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

Author headshot standing in dark suit with red tie against a dark grey backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are constantly being contacted by physicians, nurse practitioners and other licensed health professionals seeking to appeal adverse National Practitioner Data Bank (NPDB) reports.  Often, we find that an adverse report has been made when the matter should not have been.  Federal regulations and NPDB guidelines establish the types of incidents that are authorized to be reported to the NPDB.  When an employer or other organization makes an improper report, it should be challenged and removed.
Types of Matters That Are Not Authorized for NPDB Reports.
Following are some of the incidents for which we have seen adverse NPDB reports that were improperly made:
–Physician or nurse practitioner employed by hospital fired.
–Physician’s contract with a medical group or hospital terminated for cause.
–Hospital medical staff takes action against a physician or nurse practitioner requiring that individual to take continuing education courses on a certain subject.
–Physician’s clinical privileges are administratively suspended because of late medical records or notes.
–Physician or nurse practitioner has clinical privileges summarily suspended for less than 30 days while an investigation or inquiry occurs.
–Adverse action against or findings of substandard care made against an intern or resident physician are not reportable because they do not have clinical privileges.
–Withdrawal of an initial application for clinical privileges in order to avoid a denial (note: not a renewal application, an initial application).
–Adverse action a hospital takes based on the individual’s fees or advertising.
–Payment of a medical malpractice settlement because a hospital, nurse or different individual was negligent.
–Termination of clinical privileges because of inability to obtain board certification or failure to meet other eligibility criteria.
–Withdrawal of an initial application for a state license to avoid a denial (note: not a renewal application, an initial one).
–Resigning from or allowing membership in a professional association to expire before a final adverse decision by that association is made is not reportable (note:  this is unlike the situation from hospital clinical privileges or action by a state licensing board).
–Termination of clinical privileges or state license because of medical reasons.
There are many others. We see them all the time.
Improperly Reported to the NPDB?  Get a Lawyer and Challenge It!
If you are reported improperly to the NPDB, you need to retain the services of a good health lawyer experienced with NPDB issues.  An adverse NPDB report can follow you for life and can make future employment very difficult.  An experienced health lawyer will know exactly what to do to have the improper report removed.
Click here to read one of my prior blogs on how to fight back against adverse NPDB reports.
Don’t Wait Until It’s Too Late, Contact Experienced Health Law Attorneys.
The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024, George F. Indest III, The Health Law Firm. All rights reserved.
No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder.  The copyright holder reserves the exclusive right to have his name associated with this work.
By |2024-03-14T09:59:09-04:00April 1, 2024|Categories: Dental Law Blog, Health Facilities Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples
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Male Surgeon Wins $15 Million Verdict in Suit Based on “Reverse Discrimination” and Anti-Male Bias; Hospital Requests New Trial

