CVS Refuses to Fill Prescriptions For Some Florida Doctors

The crack down on Florida pill mills continues with CVS pharmacies notifying some doctors that they no longer will fill their prescriptions for certain narcotic medications.

According to Health News Florida, this new policy appears to be limited to Florida, but CVS has not clearly stated what is being used to determine which doctors can have their prescriptions filled for which drugs (though oxycodone definitely appears to be a target).

The Florida Academy of Pain Management, released a letter via email alert that was sent by CVS to a Central Florida physician. The physician who received the letter had never been disciplined by state medical regulators and had extensive pain management training. The email alert, stated that CVS appears to “have initiated an internal program where they are profiling physicians’ controlled substance prescribing habits and possibly their patients’ prescriptions.”

A spokesperson for CVS said that the company is refusing to fill prescriptions for a “small number of Florida physicians” and is supporting measures by federal and state law enforcement officials to “keep controlled substances out of the wrong hands.”

While some pain physicians have not received a letter, they have been told by patients that they are being analyzed by CVS for writing prescriptions for narcotics, especially a specific combination of medications with high potential for abuse — oxycodone, Xanax and Soma. This trio has been widely prescribed at pill mills.

Although the actions taken by CVS may be extreme, other pharmacies and pharmacists are increasingly hesitant about filling certain prescriptions. With pain killers now responsible for more than seven overdose deaths a day in Florida, there is reason to be cautious, and pharmacists are professionally obligated not to fill prescriptions they find questionable.

However, stricter regulations on pain clinics, pain management physicians and prescription writing has left patients who face real pain unable to obtain necessary medication. Legitimate patients are being punished for the actions of a small group of corrupt practitioners.

Florida must find a way to get out of the Catch-22 in which the state is currently entangled. Yes, prescription drug abuse is a problem, but so is the real pain faced by many patients.

For more information on legal matters concerning pain clinics and pain management physicians, visit

The Collateral Effects of Voluntary Relinquishment with Investigation Pending or other Discipline on Your Massage Therapy License

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

Many massage therapists are unaware of the drastic long-term effects that discipline on their massage therapist license could have. This includes submitting a voluntary relinquishment of the massage therapist’s license while there is an investigation pending or while there are charges pending. Although this particular article is being prepared specifically for massage therapists, similar principles apply to physicians, nurses, pharmacists, psychologists, dentists, mental health counselors and other licensed health professionals.

A voluntary relinquishment of the license after notice of the opening of an investigation or while a charge is pending is treated the same as a disciplinary revocation of the license. It is reported out the same and is treated the same. In some cases it may even be worse, if the agreement to voluntarily relinquish also includes an agreement to never apply for another license again.

Even discipline on the massage therapy license such as a suspension, probation, restrictions, etc., can have far-lasting adverse repercussions. Most people do not understand what else can happen as a result of a discipline, revocation or even voluntary relinquishment (under these circumstances).

Reports to National Organizations on the Discipline.

First and foremost, the discipline (including voluntary relinquishment) will be a public record. It will also be reported out to national reporting agencies, including the National Practitioner Data Bank (NPDB) and the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB).

As a result of the report to the NPDB, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) will probably start action to exclude the disciplined therapist from the Medicare Program and place him or her on the OIG’s List of Excluded Individual’s and Entities (LEIE). This will bar you from the Medicare Program or working for or contracting with anyone else who does (including insurer’s medical clinics and most health care providers). This by itself will also have many negative consequences. For example, if you are excluded from the Medicare Program you are automatically placed on the U.S. General Services Administration (GSA) “debarred” list. You are automatically excluded from working for or contracting with, in any capacity, any organization, individual or agency that has any government contracts or accepts any federal funding. This act can bar you from working for a public school, working as a real estate agent, or many other jobs.

The NCBTMB will also take action to revoke your national certification given by the NCBTMB. This will exclude you from being licensed in any other state.

Summary of Adverse Consequences of Revocation or Other Discipline.

To summarize, the most important adverse problems that may be caused as a result of discipline on your license, may include the following:

1. May cause discipline to be commenced against any other health professional license you have, such as a nurse, acupuncture physician, chiropractic assistant, nurse’s aide, home health assistant, etc.

