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Welcome to The Health Law Blog2019-11-12T16:53:24-05:00

HHS Announces Proposed Rules to Reform Stark Law and AKS Regulations

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued two proposed rules to reform the federal Stark Law (dealing with prohibited self-referrals) and Anti-Kickback Statute (AKS) (addressing giving or receiving any thing of value in exchange for a patient referral) regulations.

The long-awaited proposed rules aim to “modernize and clarify” federal laws relevant to value-based and patient coordinated care programs. The proposals would ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.

The Proposed Stark Rule.

The proposed rule that would further implement and clarify the Stark Law, “Modernizing and Clarifying the Physician Self-Referral” would, if finalized, create new exceptions to the existing Stark Law for value-based arrangements, according to CMS. These exceptions would apply broadly to care provided to all patients, not just Medicare beneficiaries, CMS said. The proposed rule also includes additional clarifications and guidance on key statutory terms and other technical compliance requirements.

For more info, click here to view the Stark proposed rule’s fact sheet issued by CMS.

The Proposed AKS Rule.

The proposed rule to further implement and clarify the AKS, “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements” would make several changes to the AKS and beneficiary inducement provisions of the Civil Monetary Penalties Law (CMP). These changes would include the addition of several new AKS safe harbors for certain remuneration exchanged between or among eligible participants.

The new AKS safe harbors include care coordination arrangements aimed at improving quality and outcomes; value-based arrangements with substantial downside financial risk; and value-based arrangements with full financial risk, according to OIG.

Click here to view the fact sheet issued by CMS to learn more about the proposed rule.

To view the press release issued by the HHS in full, click here.

Contact Health Law Attorneys Experienced in Handling Stark Law and Anti-Kickback Statute Compliance.

If you are involved in referring or providing DHS, your arrangements must be reviewed for compliance with Stark and other anti-fraud laws. Violations of these laws can carry severe financial and criminal penalties. One of the best ways to avoid these sanctions is to have your current or potential arrangement reviewed by an attorney who is experienced in these matters.

The Health Law Firm routinely advises healthcare providers on Stark compliance issues for practitioners and providers of all types of DHS. We can advise you on the legality of a particular arrangement and can assist with remedying any perceived compliance issues. Our attorneys also represent 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.

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.

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

Sources:

Kearbey, Amy. “CMS Publishes Proposed Amendments To Stark Law Advisory Opinion Regulations.” The National Law Review. (October 9, 2019). Web.

HHS Press Office. “HHS Proposes Stark Law and Anti-Kickback Statute Reforms to Support Value-Based and Coordinated Care.” HHS.gov, U.S. Department of Health & Human Services. (October 9, 2019). Web.

“CMS, OIG Release Long-Awaited Stark, AKS Proposed Rules.”AHLA. (October 9, 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: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Stark Law defense, Stark Law representation, Anti-Kickback Statute (AKS) representation, AKS defense, AKS lawyer, AKS representation, Centers for Medicare & Medicaid Services (CMS), CMS representation, CMS defense attorney, CMS lawyer, representation for CMS investigation, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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.

Florida Doc Charged in Largest Medicare Scheme Ever Reported Involving Genetic Testing

By Carole C. Schriefer, R.N., J.D.
On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Alleged Fraudulent Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALfs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistleblower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.

KeyWords: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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.

Florida Doctor Charged for $2.1 Billion Medicare Fraud; Largest Healthcare Fraud Scheme Ever Reported

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 October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Alleged Fraudulent Orders for Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALfs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistleblower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

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: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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.

Tips to Prepare For Clinical Privileges and Peer Review Hearings Part 2 of 2

Attorney Indest headshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In Part 1 of this blog, I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of internal or external peer review hearings.

20 Tips For Successful Outcome in Peer Review Hearings (Continued):

10. If you are given the opportunity to meet with the reviewers or provide information to them, do so. If you haven’t been offered this, ask for it in writing.

11. Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12. In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses. Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13. It is never too early to engage experienced health car legal counsel to assist you in such matters. But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review hearings. This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14. If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15. If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16. If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this. For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor. We are able to obtain an affidavit from the mother swearing that she had never stated that. The peer review matter was dismissed and closed.

17. If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place. Read the handwriting on the wall. However, see #1 above. Do not resign with any type of peer review pending.

18. Remember that peer review proceedings are supposed to be confidential. Therefore work through your legal counsel in obtaining outside reviews. Do not discuss the matter with those outside the medical staff.

