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Doctor Dubbed “King Of Nursing Homes” Downplayed Patient Harm From Illegal Kickback Scheme

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 8, 2016, federal prosecutors blasted Dr. Venkateswara Kuchipudi, a Chicago physician nicknamed the “King of Nursing Homes,” convicted of sending nursing home patients to a hospital he believed was subpar allegedly in exchange for free staff. According to prosecutors, the doctor attempted to “whitewash his actions” when asking for a lenient sentence and caused actual harm to patients to satisfy his “callous greed” (words prosecutors reportedly used).

Prosecutors argued that U.S. District Judge Matthew Canaille should give Dr. Venkateswara Kuchipudi a sentence that reflects how vulnerable his victims were and how much Dr. Kuchipudi profited from billing insurers for the work he didn’t pay his staff to do. In March 2016, Dr. Kuchipudi was convicted of a charge related to the illegal kickback scheme. Click here to read more.

The “King of Nursing Homes”

Dr. Kuchipudi earned the nickname “King of Nursing Homes,” from the hundreds of nursing home patients he treated and allegedly from accepting kickbacks for referring Medicare patients to Sacred Heart Hospital (in the Chicago area) in exchange for staff in 2016. The victims of Kuchipudi’s kickback scheme were “elderly and physically and/or mentally impaired nursing home-bound patients,” whose vulnerability gave Kuchipudi “nearly limitless discretion” over where they were treated, the government said in a sentencing memorandum. Dr. Kuchipudi allegedly chose a hospital he constantly criticized as “substandard” and that was located far from many of his patients, prosecutors said. Click here to read the sentencing memorandum in full.

Jeopardizing Quality of Care.

The government pointed out the victims at were brought to Sacred Heart Hospital on Dr. Kuchipudi’s orders, despite it not being the closest hospital, when they were suffering conditions that could have been life threatening, including heart attack, embolism and stroke. Other patients were forced to undergo unnecessary testing, stay at the hospital longer than necessary or, in one case, stay nine days to wait for surgery because the hospital lacked the proper equipment.

“Kuchipudi should never have sent an elderly patient with a broken hip to Sacred Heart if Sacred Heart did not have the equipment, such as a surgical table, already in place to provide necessary patient care,” the government said. “The table should wait for the patient. The patient should not have to wait nine days for the table.”

Additionally, Dr. Kuchipudi refused to work weekends or take calls at night, but wouldn’t let other doctors see his patients, so that he himself could bill for them, the memorandum states. Eventually Sacred Heart had to hire another doctor to take on Dr. Kuchipudi’s patients, for which he would then bill (according to prosecutors). This, by itself, would probably violate the Anti-Kickback Statute. According to prosecutors, when he was at the hospital, he would see his patients for 10 to 15 minutes total and make no notes, leaving the work to physician assistants and nurses.

He would often bill Medicare for the work done by these other physician assistants, nurses and the doctor the hospital hired for his patients, as if he did the work himself, the government stated.

In addition to having Sacred Heart pay for Dr. Kuchipudi’s staff, the physician received “well over $750,000” from insurers for their labor, the government said. As the kickback is more than $550,000, the offense level under the sentencing guidelines should increase, according to prosecutors.

Kuchipudi’s sentencing memorandum showed no signs of his acknowledging or feeling remorse for his crimes, the government said. Click here to read more.

To read a prior blog I wrote on illegal kickback schemes, click here.

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

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

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

Sources:

Kass, Dani. “’King Of Nursing Homes’ Downplayed Patient Harm, Feds Say.” Law360. (August, 8, 2016). Web.

Eltagouri, Mawra. “Doctor known as ‘king of nursing homes’ convicted in kickback scheme.” The Chicago Tribune. (March 16, 2016). 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: King of Nursing Homes, Medicare fraud scheme, Medicare audit, submitting false claims, Department of Justice (DOJ), health care fraud scheme, illegal kickback scheme, Medicare beneficiaries, services not rendered, unnecessary tests and procedures, improper billing, nursing home health facilities, health care kickbacks, Florida health care lawyer, The Health Law Firm
“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 © 2016 The Health Law Firm. All rights reserved.