2. Will prevent you from obtaining any health professional license in the future.

3. May cause discipline to be commenced against any massage therapy establishment license for a massage therapy establishment you own in whole or in part.

4. Any other states or jurisdictions in which you have a license will also initiate action against him or her in that jurisdiction.

5. The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) will also take action to revoke your national certification given by the NCBTMB. This will exclude you from being licensed in any other state and will cause any other state in which you are licensed to take action against you.

6. Mandatory report to the National Practitioner Data Base (NPDB)), which remains there for 50 years. (Note: Healthcare Integrity and Protection Data Bank or HIPDB recently folded into NPDB.)

7. The OIG of HHS will take action to exclude the provider from the Medicare Program. If this occurs, (and most of these offenses require mandatory exclusion) the provider will be placed on the List of Excluded Individuals and Entities (LEIE) maintained by the OIG HHS.

8. If the above occurs, the provider is also automatically “debarred” or prohibited from participating in any capacity in any federal contracting and is placed on the U.S. General Services Administration’s (GSA’s) debarment list.

9. Third party payors (health insurance companies, HMOs, etc.) will terminate the professional’s contract or panel membership with that organization.

10. Regardless of any of the above, any facility licensed by AHCA (hospitals, skilled nursing facilities (SNFs), public health clinics, group homes for the developmentally disabled, etc.) that are required to perform background screenings on their employees will result in AHCA notifying the facility and the professional that he or she is disqualified from employment.

What Can be Done?

If you have submitted a voluntary relinquishment without understanding the consequences, and the Board of Massage Therapy (“Board”) has not acted to accept it, you may withdraw it. What we do is submit a letter to the Executive Director of the Board stating it was submitted by mistake without fully understanding the consequences, and the massage therapist desires to withdraw the voluntary relinquishment. We submit this immediately (keeping a copy, of course) and by certified mail, return receipt requested, so we have proof of sending and proof of receipt.

However, you must also ask for a formal hearing to dispute the facts in your case, as well. We usually do this at the same time and by the same method. If you fail to request a formal hearing, then you are waiving your rights to challenge your guilt or innocence.

If you have requested an informal hearing, you have made a big mistake. For an informal hearing, you admit that everything stated in the complaint against you is true. You have admitted that all of the charges against you are correct, so you are pleading guilty to the charges. You are then giving up the right to have a hearing to determine whether you are really guilty or innocent. All you are going to be arguing about is the punishment you will receive. You will not be allowed to testify on or introduce any evidence on your guilt or innocence.

If you have submitted a request for an informal hearing, not realizing this, then what we usually do is to submit an immediate request to have the hearing changed over to a formal administrative hearing where you are allowed to dispute the facts against you and prove your innocence. In such a case, it is necessary to submit a Petition for a Formal Administrative Hearing and to specify which facts are contested or disputed and why.

The case is then sent to a neutral administrative law judge (ALJ) to hold a hearing on the case. The state Department of Health (DOH) (the parent agency over the Board of Massage Therapy) is then required to prove the facts against you by clear and convincing evidence. In fact, you do not even have to introduce any evidence or testimony, the burden of proof is on the DOH to prove the case against you.

Emergency Suspension Orders (ESOs), Appeals and Election of Rights (EOR) Forms.

In Florida, if you have an Emergency Suspension Order (ESO), you can appeal it to a court of appeal. The problem with this is that it is very technical to do so and is very costly. Call an attorney who specializes in appeals or appellate law and ask. Additionally, the court of appeal only rules on the law and not the facts. The appeal court will be required to accept everything that is stated in the ESO as true. There is no fact hearing, there are only legal arguments. Your basic case will be delayed while this takes place, and you will probably lose on appeal. This may not be the correct choice for you.

However, if there is an ESO, you also have the right to an expedited fact hearing on it. This may be the best course of action if you have documents and facts to show you are not guilty of the charges.

Furthermore, there will also be an additional document served on you, an administrative complaint (AC). When you receive the AC, it will probably say just about the same thing as the ESO. You will be given your hearing rights when this occurs (called an “Election of Rights” form or “EOR”). As we indicated above, you will almost always want to select a formal administrative hearing in which you dispute (challenge or contest) the allegations (charges) made against you. This is the only way you will have the right to have a full and fair hearing on your innocence of the charges. Make sure it is submitted in plenty of time to be received within the 21 days given. Seek legal advice in completing it. Do not admit to anything; you don’t have to as the state DOH has the burden of proof.

