Court Assesses $170 Million in Fines Against Two Texas Ophthalmologists For False Claims

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

On November 18, 2021, the Justice Department announced that two Texas ophthalmologists and their eye clinic must pay millions of dollars in penalties for fraudulently billing Medicare. The penalties were assessed in connection with their evaluation and treatment of glaucoma.

U.S. District Judge Lynn Hughes assessed $170 million in penalties against the ophthalmologists and their eye clinic in Houston, Outreach Diagnostic Clinic.

A Former Employee Blew the Whistle.

According to the U.S. Department of Justice (DOJ), the action resulted from a False Claims Act (FCA) or “qui tam” suit. The whistleblower was a former employee of the clinic. The suit alleged that between February 2006 and December 2011, the two ophthalmologists fraudulently billed the Medicare Program for single eye pressure measurement tests used to assess and treat glaucoma. In addition, the suit claimed that both physicians allegedly billed the federal health care program using an improper reimbursement code that provided a higher reimbursement than that authorized.

The clinic allegedly submitted 14,450 claims and received $807,450 in payments from Medicare during this time relating to the allegations of fraud.

Assessment of Damages and Penalties.

In March 2020, the government won a summary judgment against the Texas clinic. Read more here.

As a result, the judge assessed a treble damages penalty that amounted to $2,422,350. Additionally, Judge Hughes assessed a penalty of $11,803 for each false claim, which is the minimum penalty that could have been assessed under the current version of the statute. According to the press release issued by the DOJ, the court’s assessments resulted in a total of $170,553,350 in penalties.

Click here to read more.

To read about an ophthalmologist involved in a similar Medicare fraud scheme, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent licensed ophthalmologists and other healthcare providers in Medicare audits, integrity audits, and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or Toll-Free at (888) 331-6620.

Sources:

Health Law Weekly. “Ophthalmologists Must Pay $170 Million in Penalties.” American Health Law Association. (December 3, 2021). Web.

“Court assesses $170 million in penalties against two Houston opthalmologists.” Houston Business and Energy Blog. (November 18, 2021). Web.

Paavola, Alia. “Judge orders 2 ophthalmologists to pay $170M for false claims violations.” Becker’s Hoptial Review. (November 19, 2021). 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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

2023-05-10T20:02:02-04:00May 12th, 2023|Categories: Health Facilities Law Blog, In the News|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Surgeon, Device Company Owner Arrested For Paying Bribes, Kickbacks

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

On September 7, 2021, federal prosecutors announced the arrest of a Florida surgeon and owner of device company SpineFrontier Inc on charges of bribing surgeons to use products by paying sham consulting fees.

Accused in an indictment in Boston federal court for violating the federal Anti-Kickback Statute (AKS) and conspiracy to commit money laundering, is the company’s founder and CEO from Florida. Also charged in the indictment were the company’s chief financial officer from Massachusetts and the device company itself. The charges of AKS violations carry a maximum prison sentence of 10 years, while the money laundering conspiracy charge carries a maximum sentence of 20 years.

Click here to view the indictment in full.


Alleged Bribes & Kickbacks.

The allegations are that from March 2013 through December 2018, the defendants entered into consulting contracts in which they allegedly agreed to pay surgeons between $250 and $1,000 per hour for consulting work. However, prosecutors claim that the surgeons paid did little consulting work, and the payments only served as bribes to use their company’s products. During that time, surgeons accepted between $32,625 and $978,000 in improper payments, according to the indictment.

Department of Justice Civil Lawsuit For ‘Sham’ Consulting Fees.

In March 2020, the DOJ filed a civil lawsuit against SpineFrontier, accusing the company of illegally funneling more than $8 million to nearly three dozen surgeons.  The complaint alleges that the defendants created a separate company which was used as an intermediary to funnel illicit payments to surgeons.  Additionally, the indictment lists seven surgeons who have allegedly received bribes totaling $2,747,463 to serve as “sham consultants.”  Read the complaint in full here to learn more.


In Summary.

The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, TRICARE, and other federally funded programs.  It is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives. Conspiring to violate the kickback laws, can bring up to five years in prison while actually violating the kickback laws can result in a sentence of up to 10 years.

“Kickbacks paid to surgeons as sham medical consultants, as alleged in this case, cheat patients and taxpayers alike,” reportedly said Phillip Coyne, Special Agent in Ccharge of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). “Working with our law enforcement partners, we will continue to investigate kickback schemes that threaten the integrity of our federal health care system, no matter how those schemes are disguised.”

