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.

By |2024-03-14T09:59:13-04:00January 31, 2024|Categories: In the Know, Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on What is the Cost For Legal Defense in a Hospital Medical Staff Peer Review Fair Hearing?
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Don’t Voluntarily Relinquish Your Medical License or DEA Registration Number, Here’s Why

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

I am often contacted by clients who are health professionals or own businesses in the health care industry who have been approached by government agents or investigators regarding possible complaints or charges. In many cases, the individuals involved do not think to consult with an attorney until many months later. This may be too late to save the business or professional practice involved. This holds for physicians, dentists, nurses, pharmacists, pharmacies, pain management clinics, physician assistants, group homes, assisted living facilities (ALFs), and home health agencies.

“Voluntary” Relinquishment Treated the Same as a Revoked License.

We have seen a trend recently, especially here in Florida, of investigators immediately offering the person being investigated the option to voluntarily relinquish his or her professional license. This is offered as an option to being investigated, even in the event of very minor or frivolous complaints. The problem is that once an investigation has been opened, voluntary relinquishment of a license is treated as if it were revoked for disciplinary reasons. It will be very difficult, if not impossible, to ever get a new license under the circumstances.

Furthermore, if the professional has other licenses or similar licenses in other states, this will be reported to the other states, and disciplinary action will probably be initiated against those other licenses.

We have heard horror stories of investigators, accompanied by police or sheriff’s deputies, or Drug Enforcement Administration (DEA) agents, making all sorts of threats against health professionals to intimidate them into giving up a DEA registration number or professional license, including medical licenses, nursing licenses, and pharmacy licenses.

In the case of such an incident occurring in Florida, the “voluntary” relinquishment must still be presented to the applicable professional Board and voted on at a scheduled meeting since it is considered disciplinary. It may be possible to withdraw the “voluntary” relinquishment before it is voted on, so all may not be lost.

Think Long and Hard About Relinquishing DEA Registration Number.

However, in the case of the DEA, a DEA registration number is considered gone as soon as the “voluntary” relinquishment paper is signed. This is one of the reasons it is crucial to talk with a knowledgeable health law attorney before making such a decision. The ones putting pressure on you to do this will do everything they can to persuade you not to talk to an attorney. But it is your right to do so. Don’t be rushed or intimidated into making a foolish decision you regret.

We have represented clients attempting to obtain a new DEA registration number or a new professional license years after their voluntary relinquishment. In most cases, it is a highly uphill battle and is often not successful.

Additional Consequences of Voluntary Relinquishment of a Professional License or DEA Registration Number.

The following are some of the additional consequences of voluntary relinquishment of a professional license or DEA number after notice of an investigation:

1. Disciplinary action will be commenced against any other professional licenses in the state.

2. Disciplinary action will be commenced against similar licenses in other states.

3. The matter will be reported to any national certification boards of which you are a member. They will most likely commence an action against you to revoke your national certification.

4. You will be placed on the Office of the Inspector General’s (OIG) List of Excluded Entities and Individuals (LEIE) and excluded from the federal Medicare Program.

5. You will be terminated from the state’s Medicaid Program if you are a Medicaid provider.

6. You will be terminated from the panels of any health insurers or managed care plans of which you are a provider member.

There are many other possible repercussions to such actions, so it is extremely important to be prepared for such an event. To prepare, you can:

1. Purchase professional licensing defense insurance coverage through Lloyd’s of London, Healthcare Provider’s Service Organization (HPSO), Nurses Service Organization (NSO), or one of the other reputable insurance companies that provide such coverage.

2. Have the names, telephone numbers, and other information on good, reputable criminal defense and health law attorneys. Make sure your practice manager has this information as well.

3. Call as soon as an investigator walks in. Don’t wait.

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

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


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

 

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.


Attorney Positions with The Health Law Firm.  The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax 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 © 2022 The Health Law Firm. All rights reserved.