The Need for an Experienced Health Law Attorney.

It is very difficult to take the actions necessary yourself if you do not have any legal training. Nonlawyers make many stupid mistakes in these proceedings, including submitting written statements that can be used against them when they do not have to do so, talking to the DOH investigator or Board personnel, talking to the DOH prosecuting attorney, making admissions which can be used against them, and waiving their rights when they do not have to do so.

Most attorneys are not familiar with these types of procedures if they do not practice health law. They do not realize that the same rights which apply in criminal cases also apply to professional licensure cases. You need to find and hire an attorney experienced in this type of case. That would be a health law attorney, and preferably one who is Board Certified by the Florida Bar in Health Law.

What You Should Do.

So the bottom line is that if you are innocent and want to dispute any charges against you, you should:

1. If you have professional insurance coverage, such as HPSO Insurance, see if your insurance will cover your legal defense expenses in this type of case. Many will. We know HPSO will.

2. Act right away to request all of your rights in any matter. Make sure that anything you submit is actually received (not mailed, received) before the deadline given.

3. Do not call, write or speak to the DOH investigator, Board personnel, DOH personnel or the DOH attorney.

4. Do not make a statement, written or oral, to the DOH investigator, Board personnel, DOH personnel or the DOH attorney.

5. Contest (dispute or fight) every action that might be stated against you, including one by the NCBTMB or OIG.

6. Do not admit to anything you don’t have to as the state DOH has the burden of proof.

7. Keep copies of all forms or letters submitted, along with proof of mailing and proof of receipt (send via certified mail, return receipt requested).

8. Retain the services of a health lawyer who has experience in Board of Massage Therapy/Department of Health (DOH) cases (ask him or her how many he or she has actually done). DO THIS FIRST, NOT LAST!

Contact Health Law Attorneys Experienced with Department of Health (DOH) Investigations of Massage Therapists.
The attorneys of The Health Law Firm provide legal representation to massage therapists in Department of Health (DOH) investigations, licensing matters 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

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

“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.

Nurse Accused of Illegally Writing Herself Prescriptions for Painkillers

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

A Central Florida nurse is in trouble with the law for allegedly writing fake prescriptions and illegally obtaining painkillers for herself, according to the Orlando NBC affiliate, WESH television. The nurse was allegedly arrested during the week of December 31, 2012. She is accused of trafficking in oxycodone and trying to fill forged prescriptions.

Click here to read the WESH article.

Pharmacist Did Not Fall for Fake Prescriptions.

According to an Orlando Sentinel article, a pharmacist, who was suspicious of one of the prescriptions the nurse tried to fill, called the doctor listed on the prescription. The doctor informed the pharmacist that she (the doctor) was the nurse’s employer, and the nurse was not a patient. It was then discovered that the nurse used the names of two doctors at her place of employment. She had stolen the prescriptions to obtain painkillers for herself.

A search of Florida’s Prescription Drug Monitoring Database allegedly showed that the nurse had obtained dozens of prescriptions for controlled substances for herself in the past year.

To read the article from the Orlando Sentinel, click here.

Nurse’s License is Currently Suspended.

According to the Department of Health (DOH) the nurse’s license is currently suspended. A complaint on the nurse’s record also shows that in December 2009, the nurse admitted to stealing pain medication from her patients. Click here to read the entire complaint from the DOH.

Useful Tips on How to Prevent Employees from Stealing.

I recently wrote an article for Medical Economics on how to prevent or detect employee embezzlement in the medical or dental office. It contains valuable information for any small health care practice owner. Topics discussed in the article include: how to recognize embezzlement warning signs, steps to take to safeguard your assets, and the proper way to take action against a suspected embezzler. To read it in its entirety, click here.

I have also written a number of blogs on abuses with narcotics. See my blog on a fake prescription ring busted in Osceola County, and a Drug Enforcement Administration (DEA) arrest of a doctor allegedly on crack cocaine charges, for example.


Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, Department of Justice (DOJ) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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



As a health professional how do you keep tabs on your important office supplies? How would you handle an employee stealing from your office? Please leave any thoughtful comments below.


Pavuk, Amy. “Nurse Charged with Stealing Scripts, Illegally Obtaining Painkillers.” Orlando Sentinel. (January 3, 2013). From:

WESH-TV. “Nurse Accused of Illegally Obtaining Painkillers.” WESH. (January 3, 2013). From:

Department of Health v. Tabetha Terry, R.N. Case Number 2010-13467. Administrative Complaint. (February 22, 2011). From:

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

“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.

Florida’s Strike Force Raids Pain Management Physicians

Florida is reported to have one of the worst prescription drug abuse problems in the country. Because of this issue, pain management physicians have been under increasing scrutiny and attack by federal and state agencies.  If you are a pain management physician or you work in a pain a management clinic, you need to be aware of the measures that state and federal agencies are taking against doctors who practice pain management and the owners of pain management clinics.

A news release sent out by the Florida Department of Health (DOH) this summer discusses “inspections” of physicians’ offices across the state, allegedly to ensure compliance with Florida’s new prescription drug law (House Bill 7095).  However, many of these may be more aptly termed as “raids.”  These raids, under the guise of being inspections, have resulted in a massive quantity of narcotics being seized from clinics and physicians’ offices by the Strike Force. It is claimed that no search warrants are necessary as the Strike Force states it is performing an “administrative inspection.” The pain management physicians targeted by these inspections are identified based on their purchasing, prescribing and dispensing levels.

Often these “inspections” will include Department of Health Investigators, Florida Department of Law Enforcement Special Agents, local police and law enforcement agents, and Drug Enforcement Administration (DEA) Special Agents.

  •  Our primary concern and warning to the physician or owner is to not talk to any investigators or inspectors, but call your personal attorney immediately. Have the investigator or inspector talk to your attorney. All communications should be with and through your attorney.
  • If you are requested to “voluntarily” relinquish (give up) your DEA registration or your medical license or other professional license, do not do this.  It will not help you and it will make every aspect of your case more difficult to defend.
  • Do not make any statement (oral or written) or allow yourself to be interviewed.
  • Obtain the complete names, addresses, titles and agencies for each agent there.  Obtain their business cards (which they should have).
  • Do not volunteer up any documents, items or information.

To read more about inspections from the document released by the Florida Department of Health click here.

If your office has been “inspected” and you need legal representation, you may call and speak to one of our health attorneys at (407) 331-6620 or (850) 439-1001.

Overcoming License Suspension and Revocation Pending Appeal

By Lance O. Leider, J.D.

If you are a doctor, nurse, dentist, psychologist, pharmacist, massage therapist or other licensed health professional whose license has been recently revoked or suspended, there may still be hope. Ordinarily, you must immediately stop practicing or you risk being prosecuted for unlicensed practice, a felony. Although this blog deals with Florida law, similar relief may be available in other states, too.

One of the hardest things about having a license suspended or revoked is that it immediately cuts off the licensee’s sole source of income. If you have a thriving practice, this will usually destroy any value your business has. Without income, paying your bills will be a challenge, much less the cost to fight the legal action or to appeal.

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

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

A Look Into Supersedeas Relief.

Supersedeas relief is a form of relief granted by a reviewing court (court of appeal) that suspends the enforcement of the judgment of the lower court (or agency) while the underlying issues are decided on appeal.  What this means is that you can have the action to revoke or suspend your license put on hold while you appeal the decision of the Department of Health (DOH).

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

The relief is not automatic, however.  Both provisions specifically prevent supersedeas from being granted if the licensee poses a probable threat to the health, safety or welfare of the state.  Fortunately, it is the burden of the agency whose order is being reviewed to prove that there is a danger to the public.

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

Tips to Seeking Supersedeas Relief.

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

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

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

Other Considerations.

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

Remember – Appeals Are Very Technical and Require a Specialized Knowledge of the Law.

What few people understand is that appeals are very technical and have complex, procedural rules that you must follow. An appeal of an agency final order is not the place to argue about the facts of your case or to try to prove different facts.

An appeal is all about the law and the court cases that have interpreted the law. Unless the agency (in this case your board) made a legal error and violated the law, you won’t win.

