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

3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This is Part 3 of a 3 part series on this issue.

I continue with my tips for preparing good, professional correspondence.

19. In longer correspondence, use section headings (in bold or underlined) or headings for each issue, to better organize it. Think of these as road signs on a long road.  They help the reader to know where he or she is at any given time.

20. When using headers, skip two lines before the header and one line after the header. This helps to set off the new section and header and show a definite division.

21. Keep your language objective and professional.  Do not ever use profanity [Oops, I just went back and removed the word “damn” I used above.]  Do not ever use any comments even remotely resembling racism, sexism, or antisemitism or prejudice.  Do not be sarcastic.

22. If there are any deadlines by which you must respond, be aware of these and make sure your response is received by that date.  Remember “received” means “actually received” by the correct person (or office) at the correct address.  It does not mean “mailed by” or “postmarked by.”  If you have correspondence or a document to which you a response must be received aby a ceratin date, you need to make sure it is in the receiving person’s hands by that date, even if you must hand carry it.

23. Be direct and concise in your language.  To the greatest extent possible, use the same terminology and wording that the other party uses, or has used, or whatever statutes, regulations or governing documents with which you are dealing use (but also, be sure you know what the words and terms mean).

24.  If you intend to request a formal hearing say “I request a formal hearing.”  If you want a refund, state:  “I request a full refund.”  If you want to appeal the decision, state:  “I want to appeal the decision.”  Don’t be wishy-washy or vague.  For example, don’t say, “I am looking for an attorney to file an appeal for me,” when what you mean to say is “I appeal the decision” or “I request an appeal.”

25. In closing your correspondence conclude by stating what action is next, whether this is action you intend to take, or action you are requesting the other party to take.  For example:  “I expect to hear from you within ten days as to whether you grant my request or not.”  “Please contact me with hearing dates within the next fourteen days.”  “I will forward you a refund within five days.”  “I will send you my records within five days.”

26. Always advise the other party of exactly how they should contact you;  provide multiple means of contacting you.  If you are very busy or have an assistant who is authorized to act for you, provide that person’s name and contact information, as well.  Then be available to receive the return communication(s).  Don’t give telephone numbers you never answer.

27. In dealing with dates and deadlines, remember that ten days is ten days;  fourteen days is fourteen days, twenty-one days is twenty-one days.  Made up rules such as “weekends and holidays don’t count” are just that, made up (outside of formal legal proceedings).  If the other party has given you “fourteen days to respond,” this means fourteen days from the date on the letter, unless specifically stated otherwise.  Fourteen days means fourteen days, unless it is specifically stated otherwise (e.g., “you have fourteen business days to reply”).

28. Include a professional closing above your signature.  This should be “Sincerely,” “Sincerely yours,” “respectfully submitted,” or some other professional closing.

29. In your signature block, include your full typed name, with credentials and title or position listed.  For example, your full name, followed by your degree and other credentials (e.g.,  “John J. Smith, M.D., F.A.A.C.P.”) should be on the line immediately below where you sign.  Next should be listed your position within your organization (if applicable) (e.g., “Chair, Pediatrics Department”).

30. If you have enclosures, list them at the end of the correspondence, giving a brief or shortened description and numbering them.  List and number them in the order you discuss them in your correspondence.  Be sure they are properly organized, labeled and divided, especially if any are lengthy.

Following these simple rules most people learn in middle school will help to keep your correspondence professional looking and in conformity with what most professionals see on a daily basis.

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.

KeyWords: The Health Law Firm, legal representation for health care physicians, reviews of The Health Law Firm, tips for professional correspondence, The Health Law Firm attorney reviews, legal representation for nurses, professional correspondence for a legal dispute, owners of health care businesses defense attorney, physicians defense lawyer, 30 tips for professional correspondence, The Health Law Firm reviews

“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 |2017-01-20T07:00:03+00:00May 15th, 2018|Mental Health Law Blog|0 Comments

Massachusetts Mental Health Centers Submitted False Claims According to Suit

7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.

