Health Facilities Law Blog

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Former UCLA Phlebotomist Awarded Nearly $1.6 Million in Harassment Suit

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 7, 2019, a jury awarded almost $1.6 million to a woman who alleged she was fired for complaining about coworker’s subjecting her to racial insults and discriminatory comments at her job. Nicole Birden claimed that UCLA Medical Center, Santa Monica, failed to investigate when supervisors harassed and insulted her and several other African-American employees. Additionally, she alleged that she was fired from her job as a phlebotomist after raising concerns about the issue, according to the verdict filed in  Los Angeles Superior Court.

Alleged Hostile Work Environment.

According to Birdnne’s complaint, she began working at UCLA Medical Center Santa Monica, as a phlebotomist in 2015. Shortly after, she claims coworkers made disparaging remarks about the color of her skin and racially stereotyped her in Spanish. In June of 2016, the UC Board of Regents abruptly terminated her employment despite the fact that she had never previously received any kind of disciplinary action against her.

Following her termination she filed a complaint in 2017, alleging that the UCLA Health created a hostile work environment. Additionally, she alleges that the University of California Board of Regents violated California’s Fair Employment and Housing Act for harassment, race and age discrimination, and retaliation, according to the complaint.

To read the verdict for this case in full, click here.

Click here to read one of my prior blogs that also deals with discrimination in the workplace.

Contact Health Attorneys Experienced in Health Law and Employment Law.

The Health Law Firm represents both employers and employees in the health care industry in defending allegations of employment discrimination and other complaints from employees and patients. We represent employers and employees in unemployment compensation hearings, in defending against EEOC (discrimination) complaints, and in defending litigation involving wage and hour disputes, as well as other types of contract or employment litigation. We also can investigate such allegations and attempt to negotiate settlements where warranted. Our attorneys represent individuals and institutions in litigation, civil or administrative, state or federal.

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

Sources:

“UC Regents to Pay $1.5 Million in Hostile Work Environment Case.” Associated Press. (August 7, 2019). Web.

Stawiki. Kevin. “Ex-UCLA Blood Tech Wins $1.6M In Racial Harassment Suit.” Law360. (August 7, 2019). Web.

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

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

By |2019-08-09T19:38:06+00:00August 9th, 2019|Health Facilities Law Blog|0 Comments

Steps to Challenge OIG Exclusion Action from Medicare Program

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.

The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation.  Below are the steps in the process you must follow to protect your career and your livelihood.

The Administrative Process to Challenge OIG Exclusion Actions.

1.    Notice of Intent (NOI) received: If the OIG is proposing to exclude a person or entity from Medicare, it will send out a letter called a “Notice of Intent” or “NOI.” This will contain the reasons for the exclusion and will detail hearing or appeal rights.  It is very important to make sure that your state licensing board and Medicare have your correct current address on file because the address which Medicare has will be where the NOI is mailed.  (Note:  the OIG may not send a NOI for mandatory exclusions which carry a 5-year minimum exclusion period.)  You will not have a second chance. Regardless, you usually only have 30 days to submit a written response requesting a hearing and containing information the OIG will consider in making its decision.  In some cases, providers may have the opportunity to present oral arguments before OIG officials. You must make sure that your request is received by the deadline, not just mailed by the deadline.  Send your request by a fast, reliable means (such as Federal Express or U.S. express mail) that you can track; or register for and file it electronically online.  Read the instructions in the letter and follow them. Be sure you get a receipt when you file.

2.    Notice of Exclusion (NOE): Sometimes the OIG will send a “Notice of Exclusion” or “NOE” if it decides to exclude a provider regardless of the response provided to a NOI or in certain cases of mandatory exclusions or certain permissive exclusions where no NOI is ever sent. Medicare exclusions usually take effect 20 days after the NOE is mailed. In cases involving fraud, kickbacks and other prohibited activities, a Notice of Proposal to Exclude or NOPE may be sent instead.