For an appeal, a person needs an attorney. To prevail on an appeal, you must have a detailed knowledge of the correct, relevant court cases and you must be able to argue these in the proper form in legal briefs.

There are many other procedural steps you must follow in an appeal that only a good appellate attorney will know. To attempt to do this yourself is not advisable.

Contact Health Law Attorneys With Experience Handling Licensing Issues.

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

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

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

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.  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 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.

Dentists, Talk to an Attorney Before You Talk to an Investigator

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

In Florida, You DO NOT Have to Speak to an Investigator!

Despite mailing out hundreds of thousands of postcards and letters to dentists, throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Department of Health (DOH) investigators (who are sometimes titled “Medical Quality Assurance Investigators” or “Medical Malpractice Investigators”), Drug Enforcement Administration (DEA) special agents, police officers, sheriff’s deputies, or criminal investigators of any type.

Investigators are NOT There to Help You.

Let me state this as succinctly and clearly as possible. If you are being investigated, you will not be better off making a statement. You will not be better off explaining your side of the story. The investigator is not your friend. The investigator is not on your side. All you are doing is falling for a trick and helping the government to make a case against you.

Protect Your License and Your Livelihood.

You have a right under the U.S. Constitution to not make any statement that may be used against you. This is so important that in criminal cases government investigators are required to advise you of this by reciting to you your Miranda rights.

However, in cases where you might have your dental license revoked or have your DEA number revoked or lose your Medicare provider status or your Medicaid provider status, the investigator is not required to advise you of your rights.

In a criminal case, there may be ways to have your statement thrown out. However, in a professional licensing case or other administrative case, it may be too late to avoid the damage. You may be the best witness the government has and you may be the only witness the government needs to prove ths case against you.

In the case where you could receive a $100 criminal fine, the investigators are required to read you your constitutional Miranda rights and to be sure that you understand them before you make a statement. However, in a case where you can lose your dental license, where you could lose your livelihood and ability to make a living, where you could lose everything you have worked so hard to obtain, they are not required to do this. You must protect yourself.

Many dentists, when confronted by an investigator, who will usually call at a very inconvenient time (to catch you by surprise) and will usually flash a badge (to intimidate you), will refuse to acknowledge the seriousness of the matter and will fall for the bait to “tell their side of the story.” This can be fatal to your defense and fatal to your license.

If You Anything You Run the Risk of Ruining Your Defense.

In the absence of a statement by the suspect (in this case, let’s assume this is YOU), the government may have a very difficult time of proving that you have committed any offense. It may have other witnesses (who may not be around at the time of any hearing or trial). It may have a lot of physical evidence or documents. But it may be impossible for the government investigators to make any link between you and the evidence, unless you help the investigators do this. You would be surprised at how many dentists believe that they can just talk their way out of the situation; in reality, they are just giving evidence that is used to make the case against them.

Any evidence at all, just admitting that you were there, admitting that the documents are yours, admitting that the patient was yours, admitting that you worked at the clinic, admitting that you wrote the prescription, admitting that the property is yours, admitting that you were on duty at the time, admitting that you have taken a drug, admitting that you signed the form, can be a crucial piece of evidence that could not otherwise be proven without your own testimony.

Remember, this is the investigators’ job and profession. This is what they do full time, every day. And they are very good at it. They are 1,000 times better at getting you to admit the crucial elements of a disciplinary infraction than you are in “talking your way out of it.” They will not be convinced by any excuses you make. They do not have to be. They will not be the ones making the final decision against you. Theirs is the job of putting together the case against you. You will help them by talking to them, explaining why your decisions are correct, explaining why what you did is excusable, etc. It will not work. You will merely be giving them enough rope to hang you with.

Why are You Being Investigated?

Hint: If it is a Medicaid Fraud Control Unit (MFCU) special agent (investigator), you are probably under investigation for Medicaid fraud.

Hint: If it is an “auditor,” “surveyor” or “investigator” from an agency or company with “integrity” or “program integrity” in its name, they are probably investigating you for “lack of integrity,” i.e., false claims or fraud.

Hint: If it is a Drug Enforcement Administration (DEA) special agent (investigator) they are probably investigating you to prosecute you or to revoke your DEA registration for drug or prescribing violations.

