Mental Health Counselor | The Health Law Firm Blog

The 25 Biggest Mistakes Psychologists Make After Being Notified of a Department of Health Complaint

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

The investigation of a complaint which could lead to the revocation of a psychologist’s license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the psychologist who receives it. Yet, in many cases, attorneys are consulted by psychologists after the entire investigation is over, and they have attempted to represent themselves throughout the case. Often, the mistakes that have been made severely compromise an attorney’s ability to achieve a favorable result for the psychologist.

These are the 25 biggest mistakes we see in the psychology cases we are called upon to defend after a DOH investigation has been initiated:

1. Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.

2. Contacting the DOH investigator and providing him/her an oral statement or oral interview. (Note: There is no legal requirement to do this.)

3. Making a written statement in response to the “invitation” extended by the DOH investigator to do so. (Note: There is no legal requirement to do this.)

4. Failing to carefully review the complaint to make sure it has been sent to the correct psychologist. (Note: Check name and license number).

5. Failing to ascertain whether or not the investigation is on the “Fast Track” which may then result in an emergency suspension order (ESO) suspending the psychologist’s license until all proceedings are concluded. (Note: This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, or failure to comply with PRN instructions.)

6. Providing a copy of the psychologist’s curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so. (Note: There is no legal requirement to do this.)

7. Believing that if they “just explain it,” the investigation will be closed and the case dropped.

8. Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.

9. Failing to forward a complete copy of the patient medical record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.

10. Delegating the task of providing a complete copy of the patient record to office staff, resulting in an incomplete or partial copy being provided.

11. Failing to keep an exact copy of any medical records, documents, letters or statements provided to the investigator.

12. Believing that the investigator has knowledge or experience in health care matters or procedures being investigated.

13. Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.

14. Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.

15.Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.

16. Believing that because they haven’t heard anything for six months or more the matter has “gone away.” The matter does not ever just go away.

17. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

18. Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case.

19. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of your licensing board for a decision.

20. Taking legal advice from their colleagues regarding what they should do (or not do) in defending themselves in the investigation.

21. Retaining “consultants” or other non-lawyer personnel to represent them.

22. Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel.

23. Attempting to defend themselves.

24. Believing that because they know someone with the DOH or a state legislator, that influence can be exerted to have the case dismissed.

25. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.

Bonus Point: 26. Communicating with the Department of Health about the pending case.

Not every case will require submission of materials to the Probable Cause Panel after the investigation is received and reviewed. There will be a few where the allegations made are not “legally sufficient” and do not constitute an offense for which the psychologist may be disciplined.

In other cases, an experienced health care attorney may be successful in obtaining a commitment from the DOH attorney to recommend a dismissal to the Probable Cause Panel. In other cases (usually the most serious ones), for tactical reasons, the experienced health care attorney may recommend that you waive your right to have the case submitted to the Probable Cause Panel and that you proceed directly to an administrative hearing. The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board in such cases and does so on a regular basis.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Psychologists.
The attorneys of The Health Law Firm provide legal representation to psychologists in Department of Health (DOH) investigations, FBI investigations and other types of investigations of health professionals and providers.

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

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

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Clinical Social Worker, Mental Health Counselor, Mental Health Counselor Law, Occupational Therapist, Psychology, Resident|Tags: D.O., department of health, doh, FBI investigation quality assurance, investigation, license revoked, psychologist investigation, psychology, what should a psychologist do if being investigated|Comments Off

Psychologists: Don’t Fall Victim to Scammers that Call and Claim to be DEA Agents

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

The Drug Enforcement Administration (DEA) is warning psychologists to be aware of a prescription drug scam. This telephone scheme is extorting money from people all over the country. On November 28, 2012, the DEA released a press release explaining the details of the scam.

Details of the Scam.

The scam starts with criminals posing as DEA agents calling victims by telephone. Frequently the victims will have recently purchased prescription drugs over the internet or by phone. The imposters tell the victims that purchasing the drugs in that manner is illegal, and that they must pay a fine. If the victims refuse to send money, the phony DEA agents threaten to arrest the victims or search their property. Some of the victims have also reported unauthorized use of their credit cards after purchasing the prescription drugs.

Click here to read more on this scam from a DEA press release.

The DEA wants to remind psychologists that no DEA agent will ever contact you by telephone. They might show up at your house early in the morning or while you are eating dinner, however. Also, agents never request money or any other form of payment.

When Is It Legal to Buy Controlled Drug by Telephone or Over the Internet?

Many times it may be illegal to purchase controlled drugs by phone or over the internet. That’s why you should go to Canada to do it. There are direct flights from Orlando. However, some pharmacies that meet stringent requirements and are registered by the DEA are allowed to sell drugs over the internet or by phone. So don’t be fooled by this telephone scam.