3.    Administrative Law Judge (ALJ) Hearing: Providers have the right to appeal a proposed exclusion by requesting an administrative hearing (similar to a trial) before an “Administrative Law Judge” or “ALJ.” ALJ’s are part of the Department of Health and Human Services (HHS). If you wish to request an ALJ hearing, you must do so within 60 days of receiving the Notice of Exclusion (or according to the instructions), and you must be prepared to raise all of your arguments over issues regarding the decision itself, the proposed exclusion period, mitigating factors or other aspects of the action.

4.    Department Appeals Board (DAB): If you disagree with the ALJ hearing decision, you can further appeal to the HHS “Departmental Appeals Board” or “DAB.” This is a written appeal which will be required to set forth legal errors which were made in the ALJ hearing.

5.    Judicial Review: If you disagree with the decision made by the DAB, your only option is to challenge the final decision in a U.S. District Court.

MOST IMPORTANT, consult a health law attorney experienced in such matters. The consequences of  Medicare exclusion, even a permissive exclusion for one year or three years, are severe. Most people do not realize this until it is too late; then it is too late (in many, but not all, cases).

To learn more about the consequences of OIG exclusion, click here to read one of my prior blogs.

Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program.

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

To contact The Health Law Firm please call (407) 331-6620 or (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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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

By |2019-06-18T20:03:35+00:00July 30th, 2019|Health Facilities Law Blog|0 Comments

New Changes to Florida’s Certificate of Need Law Eliminate CONs for Hospitals

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

On June 3, 2019, Tallahassee healthcare regulators began the complex process of reshaping the state’s certificate of need (CON) program. Florida regulators are moving ahead to eliminate the certificate of need program for hospitals and to focus it on nursing homes, hospices, and institutions for individuals with developmental disabilities.

The Proposed Changes to the CON Laws.

In May 2019, the Florida Legislature eliminated certificate of need program requirements for general acute care hospitals and tertiary services. The new law keeps CON requirements for specialty hospitals in place only until July 1, 2021. Click here to read more.

Rules being proposed to implement the legislative changes would maintain the four review cycles but split them into two different categories. One category would deal with applications for hospital facilities and hospices. The other category would be dedicated to nursing homes and intermediate-care facilities for individuals with disabilities.

Florida’s Certificate of Needs Programs.

Opponents of the CON program argue that it limits the ability to create new healthcare services and to build new facilities (in other words, “competition is good”). Advocates for CONs have argued that geographic areas where hospital and other health facilities are overbuilt can actually lead to increased healthcare costs and reduced services (in other words, “competition is bad”).

Critics of CONs argue that they limit the free market and, because CONs stifle competition, lead to increased costs. They have long argued that the requirements to maintain CONs can be shifted from certificates of need to simple licensing requirements.

To read my prior blog dealing with a certificate of needs case, click here.

Consult With A Health Law Attorney Experienced in the Representation Health Care Professionals.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in academic disputes, contract negotiations, license applications, board certification applications, credential hearings and civil and administrative litigations and hearings. We also have experience in representation for health care investigations by the Agency for Healthcare 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).

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

Sources:

Sexton, Christine. “Florida regulators float new rules in hospital wars.” Sun-Sentinel. (July 5, 2019). Web.

“State Regulators Float New Rules in Hospital War Battles.” Law.com. (July 6, 2019). Web.

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

Keywords: Florida formal administrative hearing attorney, Florida formal administrative hearing legal representation, Florida formal administrative hearing lawyer, Florida formal and informal administrative hearing representation, legal representation for rule challenge hearings, legal challenge to state agency rules. legal representation for emergency suspension hearings, legal representation for revocation hearings, Administrative Law Judge (ALJ) hearing attorney, Florida Agency for Health Care Administration (AHCA) formal hearing defense representation, Florida Agency for Health Care Administration (AHCA) formal hearing defense attorney, Florida Agency for Health Care Administration (AHCA) formal hearing defense lawyer, legal representation for investigations of health care providers, health law defense lawyer, representation for health care professionals, reviews of The Health Law Firm. The Health Law Firm attorney reviews, representation for Florida Department of Health (DOH) investigations and hearings, license investigation representation defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews

