights are lost and you are very likely stuck with the decision.

Appeals Are Very Technical and Require a Thorough, Specialized Knowledge of the Law.

What few people understand is that appeals are very technical and have complex, procedural rules that you must follow. An appeal of an agency final order is not the place to argue about the facts of your case or to try to prove different facts.

An appeal is all about the law and the court cases that have interpreted the law. Unless the agency (in this case your board) made a legal error and violated the law, you won’t win.

For an appeal, a person needs an attorney. To prevail on an appeal, you must have a detailed knowledge of the correct, relevant court cases and you must be able to argue these in the proper form in legal briefs.

There are many other procedural steps you must follow in an appeal that only a good appellate attorney will know. To attempt to do this yourself is not advisable.
Contact Health Law Attorneys With Experience Handling Licensing Issues.

If you have had a license suspended or revoked, or are facing imminent action against your license, it is imperative that you contact an experienced healthcare attorney to assist you in defending your career. Remember, your license is your livelihood, it is not recommended that you attempt to pursue these matters without the assistance of an attorney.

The Health Law Firm routinely represents physicians, dentists, nurses, medical groups, clinics, and other healthcare providers in personal and facility licensing issues.

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: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“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.

 

Embezzling Administrator of Pediatric Clinic Faces Health Care Fraud Sentencing

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

An administrator of a Louisiana pediatric clinic has recently pleaded guilty in a health care fraud case. She faces up to 10 years in prison and over $200,000 in fines. The charges allege embezzling more than $500,000 of the clinic’s money and diverting it to her personal account, from approximately August through September of 2014. She allegedly used this massive amount of money to purchase luxury items for herself including jewelry, custom artwork and a motorcycle. Much of the money came from reimbursement the clinic received from the state’s Medicaid program.

The Investigation.

The administrator was investigated by the Federal Bureau of Investigations (FBI) and Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). The investigation disclosed that the administrator used a business credit card to charge approximately half a million dollars in personal charges. To pay the credit card bills, teh administrator used money from the clinic’s bank accounts, which included its Medicaid reimbursements. She maintained her front by hiding the monthly statement from the clinic and disguising payments. Her sentencing is set for September 7, 2017.

Embezzlement by Employees Should Be Reported to Law Enforcement and Prosecuted.

We have been consulted by health care practices who have had employees embezzle from them. These should always be reported to law enforcement and prosecuted. Employees that do this will also falsify claims to Medicare, medicaid and health insurers, multiplying your problems.

To read an article I published on embezzlement by health care employees, click here.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

Sources:

“Louisiana Woman Pleads Guilty in Health Care Fraud Case.” The Eagle. B.H. Media Group Inc., (01 June 2017). Web.

“Louisiana Woman Pleads Guilty in Health Care Fraud Case.” The Washington Times. The Washington Times. (01 June 2017). Web.

McKnight, Laura. “Marrero Pediatric-clinic Administrator Pleads Guilty to over $536K in Health-care Fraud.” NOLA.com. (31 May 2017). 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: Legal representation for health care embezzlement, legal representation for allegations of health care embezzlement, legal representation for health care employment issues, employment law defense attorney, legal representation for employment conflicts, legal representation for health care professionals, legal representation for work place investigations, legal representation for investigations against health care professionals, health care fraud attorney, health care fraud defense attorney, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, legal representation for OIG investigations, legal representation for HHS investigations, legal representation for false billing, legal representation for health care fraud investigations

“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 © 2017 The Health Law Firm. All rights reserved.

 

If You Are a Dentist Facing Legal Challenges, Choose an Attorney Who is Board Certified by The Florida Bar in Health Law

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

Dentists, nurses, pharmacists, health professionals, and health facilities often face legal challenges from many different sources. These challenges can come from federal and state regulators, medical malpractice trial lawyers, hospitals, clinics and colleagues. If you find yourself faced with a legal problem, the first person you should contact is an attorney who is Board Certified by The Florida Bar in Health Law.

A Board Certified Health Law Attorney is Your Legal Specialist.

To find a lawyer who has expertise in the area of law relating to your legal needs, the Supreme Court of Florida directed The Florida Bar to offer a “Board Certification” program for Florida Bar members. The program is designed to help the public make an informed decision when seeking and selecting a lawyer. Not all states use board certification to designate attorneys, and those that do may not have board certification in the area of Health Law. However, both Florida and Texas are states that do offer a board certification program for their health lawyers.