You can read the DOJ’s press release on the case here.

Physicians Beware of Such Schemes.

Physicians should beware of any contract, plan or offer which offers them money for little or no work at all.  They should also be aware of plans in which they are “given” ownership interest in or made officers in companies and businesses without their having to buy into them. Such schemes are often used by unscrupulous non-physicians to sucker in physicians so that they can be used to perpetrate criminal enterprises. In may cases, the scheme is to defraud Medicare or another health insurer.  Often older or retired physicians seeking to supplement their income fail prey to such schemes.  Often the purpose is just to obtain the physician’s personal identification number or DEA number to order false prescriptions and diagnostic tests or to carry out other fraudulent billing schemes.  Physicians should always remember two old adages: “Nothing is free” and “If it seems to good to be true, it isn’t.”


Contact Health Law Attorneys Experienced with Health Care Fraud,  False Claims Act Violations, and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, ZPIC audits and RAC audits, False Claims Act cases, and whistleblower/qui tam cases throughout Florida and across the United States. Our attorneys also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Schulte, Fred. “Florida Spine Surgeon and Device Company Owner Charged in Kickback Scheme.” Kaiser Health News. (September 8, 2021). Web.

Pierson, Brendan. “SpineFrontier execs arrested, charged with kickback scheme.” Reuters. (September 7, 2021). Web.

“Florida Spine Surgeon And Device Company Owner Charged in Kickback Scheme.” Health News Florida. (September 8, 2021). 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 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

2023-04-19T20:01:03-04:00April 21st, 2023|Categories: Health Facilities Law Blog, In the Know|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

Florida Surgeon Handed Seven Years in Prison for $28 Million Health Care Fraud Scheme

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

On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. The scheme involved performing hundreds of medically unnecessary, invasive surgical procedures on his patients.

The defendant, a dual citizen of the United States and Ghana, pled guilty to all 58 counts against him in federal court on December 18, 2020. Jason R. Cody, Acting United States Attorney for the Northern District of Florida, announced the sentence. Read more about the sentencing here.

Compromising the Health and Safety of Patients For Illegal Profit.

For almost four years, beginning in 2016 until his arrest in February 2020, it is alleged that the surgeon solicited his victims by establishing relationships with churches, nursing homes, hospitals, and outreach organizations. The 58-count indictment alleges the surgeon defrauded Medicare and Medicaid by billing for dozens of procedures that he never performed. A detailed list shows each claim was for more than $21,000. Federal prosecutors said that the claims that were improperly billed reached $23 million.

A later motion filed by the government alleges that the doctor’s calendar showed that he performed 14 surgeries in one day.

In addition to performing unnecessary surgical procedures, the doctor was accused of victimizing others by falsifying their medical records to reflect surgical procedures that he did not perform. He created erroneous and misleading medical records that could cause doctors who treated the same patients in the future to commit errors in their treatment of the same patients.

The Consequences of the Surgeon’s Actions.

In addition to prison time, the sentence included forfeiture of the surgeon’s assets in the United States and overseas. The assets included luxury vehicles, jewelry, and homes located in Manhattan, Miami, and Houston. The court also ordered the payment of $28.4 million in restitution.

“Instead of caring for his patients, this defendant targeted vulnerable members of our community, subjected them to unnecessary surgical procedures, and falsified documents so he could line his pockets with millions of taxpayer dollars,” a law enforcement authority reportedly stated.

Click here to read the press release in full issued from the U.S. Department of Justice (DOJ) to learn more.

To read about a similar case involving another healthcare professional, click here to read my prior blog.

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

The attorneys of The Health Law Firm provide legal defense representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in healthcare fraud investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare and Medicaid investigations, Office of Inspector General (OIG) actions, Department of Health (DOH) investigations, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Paavola, Amy. “Florida physician gets 7-year sentence for $29M fraud scheme.” Becker’s Hospital Review. (November 18, 2021). Web.

AHLA. “Florida Surgeon Draws Seven-Year Prison Term for $28 Million Health Care Fraud.” American Health Law Association. (December 3, 2021). Web.

Casey, Monica. “Florida Surgeon Draws Seven-Year Prison Term for $28 Million Health Care Fraud.” WCTV. (November 18, 2021). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

 

Phony Florida Nursing Diploma Scam: Federal Criminal Indictments in “Operation Nightingale”

Attorney George F. Indest III Headshot

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

In January 2023, the U.S. Department of Justice (DOJ) announced the prosecution of a massive fake nursing diploma scheme against three Florida-based nursing schools. The investigation has now expanded to include at least eight (8) nursing schools.