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

By |2019-07-16T21:46:59+00:00July 16th, 2019|Health Facilities Law Blog|0 Comments

Although the Law Stacks the Deck Against You, Leaving a Foreign Body in a Patient Doesn’t Always Mean Negligence or Discipline

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

Leaving a foreign object (sometimes referred to as a “retained foreign body” or “RFB”) in a patient, such as a sponge, clamp, forceps, surgical needle, guide wire, part of a surgical instrument or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures, does not necessarily mean that the physician has committed an act of negligence or that the physician will be disciplined by the Board of Medicine (BOM) or Department of Health (DOH). There are many defenses in such a case and many incidents which do not constitute negligence. However, as a preliminary matter, the law does seem to stack the deck against the physician in such cases.

Medical Negligence Statutes.

Section 766.102(3)(b), Florida Statutes (previously Section 768.45, Florida Statutes),
states:

The existence of a medical injury does not create any inference or presumption of negligence against a health care provider, and the claimant must maintain the burden of proving that an injury was proximately caused by a breach of the prevailing professional standard of care by the health care provider. . . . However, the discovery of the presence of a foreign body, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or diagnostic procedures, shall be prima facie evidence of negligence on the part of the health care provider.

Grounds for Disciplinary Action Against a License.

Chapter 456, Florida Statutes, applies to all health professionals who are licensed by the Florida Department of Health (DOH). Section 456.072(1), Florida Statutes, which provides the grounds for possible discipline of any licensed health professional contains a subsection (cc), which provides the following as a basis for disciplinary action:

Leaving a foreign body in a patient, such as a sponge, clamp, forceps, surgical needle, or other paraphernalia commonly used in surgical, examination, or other diagnostic procedures. For the purposes of this paragraph, it shall be legally presumed that retention of a foreign body is not in the best interest of the patient and is not within the standard of care of the profession, regardless of the intent of the professional.

Applicable to Others than Just Surgeons and Physicians.

We typically envision objects such as clamps or lap pads (“sponges”) being left in a patient after surgery. Note, however, these provisions of the law could apply equally to a nurse practitioner’s leaving a broken needle in a patient or a dentist’s leaving a burr or broken probe in a patient.

Res lpsa Loquitur.

Many surgeons and other physicians who are charged with such an allegation just give up, do not defend themselves, and agree to accept punishment from their professional board. The statutes quoted above are, basically, a restatement of the common law rule known as “res ipsa loquitur in medical malpractice cases.

The term “medical injury” in the statute refers to an injury sustained as a direct result of medical treatment or diagnosis, and does not encompass injuries totally unrelated thereto. Thus, when a plaintiff establishes that the injury is outside the scope of medical treatment or diagnosis, and the facts and circumstances attendant to the injury are such that, in light of past experience, negligence is the probable cause and the defendant is the probable actor, the doctrine of res ipsa loquitur is applicable.

In Florida, there is a Florida law that is set forth within Chapter 456, Florida Statutes. Chapter 456 of Florida Statutes applies to all health professionals who are licensed by the Florida Department of Health (DOH).

Many surgeons and other physicians who are charged with such an allegation just give up, do not defend themselves, and agree to accept punishment from their professional board.

Florida Cases on Retained Foreign Objects.

Archer v. Maddux, 645 So. 2d 544 (Fla. 1st DCA 1994) a surgeon left a tube in a patient after surgery by accident. The trial court dismissed the case because there was no affidavit from a medical expert corroborating that medical negligence had occurred that had been filed before the running of the statute of limitations. The Court of Appeal upheld the dismissal of the case.

DeAlmeida v. Graham, 524 So. 2d 666 (Fla. 4th DCA 1987), a surgeon left a Kelly clamp inside of a patient.