While all lawyers are allowed to advertise, only certified attorneys are allowed to identify themselves as “Florida Bar Board Certified” or as a “specialist.” Being certified is the highest level of recognition by The Florida Bar of the competency and experience of attorneys in health law.

A lawyer who is a member in good standing of The Florida Bar and who meets the standards set by the state’s Supreme Court, may become a “Board Certified Health Law Attorney.”

Not all qualified lawyers are certified, but those who are board certified have taken the extra step to have their competence and experience recognized. You can read more about what distinguishes “Board Certified” attorneys from others by visiting The Florida Bar website here.

Requirements for Becoming Board Certified by The Florida Bar in Health Law.

To qualify to take the health law certification examination, attorneys must:

1. be members of The Florida Bar for at least five years,
2. be engaged in the full-time practice of law,
3. be substantially involved, at least forty percent (40%), in health law for the prior three years of their practice,
4. complete at least 60 hours of advanced continuing legal education of approved health law credits and,
5. Pass a stringent peer review process.

To become certified in health law, an attorney is also required to pass a rigorous written board certification examination designed to test the attorney’s knowledge, skills and proficiency in the field of health law. All currently certified attorneys must apply for recertification every five years.

Read more on The Health Law Firm’s Board Certified Health Law attorneys here.

To view a press release on the recertification of George F. Indest III and Michael L. Smith, click here.

You Seek Specialized Medical Care from a Medical Specialist; Seek Specialized Legal Services from a Health Law Specialist.

If you have a medical issue you seek treatment from a physician who is board certified in a medical specialty, such as obstetrics and gynecology, orthopedic surgery, neurology or others. This is because they have superior education, training, knowledge and experience in that area of medicine.

Likewise, when you have a legal problem in the area of health practice, health licensing, health care regulation or other legal situations unique to the health care industry, you should seek legal advice and representation from a legal specialist in health law.
Contact The Health Law Firm to Speak with an Attorney who is Board Certified by The Florida Bar in Health Law.

The Health Law Firm currently has two Board Certified Health Law attorneys:

George F. Indest III, J.D., M.P.A., LL.M, is Board Certified by The Florida Bar in Health Law.
Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law.

To learn more about all the attorneys at The Health Law Firm, click here.

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

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

KeyWords: Board Certified by The Florida Bar in Health Law, Board Certified in Health Law, health law attorneys, health law attorneys Florida, health law expert, legal specialist in health law, Health law defense lawyer, legal representation of health care professionals, Medicare fraud defense attorney, Medicare audit defense attorney, Medicaid fraud defense attorney, Medicaid audit defense attorney, Baker Act defense attorney, disruptive physician defense attorney, legal representation for disruptive physician, legal representation for Baker Act cases, legal representation for Medicare fraud, legal representation for Medicaid fraud, legal representation for clinical research investigations, legal representation for clinical research fraud, Florida health law attorney, 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 © 2017 The Health Law Firm. All rights reserved.

New Hampshire Dentist Indicted on 189 Counts of Medicaid Fraud

George IndestBy 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.

6 Charged In Florida Chiropractic PIP Insurance Fraud Scheme

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 4, 2017, federal prosecutors charged six Florida residents with running a multi-million dollar insurance fraud scheme through a dozen chiropractic clinics. The alleged scheme involved paying kickbacks to chiropractors and tow truck companies to refer accident victims and then fraudulently billing insurers for services the victims did not need.
An indictment unsealed in Fort Lauderdale charges three of the individuals involved with racketeering, conspiracy to commit fraud and making false statements relating to health care matters.  Three additional people were also charged with conspiracy to commit fraud.


Insurance Fraud Scheme.

Prosecutors claim that beginning in 2010, two of the individuals charged, ran a scheme through chiropractic clinics in South Florida that were used to commit automobile insurance fraud.  They are alleged to have set up the clinics using licensed chiropractors as fake owners and then paid illegal kickbacks of between $500 and $2,100.  Those who received the illegal kickbacks included tow truck drivers, who could solicit car crash victims for the clinics, according to the indictment. Unnamed tow truck drivers and others were paid $2,100 to visit either Yonover’s clinics or Dalley’s law office after they were involved in car accidents.

The accident victims were encouraged to visit the clinics at least 30 times so the clinic owners could receive the largest personal injury protection (PIP) insurance reimbursement, prosecutors said.  Prosecutors also claim that two of those charged told employees to falsely inflate the pain levels of accident victims in order to get the insurance companies to pay for the treatments.

If convicted, those involved could receive sentences of up to 80 years in prison in addition to massive fines.

Florida is Serious in Combating PIP Fraud.