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
In a massive jury verdict awarding a male attending physician more than he requested, a jury found that a hospital demonstrated reverse discrimination and an anti-mail bias in how it handled a female resident physician’s complaint against him.
On January 8, 2024, Thomas Jefferson University Hospital urged a Pennsylvania Federal court to reverse a $15 million judgment against it over its handling of a sexual assault investigation in a gender bias case. In December 2023, a federal jury in the U.S. District Court for the Eastern District of Pennsylvania found that there was proof that the hospital exhibited anti-male bias and violated a male orthopedic surgeon’s civil rights when it investigated allegations that he sexually assaulted a medical resident.  Thomas Jefferson University Hospital claimed the court unfairly excluded key evidence that would have countered the surgeon’s claims that the female medical resident was actually the aggressor.
The Initial Incident.
In 2018, Plaintiff John Abraham, a male orthopedic surgeon at Thomas Jefferson University Hospital, alleged that a female resident physician attended a pool party at his residence and engaged in sexually aggressive behavior towards him without his consent.  According to the law suit, he reported the female resident’s conduct to the hospital.
Dr. Abraham later learned that the female resident had already filed a complaint against him, resulting in an investigation into his behavior.  No charges against him aver resulted from the hospital’s investigation or a related criminal investigation.
The Alleged Gender Discrimination. 
Dr. Abraham sued Thomas Jefferson University Hospital, accusing it of practicing discrimination against men during its investigation of the sexual assault allegations.  According to him, the hospital demonstrated gender bias by disregarding his allegation that he was assaulted by the female and pressuring him to take a leave of absence.  This was compounded by its failure to take any action against the alleged female aggressor about whom he complained.  The investigation was eventually terminated with no findings after Dr. Abraham relinquished his privileges at the hospital.
In the suit Dr. Abraham sought $5 million in compensatory damages.  However, after the four-day civil trial, the federal jury awarded him $11 million in compensatory damages and $4 million in punitive damages.
The Hospital’s Request for a New Trial.
Thomas Jefferson University Hospital requested a new trial after the jury handed down the verdict. The hospital claimed that the court excluded critical evidence that it would have used on cross-examination of Dr. Abraham to help it win its case.  The excluded evidence included texts stating Dr. Abraham was not drunk at the party and that he intended to have sex with the female resident even though he knew it was unethical because she was his student.
The hospital also argued that the court gave incorrect jury instructions about the difference between anti-male discrimination and anti-respondent discrimination in a sexual assault investigation. According to the hospital’s motion, taking “risk minimization measures” against someone accused of sexual assault, like placing them on a leave of absence, is not cause for a Title IX gender discrimination lawsuit. Additionally, the hospital claims, not specifying this difference to the jury incorrectly led the jury to believe that anti-respondent bias was, in fact, anti-male bias.
The judge has not yet ruled on the hospital’s request.
To read two recent blogs I wrote about Title IX and its applications to resident physicians and fellows, click here and here.
Contact Experienced Health Law Attorneys Representing Health Care Professionals, Medical Students, Residents, and Fellows.
The Health Law Firm routinely represents students, including medical students, dental students, nursing students, pharmacy students, resident physicians, and fellows, who have legal problems with their schools or programs. We also represent students, residents, and fellows in investigations, academic probation and suspensions, disciplinary hearings, clinical competence committee (CCC) hearings, and appeals of adverse actions taken against them. The Health Law Firm’s attorneys include those who are board-certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
Our firm also specializes in providing legal representation to a wide range of healthcare professionals, including pharmacists, massage therapists, mental health counselors, registered nurses, and more.
To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Abraham v. Thomas Jefferson University No. 2:20-cv-02967-MMB (E.D. PA. January 8, 2024)
Abraham v. Thomas Jefferson University No. 2:20-cv-02967-MMB (E.D. PA. June 19, 2020)
D’Annunzio, P.J.. “Info Kept From Jury In $15M Gender Bias Case, Pa. Court Told.” Law360. (9 January 2024) https://www.law360.com/articles/1783770
Rock, Amy. “Thomas Jefferson University to Pay $15 Million to Male Surgeon for Gender-Biased Rape Investigation.” Campus Safety Magazine. (15 December 2023) https://www.campussafetymagazine.com/university/thomas-jefferson-university-to-pay-15-million-to-male-surgeon-for-gender-biased-rape-investigation/
Ruderman, Wendy. “Former Rothman orthopedic surgeon takes on Jefferson in federal court over sexual assault allegations.” The Philadelphia Inquirer. (5 December 2023) https://www.inquirer.com/health/john-abraham-rothman-jefferson-sex-discrimination-case-jury-federal-20231205.html
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice.
Hartley Brooks is a law clerk with The Health Law Firm. Its main office is in the Orlando, Florida area.
The Health Law Firm can be visited at:  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.
By |2024-03-14T09:59:09-04:00March 26, 2024|Categories: Health Facilities Law Blog, Mental Health Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Male Surgeon Wins $15 Million Verdict in Suit Based on “Reverse Discrimination” and Anti-Male Bias; Hospital Requests New Trial
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Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

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

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

Physician Fee Schedule Rate Reductions; Counselors Added.