The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”

According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.

The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.

Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.

There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. 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 whistle blower cases, as well.

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

Sources:

Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.

Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 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: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, psychiatrist and psychologist defense attorney, medical group defense attorney, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense counsel, psychiatrist and psychologist defense counsel, Board of Medicine and Psychology license defense attorney, Board of Medicine and Psychology license defense lawyer, Board of Medicine and Psychology license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, mental health facilities defense counsel, mental health facilities defense attorney, mental health facilities defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, mental health counselor and social worker defense attorney, mental health counselor and social worker defense lawyer, mental health counselor and social worker defense counsel.

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

By |2018-01-29T21:07:23+00:00May 15th, 2018|Mental Health Law Blog|1 Comment

U. S. Surgeon General Names Mental Health Third “Critical Pillar” Of Wellness and Health

7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In a recent interview, U. S. Surgeon General Vivek Murthy said that mental health is the third “critical pillar” of wellness, along with nutrition and exercise. In Murthy’s role as Surgeon General, it is his responsibility to provide Americans with the best information for maximizing their heath in every way possible. That’s exactly why Murthy has made emotional well-being a priority during his tenure, emphasizing that emotional wellness is just as important as physical wellness.

Three Critical Pillars.

According to Murthy, nutrition and exercise are the “two critical pillars” when it comes to health and wellness. But the third pillar of the equation, he added, involves mental health. In a recent interview with HuffPost editor-in-chief Arianna Huffington he stated, “Emotional well-being is more than the absence of a mental illness,” Murthy said. “It’s that resource within each of us which allows us to reach ever closer to our full potential, and which also enables us to be resilient in the face of adversity.”

Significant Impacts on Mental Health.

As overall mental health and emotional well-being has gained more attention and more research is conducted, the more its “significant impacts” are realized on the risk for cardiovascular disease, diabetes and other neurological conditions, he said. “So this is why I have been focusing on emotional well-being because I believe that it is the fuel that makes everything else possible,” Murthy said.

Murthy also spoke about the importance of rest during the recent interview. Many people view sleep as a luxury instead of a “biological necessity,” Murthy said. He explained how many don’t realize that lack of sleep is associated with health complications like obesity, diabetes, heart disease, depression and mood disturbances.

“What you quickly realize once you commit to getting more sleep is it can increase your productivity, it can improve your mood,” Murthy said. “And that doesn’t just help you at work, but it helps you be the kind of person you want to be with your family and your friends and that’s ultimately what matters most.”

Click here to watch the video of the recent interview conducted and learn more.

To learn more about mental health issues and the importance of research and knowledge, click here to read one of my prior blogs.

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.

Sources:

“Surgeon General Names Mental Health Third “Critical Pillar” Of Wellness.” AHLA Weekly Bulletin. (July 25, 2016). Web.

Diamond, Madeline. “Why Mental Health Is A Top Priority For The U.S. Surgeon General.” Huffington Post. (July 25, 2016). Web.

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

KeyWords: Mental Health awareness, three pillars of wellness, critical pillars of health and wellness, legal representation for mental health professional, mental health lawyer, U.S. Surgeon General, emphasizing emotional well-being, legal counsel for emotional health professionals, mental health defense lawyer, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 2016 The Health Law Firm. All rights reserved.

By |2016-07-25T22:52:17+00:00May 15th, 2018|Mental Health Law Blog|2 Comments

Florida’s Baker Act: What You Need to Know – Part 2

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

Our firm is frequently retained to act to obtain the release of individuals erroneously confined and held involuntarily under the Baker Act. We hope to share some of the lessons we have learned in representing such individuals and obtaining their release.

This is Part 2 of our blog on Florida’s Baker Act. To read Part 1 of this blog, click here.

Selected Examples of Some of Our Prior Cases.

Here are examples of actual cases in which we have been retained to obtain the release of a Baker Act patient. We have changed the facts somewhat to protect the identities of the individuals and the facilities involved.