Physicians, especially dentists, chiropractors, and optometrists, should always be extremely wary about working for a clinic or medical group owned in any part by someone who is not a licensed health professional.  If the clinic, practice or group is owned in any part, even one percent (1%) by a person or business entity that is not a Florida licenced health professional, it may be operating illegally. This includes someone licensed in another state or who has a revoked or inactive Florida license. Dentists, optometrists and chiropractors in Florida have even more restrictions placed on their practices than other health professionals and most other states.

Florida specifically prohibits the corporate practice of dentistry. The key provision in Florida law that establishes this is Section 466.028, Florida Statutes, but the Florida Board of Dentistry has also adopted administrative rules on this topic as well.
Chiropractors have a statutory provision, Section 460.4167, Florida Statutes, that places stringent limits on who may own or control a clinic that involves the delivery of chiropractic services. As a general rule, it prohibits anyone who is not a Florida licensed chiropractor, M.D., D.O. or podiatrist from owning in any part a clinic that employs a chiropractor.

Physicians who are “partners,” “shareholders” or “co-owners” with unlicensed personnel need to ensure they are in full compliance with the Florida HCCLA and all other applicable Florida laws and regulations. Consult with an experienced health lawyer before making an expensive mistake.

To read a prior blog I wrote on a very similar case involving PIP fraud, click here.

Clinics Setting up Phoney Physician Owners Violate the Laws.

We have been consulted by many different dentists, medical doctors and chiropractors who have found themselves involved in clinics owned by or controlled by individuals who do not have any license or any Florida license.  Often these situations result in complaints, investigations and prosecutions being initiated against the physician who is unwittingly involved.  In one case we were called upon by a radiologist who was sued by the U.S. Food and Drug Administration (FDA) for over six million dollars ($6,000,000) in civil monetary penalties because the real unlicensed owners of an independent diagnostic treatment facility (IDTF) had falsely listed him as the owner to illegally avoid obtaining the correct licensed they needed.

Licensed physicians, chiropractors, dentists and other health professionals must be diligent and make sure that a dental or health care clinic or practice does not list her or him as an “owner” (including a shareholder or member) or officer (including “president” or “managing member”) of a corporation, limited liability company or other business entity unless he or she actually is one.  Allowing your name to be used as the owner “for paperwork reasons only” or “for licensure reasons only” or “for insurance purposes only” is just an indication that you are actually aware of and involved in the fraud.  An owner “in name only” is merely a “phony owner” or a “straw man owner,” all terms meaning the same thing:  for the purpose of defrauding someone.

How can you tell if you are a real owner (shareholder or member), and not merely a “straw man” or “phony owner”?  Here are some indicators:

1. You actually paid money to obtain the ownership interest (shares or membership interest).

2. You have a written, signed, dated shareholders agreement or membership agreement.

3. You have stock certificates or membership certificates showing your ownership interest in the business interests.

4. You receive a shareholders or members distribution each year that is reported to the Internal Revenue Service (IRS).

5. You receive a tax document (usually a form K-1 or Form 1099-DIV) annually as a result of the corporate or limited liability company income tax return that shows your percentage interest in the corporation or company and what percentage of the income was paid to you.

6. You will have access to and some control over the books, records and accounts of the business.

Contact Experienced Health Law Attorneys in Matters of Fraud.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses, chiropractors and other health providers in fraud investigations, regulatory matters, licensing issues, litigation, denials and demands for repayment from insurance companies, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. It also represents shareholders, members and business entities in corporate and business litigation in state or federal court.  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:

Musgrave, Jane. “Delray lawyer, Boca man charged in million-dollar PIP fraud scheme.” The Palm Beach Post. (October 4, 2017). Web.

Bolado, Carolina. “6 Charged In Florida Chiropractic Insurance Fraud Scheme.” Law360. (October 4, 2017). 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: Personal Injury Protection (PIP) fraud, legal representation for PIP claims, legal representation for PIP fraud, legal representation for chiropractors, chiropractor defense attorney, legal representation for licensed health care professionals, “straw man owner,” “phony owner of health care clinic,” medical practice legal representation for health care clinic owners, health fraud defense lawyer, legal representation for health care fraud, health care clinic attorney, litigation over ownership of clinic, corporate practice of medicine, health fraud defense attorney, false claims lawyer, insurance fraud defense attorney, Florida Division of Insurance Fraud, legal representation for allegations of false claims, legal representation for submitting false claims to the government, false claims defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, attorney for health care clinic license, medical business dispute attorney, proprietorship of dental practice attorney, proprietorship of chiropractic practice 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 © 2017 The Health Law Firm. All rights reserved.

