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Autistic Kids in Florida May Lose Care as Medicaid fraud Investigation Continues

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

On July 26, 2018, state investigators revealed that six behavioral therapists in Florida billed the state for “impossible” days of service that at times indicated they worked for more than 24 hours in a day. The six therapists, who worked with low-income children with autism, were then subsequently terminated from the Medicaid program.

The company that employed them, DRA Behavioral Health, was among four South Florida behavioral therapy companies sanctioned by the Agency for Health Care Administration (AHCA) for failing to pay fines, hiring unqualified therapists and failing to disclose required information to the state.

Is AHCA Delaying Health Care?

While AHCA continues its probe into behavior analysis services paid for by Medicaid, schools and programs say the agency is dragging out authorizations for therapy and approvals of new therapists. Thus, AHCA is effectively preventing children from getting therapy for months while reducing the costs to the state.

Advocates claim that AHCA used wrong or outdated information as a reason to suspend their therapists from Medicaid and then forced the provider to repay thousands of dollars.

In response, AHCA has urged parents of children with Medicaid to contact the agency if they are having difficulty getting behavioral analysis services as the state continues to add new providers to meet demand. For more information, click here.

Be sure to check our Mental Health Law Blog regularly for updates.

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.

Sources:

Chang, Daniel. “Autistic kids could lose care as Florida cracks down on Medicaid fraud.” Miami Herald. (July 26, 2018). Web.

Viteri, Amy. “Autistic children caught up in Medicaid fraud investigation.” (August 7, 2018). Web.

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

KeyWords: Representation for Medicare fraud, Medicare fraud investigation representation, Medicare attorney, Medicare fraud defense lawyer, representation for AHCA investigations, AHCA attorney, representation for health care professionals, doctor lawyer, doctor attorney, representation for doctors, doctor defense attorney, health care professional defense lawyer, health law defense attorney, health care facility representation, health care law defense, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Florida health law firm, Florida health law defense 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 © 2018 The Health Law Firm. All rights reserved.

Massachusetts Insurance Company Sued in Mental Health Discrimination Suit

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

On July 20, 2018, a Massachusetts federal judge allowed a woman to move forward with a proposed class action against Harvard Pilgrim Health Care Insurance Company (Harvard Pilgrim). The woman is claiming that Harvard Pilgrim, which covers medical expenses at nursing homes, must also cover mental health care at her son’s behavior-correcting summer camp.

Mental Health Parity Act.

U.S. District Judge Denise J. Casper denied a motion to dismiss from the insurer, saying that the plaintiff adequately equated the two types of health settings in a lawsuit. In the suit, the insurer is accused of violating the Mental Health Parity Act when it denied coverage for behavioral services at wilderness programs. Its blanket exclusion for services rendered at wilderness treatment programs is a separate treatment limitation applicable only to mental health benefits and thus violative of the Parity Act.

The statute generally requires insurers to cover mental health treatments on the same terms that they cover medical and surgical care. As a result of this violation, the plaintiff was forced to pay more than $16,000 out of pocket for her teenage son, the lawsuit alleges.
Click here to view the complaint in full.

The Defendant’s Arguments.

In response, Harvard Pilgrim argued that it excludes wilderness-like medical benefits such as diabetes camps, so excluding wilderness mental health care is not differential. In addition, in court documents it insisted that the correct comparison was whether both types of treatment, physical and cognitive, would be excluded if offered through a wilderness program.

Despite the arguments, Judge Casper stated that the First Circuit has held that a plan administrator, in terminating or denying benefits, may not rely on a theory for its termination or denial that it did not communicate to the insured prior to litigation. To read Judge Casper’s order in full, click here.

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.

Sources:

Wille, Jacklyn. “Harvard Pilgrim Sued Over Wilderness Therapy Coverage.” Bloomberg Law. (July 24, 2018). Web.

Noon, Alison. “Harvard Pilgrim Must Face Mental Health Discrimination Suit.” Law360. (July 24, 2018). Web.

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

KeyWords: Mental Health Counselor Law, Occupational Therapist representation, mental health representation, mental health counselor attorney, mental health attorney, Mental Health Counselor representation, legal counsel for mental health professionals, mental health defense lawyer, representation for mental health professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida mental health professional representation, Florida mental health professional 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 © 2018 The Health Law Firm. All rights reserved.