Case #1: An independent elderly woman who still worked and was completely independent tripped and fell in her apartment, injuring herself. Her roommate took her to the local hospital emergency room to be examined and treated for the physical injury. The emergency room staff had her involuntarily confined in the hospital’s Baker Act unit and would not release her. She was not a danger to herself or to others. She was completely independent and held a good paying job. Her roommate drove her around and to medical appointments. She had never been diagnosed with a mental illness before and had never been Baker Acted before. Because of the Baker Act confinement, she missed several of her regular medical appointments which she had scheduled.

Case #2: The president of a medium-sized manufacturing company in another state came to Florida for a business conference at which his company had a display. On the last night of the conference, he partied late, drank too much and a friend took him to a hospital emergency room. He had a plane ticket to leave the next day. The hospital emergency room staff diagnosed him with depression and had him involuntarily confined under the Baker Act. He missed his flight home, and one of his company officials had to come to Florida to try to get him released.

Case #3: The fairly new wife of a businessman who worked a lot and who already had two small children, delivered twins. About six months later, the nanny quit at during the same week that they were supposed to move to a new home. The wife went to her OB/GYN for her routine follow-up visit. She was tired and run down from the loss of her nanny, getting ready to move, taking care of all of the small children, etc. Questioning by her OB/GYN indicated that she may have been depressed. The OB/GYN had his two nurses from his office walk her over to the hospital emergency room (which was next door) to be Baker Acted. Her husband and kids were then at home without a nanny and without mom. Mom was angry and upset because she was not suicidal, felt that she had been betrayed by her doctor and was not a threat to herself, her children or anyone else. She felt she was a prisoner, confined without any rights.

Case #4: A 14-year-old girl in high school broke up with her best friend around Christmas time. She was somewhat depressed and wrote down her thoughts about “ending it all.” Several months later, at the end of the school semester someone found the anonymous note (it had been inside her textbook) and turned it into the teacher. The teacher and principal are eventually able to identify the handwriting and confront the teenager. She admitted that it was her note but denied any suicidal thoughts. The principal called the sheriff’s department and sheriff’s deputies came and took her away to a Baker Act facility over her parents’ protests. She was then involuntarily confined there.

Case #5: A happily married mother of three young adults (who were in college and lived with their mother and father) had a long history of depression for which she saw her own psychiatrist on a regular basis (for more than ten years) and received prescription medication to control it. Her psychiatrist routinely adjusted her medications as needed. Her psychiatrist had recently adjusted her medication, but then was out of town on vacation for two weeks. She had a reaction to the medication adjustment. She telephoned her psychiatrist’s office and was instructed to go to the nearest hospital emergency room to have her medications adjusted. She did this. Instead of getting her medications adjusted, she was involuntarily confined in the hospital’s behavioral health unit under the Baker Act, Her husband (a professional) and her children, who live with her and depend on her, are distraught and could not convince the hospital or its medical staff to release her.

The cases above are all based on actual cases in which we were retained by the individual or the family. We were able to obtain the individual’s prompt release from the Baker Act facility.

Serious Problems We See Over and Over Again.

– The staff and treating physician constantly pressure the patient to convert their involuntary confinement (which may be expiring shortly, or there may be no grounds to renew it) to a voluntary admission. If this occurs, then they can keep the person as long as they desire. However, they threaten that if the patient attempts to leave, even though the patient is now there voluntarily, then they will have the patient involuntarily confined under the Baker Act.

– The patient is angry and upset at being imprisoned when he or she came to the hospital voluntarily for help. As a result, he or she rants and raves and threatens the doctors and staff with litigation or refuses to talk to them. This may serve to reinforce the doctor and staff’s concerns that the patient is mentally ill or irrational.

– Some of our clients have expressed concerns that because they have excellent health insurance, Medicare, Medicaid, or TRICARE coverage (all of which cover hospitalizations), that they are being held involuntarily against their will when they should not be, while indigents who really have serious mental health issues are discharged immediately. They express concerns that they are being held involuntarily solely because the hospital and physician are getting paid to keep them.