By |2016-08-29T07:17:13+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

Orlando City Council Vote to Extend Temporary Ban on Medical Marijuana Dispensaries

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 14, 2016, Orlando’s City Council voted to extend its temporary ban on new marijuana dispensaries, less than a week after Florida voters backed a constitutional amendment to expand medical use of the drug. Back in July 2016, city commissioners voted to approve the temporary pause on marijuana dispensaries. The current ban is set to expire December 2016, but the city is pursuing an extension that would stretch the ban until July 1, 2017.

The Temporary Ban.

According to the city, the temporary ban will be beneficial because it will allow staffers to study the potential impacts of marijuana distributors, including whether they should be kept at arm’s length from neighborhoods, churches and schools. After the Legislature in 2014 legalized the low-THC oil known as Charlotte’s Web, the city of Orlando determined its current rules would categorize dispensaries as drug stores, like Walgreens and CVS. The city of Orlando pursued the July 2016 moratorium after three potential sellers of either medicinal marijuana or Charlotte’s Web had expressed interest in Orlando storefronts where proper zoning would allow them. So far, several South Florida cities have also adopted similar temporary bans on new potential dispensaries. The Orlando City Council will take its final vote on the extension in December 2016.

To learn more on the status of marijuana in Florida, click here to read one of my prior blogs.

Problematic Approach.

To me this is very problematic. The citizens of Florida have spoken in making medical marijuana legal. However, it seems likely that we will be burdened with government officials acting to try to prohibit retail sellers and dispensaries in an attempt to prevent it nevertheless. For example, what would happen if every county now voted to prohibit dispensaries within their boundaries. This would cut the legs out from under the constitutional amendment passed by the voters.

We may have to go back to the polls again and vote in a constitutional amendment that blocks cities, counties and state agencies from preventing sales within their limits. Either that or elect John Morgan governor!

Contact Experienced Health Law Attorneys for Medical Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting and/or licensing, while complying with Florida law. We can also represent doctors, pharmacies and pharmacists facing proceedings brought by state regulators or agencies.

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

Sources:

Weiner, Jeff. “Orlando extends temporary ban on marijuana dispensaries.” Orlando Sentinel. (November 14, 2016). Web.

Weiner, Jeff. “City votes for pause on pot dispensaries.” Orlando Sentinel. (July 11, 2016). 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: Medical and recreational marijuana use, legal counsel for medical marijuana, marijuana defense attorney, legal representation for medical marijuana growers and distributors, expanding marijuana industry, medical marijuana defense attorney, The Health Law Firm Reviews, lawyer for medical marijuana growers and distributors, health lawyers for marijuana distributors, medical marijuana lawyer, legal counsel for marijuana industry, approval of Florida’s Amendment 2, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2016 The Health Law Firm. All rights reserved

By |2017-02-20T07:41:42+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

U.S. Court in Florida Dismisses Whistleblower’s Complaint Against Nuclear Pharmacy

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

On September 28, 2017, the U.S. District Court for the Middle District of Florida dismissed a relator’s (whistle blower’s) False Claims Act (FCA) complaint against a nuclear pharmacy in Tampa. The court found that the relator failed to plead fraud with the required amount of specificity that the law requires.  The case awas filed against GE Healthcare, Inc.’s nuclear pharmacy.

The Allegations.

GE Healthcare operates 31 nuclear pharmacies in the United States, where it produces radiopharmaceuticals through a process of compounding drugs.  The relator was a board-certified nuclear pharmacist who formerly worked at GE Healthcare, Inc.’s nuclear pharmacy in Tampa, Florida. The relator’s allegations included the manner in which GE compounded and labeled radiopharmaceuticals. More specifically, the whistle blower claimed that GE sold diluted and expired drugs. Additionally, the whistle blower alleged that GE falsely inflated the reimbursement rate for certain drugs by providing false sales data to Medicare.