New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million

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

For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due to credible allegations of fraud, according to KUNM News. The behavioral health agencies are accused of collectively defrauding Medicaid of $36 million over three years. The findings in an audit conducted in 2012, by OptumHealth, the contractor that handles Medicaid payments for New Mexico’s behavioral health system, alarmed state officials to the point that they hired Public Consulting Group (PCG), a firm that specializes in Medicaid fraud, to conduct another audit in June 2013.

These behavioral health agencies provided services to approximately 30,000 patients. According to KUNM News, Arizona companies have been hired to step in to help patients needing treatment.

Click here to read the KUNM News article.

Audits and Whistleblower Claims Uncover Serious Accusations.

The reason for the Medicaid funding freeze, according to the HSD, was the initial audit conducted by OptumHealth, the company that manages Medicaid dollars for New Mexico’s behavioral health agencies. OptumHealth allegedly found problems with billing by the agencies in question. Then a second audit by PCG allegedly uncovered widespread overpayments for services that had never been provided. According to the New York Times, a quarter of patients’ claims were processed with mistakes.

During the PCG audit, whistleblowers also came forward with their own accusations, according to the New York Times. In one case, an employee was allegedly ordered not to inform the state that a patient had died. In another, an ex-employee at an agency reported being fired after refusing to overbill for services.

Click here to read the entire New York Times article.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Mental Health Providers Fight for Funding.

New Mexico officials state that they were obligated under federal law. Under the Affordable Care Act, states have more power to suspend payments when there is credible evidence that Medicaid dollars are being misused. All 15 mental health providers sought exceptions from the state so their Medicaid funding could be restored while the investigation continues. Only three exceptions were granted, according to the New York Times.

Mounting Pressure to Root Out Medicare and Medicaid Fraud.

Just this year, we’ve noticed the government become more aggressive in its anti-fraud and recovery efforts. The Affordable Care Act also gives investigators and prosecutors new tools to crack down on abuse. Now that the government is collecting more money, you can expect their efforts to get worse.

Since whistleblowers stand to receive up to thirty-five percent (35%) of a recovery made by the government, plus attorney’s fees and costs, you can expect more whistleblower lawsuits to be filed. Therefore, it is now more important than ever to verify accurate billing and coding.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower 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.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Frosch, Dan. “Fraud Investigation Unsettles Mental Health Care in New Mexico.” New York Times. (September 16, 2013). From: http://www.nytimes.com/2013/09/14/us/fraud-investigation-unsettles-mental-health-care-in-new-mexico.html?pagewanted=all&_r=0

Ahtone, Tristan. “A Timeline of NM’s Shakeup of Behavioral Health Providers.” New Mexico In Depth. (September 13, 2013). From: http://www.nmindepth.com/2013/09/13/a-timeline-of-nms-shakeup-of-behavioral-health-providers/#

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.

It’s Always a Bad Idea For Mental Health Professionals To…

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

In my 30 plus years of practice representing physicians, dentists, nurses and mental health professionals, I have defended clients involved in many different situations. Several of these seem to be problem areas which we see repeatedly.

Following is a list of those problems which it would seem to be common sense for a mental health professional or other health care professional to avoid doing. If you do any of these you can rest assured that you will eventually be confronted with charges and an investigation by your state licensing board, the Drug Enforcement Administration (DEA), your national certification board, any facility at which you have privileges and other law enforcement agencies.

I can assure you, it is always a bad idea for a mental health professional or other health care professional to:

1. Write a prescription for any medication for yourself.

2. Start a romantic relationship with a patient.

3. Take someone else’s prescription medication, ever.

4. Write a prescription for or treat a patient, especially a family member, for a condition outside the scope of his or her specialty (e.g., a dentist prescribing antibiotics to her children to treat a cold; a pediatrician prescribing pain medications for an adult; an OB/GYN prescribing antidepressants for a male).

5. Write any prescription for or treat any patient who is in another state when the mental health professional is not licensed in that state.