– Individuals who have medical problems, but are successfully living independently and obtaining regular medical treatment for their ailments, may not receive the appropriate type of medical care they need when they are being confined in a psychiatric facility. Their prescription medications are at home, and they are not able to take their prescribed medications. Their regular treating physicians are not called or consulted. Their continuity of care is interrupted by the confinement.

– The regular treating physicians of those confined may not visit or see them while they are confined in a different hospital from the one(s) in which the treating physician has approved clinical privileges.

We Work to Get Victims Out Quickly.

Our firm has a process we follow to make sure that a person who should not be held under the Baker Act may be released in a very short time. If the basic criteria for a Baker Act confinement are not present, the person is not required to be held and should be released. If the person has been living independently for decades, has family and a support system available, and has had no prior mental health problems, the odds are he or she should not be involuntarily confined. We act immediately to begin our representation, to make the hospital and its physicians aware that we are representing a victim, and to take measures to obtain release. If required, we are prepared to file an emergency Petition for Writ of Habeas Corpus with the local Circuit Court to have the victim brought before the judge for an emergency release hearing. These cases can be time intensive, require a great deal of immediate work, but can yield fast results in most cases.

Contact Health Law Attorneys Experienced in Handling Victims of Involuntary Confinement Through the Baker Act Act.

The Health Law Firm represents individuals, families and friends in challenges to and hearings related to the Florida Baker Act and Marchman Act, when the basic criteria for confinement are not met and there is no medical necessity for further confinement.

Our firm has a process we follow to make sure that a person who should not be held under the Baker Act may be released quickly. We act immediately to begin our representation, to make the hospital and its physicians aware that we are representing the victim, and to take measures to obtain release. If required, we are prepared to file an emergency Petition for Writ of Habeas Corpus with the local Circuit Court to have the victim brought before the judge for an emergency release hearing. These cases can be time intensive, require a great deal of immediate work, but can yield fast results in most cases.

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: Legal representation for Baker Act cases, Baker Act defense attorney, legal representation for involuntary Baker Act confinement, legal representation for involuntary confinement in hospital, legal representation for confinement in Baker Act facility, legal representation for mental health confinement, petition for Writ of Habeas Corpus, Baker Act attorney, Baker Act defense lawyer, Florida Baker Act defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

By |2017-04-27T07:30:33+00:00May 15th, 2018|Mental Health Law Blog|0 Comments

Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals – Part 2

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

Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.

I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. Sometimes these are only “probe” audits, initial audits requesting one (1) to five (5) medical records. Other times the MAC has been requesting anywhere from 120 to 375 records.

This blog is party two in my series on Medicare and Medicaid audits initiated against psychologist and other mental health professionals. Click here to see part one.

Areas Being Targeted.

In state Medicaid audits, I have recently seen increased scrutiny in the following areas:

1. Pediatric care
2. Therapy (speech therapy, physical therapy, occupational therapy) especially to pediatric patients and developmentally disabled patients.
3. Small assisted living facilities (ALFs), group homes, homes for the developmentally disabled (DD) and other small facilities.
4. Home health agencies.
5. Pediatric dentistry.
6. Optometry care, especially if delivered in a nursing home or assisted living facility (ALF).
7. Ambulance and medical transportation services, especially of nursing homes.
8. Psychiatric psychological and mental health.

Use of Statistical Sampling and Extrapolation Formulas to Multiply Repayment Amounts.

In both state Medicaid audits and in Medicare audits, I have experience increased reliance by the auditing agency on use of mathematical extrapolation formulas to estimate the amount that should be repaid. The formula used usually takes the overpayment that has actually been found and, based on several factors, multiplies it out to many times the actual overpayment amount. Thus, a found overpayment of $2,800 may become a demand for repayment of $280,000, based on the statistical extrapolation.

Things you should know about this are as follows.

1. Neither the Medicare program nor the state Medicaid programs should use an extrapolation formula, unless:

     a. There is a “high” error rate in the claims that have been submitted; or 

b. There have been prior educational efforts or prior audits of the provider, and the      provider has failed to correct the problems in claims submission previously found.

