Medicare Decreases Physician Rates but Mental Health Counselors Now Allowed to Bill Medicare

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 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 on January 1, 2024.

Physician Fee Schedule Rate Reductions.

The overall payment rates under the 2024 PFS will be reduced by 1.25 percent in 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. This is bad news for physicians who continue to suffer reduced […]

By |2024-06-14T15:08:23-04:00June 14, 2024|Mental Health Law Blog|
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The Importance of Retaining Mental Health Records

By Amanda I. Forbes, J.D.
One of the key professional obligations of any psychotherapist involves providing reasonable access to client/patient records and securely maintaining client/patient records, even after the termination of the psychotherapist-client relationship. Proper documentation of client treatment records is crucial for defending against malpractice lawsuits, licensing board complaints, ethics complaints and Medicare or health insurance audits.
Section B.6.h. of the American Counseling Association (“ACA”) Code of Ethics states:
Storage and Disposal After Termination
Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with federal and state laws and statutes such as licensure laws and policies governing records, and dispose of client records and other sensitive materials in a manner […]
By |2024-06-14T14:55:54-04:00June 14, 2024|Mental Health Law Blog|
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Humana Agrees To Pay $11.2 Million Settlement to End Nurses’ Overtime Suit

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

On September 27, 2021, Humana agreed to pay $11.2 million to end claims that the health insurance company denied a group of nurses overtime pay by misclassifying them as exempt employees. A Wisconsin federal judge approved the deal with Humana, and a group of more than 200 nurses reached, securing a $36,000 average payment for each nurse involved in the suit.

A Violation of the Fair Labor Standards Act (FLSA).

This dispute stems from a class-action lawsuit filed in 2017 alleging that Humana misclassified its clinical nurse advisers as exempt employees and denied them overtime compensation, violating […]

By |2024-05-31T20:00:09-04:00June 2, 2024|Mental Health Law Blog|
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Court Rules New York Doctor Can Subpoena Yelp for User Info in Defamation Suit

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

On October 7, 2021, the United States District Court for the Southern District of New York ruled that Yelp is subject to a subpoena to reveal the names of anonymous users who left negative reviews for a doctor and his medical practice. The federal court judge found that the statements in the reviews made on Yelp contained factual claims that the doctor did have a legal right to contest in court. This is a factor that is usually missing in such cases. Accordingly, a motion for expedited discovery filed by the plaintiff physician was granted by […]

By |2024-05-13T20:00:05-04:00May 15, 2024|Mental Health Law Blog|
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HHS Releases Final Substance Use Disorder Confidentiality Rule

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

On February 8, 2024, the U.S. Department of Health and Human Services (HHS) released a final rule modifying the Confidentiality of Substance Use Disorder (SUD) Patient Records federal regulations (42 C.F.R. Part 2). The new regulation will supposedly help ensure that health care providers have more complete information when treating patients with substance use disorders and improve that regulations compatibility with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations.

Background.

The SUD final rule came out of the bipartisan Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which, among other things, required HHS to align […]

By |2024-04-18T14:24:28-04:00May 9, 2024|Health Facilities Law Blog, Mental Health Law Blog|
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Manager of Dental Office Sentenced to One Year Prison Term for Defrauding Medicaid Out of More Than $813,000

George Indest Headshot

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

On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. Mahsa Azimirad, was the office manager for Universal Smiles, a D.C.-based dental practice, according to the U.S. Attorney’s Office for Washington, D.C.

She was indicted in January 2019, along with the dentist who ran the practice. The dentist pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and reportedly admitted that she received over $813,000 through false billings.

The Fraudulent Billing Scheme.

Both the office manager and […]

By |2024-05-05T20:00:07-04:00May 7, 2024|Mental Health Law Blog|
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Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme

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 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 […]

By |2024-03-14T09:59:08-04:00April 15, 2024|Mental Health Law Blog|
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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 […]
By |2024-03-14T09:59:09-04:00March 26, 2024|Health Facilities Law Blog, Mental Health Law Blog|
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Supreme Court of Pennsylvania Says Serial Killer Cannot Sue Psychiatrist for Medical Malpractice

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 and Hartley Brooks, Law Clerk, The Health Law Firm

On November 22, 2023, the Supreme Court of Pennsylvania unanimously decided that a serial killer cannot sue his psychiatrist for gross negligence because the action is barred by the Pennsylvania state law that prohibits criminals from benefitting from their crimes.

The Murderer’s Mental Health History.

In February 2016, Cosmo DiNardo was diagnosed with a major depressive disorder. Three months later, DiNardo was in an ATV accident in which he sustained head injuries. His mother reported that […]

By |2024-03-14T09:59:10-04:00March 11, 2024|Mental Health Law Blog, The Health Law Firm Blog|
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