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

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

Telehealth Expansions.

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

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

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

Outpatient Program Payment Increases.

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

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

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

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

Sources:

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

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

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

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

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

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

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

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

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

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

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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced by anyone in any medium without the author’s express written permission. The author reserves the right to have his name associated with this work at all times.

By |2024-03-14T09:59:09-04:00March 25, 2024|Categories: Health Facilities Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors
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Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

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

On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts. The fraud was allegedly perpetrated through two Florida companies the man owned, Expansion Media, LLC, and Hybrid Management Group, LLC. According to federal prosecutors in Boston, the scheme involved utilizing telemedicine and telemarketing enterprises to create fabricated orders for medical equipment, particularly knee braces. The scheme allegedly lasted from March 2016 to January 2023.

Specifics on this Medicare Fraud Scheme.

The Florida businessman and owner of Expansion Media, LLC, and Hybrid Management Group, LLC, allegedly sold medically unnecessary Durable Medical Equipment (D.M.E.) to medical staffing companies. According to the government, he used telemedicine and telemarketing companies to create false leads. The telemarketers would pay the Florida man’s companies to generate orders for the medical groups that signed off on them, even though they had no contact with any of the Medicare beneficiaries. The medical devices ordered resulted in $110 million in fraudulent claims, of which Medicare paid $52.5 million.

Prosecutors say the Florida man took many steps to conceal the scheme, including changing his business names, creating fictitious e-mails tied to those companies, and using third-party pass-through payment options.

The Florida man was ordered by the court to pay back $15.7 million and a laundry list of expensive jewelry purchases, such as multiple Patek Philippe watches and Tiffany & Co. jewelry. He agreed to plead guilty, and his deal includes a ten-year prison sentence with supervised releases for three years and fines up to $250,000.

No mention was made about what happened to the Patek Phillippe watches or the Tiffany jewelry, but I have asked the FBI to keep me advised. I have an anniversary coming up.

To view the press release from the U.S. Attorney’s Office, District of Massachusetts, click here.

Florida Man: Joyfully Spreading Florida’s Crime All Over the Place

This blog relates one of my biggest pet peeves. That scurrilous, underhanded Florida Man. Now he has spread his disease of fraud and theft all the way up to the beautiful city of Boston. Why don’t they finally lock him up once and for all?

Is Florida really going to make Florida Man the official state bird, replacing the beautiful Northern Mockingbird? Maybe that’s what he was doing up north in Massachusetts, mocking them.

This case also points out Florida’s reputation as a state which shelters and promotes the use of shell corporations and limited liability companies used to defraud the public and its protection of conmen and fraudsters.

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

The attorneys of The Health Law Firm represent physicians, pharmacists, durable medical equipment (DME) suppliers, and other health care providers in Medicare audits, investigations and subpoenas, Medicaid audits and subpoenas, Medicare and Medicaid investigations, Department of Health (DOH) subpoenas and investigations, Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) subpoenas and investigations, and Medicaid Fraud Control Unit (MFCU) subpoenas, audits and investigations, in Florida, Colorado, Louisiana, the District of Columbia, Virginia, and across the U.S. They also represent healthcare providers in actions to terminate billing privileges, termination from the Medicare or Medicaid programs, and state and federal administrative hearings and litigation.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

DOM. (February 16, 2024). Owner of telemedicine companies charged with $110 million medicare fraud scheme. United States Attorney’s Office. Retrieved from https://www.justice.gov/usao-ma/pr/owner-telemedicine-companies-charged-110-million-medicare-fraud-scheme#:~:text=BOSTON%20%E2%80%93%20The%20owner%20of%20Expansion,as%20back%20and%20knee%20braces.