By |2024-03-14T09:59:16-04:00December 3, 2023|Categories: DEA, Licensing issues, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Don’t Voluntarily Relinquish Your Medical License or DEA Registration Number, Here’s Why
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COVID-19 Burn Out Causing More Resident Physicians to Unionize, Part 2

stethoscope and gavel with the word covid-19 written before it
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This is part two of a blog series focusing on the effects of COVID burnout in healthcare professionals. Don’t forget to read part one.


The Problem With Residents’ Working Conditions Existed Long Before the Pandemic.

It’s common for resident physicians to work long hours for relatively low pay. They have little or no ability to determine their schedule and are generally locked into positions for up to seven years. Certainly, medical residents have voiced concerns about their work lives long before the pandemic. Some describe years of grueling schedules, sometimes with 24-hour shifts, including 80-hour workweeks. “Residents were always working crazy hours, then the stress of the pandemic hit them really hard,” John August, a director at Cornell University’s School of Industrial and Labor Relations, is quoted as having said.

To learn more about issues that affect residents and fellow physicians, click here to visit the American Medical Association (AMA) Resident and Fellow Section.


Benefits & Drawbacks of Unionizing.

Medical residents looking to unionize often cite such basics as pay and working conditions as top reasons. For reference, first-year residents earned just under $60,000 on average in 2021, according to a survey done by AAMC.  At 80 hours a week, one could calculate that residents could very well be earning less than the minimum wage, according to the AAMC data.

Those unionizing typically say wages are too low, especially given residents’ workload, student loan debt, and the rising cost of living.

Additionally, some residents say that unions can have upsides for hospitals and can also help enhance patient care. Patients deserve physicians who aren’t exhausted and preoccupied with the stress of finances. “To take good care of others, we need to be able to care for ourselves. We love being residents and caring for patients. But we can’t do that well if we neglect ourselves,” said a University of Vermont Medical Center resident.

On the other hand, residents unionizing is not without its potential drawbacks. For hospitals, money is an issue. Although federal funding helps pay residents’ salaries, most training expenses come from hospitals. In many instances, because of the pandemic, those funds are now depleted, said Janis Orlowski, MD, AAMC chief health care officer.

Some worry that unionizing can undermine the connections between residents and the physicians who train them. Another primary concern for hospitals is the threat of a strike; although rare, it has been decades since the last one. Many residents also worry that unionizing could undermine patients’ and communities’ trust in them.

Happy Residents, Happy Patients.

For some healthcare workers, the COVID-19 pandemic solidified the importance of a union. Residents have been on the front lines of care but were not alwaysmedical residents giving a thumbs up with arms up in the air the first to access PPE or lifesaving vaccines. Others are simply looking for acknowledgment of the sacrifices they’ve made while caring for the country’s most vulnerable patients.

However, one thing remains clear; both sides agree that the goal is to become a good physician and get taken care of in the process.

For more information on residency programs, click here to watch one of our video blogs, and make sure to check out our YouTube page.


Contact Experienced Health Law Attorneys Representing Residents, Fellows, and Medical Students.

The Health Law Firm routinely represents resident physicians, fellows and students, including medical students, dental students, nursing students, pharmacy students, and other healthcare professional students, who have legal problems with their schools or programs. We also represent students, residents, and fellows in investigations, academic probation and suspensions, disciplinary hearings, clinical competence committee (CCC) hearings, and appeals of adverse actions taken against them. The Health Law Firm’s attorneys include those who are board-certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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:

Weiner, Stacey. “Thousands of medical residents are unionizing. Here’s what that means for doctors, hospitals, and the patients they serve.” AAMC News. (June 7, 2022). Web.

Kwon, Sarah. “Burned out by COVID and 80-hour workweeks, resident physicians unionize.” Kaiser Health News. (May 27, 2022). Web.

Murphy, Brenden. “Why more resident physicians are looking to unionize.” AMA. (June 28, 2022). Web.

Author HeadshotAbout the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with 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 Avenue, Suite 1000, Altamonte Springs, Florida 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.