The investigation has now resulted in charges against 25 people in five states and found evidence that they allegedly worked to “sell” more than 7,600 fake diplomas, along with school transcripts, between 2016 and 2021. Click here to learn more.

The Federal Indictment.

We have obtained a copy of the federal indictment filed against the individual owners, operators, and staff members whom the FBI alleges were committing crimes, including selling diplomas and transcripts. View the federal indictment filed in the investigation to check for any names you recognize by clicking here: https://www.thehealthlawfirm.com/uploads/Nursing%20School%20Indictment.pdf.

Additionally, you can view other helpful press releases and documents on “Operation Nightingale” on our website here.

Concerns We Have About This Investigation.

We have several concerns about this investigation based on the nurses we spoke with. As usual, the events that have resulted in this “scandal” have been going on for as many as eight years. Nothing has been done until recently, and then it is as though a tornado has just hit. We are concerned about what we view as a massive overreaction that is resulting in many babies being thrown out with the bad bath water.

What seems to have been overlooked is that these nursing schools were all accredited by the proper accreditation bodies until this happened. We have clients who contacted the Florida Board of Nursing, which affirmed that the schools were legitimate, accredited schools before our clients enrolled in them and only enrolled after being assured that they were.

In many cases, our clients and others with whom we have spoken attended other accredited nursing schools but then transferred to one of the Florida schools and received credits for their transferred courses. There was and is nothing illegal or wrong about this. We have spoken to many nurses who took all required courses to become nurses, performed their clinical, graduated, received diplomas, took the NCLEX (national nursing) examination, passed, and became licensed nurses. Some of these have been practicing for years. Some have been practicing for only days. Yet now, they are all getting letters telling them they are being investigated for possible fraud. It is devastating to many who worked so hard to become nurses.

Contact Health Law Attorneys Experienced in Investigations Against Nurses and Nursing Students.

The attorneys of The Health Law Firm provide legal representation to nurses, nursing students, and ARNPs in Department of Health (DOH) investigations, nursing board cases, Department of Health investigations, DOJ and FBI investigations, Board of Nursing investigations, formal and informal administrative hearings, emergency suspension orders, emergency restriction orders and other types of investigations of nurses and other health professionals.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 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., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: PAlexander@TheHealthLawFirm.com or fax them to (407) 331-3030.

“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 © 2023 The Health Law Firm. All rights reserved.

 

Follow Our Tips for Taking Your USMLE Step Exams If You Want To Score Higher

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

Here are some common-sense tips you should be sure you follow that may help you to reduce stress and score higher when you take your United States Medical Licensing Examination (USMLE) Step examinations. You should be doing everything within your control to minimize your stress and the risk of being late for the examination. Again, these are common sense; if you have taken a lot of standardized examinations, you may already be aware of these.

1. Do not plan on driving to the test site from your home the morning of the examination, even if you leave in the same city as the testing center.

a. Unexpected car problems could occur.
b. Traffic backups and delays always occur.
c. Accidents always happen.
d. Road problems, construction delays, and detours are common.

Eliminate these unnecessary risks.

2. Find the hotel closest to the testing center and stay there the night before the test. Hopefully, this will be within walking distance of the test site if it is necessary to walk there.

3. Read all of the applicable testing procedures, the applicable USMLE and/or Educational Commission for Foreign Medical Graduates ( ECFMG) Handbook, Guidelines and Procedures again the day before the examination you are taking. You signed an agreement to be bound by these and you are expected to know these for the examination. Be sure you understand how scheduled and unscheduled breaks work, how the time is accounted and what you are allowed to do and prohibited from doing on breaks.

4. Make sure you know ahead of time exactly how much time you will be given for each part of the examination and for breaks, Be sure you have calculated how much time you have for each question on each section of the examination, answer within the times you have calculated and move on through the examination in a timely manner.

5. Do not let other occurrences and disturbances in the testing center upset you or distract you.

6. If some extremely disruptive event occurs, for example, fire alarms and evacuations taking place, other examination takers having seizures and being removed by paramedics, etc., consider leaving and taking an incomplete on this examination. Be sure to ask the test center monitors/proctors to file an incident report on what occurred at the test center, Then, within 24 hours, write to the USMLE and ECFMG and advise the organization of exactly what happened and why you had to leave.

7. Bring your own lunch, snacks, and beverages, including something like energy bars or chocolate bars, to provide needed sustenance. Do not leave the testing center for lunch unless you absolutely have to, and then, stay local and on foot. Do not take the risk of driving someplace and back.