GE argued that the realtor’s claims should be dismissed pursuant to the FCA’s public disclosure bar because the allegations overlapped with an action filed by a different relator, James Wagel, in 2006. To read about this FCA case, click here.

The Court’s Decision. 

The court found that Sunil Patel’s allegations were not “based on” or “substantially the same as” the allegations in the prior public disclosures. However, the court dismissed the realtor’s claims on another ground:  failing to plead the allegedly fraudulent claims with sufficient particularity. According to the court, the allegations that defendant “presented or caused to be presented” a false claim fell “well short of alleging ‘exact billing data.'”  In other words, the relator failed to plead one or more false claims by giving the specifics, such as date, amount, patient, billing code, amount paid by the government, etc.  The court found that the relator identified no “particular facts about the ‘who,’ ‘what,’ ‘where,’ ‘when,’ and ‘how’ of fraudulent submissions to the government.”

The case is United States ex rel. Patel v. GE Healthcare Inc., No. 8:14-cv-120-T-33TGW (M.D. Fla. Sept. 28, 2017).

Click here to read one of my prior blogs on a similar FCA case involving a pharmaceutical company.

Specifics of the False Claims Are Required for Any Qui Tam Whistle Blower’s Case.

This is one of the biggest short comings we see in potential clients who contact us with information about false claims being submitted by their employers or other healthcare providers.  They do not have the specifics of any single false claim.  Yet the law requires this or a whistle blower’s case can get dismissed by the court outright.  You can do an awful lot of work investigating, pleading and litigating a whistle blower’s case only to have the court dismiss it without its ever getting anywhere near a trial.  Even if a scheme or system is inherently fraudulent, you must be able to show one or more claims that were submitted were actually false claims.

We advise health care professionals who consult us with possible False Claims Act/whistle blowers cases, be sure you have the details, and preferably copies of the documents, that show a false bill was submitted to the government.  This can be a CMS Form 1500 or an explanation of benefits that the patient and the insurer or facility receives back.  Sometimes you can get these form the patient if you do not have access to these from the employer.  But without a false claim and, preferably, a number of false claims, you don’t really have a False Claims Act suit.

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

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower 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 have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Sources:

Fraud and Compliance. “U.S. Court in Florida Dismisses Whistleblower Action Against Nuclear Pharmacy.” AHLA Weekly. (October 6, 2017). Web.

Mayo, Rebecca. “Evidence of likely submission not enough to prove FCA violation.” Wolters Kluwer Health Law Daily. (October 2, 2017). Web.

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

KeyWords: Health care fraud defense attorney, legal representation for allegations of health care fraud, False Claims Act (FCA) attorney, FCA defense attorney, False Claims attorney, legal representation for FCA investigations, legal representation for FCA complaints, Whistleblower attorney, Whistleblower defense attorney, legal representation for Whistleblower investigations, legal representation for Whistleblower complaints, qui tam attorney, qui tam defense attorney, legal representation for qui tam cases, legal representation for qui tam investigations, FCA legal representation, relator attorney, relator defense attorney, health law defense attorney, The Health Law Firm, 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 © 2017 The Health Law Firm. All rights reserved.

By |2017-11-20T21:33:06+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

Federal Judge Refuses to Dismiss Florida Compounding Pharmacy’s FCA Suit

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 4, 2017, a Florida federal judge refused to dismiss the federal government’s False Claims Act (FCA) suit against a compounding pharmacy. RS Compounding LLC and its owner, Renier Gobea, are accused of overbilling Tricare for prescriptions. The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner.

Judge Finds Claims Are Sufficiently Stated.

According to U.S. District Judge Virginia M. Hernandez Covington, the government adequately pled its claims that RS and Gobea had knowingly charged Tricare prices well in excess of what it charged cash payors for substantially the same drugs. “The United States’ amended complaint in partial intervention sufficiently states claims for unjust enrichment and violation of the FCA,” the judge said.

