Women Who Posed as Nurse Sentenced to Prison For Health Care Fraud, Identity Theft, and Wire Fraud

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

On September 23, 2020, a Tennessee woman who posed as a nurse working at several medical facilities was sentenced to more than four years in prison. In December 2019, she pled guilty to wire fraud, healthcare fraud, identity theft, and practicing nursing without a license.

How a Phony Nurse Gained Employment.

According to a news release from the U.S. Attorney’s Office, the woman posed as a registered nurse, despite not having a nursing degree or a nursing license, and having no nursing experience. To accomplish the fraud, she obtained the license numbers of real nurses with similar first names. She admitted to providing fraudulent information on job applications to gain employment. She was employed by at least eight different health care providers between September 2012 and November 2018. She also falsely claimed that she held nursing degrees from two educational institutions, Walters State College and Carson Newman University.

This is a long time, six years, to get away with health fraud. Usually, we only see things like this in Florida. However, in the past few years, Florida seems to be seeing fewer and fewer fake doctors, nurses, and health professionals. Perhaps the crackdown by the Florida Department of Health on the unlicensed practice of health professions has had some impact on this.

Continuing Lies & Fraudulent Behavior.

While posing as a nurse, the fake R.N. worked in various medical settings, including nursing homes, rehabilitation and assisted living facilities, a doctor’s office, and home health agencies. She rendered nursing care to numerous patients, dispensed prescription medications, and gained access to patients’ sensitive and private medical information, the U.S. Attorney’s Office said. Furthermore, the woman made false entries in patients’ medical records and submitted or caused the submission of at least $500,000 in false claims to public and private health care benefit programs.

The phony nurse performed procedures that she was, of course, unqualified to perform. She failed to act or to notify others of the necessary procedures for patients and failed to chart and document patient care. According to the written plea agreement, at least one patient required re-admittance to the hospital and an additional three-day hospital stay due to her inept care.

The Tennessee Bureau of Investigation Director David Rausch is quoted in the media as having stated: “Our Medicaid Fraud Control Division remains committed to working with our federal partners to ensure healthcare fraud and identity theft cases like this one are addressed and investigated thoroughly.”

Judge Clifton L. Corker of the U.S. District Court for the Eastern District of Tennessee sentenced her to 51 months in prison, followed by three years of supervised release. She was also ordered to repay $700,000 in restitution to her employers.

To read the DOJ’s press release about this case in full, click here.

To read about a similar case in Florida, click here to view one of my prior blogs.

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 (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“Morristown woman posed as nurse for 6 years at 8 health care providers.” ABC 6 Local News. (December 12, 2019). Web.

Starks, Ariel. “Fake nurse sentenced to 51 months in prison, ordered to repay employers $700,000.” WVLT 8 Local News. (September 23, 2020). Web.

Bonvissuto, Kimberly. “Nurse imposter who worked in assisted living sentenced for wire fraud, healthcare fraud, identity theft.” McKnight’s Senior Living. (September 25, 2020). 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 © 2020 The Health Law Firm. All rights reserved.

UF Rescinds Prospect For Racist Online Post

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

On June 8, 2020, the University of Florida (UF) reportedly announced via Twitter that it had rescinded its offer of acceptance to a prospective student. The offer was rescinded by the university because of an allegedly racist message posted by the student on social media. According to reports, UF spokesman Steve Orlando stated that the university received multiple e-mails complaining about the post. As a result of the investigation, the student is no longer a UF prospect, according to the announcement.

Social networks provide students, resident physicians, fellows, and clinical professors with opportunities for greater communication, information/experience sharing, collaborative learning, professional interactions, and outreach. However, they can also be dangerous if someone has unprofessional comments or content. Many applicants may not be aware that their social media presence may have an impact on their chances of acceptance, especially for medical students.

Although it is true that we all have a First Amendment right to freedom of speech, by getting up and making a speech that violates a school, institution, or program’s policies, you are asking for trouble. we have had cases of students and of residents getting into trouble for not only allegedly racist FaceBook and Twitter posts and re-posts, but also for “unprofessional” posts and re-posts. These include the use of profanity, racist comments, and “unprofessional” photographs. Those who are students or resident physicians typically are in an environment where there is heightened awareness of and heightened scrutiny regarding such matters. Although they must be provided with “due process of law” before they are terminated, this could be very expensive and result in unnecessary blemishes on a person’s record. If the individual making the comments, posts, or re-posts, hasn’t started yet, then they have far fewer rights and do not have any “interest” that is protectable under due process of law principles. So why take the risk?