2. The states each have different guidelines, rules or regulations on when they will apply the statistical formula. Some do not use it. Some use a higher percentage error rate to prompt use of the formula and some lower. North Carolina is one of the lowest we have encountered; an error rate of more than five percent (5%) will prompt its Medicaid agency to apply the statistical extrapolation to the recovery amount.

Problems Psychologists and Mental Health Professionals May Encounter Producing Records for Audits.

Many psychologists, therapists and health professionals are being audited because they are treating patients in a nursing facility or assisted living facility.

In most cases, a history, physical, comprehensive assessment, physician orders, diagnosis, medication list, medication administration records, consultations, social service notes and other medial documents being relied upon by the therapist are reviewed and assessed in connection with treatment of the patient. The big problem here is that these usually stay in the facility. When an audit occurs, these may not all be available.

The biggest issue that Medicare and Medicaid seem to be targeting is lack of documented “medical necessity.” The auditors take the position that the audited therapist must produce copies of the documents listed above, in part, to show “medical necessity” for the services provided.

Additionally, most physicians who treat patients in nursing facilities place their own assessments, plans and notes into the facility’s chart and do not retain a copy themselves. When the audit comes, they may not be able to produce copies of their own notes and evaluations.

I recommend that any provider treating residents of nursing homes and assisted living facilties (ALFs):

1. Review the local coverage decision (LCD) applicable to the code(s) you bill so you know what requirements must be met and what documentation is required.
2. Review the Medicaid provider handbook or state regulations for the services you provide if you are a Medicaid provider.
3. Obtain and keep copies of all applicable histories, physicals, care plans, physician orders, physician consults, etc. This is best done by obtaining and using a portable scanner. You can then keep the copies electronically in a properly secured, protected server in your office (backed-up, off site, of course).
4. Sign all of your evaluations, prepare your reports, evaluations progress notes and consultations on your laptop or other computer and sign it electronically before you print it out. Alternatively, if you still use paper, scan the paper copy (after signed) and maintain it electronically.
5. Do not use unusual or non-standard terms and abbreviations. If you do, you must keep an “abbreviations and definitions” list and produce it with your records in any audit response.
6. In your reports, evaluations and notes, use the terminology from the LCD and Medicaid provider handbook. Also, always include the start time, stop time and total time spent with any resident in your report, evaluation and notes.
7. Be sure the patient, patient’s next of kin/surrogate, patient’s physician or nursing home administrator signs off as having received the services each time. The patient’s signature is preferred.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.

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, 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.

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.

U.S. Enforcing Law For Equal Insurance Coverage For Mental and Physical Illnesses

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 October 27, 2016, President Obama made one more major health care initiative as his presidency comes to an end. The administration is stepping up enforcement of laws that require equal insurance coverage for mental and physical illnesses. Officials are hoping this decision will help combat an opioid overdose epidemic.

Drug Addiction Equal to Mental Illness.

The White House Mental Health and Substance Use Disorder Parity Task Force (Task Force) said that insurers need to understand that coverage for the treatment of drug addiction must be comparable to that for mental health conditions like depression and schizophrenia. According to the administration, insurers may not require prior approval for drugs to treat opioid addiction if they do not impose similar restrictions on drugs prescribed for physical and mental illnesses.

Additionally, the Obama administration said that insurers clearly violated the law if they charged higher co-payments for mental health care or if they imposed stricter limits on the number of visits to mental health care professionals.

Federal laws and rules such as The Mental Health Parity Act (MHPA), have been adopted with bipartisan support, but the Task Force found that compliance in these laws has been slow in being implemented.
The Task Force, which President Obama created in March 2016, called for more frequent audits of health care plans and warned insurers against imposing stricter requirements on mental health services than on other types of medical health care. Click here to read the Presidential Memorandum from the White House about the Task Force.

According to the administration, about one in five American adults experience some kind of mental illness each year. Additionally, more than 20 million American adults have a “substance use disorder” involving drugs or alcohol.