By |2024-03-14T09:59:17-04:00November 11, 2023|Categories: Health care Law, Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on COVID-19 Burn Out Causing More Resident Physicians to Unionize, Part 2
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Finding a Lawyer Who Accepts NORCAL Insurance to Defend Your License

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Many nurses, nurse practitioners, and certified registered nurse anesthetists (CRNAs) carry professional malpractice insurance through NORCAL Mutual Insurance or one of the other similar insurance companies. This insurance is inexpensive and provides excellent coverage.
What you may not realize, however, is that such insurance provides many added benefits, other than just coverage on nursing liability lawsuits, provided you have obtained the additional coverage from it. It will pay for legal defense expenses if there is a complaint filed against your nursing license. It will pay legal expenses for a lawyer to get involved and represent you if you receive a subpoena to testify or provide records. It will cover you if you have a HIPAA complaint or breach of medical privacy complaint filed against you.
We don’t get paid to write blogs like this. We just do it because we know so many nurses and other health professionals either have no professional liability insurance or have only partial coverage when they need the broadest coverage available.  NORCAL is one of the insurance companies that we know provides such coverage to health professionals.

Advantages of Having Liability Insurance.

The medical professional’s NORCAL Insurance covers can give a sigh of relief knowing they have excellent insurance coverage. This type of insurance provides professional liability coverage that protects them in the event of a lawsuit or negligence claim.  However, it’s not just the significant professional negligence cases that NORCAL covers.
More often than not, nurses and other healthcare professionals receive a notice of an investigation, a subpoena for a deposition in someone else’s case, a demand because of an allegation of sexual harassment or sexual impropriety, a complaint because of a breach of medical records confidentiality, or a Health Insurance Portability and Accountability Act (HIPAA) Privacy complaint, or some other administrative type of action. These situations can be incredibly stressful and time-consuming, but NORCAL provides excellent coverage.
Whether you’re a nurse, pharmacist, mental health counselor, psychologist, or other healthcare professional, knowledgeable and skilled attorneys can assist you with legal issues.

NORCAL Insurance Additional Coverage Endorsements You Should Have

As long as you have obtained the additional endorsements available (ask your insurance agent or call NORCAL to make sure), your policy should contain the following coverages:
Administrative Defense Coverage
Provides coverage to pay for your legal defense fees and expenses associated with:

Nursing and professional license complaints and investigations;

Clinical privileges actions, peer review actions and fair hearings;

Employment practices (alleged discrimination and harassment);

Billing errors (insurance billing, Medicare billing, Medicaid billing);

EMTALA proceedings and complaint investigations;

CLIA proceedings and investigations;

Stark Act violations, complaints and investigations;

Other administrative actions that may result in fines and penalties (e.g., DEA complaints and orders to show cause (OTSC), FDA investigations and complaints for civil monetary penalties.

Information and Network Security Coverage
This endorsement provides substantial coverage for a wide variety of potential costs related to information security, including:

Information & network security liability (protection against claims alleging unauthorized release of personal information, violations of information privacy law, or unauthorized use of/access to your computer system);

Media liability (defense of claims arising from material published on the Internet, on a website, YouTube, TikTok, in advertisements, etc., including allegations of libel, slander, copyright infringement, or trademark violations);

Regulatory privacy proceedings and regulatory fines and penalties (defense of HIPAA violations, state and federal information privacy law violations, etc.);

Customer notification and credit monitoring expenses (coverage for expenses incurred as a result of information breaches, including costs of notifying affected parties and providing them with credit monitoring services);

Electronic data recovery and replacement expenses (coverage for expenses incurred to recover or replace electronic data lost or damaged because of a computer virus, hacking or other system invasion);

Cyber extortion; and

Cyber terrorism.

Our firm can provide legal representation for most of the areas described above.

Free Legal Advice: Get Good Broad Insurance Coverage Now!