Criminals May Be Cold Calling Victims.

The scammers are counting on the fact that if you have done this, you, as a psychologist, will get scared and believe their accusations. Many people have no idea whether such conduct is legal or illegal. These imposters are banking on your ignorance and fear of losing your license to practice. They are also banking on the fact you won’t report this to the real police.

Where do they get this information? Chances are, they are just “cold-calling” people. There are bound to be a certain number of people they reach who have done this. However, if they seem to have your personal information (or credit card number) report this to the police right away. Be sure to obtain a written police report. Also, you should file a HIPAA Privacy Complaint with the Office of Civil Rights (OCR) to begin an investigation if you believe your personal information has been stolen by or given to someone else to use.

Restrictions and Regulations Make it Hard for Legitimate Patients to Get Controlled Drugs.

It is no surprise that the DEA, along with other law enforcement agencies, has stepped up its efforts to cut down on overprescribing. To see examples of what I am talking about read my past blogs: Walgreens fights the Drug Enforcement Administration’s (DEA) immediate suspension order and Drug Enforcement Administration (DEA) pulls controlled substance licenses from two Sanford, Florida, CVS pharmacies.

If the largest, legitimate pharmacy chains in the state and nation are not allowed to fill these prescriptions, where will chronic-pain patients turn? Are these actions driving our citizens into the hands of shady pharmacies that have fewer safeguards and less accountability, such as online pharmacies? Are these actions driving our citizens to seek out illegal drug dealers and turn to illegal drugs to cope with their legitimate medical problems? That is just one opinion. Tell us yours below.

Contact Health Law Attorneys Experienced with Investigations of Psychologists.
The attorneys of The Health Law Firm provide legal representation to psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

Comments?

As a psychologist, have you been contacted by these phony DEA agents? Please leave any thoughtful comments below.

Sources:

Pavuk, Amy. “DEA Warns of Prescription-Drug Scam.” Orlando Sentinel. (November 29,2012). From: http://www.orlandosentinel.com/news/local/breakingnews/os-dea-warns-scam-internet-20121128,0,5800536.story

Drug Enforcement Administration. “DEA Scam Alert – Extortion Scheme.” DEA. (November 28, 2012). From: http://www.justice.gov/dea/divisions/mia/2012/mia112812a.shtml

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Clinical Social Worker, Department of Health, Intern, Marital and Family Therapist, Mental Health Counselor, Psychology, Resident|Tags: clinical social workers, controlled substance purchases online, DEA agents, DEA investigation, defense attorney, defense for psychologists, defense lawyer, Drug Enforcement Administration (DEA), drug purchases on the telephone, extortion scam, HIPAA Privacy Complaint, interns, marital and family therapists, Office of Civil Rights (OCR), online drug purchase, pharmacies, pharmacist, pharmacy, prescription-drug scam, psychologist, psychology, representation of psychologists, residents, scam alert|Comments Off

Finding a Healthcare Providers Service Organization (HPSO) Insurance Defense Lawyer

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

We are sometimes told by the health professionals we represent especially pharmacists, licensed mental health counselors (LMHCs), advanced registered nurse practitioners (ARNPs), massage therapists and physical therapists that after they received a complaint regarding their license from the Florida Department of Health (DOH) they had difficulty finding an experienced attorney in Florida who would accept their professional liability insurance. In this case, I am speaking specifically about Healthcare Providers Service Organization (HPSO) Insurance.

Benefits of HPSO Insurance.

The professionals who are covered by HPSO Insurance have excellent insurance coverage. HPSO Insurance provides professional liability coverage that protects in the event of a lawsuit or negligence claim. But much more often the professional receives a notice of an investigation, a subpoena for a deposition in someone else’s case, a demand because of an allegation of sexual harassment or sexual impropriety, a complaint because of a breach of medical records confidentiality or Health Insurance Portability and Accountability Act (HIPAA) Privacy complaint, or some other administrative type of action.

HPSO provides great coverage for these. For example, HPSO currently reimburses up to $10,000 in legal fees and expenses just for representation of you at depositions. HPSO currently reimburses up to $25,000 in legal fees and expenses for your defense in a DOH or Agency for Health Care Administration (AHCA) notice of investigation or complaint. HPSO currently reimburses up to $25,000 in legal fees and expenses for your legal representation in defense of a complaint or investigation regarding breach of medical confidentiality.

If you are a pharmacist, own a pharmacy, are a massage therapist, own an assisted living facility (ALF), are a mental health counselor or a social worker, or you are one of the many other types of health care professionals who HPSO insures, it should be fairly easy to find experienced health lawyers to represent you, especially in Florida.