How Social Media Can Impact Medical Students and Admissions.

On social media sites, healthcare professionals, including medical students, should always represent themselves in a manner that reflects values of professionalism, integrity, acceptance of diversity, and commitment to ethical behavior. Physicians must be aware that content posted may negatively affect their reputations among patients and colleagues. Basically, your actions online may also affect your medical career, especially for medical students.

In one recent situation, a medical student says the University of New Mexico gave him two options: change his Facebook post or get out. Click here to read more about it.

With the increase in popularity and usage of social media platforms, the American Medical Student Association (AMSA) published Guidelines for Medical Students and Physicians. Click here to read the guidelines in full.

To read about how our firm can assist medical students, residents, and graduates in a variety of legal matters, click here.

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows, and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows, and medical school students in disputes with their medical schools, supervisors, residency programs, and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

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

Sources:

Keating, Jennifer. “Social Media Guidelines for Medical Students and Physicians.” American Medical Student Association (AMSA). (September 15, 2016). Web.

Nelson, Sarah. “Florida student who wrote racist social media post won’t join UF.” Palm Beach Post. (June 10, 2020). Web.

“How Medical School Applicants Should Manage Social Media.” U.S. News. (June 11, 2018). 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

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“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 © 2020 The Health Law Firm. All rights reserved.

Emergency Order Allows Florida Pharmacists to Temporarily Order, Administer COVID-19 Tests

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On April 24, 2020, Florida Gov. Ron DeSantis announced he would expand the opportunities for people to obtain COVID-19 tests by allowing licensed pharmacists to order and administer them. For purposes of preparing for, responding to, and mitigating any effect of COVID-19, Emergency Order 20-006 was filed, suspending section 483.813, Florida Statutes. You can click on the link to read the entire Order.

According to the Order, it was necessary to waive certain statutes and rules of the Florida DOH in order to effectively respond to the emergency caused by COVID-19. Section 483.813, Florida Statutes, requires a pharmacist to be separately licensed to perform a clinical laboratory test. Additionally, section 465.003(13), Florida Statutes, has provisions that prohibit a pharmacist from ordering, administering, or reporting the results of COVID-19 tests, including serology tests, authorized by the United States Food & Drug Administration (FDA). The Emergency Order temporarily sidesteps the law to allow pharmacists to perform these functions.

This suspension of the applicable law applies until the expiration of Executive Order 20-52.

The full version of the Emergency Order may be found on the Florida Board of Pharmacy’s website here as well as on our website here.

It’s important to remember that as with all new guidance and policy changes, it is essential to understand how these changes fit into the existing regulatory frameworks that govern the health care industry.

Consult With A Health Law Attorney Experienced in the Representation of Pharmacists and Pharmacies.

We routinely provide deposition coverage to pharmacists, pharmacies, and other health professionals being deposed in criminal cases, negligence cases, civil cases, or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing physicians, physician assistants, and other health professionals in investigations and at Board of Pharmacy hearings. Call now or visit our website www.TheHealthLawFirm.com.

Sources:

Gross, J. Samantha. “Florida pharmacists to be allowed to issue COVID-19 tests, DeSantis says.” Miami Herald. (April 24, 2020). Web.