The recognition and proper treatment of mental illness, as well as drug addiction, is extremely important. To learn more, click here to read one of my prior blogs.

To learn more on how others are trying to expand the awareness of mental health, click here to read one of prior blogs on this topic.

If you are a mental health care professional, click here to learn how The Health Law Firm can benefit you.

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.

Sources:

Pear, Robert. “U.S. enforcing laws to help fight opioid abuse.” The New York Times. (November 7, 2016). Web.

Gold, Jenny. “Federal Panel Calls For Stricter Enforcement Of Mental Health Care Parity Law.” NPR. (October 31, 2016). Web.

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


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Mental Health awareness, equal insurance coverage for drug addiction and mental health illnesses, The White House Mental Health and Substance Use Disorder Parity Task Force, The Mental Health Parity Act (MHPA), legal representation for mental health professionals, mental health professional defense attorney, legal counsel for mental and wellness health professionals, legal representation for mental health counselors, mental health defense lawyer, legal representation for psychiatrists, psychologist defense attorney, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, The Health Law Firm

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

By |2016-11-23T15:30:51+00:00May 15th, 2018|Mental Health Law Blog|0 Comments

Doctors, Nurses and Health Care Professionals Take Heed: It is Always a Bad Idea to . . . .

8 Indest-2008-5By 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 health care professionals, I have defended clients involved in many different situations. Several of these seem to be problem  areas which we see repeatedly. The following is a list of those problems which it would seem to be common sense for a physician or other health care professional to avoid doing.

I can assure you, it is always a bad idea for a physician 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 her specialty (e.g., a dentist prescribing antibiotics to her children to treat a cold;  a pediatrician prescribing pain medications for an adult;  a dentist writing a prescription for pain medications for a patient’s back pain;  an OB/GYN prescribing antidepressants for a male; podiatrist writing prescriptions for narcotics to treat back pain).
5. Write any prescription for or treat any patient who is in another state when the physician or 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, especially, allow a patient to “volunteer” to work in your office.

8. Pre-sign blank prescriptions for your physician assistant, ARNP, medical assistant, nurse, receptionist, or anyone else, to complete later, or have pre-signed blank prescriptions in your office.

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

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

11. 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.

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

13. 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.

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

These are actual examples from cases in which I have had to represent licensed health professionals in defending their licenses and attempting to keep their jobs.  For each of the above, there have been more than one.

Avoid doing these things and you will be avoiding some of the major actions including 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.

For more information on things that could be harmful to your professional license, click here to read one of my prior blogs.

To learn more about how The Health Law Firm can assist you, click here to visit our website’s areas of practice page.

Click here to view a powerpoint presentation from a previous lecture on how to protect your license.

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

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, 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.
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, legal representation for investigation by state licensing board, legal representation for Drug Enforcement Administration (DEA) investigations, DEA investigation defense attorney, legal representation for Board investigations, legal representation for Board complaints, legal representation for licensure revocation, license defense attorney, licensure defense for health care professionals, legal representation for health professionals, legal representation for DOH investigations, DOH defense attorney, legal representation for DOH complaints, legal representation for disciplinary actions,  legal representation for health professionals, legal representation for doctors, Legal counsel for licensure issues, licensure defense attorney, legal representation for suspended or revoked license, legal representation for adverse disciplinary actions, administrative defense attorney, legal representation for investigations and complaints, legal representation for administrative hearings, complaint investigation defense attorney for health care professionals, appeals (and variations on appeal ) of adverse license action, 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 and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2018 The Health Law Firm. All rights reserved.

By |2018-02-19T22:24:45+00:00May 15th, 2018|Mental Health Law Blog|0 Comments

The Importance Of The Baker Act

3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Time after time, we are consulted by family members of individuals who are wrongfully restrained under The Florida Baker Act or who believe their family member is being held without a legitimate reason. The Baker Act, also known as the Florida Mental Health Act, was passed in order to implement programs that are created to “reduce the occurrence, severity, duration, and disabling aspects of mental, emotional, and behavioral disorders.” Section 394.453, Florida Statutes. Invalid confinement under the Baker Act can take place for numerous reasons. The result, however, is that an independent citizen is confined in violation of his constitutional rights to liberty and privacy.