8. If a certain testing center has a bad reputation for being a poor testing site or having frequent computer failures, schedule to take the test at a site in another city or state. Travel there and stay at a hotel within walking distance of the test site, perhaps a few days before the examination date. You can then use the additional time and isolation for additional studying and test preparation.

9. Do not refer to or use any cell phone, tablet or personal device while the test is still underway. Be sure you are familiar with all test-taking procedures.

10. To avoid any risks of misunderstandings, do not write down anything during the examination or about the examination at the testing center. Outside during lunch may be okay; otherwise, wait until you return home.

Although common sense, you would be surprised how many test-takers violate these common-sense tips and then suffer the consequences.

Plan for and have as stress-free of an examination as you can. Control the controllable.

For more helpful tips and to learn more about examples of “Irregular Behavior,” click here to read my prior blog.

Additionally, click here to view one of our blogs on our experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs, and dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm.  The Health Law Firm always seeks qualified individuals interested in health law.  Its main office is in the Orlando, Florida, area.  If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: PAlexander@TheHealthLawFirm.com or fax them to (407) 331-3030.

“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 © 2023 The Health Law Firm. All rights reserved.

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, secure nursing licenses, and ultimately obtain nursing jobs in medical facilities not only in Florida but elsewhere across the country,” officials said. Additional defendants charged include “recruiters” to bring in would-be buyers.

Operation Nightingale.

The scheme sold fake and fraudulent nursing degree diplomas and transcripts obtained from accredited Florida-based nursing schools to aspiring Registered Nurse (RN) and Licensed Practical/Vocational Nurse (LPN/VN) candidates. The nursing schools, Siena College, Palm Beach School of Nursing, and Sacred Heart International Institute, are now closed.

Officials said nursing candidates who allegedly participated in the scheme would pay as much as $15,000 for the fraudulent diplomas.

The individuals who acquired the fraudulent nursing credentials used them to qualify to sit for the national nursing board exam. Upon completing the board exam, the nursing applicants became eligible to obtain licensure in various states to work as an RN or an LPN/VN. Once licensed, the individuals could get employment in the healthcare field. The overall scheme resulted in the distribution of more than 7,600 fake nursing diplomas and transcripts.

Each defendant faces up to 20 years in prison. Learn more about “Operation Nightingale” from the OIG here.

Dangerous Healthcare Licensing and Credentialing Shortcuts.

We expect our healthcare professionals to be who they claim they are. We expect that they’ve had the proper training and credentialing. “Specifically when we talk about a nurse’s education and credentials – shortcut is not a word we want to use,” said U.S. Attorney for the Southern District of Florida Markenzy Lapointe. “When we take an injured son or daughter to a hospital emergency room, we don’t expect that the licensed practical nurse or registered nurse training our child took a shortcut.” The scheme enabled these nursing candidates allegedly buying the fake diplomas “to avoid hundreds, if not thousands, of hours of clinical training countless hours getting that experience,” Lapointe said. “These people didn’t go through that. That part was completely skipped.”

This fraud scheme is a public safety concern and tarnishes the reputation of nurses who complete the demanding clinical work required to obtain their professional licenses and employment. Additionally, it can erode public trust in our healthcare system. The alleged selling and purchasing of nursing diplomas and transcripts to willing but unqualified individuals is a serious crime that can endanger the health and safety of patients.

Click here to view the U.S. Department of Justice press release.

Contact Health Law Attorneys Experienced in Investigations Against Nurses and Nursing Students.

The attorneys of The Health Law Firm provide legal representation to nurses, nursing students, and ARNPs in Department of Health (DOH) investigations, licensure defense representation, investigation representation, Department of Health investigations, DOJ investigations, Board of Nursing investigations, formal and informal administrative hearings, emergency suspension orders, emergency restriction orders and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Pezenik, Sasha. “Feds announce massive takedown of fraudulent nursing diploma scheme.” ABC News. (January 27, 2023). Web.

D’Angelo, Bob. “Operation Nightingale: 25 charged in fake nursing diploma scheme in Florida.” Cox Media Group. (January 27, 2023). Web.

U.S. Department of Health and Human Services. “2023 Operation Nightingale Enforcement Action.” (January 26, 2023). 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., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: PAlexander@TheHealthLawFirm.com or fax them to (407) 331-3030.

“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 © 2023 The Health Law Firm. All rights reserved.

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 claimed they were never paid for overtime even though they were required to work more than 40 hours per week to meet Humana’s production goals and expectations.