“Pharmacists Authorized to Order and Administer COVID-19 Testing.” The National Law Review. (April 20,2020). 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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Florida Board of Pharmacy defense representation, legal defense for pharmacists, pharmacist defense lawyer, Board of Pharmacy defense lawyer, Board of Pharmacy hearing legal representation, pharmacy license disciplinary charges defense attorney, legal representation for pharmacist, legal representation for pharmacy, pharmacy defense lawyer, pharmacy audit defense representation, pharmacy audit defense attorney, board representation for pharmacists, board representation for pharmacies, board representation for physicians, Board of Pharmacy investigation representation, legal representation for board investigations, The Health Law Firm, administrative hearing defense attorney, DEA order to show cause (OSC) defense lawyer, legal representation for administrative hearings, DEA hearing defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, DEA order to show cause (OSC) defense attorney, Drug Enforcement Administration (DEA) defense attorney, Drug Enforcement Administration (DEA) investigation defense attorney, Drug Enforcement Administration (DEA) subpoena defense lawyer, Drug Enforcement Administration (DEA) inspection defense attorney, Drug Enforcement Administration (DEA) hearing defense attorney, Drug Enforcement Administration (DEA) order to show cause (OTSC) defense lawyer

“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 © 2020 The Health Law Firm. All rights reserved.

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Insurer Faces Possible Class Action Over Rejected Pandemic Business Interruption Claims

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

On April 14, 2020, several companies announced they are considering a class action lawsuit against Hiscox Insurance over its failure to pay business interruption claims relating to the coronavirus lockdown. Hiscox, sold policies before COVID-19 hit. The policies allegedly stated that they would cover claims related to businesses being forced to shut owing to a notifiable disease. Business owners have reportedly filed claims with Hiscox and other commercial insurance companies, only to be told that their policies don’t cover the losses related to the pandemic.

Policy Wording.

The company’s policy wording says business interruption claims can be made if a public authority makes the business premises unusable due to “an occurrence of any human infectious or human contagion disease.”

Hiscox claims the policy’s coverage would only be triggered by “certain specific events at, or local to, the premises.” The insurer said its policies were not designed to cover the extraordinary circumstances caused by the pandemic. In a statement, the company said, “We understand that these are incredibly difficult times for businesses affected by COVID-19. At Hiscox, we strive to pay claims that are covered by the policies fairly and quickly. However, general business interruption policies across the industry, including Hiscox’s, were not designed to cover these extraordinary circumstances. Like terrorism and flood, which have government-backed insurance schemes, pandemics like coronavirus are simply too large and too systemic for private insurers to cover,” it added.

Business Interruption.

Business interruption insurance usually provides protection against the closure of business because of damage to property. Multiple “non-damage” extensions can be added to standard policies, including those for denial of access because of communicable disease. A communicable disease extension or addendum will typically cover losses arising from closure resulting from an outbreak of a virus or bacteria on-site or nearby.

Many policies’ word also includes a defined list of diseases covered under the terms of the policy, which range from the SARS virus to smallpox. Others are less specific, offering coverage for any “notifiable disease” outbreak required by law to be reported to authorities. Additionally, sometimes communicable disease policy addendums contain exclusions, which state that an outbreak must have occurred on the business premises or within a defined vicinity.

The Problem With Policies?

The difficulty is that in the majority of cases, these policies cite “direct physical loss or damage” as a requirement to be triggered. Unfortunately, a quarantine, travel ban, shelter-in-place orders, or pandemic might make it impossible for a business to keep its doors open, but unfortunately may not constitute obvious “physical damage.” So, if the wording fits, as far as the insurance company is concerned, it’s not their problem!

Hiscox denied the claims made against them and responded that the clause was designed to cover losses “solely and directly” from restrictions imposed by a public authority. It would not apply in this case because losses would have still occurred even if businesses had not been closed, because of the government-imposed lockdown.

Legal Issues For Insurance Policies.

There are several important points to remember when dealing with insurance policies and claims made to an insurer.

First, insurance is governed by state law, so interpretations and policy coverage requirements may differ from state to state. Always check your state’s insurance laws and the cases that interpret them to see if the issue is governed by them.

Second, your insurance policy is a contract between you and the insurance company. Read the contract and see what it states. If it is vague or there is a doubt after you read it, you may have a good case. See the next step below.

Third, the insurance company wrote the policy. The insurance company had complete control over the wording of the policy. It was up to the insurance company to be definite and specific in what was covered or not covered. If there is doubt in the coverage that is provided in the policy, the courts will usually interpret this against the insurance company so as to provide coverage to the insured for the loss.

Fourth, when there is a problem with an insurance claim or a denied claim, immediately retain the services of one of the many attorneys who are experienced in suing insurance companies. These attorneys usually know what they are doing and will not charge you unless they obtain a recovery for you.