Dowling, B. (February 16, 2024). Telemedicine exec admits $110 Medicare fraud scheme. Law360. Retrieved from https://www.law360.com/articles/1803737/telemedicine-exec-admits-110m-medicare-fraud-scheme

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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

By |2024-03-14T09:59:09-04:00March 25, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme
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Florida Primary Care Practice Settles HIPAA Investigation for $20,000

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

On December 15, 2022, the Department of Health and Human Services (HHS), Office for Civil Rights (OCR), announced that Health Specialists of Central Florida, Inc., will pay $20,000 to resolve alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule’s right of access standard.

The primary care provider also agreed to a corrective action plan (CAP) with two years of monitoring.

It is extremely important that Florida physicians and health professionals remember that there is a federal law requirement under HIPAA that requires the timely furnishing of a health record requested by a patient. You must be sure to meet the deadline, but, more importantly, document that you have met it. Use cover letters, obtain receipts when possible, and document the date you provided the record in the record.

Click here to view the press release issued by the OCR.

Right of Access Standard.

OCR first launched an investigation into Health Specialists of Central Florida after the daughter of a deceased patient filed a complaint in November 2019. The complainant made a written access request for her father’s medical records but did not receive them for nearly five months, and only after multiple requests.

The HIPAA right of access standard requires covered entities to respond to requests for records within 30 days of receipt or 60 days if it obtains an extension of time. OCR’s guidance on the right of access is available here.

The Settlement.

In addition to the monetary settlement, Health Specialists of Central Florida will undertake a corrective action plan (CAP) that includes two years of monitoring. The CAP requires the practice to develop, maintain, and revise its written privacy procedures and policies, distribute them to the workforce, and review and update its right of access to PHI policy.

This case marks the 42nd case resolved under OCR’s HIPAA Right of Access Initiative. To view the settlement agreement and CAP, click here.

 

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

The attorneys of The Health Law Firm represent physicians, dental practices, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in investigating and defending against HIPAA investigations and complaints 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 toll-free (888) 331-6620.

Sources:

Health Law Weekly. “Florida Primary Care Provider to Pay $20,000 to Resolve Right of Access Probe.” AHLA. (December 16, 2022). Web.

Giles, Bruce. “Florida primary care practice fined HHS $20K for not giving timely access to patient data.” Becker’s Hospital Review. (December 16, 2022). Web.

McKeon, Jill. “OCR Resolves HIPAA Right of Access Case With FL Primary Care Practice.” Health IT Security. (December 16, 2022). Web.

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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

 

By |2024-03-21T20:00:52-04:00March 23, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Primary Care Practice Settles HIPAA Investigation for $20,000
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When the DEA Comes Knocking: 15 Tips If You Find Yourself Facing a “Routine” DEA Inspection

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

As the United States continues to open back up from the COVID-19 shutdown, the Drug Enforcement Agency (DEA) is resuming on-site routine inspections.  Therefore, healthcare professionals must ensure compliance and regulatory efforts are in place.

This is part 1 of a 2-part blog series. Check back for part 2 of this blog series soon!


DEA Inspections and Site Visits:  Subpoenas.

DEA agents are often pushy, demanding, and intimidating.  They will try to use subpoenas (which are merely requests for documents that afford you at least ten days to produce the requested documents) as search warrants.  THEY ARE NOT.  They will try to use an administrative subpoena to obtain documents and get your testimony immediately. YOU DO NOT HAVE TO PRODUCE THEM RIGHT AWAY. A copy of a sample subpoena used by the DEA is on our website for reference here.


Not Just a Routine Audit, Inspection, or Investigation.

Beware the “Notice of Inspection of Controlled Premises” (DEA Form 82).   Although the DEA often treats it as one, it is not a search warrant.  Also, it is probably NOT a “Routine Inspection.”  IT WILL NOT TAKE ONLY 15 TO 20 MINUTES.

We have had several clients who have had to close down their businesses all day to try to accommodate the demands of the agents performing their “routine inspection.”  The DEA should not cause you to shut down or should not cause you to turn away patients.  It should not interfere with your patient services or your ability to provide them.  You can ask them to come back at a later date.