The Settlement.

The settlement agreement will allocate almost $3 million to cover attorney fees and costs. Additionally, the 221 nurses that are part of the settling class will get nearly $8 million based on the number of full-time weeks the nurses worked. According to the motion, the average payment per nurse for unpaid overtime and liquidated damages will be over $36,000.

The case is O’Leary v. Humana Insurance Co., et al., case number 17-cv-1774, in the U.S. District Court for the Eastern District of Wisconsin. Click here to view the court’s brief in full.

To read about another case dealing with alleged pay discrimination in the healthcare field, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Nurses and Other Healthcare Professionals.

The Health Law Firm’s attorneys routinely provide legal representation to nurses, pharmacists, pharmacy technicians, dentists, dental assistants, physicians, physician assistants, mental health counselors, and other health providers. We also provide legal representation for employers in EEOC complaints, workplace discrimination complaints, and suits involving harassment or discrimination complaints. We also provide legal representation in Department of Health, Board of Medicine, Board of Nursing investigations and complaints, DORA investigations and complaints. We provide litigation services in state and federal courts and state and federal administrative hearings. We provide legal representation across the U.S., not just in Colorado, Florida, Louisiana, Virginia, and Washington, D.C.

To contact The Health Law Firm please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Spezzemonte, Irene. “Humana To Pay $11.2M To End Nurses’ Misclassification Suit.” Law360. (September 27, 2021). Web.

Webster, Katherine. “Court OKs $11.2M Overtime Settlement Between Humana, Nurses.” Top Class Actions. (September 30, 2021). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

 

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 © 2021 The Health Law

 

 

 

 

 

Good News and Bad News for ECFMG & USMLE Applicants: Recent Changes for the USMLE Step Exams

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

These are some recently announced changes that could significantly impact anyone seeking to take the USMLE Step exams. This could be construed as good news by many and bad news by many others. Regardless, here it is.

Step 1 Exam Changing to Pass/Fail Grade and Score Reporting.

The USMLE announced recently that it would change the scoring and reporting for Step 1 exam scores. Step 1 score reporting will transition to pass/fail only for administrations on or after January 26, 2022. All of the worry about passing with a low score and how that might affect residency choices will be eliminated by this change.

Number of Attempts for Step 1 or Step 2 Exam Limited to Four (4) Lifetime Attempts.

Remember when you had no limit on the number of times you could take a USMLE Step exam? Remember when it was reduced to a maximum of six (6) attempts, not that long ago? Guess what? Not anymore!

Effective July 1, 2021, the number of attempts you can have to pass any USMLE Step exam will change. The change latest change reduces the total number of allowable attempts from six (6) attempts to four (4) attempts for any single Step exam, including any incomplete attempts. This is in effect for all applications submitted on or after July 1, 2021. So now, examinees who have already attempted any USMLE Step exam four (4) or more times and have not passed, will no longer be eligible to apply for the USMLE exams.

Is it possible to obtain an exemption? Depending on your circumstances, we can petition for one, but that does not mean it will be granted.

Step 2-CS Exam Completely Eliminated!!!!

Remember the Test of English as a Foreign Language (TOEFL), also known as “der Teufel” (1), that used to be required for Foreign Medical Graduates (now known as “International Medical Graduates” or “IMGs”)? No? Well, I don’t either.

Remember when the Step 2-CS was easily considered the most difficult exam for a foreign medical graduate to pass. Well, I do remember this!

The Step 2-CS (for “clinical skills”) exam was supposed to address any foreign language problems in practicing in the United States. This became, in my opinion, one of the biggest obstacles to for IMGs becoming licensed in the U.S. It was originally discontinued for approximately a year and a half because of problems caused by the COVID-19 epidemic.

Guess what? It doesn’t exist anymore. Accordingly, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), co-sponsors of the United States Medical Licensing Examination (USMLE) by the USMLE Secretariat, announced on January 26, 2021, that it was discontinuing the Step 2-CS exam.

I guess the powers that be learned when they eliminated the Step 2-CS during the COVID-19 pandemic in 2020, that it was not so necessary after all. Now it is gone.

“Will it ever return, no it will never return; its fate is still unknown.”(1) There is no expectation that it will ever come back. What do you do now with all of those low score “fails” and lows test score “passes” you previously received on the Step 1 exam and the Step 2-CS? The answer is lost in chaos. We will just have to wait and see.

Major Chinese Medical Schools Disqualified in 2019.