Moreover, the provision of Fla. Stat. ch. 766.102(4) that discovery of a “foreign body” such as surgical paraphernalia is prima facie evidence of negligence, is clearly inapplicable in a case where the mesh was intentionally placed in patient’s body as part of her treatment, and like screws, plates, pacemakers, and/or artificial joints was intended to permanently remain in her body. (Kenyon v. Miller, 756 So. 2d 133 (Fla. 3d DCA 2000)

Smith v. Zeagler, 116 Fla. 628, 157 So. 328 (1934)
It is negligence per se for a surgeon to leave a sponge in an abdominal incision made in his patient in the course of his performance of a surgical operation upon such patient. The burden of showing due care is upon a surgeon who leaves a sponge enclosed in a wound after the performance of an operation, and he cannot relieve himself from liability unless the sponge was so concealed that reasonable care on his part would not have disclosed it, and conditions were such that, in his professional judgment, a special exploration for the sponge would have endangered the safety of the patient. Where a patient’s condition is critical and the paramount requirement is complete the operation in the shortest possible time, the failure to remove a sponge may be an accidental and excusable ship or inadvertence that is not actionable negligence, depending upon the circumstances of the case, the burden being on the physician to show to the satisfaction of the jury that the particular act was not blame-worthy because of the supervening necessity to complete the operation without delay.

The authorities are legion to the effect that it is negligence [***3] per se for a surgeon to leave a sponge in an abdominal incision made in his patient in the course of his performance of a surgical operation upon such patient. Ruth v. Johnson, 172 Fed. 191; Reeves v. Lutz, 179 Mo. App. 61, 162 S.W. Rep. 280; Rayburn v. Day, 126 Oregon 135, 268 Pac. Rep. 1002; Wynne
v. Harvey, 96 Wash. 379, 165 Pac. Rep. 67; Harris v. Fall, 177 Fed. 79, 27 L.R.A (N.S.) 1174; Moore v. Ivey (Texas Civ. App.), 264 S.W. Rep. 283; 21 R.C.L. 388.

The burden of showing due care is upon a surgeon who leaves a sponge enclosed in a wound after the performance of an operation, and he cannot relieve himself from liability unless the sponge was so concealed that reasonable care on his part would not have disclosed it, and conditions were such that, in his professional judgment, a special exploration [*631] for the sponge would have endangered the safety of the patient. Davis v. Kerr, 239 Pa. 351, 86 Atl. Rep. 1007, 46 L.R.A. (N.S.) 611.


Adverse Consequences of Accepting Discipline in a RFB Case.

Many health professionals agree to accept punishment from their professional board without realizing the harsh consequences. Any disciplinary action will be reported to the National Practitioner Data Bank (NPDB). If you are reported to the NPDB or another health care data base, you could have issues obtaining hospital privileges, state licenses, you may be excluded from the Medicare and Medicaid Programs, and it could also affect your ability to work in the health care field. Additionally, similar actions will be taken against any licenses you have in other states.

Shared Responsibility Between Surgeon and Hospital Staff.

Most hospitals have internal policies and procedures which make it a shared responsibility between the surgeon and the hospital’s staff (especially surgical technicians and operating room nurses) to safeguard against leaving foreign objects in patients.

The Health Law Firm has successfully defended physicians and other licensed health care professionals in administrative investigations and patients complaints relating to retained foreign bodies.

For more information on how we can help you in situations such as this, visit our Areas of Practice page on our website.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

About the Author: George F. Indest III, J.D., M.P.A., LL.M., 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: Representation for licensed healthcare professionals, National Practitioner Data Bank, NPDB defense lawyer, NPDB representation, Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

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

By |2019-05-21T19:58:49+00:00May 21st, 2019|Health Facilities Law Blog|0 Comments

Genetic Testing Scams Ripping off Government Programs for Millions, Part 1 of 2

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

Several genetic testing companies have come into the spotlight for allegations of ripping off Medicare and False Claims Act (FCA) violations. Health care professionals need to be aware of these types of schemes and the dangers they may face if involved. In each of these cases, the companies agreed to a pay a settlement in the millions to resolve allegations they submitted claims for unnecessary genetic testing.

This is part one of a two part blog series. Click here for part two.

The Details.