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 (407) 331-6620 and visit our website at www.ThehealthLawFirm.com

Sources:

Croucher, Martin. “Insurers Face Legal Tests Over Rejected Pandemic Claims.” Law360. (April 17, 2020). Web.

Croucher, Martin. “Hiscox Could Face Class Action Over COVID-19 Response” Law360. (April 14, 2020). Web.

Cox, Josie. “Coronavirus has exposed Britain’s insurance industry as a shambles.” The Guardian. (March 18, 2020). 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.

KeyWords: healthcare employment law representation, legal representation for physicians, doctor defense legal representation, legal representation for healthcare professionals, complex health care litigation attorney, complex civil litigation attorney, complex healthcare litigation lawyer, complex medical litigation lawyer, representation for complex medical litigation, representation for healthcare business litigation matters, The Health Law Firm, reviews of The Health Law Firm Attorneys, The Health Law Firm attorney reviews, legal representation for physicians and health care professionals

“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 © 2020 The Health Law Firm. All rights reserved.

Finding an NSO Insurance Attorney to Defend You in a Complaint Against Your Nursing License or Nurse Practitioners License

Attorney George F. Indest head shotBy 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 the Nurses Service Organization (NSO) 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. 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.

Under such policies, the insurance company will pay the legal fees and other costs related to your defense. However, most of the time, you will still be required to locate and retain the appropriate attorney to represent you in the matter.

What to Look for When Retaining an Attorney to Defend You.

1. Your primary concern should be to find and retain an attorney who accepts the insurance that you have, whether it is NSO Insurance, CPH & Associates Insurance, Philadelphia Insurance, Trust Management Services, Firemans Fund, or another national company. This will ensure that you have an attorney who will give you the lower rates the insurance company had negotiated and will have a good working relationship established with your insurance company. If an attorney with our firm cannot represent you, we will certainly try to find an attorney who will.

2. Another primary qualification for any attorney you hire to represent you should be his or her experience in working with health professionals in the same field and on similar matters. If the attorney is not familiar with your area of health practice, it may be difficult for that attorney to get up to speed to represent you properly.

3. If you come across an attorney who states that she or he will help you make a statement to the investigator or assist you in the investigation, but does not appear with you in hearings, then this is the wrong attorney. You need an attorney who can represent you from start to finish.

4. Often you will come across an attorney who only wants you to accept a consent order, stipulation, or settlement agreement. Remember that these are all merely “plea bargains” and by signing this type of agreement, you will be pleading guilty to whatever offenses are charged. In most cases, you will probably be innocent of the charges and should request a formal administrative hearing in order to prove this.

5. You also want to retain the services of an attorney who has appeared before your professional board or professional licensing authority in investigations and hearings, especially formal and informal administrative hearings. The lack of familiarity with such investigations and boards can be costly to you.

6. You don’t necessarily need an attorney who is located in your city, county, or state. Almost all the work on the case will be done by telephone and e-mail. You usually have only one meeting or hearing with the investigator or its board and, depending on what type of hearing it is, it could be located in many different locations. Our attorneys will travel to those locations for meetings and hearings.

7. Beware of attorneys who hold themselves out in Internet advertising as health attorneys or professional license defense attorneys but are really some other type of attorney. We see this a lot from medical malpractice attorneys, criminal defense attorneys and attorneys who sue insurance companies. Be sure you get an attorney who concentrates his or her practice in defending nurses with nursing complaints, investigations and hearings.

8. If you can’t find an attorney to meet your immediate needs through an Internet search, you may contact your insurance company or professional association and ask if they have a list of attorneys that can do the legal work you require. For example, you may reach Nurses Service Organization (NSO) at (800) 247-1500; you can reach CPH & Associates at (800) 875-1911 or (312) 987-9823; you can access a list of professional license defense attorneys who represent nurses online at https://taana.org/referral/.

