In the Know | The Health Law Firm Blog

E&M Services Now Under Review by the Recovery Audit Contractors (RACs)

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

In September 2012, the Centers for Medicare and Medicaid Services (CMS) made the decision to allow Recovery Audit Contractors (RACs) to begin reviewing the billing codes for office visits for healthcare providers. Those at issue are the codes referred to as evaluation and management (E&M) codes. These claims had previously been off-limits to RACS.

Connolly, Inc., the contractor for RAC audit services for 15 states and two U.S. territories, will sort through claims filed by doctors and hospitals from as far back as October 1, 2007. According to an article in American Medical News, the plan is to conduct limited reviews in those states and territories using statistical sampling to project how many physician claims that used the high-level, established […]

Posing as Physician Assistant Lands Kissimmee Teen Behind Bars for One Year

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

The Kissimmee, Florida, teen found guilty in August 2012 for impersonating a physician assistant (P.A.) faced up to 20 years in prison for two counts of impersonation and two counts of practicing without a license. On November 14, 2012, the teen was sentenced to one year in jail by an Osceola County judge.

The phony P.A. was given credit for his 264 days already served in jail, so he will only have to spend the remaining 101 days behind bars. The judge ordered the teen to receive mental health counseling, and he will also serve eight years of supervised probation, according to WESH news in Orlando.

You can click here to watch video of the sentencing from WESH news. Click here to see the […]

Health Care Professionals Take Note of the New HIPAA Rules

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

With the popularity of electronic health records (EHRs), social media and everything in between, the U.S. Department of Health and Human Services (HHS) has released stronger rules and protections governing patient privacy. On January 17, 2013, the HHS announced the omnibus rule to strengthen the privacy and security protection established under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Click here to read the entire 563-page rule.

Now, I can’t say that I’ve read the entire document yet, but I can tell you about the major parts of the omnibus rule, and what it means to you.

It is Your Responsibility to Keep Patient […]

Enforcing Your Right to Access Public Records

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

Citizens of the state of Florida enjoy broad access to the public records created by state agencies. Those records range from information on state contracts to certain police records to information on state licensees. Almost all records created by or held by state agencies on you are considered public records with certain limited exceptions.

Access to public records is guaranteed by both Article I, Section 24, of the Florida Constitution and Chapter 119, Florida Statutes. Those laws state that every person has the right to access any public record made or received in connection with the official business of any public body, officer or employee of the state of Florida, subject to certain specific exceptions.

What to do if Your Records Request is Refused.

Public records requests can be refused for many reasons. […]

By The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|Categories: In the Know, Public Records, The Health Law Firm Blog|Tags: attorney's fees, custodial agency, Department of Health (DOH), Department of Health disciplinary files, destruction of public records, electronic records of discipline, Florida Administrative Code Rule, florida attorney, Florida Constitution, Florida lawyer, Freedom of Information litigation, Petition for Writ of Mandamus, police records, Privacy Act litigation, professional reputation, public records, public records litigation, public records requests, records on state contracts, records on state licensee, secret records, shadow file, shadow files, statutory exemption, Sunshine Act litigation, the health law firm, undisclosed shadow file|Comments Off

Florida Supreme Court Overturns Medical Malpractice Caps

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

Florida’s Supreme Court ruled 5-to-2 in favor of invalidating medical malpractice caps on non-economic damages. The initial legislation was put into place in 2003 by the Florida Legislature due to an alleged medical malpractice crisis. The caps limited payments to patients for non-economic damages at $500,000 in most malpractice cases and $1 million in cases involving deaths. However, on March 13, 2014, the Supreme Court concluded that the cap on wrongful death non-economic damages violates the state Constitution’s equal protection clause.

This decision by Florida’s highest court makes Florida the seventh state to make such a ruling that such limitations are unconstitutional. There are 35 states that currently have some type of cap on medical malpractice awards.

This decision stirs up harsh criticism from doctors, and […]

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|Categories: Health Care Industry, In the Know, The Health Law Firm Blog|Tags: defense attorney, defense lawyers, doctor, Florida doctor, Florida legislature, Florida medical malpractice, Florida physician, Florida Supreme Court, health law firm, invalidate medical liability, limits on pain and suffering, litigation, medical attorneys, medical lawyers, medical liability, medical liability Florida, medical malpractice, medical malpractice case, medical malpractice lawsuits, medical malpractice liability, medical malpractice limits, negligence lawsuits, physician, professional liability, the health law firm|Comments Off

Will Florida Board of Medicine Follow Board of Pharmacy’s Lead and Recommend PRN Evaluations for Applicants Before Application is Considered?

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

At the February 12, 2014, Florida Board of Pharmacy meeting, some board members expressed frustration with the fact that applicants for licensure with prior mental health or substance abuse related issues had not been evaluated by the Professionals Resource Network (PRN) prior to the consideration of their applications by the Board. The applications were scheduled for consideration, but applicants were told to come back after they had PRN evaluations. This recommendation by the Board of Pharmacy could have potentially serious consequences for applicants.

So far, the Board of Pharmacy is the only Board we are aware of to make such a recommendation. We are waiting to see if the Board of Medicine or other professional boards follows suit.

No Statutory Requirement to Get Preemptive PRN Evaluation.