The DEA often refers to “routine audits” as “Accountability Investigations” and requires the pharmacy or registrant to be given certain rights in connection with it. For example, DEA Form 82 states you are given the following rights:

1.    The constitutional right not to have an administrative inspection without an Administrative Inspection Warrant (AIW),
2.    Has the right to refuse consent to such an inspection,
3.    Presented with a Notice of Inspection,
4.    Given consent voluntarily, without threats of any kind,
5.    May withdraw consent at any time during the course of the inspection, and
6.    Incriminating evidence may be seized and used in criminal prosecution.

Although the DEA agent may tell you that the site visit is “completely random,” do not believe it.  If the DEA agent has brought a list of records to obtain from you, try to keep a copy of it, as your lawyer may find it very useful later when they are defending you.


What to Do When Confronted with a DEA Inspection or Site Visit.

1.    Notify the owner right away.  If you are not the owner, don’t sign anything, give permission, or agree to anything. You probably have no authority to do so.

2.    Call your health lawyer and get them over immediately.  This is an emergency!

3.    Yes, you have the right to consult with your attorney;  do not believe them if they say you can’t (which they may do, believe it or not).

4.    Request photo identification from everyone to ensure the individuals are who they say they are.  No identification? No access. Federal agents, including DEA agents, will always have their photo ID.

5.    Obtain a business card from each person present.  DEA agents always carry business cards.  If they do not have one, you will have to write all contact information for that agent from their photo id card (or photocopy, if they will allow you to do so).

6.    Do the same as the above for anyone else the DEA brings, whether they claim to be a federal or state investigator, Department of Health investigator, or local police. Please note that our experience has been that the DEA and state agencies contend that they don’t go on joint inspections or investigations (however, we don’t believe this to be true).  Therefore, get all parties’ information at the very start, or you may never get it until they testify against you.

7.    DO NOT SIGN A VOLUNTARY AGREEMENT TO RELINQUISH YOUR DEA REGISTRATION.  Agents may try to pressure and intimidate you into signing one by telling you it will be easier if you sign it. They might even try to scare you by warnings of criminal prosecution unless you sign it.  Yes, you have the right to consult with an attorney before deciding whether or not to sign it (they may falsely tell you that you don’t). However, once you sign it, it is gone.  If you are a prescribing physician or health professional, your authority to prescribe is gone forever.  If you are a pharmacy/pharmacist, your ability to order or fill any controlled substances is forever gone. So go ahead and put a sign on the door that says “CLOSED-Out of Business.”

8.    Before the inspection begins, you should be given a form to read and sign. If not, request it. It will usually be a DEA Form 82 “Notice of Inspection of Controlled Premises” Form. Before the inspection, it should be read, explained, agreed to, and signed, not during or after.

9.    Read the form carefully. You have the right to fax it, scan and e-mail it, or call and read it to your attorney before you sign it. If it says you have the right to refuse the inspection, consider putting it off until a later date. Especially if you are busy and have patients you must serve.

10.    Obtain a copy of the form (inspection form or subpoena) at the beginning and keep it.  You will need this later.

11.    Obtain a complete, detailed receipt for any documents, prescriptions, or other items taken by the agents. Again, since this is not a search warrant, the DEA does not have the authority to take your only originals and leave you without a copy.

12.    You may or may not be in serious trouble and subject to future criminal charges or administrative action to revoke your DEA registration. Your attorney should be able to evaluate this and advise you. Don’t bother to ask the agents, as they will not tell you what is in your own best interest to know.

13.    If you don’t have an attorney who is experienced in health law and DEA defense,  get one NOW.  You should begin preparing now.  It often takes the DEA a year or more to work up charges against you.  Once you are served with charges, you will only have a very short time to prepare your defense.  It is a completely unfair system for the subject of charges as the government will have longer to prepare its case against you than you have to prepare your defense.  Take advantage of the time you have. Do not waste it.

14.    Be polite and do not argue with a DEA agent.

15.    Do not volunteer information, but never tell a lie. Making a false statement to any federal agent is a felony criminal offense. A subpoena for documents is not an authorization to interrogate you.  A search warrant is not an authorization to interrogate you.