Our firm and our attorneys, including George F. Indest III, Michael L. Smith, Joanne Kenna, Carole C. Schriefer, Lance O. Leider, Christopher E. Brown and Danielle M. Murray, routinely represent licensed health care professionals, interns and students in all types of administrative investigations and hearings and in defending lawsuits and other actions that have been filed. We also represent health facilities in license defense, survey complaints and administrative hearings. We represent them throughout Florida, from Pensacola, to Jacksonville, to Key West. We also occasionally represent them in other states, as well. We accept HPSO Insurance assignments.

Free Legal Advice: Get Insurance Immediately.

It is very important for every health professional to carry insurance that covers any investigation, complaint or administrative hearing that might be filed or opened against your license. You may think that you are covered for this by your employer, but you are not. If your employer contradicts this, ask for a statement in writing that your employer will pay for your legal defense for any such matter arising during your employment.

What typically happens, especially in the case of a hospital employee, nursing home employee, pharmacy employee or corporate employee, is that the employer is the one who terminates the employee and then files a complaint with the DOH. The DOH then opens an investigation against the health professional. The employer is not going to pay your legal defense costs if the employer has reported you.

You may very well be out of work, out of money and face an investigation and complaint that could terminate your professional license and career. You should not take this chance. Insurance such as HPSO Insurance is inexpensive and reliable. Buy it while you can afford it. After the actions have occurred, it is too late.

Find an Experience Health Law Attorney in the Event of an Investigation.

Also, you should immediately contact an experienced health law attorney if you are telephoned or visited by any investigator, or if you receive a letter advising you that an investigation has been opened regarding your care. Call immediately for advice before you speak with an investigator or provide any documents or statements of any kind.

You cannot and should not seek “legal advice” on what to do from the investigator, from a DOH employee, from your professional board or from any attorney representing any of them. They are not your friends. They are on the side against you. You should definitely not take any advice from them.

Do Not Skimp on Insurance Coverage.

If you have good insurance, it will pay for your legal expenses from the very beginning, so use it. However, beware of cheap insurance policies from professional associations that do not provide any coverage for disciplinary complaints and licensure investigations. Always check to be sure this is covered. Get it in writing. With some companies you have to pay an extra premium to obtain this coverage. With some insurers, they do not offer it, and you have to purchase a completely separate policy covering just this. It is worth it! Do it!

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

Our firm regularly represents pharmacists, massage therapists, mental health counselors, registered nurses, assisted living facilities, home health agencies, nurse practitioners, lab technicians, occupational therapists, physical therapists, social workers, physician assistants, psychologists and other health professionals in many different legal matters.

Services we provide include representation before your professional board, in DOH investigations, in administrative hearings, in civil litigation, in defense of malpractice claims, in professional licensing matters, in defense of allegations concerning HIPAA privacy violations and medical record breaches, in Drug Enforcement Administration (DEA) actions, and in many other matters.

We routinely represent physicians, dentists, nurse practitioners, and others in defending against malpractice claims, civil lawsuits, administrative complaints, peer review actions, DOH investigations, Medicare audits, Medicaid audits, and other matters. In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.

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 (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you have professional liability insurance? Why or why not. Please leave any thoughtful comments below.

“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.

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Clinical Social Worker, Intern, Marital and Family Therapist, Mental Health Counselor, Occupational Therapist, Psychology, Resident|Tags: administrative attorney, administrative complaint, administrative hearings, administrative lawyer, Agency for Health Care Administration (AHCA) investigation, AHCA complaint, assisted living facility (ALF), defense attorney, defense lawyer, DOH investigation, experienced health attorney Florida, experienced health lawyer Florida, Florida defense attorney, Florida defense lawyer, Florida Department of Health (DOH), Florida license defense, health facilities, health professionals, Healthcare Providers Service Organization (HPSO) Insurance, licensed mental health counselors (LMHCs), physical therapists, professional liability insurance, psychologists, social worker|Comments Off

Have You Received a Notice of Termination of Your Medicare Provider Number?

By Danielle M. Murray, J.D.

Have you received a notice of termination of your Medicare provider number? Medicare has been revoking the Medicare provider numbers of many different Medicare providers including psychologists and other mental health providers, based on returned mail sent to old addresses which have not been updated or based on inspection team site visits to old addresses.

Often the termination is retroactive to a much earlier date the change or move may have been determined to have occurred. Even if the mailing address is correct or was changed, the physical address of the business must have been updated, as well. It is usually an incorrect or old physical address which causes this to occur.

