Psychology | The Health Law Firm Blog

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

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

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

Details of the Scam.

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

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

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

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

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

Criminals May Be Cold Calling Victims.

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

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

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

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

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

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

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

Comments?

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

Sources:

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

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

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

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

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

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

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

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

Benefits of HPSO Insurance.

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

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

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

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

Free Legal Advice: Get Insurance Immediately.

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

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

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

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

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

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

Do Not Skimp on Insurance Coverage.

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

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

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

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

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

We also defend health professionals and health facilities in general litigation matters and business litigation matters.

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

Comments?

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

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

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

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

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

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

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

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

The Health Law Firm routinely represents mental health counselors, psychologist, social workers, family therapists and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies.

Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys. In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company.

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

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

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

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

Health Professionals Who Are Employees Must Have Personal Professional Liability Insurance

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

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

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

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

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

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

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

You Can Afford an Independent Professional Liability Insurance Policy.

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

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

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

We Reccommend Theses Professional Liability Insurance Companies.

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

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

Conclusion.

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

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

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers and family therapists in Department of Health (DOH) investigations, FBI investigations and other types of investigations of health professionals and providers.

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

Comments?

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

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Department of Health and Human Services Announces Mental Health Parity Final Rule

By Lance O. Leider, J.D., The Health Law Firm

On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system has openly discriminated against Americans with behavioral health problems.”

The purpose of the regulations is to close the gaps in coverage that permit insurance carriers to treat mental and substance-abuse related treatment different from traditional medical and surgical benefits.

Among the key provisions of the regulations are the elimination of separate mental health deductibles, co-insurance, etc.; elimination of limits on lifetime benefits; as well as several other measures insuring that mental health benefits are treated on par with traditional medical and surgical benefits.

Compliance with the final rule will be required by group health plans and health insurance issuers offering group health insurance coverage on the first day of the first plan year beginning on or after July 1, 2014.

Click here to read the press release from the HHS.

Effects on Healthcare Providers.

From a business perspective, this final rule may change the type of coverage that is required to be offered by a practice to its employees. Likewise, employed practitioners may see changes in the way the coverage offered by their employers works.

Also, these rules may allow primary care providers to significantly limit their exposure to civil and administrative complaints resulting from the provision of basic mental health services. Often times patients who are unable to afford mental health coverage rely on their primary care physician for assistance. This sometimes leads to primary care doctors prescribing and managing medication for which they are inadequately trained or otherwise uncomfortable with.

By ensuring parity in coverage, primary care physicians should be able to make referrals to mental health providers with confidence that their patients will not face any artificial barriers to coverage.

Additionally, mental health providers will likely see an increase in patient volume and utilization. These increases will likely come from additional referrals from physicians as well as increased self-referrals from patients seeking to take advantage of their coverage.

Finally, with increased utilization comes increased revenue, and with increased revenue comes increased scrutiny. Private insurers have undertaken an auditing protocol that is remarkably similar to that of federal payors like Medicare, Medicaid, TRICARE, etc.

Considering the abuses that have been publicized in the mental health sector and the increased scrutiny coming from federal and state governments, we expect mental health providers will receive the same or similar audit treatment from private payors.

Be Prepared for Possible Change in Mental Healthcare Field.

Should the Affordable Care Act (ACA) ultimately serve to dramatically increase the number of Americans with insurance coverage, mental health providers may find themselves at the forefront of a rapidly expanding part of the healthcare field.

Be prepared for these changes by reviewing your processes and documentation. Consult with an experienced healthcare attorney or other similarly qualified expert to make sure your practice is ready.

The Health Law Firm Supports the Mental Health Parity Rule.

The Health Law Firm fully supports the Mental Health Parity Rule. The provision of mental health services for our citizens is long overdue.

Many fail to recognize the costs paid by our society to deal with those who have mental health issues outside of the healthcare system. Jails and prisons are often the final repository for those who should receive hospital treatment. Many individuals who are homeless, who are veterans, or who have serious mental health issues could lead constructive, productive lives if they receive proper mental health treatment.

Psychologists, psychiatrists, mental health counselors and social workers should be happy for the adoption of the regulation. In addition, law enforcement officials, judges and relatives of those with mental illness must also be thankful.

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

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers and family therapists in Department of Health (DOH) 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.

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

Comments?

Were you familiar with the final mental health and substance use disorder parity rule? How do you think it will affect the mental healthcare field? Please leave any thoughtful comments below.