Lastly, don’t forget to check back to read part 2 of this blog series.

Please remember: This blog’s statements are opinions based on our experience.  If you do not agree with it, then you are probably the DEA.

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

The attorneys of The Health Law Firm provide legal representation to physicians, pharmacists, pharmacies, medical groups, nurses, nurse practitioners, CRNAs, dentists, 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 (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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


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


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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

By |2024-03-19T20:00:14-04:00March 21, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on When the DEA Comes Knocking: 15 Tips If You Find Yourself Facing a “Routine” DEA Inspection
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Under Medical Peer Review from the Military or the VA? Get Experienced Legal Representation Now

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Our firm is often consulted by military physicians, Veterans Administration (VA) physicians, and former military and VA physicians concerning matters involving peer reviews of their care. In the military, whether Army, Navy, or Air Force, peer review for all physicians is now governed by one general department. The Department of Defense (DOD) Regulation, that is, Defense Health Agency Procedures Manual (abbreviated DHA PM) 6025.13, became effective October 1, 2019. VA physicians have different, but somewhat similar regulations that apply to them.
We are often consulted by these physicians, who no longer serve with those agencies, or after action has already been taken to report them to the National Practitioner Data Bank (NPDB) for allegedly substandard care. Such reports go into the NPDB for fifty (50) years and are reported to all state licensing boards and to the Federation of State Medical Boards (FSMB).
They can haunt a physician’s career for life.
What Should You Do When Notified of a Claim, Investigation, Peer Review Action, or Quality Assurance Investigation (QAI)?
When you first notice that you are the subject of or named in a Federal Tort Claims Act (FTCA) claim or any type of inquiry or investigation related to your care, you should consult with a healthcare attorney with experience in such matters. We are few and far between, but you can find us if you look for us.
You will usually have at least two opportunities to provide input into such matters, but you need to take advantage of the earliest opportunity to influence the outcome.
1.You must obtain and review a copy of the medical record.
2.You need to have an expert in your medical field review the case for you.
3.You can request an extension of time if needed.
What Are Questions I Should Ask of an Attorney with Whom I Consult?
These are the questions that I suggest you ask any attorney you consult with:
1.What is your experience dealing with the military or VA medical system?
2.How many similar matters of this nature have you handled?
3.Are you familiar with National Practitioner Data Bank (NPDB) reports, challenges and appeals?
4.How many NPDB matters have you handled?
5.How many cases have you handled in which you assisted in making statements for input into such investigations or inquiries?
6.Are you familiar with the Memorandum of Understanding (MOU) between the DOD and the Department of Health and Human Services (DHHS) taking DOD NPDB reports out from under the regular NPDB procedures?
7.How many military or VA quality assurance investigations have you represented physicians?
8.How many VA and military peer review/clinical privileges hearings have you done?
9.How familiar are you with hospitals and health systems?
10.How familiar are you with the military medical system, the roles of the Surgeons General, and the Department of Defense Division of Health Affairs (DOD HA)?
11.How familiar are you with DOD PM 6025.13?
12.How familiar are you with:  VHA Directive 1190 (Peer Review for Quality Management), VHA Handbook 1050.01 (VHA National Patient Safety Improvement Handbook), VHA Handbook 1100.17 (National Practitioner Data Bank (NPDB) Reports), VHA Handbook 1100.19 (Credentialing and Privileging), VHA Directive 2008-077 (Quality Management (QM) and Patient Safety Activities . . . ), VHA Directive 1026 (VHA Enterprise Framework for Quality, Safety and Management), and VA Handbook 5120/14 (Employee/Management Relations)?
Don’t Wait Until After the Decision to Report You Has Been Made.
Don’t wait until the final decision has been made to report you to obtain experienced legal counsel to represent you in defending yourself against allegations of substandard care. Avail yourself of any and all opportunities to provide your concise, objective, and well-reasoned medical rationale for your care at the earliest stage you are allowed to do so.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620
Attorney Positions with The Health Law Firm.  The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.
By |2024-03-14T09:59:09-04:00March 19, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Under Medical Peer Review from the Military or the VA? Get Experienced Legal Representation Now
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Letter from the OIG Terminating You from the Medicare Program? What You Need to Do!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Military service, forget it.