The effect of this termination includes:

1. You are prohibited from reapplying to Medicare for at least two (2) years.

2. You may have to pay back any monies received from the Medicare Program since the effective date of the termination (often many months prior to the notification letter).

3. Other auditing agents may be notified such as the Medicare Zone Program Integrity Contractors (ZPIC) and the state Medicare Fraud Control Unit (MFCU).

4. You may no longer contract with Medicare or anyone who does.

5. You may and probably will be terminated from the approved provider panels of health insurance companies with which you are currently contracted.

6. You may and probably will be terminated from skilled nursing facilities (SNFs) and home health agencies (HHAs) with which you have contracts.

7. You may and probably will have your clinical privileges terminated by hospitals or ambulatory surgical centers (ASCs) where you have them.

What you should not do includes:

1. Don’t bother to write letters.

2. Don’t bother to call the Centers for Medicare & Medicaid Services (CMS).

3. Don’t bother to call the Medicare Administrative Contractor (or MAC) (previously called the “carrier” or “fiscal intermediary”).
4. Don’t bother to file a new CMS Form 855 (application) or a CMS Form 855C (change).

5. Don’t bother to start communicating with CMS or the MAC about your situation and what you need to do about it.

6. Don’t bother to complete and file the short, one-page Corrective Action Plan (CAP) form that is on the CMS or Carrier/MAC website (unless you are close to the deadline and don’t have representation; then you must.)

What we recommend is:

1. Immediately go into the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and the National Plan & Provider Enumeration System (NPPES) NPI Registry and print out a copy of the existing information. Then update or correct any incorrect information on you or your company, if you can. Print out the information as it existed before and print out the information after you have corrected it. (Note: Medicare will act shortly after the letter to you to terminate your access to this, so it may be too late).

2. Hire an experienced health attorney immediately to assist you in putting together and submitting a comprehensive Corrective Action Plan (CAP), a Request for Reconsideration (RFR) and a request for an Appeal Hearing.

3. Note that there is a thirty (30) day deadline for submitting the CAP and a sixty (60) day deadline for requesting an appeal hearing. Do not miss these.

4. Implement formal, written internal policies and procedures to prevent a recurrence of the type of error, oversight or event that caused the termination. Train your management and staff on these.

The CAP should address every element of the applicable conditions of participation (COP) contained in the Code of Federal Regulations (CFR). It should include and be supported by all relevant documents, including but not limited to:

1. Documents showing how the error occurred or past efforts to comply.

2. Surety bond guarantees and documents (where required).

3. Insurance coverage documents showing current coverage (general liability, professional liability, vehicle/auto liability).

4. Current licenses and permits.

5. Certificates of good standing and latest annual reports for any corporation or limited liability company.

6. Print-outs from PECOS/NPPES Registry discussed above.

7. Accident reports, insurance claims, police reports, fire reports or other documentation showing why a relocation was required (if this was an issue).

8. Certificates of compliance training for you and your staff, if available.

9. Copies of policies and procedures that you have adopted to keep there from being a recurrence of the situation that led to the termination.

10. An authorization form for your consultant or attorney to represent you in the matter.

All copies should be clear, legible, complete, straight, no corners cut off an no handwriting on them, to the greatest extent possible.

Everything should be professionally assembled, typed, indexed and labeled. It should include a table of contents or an index. Number every page. It should be submitted to the MAC (or the agency/address given in the termination letter) by two (2) reliable means that document both sending and receipt. Keep copies of everything, including postal receipts, airbills, Federal Express labels, courier receipts, etc. It must be received at the address given in the termination letter you received (usually MAC) by the deadline given above. Keep copies of online tracking reports and return receipts.

In most instances, should you show a legitimate reason for the error, show you are currently in compliance, and show what remedial measures you have taken to keep there from being a repeat, the MAC will accept your corrective action plan (CAP) and will reinstate your Medicare number, as things stand currently.

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 durable medical equipment (DME) suppliers and health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid Program and administrative hearings.

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

Comments?

What do you think of this blog post? Please leave any thoughtful comments below.

About the Author: Danielle M. Murray 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

By The Health Law Firm|2024-03-14T10:01:05-04:00May 15, 2018|Categories: Medicare Audit, Medicare Fraud, Mental Health Counselor, Mental Health Counselor Law, Psychology|Tags: audit defense lawyers, defense attorney, Florida Medicare, fraud defense, fraud defense attorneys, fraud schemes, government health programs, legal representation, medicare, Medicare fraud, Medicare overbilling|Comments Off

Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme

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

A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the Florida Office of the Attorney General (AG). On March 27, 2013, the facility owner was arrested. She faces charges of racketeering, Medicaid fraud and identity theft. According to the AG, local, state and federal law enforcement officers were all involved in the investigation.