Source:

U.S. Department of Health and Human Services Press Office. “Administration Issues Final Mental Health and Substance Use Disorder Parity Rule.” U.S. Department of Health and Humans Services. (November 8, 2013). From: http://www.hhs.gov/news/press/2013pres/11/20131108b.html

About the Author: Lance O. Leider 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.

By The Health Law Firm|2024-03-14T10:01:51-04:00May 15, 2018|Categories: Mental Health Counselor, Mental Health Counselor Law, Psychology|Tags: ACA, administrative complaints, Affordable Care Act, behavioral health, civil complaints, defense attorney, defense lawyer, Department of Health and Human Services, Final Rule, health law firm, hhs, insurance coverage, mental health, mental health and substance use disorder parity rule, mental health audit, mental health deductibles, mental health insurance treatment, mental health services, mental health treatment, mental healthcare, Obamacare, substance abuse, substance abuse treatment, the health law firm|Comments Off

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

By Danielle M. Murray, J.D.

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

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

The effect of this termination includes:

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

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

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

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

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

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

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

What you should not do includes:

1. Don’t bother to write letters.

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

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

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

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

What we recommend is:

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

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

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

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

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

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

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

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

4. Current licenses and permits.

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

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

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

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

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

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

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

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

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

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.
The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid Program and administrative hearings.

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

Comments?

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

About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714

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

Our Firm Often Represents Psychologists, Psychiatrists, Mental Health Counselors, Social Workers and Other Mental Health Professionals in Last Minute Depositions and Hearings

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

Our attorneys often receive calls from psychiatrists, mental health counselors, social workers, licensed marriage and family therapists and other mental health professionals regarding the possibility of representing them on short notice at a hearing before the Board of Medicine, Board of Psychology, or the Board of Clinical Social, Marriage and Family, and Mental Health Counseling at a deposition related to a health care matter.

Many Other Law Firms Will Not Take Short-Notice Cases.

Many law firms refuse to represent a client at a hearing unless given plenty of advance notice. We would always prefer to have sufficient time to obtain documents, review files, interview witnesses, conduct research and prepare, in order to provide our clients the best possible representation. However, we realize that in certain cases, the alternative is that the client either gets legal representation on little or no advance notice, or has to suffer the consequences of having no legal representation.

It is important to note, if we believe the case is too complex for us to represent you effectively or that any legal representation would be completely futile, we may refuse your case. However, this situation does not occur often.

These Proceedings can be Very Complicated.

Individuals responding to a disciplinary complaint may believe that they can effectively represent themselves. They later find out that they have gotten in over their heads. Laypersons (meaning nonlawyers) who are not aware of such complex matters as the Administrative Procedure Act, the Rules of Civil Procedure, the Rules of Evidence, the Florida Administrative Code (F.A.C.) Rules which the Board of Medicine, Board of Psychology, Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling and the Department of Health (DOH) have enacted may quickly be confused. Many times the individual may only figure this out weeks before the final hearing.

The inexperienced individual, or even the inexperienced attorney, in these matters can fall into a number of procedural traps that damage an effective defense. This can be advising the individual to talk to the DOH investigator, filing an unnecessary answer to an Administrative Complaint, forgetting or not knowing that the client’s right to be free of self-incrimination applies in this type of case and others.

Procedural Mistakes Can Be Damaging To Your Defense.

Merely having an experienced attorney to represent you at a hearing or Board meeting will assist you in avoiding mistakes that can harm your case and assist you in preserving your rights for an appeal. For example, many nonlawyers do not know that if you elect an informal hearing before the Board of Medicine, Board of Psychology, or Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling, you have waived your right to prove you are innocent by contesting the facts alleged against you.

What few know is that you can ask at the informal hearing before the Board of Medicine, Board of Psychology, or Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling, to contest the facts, to prove you are not guilty of the charges, and to have the hearing converted to a formal hearing. In a formal hearing you have more procedural rights than you have at an informal hearing. However, we still recommend that you have an experienced health lawyer represent you at a formal hearing.

Check to See If Your Professional Liability Insurance Will Pay for Deposition Coverage.

If you are a psychiatrist, mental health counselor, social worker, licensed marriage and family therapist or other mental health professional who has a professional liability insurance policy, these often provide legal coverage for depositions. This is primarily because the outcome of the deposition may include having you named as a defendant in a professional liability or negligence lawsuit or having disciplinary charges filed against you.

If you receive a subpoena or a notice of a deposition, first contact your professional liability insurance carrier and see if it will pay for an attorney to represent you. For example, Healthcare Providers Service Organization (HPSO), CPH & Associates, Nurses Service Organization (NSO) and many other malpractice insurance companies provide excellent deposition coverage.