As a healthcare professional, it is essential to understand the importance of carrying a policy providing broad insurance coverage that covers any investigation, complaint, or administrative hearing that may be filed or opened against your license. Many healthcare professionals mistakenly believe their employer will cover them in such situations, but this is not always true.  In fact, it is usually untrue.
Unfortunately, in many cases, the employer terminates an employee and then files a complaint with the Department of Health (DOH). This can result in the DOH opening an investigation against the healthcare professional, leaving them vulnerable to potential legal action. In such cases, the employer is unlikely to pay for the nurses’s legal defense costs, leaving the professional in a difficult position.
If you find yourself in this situation, you may be out of work, out of money, and facing an investigation and complaint that could result in your professional license and career termination. Taking proactive steps to protect yourself and your career is essential by investing in insurance that covers legal defense costs.
NORCAL Insurance is both inexpensive and reliable. By purchasing this insurance, while you can afford it, you can rest assured that you will have the legal support you need in case of a complaint or investigation against your nursing license.

We Recommend That You Seek the Services of an Experienced Attorney in the Event of Any Notice of an Investigation.

If you work as a nurse in the healthcare industry, you must be aware of the potential legal issues that could arise. One such issue is disciplinary action or licensure investigations. If you find yourself in this situation, seeking an experienced health law attorney is crucial. Don’t speak with investigators or provide documents or statements without seeking legal advice.
It’s important to remember that investigators and other professionals involved in the investigation are not on your side. They are looking for evidence against you, so don’t take any advice from them. Instead, rely on the guidance of a skilled attorney who can protect your rights and interests.
Another important consideration is insurance coverage. If you have good insurance, it can help cover the costs of legal expenses from the outset. However, not all insurance policies cover disciplinary complaints and licensure investigations. Be sure to check your policy carefully and ensure this type of coverage is included. If not, consider purchasing a separate policy that provides this coverage. It may cost extra, but it’s worth protecting yourself in case of a legal issue.  It is worth it!  Please do it!

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Board of Nursing investigations and complaints, DORA investigations and complaints, and Department of Health (DOH) investigations and complaints. We appear before the Board of Nursing in licensing matters and in many other legal matters. We represent advance practice nurses (APRNs) and certified nurse anesthetists (CRNAs) as well as other professionals in hospital clinical privileges actions, HIPAA privacy complaints, DEA actions, and many other types of proceedings.  We represent nurses and physicians across the U.S., not just in Colorado, Florida, Louisiana, Virginia, and Washington, D.C.
We also handle DEA actions and other legal matters. Our team frequently defends physicians, dentists, nurse practitioners, and others against malpractice claims, civil lawsuits, administrative complaints, peer review actions, and audits by Medicare and Medicaid. If a nurse or healthcare professional has liability insurance that covers these types of claims, we will work to obtain coverage and seek reimbursement for legal fees. In some cases, we may accept an assignment of insurance policy proceeds to directly submit our bills to the insurance company.
We also defend health professionals and health facilities in general litigation matters and business litigation matters, in state and federal courts.
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.

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

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax 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 George F. Indest III. All rights reserved.
By |2024-03-14T09:59:21-04:00September 6, 2023|Categories: The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Finding a Lawyer Who Accepts NORCAL Insurance to Defend Your License
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NC Medical Malpractice Suit Against the U.S. Dismissed Due to 4-Year Time Limit

author headshot standing in a dark suit against grey backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On July 18, 2023, a federal judge in North Carolina granted a motion to dismiss a suit against Naval Hospital Camp Lejeune based on a state law four-year time bar on malpractice claims.

Background Facts.

We have the facts from the court’s decision in this case.

On December 3, 2016, the plaintiff patient arrived at the Naval Hospital Camp Lejeune Emergency Department with abdominal pain, nausea, and vomiting. After examination, she was diagnosed with a kidney stone and discharged. But her symptoms worsened, and she returned to the Naval Hospital the next day with a fever, shortness of breath, and disorientation.