Click here to read the press release from the AG.

Mental Health Counselor Reportedly Billed Medicaid for Services Never Rendered.

According to the Orlando Sentinel, between 2012 and 2013, the mental health counselor billed Medicaid more than $3 million for services provided to Medicaid recipients with mental health needs that were never rendered. The facility owner is also accused of using gift cards to bribe people into letting her use their Medicaid numbers and service applications. Click here to read the entire article from the Orlando Sentinel.

Money was Used on Luxury Items.

Authorities said the mental health counselor allegedly used the money to buy a cruise trip for seven people, a trip to Mexico, jewelry and more than $175 worth of Louis Vuitton products. Agents allegedly searched the mental health counselor’s home and business. They apparently seized a Cadillac Escalade and a Ducati Superbike from her home, according to the AG.

The mental health facility owner is charged with one count of second-degree Medicaid fraud, one count of first-degree racketeering, and one count of second-degree identity theft.

Medicare and Medicaid Investigations and Audits of Psychologists and Other Mental Health Professionals.

Over the past year we have observed an increasing number of Medicare and Medicaid investigations and audits being initiated against all mental health professionals. We have also seen a number of investigations and audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. There is a two-part blog on our website on this topic. Click here for part one, and click here for part two.

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

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?

Do you think there is an increase in investigations on mental health care providers? Please leave any thoughtful comments below.

Sources:

Meale, Jenn. “Medicaid Fraud Control Unit and Partners Arrest Ringleader of $3 Million Medicaid Fraud Scheme.” Office of the Attorney General. (March 27, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/283E6646009F8B9685257B3B00664A79

Pavuk, Amy. “Bondi: Orlando Woman Ran $3M Medicaid Fraud Scheme.” Orlando Sentinel. (March 27, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-medicaid-fraud-investigation-20130327,0,2857142.story

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

Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law. He 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 Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Medicaid audit, Mental Health Counselor, Mental Health Counselor Law|Tags: attorney general’s (AG) office, defense attorney, defense lawyer, Florida defense attorney, Florida Medicaid, legal defense, medicaid audit, Medicaid defense attorney, Medicaid fraud, Medicaid fraud defense lawyer, Medicaid numbers, Medicaid scheme, mental health professional, mental health service program|Comments Off

Mental Health Counselors, Psychologists, Social Workers and Family Therapists Should Be Sure They Carry Insurance to Cover Complaints Against Their Licenses

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

From our experience mental health counselors, psychologists, social workers and family therapists are at a high risk of having a client or patient file a complaint against them with their licensing board.

Many of their clients/patients have mental health problems, emotional problems or personality disorders; this is why they are seeing a therapist to begin with. If there is a disagreement between the therapist and the client/patient over treatment, diagnosis or other issues, this can easily result in that person filing a complaint.

We have also seen complaints filed when a therapist is retained to evaluate someone for a court proceeding, for vocational rehabilitation programs, for disability insurance and for other types of evaluations where the person is not the client or the patient of the therapist.

Situations to Be Aware of As a Mental Health Counselor, Psychologist, Social Worker and Family Therapist.

Many complaints seem to arise out of situations in which the therapist has socialized with the client or patient. Socializing with a client or patient should be strictly avoided.

Divorces, custody disputes and other family law matters have resulted in an increase in the number of complaints filed against therapists. If one parent disagrees with an evaluation in a child custody dispute, this may result in a complaint against the professional with the licensing board.

We have experienced cases in which family law attorneys have suggested to their clients that they file such complaints in a misguided attempted to have that therapist disqualified from giving an opinion or intimidated into withdrawing.

Steps to Take to Help Alleviate the Consequences of a Complaint Against Your License.

Defending oneself in the investigation of a complaint against your license can be expensive and time consuming. There are two primary actions that can be taken to help alleviate the consequences of such actions by disgruntled clients/patients.

1. Be sure you have and maintain good professional liability insurance that provides professional license defense expense coverage of at least $25,000. You can easily spend this amount in legal fees to successfully defend yourself, even from a completely meritless complaint. This type of insurance is cheap and easy to obtain. Two insurers we know to provide this are Healthcare Providers Service Organization (HPSO) and Lloyd’s of London. Check with your insurance agents for others.

2. Immediately retain the services of an attorney who has experience with your type of case and with your professional board. Ask for numbers of cases and outcomes. Usually this will be a health law attorney or administrative law attorney, but make sure the attorney has experience with your board. Many states now recognize the legal specialty of health law. In these states, you want an attorney that is board certified in health law.

Discipline is Forever-Hire an Attorney to Help.