On February 11, 2019, the Department of Justice (DOJ) announced that GenomeDx Biosciences Corp. (GenomeDx) agreed to pay $1.99 million to resolve FCA allegations. The false claims to Medicare were for a post-operative genetic test for prostate cancer patients. GenomeDx allegedly submitted claims for the genetic test to Medicare between September 2015 and June 2017. They were not medically reasonable nor necessary because the prostate cancer patients did not have risk factors necessitating the test. You can read the DOJ’s press release and learn more here.

In a similar case, on March 8, 2018, the U.S. Attorney announced a settlement with a California genetics testing company, Natera, Inc. The company agreed to pay $11 million to resolve FCA allegations for improperly billing TRICARE for non-invasive prenatal testing. According to the government, Natera improperly billed for genetic screenings to test a baby’s risk for certain disorders and syndromes. Natera allegedly used an improper billing code to misrepresent the services and screened patients with low-risk pregnancies who did not need it, according to the government.  The suit was initiated by a pair of whistleblowers under the qui tam provisions of the FCA.

Click here to read the press release in full.


Consequences of These Types of Scams.

In both cases, the message is clear, “if you take advantage of programs like Medicare, you will be held accountable,” according to the government. Companies and providers who file false claims to generate more revenue are stealing from the taxpayers and those who rely on those federally funded programs.

Don’t allow your name, provider number and NPI to be used for ordering illegal medically unnecessary tests, procedures or treatments. If you do, you may very well find yourself caught up in a similar FCA or other government investigation. These hefty settlements send a message that pursuing healthcare fraud is a priority to the DOJ. In 2018, it recovered more than $2.8 billion from FCA cases alone. Click here to learn more.

Be sure to continue with part two of this blog series to learn more about these types of fraud scams.

Contact Health Law Attorneys Experienced with FCA, Qui Tam or Whistle Blower Cases.

Attorneys with The Health Law Firm also represent physicians, clinics, health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We also represent doctors, nurses and others as relators (whistle blowers) in bringing qui tam or whistle blower cases, as well.  We represent health professionals and health facilities in complex litigation involving medical issues in state and federal courts.

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

Sources:

“Genetic Testing Company Settles Whistleblower Suit for $11.4M.” Constantine Cannon Lawyer Group. (March 14, 2018). Web.

“Whistleblower Suit Over Falsified Prenatal Test Billing Settles.” Allison Legal Law Firm. (March 11, 2018). Web.

Raymond, Nate. “Natera settles U.S. billing probe over prenatal gene tests for $11.4 mln.” Reuters. (March 12, 2018). Web.

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

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

By |2019-05-10T02:04:52+00:00May 10th, 2019|Health Facilities Law Blog|0 Comments

Gov. DeSantis’ Prescription Drug Import Plan Gains FL House Support

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On March 12, 2019, the Florida House of Representatives’ Health Quality Subcommittee voted 15 to 2 to approve House Bill 19 (HB 19) that would implement one of Florida Gov. Ron DeSantis’ recently announced health care proposals. In February 2019, the new Florida governor, who was criticized for not having a health care platform while he campaigned, announced the proposal that Florida start importing drugs from Canada.

HB 19 -Prescription Drug Importation Programs.

HB 19 was created for the purpose of safely importing cost-effective prescription drugs from Canada and other foreign nations under specified conditions. The proposed program would go into effect on July 1, 2019.

HB 19 provides eligibility criteria for prescription drugs and program participants; provides distribution requirements; provides annual reporting requirements; provides application and permitting requirements for certain participating entities; and provides that implementation of International Prescription Drug Importation Program is contingent on federal arrangement or obtaining federal guidance. Click here for more information on HB 19.

Two Programs, One Goal – Lowering Prescription Drug Prices.

The program will offer access to FDA-approved prescription drugs imported from Canada, allowing the drugs to be sold to Floridians at a much lower cost than they could otherwise purchase them here. “One of the biggest drivers of this country’s out of control healthcare spending is the cost of prescription drugs,” said Governor DeSantis.