19. Although the peer-review process is confidential, it is not supposed to be “secretive.” The person who is the subject of peer review should have access to the complaint and medical records involved. This should not be a Star Chamber proceeding. Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20. In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up. Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again. This is especially true when it is your first “offense” and you have many years of otherwise excellent performance. The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems. However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice. You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Review Hearings.

If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.

At the Health Law Firm, we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers, and acquisitions. We also represent physicians and health care providers in complex litigation in both state and federal courts.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer-review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.

Florida Doctor Charged in Largest Medicare Fraud Scheme Ever Reported

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

On October 1, 2019, a Florida doctor was implicated in what federal investigators say is one of the largest health care fraud schemes ever charged. According to prosecutors, the doctor allegedly authorized genetic testing for patients he never met, in a state where he’s not licensed to practice.

The vast fraud scheme totaled $2.1 billion worth of false Medicare and Medicaid claims between July 2018 and January 2019. The physician is being charged in the United States District Court of New Jersey with conspiracy to commit health care fraud.

Fraudulent Orders for Genetic Testing.

Thirty-five separate defendants are now facing felony charges for their alleged participation in one of the largest health care fraud schemes ever investigated and charged. All defendants involved were somehow associated with telemedicine companies and cancer genetic testing laboratories, according to a Department of Justice (DOJ) news release. Click here to read the DOJ press release in full and learn more about the case and all the defendants being charged.

According to the release, one of the defendants, the Florida doctor, submitted fraudulent orders for genetic tests to numerous clinical laboratories. He allegedly authorized his signature on patient documents to order tests for patients he had never met, seen, treated or evaluated. Additionally, according to an indictment filed by the District Court of New Jersey, this physician received about $5,000 a month for his role as Privy Health Lab’s medical director in Illinois. During this period, according to prosecutors, he falsely reported himself as the patients’ ordering physician so that he could sign orders for the genetic testing. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that he allegedly ordered in this manner.

The Gainesville doctor faces charges of conspiracy to commit healthcare fraud following an investigation by the DOJ, U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG), and the Federal Bureau of Investigation (FBI).

To learn about a similar case of healthcare fraud dealing with genetic testing, click here to read part one and here to read part two of my blog series on a prior scam.

Innocent until Proven Guilty in a Court of Law.

We are writing this blog from information from several different media sources including those referenced below and a DOJ press release. It must be remembered that just as is consistently stated in the “Bad Boys” television series, “the defendants are presumed innocent until proven guilty in a court of law.”

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, medical practices, clinical labs, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALfs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistleblower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented several doctors and other licensed health professionals as relators in bringing qui tam or whistleblower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistleblower cases.

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

Sources:

Mavrakis, Emily. “Gainesville doctor charged for fraud over genetic testing.” The Gainesville Sun. (October 1, 2019). Web.

Villegas, Brianda. “Gainesville doctor charged in federal health care fraud case.” WCJB TV20. (October 1, 2019). Web.

U.S. Department of Justice, Press Release dated September 26, 2019, (https://www.justice.gov/usao-nj/pr/federal-health-care-fraud-takedown-northeastern-us-results-54-defendants-charged-and)

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: Healthcare fraud representation, healthcare fraud lawyer, healthcare fraud defense attorney, Whistle blower plaintiff-relator attorney, Qui tam suit plaintiff-relator attorney, False Claims Act suit plaintiff-relator attorney, Medicare audit defense attorney, Medicare audit defense legal representation, Medicare audit defense lawyer, Tricare audit defense attorney, Tricare audit defense legal representation, Tricare audit defense lawyer, Medicaid audit defense attorney, Medicaid audit defense legal representation, Medicaid audit defense lawyer, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Medicaid Fraud Control Unit (MFCU) defense lawyer, Medicare overpayment demand defense attorney, Medicare overpayment demand defense legal representation, Medicare overpayment demand defense lawyer, Office of Inspector General (OIG) investigation defense attorney, Office of Inspector General (OIG) investigation defense legal representation, Office of Inspector General (OIG) investigation defense lawyer, Civil Monetary Penalty defense attorney, Civil Monetary Penalty defense legal representation, Civil Monetary Penalty defense lawyer, Whistle blower suit defense attorney, Whistle blower suit defense legal representation, Whistle blower suit defense lawyer, Qui tam suit defense attorney, Qui Tam suit defense legal representation, Qui tam suit defense lawyer, False Claims Act suit defense attorney, False Claims Act suit defense legal representation, False Claims Act suit defense lawyer, representation for allegations of overbilling, representation for FCA investigations, Office of Inspector General (OIG) interview defense attorney, Office of Inspector General (OIG) interview defense legal representation, Office of Inspector General (OIG) interview defense lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“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.