Hire an attorney as soon as you suspect there may be a complaint or an investigation. Do not attempt to do this yourself. Do not make any statement, oral or written, to any investigator until you consult with an attorney. The simplest statement can be used against you to help prove a charge resulting in discipline on your license.

Discipline is for life. Don’t take a chance.

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, social workers and family therapists in Department of Health (DOH) investigations, FBI investigations and other types of investigations of health professionals and providers.

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

Comments?

Have you ever had a patient or client file a complaint against you with your licensing board? Do you have professional liability insurance? Please leave any thoughtful comments below.

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

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:08-04:00May 15, 2018|Categories: Clinical Social Worker, Marital and Family Therapist, Mental Health Counselor, Mental Health Counselor Law, Occupational Therapist, Psychology, Resident|Tags: attorney, Board of Psychology, complaint against a family therapist, complaint against a social worker, complaint against mental health counselor, complaint against psychologist, Family Therapists, health care lawyer, health law, health law attorney, Healthcare Providers Service Organization (HPSO), investigation of a family therapist, investigation of a mental health counselor, investigation of a psychologist, investigation of a social worker, lawyer, license complaint, licensing board, Lloyd’s of London, mental health counselors, professional liability insurance, psychologists, Social Workers|Comments Off

Lloyd’s of London (Lloyd’s) Attorneys, Lawyers and Defense Council in Florida

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Often we learn after the fact that a health professional such as physicians, nurses, podiatrists, psychologists and other health professionals has received Lloyd’s of London Insurance, has had a legal problem, and has not been able to locate an attorney or law firm that accepts this type of insurance. We have offices in Florida and Colorado, but we have attorneys licensed in Florida, Colorado, Louisiana, the District of Columbia, Virginia and other states. Additionally, we can provide legal advice and representation in license investigations and administrative proceedings in many other states. If you have Lloyd’s of London Insurance, do not go without an attorney or with a lawyer that has little or no experience where you need it.

Our Attorneys will Work with Lloyd’s of London of Your Insurance Company.

Call us first. We can assist you in determining if your legal problem is covered by your insurance, and we can help you file a claim to have your legal defense expenses and costs covered. In most cases, we will accept the assignment of your insurance so that you do not have to worry about legal bills while your case is going on.

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

The Health Law Firm routinely represents mental health counselors, psychologist, social workers, family therapists 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. In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company.

We will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company, if your insurance company will allow this. Many of these insurers will pay our firm to represent you in the legal defense of an investigation or complaint against your professional (nursing, medical, dental, psychology, mental health counselor) license or for an administrative hearing involving professional discipline.

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

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Clinical Social Worker, Intern, Marital and Family Therapist, Mental Health Counselor, Occupational Therapist, Psychology, Resident|Tags: administrative law, administrative proceedings, attorney, complaint against a health care professional, complaint against a health care provider, complaint against a physician, health attorney, health care lawyer, health care professional, health care provider, health law, health law attorney, insurance, investigation of a health care professional, investigation of a health care provider, investigation of a physician, legal defense expenses, Lloyd’s of London, nurse, physician, Podiatrist, professional liability insurance, psychologist|Comments Off

Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000

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

The two owners of a Minneola, Florida, ministry that helps provide counseling therapy and case management for children and families, each face up to 15 years in prison for allegedly defrauding Medicaid. According to the Florida Attorney General (AG), the pair was arrested on December 11, 2013. The owners were arrested after an investigation by the AG’s Medicaid Fraud Control Unit (MFCU) revealed that they allegedly bilked the Medicaid program out of $80,000.

Click here to read the press release from the AG.

Pair Charged With Participating in an Organized Scheme to Defraud Medicaid.

According to a Daily Commercial article, the two owners ran a counseling center that was suppose to link Medicaid recipients with a mental health condition to state-approved mental health counseling centers in the community. However, the MFCU’s investigation uncovered that the owners allegedly billed Medicaid for services that were never rendered. According to the investigation, the duo also instructed their employees to bill for entire families when only one family member received services. Employees of the ministry also allegedly billed for unauthorized expenses. Additionally, it is alleged the ministry received reimbursements for services provided to children who did not have any documented mental health condition.

The two owners are both charged with one count of participating in an organized scheme to defraud Medicaid, according to the Daily Commercial. If convicted, they each face up to 15 years in prison, up to $10,000 in fines, and restitution. Click here to read the article from the Daily Commercial.

Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Take Fraud Charges Seriously.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

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

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Ray, Whitney. “Attorney General Bondi’s Office Announces Arrest of Lake County Couple for Nearly $80,000 Medicaid Fraud.” Florida Attorney General. (December 11, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/7BAB936C94315B3885257C3E006F8895

Daily Commercial. “Ministry Owners Charged with Medicaid Fraud.” Daily Commercial. (December 12, 2013). From: http://www.dailycommercial.com/news/article_cc247b13-5771-5da4-9cab-545c5614aa91.html

By The Health Law Firm|2024-03-14T10:01:09-04:00May 15, 2018|Categories: Medicaid audit, Mental Health Centers, Mental Health Counselor|Tags: Agency for Healthcare Administration (AHCA), Attorney General (AG), counseling center, counseling therapy, defense attorney, defense lawyer, florida attorney, Florida lawyer, Florida Medicaid, Florida Medicaid Program, fraudulent claims, medicaid, medicaid audit, Medicaid claims, Medicaid fraud, medicaid fraud control unit, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicaid investigation, mental health disorders, mfcu, services never rendered, the health law firm|Comments Off

Health Professionals Who Are Employees Must Have Personal Professional Liability Insurance

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

We are often asked what we consider to be the biggest problem that a health professional experiences in defending himself or herself in a complaint against their license. In our opinion, it is not having the financial resources to retain the services of an experienced attorney to defend him or her. Because of this, we believe that any licensed mental health counselor, psychologist, social worker and family therapist who is an employee of any hospital, skilled nursing facility, home health agency, assisted living facility, medical group, or any other organization must have his or her own personal professional liability policy that provides ample insurance coverage for professional license defense expenses.

We see more license complaints that must be defended than we ever see civil claims for damages filed.

Don’t Assume if You Are Insured by Your Employer That You are Completely Covered.

In our experience, most of the complaints filed against health professionals come from employers. In many cases, a client or patient will complain to the employer and the employer will file the complaint. In other cases, the employer initiates the complaint because of substandard performance, documentation problems, allegations of theft or drug diversion, allegations of falsification of documents or records, allegations of inappropriate sexual conduct, etc. When this happens in most cases, the employer terminates the health professional. This is why we say that a health professional must have his or her own independent professional liability insurance policy.

Just when you need it the most, you may find yourself out of a job, with no income and no money to pay for a legal defense. This may ultimately lead to your losing your professional license and your ability to ever work as a mental health counselor, psychologist, social worker and family therapist again.

Many health professionals labor under the incorrect assumption that they are “insured” by their employer or their agency or that their employer’s or agency’s insurance covers them. This is a fallacy, especially when it comes to defending against a complaint made against one’s professional license. If your employer or agency is the one that files the complaint against you, you don’t really think that your employer or agency is going to cover the legal expenses associated with your defense, do you?

You Can Afford an Independent Professional Liability Insurance Policy.

Professional liability insurance policies for non-physician licensed health professionals are very cheap, often policies run about ten or 20 dollars a month. Usual limits of coverage for this small premium payment are one million dollars of coverage for civil suits and $25,000 or more coverage for professional license defense.

Take note, it is not as simple as just purchasing the first professional liability insurance policy you find offered. Many professional liability insurance policies do not offer license defense coverage. Or, if they do, it is limited to only complaints where there is also the threat that a patient is going to sue for money. Still others provide such low limits of coverage for license defense expenses (e.g., $5,000 or $10,000) that it is not worth the money paid for it.

Be very careful when purchasing insurance through your professional association. Make sure it provides at least $25,000 of coverage for complaint defense and make sure it provides coverage when no claim for damages from a patient or client is expected. Get this in writing.

We Reccommend Theses Professional Liability Insurance Companies.

We usually tout insurance such as that provided by Nurses Service Organization (NSO) and Healthcare Professionals Service Organization (HPSO) as providing great bang for the buck. But here lately, we’ve been seeing (and hearing) more and more about CPH & Associates insurance. Not only does it provide one million dollars in coverage if you are sued in a civil court, but it also provides up to $35,000 in coverage for professional license defense coverage. Additionally, for a very small additional payment, with CPH & Associates Insurance you can increase that coverage to $100,000 for professional license defense. The other company we hear good things about is Lloyd’s of London.

If you have a complaint filed against your license and you have to prove your innocense through a formal administrative hearing (trial), this can be very expensive. Additionally, if you lose at this level, you may have to appeal the results to a higher court. These expenses can easily cost $75,000, even if you win. And you are not ever assured that you will get any of this money paid back to you, even if you are innocent and you win the case. Inexpensive insurance coverage is the only thing that makes since. Buy it!

Conclusion.

We urge all licensed mental health counselors, psychologists, social workers and marriage and family therapists, especially those employed by other organizations, to purchase and maintain their own personal professional liability insurance policy. It’s tax deductible. But check to make sure you have coverage for professional license defense, even when there is no claim for damages expected from a patient. Additionally, pay the extra premium to purchase a higher limit of coverage for professional license defense cases, or buy a second insurance policy for this additional coverage. You will never regret this decision.