The plaintiff was transferred to medical intensive care with concerns of septic shock. Upon her second discharge from the Naval Hospital, she was diagnosed with severe sepsis, shock, heart, lung, and kidney failure.

During treatment, the patient was prescribed vasopressors, which raise blood pressure by constricting blood vessels. The medications caused her to develop gangrene on her fingers and toes, resulting in the amputation of her hands and feet.

She sued the United States on October 21, 2022, for alleged negligence regarding her treatment at the Naval Hospital. This suit came after a four-year administrative process with the Department of the Navy that began in 2018.


North Carolina Time Bar.

The federal government argued in its motion to dismiss that the North Carolina statute of repose applied to the medical malpractice claim against the U.S., and that it barred the plaintiff from pursuing the matter in court.

A statute of repose establishes a maximum specified time period in which a suit must be brought for a cause of action to be recognized. As the name implies, a statute or repose kills the cause of action completely; it is an unyielding and absolute barrier that prevents a plaintiff’s right of action after the specified time.  A statute of repose is different from a statute of limitations because statutes of limitations merely make a claim unenforceable after a specified time period.

The North Carolina statute of repose prohibits bringing an action for medical malpractice more than four years from the defendant’s last act that gives rise to the claim. The defendant’s last act in this case was December 4, 2016, and the plaintiff filed the suit October 21, 2022, exceeding the four-year time bar imposed by North Carolina law.

The Federal Torts Claims Act.

The Federal Tort Claims Act (FTCA) is a law passed by Congress to allow some types of lawsuits against the United States for negligent acts its employees commit when they are acting within the course and scope of their employment as federal employees.  Otherwise, the doctrine of sovereign immunity bars such suits (no one is allowed to sue the king!).  It can be found in 28 U.S. Code Chapter 171 (28 U.S.C. Sections 2671-2680).  The FTCA applies the law of the state in which the tort occurs.

In response to the defendant’s motion to dismiss, the plaintiff argued that the Federal Tort Claims Act (FTCA) preempted the state’s statute of repose and gave her a cause of action.  However, the FTCA is limited in that it only imposes tort liability on the United States in the same manner and to the same extent as a private individual under similar circumstances by the state’s law where the act occurred. In other words, the FTCA incorporates state law.

The plaintiff argued that the FTCA overrides North Carolina’s time bar because it imposes its own time limitations. The FTCA states that all tort claims against the United States are barred forever unless an administrative claim is presented in writing to the appropriate federal agency within two years of the claim’s arising. It also states that claims are barred unless the court action is filed within six months after the administrative claim is denied by the federal agency.

The plaintiff argued that the FTCA preempted the North Carolina statute of repose because the FTCA spells out how it preempts statutes of limitations.  However, the two statutes are not the same.

The court agreed that the statute of repose applied to the tort claim, barring it.

In fact, all the federal circuit courts that have considered the issue have ruled consistently that the FTCA incorporates state statutes of repose and does not preempt them.

Judge’s Decision.

The judge conceded that the delay in the administrative process was unfortunate. However, the court ruled, it was still inappropriate to expand the FTCA’s provisions to override the state’s time bar. The court held that the North Carolina statute of repose applied to the medical malpractice suit against the federal government, which meant that the plaintiff could not bring a cause of action against the U.S. or the naval hospital.

The judge also stated that the FTCA only allows lawsuits against the United States if the state’s law permits a similar suit against a private person. Since the North Carolina statute of repose would not have allowed the lawsuit to be filed against a private doctor, it cannot be filed against the United States. Accordingly, the judge dismissed the case.


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

At the Health Law Firm, we provide legal services for all health care providers and professionals. This representation includes military (Army, Navy and Air Force) physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, as well as other federal and civilian health care providers.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in civil litigation in state and federal courts. We represent physicians and other health professionals in cases before medical boards, before state licensing agencies, and in National Practitioner Data Bank (NPDB) disputes.  We represent physicians accused of wrongdoing, in patient complaints and in Department of Health investigations.