6. Treat or prescribe for any spouse, other family member, friend or colleague, without opening a medical record and fully documenting the treatment or prescription, as you would for any other patient.

7. Hire a patient to work for you in your office or allow a patient to “volunteer” to work in your office.

8. Pre-sign blank prescriptions for your assistant, ARNP, Medical Assistant, receptionist, or anyone else, to complete later.

9. Seek psychotherapy or drug/alcohol abuse treatment with a physician or HCP health professional in your own medical group, institution or the staff of your hospital.

10. Add to, alter or change any medical record entry after you know there may be a claim, investigation or litigation involving it.

11. Take and use your own drug samples provided by pharmaceutical companies.

12. Go into a hospital where you do not have clinical privileges and treat or “assist” in treating a patient there, even if it is your own patient.

13. Have a sexual relationship ( including “sexting” or “telephone sex”) with a patient or patient’s immediate family member.

14. For a mental health professional (psychiatrist, psychologist, mental health counselor, social worker, psychiatric nurse practitioner) to have any type of social relationship with a current patient.

If you find yourself doing any of the items listed above, don’t wait until it’s too late. An experienced health care attorney can help guide and defend against licensing issues including investigations from your state licensing board and the DEA.

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

The attorneys of The Health Law Firm provide legal representation to psychiatrists, mental health counselors, psychologists, social workers and family therapists in Department of Health (DOH) investigations, medical malpractice investigations, business transactions, contracts, structuring business ventures, clinical privileges actions, professional licensure matters, Board hearings, business litigation, Medicare and Medicaid audits, and other types of investigations of health professionals and providers.

Often the early advice and representation of an experienced health law attorney can help avoid discipline which will be on your record for a lifetime.

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

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

KeyWords: Items health care professionals should avoid doing, investigation by state licensing board, Drug Enforcement Administration (DEA), licensure defense for health care professionals, legal representation for health professionals, DOH investigations, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys, 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.

First Medical Marijuana Dispensary in Hawaii Gets Green Light From DOH

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On August 8, 2017, after waiting 17 years, Hawaii will begin dispensary sales of medical marijuana to patients. Maui Grown Therapies got the green light from the Hawaii Department of Health (DOH) to begin selling medical cannabis. I know (from reliable sources, that is) that Hawaiian grown marijuana has always been a favorite with the connoisseur.

Maui Grown Therapies.

The Maui dispensary has been pre-registering patients and will begin selling medical cannabis to patients by appointment only, said Freitas Gorman, director of community relations and patient affairs. Walk-in sales will start in about a week.

In 2000, Hawaii was among the first states to legalize medical marijuana. But the state didn’t legalize dispensaries until 2015, so the state’s 18,000 patients had to grow or obtain the drug on their own.

“This is an important day for qualified patients and caregivers on Maui who now have assurance the medical cannabis they purchase at Maui Grown Therapies has been thoroughly tested and is safe for them to use,” said Virginia Pressler, director of the state Department of Health, in a statement. “Implementing a new health program is always challenging, and the dispensary program was no exception.”

To read the press release from the DOH, click here.

To read more on the status of medical marijuana in Florida, click here to read my prior blog.

To learn more about how the attorneys of The Health Law Firm can assist you in legal matters involving medical marijuana, click here.

To stay on top of medical marijuana issues, be sure to check out our Medical Marijuana Law Blog regularly.

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.

Sources:

Bussewitz, Cathy. “FIRST MEDICAL MARIJUANA DISPENSARY OPENING IN HAWAII.” The Associated Press. (August 8, 2017). Web.

Department of Health. “First dispensary receives approval from Department of Health to
begin sales of medical cannabis for Hawai‘i patients.” State of Hawaii, DOH. (August 8, 2017). Web.

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: Medical marijuana legislation, medical marijuana defense attorney, legal representation for medical marijuana, legal representation for Department of Health issues, medical marijuana representation in Florida, Medical and recreational marijuana use, legal counsel for medical marijuana, marijuana defense attorney, complex health related business transactions, legal opinions on medical issues, legal representation for medical marijuana growers and distributors, legal counsel for medical marijuana, DOH defense attorney, The Health Law Firm attorney reviews, The Health Law Firm reviews, Florida medical marijuana defense attorney, Board of Medicine defense lawyer, reviews of The Health Law Firm, access to medical marijuana in Florida, The Health Law Firm, legal representation for applicants of marijuana dispensary license, legal representation for marijuana dispensary medical directors, legal representation for contracts for marijuana related matters, legal representation for physicians and medical director agreements, legal representation for licensure and regulatory matters involving growers, legal representation for dispensaries and medical directors

“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.