According to the bill, the U.S. spends 30 to 190% more than other developed countries on prescription drugs, and up to 174% more for the exact same for prescription drugs. The proposed bill aims to lower these unnecessary high costs by establishing two different drug importation programs.

The first program would allow the state to import prescription drugs from Canada for use by the Florida Medicaid Program and prison health care system. It would be known as the Canadian Drug Importation Program. It would be run by the Florida Agency for Health Care Administration (AHCA).

The second program would be known as the International Drug Importation Program. It would be run by the Florida Department of Business and Professional Regulation and would be available to individual residents.

Despite gaining house support, both programs would still need approval from the federal government before they could be implemented in Florida.

To learn more about Gov. DeSantis’ proposal, click here to read his press release.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

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

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

Sources:

Sexton, Christine. “DeSantis prescription drug savings plan gets early House support.” Orlando Sentinel. (March 12, 2019). Web.

News Service of Florida. “DeSantis Drug Importation Plan Wins House Support.” Sunshine State News. (March 13, 2019). Web.

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

KeyWords: Legal representation for pharmacies, representation of health care professionals, health law defense attorney, doctor attorney, nurse attorney, Legal Defense for Pharmacists, pharmacy defense attorney, representation for pharmacists, representation for pharmacies, Department of Health defense attorney, DOH investigation representation, quality assurance representation, DEA investigation, DEA attorney, DEA representation, prescription E-FORSCE representation, DEA defense lawyer, representation for overprescribing, Medicare investigation lawyer, representation for Medicaid investigation, representation for health care professionals, license defense lawyer, licensure representation, board representation attorney, representation for board investigations, whistleblower representation, qui tam representation, whistleblower attorney, whistleblower defense attorney, qui tam attorney, qui tam defense lawyer, representation for license defense, licensure defense attorney, protecting your professional license, Florida opioid crisis, Florida’s ongoing lawsuit for opioid crisis The Health Law Firm, 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 © 2019 The Health Law Firm. All rights reserved.

By |2019-03-18T19:17:55+00:00May 6th, 2019|Health Facilities Law Blog|0 Comments

DOJ Announces $2.8 Billion Recovered Funds From Healthcare Cases in 2018

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

On December 21, 2018, the U.S. Department of Justice (DOJ) announced that it recovered more than $2.8 billion from False Claims Act (FCA) (also known as “qui tam” or “whistleblower cases”) cases in 2018. Of the $2.8 billion in settlements and judgments that the government obtained during the year through FCA cases, more than $2.5 billion involved health care fraud. These cases included drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical device industry. In one example, AmerisourceBergen Corporation paid a whopping $625 million to settle charges filed under the whistleblower provisions of the FCA. The charges alleged that it illegally distributed misbranded drugs for cancer patients. Of that amount, $581.8 million was paid to the federal government and $43.2 million was paid to state Medicaid programs. Click here to read more on that.

Whistleblower Complaints.

Of the $2.8 billion recovered in 2018, more than $2.1 billion arose from lawsuits filed under the qui tam provisions of the FCA. The government paid out $301 million to the whistleblowers who exposed fraud and false claims by filing these actions. There was a total of 645 qui tam suits filed in 2018. Click here to see the DOJ’s 2018 statistics.  To view the DOJ’s press release on fraud for the fiscal year 2018, click here.

Health Care Fraud is a Serious Matter.

We have been consulted by many individuals, both before and after criminal convictions for health care fraud or related offenses. In many cases, those subject to Medicare fraud audits and false claims investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding health care fraud.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of health care fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

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

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.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistleblower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented number of doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Bantz, Phillip. “US Justice Department Recovered $2.8 Billion From False Claims Act Cases in 2018.” Law.com. (December 28, 2018). Web.

“Health Care Dominates FCA Judgments and Settlements in 2018.” The National Law Review. (December 31, 2018). Web.

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

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

By |2019-01-17T01:11:46+00:00January 28th, 2019|Health Facilities Law Blog|0 Comments

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

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

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

Trial Date is Set.