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.

Source:

Baldwin v. United States, No. 7:22-CV-180-FL. (E.D.N.C., July 18, 2023).

Bland, Travis. “NC Time Bar Ends Med Mal Suit Over Amputations.” Law360. (18 July 2023). https://www.law360.com/health/articles/1701132?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-07-19&read_main=1&nlsidx=0&nlaidx=15


About the Authors: 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. Hartley Brooks is a law clerk with the health law firm. Its main office is in 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.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax 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.

By |2024-03-14T09:59:21-04:00September 6, 2023|Categories: The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , |Comments Off on NC Medical Malpractice Suit Against the U.S. Dismissed Due to 4-Year Time Limit
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United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency

Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Hartley Brooks, Law Clerk, The Health Law Firm
On May 18, 2023, the United States Court of Appeals for the Sixth Circuit affirmed a U.S. district court’s decision to deny U.S. Nursing Corporation a new trial. The appellate court stated that the opposing counsel’s closing argument and the erroneous preclusion of evidence had no substantial effect on the trial’s outcome; thus, there was no reversible error.
The First Lawsuit.
The original lawsuit filed in state court concerned a patient suing Appalachian Regional Healthcare, Inc., for exacerbating his spinal injury. He claimed that a nurse transported him from a car into the emergency room without first stabilizing and immobilizing him, which caused further damage. When the incident occurred, the nurses on staff were two employees of Appalachian Regional and one supplied by U.S. Nursing Corporation to the hospital.
 The court granted a motion that dismissed the Appalachian Regional nurses as defendants because no evidence in the record alleged that they moved the patient. As the trial neared, the court granted another motion prohibiting the parties from introducing evidence that the Appalachian Regional nurses moved the patient from the truck into the emergency room.
This earlier state court lawsuit concluded with Appalachian Regional Healthcare paying $2 million in settlement and incurring $823,522.71 in legal fees.
It is important to note that when U.S. Nursing supplied its nurse to Appalachian Regional, they entered into an agreement that stated U.S. Nursing would indemnify and defend Appalachian Regional for the negligence of any of its employees assigned to Appalachian Regional. The settlement was reached, Appalachian Regional Healthcare demanded that U.S. Nursing indemnify it, but the staffing company refused to do so. In response, Appalachian Regional Healthcare, Inc., sued U.S. Nursing for the $2,823,522.71 state court settlement it paid.
The First Appeal.
In its first appeal, U.S. Nursing argued that the opposing counsel made an inappropriate closing statement when they stated no evidence showed the Appalachian Regional Healthcare nurses moving the patient and that U.S. Nursing had not argued that such evidence existed. U.S. Nursing claimed this statement was inappropriate because it was prohibited from admitting evidence that showed Appalachian Regional Healthcare nurses having moved the patient. The appellate court decided that U.S. Nursing did not have a full and fair opportunity to litigate the issue, so the appellate court remanded to the district court to determine if the error required a new trial.
The nurse staffing company argued that it was incorrectly prohibited from introducing evidence regarding the other nurses on duty and the possibility that they could have been the ones to move the patient. U.S. Nursing also argued that the opposing counsel exploited the court’s error in their closing statements, though the district court never addressed this claim. However, the appellate court asserted that the evidence excluded would not have caused a different outcome at trial, so no new trial was granted.
The Second Appeal.
In its second appeal, U.S. Nursing argued that the district court abused its discretion when it determined the evidentiary error did not affect the trial. The Sixth Circuit Court of Appeals found that the excluded evidence did very little to support U.S. Nursing’s argument, and excluding this evidence did not affect U.S. Nursing’s substantial rights. However, the court stated that the opposing counsel misled the jury with their statements. The remarks did not constitute an error significant enough to warrant a new trial since Appalachian Regional Healthcare, Inc., was highly likely to prevail, despite counsel’s comments.
Contact Health Law Attorneys Experienced in Representing Nurses and Other Healthcare Professionals.
The Health Law Firm’s attorneys routinely represent 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.
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.
Source:
About the Authors: 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free (888) 331-6620
Hartley Brooks is a law clerk at The Health Law Firm. She is preparing to attend law school.
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: [email protected] 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 George F. Indest III. All rights reserved.
By |2024-03-14T09:59:22-04:00September 1, 2023|Categories: Dental Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on United States Court of Appeals Denies U.S. Nursing Corporations Indemnification Challenge Against Nurse Staffing Agency
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COVID-19 Provider Relief Fund Expected To Run Out of Money If Congress Doesn’t Act Soon