 

Florida Woman Who Performed Illegal Silicone Injections Sentenced After “Patient’s” Death

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

On May 26, 2017, a Sanford, Florida, woman who performed illegal cosmetic silicone injections was sentenced to 11 years in federal prison. According to prosecutors, the illegal procedures done by Deanna Roberts, led to serious health problems and the death of a prominent night club performer.
Illegal Injections.

From reports, Deanna Roberts bought about 178 gallons of non-medical grade liquid silicone between 2004 and 2015. She apparently told officials checking on this that she used the substance to lubricate medical equipment, according to the U.S. Department of Justice (DOJ). Despite what she told officials, prosecutors said she falsely claimed to be a licensed medical practitioner and illegally injected liquid silicone into at least five people during cosmetic procedures.

Come on, you know that if she purchased 178 gallons of silicone, she must have injected hundreds of patients.

Health Risks of Liquid Silicone.

The U.S. Food and Drug Administration (FDA) does not allow liquid silicone to be injected because of the health problems it can cause. Many of her “clients” were hospitalized with respiratory problems and other ailments when the silicone migrated to different parts of the body like their lungs, which is what it does. A prominent Atlanta performer died after the substance moved into her lungs, heart, brain and other organs, only 36 hours after the injection.

Roberts pleaded guilty. She was sentenced to 11 years and three months in federal prison, followed by three years of supervised release.

Why Don’t Patients Check Out the Credentials of Their Physicians?

Why don’t patients check out the credentials of their physicians? This just seems like common sense. Yet Florida abounds with phony doctors, phony paramedics, phony dentists and others practicing medicine or some other health profession without being licensed or even knowing anything about the field. Is it driven by the expense of medical procedures? To a certain extent it may very well be. It may also be partially explained by a failure of the “patients” to comprehend the possible adverse consequences of what may be viewed as a “minor” procedure. To a large extent, the unlicensed individuals who do this also prey on foreign born immigrants and foreigners, trusting them because they speak the same language.

I think the problem goes way beyond just the lack of licensure of the person providing the medical services. I constantly see cases of licensed medical doctors holding themselves out as experienced practitioners in medical specialties for which they are not board certified. I seen cases where board certified obstetricians/gynecologists are practicing pain management, where family practice physicians are performing plastic surgery procedures, where dentists are running medical spas providing cosmetic laser services, where nurses are performing cosmetic medical procedures, etc.

If you were diagnosed with a brain tumor, would you go to a family practice doctor to have it removed because he didn’t charge as much. If you needed a hernia repair, would you go to the “doctor” at the flea market, because she was so inexpensive? Consumers really need to be more worried about the experience and credentials of their physicians and check them out completely. Neighbors who have “doctors” set up clinics in their homes and garages need to rat these people out. Phony plastic surgeons who only advertise in Spanish on Spanish radio stations need to be reported to the authorities. Florida needs to do more about these unlicensed and licensed, but unqualified, health practitioners.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

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

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

Sources:

Hayes, Crystal. “Sanford woman sentenced after silicone injection scheme led to drag queen’s death.” Orlando Sentinel. (May 26, 2017). Print.

Eldridge, Ellen. “Woman who killed Atlanta drag queen with silicone injection heads to prison.” The Atlanta Journal Constitution. (May 26, 2017). 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: Legal representation for health care professionals, health law defense attorney, Florida health law attorney, health care fraud defense attorney, legal representation for health care fraud, legal representation for health care fraud investigations, health care fraud investigation representation, legal representation for U.S. Department of Justice (DOJ) investigations, DOJ investigation representation, review of The Health Law Firm attorneys, The Health Law Firm 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 © 2017 The Health Law Firm. All rights reserved.

Colorado Unveils New Weapon in Fight Against Prescription Drug Abuse

By Carole C. Schriefer, R.N., J.D., The Health Law Firm

In the United States, Colorado ranks among the highest in prescription drug abuse. Prescribing practices have contributed to both the overuse as well as the illegal use of controlled substances. Recently, the Colorado Medical Board in collaboration with the Colorado Dental Board, Colorado Board of Nursing, Colorado Board of Pharmacy, and the Nurse-Physician Advisory Task Force for Colorado Healthcare, passed a policy for prescribing and dispensing opioids. This is the first time that all four Colorado licensing agencies have worked together to formulate a common policy for health care providers.

The new guidance sets the tone for how complaints involving prescribing and dispensing controlled substances will be viewed by these regulatory boards.