Hint: If it is an Office of the Inspector General (OIG) special agent (investigator), you are probably under investigation for Medicare fraud or Medicare false claims.

Hint: If it is a Department of Health Quality Assurance Investigator or Medical Malpractice Investigator, they are probably only investigating possible disciplinary action against your license that could result in large administrative fines or revocation of your license.

Talking to the Investigator May Make It Worse.

Do not believe for a second that you are smarter than the investigator. Do not believe for a second that you will convince the investigator (or anyone else) that there is a legal or medical justification for what you did or what they allege. If it were as simple as that, then why would there be an investigation and why would you be the one being investigated?

Additionally, do not believe for a second that you can lie your way out of it, either. Remember, if the government cannot prove the basic offense that it is investigating against you, it may be able to prove that you have committed perjury or lied to an investigator. In the case of a federal official or a federal investigation, merely making a false statement (oral or written) to an investigator is a criminal act. This is what Martha Stewart and many others have served time for in federal prisons.

These investigators are lied to all the time. They are usually better at detecting lies than a polygraph expert is. Furthermore, in most cases, you will be the very last person to be interviewed. Therefore, they will already know just about everything that can be used against you. If your statement contradicts in any way what others have told them, they will know you are the one who is lying. However, knowing something or suspecting something does not mean it will be something that can be proven in court or in an administrative hearing.

Talk to a Lawyer Prior to Making a Statement.

It is much better to make no statement at all. Blame it on your attorney. Tell the investigator that your attorney will kill you if you were to talk to the investigator without your attorney being there ahead of time. “Speak to my attorney.” “My attorney can help you, I can’t.”

All you have to do is state “I must talk to my lawyer before I say anything.” “I will have my lawyer contact you.” “I cannot say anything until I talk to my lawyer.” “I want a lawyer.”

If you are not the one being investigated, then there is no good reason why the investigator would want you to make a statement before you consulted with your attorney. What is the rush?

Then you must also avoid the old trick of the investigator telling you “If you don’t have anything to hide, why would you need a lawyer?” Please don’t fall for this trick, either. This is America. Smart people and rich people spend a lot of money on attorneys and other professionals to represent them and advise them. There is a good reason why they do this.

Far too often the doctor only calls us after he has given a statement. This is usually too late to avoid much of the damage that will have been be caused.

Everything above applies to oral statements or written statements. Do not make either. Contact a lawyer as soon as possible, preferably before making any statement, no matter how simple, defensive, self-serving or innocuous you may think it to be.

Think of this as an intelligence test. Are you smart enough to follow this guidance and avoid this type of mistake?

Contact Health Law Attorneys Experienced with Investigations of Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists 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

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

“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.


Recent Changes to Florida’s Pain Management Laws

If you are a pain management physician, it is important for you to be aware of changes in the laws governing the practice of pain management. The following laws were updated this summer, so the Florida Department of Health (DOH) will be enforcing these changes, including new penalities for inappropriate prescribing and new regulations for prescribing controlled substances.

  1. Minimum penalties for inappropriate prescribing for licensed health professionals – six (6) month suspension and $10,000 fine per count.  “Inappropriate prescribing” is in new Section 456.44, Florida Statutes.
  2. Effective January 1, 2012, every physician prescribing controlled substances must designate himself or herself as a controlled substance prescribing practitioner on the physician’s profile maintained by the Florida Department of Health.
  3. Effective July 1, 2011, new required elements must be documented in medical records of each pain management patient and there are new Standards of Practice for pain management physicians.
  4. Effective July 1, 2011, each physician practicing in a pain management clinic must notify the Florida Board of Medicine within 10 days after beginning or ending practice at the pain management clinic.
  5. Effective July 1, 2011, each physician practicing in a pain management clinic is personally responsible for the clinic’s compliance with all operational requirements. 
  6. Effective July 1, 2011, each pain management clinic must report to the Department of Health:
      a.  the number of new and repeat patients;
      b.  the number of patients discharged due to drug abuse;
      c.  the number of patients discharged due to diversion; and
      d.  the number of patients who live outside Florida.
  7. Effective July 1, 2011, dispensing physicians are no longer authorized to dispense Schedule II and Schedule III controlled substances. 
  8. Dispensing physicians must return all Schedule II and Schedule III controlled substances to the distributors or dispose of them by July 10, 2011.
  9. The Florida Department of Health will identify dispensing practitioners who purchase more than an average of 2,000 doses of Schedule II or Schedule III controlled substances per month and decide which of these practitioners poses the greatest risk to the public health. (We expect that individuals will be targeted by criminal law enforcement authorities, including the DEA, based on these reports.)
  10. Three days after the effective date, the Department of Health and Law Enforcement will enter the businesses of all dispensing practitioners identified as posing the greatest threat to public health and ‘quarantine’ the practitioner’s inventory of Schedule II and Schedule III controlled substances.