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

In 2020, the U.S. Department of Health and Human Services (HHS) created the “Provider Relief Fund” (PRF) to help support healthcare providers in the battle against the COVID-19 pandemic. The federal program has served as a lifeline to frontline healthcare workers who’ve experienced revenue losses and increased demand for their services during the pandemic.

To date, it has allocated more than $178 billion in payments to over 410,000 providers across the United States. Click here to learn more.

COVID-19 Uninsured Relief Fund.

Let’s start with some good news: Under the COVID-19 relief funding, HHS created the “uninsured relief fund.” This program provides claims reimbursement to health care providers for testing, treating, diagnosis, and administering vaccines to uninsured individuals for COVID-19. It has paid out more than $17 billion throughout the pandemic. It has paid out more than $17 billion throughout the pandemic.

Of the $17 billion, HHS has distributed nearly $10 billion for testing, more than $6 billion reimbursed for treatment, and the remainder covered vaccinations. Read more on the statistics here.

Running Out of Money.

Now for the bad news: According to an HHS spokesperson, there’s only $7.6 billion left, and the money will run out in the coming months. Congress isn’t currently considering making more funding available, meaning providers and patients are likely to have soon to bear the costs themselves.

Therefore, many hospitals and healthcare organizations urge Congress to replenish the PRF. “One of the most helpful and patient-oriented uses of the PRF was to help those people who for whatever reasons are uninsured and suffer from COVID-19,” said Federation of American Hospitals CEO Chip Kahn. “It meant that no one should have any reluctance to go to the hospital if they have COVID but no insurance.”

Additionally, on February 9, 2022, the American Hospital Association released a statement urging readers to contact lawmakers to get Congress to provide another $25 billion for the PRF in the government funding package. Read the AHA’s action alert here.

As we approach nearly two years since HHS declared COVID-19 a national public health emergency, PRF has been a lifeline to hospitals, health systems, and medical professionals. It has been helping to keep doors open during the pandemic to continue providing essential care to patients and communities. However, if the program runs out of money and Congress doesn’t appropriate more, hospitals could be left footing the bill, which will hurt both providers and patients in the end.

Read one of my previous blogs on a similar case regarding a Florida Dentist’s COVID-19 Business Interruption Insurance Claim to learn even more.

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

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.

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

Sources:

Hellmann, Jessie. “HHS running out of money to pay providers for treating uninsured COVID-19 patients.” Modern Healthcare. (February 8, 2022). Web.

HRSA. “Covid Uninsured Claim.” Health Resources & Services Administration. (February 2022). 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.

By |2024-03-14T09:59:27-04:00June 16, 2023|Categories: Health Facilities Law Blog, In the News|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on COVID-19 Provider Relief Fund Expected To Run Out of Money If Congress Doesn’t Act Soon
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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.

By |2024-03-14T09:59:30-04:00May 12, 2023|Categories: Health Facilities Law Blog, In the News|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Court Assesses $170 Million in Fines Against Two Texas Ophthalmologists For False Claims
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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.

By |2024-03-14T09:59:31-04:00April 21, 2023|Categories: Health Facilities Law Blog, In the Know|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Surgeon, Device Company Owner Arrested For Paying Bribes, Kickbacks
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“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 © 2022 The Health Law Firm. All rights reserved.
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