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

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

Comments?

Do you have personal professional liability insurance? Why or why not? After reading this blog, will you consider getting it? Please leave any thoughtful comments below.

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Clinical Social Worker, Marital and Family Therapist, Mental Health Counselor, Occupational Therapist, Psychology|Tags: and Family Therapists, assisted living facility, best insurance coverage for nurses, CHP & Associates, complaint against a family therapist, complaint against a mental health counselor, complaint against a psychologist, complaint against a social worker, complaint on a mental health counselor’s license, complaint on a psychologist’s license, complaint on a social worker’s license, complaints on a family therapist’s license, defense attorney, defense lawyer, Department of Health (DOH), Department of Health complaint, do health care professionals need insurance, employer insurance, family therapist defense, health attorney, health lawyer, Healthcare Professionals Service Organization (HPSO), home health agency, hospital, legal defense, legal expenses, license complaint, Lloyd’s of London, medical group, mental health counselor defense, mental health counselors, Nurses Service Organization (NSO), professional liability insurance, professional license defense, psychologist defense, psychologists, skilled nursing facility, social worker defense, Social Workers, the health law firm|Comments Off

Mental Health Professionals Need to Know How To Handle Difficult Patients – Part 1

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

Psychologists, mental health counselors, social workers, and other psychotherapists, because of the nature of their professions, will often encounter difficult, abusive, or obsessive clients/patients. It comes with the territory. The clients or patients to whom they are expected to provide treatment and therapy to, often suffer from mental disorders, personality disorders, or illnesses.

Although it is traditional for many mental health professionals to refer to “clients” instead of “patients,” we will use the term “client/patient” in this blog.

First, Protect Your Own Privacy.

You should safeguard your own privacy and the security of your office, staff and family.

Obtain a telephone number and line dedicated exclusively for your office or practice. Do not give out your cell phone number or your home telephone number. Make sure your office staff, receptionist and colleagues know not to ever give out your cell phone number. Make sure that your own cell phone number is masked or blocked for those times when you may use it to call clients/patients.

Do not allow your home address to be published whenever possible. You can request that telephone carriers and directories not list your home address. Check Internet and online directories to make sure your home address is not available online. List only your office address or a post office box on your official Department of Health Licensure forms. Under no circumstances give out or allow your home address to be give to clients/patients.

Your Professional Time Is Valuable: Require Clients/Patients To Pay For It.

You are a professional. You are supposed to be paid for your time.

Yet, over and over again, I consult with therapists who have only seen a client/patient for a few paid sessions, but are spending countless additional hours talking to the client/patient on the telephone, responding to client/patient e-mails and text messages, or attending to problem situations caused by the client/patient.

I recommend that at the very first encounter with the client/patient, you explain to the client/patient that you expect to be paid for your time. Explain that insurance carriers and other third party payers do not pay for the time you may spend:

1. Talking to the client/patient or the client’s/patient’s family or other
professionals on the telephone;

2. Responding to client/patient e-mails, letters or text messages;

3. Completing forms for the client/patient, including insurance forms, disability
applications, request for information, etc.; or

4. Time you expend on other tasks the client/patient requests, such as court
appearances, meetings with others, or any acts the client/patient asks you to
perform to assist them.

Make sure that the client/patient understands that he or she will have to pay for these separately out of his or her own pockets. Have the client/patient sign an acknowledgment form (similar to a Medicare ABN: Advance Beneficiary Notice) stating that he/she understands they will be billed for these and the client/patient is expected to pay. Include this in your client/patient financial agreement.

Click here for a form you may consider adopting for your use.

Keep a lookout for part 2 of this blog. Part 2 will include scenarios in which a client/patient can abuse a professional relationship and how you as the mental health professional can appropriately handle such incidents.

Comments?

Have you ever experienced a strained relationship with any of your clients/patients? Do you have a difficult, abusive client/patient? Please leave any thoughtful comments below.

Contact Health Law Attorneys Experienced in the Representation of Mental Health Counselors, Psychologists, Social Workers, and Marital and Family Therapists.

We have had mental health professionals who became victims of completely unreasonable demands from their clients/patients (house sitting, pet sitting, etc.), stalking by their clients/patients, identity theft and computer hacking by their clients/patients. Don’t become a victim yourself.

The attorneys of The Health Law Firm can assist and advise you in dealing with difficult clients/patients. We can stop stalking, cyber-stalking and harassment. We can respond to client/patient letters. We can defend you if a client/patient files a complaint against you.

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