The Baker Act contains a wide range of provisions ranging from screening, to appointment of legal guardians. But, what the Act is most known for are the involuntary evaluation and confinement provisions for someone who has mental health issues that meet certain criteria. Involuntary confinement because of alcoholism, drug addiction or impairment is addressed in Florida by the Marchman Act, a different law, and is not the subject of this article.

What is Involuntary Evaluation?

Essentially, being Baker Acted means that an individual has displayed some act of behavior that makes it seem as though they have a mental illness. Without seeking proper care or treatment, the individual can be found to neglect and harm themselves or others.

The initial determination can be made by one of three types of people:

(1) A court can issue an order stating the person appears to meet the criteria and can direct that person to be transported to a facility for an involuntary evaluation;

(2) A law enforcement officer can take a person who appears to meet the criteria into custody and transport him/her to a facility for an involuntary evaluation;

(3) A physician, clinical psychologist, psychiatric nurse, mental health counselor, marriage and family therapist or clinical social worker may execute a certificate stating that he/she has evaluated the person within the last 48 hours and the person appears to meet the criteria for involuntary evaluation.

When a person is the focus of an involuntary examination, they can be detained in a facility for a maximum of 72 hours. During this duration, physicians and counselors will examine and interview the patient to determine his/her mental state. This assists in determining the type and further treatment that may be needed including further involuntary confinement.

The facility must, within the 72 hours, do one of the following things:

(1) Release the patient without condition;

(2) Release the patient for voluntary outpatient treatment;

(3) Request that the patient give consent to being admitted for voluntary inpatient treatment;

(4) File a petition for involuntary placement with the appropriate circuit court when outpatient or inpatient treatment is necessary but the patient refuses to consent.

How to Get Out.

The facility is not, by any means, the only one with the ability to get the court system involved. A patient or the patient’s guardian advocate can file a petition for writ of habeas corpus requesting a hearing regarding release from involuntary confinement.

Before you file a petition, a friend or family member, with the assistance of legal counsel, may be able to help obtain a patient’s release during the 72-hour window. The predominant factor is whether the individual being held is a danger to themselves or others. This means that a family’s plans to address the facility’s concerns through voluntary treatment or the active participation of family can be very effective.

One of the most effective ways to let the facility know that you are serious about getting someone released is to hire an attorney. The mere presence of an attorney along with family members allows the facility to acknowledge there is a support system in place.

The Baker Act specifically states that confinement is not appropriate when any apparent harm “may be avoided through the help of willing family members or friends” Section 394.463(1)(b)(1), Florida Statutes.

The Hearing Process.

If you are unable to obtain a person’s release prior to the facility filing a petition for involuntary confinement, here are some strategies to prepare for the hearing.

(1) Meet with the patient to try to explain the situation and try to prepare them for the hearing by explaining the purpose of the hearing and what questions to expect.

(2) Meet with the facility’s director to try and gauge the institution’s position on further treatment and involuntary confinement. Depending on the plans put in place by the confined person’s family, you may be able to convince the facility to withdraw the petition and discharge the patient.

(3) Meet with the counselors and nurses caring for the patient to discuss their opinions. These people are likely to be key witnesses during the hearing.

(4) Meet with the physician who examined the patient and try to determine why he/she is recommending further treatment. Also, try to discuss alternative treatment plans that would be acceptable so that those arrangements can be made prior to the hearing.

(5) If possible, meet with the assistant state attorney who will be representing the government in the hearing to discuss options. If you can get the treating physician on your side, you may be able to get the government to support a discharge.

Many of these tips require knowledge of the legal system and the medical field. You or your family member stand the best chance of being discharged from a Baker Act confinement if you have experienced legal counsel or a patient advocate to assist. To learn even more about the Baker Act, click here to read one of our past blogs.

