HHS Releases Final Substance Use Disorder Confidentiality Rule

Attorney and Author George F. Indest III HeadshotBy: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On February 8, 2024, the U.S. Department of Health and Human Services (HHS) released a final rule modifying the Confidentiality of Substance Use Disorder (SUD) Patient Records federal regulations (42 C.F.R. Part 2). The new regulation will supposedly help ensure that health care providers have more complete information when treating patients with substance use disorders and improve that regulations compatibility with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations.
Background.
The SUD final rule came out of the bipartisan Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which, among other things, required HHS to align the Part 2 SUD program with HIPAA Privacy, Breach Notification, and Enforcement Rules.
The final rule strengthens confidentiality protections while improving care coordination for […]

Florida Man Pleads Guilty To $36.2 Million Telehealth Medicare Fraud Scheme

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

On March 20th, 2024, the U.S. Attorney’s Office, in the Middle District of Florida, announced that a Florida man pled guilty to conspiring to commit health care fraud in a $36.2 million telemedicine fraud scheme. As part of the scheme, the Fort Lauderdale-based pharmacy owner paid kickbacks and bribes to telemarketers and telemedicine providers for medically unnecessary prescriptions that were billed to Medicare.

Kickbacks & Bribes to Telemarketing Companies.

According to the plea agreement, the Fort Lauderdale-based, Florida man and his co-conspirators owned and operated pharmacies participating in the Medicare program. From September 2018 through November 2021, they paid kickbacks and bribes to telemarketing companies in exchange for recruiting Medicare beneficiaries to accept prescriptions for various medications that the patients did not want or need. The Florida man […]

Feds Charge 25 Individuals in Massive Fake Nursing Diploma Scheme in Florida

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

On January 25, 2023, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) launched a multi-state coordinated law enforcement action to apprehend individuals engaged in a scheme to sell false and fraudulent nursing degree diplomas and transcripts. The enforcement action resulted in the execution of search warrants in Delaware, New York, New Jersey, Texas, and Florida. 25 individuals have been charged in the Southern District of Florida for their alleged participation in a fraud scheme that created an illegal licensing and employment shortcut for aspiring nurses.

The defendants include “owners, operators, and employees” of the schools who “prepared and sold the fake nursing school diplomas and transcripts, knowing that the candidates would use those false documents to sit for nursing board examinations, […]

New Jersey Appeals Court Says Plaintiffs Don’t Need Presuit Affidavits to Sue LPNs in Medical Malpractice Cases

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

In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a licensed practical nurse (LPNs). The Superior Court of New Jersey, Appellate Division, said that an LPN is not included in the “licensed person” definition under the state’s affidavit of merit statute.

Additionally, the court’s ruling stated that an LPN could not use the absence of such an affidavit to avoid a medical malpractice suit. In this case, the malpractice suit was brought by a widower who says his wife died as a result of bad medical advice given by her LPN.

Allegations Made in the Lawsuit.

The plaintiff […]

By |2024-04-17T20:00:38-04:00April 19, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on New Jersey Appeals Court Says Plaintiffs Don’t Need Presuit Affidavits to Sue LPNs in Medical Malpractice Cases

Male Surgeon Wins $15 Million Verdict in Suit Based on “Reverse Discrimination” and Anti-Male Bias;  Hospital Requests New Trial

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
In a massive jury verdict awarding a male attending physician more than he requested, a jury found that a hospital demonstrated reverse discrimination and an anti-mail bias in how it handled a female resident physician’s complaint against him.
On January 8, 2024, Thomas Jefferson University Hospital urged a Pennsylvania Federal court to reverse a $15 million judgment against it over its handling of a sexual assault investigation in a gender bias case. In December 2023, a federal jury in the U.S. District Court for the Eastern District of Pennsylvania found that there was proof that the hospital exhibited anti-male bias and violated a male orthopedic surgeon’s civil rights when it investigated […]
By |2024-03-14T09:59:08-04:00April 16, 2024|Categories: Dental Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Male Surgeon Wins $15 Million Verdict in Suit Based on “Reverse Discrimination” and Anti-Male Bias;  Hospital Requests New Trial

Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples

Author headshot standing in dark suit with red tie against a dark grey backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are constantly being contacted by physicians, nurse practitioners and other licensed health professionals seeking to appeal adverse National Practitioner Data Bank (NPDB) reports.  Often, we find that an adverse report has been made when the matter should not have been.  Federal regulations and NPDB guidelines establish the types of incidents that are authorized to be reported to the NPDB.  When an employer or other organization makes an improper report, it should be challenged and removed.
Types of Matters That Are Not Authorized for NPDB Reports.
Following are some of the incidents for which we have seen adverse NPDB reports that were improperly made:
–Physician or nurse practitioner employed by hospital fired.
–Physician’s contract with a medical […]
By |2024-03-14T09:59:09-04:00April 1, 2024|Categories: Dental Law Blog, Health Facilities Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples

9th Circuit Says Former Federal Nurse Can Proceed With Medical Malpractice Suit Against VA Hospital

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

On September 29, 2021, the U.S. Court of Appeals for the Ninth Circuit ruled that a former federal employee can sue the United States under the Federal Tort Claims Act (FTCA). The suit alleges medical negligence that occurred during psychiatric treatment for a non-workplace-related injury.

As a result, the three-judge panel of the appeals court said that U.S. Navy veteran and VA nurse S.H.s’ lawsuit against a Seattle VA hospital can proceed. (Please note: we are not providing the nurse’s name out of respect for her privacy.)

In 2019, the district court dismissed S.H.’s federal tort lawsuit because the alleged malpractice occurred when doctors were treating an injury she said she sustained at her workplace. The district court reasoned that all existing or exacerbated injuries stemming […]

By |2024-03-24T20:02:06-04:00March 26, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on 9th Circuit Says Former Federal Nurse Can Proceed With Medical Malpractice Suit Against VA Hospital

Humana Agrees To Pay $11.2 Million to End Nurses’ Overtime Suit

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

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

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

This dispute stems from a class-action lawsuit filed in 2017 alleging that Humana misclassified its clinical nurse advisers as exempt employees and denied them overtime compensation, violating the Fair Labor Standards Act.  Many professionals and supervisors or managerial employees are considered to be exempt from overtime laws.

In the suit, the company faced allegations from nurses who […]

Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements will fall by 3.4 percent under the PFS in 2024.

However, in a piece of good news, the 2024 final rule allows marriage and […]

Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy to commit healthcare fraud charges.

Esformes, who then owned more than 30 Miami-area nursing and assisted living facilities, was first charged in July 2016 with what the Department of Justice (DOJ) called a $1 billion, decades-long Medicare fraud and money-laundering scheme. Click here to read the DOJ’s press release. (https://www.justice.gov/opa/pr/three-individuals-charged-1-billion-medicare-fraud-and-money-laundering-scheme)

The Fraudulent Health Care Scheme.

The government initially accused The Florida Man of bribing physicians to refer patients to the nursing homes he owned in the Miami area. He would then move the patients […]

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