See my next blog on what happened to eight (8) major Chinese medical schools so that their graduates cannot take the Step exams or become licensed in the U.S. anymore. Click here to read about the Chines medical schools.

Endnotes:

(1) German for “the Devil”

(2) Paraphrase of verse from “MTA” [standing for the Boston Metropolitan Transit Authority or subway train] written by Jacqueline Steiner and Bess Lomax Hawes, recorded and made famous by The Kingston Trio in 1959.

(3) Answer to the final question asked at the end of every episode of the Japanese Anime series “Dorohedoro” or “Doro and Doro” (2020) (available on Netflix), about a man named “Caiman” who wakes up one morning with the head of a lizard and amnesia and searches for the reason.

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation, and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

To contact The Health Law Firm please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“USMLE policy updates following Step 2 CS discontinuation.” United States Medical Licensing Examination Announcements. (July 21, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., L.L.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com. The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

 

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

 

 

What is the Cost For Legal Defense in a Hospital Medical Staff Peer Review Fair Hearing?

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

If you are a physician, nurse practitioner, oral surgeon, dentist, or other health professional with clinical privileges in a hospital, you may face a situation where you are required to defend yourself at a “fair hearing.”  A “fair hearing” is held by the hospital’s medical staff pursuant to the Medical Staff Bylaws or Rules and Regulations of the Medical Staff.

“Fair Hearing”–A Term of Art.

The hearing is called a “fair hearing,” which is a term of art.  Usually, those defending themselves at such hearings don’t find them to be fair at all. However, according to the federal Health Care Quality Improvement Act (HCQIA), such proceedings are required to provide the affected healthcare practitioner with certain “due process,” such as the right to be advised of the specific charges made against them, the right to legal representation, the right to produce witnesses and evidence of their own and other rights.

Be Sure You Have Professional Liability Insurance That Includes Coverage for Clinical Privileges Actions.

If you face such a hearing, you will find it difficult to find an experienced lawyer to represent you and, when you do, it will be a costly endeavor.  This is one of the primary reasons to purchase good professional liability insurance, including legal defense of such peer review actions. Unfortunately, most insurance companies that provide such coverage have limits far too low to pay all legal defense expenses you will probably incur.

Standard Insurance Coverage Amounts May Not Be Sufficient to Protect You Properly.

However, the basic amount provided for such coverage in most insurance policies is not sufficient to cover the actual expenses of the proceeding.  Standard coverage amounts are usually in amounts of $25,000, $35,000, or $50,000;  again, these are not sufficient to pay for even the most basic fair hearing.  Some insurers have much higher limits;  it is important to find out precisely what you have to increase the coverage or buy additional coverage.

There are often additional “riders” to insurance policies that you can purchase, “additional coverages,” or even a completely separate policy that will provide such legal defense coverage for you.  It is usually not that expensive and is worth inquiring about.  This type of coverage often goes hand-in-hand with professional license defense coverage as one can cause the other to occur. For example, a hospital peer review action can result in a report to your state licensing board. A licensing complaint or action may cause hospital peer review action to be initiated against you.

You should think of a “fair hearing” as similar to a medical malpractice trial and plan accordingly.


Costs and Expenses of a “Fair Hearing”

One of the most significant expenses you will incur in preparing for a “fair hearing” is expert witness fees. In almost every case we have ever had, obtaining one or more expert witnesses to testify at the hearing has been necessary.  Obtaining experts in medical sub-specialties will cost more, of course, than those in specialties such as family medicine and internal medicine.  It is often difficult to find an expert witness who will not only support your position in the case but will also show up at the hospital to testify at the “fair hearing.”

Additionally, the mere preparation for the hearing (including document reviews and working with the expert witnesses) and representation at the hearing is a time-intensive endeavor.  It has been our experience that even the most routine “fair hearing” costs approximately $100,000. For example, in one case we had involving several different areas of spinal surgery, requiring five (5) expert witnesses, cost in excess of $250,000 (note:  all charges against the doctor were dismissed at the hearing).

Conclusion.

Peer review “fair hearings” in hospitals are costly to defend and require an experienced attorney and the financial resolve to see the case through to its conclusion.  Often insurance does not provide sufficient coverage for such hearings. Therefore, physicians, nurse practitioners, oral surgeons, psychologists, and others having hospital clinical privileges should purchase additional coverage for such events and hire experienced legal counsel to represent them at the earliest stage of the proceedings.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers in Peer Review and “Fair Hearing” Matters.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

About the Author: George F. Indest III, J.D., M.P.A., L.L.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com. The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.

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