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 nurses across the U.S., not just in Colorado, Florida, Louisiana, Virginia, and Washington, D.C.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 or (970) 416-7456 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 Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Nurses Service Organization (NSO) insurance defense attorney, NSO lawyer, Florida NSO defense attorney lawyer, Colorado NSO defense attorney lawyer, legal representation for NSO matters in Colorado, legal representation for NSO matters in Florida, representation for professional liability insurance cases, Louisiana NSO defense attorney lawyer, legal representation for NSO matters in Louisiana, NSO deposition defense coverage, Virginia NSO defense attorney lawyer, legal representation for NSO matters in Virginia, legal representation for NSO matters in Virginia, representation for professional liability insurance cases, Virginia NSO deposition defense coverage, nurse legal representation, Board of Nursing informal hearing attorney, Board of Nursing formal hearing attorney, Department of Health (DOH) investigation of nurses, representation for deposition of nurses, nurse administrative complaint defense, appeal of board of nursing final order, nurse license application, nurse emergency suspension order appeals representation, legal representation of Advanced Registered Nurse Practitioners (ARNPs), Certified Registered Nurse Anesthetist (CRNA) attorney representation, Certified Nurse Midwife (CNM) legal representation, nurse attorney Florida Colorado Louisiana Virginia, representation for Louisiana and Florida Department of Health (DOH) complaint investigations, Louisiana and Florida Department of Health (DOH) defense lawyer, Colorado Division of Regulatory Agencies (DORA) defense attorney, representation for Florida Colorado Division of Regulatory Agencies (DORA) complaint investigations, Colorado Division of Regulatory Agencies (DORA) defense lawyer, Health Law Firm reviews, reviews of The Health Law Firm attorneys, administrative complaint defense attorney, administrative hearing defense lawyer

“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 © 2020 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:01-04:00April 14, 2020|Categories: Nursing Law Blog, Uncategorized|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Finding an NSO Insurance Attorney to Defend You in a Complaint Against Your Nursing License or Nurse Practitioners License

CMS Announces Final Rule to Reduce Criminal Behavior in Medicare, Medicaid

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

On September 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the ability to stop fraud and abuse before it happens. The “Program Integrity Enhancements to the Provider Enrollment Process” goes into effect on November 4, 2019, and will help keep untrustworthy providers out of federal health insurance. The new affiliations provision will allow CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse and repeat offenders.

Details on the Rule.

The final rule, (CMS-6058-FC), creates several new revocation and denial authorities to enhance CMS’ efforts to stop fraud and abuse.

Similar to the affiliations component, these authorities provide a basis for administrative action to revoke or deny, as applicable, Medicare enrollment if:

• A provider or supplier circumvents program rules by coming back into the program, or attempting to come back in, under a different name (e.g. the provider attempts to “reinvent” itself);

• A provider or supplier bills for services/items from non-compliant locations;

• A provider or supplier exhibits a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs; or

• A provider or supplier has an outstanding debt to CMS from an overpayment that was referred to the Treasury Department.

Additionally, the rule gives CMS the ability to prevent applicants from enrolling in the program for up to three years if found to have submitted false or misleading information in its initial enrollment application.

Furthermore, the new rule expands the re-enrollment bar that prevents fraudulent or otherwise problematic providers from re-entering the Medicare program. CMS can now block providers and suppliers who are revoked from re-entering the Medicare program for up to 10 years. Previously, revoked providers could only be prevented from re-enrolling for up to three years.

Additionally, if a healthcare provider or supplier is revoked from Medicare for a second time, CMS can now block him/her from re-entering the program for up to 20 years. These new authorities and restrictions are effective on November 4, 2019.

For more information, click here to view the final rule with comment.

To learn more about the Medicare enrollment application process, click here to read my prior blog.

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

The lawyers of The Health Law Firm routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicare and Medicaid investigations, audits and recovery actions. They also represent them in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge. Attorneys of The Health Law Firm represent health providers in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

Sources:

Kacik, Alex. “CMS targets healthcare providers’ affiliates in new rule.” Modern Healthcare. (September 5, 2019). Web.

“CMS Announces New Enforcement Authorities to Reduce Criminal Behavior in Medicare, Medicaid, and CHIP.” Orlando Medical News. (September 5, 2019). Web.