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., 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: Attorney, Florida Baker Act, Florida Mental Health Act, Baker Act case, defense Baker Act defense, involuntary Baker Act confinement, involuntary confinement in hospital, confinement in Baker Act facility, mental health confinement, petition for Writ of Habeas Corpus, Baker Act attorney, reviews for the Health Law Firm, Baker Act lawyer, consumer reports on Florida Baker Act, Health Law Firm reviews, Florida Marchman Act, Baker Act defense counsel, Baker Act defense lawyer, consumer, Baker Act law reports, Baker Act forms, Marchman Act attorney, health law, health law firm, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

 

By |2016-11-28T07:15:12+00:00May 15th, 2018|Mental Health Law Blog|0 Comments

What You Need to Know About Preparing and Responding to an Initial Medicaid Audit Request

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities.

The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicaid program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities.

Facts You Should Know About the Medicaid Audit Process.

Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. The most important thing to remember is that just because you are being audited, it does not mean that you or your business have done anything wrong. State and federal governments conduct audits for several different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing and complaints of possible fraud.

If You Are the Subject of an Audit.

A Medicaid audit will usually begin with the provider receiving an initial audit request, usually by letter or fax. This request will serve to notify the recipient that it is the subject of an audit. The initial letter will not always identify the reason for the audit. It will, however, contain a list of names and dates of service for which the auditors want to see copies of medical records and other documentation.

Once the records are compiled and sent to the auditor, the process shifts and you are now going to have to dispute the auditor’s findings in order to avoid overpayment.

The biggest mistake that someone who is the subject of an audit can make is to hastily copy only a portion of the available records and send them off for review. The temptation is to think that because the records make sense to you, they will make sense to the auditor. Remember, the auditor has never worked in your office and has no idea how the records are compiled and organized. This is why it is so important to compile a thorough set of records. The records should be presented in a clearly labeled and organized fashion that provide justification for every service or item billed.

Compiling a Response to an Initial Audit Request.

The following are steps that you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process:

1. Read the audit letter carefully and provide everything that it asks for. It’s always better to send too much documentation than too little.

2. If at all possible, compile the records yourself. If you can’t do this, have a compliance officer, experienced consultant, or experienced health attorney compile the records and handle any follow-up requests.

3. Pay attention to the deadlines. If a deadline is approaching and the records are not going to be ready, contact the auditor and request an extension before it is due. Do this by telephone and follow up with a letter (not an email). Send the letter before the deadline.

4. Send a cover letter with the requested documents and records explaining what is included and how it is organized as well as who to contact if the auditors have any questions.

5. Number every page of the records sent from the first page to the last page of documents.

6. Make a copy of everything you send exactly as it is sent. This way there are no valid questions later on as to whether a particular document was forwarded to the auditors.

7. Send the response package using some form of package tracking or delivery confirmation to arrive before the deadline.

Compiling all of the necessary documentation in a useful manner can be an arduous task. If you find that you cannot do it on your own, or that there are serious deficiencies in record keeping, it is recommended that you reach out to an attorney with experience in Medicaid auditing to assist you in the process.

To learn how The Health Law Firm can assist you with a Medicaid audit, click here.

If you have been accused of Medicaid fraud and need to prepare for an audit, click here to watch our informational video blog.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing 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.

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: Medicaid fraud defense attorney, Medicaid audit defense attorney, legal representation for false billing, legal representation for Medicaid overpayment, legal representation for Medicaid audit, legal representation for Medicaid investigation, health care fraud defense attorney, Medicaid fraud attorney, Centers for Medicare & Medicaid Services (CMS) , legal representation for allegations of overbilling, audit defense attorney, ZPIC audit defense attorney, legal counsel for responding to Medicaid audits, legal representation for Medicaid fraud allegations, legal counsel for Medicaid audits, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

By |2017-05-29T07:49:32+00:00May 15th, 2018|Mental Health Law Blog|0 Comments
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