The Board of Pharmacy’s recommendation that any applicants with […]

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|Categories: Board of Medicine, IPN and PRN, The Health Law Firm Blog|Tags: board of medicine, Board of Medicine hearing, Board of Medicine license application, Board of Medicine representation, Board of Pharmacy, defense attorney, defense lawyer, health law firm, license, license application, license approval, mental health issues, nurse, nurse attorney, Nurse lawyer, preemptive PRN evaluation, prn, PRN contract, PRN evaluation, PRN evaluator, Professionals Resource Network, substance abuse issues, the health law firm|Comments Off

Speech Therapist Arrested for Billing Medicaid $500,000 for Work at Florida Day Care Centers While Living in Illinois

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

A speech therapist was arrested on March 29, 2013, for allegedly billing Medicaid more than $500,000 for services that she did not provide, according to the Florida Office of the Attorney General (AG). The speech therapist now faces charges of Medicaid fraud and grand larceny.

Click here to read the press release from the AG.

Billed Medicaid for Services Provided in Florida, While Living in Illinois.

According to an article in The Palm Beach Post, authorities began investigating the speech therapist when they received a tip that she was overbilling for services provided. During the investigation it was found that while the speech therapist reported to Medicaid she lived in Florida, she has been allegedly living in Illinois for the past eight years. The speech therapist […]

By The Health Law Firm|2024-03-14T10:00:47-04:00June 1, 2018|Categories: Medicaid, Medicaid audit, The Health Law Firm Blog|Tags: defense attorney, defense lawyer, false claims act, FCA, Florida defense attorney, Florida defense lawyer, Florida Office of the Attorney General (AG), legal defense, legal representation, medicaid, medicaid audit, Medicaid defense attorney, Medicaid defense lawyer, Medicaid fraud, Medicaid Fraud Control Unit (MFCU), Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicaid overbilling, Medicaid scheme, Medicaid therapist provider, speech therapist|Comments Off

Ready or Not, It’s Irregular Behavior Season…

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

Every year at regular intervals, our firm receives calls from panicked medical students and residents about a recent letter they have received, alleging irregular behavior.

This letter may come from the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE), or the Educational Commission for Foreign Medical Graduates (ECFMG). No matter the organization, if you receive a letter alleging irregular behavior, it will typically say the following:

1. A bulletin or policy related to the exam stating that Irregular Behavior is not permitted.
2. The facts alleging irregular behavior in this case.
3. You have an opportunity to respond to the allegations, in person, with counsel.

Often there is a very short window of time to respond to such allegations. While this is important because it is urgent that you […]

By The Health Law Firm|2024-03-14T10:00:59-04:00June 1, 2018|Categories: Medical Student, Medical Students, NBME, The Health Law Firm Blog, USMLE|Tags: accused of irregular behavior, cheating, defense attorney, defense lawyer, Examination Committee for Foreign Medical Graduates (ECFMG), irregular behavior, legal representation, medical intern attorney, medical intern lawyer, medical resident, medical resident attorney, medical resident lawyer, medical student attorney, medical student lawyer, medical students, National Board of Medical Examiners (NBME), United States Medical Licensing Examination (USMLE), USMLE appeals, USMLE hearings, USMLE preparation course|Comments Off

Ambulance Company in Tennessee Settles A $2 Million Overpayment Lawsuit

George F. Indest III, Board Certified by The Florida Bar in Health Law

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney

A Tennessee ambulance company and the U.S. Department of Health and Human Services (DHHS) announced a settlement in a case over a post payment audit for more than two million dollars in May 2012. Back in March of 2010, the Nashville ambulance company sued the DHHS after being sent a $2.65 million overpayment demand, according to the Nashville Business Journal.

To see the Nashville Business Journal article on the lawsuit, click here.

Huge Fine Found Using Error Rate Extrapolation Formula.

According to the lawsuit, the ambulance company claimed that the […]

By The Health Law Firm|2024-03-14T10:00:37-04:00June 1, 2018|Categories: Appeal, Medicare, Medicare Audit, The Health Law Firm Blog|Tags: administrative appeal, AdvanceMed, ambulance company, ambulance services, conspiracy, defense attorney, Department of Health and Human Services (DHHS), false representation, falsified data, falsified reports, health care fraud, Medicaid audit defense attorney, Medicare administrative contractor (MAC), medicare audit, Medicare audit defense attorneys, medicare audit lawyers, Medicare fraud, overbilling|Comments Off

Miami “Rock Doc” Arrested on Medicare Fraud Charges

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

An osteopathic physician in Miami, Florida, dubbed the “Rock Doc,” was arrested on September 30, 2013. He is charged with twelve (12) counts of health care fraud, according to the Department of Justice (DOJ). The “Rock Doc” is accused of falsely billing the Medicare program for physical therapy procedures, such as massages and electrical stimulation, which were not necessary. If convicted the doctor faces up to ten (10) years in prison and a $250,000 fine.

Click here to read the press release from the DOJ.

In 2010, this osteopathic physician was the feature of a Wall Street Journal article called “Confidentiality Cloaks Medicare Abuse.” The article looked into the billing practices of the “Rock Doc” and many other doctors performing […]

By The Health Law Firm|2024-03-14T10:00:52-04:00June 1, 2018|Categories: Health Care Industry, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|Tags: defense attorney, defense lawyer, Department of Justice (DOJ), doctor, false claims, florida health attorney, Florida health lawyer, health care fraud, Health Care Fraud Prevention and Enforcement Action Team (HEAT), health care fraud scheme, health care kickbacks, health law The Health Law Firm, M.D., medically necessary services, medicare, medicare audit, Medicare beneficiaries, Medicare fraud, Medicare fraud scheme, Miami Medicare fraud, Miami Medicare scheme, osteopathic physician, physical therapy fraud, physical therapy services, physician|Comments Off