“CMS takes action to keep fraudsters out of Medicare and Medicaid.” CMS.gov. (September 5, 2019). 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“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 © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:10-04:00September 24, 2019|Categories: The Health Law Firm Blog, Uncategorized|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on CMS Announces Final Rule to Reduce Criminal Behavior in Medicare, Medicaid

Here Are Some Common Sense Tips for Taking Your USMLE Step Exams and Scoring Higher

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

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

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

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

Eliminate these unnecessary risks.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To contact The Health Law Firm please call (407) 331-6620 or (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

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“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 © 2019 The Health Law Firm. All rights reserved.

How to Challenge an OIG Exclusion Action from Medicare

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

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional careers and future employment. Whether you are a physician, nurse, dentist, psychologist or other health professionals, if you allow yourself to be excluded from the Medicare program, devastating economic results may follow.

The administrative process by which you may challenge a proposal from the OIG for most permissive or mandatory exclusion is challenging. In most cases, you will need experienced legal representation.  Below are the steps in the process you must follow to protect your career and your livelihood.

The Administrative Process to Challenge OIG Exclusion Actions.

1.    Notice of Intent (NOI) received: If the OIG is proposing to exclude a person or entity from Medicare, it will send out a letter called a “Notice of Intent” or “NOI.” This will contain the reasons for the exclusion and will detail hearing or appeal rights.  It is very important to make sure that your state licensing board and Medicare have your correct current address on file because the address which Medicare has will be where the NOI is mailed.  (Note:  the OIG may not send a NOI for mandatory exclusions which carry a 5-year minimum exclusion period.)  You will not have a second chance. Regardless, you usually only have 30 days to submit a written response requesting a hearing and containing information the OIG will consider in making its decision.  In some cases, providers may have the opportunity to present oral arguments before OIG officials. You must make sure that your request is received by the deadline, not just mailed by the deadline.  Send your request by a fast, reliable means (such as Federal Express or U.S. express mail) that you can track; or register for and file it electronically online.  Read the instructions in the letter and follow them. Be sure you get a receipt when you file.

2.    Notice of Exclusion (NOE): Sometimes the OIG will send a “Notice of Exclusion” or “NOE” if it decides to exclude a provider regardless of the response provided to a NOI or in certain cases of mandatory exclusions or certain permissive exclusions where no NOI is ever sent. Medicare exclusions usually take effect 20 days after the NOE is mailed. In cases involving fraud, kickbacks and other prohibited activities, a Notice of Proposal to Exclude or NOPE may be sent instead.

3.    Administrative Law Judge (ALJ) Hearing: Providers have the right to appeal a proposed exclusion by requesting an administrative hearing (similar to a trial) before an “Administrative Law Judge” or “ALJ.” ALJ’s are part of the Department of Health and Human Services (HHS). If you wish to request an ALJ hearing, you must do so within 60 days of receiving the Notice of Exclusion (or according to the instructions), and you must be prepared to raise all of your arguments over issues regarding the decision itself, the proposed exclusion period, mitigating factors or other aspects of the action.

4.    Department Appeals Board (DAB): If you disagree with the ALJ hearing decision, you can further appeal to the HHS “Departmental Appeals Board” or “DAB.” This is a written appeal which will be required to set forth legal errors which were made in the ALJ hearing.

5.    Judicial Review: If you disagree with the decision made by the DAB, your only option is to challenge the final decision in a U.S. District Court.

MOST IMPORTANT, consult a health law attorney experienced in such matters. The consequences of  Medicare exclusion, even a permissive exclusion for one year or three years, are severe. Most people do not realize this until it is too late; then it is too late (in many, but not all, cases).

To learn more about the consequences of OIG exclusion, click here to read one of my prior blogs.

Contact Attorney Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Office of Inspector General (OIG) Medicare exclusion attorney, OIG investigation legal defense representation, OIG exclusion defense attorney, OIG exclusion defense lawyer, Medicare audit defense legal counsel, Office of Inspector General (OIG) Medicare exclusion defense counsel, Medicare audit defense attorney, Office of Inspector General (OIG) Medicare exclusion legal defense counsel, attorney legal representation for OIG notice of intent to exclude, Medicare exclusion hearing defense attorney, Medicare administrative law judge hearing legal representation, Medicare administrative law judge hearing defense attorney, Medicare and Medicaid audit defense attorney, legal representation for Medicare and Medicaid audits, health care fraud defense attorney, legal representation for health care fraud, Centers for Medicare and Medicaid (CMS), legal representation for CMS investigations, health care professional defense attorney, legal representation for health care professionals, legal representation for fraud investigations, reviews for The Health Law Firm, The Health Law Firm attorney reviews, healthcare fraud representation, allegations of healthcare fraud, representation for CMS investigations, representation for healthcare investigations, representation for medical overbilling, False Claims attorney, FCA lawyer, FCA attorney, representation for submitting False Claims