The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Additionally, Judge Covington rejected the owner’s argument that claims against him personally should be dropped from the case pointing to his “extensive involvement” in RS’s operations and his profit-taking from the company.

The Relator’s FCA Suit.

The relator McKenzie Stepe, a former RS sales representative, originally filed her complaint in December 2013. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. Those drugs, all mixtures containing the anesthetic ketamine, were charged to the government at prices of between $400 and $3,000 per bottle when the equivalent rate for an uninsured cash payer was between $15 and $45 a bottle.

The relator’s complaint was dismissed in November 2017, based on what Judge Covington said was a lack of firsthand knowledge to support her claims, but with leave to file an amended complaint by December 7, 2017.

To read the court’s order in full, click here.

To learn about a similar case involving a Florida compounding pharmacy, click here to read one of my prior blogs.

 

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:

Wilson, Daniel. “Fla. Compounding Pharmacy Can’t Escape Tricare FCA Suit.” Law360. (December 4, 2017). Web.

Raymond, Nate. “Florida compounding pharmacy must face U.S. fraud suit – judge.” Reuters. (December 4, 2017). Web.

KeyWords: False Claims Act defense attorney, FCA legal counsel, TRICARE false claims legal defense attorney, TRICARE physician representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, whistle blower lawyer, FCA violations, fraud detection, financial interest in physician referrals, TRICARE fraud attorney, health attorney, defense attorney, The Health Law Firm, health law firm, fraud investigations, consumer reports of health care fraud, conflict of interest in physician referrals, compound medication prescriptions, compounding pharmacy lawyer, prescription reimbursement, legal defense of military physicians, legal defense of TRICARE providers, attorney reviews of The Health Law Firm, Veterans Administration (VA) physician defense attorney, The Health Law Firm attorney reviews, legal representation for pharmacies, legal representation for pharmacists, health law defense attorney, legal representation for health care professionals

“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 |2018-03-26T21:09:45+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

Licensed Health Professionals Should Have No Trouble Locating an Attorney/Legal Counsel Who Takes CPH & Associates (CPH&A) Insurance To Represent Them in Licensing Actions and Hearings

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

We often hear from licensed health professionals who call and retain us to represent them in complaints against their professional licenses in investigations and formal licensure complaints. Often these professionals retain us after adverse disciplinary action has already been taken. In many cases they had good insurance coverage with CPH & Associates (CPH&A) Insurance, or another professional liability insurance company but could not find an attorney that would accept it.

They retain us to appeal or attempt to reverse an adverse disciplinary action taken against their license, including suspensions and revocations. Matters which may arise include letters from the Department of Health (DOH) advising them that they are being investigated, administrative complaints, a pending administrative hearing emergency restriction orders (EROs), and emergency suspension orders (ESOs).

Finding legal counsel that accepts your insurance should not be a difficult task. Our firm and its attorneys have accepted CPH&A Insurance, and many others, for years.

Our firm has attorneys that are licensed in and can defend licensed health professionals in Florida, Colorado, Louisiana, Virginia and the District of Columbia. Additionally, there are many states, such as Tennessee, Georgia, Oregon, Pennsylvania, New York, Delaware, and others, which allow us to appear before their professional licensing boards and authorities and represent clients in these state under their “multi-jurisdictional practice” rules, because this is an area in which we routinely practice.

Legal areas in which we can represent an CPH&A insured that CPH&A will pay for include: investigations commenced against a massage therapist’s license, administrative hearings, complaints against a professional license, emergency restriction orders, emergency suspension orders, administrative complaints, appeals from adverse disciplinary actions, a deposition for which you may be subpoenaed, and many others.