If you are concerned about your pain management clinic, or if you are a pain management physician who has been subjected to raids or other investigations call us at (407) 331-6620 0r (850) 439-1001 or visit our website for more information at

New System for Patients to Report Medical Mistakes in the Works

By Danielle M. Murray, J.D.

According to the New York Times, the government wants to implement a new system that would allow patients to report medical mistakes and unsafe practices by health care providers to a central reporting organization. This includes doctors, hospitals, pharmacists, and all other professionals or entities that provide medical treatment. While it is only an idea at this point, the government envisions patients reporting problems through a website or a phone number by answering a short questionnaire.

Federal officials believe that medical mistakes frequently go unreported and patients could have useful information that could be used to identify health care providers and facilities where errors are made.

A Tool to Help Doctors and Hospitals Learn from Mistakes.

Hospitals and some doctors like the idea. They argue that it would allow them to better understand the prevalence and characteristics of medical errors and learn how to better prevent those errors.

However, some suggest that these reports need to be matched with a patient’s medical records and taken with a grain of salt. Health care providers believe patients may perceive something as an adverse event that is actually not a problem or is common with the procedure they received. The example used in the New York Times article is that a patient with a hip replacement surgery may report a dislocated hip when the patient hears or feels a popping sensation, but this is a normal sensation after this type of procedure.

System Will Monitor Quality.

Health care providers are already under scrutiny by the government through Medicare and Medicaid. This would be another tool used to monitor doctors’ ability to give care. It’s great for patients, but what will the effect be on providers? It’s too soon to say. The American Medical Association did not comment for the New York Times article, stating that it needed to study the details.

To read the New York Times article, click here.


As a provider, do you agree with this proposed system? Leave a comment below.

How Patient Complaints Can Impact Your License.

As many health professionals are aware, patient complaints are a frequent cause of problems for your license. When a patient complains to the Department of Health (DOH), the DOH will hold a hearing, called a probable cause panel, to determine, based on the complaint, if there is enough information to proceed against your license. If there is, the DOH will file an administrative complaint against your license, and ask you to voluntarily relinquish your license.

When you receive the first correspondence from the DOH that there is a pending investigation, do not sit idly. Call an experienced health law attorney, such as those available at The Health Law Firm, to evaluate your case and let you know what your options are. Do not speak with any investigator or DOH representative, and do not voluntarily relinquish your license. Your career and livelihood are at stake.

For a list of the 25 biggest mistakes health professionals make when notified of a DOH investigation, click here.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH Cases.

The Health Law Firm represents pharmacists, pharmacies, physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies.

If you are aware of an investigation of you or your practice, or if you have been contacted by DOH, contact an experienced health law attorney immediately.

To contact the Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at


Pear, Robert, “New System for Patients to Report Medical Mistakes.” The New York Times, (September 22, 2012). From: ttp://


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. The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714

“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.

How to Relocate Your Practice

By Thu Pham, O.D., Law Clerk, The Health Law Firm

Relocating your practice can be stressful. There are many things that you need to do such as physically moving all of your equipment, moving your utility services, and notifying your insurance companies, notifying the Department of Health (DOH), notifying Medicare and Medicaid, and, most important, notifying your patients. Optometrists sometimes forget that they should also notify their patients of the move.

Florida Administrative Code.