 

Holding off a Professional License Revocation or Suspension During Appeal

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

If you are a physician, dentist, nurse, psychologist, pharmacist, physician assistant, nurse practitioner, massage therapist or other licensed health professional whose license has been recently revoked or suspended, there may still be hope. As a matter of course, you would be required to immediately stop practicing or risk being prosecuted for unlicensed practice, which is a felony. Although this blog deals with Florida law, similar relief may be available in other states, too.

One of the hardest things about having a license suspended or revoked is that it becomes effective immediately, whether there was a mistake, the action taken was erroneous or because of other reasons which may support an appeal. This cuts off the health professional’s sole source of income, which may also prevent you from having enough to pay for an appeal. If you have a thriving practice, this will usually destroy any value which your business has. Without income, paying your bills will be a challenge, much less paying the legal expenses to appeal or further fight the action that was taken.

Even if you appeal the decision and win the appeal, you will be out of practice for many months, often more than a year, before your license is reinstated. You still have all the lost income and business, and you never get this time and money back.

Fortunately, Florida law provides a remedy for temporary relief from the adverse decision, so that you may retain your license and practice your profession pending appeal of your case. This legal process is called a “writ of supersedeas.”

What is Supersedeas Relief?

Supersedeas relief is a form of relief granted by a reviewing court (court of appeal) that suspends the enforcement of the decision of the lower court (or agency) while the underlying issues are decided on appeal. What this means is that you can have the action to revoke or suspend your license put on hold while you appeal the decision of the Department of Health (DOH), in the case of a health care professional. The same applies to other professional licenses issued by other state agencies in Florida, as well.

Supersedeas relief is authorized in two separate locations in Florida law: Section 120.68(3), Florida Statutes, and Rule 9.190(e)(2)(C), Florida Rules of Appellate Procedure. Both of these provisions state that a reviewing court can grant a stay of enforcement of the revocation or suspension of a license pending review.

This relief is not automatic, however. You must request it. Additionally, both legal authorities specifically prevent supersedeas from being granted if the licensee poses a probable threat to the health, safety or welfare of the state. In most cases, this is not applicable. Regardless, it is the burden of the agency which has the order is being reviewed to prove that there is a danger to the public.

Additionally, the Appellate Rule permits you to ask for expedited review. (Which of course is recommended because you want to be back to work as quickly as possible, right?) This means that the agency only has ten (10) days to file its opposition and the appellate court will make an expedited decision on this. This shortened time period may make it difficult for an overworked government attorney to file on time or to produce quality opposition.

Steps to Seeking Supersedeas Relief.

Following are the steps which an experienced health lawyer or appellate lawyer would take to obtain such relief:

1. File an appeal of the Final Order revoking or suspending your license with the appropriate agency and a copy to the appellate court. Be sure to follow all appellate rules, local court rules and instructions.

2. File a Petition for Expedited Supersedeas Relief with the appellate court at the same time.

3. If you receive a favorable ruling from the court, deliver that order to the licensing agency (in this case, the DOH) and request that your license be reinstated immediately.

We do not recommend that you attempt to represent yourself on such matters. Appeals are complex and require an intimate knowledge of the law and appellate procedures. You should engage the services of an experienced health lawyer at the earliest possible opportunity.

Other Considerations.

It is important to note that this form of relief will not make the underlying disciplinary action disappear. Your return to practice will only be temporary, unless you win the appeal. You will still have to show the licensing agency did something contrary to law when it imposed the discipline in order for the appellate court to overturn the decision. This is not often an easy task. Furthermore, the law only permits a thirty (30) day window in which to appeal the agency’s decision, after which your rights are lost and you are very likely stuck with the decision.

Appeals Are Very Technical and Require a Thorough, Specialized Knowledge of the Law.