“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 © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:13-04:00July 9, 2019|Categories: Pharmacy Law Blog, Uncategorized|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on How to Challenge an OIG Exclusion Action from Medicare

FL May Allow Nurses to Avoid Past Mental-Health Conditions, Drug Issues on License Applications

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

Nurses ask patients about their medical histories every day as part of treating them. But what happens when they are requested to divulge in their own history to the state as part of the licensing process? Before being licensed in the state of Florida, for example, nurses are required to disclose if they have been treated for mental-health or substance-abuse disorders within in the past five years. However, this could be changing very soon.

Changes to Past Health Questions.

In December 2018, a committee of the Florida Board of Medicine gave preliminary approval to eliminate questions about past treatment of mental health and substance abuse from applications for medical licenses in Florida. Rather, applicants would be asked only whether they currently have any condition that impairs them from safely practicing.

Medical history questions are asked during the initial application for license, whether the applicant is a new provider or a provider from another state who is seeking a Florida license. This is true for most states. The new questions are designed to be more open-ended and lend themselves to subjective answers.

The proposal to change the initial application questions comes after several studies revealed an alarming suicide rate among health care professionals and medical students. According to a 2015 study published in the journal JAMA Psychiatry, between 300 and 400 physicians commit suicide each year.

Despite these numbers, the proposal still requires full board approval and faces opposition from some board members.

Click here to read one of my prior blogs about rising baker acts among college students in Florida.

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

The attorneys of The Health Law Firm provide legal representation to physicians, physician assistants, nurses, nurse practitioners, cardiologists, CRNAs, pain management doctors, 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.

Sources:

Sexton, Christine. “Florida doctors may avoid revealing past mental-health and drug-abuse issues.” Orlando Sentinel. (January 16, 2019). Web.

“Change Seeks To Remove ‘Stigma’ For Doctors.” Health News Florida. (January 16, 2019). 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.

KeyWords: Legal representation Board of Medicine cases, Board of Medicine Representation, legal representation for physicians, legal representation for licensure issues, licensure defense lawyer, legal representation for licensure defense, legal representation for medical students, residents and fellows, legal representation for Board of Medicine hearings, legal representation for complaints against license, Medical Board Cases representation, legal representation for nurses, nurse representation, Board of Nursing Representation, Medical Board defense lawyer, Medical Board representation, Florida health law defense attorney, legal representation for U.S. Department of Health (DOH) investigations, employment law defense attorney, legal representation for employment issues, legal representation for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, health law defense attorney, mental health facility defense counsel, mental health professional defense attorney, psychologist defense counsel and legal representation, social worker legal counsel and mental health counselor defense attorney, legal representation for Credentials Committee of Board of Medicine

“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 © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:16-04:00March 14, 2019|Categories: Nursing Law Blog, Uncategorized|Comments Off on FL May Allow Nurses to Avoid Past Mental-Health Conditions, Drug Issues on License Applications

Alaska Board of Pharmacy Sends Letter to its Pharmacists Sending Mixed Signals Over Filling Opioid Prescriptions (Part 1 of a 2 part series)

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

The “Opioid Crisis” in the U.S.

We all know that there is an “opioid crisis” in the U.S. It is probably prevalent in every state. In Florida we have been suffering under it for the past ten to fifteen years. So it is nothing new to Florida. Government regulators including, but not limited to the Florida Department of Health (DOH), Florida Attorney General (AG), different State’s Attorneys’ (prosecutors) offices, multi-jurisdictional task forces, local law enforcement agencies, the U.S. Drug Enforcement Administration (DEA) and the Department of Justice (DOJ), along with federal prosecutors, have been involved in ongoing efforts in Florida for the past fifteen years or so, to shut down “pill mills” and attempt to eliminate the “opioid crisis.” Florida was, unfortunately, leading this trend.