Regardless of the state, contact us at:

The Health Law Firm, Main Office
1101 Douglas Ave.
ALtamonte Springs, FL 32714
Phone: (407) 331-6620
Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
Internet Contact: www.TheHealthLawFirm.com/contact-us/

One last word, regardless of whether you are covered by CPH&A Insurance or not, if an investigator contacts you to obtain a statement from you, whether orally or in writing, always, always, always, consult with an experienced attorney in this area BEFORE giving any statement or talking to the investigator about anything.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys. We represent medical students, interns, residents, and fellows in disputes with their graduate medical education (GME) programs. We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters and other disputes with their employers. We often act as the physician’s personal counsel in medical malpractice litigation.

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

 

KeyWords: Legal representation for licensed health professionals, legal representation for doctors, health law defense attorney, Florida health law defense attorney, legal representation for formal licensure complaints, licensure defense attorney, legal representation for adverse disciplinary action, Department of Health (DOH) investigations and complaints, legal representation for DOH investigations, DOH investigation defense attorney, DOH complaint defense attorney, legal representation for administrative hearings, complaint investigation defense attorney for health care professionals, appeals (and variations on appeal ) of adverse license action, Virginia health law defense lawyer, Louisiana health law defense legal counsel, legal representation for physicians, legal representation for mental health professionals. Colorado health professional defense lawyer, Virginia health law defense counsel, District of Columbia health law legal representation, The Health Law Firm reviews, reviews of 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 © 2017 The Health Law Firm. All rights reserved.

By |2018-07-09T19:46:47+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

CMS Launches the Home Health Value-Based Purchasing Program: What Providers Need to Know

By Michelle Bedoya

According to the 2016 Home Health Final Rule, published on November 5, 2015, the Centers for Medicare and Medicaid Services (CMS) is launching a value-based purchasing (VBP) pilot program for Medicare home health care agencies (HHA). The VBP model is designed to support greater quality and efficiency of care among Medicare-certified HHAs across the nation.  Starting on January 1, 2016, HHAs in nine states representing each geographic area in the nation will be required to participate in the VBP program. HHAs that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee will compete on value in the VBP model, where payment is tied to quality performance.

What Exactly is Value-Based Purchasing?

CMS launched the VBP model due to the growing concern that the existing payment system (which focuses on volume of services provided) does not provide the necessary incentives for HHAs to provide high quality patient-focused care. The VBP model is considered to be an innovative step towards revamping how Medicare pays for health care services, moving the program towards rewarding HHAs for better value, outcomes and patient-focused care. HHAs will compete where payment is tied to quality performance and will then have their payments adjusted in the following manner:

–    A maximum payment adjustment of 3 percent (upward or downward) in 2018;

–    A maximum payment adjustment of 5 percent (upward or downward) in 2019;

–    A maximum payment adjustment of 6 percent (upward or downward) in 2020;

–    A maximum payment adjustment of 7 percent (upward or downward) in 2021; and

–    A maximum payment adjustment of 8 percent (upward or downward) in 2022.

The Bottom Line: VBP Payment Changes.

The VBP model will adjust aggregate claim payments up to the maximum percentage for each year. As a result, high performing HHAs will experience a greater reward whereas, low performing HHAs will experience a greater downside risk. Payment adjustments for each year will be calculated on improvements achieved and on comparative performance achievement levels. Adjustments will be based on each HHA’s performance relative to other competing agencies of similar size in the same state.

What Providers Should Do NOW.

HHAs participating in the VBP model are encouraged to:

(a)    Establish their HHA VBP point of contact by providing the HHVBP Help Desk (HHVBPquestions@cms.hhs.gov) with the name and email address of a primary point of contact for each CMS Certification Number (CCN).

(b)    Obtain a User Account on the CMS Secure Portal. This is an essential first step towards registration for the VBP Model portal where HHAs will receive performance reports and enter data for new measures.

(c)    Review the CY 2016 Home Health Final Rule here.

Conclusion.