What few people understand is that appeals are very technical and have complex, procedural rules that you must follow. Additionally, appeals are decided based on errors made in applying the law in the case, not based on a dispute about the facts of the case. An appeal of an agency final order is not the place to argue about the facts of your case or to try to prove different facts. This is another reason that you should have an experienced health law attorney represent you and have a full, formal administrative hearing on the case. Given the fact that most appeals will not be successful (the appellate courts err to the side of assuming the lower court or agency made the correct decision), you need to aggressively litigate and defend the action against you to try to win at the hearing or agency level. To prevail on an appeal, the attorney must have a detailed knowledge of the correct, relevant court cases and must be able to argue these in the proper form in legal briefs.

An appeal is all about the laws that apply to your factual situation and the court cases that have interpreted those laws. Unless the agency made a legal error and violated the law, you won’t win. There are many other procedural steps you must follow in an appeal that only a good appellate attorney will know. To attempt to do this yourself is not advisable.

Contact Health Law Attorneys With Experience Handling Licensing Issues.

If you have had a license suspended or revoked, or are facing imminent action against your license, it is imperative that you contact an experienced healthcare attorney to assist you in defending your career. Remember, your license is your livelihood, it is not recommended that you attempt to pursue these matters without the assistance of an attorney.

The Health Law Firm routinely represents physicians, dentists, nurses, medical groups, clinics, and other healthcare providers in personal and facility licensing issues.

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.

Key Words: revocation of medical license, suspension of medical license, supersedeas relief, revocation of dental license, revocation of nursing license, revocation of pharmacist license, revocation of health facility license, adverse agency action, health professional defense attorney, professional license defense lawyer, health care appellate attorney, appeals from adverse agency action, appeal from professional license discipline, appeal from final order, abating final order, suspending application of final order, Department of Health (DOH) defense attorney, license suspension attorney, legal representation on license revocation, license revocation defense counsel, health care appeals defense 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 © 2016 The Health Law Firm. All rights reserved.

Mental Health Counselors and Social Workers Should Not Have Difficulty in Finding A, Attorney/layer Who Takes Cph & Associates (CPH&A) Insurance to Represent Them in Complaint Investigations

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

We often hear from Mental Health Counselors, Social Workers, Psychologists and Family Therapists who call and retain us to represent them in complaints against their professional licenses in professional licensing complaints. This includes letters from the Department of Health (DOH) advising them that they are being investigated, Administrative Complaints, emergency restriction orders (EROs), and emergency suspension orders (ESOs).

In many cases they had good insurance coverage with CPH & Associates (CPH&A) Insurance, but could not find an attorney that would accept it. Often these mental health professionals retain us after adverse disciplinary action has already been taken. They retain us to appeal or attempt to reverse an adverse disciplinary action taken against their license, including revocations.

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

Our firm has attorneys that are licensed in and can defend psychologists, mental health counselors, social workers and other mental 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 boards 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 mental health professional’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 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.

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 mental health professionals, legal representation for psychologists, Department of Health (DOH) investigations and complaints, mental health professional defense attorney, legal counsel for DOH investigations and hearings, health care professional defense attorney, legal representation for medical professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida health law attorney, legal representation for administrative hearings, legal representation for complaints against a professional license, licensure defense attorney, legal representation for a complaint made for violation of HIPAA or patient privacy, CPH & Associates (CPH&A) Insurance, legal representation for cases with CPH & Associates (CPH&A) Insurance, legal representation for mental health professionals in Florida, legal representation for mental health professionals in Colorado, legal representation for mental health professionals in Louisiana, legal representation for mental health professionals in Virginia and legal representation for mental health professionals in the District of Columbia

“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

Qui Tam Cases: If You Are Thinking About Blowing the Whistle, Follow These Tips

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At The Health Law Firm, we have represented many clients that were involved in qui tam cases brought because of false claims under the Medicare False Claims Act (FCA).  We have defended health facilities and health professionals, but we have also brought whistle blower cases against health facilities and health professionals, representing the whistle blower.  If you are thinking about blowing the whistle on any type of fraud or unlawful conduct by your current or former employer, there are important facts that you should know.