Work for the VA, forget it.

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

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

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

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

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

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

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

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

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

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

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

By |2024-03-14T09:59:09-04:00March 18, 2024|Categories: Health Facilities Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Letter from the OIG Terminating You from the Medicare Program? What You Need to Do!
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Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme

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

On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy to commit healthcare fraud charges.

Esformes, who then owned more than 30 Miami-area nursing and assisted living facilities, was first charged in July 2016 with what the Department of Justice (DOJ) called a $1 billion, decades-long Medicare fraud and money-laundering scheme. Click here to read the DOJ’s press release. (https://www.justice.gov/opa/pr/three-individuals-charged-1-billion-medicare-fraud-and-money-laundering-scheme)

The Fraudulent Health Care Scheme.

The government initially accused The Florida Man of bribing physicians to refer patients to the nursing homes he owned in the Miami area. He would then move the patients to his assisted living facilities once he had charged Medicare for the maximum of 100 days the government pays for skilled nursing services.

In April 2019, a federal jury convicted the nursing home mogul on various counts of paying and receiving kickbacks, money laundering, bribery, and obstruction of justice. The judge sentenced him to 20 years in prison and ordered to pay $5.5 million in restitution and to forfeit $38.7 million. Click hear to read more. (https://www.thehealthlawfirmblogs.com/the-biggest-healthcare-fraud-case-ever-prosecuted-in-2019-big-surprise-florida-wins/)

However, in December 2020, former President Donald Trump commuted his 20 year prison sentence. The conviction remained, however, and he was ordered to pay the restitution order, which the Eleventh Circuit later affirmed.

The Retrial.

During the initial trial, the jury was deadlocked on six counts of conspiracy to commit health care fraud. The DOJ announced in April 2021 that it would retry Esformes on these counts. He appealed to the Eleventh Circuit Court of Appeals arguing that a retrial was barred because it would violate Trump’s clemency order. He also argued that the prosecution’s misconduct in reviewing privileged materials barred the retrial. The Eleventh Circuit denied his appeal of the prosecution misconduct issue and did not rule on the issue of Trump’s clemency order.

He appealed to the Supreme Court of the United States which denied his appeal in December 2023.

A Plea Deal with the District Court for the Southern District of Florida.

On February 1, 2024, the judge assigned to the retrial in the case canceled a scheduled conference because the parties had reached a plea deal. A plea in the case lets the Florida man avoid another lengthy trial — and another potentially harsh prison sentence if he were convicted. The terms of the plea deal have not been made public.

Contact Health Law Attorneys Experienced in Health Care Fraud and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Anti-Kickback allegations, and False Claims Act cases throughout Florida and across the United States. Our attorneys 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.

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

Sources:

Bolado, Carolina. “Fla. Nursing Home Mogul Reaches Plea Deal With Feds.” Law360. (1 February 2024) https://www.law360.com/health/articles/1767643?nl_pk=ab1e43aa-534e-4b86-8a5a-6b981ef7c33b&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=1767643&read_main=1&nlsidx=0&nlaidx=0

Hale, Nathan. “Esformes Told To Pay $44.2M In Massive Health Fraud Case.” Law360. (21 November 2019) https://www.law360.com/articles/1219282

Mangan, Dan. “Trump clemency recipient Philip Esformes reaches plea deal in Medicare fraud case.” CNBC. (1 February 2024) https://www.cnbc.com/2024/02/01/trump-clemency-recipient-philip-esformes-has-medicare-plea-deal.html