The post-Affordable Care Act environment enables CMS to facilitate a complete turnaround of the home health industry. Due to the launching of VBP models, HHAs are compelled to review and reinvent their standard operating practices. Providers must develop a sense of urgency to review their current operating structure and adapt operations according to ensuing reforms.

Still Want to Know More?

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

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

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

Sources:

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements, 80 F.R. 68623 (proposed Nov. 5, 2015) (to be codified at 42 C.F.R. pt. 409).

“Home Health Value-Based Purchasing Model.” The Centers for Medicare & Medicaid Services. (December 10, 2015). Web.

About the Author: Michelle Bedoya is a long-time consultant to home health agencies and is currently a graduating senior at Barry University School of Law.  She currently works, as well, for 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: Home Health Agencies (HHA), Centers for Medicare and Medicaid Services, (CMS), Work Plan 2016, Medicare fraud defense attorney, Medicaid fraud defense attorney, LEIE legal counsel, List of Excluded Individuals and Entities, Medicare Fraud Strike Force, Zone Program Integrity Contractor (ZPIC) audit lawyer, Recovery Audit Contractor (RAC) lawyer, Florida health attorney, health law attorney, Florida health lawyer, The Health Law Firm, health law defense lawyer, health professional attorney, Medicare fraud defense lawyer, Medicaid fraud defense lawyer, home health final rule, value based repurchasing (VBP), Medicare and Medicaid audit defense lawyer, Medicare and Medicaid compliance, Medicare and Medicaid investigation defense lawyer, home health agency attorney, HHA Medicare reimbursement claims, Medicaid audit appeal, Florida Health Care law attorney

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law Firm. All rights reserved.

By |2018-05-17T22:04:47+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

Texas Jury Finds Doctor Responsible for Harassment of Nurse Despite Settlement Being Reached

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

On August 9, 2016, a licensed vocational nurse in Texas who alleged she was bullied and sexually harassed by a doctor at work was vindicated when a $440,000 settlement was reached between the parties. Patricia Hahn alleged the harassment she received from Dr. Scott Davidson started soon after beginning work at North DFW Urology Associates (North DFW) in 2007.

The Alleged Harassment.

Hahn reportedly testified that on three separate occasions, Dr. Davidson screamed at her with raised arms and clenched fists, “Just shut up. Just shut up, I’m sick of you,” according to the court documents. She reported the behavior to the human resources department at her group and shortly afterwards was allegedly called by Dr. Davidson for an after-hours meeting in his office. Then, according to the nurse, he proceeded to give her a “demonstration” of what screaming was, she testified, attempting to prove that he had not screamed at her previously.

After she made a report about the sexual harassment and hostile work environment she claims she suffered at the hands of Dr. Davidson throughout her three years at North DFW, Hahn was eventually fired.

The Settlement.

Even if she had not settled, Hahn would have received damages related to the alleged mistreatment she suffered. A Dallas County, Texas, jury returned a $1.08 million verdict in her favor on claims of sexual harassment and intentional infliction of emotional distress, just minutes after the settlement was reached. Oh well, “A bird in the hand . . . .” The up side of this is that now the case is completely resolved and there won’t be any risk of appeals dragging out the final result for years.

Hahn’s attorney noted that the verdict is one of few in the country that’s been handed down by a jury relating to “bullying” claims.

Click here to read the plaintiff’s original petition.

To read about a similar case of harassment in the workplace and the repercussions, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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

Source:

Casady, Michelle. “Dallas Jury Finds Clinic, Doc Responsible For Harassment.” Law360. (August 9, 2016). 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: Bullying and sexual harassment in the workplace attorneys, intentional infliction of emotional distress lawyers, settlement for harassment in the workplace, legal representation for physicians accused of wrongdoing, reviews on The Health Law Firm lawyers, legal counsel for healthcare professionals, legal representation for nurses, health law litigation attorneys, health law defense counsel, health professionals legal counsel, The Health Law Firm reviews, state court litigation attorneys, federal court litigation attorneys, legal defense of physicians in civil litigation

“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 © 2016 The Health Law Firm. All rights reserved.