Filing a qui tam (whistle blower) case can be complicated, complex, and time consuming.  It’s important to seek experienced legal counsel to guide you through the difficult process. It is crucial that a whistle blower’s attorney have a good working relationship with the U.S. Attorney’s Office and the State Attorney’s Office, as well.
Based on years of experience with these types of cases, from both sides, here are some key tips to remember if you are thinking about filing a qui tam or whistle blower suit:

1.     You Are Doing the Right Thing.  It is important to remember in qui tam cases that you are doing the right thing. Qui tam whistle blowers often save taxpayers millions of dollars and help the government recover stolen funds by coming forward with cases of fraud or unlawful conduct.  Additionally, they help to put an end to fraudulent activities and illegal conduct that may harm patients.

2.     Choose an Experienced Attorney.  Because filing a qui tam suit under the False Claims Act (FCA) can be a difficult and complicated task, choosing an attorney with the proper experience is very important. Litigation of whistle blower cases, either prosecuting them or defending them, is a highly complex, technical area of law and not all attorneys have the experience to make the process easier, let alone be successful.

3.     Don’t Drag Your Feet If You Have Evidence of Fraud.  Once you have evidence of fraud, you need to act quickly or you may lose your opportunity to receive a monetary award. The FCA limits the time in which a suit can be filed. Generally, a qui tam suit must be filed within six years of the date the fraud was committed. Most qui tam laws, including the FCA also have a “first to file” rule. This means that a qui tam whistle blower must be the first to file a case in order to be eligible to receive an award.  Additionally, if the fraud becomes public knowledge or the government discovers the fraud on its own, it is too late for the whistle blower.

4.     Whistleblowers Are Legally Protected from Retaliation by the False Claims Act.  One concern clients have when filing a qui tam suit, is the effect it might have on their future professional career as well as their personal life.
First, because the case is filed under seal, there is no record of any kind that even shows a case has been filed, much less the name of the person filing it.  The U.S. Attorney and its investigators (including the FBI and the OIG Special Agents) will know, but they ain’t telling.  It often takes several years before the court will order the case unsealed. Second, the False Claims Act contains a provision that prohibits any type of retaliation against the whistle blower. The act  makes it unlawful for any employer to retaliate against you for exercising your rights as a whistle blower.  Additionally, if it occurs, you will have a separate right to sue an employer just for the retaliation.  I saw a whistle blower case recently which the court dismissed because there wasn’t specific information contained in the complaint about any false claim being submitted.  However, because the employer had retaliated against the whistle blower, the court did not dismiss the whistle blower’s claim for wrongful retaliation against the employer.  This was a big mistake by the employer.

5.     Silence is Golden in Qui Tam Cases. Do not discuss your case with anyone but your lawyer. Do not tell your friends. Do not tell your family. Do not even disclose that you are thinking of filing a lawsuit. Public discussions can be detrimental to your case. Qui tam suits are filed under the “seal” provision of the FCA, which prohibits the disclosure of any aspect of the case to anyone without prior court approval.

6.    Most Important, Documentation of Actual False Claims is Required. Recent court cases have strictly emphasized the requirement that you must have documented proof of actual false claims being submitted to the government.  Whether these are copies of claims, copies of superbills, copies of explanations of benefits (EOBs), copies of ledgers, copies of book keeping documents or whatever, you must have several actual claims that are false that were submitted for payment.  You must be able to specifiy these by patient name, date of service, CPT code billed, amount billed, etc.  Internal memos, policies and procedures, billing guidance and instructions, medical record entries, and other documents that show the employer’s intent to defraud the government are useful in showing a conspiracy, or organized scheme to falsely bill. However, you must also have copies of false claims documentation, as well.

Remember: Those who file qui tam cases under the FCA are valuable and important for our nation’s health care system. They help stop health care fraud and help the government recover billions of dollars. They prevent the theft or waste of millions of dollars that could be spent on actual, needed health care.  They also help prevent harm that may be caused to patients from receiving substandard treatment, unnecessary procedures and treatments or no treatment. Through qui tam lawsuits, whistle blowers have stopped harmful practices that endanger the health and lives of Medicare, Medicaid, Tricare and VA patients.