To read the new policy in its entirety, click here.

An Overview of the Prescribing and Dispensing Policy.

The new policy aims to reduce prescription drug abuse by better managing opioid prescribing and dispensing. The policy states that providers working with patients who are prescribed opioids should:

– Follow the policy for prescribing and dispensing opioids;
– Be informed about evidence-based practices for opioid use in health care and risk mitigation;
– Collaborate with the integrated health care team to decrease overprescribing, misuse and abuse of opioids;
– Use the Colorado Prescription Drug Monitoring Program (PDMP) when initially prescribing medication and with each refill;
– Use caution when dispensing to new or unknown patients, filling weekend or late day prescriptions, and when filling prescriptions issued by a provider far from the location of the pharmacy; and
– Educate patients on appropriate use, storage and disposal of opioids, risks and the potential for diversion.

Red Flags.

The new policy describes certain “red flags” health care providers should look for when prescribing and dispensing opioids. It alludes to certain prescription amounts and types that will likely be considered substandard in the absence of a compelling reason for the prescription. For example, the policy advises opioid doses greater than the equivalent of 120 mg morphine are dangerous. The policy also advises against opioid treatment that exceeds 90 days. It’s suggested that prescribers should consider discontinuing opioid therapy when:

– The underlying painful condition is resolved;
– Intolerable side effects emerge;
– The patient’s quality of life fails to improve;
– Functioning deteriorates; or
– There is aberrant medical use.

Tread Lightly When Prescribing Opioids.

Whether you are a physician, nurse, dentist, pharmacist or other health care provider practicing pain management, you should read the entire policy and strictly follow its guidance. Keep detailed records of your pain patients’ care, including copies of PDMP data. As a professional dealing with pain patients, you should also feel comfortable referring appropriate patients to addiction and pain management specialists at any sign of abuse. Failure to follow the new policy may lead to disciplinary action against your license.

For more tips to protect yourself from being accused of overprescribing, click here for a previous blog.

Comments?

What do you think of Colorado’s policy for prescribing and dispensing opioids? Do you think this new policy will make an impact on the prescription drug abuse throughout the state? As a health care provider, will you follow the new policy? Please leave any thoughtful comments below.

Contact A Lawyer Experienced in the Representation of Health Care Professionals in Pain Management Defense.

The Health Law Firm attorneys represent physicians, pharmacists, nurses, clinics, dentists, pharmacies, health facilities and other health care providers in different cases involving allegations of overprescribing narcotics and pain medications. These include criminal investigations by local police and law enforcement authorities, investigations by the U.S. Drug Enforcement Agency (DEA), complaints against professional licenses, and other types of cases. Having attorneys familiar with the medical standards of care and guidelines for prescribing narcotics and having access to expert medical and pharmacy professionals who can testify as expert witnesses in such cases is also crucial. We have represented professionals in administrative investigations and administrative hearings at both the state and federal level.

Call (970) 416-7456 now or visit our website www.TheHealthLawFirm.com.

About the Author: Carole C. Schriefer is a nurse-attorney 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.

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 © 1999-2014 The Health Law Firm. All rights reserved.

Michigan Dentist Accused of Million Dollar Medicaid Fraud Scheme Captured in Caribbean

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Michigan dentist accused of Medicaid fraud was recently captured in the Dominican Republic after evading charges for months, state authorities announced. Dr. David Johnson operated the alleged scheme through Livernois Dental in Detroit, which he owned at the time but has since sold.

27 Charges.

Dr. Johnson was charged by Michigan Attorney General Bill Schuette in May 2017, after allegedly using another dentist’s information to improperly bill Medicaid $1.7 million over a three year period of time. The charges include one count of racketeering, punishable by up to 20 years in prison; 20 counts of false Medicaid claims, punishable by up to 10 years in prison; and six counts of false health care claims, punishable by up to four years in prison.

According to the Attorney General’s press release, since the charges were issued, the dentist was living outside of the United States in an attempt to evade arrest. To read the AG’s press release in full, click here.

Unfortunately, this is not the only case of a health care professional trying to evade arrest. To read about another case, click here to read one of my prior blogs.

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

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

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

Sources:

Rahal, Sarah. “Macomb dentist accused of fraud faces 27 felonies.” The Detroit News. (October 3, 2017). Web.

“Chesterfield Township dentist accused of Medicaid fraud captured in Caribbean.” Baltimore Voice Newspaper. (October 3, 2017). 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 © 2017 The Health Law Firm. All rights reserved.

 

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