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

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

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

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

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

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

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

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S., as well as in civil and administrative litigation attempting to recoup claims that have been paid. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from Medicare and Medicaid Program.

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

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

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

Weaver, Jay. “Miami federal judge keeps massive Medicare fraud case on track for trial in January.” Miami Herald. (November 14, 2018). Web.

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

Keywords: Medicare fraud defense representation attorney, legal representation for defense of Medicare fraud charges, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, Medicaid fraud defense attorney, legal representation for Medicaid fraud, audit defense lawyer, healthcare fraud representation, healthcare fraud lawyer, legal representation for Medicaid audit, Medicaid audit defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigations, DOJ representation, representation for DOJ investigations, licensure defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

By |2018-12-07T18:57:36+00:00December 7th, 2018|Health Facilities Law Blog|0 Comments

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.

KeyWords: dental class action suit, complex healthcare litigation attorneys, legal representation for antitrust violations, representation for antitrust investigations, complex medical litigation lawyer, representation for complex litigation, representation for healthcare business litigation matters, employment contract representation, representation for physician dentist employment contract, healthcare contract review attorney, restraint of trade legal representation, representation for Board of Dentistry matters, Board of Dentistry representation, dentist lawyer,  attorney for dentists, Board of Dental Examiners legal counsel, representation for Federal Trade Commission (FTC) investigations, dental law defense lawyer, representation for dental law, representation for health care professionals, representation for dental clinics, health law defense lawyer, health defense attorney, legal representation for dentists, The Health Law Firm, reviews of The Health Law Firm Attorneys, The Health Law Firm attorney reviews, board of dentistry defense attorney, dental board defense legal counsel, representation for dentists, dentist defense lawyer

“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.

By |2018-10-01T02:42:58+00:00November 19th, 2018|Health Facilities Law Blog|0 Comments

New Update to the Medicare Program Integrity Manual Issued by CMS

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

On June 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued further guidance for reporting and reviewing final adverse legal actions (ALAs) in provider enrollment applications. Section 15.5.3 of the Medicare Program Integrity Manual (MPIM) was updated through Transmittal 797 to provide more guidance on the types of final adverse actions that must be disclosed. It also provides additional instruction to Medicare Administrative Contractors (MACs) on how to process disclosed final adverse actions.

New Language Basics.

The update in Section 15.5.3 of the MPIM clarifies the scope of disclosure, the time frames for disclosure and the evidence needed to support a disclosure.

Per the 2018 update, the list of reportable adverse actions includes: felony and misdemeanor convictions within the last 10 years; current or past suspensions/revocations of a medical license or an accreditation; current or past suspensions or exclusions imposed by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG); current or past debarments for participation in any Federal Executive Branch procurement or non-procurement program; Medicaid exclusions, revocations, or terminations; and current or past federal sanctions of any type.

New Guidance for MACs.

The second part of the update to the Manual provides additional guidance concerning how MACs will review applications and process the disclosure of final adverse actions. The update also covers how MACs should handle both reported and unreported adverse actions. MACs are now required to use either the Provider Enrollment, Chain and Ownership System (PECOS) or the System for Award Management (SAM) to research whether individuals with ownership interest of the applicant entity are excluded.

To view all the language in Transmittal 797, which outlines the updated Section 15.5.3, click here.

For more information, visit CMS’ website.

Click here to view another recent update issued by CMS.

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

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, skilled nursing facilities (SNF’s) durable medical equipment (DME) suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative
hearings at both the state and the federal level. We represent health providers in Medicare and Medicaid audits and disputes on a routine basis.

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

Sources:

King & Spalding. “CMS Updates Rules for Reporting Adverse Legal Action.” JD Supra. (August 25, 2018). Web.

Dhillion, Megan. “Update to the Medicare Program Integrity Manual: New Requirements Related to Disclosing and Processing Final Adverse Actions.” AHLA. (August 24, 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.

 

By |2018-09-07T19:00:18+00:00September 7th, 2018|Health Facilities Law Blog|0 Comments
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