For more information, read my prior blog on whistleblowers who report fraud.

Contact an Experienced Health Law Attorney to Assist in Whistle blower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim.
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.

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

Look Professional In Your Correspondence. Don’t Diminish Your Professional Reputation: 30 Tips (Part 1 of 3)

Attorney 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

I review many letters, e-mails, memoranda, and other types of correspondence prepared by my physician and nurse clients during the course of my legal representation of them.  Often this is the result of a dispute with a hospital, a dispute with their peers or the medical staff, a dispute with an insurance company, a law suit filed by a patient, a complaint being investigated by the licensing agency, or another serious legal matter.

In many cases, way too many cases, such correspondence is unprofessional and defeats the purpose of the reason you are sending the correspondence.  Sometimes it is so bad, it will be disregarded by the reader to whom it was directed. I have seen this from doctors, nurses, dentists, psychologists, owners of health care businesses, and many, many other highly educated professionals who really should know better.

When such documents are dictated and transcribed by a professional medical transcriptionist, they are usually properly formatted and many of the errors I note are avoided.  However, when the health professional types his or her own document, that is when I see the most errors.

To avoid these errors that make your correspondence and professional communications look unprofessional, follow these tips.

Remember Why You Are Writing.

Remember, the basic purpose of your correspondence is to communicate ideas effectively.  In many cases, it will be to invoke your legal rights in certain situations (such as an appeal or a hearing request).  Sometimes it will be to attempt to persuade your hospital, your peers, or your employer to take certain action or to refrain from certain action.  Remember that your correspondence is often the first impression that the other side will have of you.  Do you want it to be an impression that you are sloppy, lazy, unprofessional, not knowledgeable, uneducated, or confused?

Whether you are communicating in a letter or via e-mail, these rules hold true.  In many (if not all) situations involving legal proceedings or legal issues, it is probably best to communicate via a letter sent by U.S. mail or some other reliable service (e.g., Federal Express, Airborne Express, DHL, etc.).  Even if you are transmitting your information via an e-mail, it is my suggestion to prepare it in the form of a paper letter (if your e-mail is not set up to insert your letterhead) and then scan it in and send it electronically.

I discourage legal communications via e-mail in serious matters because they are often difficult to obtain, isolate, and authenticate when you need them for hearings.  Additionally, they are rarely secure, often available to many others who shouldn’t see them and easily susceptible to being accidentally sent to others who should not see them at all.

Horror Stories of Unprofessional Correspondence.

Why do I feel this blog is necessary?  Because of all the horrible correspondence I have seen written by allegedly highly educated professionals, mostly physicians and nurses.  That’s why.

Here are just a few:

Physician never wrote a separate response to any charges or allegations made against him on any peer review documents.  He would just hand write (scribble, actually) his remarks on the bottoms and in the margins of whatever document he was sent to him and then send it back.

Nurse practitioner was required to respond to serious charges of negligence resulting in an adverse outcome to a patient.  She hand wrote, on unlined paper, a response letter that was not addressed to anyone, not dated, not signed and did snot state who was sending it.

The physician was required to provide his analysis of a patient’s case for peer review purposes.  His typed letter of three pages, single spaced, contained one long paragraph.  I used to work for a Medical Corps Admiral when I was a Navy JAG Corps officer.  He would just glance at such correspondence and state:  “I can tell this doctor doesn’t have any idea what he is talking about.”  Failing to follow good correspondence procedures will show others your thoughts lack organization and cohesion.

A health professional was required to complete an application for clinical privileges.  He wrote all of the answers by hand, not even staying within the lines on the form, writing over the questions and around in the margins of the application.  This is what he signed and turned in.  Believe me, this did not look very professional.

Physician was requested to respond to a medical staff inquiry from the hospital.  Her response came back typed in 22 characters per inch (cpi) size type font, almost too small to read.  Perhaps she was just trying to save a sheet of paper.  But many of us would have had to pull out a magnifying glass to be able to read it.  If you are actually trying to communicate your ideas, make your correspondence easier to read, not harder to read.

A dentist was notified of a pending complaint investigation being opened against her dental license.  She wrote her response to the charges back to the investigator, without using any business address or title, and began her response statement “Dear Sharon,”.  Do not treat others informally, especially in professional or formal situations.  You will be deemed to be unprofessional when you do so.