Rule 64B13-3.002(2), Florida Administrative Code, requires that an optometrist give notice to patients when he or she relocates or withdraws services so that the patient may make arrangements for follow-up eye care and knows where to obtain a copy of the prior treatment record. The notice should identify the optometrist’s new location or the location for which the patient may obtain his records. The notice must be in compliance with Rule 64B13-3.003(7), Florida Administrative Code. This section requires that the notice be published in the newspaper of greatest general circulation in each county for which the optometrist practiced indicating that the records are available from a specified eye care at a certain location. So for example, if you live in the Orlando area, you would want to publish the notice in the Orlando Sentinel. Make sure that you obtain and keep a copy of your notice from the newspaper just in case the board audits you or someone files a complaint.

Click here for a link to obtain a complete copy of Optometry statutes and regulations.

Failure to Comply with Rules Could Result in an Investigation.

Moving can be a stressful time. It is important for an optometrist to remember to notify his patients of the move in the manner required by the Board of Optometry rules. Failure to do so could result in a complaint being filed and an investigation initiated against you.

If You Are Contacted By an Investigator, Seek the Advice of an Experienced Health Law Attorney.

When you receive any notice, by telephone, by mail, by hand delivery or by information passed along by your employer, that an investigation has been opened against your professional license, immediately contact an attorney experienced in such matters. Do not talk to the investigator. Do not talk to the prosecuting attorney. Do not call the state agency and ask for advice on what you should do. Do not send a written statement explaining your side of the story.

You have important constitutional rights that protect you. But you have to exercise the common sense required to use these rights. Part of this is by obtaining competent legal counsel who can advise you and protect your rights. Again, we remind you that unless an attorney routinely handles this type of case, he or she may be unfamiliar with what your rights are in such a situation or how to handle it.

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

Sound Off?

How did you handle a previous move? Did you find the time to be stressful for you, your staff and your patients? Please leave any thoughtful comments below.

About the Author: Dr. Thu Pham, OD, is a law clerk with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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.

What Does Proposed Liposuction Bill Mean For Florida Plastic Surgeons?

A new Florida bill aimed at making liposuction procedures safer is making its way through the Senate in Tallahassee. The bill was created as a result of the deaths of four South Florida mothers in their 30s during liposuction procedures, according to the Orlando Sentinel.

Present state rules say physician surgery offices must be inspected by the state Department of Health or accrediting organizations, unless the doctor performs procedures using only local sedatives that leave the patient awake. Cosmetic surgeons who perform liposuctions using local sedatives such as lidocaine do not have to have their offices inspected.

The bill says that any liposuction that removes more than 1 liter of fat can only be done in a regulated office. This would cover most liposuctions. It would force most liposuctions to be done in surgery offices inspected by the state, by doctors with life-support training, not in unregulated physician offices.

However, some doctors think that the legislation doesn’t go far enough. It does not ban liposuction in physician surgery offices, as some proposed. It does not force med-spas to be regulated, as Sobel proposed in bills that failed in the past. It does not force doctors to use an anesthetist for all liposuctions.

The bill has cleared the Senate Health Regulation Committee and now goes to the Senate Budget Committee, where it is expected to pass. A similar bill is pending in the state House and no opponents have come out against it so far.

The bill was filed by state Sen. Eleanor Sobel, D-Hollywood in reaction to four South Florida liposuction deaths since 2009.

Maria Shortall, 38, died when her bloodstream was blocked by fat sucked from her midsection and reinjected into her buttocks at an unregulated physician office. Kellee Lee-Howard, 32, died of drug interactions in the hours after a liposuction at the same office, and Rohie Kah-Orukotan, 37, died of an overdose of lidocaine given during liposuction at an unregulated medical spa. Another Miami woman was killed from a fat blockage after liposuction at a licensed surgery center.

Disciplinary action is pending against the doctor involved in the first two cases; the doctor in the third case has surrendered his medical license. No disciplinary action has been taken in the fourth case.

According to the Florida Society of Plastic Surgeons, which backs the bill, it won’t be expensive for the state to regulate these offices. Additionally, the Florida Society of Plastic Surgeons hopes inspections will detect doctors who may be using local sedatives, such as lidocaine, for extensive liposuctions that should warrant stronger sedatives and more safety measures. Those measures include advanced life-saving training and having an assistant give anesthesia.

While no one has come out vehemently opposing the bill, if passed it will have some consequences for plastic surgeons who don’t update their practice to comply.

For more information about this and other health law topics, please visit

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