Office of Public Affairs. “South Florida Health Care Facility Owner Sentenced to 20 Years in Prison for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice.” United States Department of Justice. (12 September 2019) https://www.justice.gov/opa/pr/south-florida-health-care-facility-owner-sentenced-20-years-prison-role-largest-health-care

About the Authors:

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

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

The Health Law Firm has its main office is in the Orlando, Florida, area, and can be reached at: www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

By |2024-03-14T09:59:10-04:00March 4, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme
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Follow These Simple Rules To Keep Your License & Avoid Complaints If You Are a Counselor or Psychotherapists

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

I represent many mental health counselors, social workers, psychologists, and professional counselors, defending them on complaints being investigated against their professional licenses. Many complaints and investigations arise because the therapist has strayed over the line and crossed the therapist-client boundary. In reviewing these cases, I have drawn up a list of a few simple “bright line” rules that can help save you many hours of stress and mental anguish as well as thousands of dollars in attorney’s fees and costs defending yourself

These “rules” may seem to be common sense, but there they are, anyway:

1. DO NOT ever meet the client at an outside social activity or attend a social event with the client. This includes “just dinner” or “just-drinks.”

2. DO NOT text the client. Texting is not secure and leads to casual and unprofessional thinking and conversation with the client. Many health care institutions prohibit their physicians and employees from texting with clients because of the HIPAA Security and Privacy Rules. You can use that as an excuse if you need one.

3. DO take a screenshot and print out the text when you violate the above rule. Place it in the client’s health record because you will probably be seeing it again, attached to a complaint.

4. DO send an e-mail or, better yet, a professional letter to the client, instead of texting the client. Print out a copy and place it in the client’s health record, because you will probably see it again.

5. DO NOT EVER make any suggestive or sexual remarks to the client in any communications, oral or written or text, or e-mail. In fact, DON’T even think about it. This includes off-color jokes and comments.

6. DO immediately terminate the relationship with the client, transferring care to a different therapist, if the client suggests anything of a sexual nature involving you.

7. DO NOT talk about other clients with the client.

8. DO NOT talk about your own personal life with the client. Especially DO NOT let the client have your personal home address or personal e-mail address.

9. DO NOT ever have sex with a client or former client. DO NOT even think of it. If you start to think of it, see Rule 6, above. Consider clients and former clients “off-limits” no matter how much you are tempted. If you are religious, just consider this as an attempt by Satan to seduce you. If it works, you are going to be in Hell, even before you die.

10. DO know what professional boundaries are and DO NOT cross them. This includes allowing a personal relationship to grow between you and the client, and includes selling anything to the client (e.g., Girl Scout cookies, tickets to a charitable event, Amway products, candy bars for your kids’ school band, etc.), agreeing to meet the client at any outside event, accepting gifts from the client, hiring the client to work for you, accepting “voluntary” services from the client (including volunteering to work in your office). If you need a friend that bad, terminate the therapist-client relationship and see Rule 6, above.

11. DO know that if you have even a suspicion that your therapist-client relationship is getting out of bounds, then it already is out of bounds. See Rule 6, above.

12. DO call a professional therapist colleague who is more senior to you and consult her or him about the “situation” if you think there may be a “situation.”

These may sound like “no-brainers” to you, but you would be surprised at how many complaints against licensed counselors and psychologists there are as a result of violating one or more of these “rules.”

(Note: These “rules” are just guidelines meant to help you keep out of trouble; these are not meant to be enforced against anyone, nor do they create or represent any “standard of care.”)

For additional information on how our firm can assist you in matters like this, click here to read one of our prior blogs.

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

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers, and family therapists in Department of Health (DOH) investigations, Department of Regulatory Agencies (DORA) investigations, board hearings, FBI investigations, and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

We also defend health professionals and health facilities in general litigation matters and business litigation matters.

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

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

“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 © 2021 The Health Law Firm. All rights reserved.

By |2024-03-14T09:59:11-04:00February 21, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Follow These Simple Rules To Keep Your License & Avoid Complaints If You Are a Counselor or Psychotherapists
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“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A.
The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
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