Tips to Prepare For Clinical Privileges and Peer Review Hearings Part 2

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
In Part 1 of this blog, I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of an internal or external peer review action.

Click here to read Part 1.

20 Tips For Successful Outcome in Peer Review (Continued):

10. If you are given the opportunity to meet with the reviewers or provide information to them, do so. If you haven’t been offered this, ask for it in writing.

11. Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12. In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses. Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13. It is never too early to engage experienced health car legal counsel to assist you in such matters. But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review actions. This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14. If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15. If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16. If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this. For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor. We are able to obtain an affidavit from the mother swearing that she had never stated that. The peer review matter was dismissed and closed.

17. If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place. Read the handwriting on the wall. However, see #1 above. Do not resign with any type of peer review pending.

18. Remember that peer review proceedings are supposed to be confidential. Therefore work through your legal counsel in obtaining outside reviews. Do not discuss the matter with those outside the medical staff.

19. Although the peer-review process is confidential, it is not supposed to be “secretive.” The person who is the subject of peer review should have access to the complaint and medical records involved. This should not be a Star Chamber proceeding. Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20. In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up. Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again. This is especially true when it is your first “offense” and you have many years of otherwise excellent performance. The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems. However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice. You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog.

For more information, read one of my prior blogs on peer review hearings, avoiding the disruptive physician label and clinical privileges.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Reviews.

If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.

At the Health Law Firm, we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers, and acquisitions. We also represent physicians and health care providers in complex litigation in both state and federal courts.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.

Tips to Prepare For Clinical Privileges and Peer Review Hearings Part 1

Attorney Indest headshotIf you are a physician or licensed other licensed health professional with clinical privileges in a hospital, chances are that one day you will be subject to peer review hearings. It may be a simple one-time matter based on an adverse outcome, or it may be a lengthy process involving a large number or your cases and records.

A peer review action may be initiated because of a patient complaint. It may be commenced because of complaints filed by hospital staff. It may be begun because of an unexpected adverse outcome. It may be begun because a patient files a medical malpractice lawsuit. It may result from a statistical review by the Utilization Review office or the Quality Improvement office.

This is part 1 of a 2 part blog series. Click here to read part 2.

A Notice of A Peer Review Should Not Be Treated Lightly.

Regardless of the source, or how petty or meritless it may seem, the health professional who is the subject of the peer review must treat it seriously. The actions you take may resolve the matter at a preliminary stage or it may cause an escalation to a hearing, adverse action, and a National Practitioner Data Bank (NPDB) Report, with career-ending results.

Tips to Survive Peer Review Hearings.

The following are tips that the individual who is the subject of a peer review action that may help you to resolve it at the lowest level feasible under the circumstances.

1. Do not resign or allow your clinical privileges to expire while the matter is pending. If you do so, this will be treated similarly to having your privileges revoked in clinical privileges matters and it will be reported out as such to the NPDB and other reporting organizations.

2. Provide a response or explanation if given the opportunity. But make sure you have reviewed the records, researched the medical issues as appropriate, and provide a well-organized, thought-out, objective and professional response.

3. Remember that this review is only about you and your actions. It is not about anyone else and this is not the place to make accusations about others. Discuss what you did (or did not do); do not point the finger at others and argue that they have done the same thing or worse.

4. Remain objective. Do not lose your temper and respond in a defensive, inflammatory matter. Assume that everyone is just trying to do their jobs.

5. In any written response, address the facts. Do not address what you think the motives of other individuals are.

6. Make sure your response is objective. Try to avoid subjective statements. Speak in terms of provable facts and what the record or other documents show. If you have documents (e.g., office records, algorithms, standards, guidelines) that those conducting the peer review do not have, attach them to your response.

7. Make sure your response is professional. Follow the rules for professional correspondence, that I wrote about in a prior blog.

8. If you don’t have all of the records on the matter, ask for them. Also, obtain and review any applicable hospital or department policies and procedures. Review the medical staff Rules and Regulations, as well.

9. Support and explain what you did logically and reference medical journal articles and medical treatises. Attach legible copies of any relevant medical literature (or relevant portions of it). Be sure to completely identify any medical literature you attach by including a title page, publication info, date, volume, pages, etc.

To find out the rest of the tips, don’t miss Part 2 of this blog series.

For more information, read one of my prior blogs on peer review hearings, avoiding the disruptive physician label and clinical privileges.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in Clinical Privileges and the Peer Review Process.

If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.

At the Health Law Firm we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions. We also represent physicians and health care providers in complex litigation in both state and federal courts.

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.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer-review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians, health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“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.

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