By |2018-05-18T11:52:51+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

Safeway Pharmacy Settles Medical Negligence and Wrongful Death Suit Over Woman’s Death

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

On December 5, 2016, a Nebraska magistrate judge signed off on an agreement resolving a widower’s wrongful death suit. The medical negligence suit contends that Safeway pharmacists negligently dispensed methadone and another medication to the plaintiff’s now-dead wife even though using the drugs together is risky, ultimately leading to her death.


Medical Negligence.

U.S. Magistrate Judge Thomas D. Thalken, granted a stipulation of dismissal in Brian Crawford’s litigation alleging that Safeway is liable for his wife’s death. Crawford alleges that Safeway is responsible for his late wife’s death because its pharmacists gave her both methadone and fluconazole, despite the fact that the medications are contraindicated for simultaneous use. Click here to read the order in full.

Brian Crawford, who originally filed suit in April 2014, alleged in an amended complaint later that year that Safeway “breached its duty to decedent Hilary Crawford by failing to provide reference material appropriate for the efficient and safe practice of pharmacy for use by its registered pharmacists which would alert the dispensing pharmacist of the adverse drug-drug interaction of methadone and fluconazole prior to the point of dispensing and delivering to decedent Hilary Crawford.”

To read the amended complaint, click here.

Crawford alleges that the failure to provide its pharmacists with those materials led to a number of missteps that contributed to her death in April 2012. For example, the pharmacists failed multiple times to provide Hilary Crawford with counseling and information about the increase in methadone when she was starting larger doses. Also, she was twice given another prescription for the drug before the prior one had run out, the complaint alleged.

The pharmacists also allegedly made several errors surrounding the dispensing of fluconazole to treat a yeast infection she contracted, according to the complaint.

The Other Side of the Story.

In its defense, Safeway moved to exclude the testimony of Brian Crawford’s toxicology expert, Henry Nipper, contending that his opinion lacked reliability. The company then followed up with a summary judgment bid in September, saying that without Nipper’s testimony, Brian Crawford wouldn’t be able to prove causation.

“There is not admissible evidence against Safeway that the combination of fluconazole and methadone taken by the plaintiff’s decedent caused her death. Rather, the overwhelming evidence is that the plaintiff’s decedent took twice as much methadone as she was instructed to by the pharmacy and by her physician. She exhibited signs of overdose in the several days prior to her death,” Safeway said. “Unfortunately, the signs and symptoms were not appreciated by her family and friends.”

However, Judge Thalken denied the motions in late September 2016, and the parties reached a settlement in October 2016, according to court filings.

To learn more about medical negligence suits, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Pharmacists, Pharmacies, and Other Health Care Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes pharmacists, pharmacies, physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment 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 and in representing physicians in investigations and at Board of Medicine and Board of Osteopathic Medicine hearings. We represent physicians accused of wrongdoing, in patient complaints and in Department of Health investigations.

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

Sources:

“Safeway Settles Medical Negligence Suit Over Woman’s Death.” Lexis Nexis. (December 5, 2016). Web.

Posses, Shayna. “Safeway Settles Medical Negligence Suit Over Woman’s Death.” Law360. (December 5, 2016). 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: Medical negligence lawsuit, wrongful death lawsuit, medical negligence defense attorney, wrongful death defense lawyer, legal representation for medical negligence, legal representation for wrongful death lawsuits, legal representation for pharmacists, legal representation for pharmacies, defense attorney for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Louisiana Board of Pharmacy attorney, Colorado Board of Pharmacy defense legal counsel, Virginia Board of Pharmacy defense lawyer, Kentucky Board of Pharmacy defense attorney, District of Columbia (D.C.) Board of Pharmacy lawyer, Louisiana pharmacist attorney, Colorado pharmacist defense legal counsel, Virginia pharmacist defense lawyer, Kentucky pharmacist defense attorney, District of Columbia (D.C.) pharmacist 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 © 2016 The Health Law Firm. All rights reserved.