The “Opioid Crisis;” Nothing New in Florida.

During this same period of time, my firm and I have been involved in defending physicians and pharmacists in criminal, civil, and administrative actions seeking to prosecute them, revoke their licenses, revoke their DEA registrations, terminate them from Medicaid participation, levy fines on them and other punitive actions. Florida was also, unfortunately, leading this trend.

So our opinions and comments in this blog, Part 1, and its Part 2, are informed by long years of experience with something that is old news in Florida, but may be new news in other states.

Alaska Sends out its Warning to Pharmacists to Keep Filling Prescriptions for Opioids.

On January 23, 2019, the Chairman of the Alaska Board of Pharmacy sent out an open letter to Alaska pharmacists, discussing the negative effect on patient health that has arisen in response to the fact that many pharmacists have stopped filling prescriptions for opioids. From its tone, it warns pharmacists to keep filling such prescriptions under threat of possible disciplinary action against their licenses, at least that is my interpretation of it. Here is a copy you can read for yourself, click here.

The two-page letter begins by stating:

The [Alaska] Board of Pharmacy has had an influx of communication concerning patients not able to get controlled substance prescriptions filled for various reasons, even when signs of forgery or fraudulence were not presented.

The letter continues stating:

As a professional reminder, failing to practice pharmacy using reasonable knowledge, skill, competence, and safety for the public may result in disciplinary actions under Alaska statute and regulation. These laws are: AS [Alaska Statutes] 08.80.261 DISCIPLINARY ACTIONS.

It then continues, quoting and citing other statutes and administrative codes under which a pharmacist could be charged for refusing to fill an opioid prescription for a patient.

Chilling? Mixed Signals? You be the Judge!

The problem I have is where is the state board of pharmacy (in any state, not just Alaska), when the DEA comes in to the pharmacy with its search warrants and arrest warrants? Where is the state board of pharmacy when the raid by local police/sheriff/multi-jurisdictional task force comes into the pharmacy? Where is the state board of pharmacy when the U.S. Attorney’s Office indicts and prosecutes the pharmacist? Where is the state board of pharmacy when the DEA issues its Order to Show Cause (OTSC) why the pharmacy’s or pharmacist’s DEA registration should not be revoked.

The state board of pharmacy is usually the one providing the expert witnesses to testify against the pharmacist or pharmacy, that’s where. The state board of pharmacy is standing by ready to take disciplinary action against the pharmacist or pharmacy, after the other government agencies get finished.

If pharmacists and pharmacies are refusing to fill prescriptions for opioids, which is something that I advise my clients to do, if they can afford to do so, then that is a smart move, until state agencies, including the state boards of pharmacy, take action to help them out of this predicament. The pharmacists are caught on the horns of a dilemma: face federal and state criminal prosecutions and actions by the DEA for filling opioid prescriptions; or face possible administrative actions by the state board of pharmacy for not filling opioid prescriptions. My advice is to choose the latter as it is much easier to defend a state administrative action, especially if you are not trying to do so from a federal prison somewhere.

The cost of defending a DEA action to revoke a DEA registration is prohibitive if done correctly, even if the pharmacist is completely innocent of any wrongdoing. The goal of these proceedings, despite the innocence of the pharmacist or pharmacy, is to put them out of business, and it almost always succeeds! Click here to read one of my prior blogs about DEA investigations of health care professionals.

To read my additional opinions on the types of actions that can be taken by states and state agencies to address the issues which the Alaska Board letter attempts to address, please see Part 2 of this blog. To read more on pill mill cases in the state of Florida, click here.

To learn more on administrative and informal hearings before the Florida Board of Pharmacy, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The Firm also represents both plaintiffs (whistle blowers or relators) and defendants in False Claims Act (whistle blower or qui tam) cases. The 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 (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., 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 the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

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“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 © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:17-04:00February 6, 2019|Categories: Uncategorized|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Alaska Board of Pharmacy Sends Letter to its Pharmacists Sending Mixed Signals Over Filling Opioid Prescriptions (Part 1 of a 2 part series)
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