Tips for Good Professional Correspondence.

Here are some pointers on professional communications that should be followed in all of your professional written communications about business, professional or legal matters, even in e-mails. Please note, the terms below in quotation marks have certain defined meanings.  If you don’t know what these terms mean, look them up.

1. Always remember that the reason you are sending the correspondence is to attempt to effectively and accurately communicate your position and ideas.  If you are trying to make your message indecipherable or difficult to understand, ignore these tips.  If you are trying to come across as someone who doesn’t give a damn about how he or she is perceived, ignore these tips.  If you want to come across as unprofessional, ignore these tips.

2. Make sure you include your complete and correct “return address” and contact information.  This includes your physical or mailing address, telephone number, telefax number and e-mail address, so that the other party knows exactly how to reach you.  In cases where you already have this on your letterhead, be sure to use your letterhead.  Also, it appears more professional to create a letter head with the information in it and to use your new letterhead instead of having a professional business letter with a typed “return address.”  However, a typed “return address” is better than none.

3. Don’t use someone else’s letterhead.  Don’t use your hospital, medical group or institutional letterhead for your own personal communications, unless you are the owner.  Use your personal letterhead (see above), instead.  If you are being accused of poor utilization review, unprofessional conduct, or personal use of hospital (or company) property, then using someone else’s letterhead just helps prove the charge against you.

4. Date your correspondence.  Date your correspondence.  Date your correspondence.  Nothing shows a lack of professionalism and lack of attention to detail as sharply as undated correspondence.  It will certainly be difficult to prove when your letter or document was sent if you do not have a date on it.  A year or two later, it may be completely impossible to do so.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the 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.

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.

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“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.
By |2018-07-09T20:05:55+00:00May 15th, 2018|Categories: Mental Health Law Blog|0 Comments

Pennsylvania Nursing Home Settles Wrongful Death Suit, Agrees to Pay $800,000

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

On December 21, 2017, the Devereux Foundation in Philadelphia, agreed to pay $800,000 to end a wrongful death suit against staff at The Devereux Pocono Center. The suit accused staff at the organization’s residential behavioral health facility in northeast Pennsylvania of failing to recognize symptoms of an infection in a developmentally disabled resident.

Details of the Wrongful Death Suit.

The family of Megan Ramsey, who died in the care of the Devereux Pocono Center in July 2014, asked a Pennsylvania federal judge to sign off on the settlement to end allegations that staff failed to detect symptoms of a perforated bowel and infection. According to court records, the patient had suffered from a rare genetic disorder known as Cornelia de Lange syndrome. Her symptoms included slow growth, small stature, gastroesophageal reflux disease, and issues with behavior and communication.

In July 2014, Ramsey complained of shoulder pain, a symptom of bowel perforation, according to the complaint. She was administered a pain reliever and observed to be uncharacteristically irritable and aggressive and was treated with doses of an anti-anxiety medication, the suit said. Ramsey asked staff members to be taken to the hospital. A residential manager at the facility, however, said only to monitor her closely, offer her fluids, and advise nursing staff of any worsening of her symptoms.

She was found dead the next morning.

The Settlement.

The patient’s family filed a pretrial memorandum in September 2017, in which investigations by state agencies resulted in findings of neglect, intentional or reckless failure to provide treatment, and intentional use of a chemical restraint or isolation.

The settlement of $800,000 includes fees for the plaintiff’s counsel of just under $267,000, the filing said. Click here to read the settlement in full.

To read one of my prior blogs about a similar case involving 14 deaths at a Florida nursing home, click here.

Contact Health Law Attorneys Experienced with Nursing Home Cases.

The Health Law Firm and its attorneys represent nursing homes, nursing home employees, mental health facilities and mental health professionals, including psychologists, social workers and mental health counselors, in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

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

Sources:

Fair, Matt. “Pa. Nursing Home Settles Patient Death Suit.” Law360. (December 21, 2017). Web.

The Meyer Law Firm. “Wrongful Death in Nursing Homes.” NursingHomeAbuseGuide.org. (December 22, 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.

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

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