The second thing you should do is to call an experienced attorney and schedule a consultation. Even if you cannot afford to retain the services of the attorney for the actual deposition, a consultation may assist you in properly preparing.

Contact A Lawyer Experienced in the Representation of Psychiatrists, Mental Health Counselors, Social Workers, Licensed Marriage and Family Therapists and Other Mental Health Professionals.

We routinely provide deposition coverage to psychiatrists, mental health counselors, social workers, licensed marriage and family therapists and other mental health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing psychiatrists, mental health counselors, social workers, licensed marriage and family therapists and other mental health professionals in investigations at the Board of Medicine, Board of Psychology, or the Board of Clinical Social, Marriage and Family, and Mental Health Counseling. Call now or visit our website www.TheHealthLawFirm.com.

Comments?

Have you ever had an informal or formal hearing before the Board of Medicine, Board of Psychology, or the Board of Clinical Social, Marriage and Family, and Mental Health Counseling? What was the experience like? Please leave any thoughtful comments below.

By The Health Law Firm|2024-03-14T10:01:51-04:00May 15, 2018|Categories: Clinical Social Worker, Marital and Family Therapist, Mental Health Counselor, Occupational Therapist, Psychology|Tags: administrative law judge, administrative procedure act, administrative proceeding, ALJ, and Mental Health Counseling, board of medicine, Board of Psychology, defense attorney, defense lawyer, department of health, deposition coverage, disciplinary charges, disciplinary complaint, doh, FAC, final hearing, Florida Administrative Cods, formal hearing, health law firm, hearing representation, Informal hearing, last minute deposition coverage, legal representation, legal representation for mental health counselor, legal representation for psychiatrist, legal representation for social worker, legal representation for therapist, licensed marriage and family therapist, local deposition coverage, Marriage and Family, mental health professional, negligence lawsuit, noticed of a deposition, or the Board of Clinical Social, professional liability insurance, psychiatrist, rights for an appeal, Rules of Civil Procedure, Rules of Evidence, short notice of representation of mental health counselor, short notice representation of psychiatrist, social worker, subpoena, the health law firm|3 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

Discipline is Forever-Hire an Attorney to Help.

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

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

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

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

Comments?

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

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

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

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

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

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

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

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

First, Protect Your Own Privacy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments?

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

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

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

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

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

Legally Speaking: Psychologists, Mental Health Counselors, Social Workers and Therapists

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

Supervised by the Board of Psychology and the Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, psychologists, Licensed Mental Health Counselors, Clinical Social Workers and Licensed Marriage and Family Therapists are responsible for an important component of patient care: mental health.

Insuring the mental health of a patient does not come without risks. For this reason, every mental health professional should carry professional liability insurance that includes professional license defense coverage (sometimes called disciplinary defense, license defense, administrative hearing coverage or broad coverage). Most often this type of insurance coverage is included in most professional liability policies; however, if it is not, it can often be added as a rider to the insurance policy for a slight additional charge. Mental health professionals should be sure that coverage for professional license defense is at least $25,000 and a $50,000 increase is recommended.

“Broad form coverage” should also be requested and obtained that includes coverage of legal fees for defense of all administrative or governmental proceedings, including Medicare audits, Medicaid audits, EEOC complaints, and other types of governmental actions that could be initiated.

Though mental health may not seem like a high-risk field, if dissatisfied, patients can file complaints that can lead to serious consequences. These complaints can be initiated against a mental health professional based solely on anonymous calls to the Department of Health Hotline, newspaper reports, prior arrest reports, disgruntled patients, disgruntled insurance companies, competitors, or other sources. Once an investigation is initiated, psychologists, therapists, counselors and other mental health professionals should obtain legal representation immediately to ensure that each action on the part of the psychologist or other mental health professional will result in a more favorable outcome.

Contact Health Law Attorneys Experienced in Representing Health Professionals.

A board certified health lawyer experienced in representing mental health professionals will be the most qualified to handle a Department of Health case. A mental health professional may never face a Department of Health investigation or Board of Psychology or Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling administrative hearing, but it is important that every psychologist and counselor has knowledge of current legislation impacting the psychology field. The Florida Statutes have recently been updated to prohibit anyone from using the title of “social worker” unless certain requirements are met. Additionally, there have been changes made to guidelines for treatment programs for impaired professional and psychologist reporting requirements.

For more information about legal matters concerning mental health professionals, visit www.TheHealthLawFirm.com.

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

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Categories: Clinical Social Worker, Intern, Marital and Family Therapist, Mental Health Counselor, Psychology, Resident|Tags: Department of Health (DOH), psychologist, social worker, therapists|Comments Off