By |2017-01-05T07:03:34+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments

Jury Finds Four New Orleans Doctors and Others Guilty for Participation in $13.6 Million Medicare Fraud Scheme

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

On May 9, 2017, a federal jury found four New Orleans doctors and two others guilty for their participation in a Medicare fraud scheme. According to prosecutors the defendants netted more than $13.6 million in fraudulent Medicare reimbursements.

Details of the Scheme.

The six defendants worked for or with Abide Home Care Services (Abide) in New Orleans. Federal prosecutors said Abide routinely falsified diagnoses so Medicare reimbursements were inflated. Abide also falsified medical records that supported medically unnecessary home health services, prosecutors said. Abide was owned by Lisa Crinel, who pleaded guilty to her role in the scheme in 2015.

In exchange for their role in the scheme, Abide made monthly payments to the doctors that were falsely characterized as medical consultant or director fees. Abide also hired Dr. Michael Jones’ wife Paula Jones and inflated her salary payments to pay for fraudulently certifying documents. Additionally, Jonathan Nora scheduled doctor visits with Abide “well knowing” that the referral did not come from the beneficiary’s own health care professional.

The Trial.

After a month long trial, a federal jury returned guilty verdicts against the six individuals charged with committing Medicare fraud. Found guilty were Dr. Henry Evans, Dr. Michael Jones and his wife Paula Jones, Dr. Shelton Barnes, Dr. Gregory Molden and Jonathon Nora. Click here to read the press release issued by Acting U.S. Attorney Duane Evans’s Office in Eastern District of Louisiana.

The Consequences.

Dr. Evans was found guilty of five counts of health care fraud. Dr. Michael Jones, Paula Jones, Dr. Barnes, Dr. Molden and Jonathan Nora each were found guilty of conspiracies to commit health care fraud, defrauding the United States, receiving and paying kickbacks and health care fraud, according to the U.S. Attorneys Office. The four doctors and Nora were convicted of additional individual counts of health care fraud. Dr. Shelton Barnes was additionally convicted of obstruction of a federal audit.

Dr. Barnes faces a maximum penalty of up to 170 years in federal prison; Dr. Molden faces up to 115 years; Dr. Michael Jones faces up to 95 years; Dr. Evans faces up to 50 years in federal prison; Paula Jones faces up to 15 years; and Nora faces up to 25 years. Each also faces a maximum fine of up to $250,000 for each count.

Doctors Beware.

In our practice we have represented a number of doctors who have been exploited by nonphysicians intent on committing fraud. They will often target older and semi-retired physicians. The goal is merely to get their name and identification number to use in falsifying medical records and claims. If the deal you are being offered seems like too good of a deal, involves little or no work on your part to receive a large check each month or involves working for nonphysicians or individuals you do not know, you should beware. Always know who you are working for, the location of their actual place of business and residence, and with whom (physician-wise) they have done business before. You do not want to spend the later years of your life in prison, after pursuing an honorable career for decades.
Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many cases, those subject to Medicare fraud audits and 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.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March of 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 Medicare 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 Medicare 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.

To read further about the seriousness of Medicare fraud, click here to read one of my prior blogs.

Additionally, you can watch our informational video blog on Medicare fraud, here.

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

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

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

Lane, Emily. “4 New Orleans doctors, 2 others convicted in $13.6 million Medicare fraud scheme.” The Times-Picayune. (May 10, 2017). Web.

“4 New Orleans doctors, 2 others convicted in $13.6 million Medicare fraud scheme.” Health Leaders Media. (May 11. 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Keywords: Legal representation for Medicare fraud, 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 allegations 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 illegal kickbacks, Medicare false claims defense attorney, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, 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 © 2017 The Health Law Firm. All rights reserved.

By |2017-06-02T07:14:35+00:00May 15th, 2018|Health Facilities Law Blog|0 Comments
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