Centene Will Pay $19 Million to Washington State For Medicaid Fraud Allegations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.
The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.
Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s office. In addition, a whistleblower who sued the company on behalf of the state will also receive $1 million. It is the second-largest Medicaid fraud settlement in Washington’s history.
An Investigation and a Whistleblower.
According to the press release, the Washington AG’s office began investigating pharmacy benefit managers in 2019 after a whistleblower said the company failed to disclose actual pharmacy benefits and service costs. Furthermore, Centene allegedly failed to pass on discounts it received to the state Medicaid program, causing inflated fees, according to the release.
Washington sued Centene in July 2022, alleging the company and a subsidiary, Coordinated Care of Washington, violated the state’s Medicaid False Claims Act. Coordinated Care of Washington contracts with Washington’s Health Care Authority to manage its Medicaid program, Apple Health.
Shelling Out Big Bucks For Settlements.
Centene did not admit to any wrongdoing in this case, as is usual with settlement agreements. “This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making healthcare delivery local, simple and transparent,” Centene’s spokesperson said.
But, while denying any wrongdoing, it has settled claims over similar alleged conduct in ten other states for more than $260 million. Additionally, it said last year that it was still in negotiations with more states and had set aside $1.25 billion to settle such claims. Click here to learn more.
To view the settlement agreement in full, click here.
Similar Patterns of Misconduct?
We need to ask: “Is this the business model of Centene and its different owned subsidiary companies?” We note that on March 22, 2022, the Centers for Medicare and Medicaid Services (CMS) assessed civil monetary penalties (CMP) against Centene Corporation for similar alleged wrongful activities involving the states of California, South Carolina, Texas, Ohio, Michigan, and others. And in a letter dated March 11, 2022, the Florida Agency for Health Care Administration issued a $9.1 million fine over Centene/Sunshine Health’s improper failure to pay benefits to Florida’s neediest, sick children. We have not found any report that Centene challenged or appealed either government penalty.
When multiple billions of dollars in government contracts are handed out to one contractor, and it is the subject of so many allegedly wrongful acts, one must ask if it is just treating such penalties and fines as the routine costs of doing business. Considering that $9.1 million is less than three (3) hundredths of a percent (.0003) of its $31 billion in contracts with the state of Florida, this cost may not even be significant enough for it to post on its profit ad loss statements.
Contact Health Law Attorneys Experienced with Medicare and Medicaid Audits, Healthcare Audits, and Insurance Payment Disputes.
The attorneys of The Health Law Firm represent counselors, therapists, physicians, healthcare providers and healthcare facilities in defense of Medicare and Medicaid audits, audits by insurance companies and managed care, and demands for repayment of overpayments. They represent healthcare providers in audits, audit appeals and repayment disputes against Centene Corporation and Sunshine Sate Health Plan d/b/a Sunshine Health. They also represent healthcare providers in defense against allegations of false billing, overbilling, False Claims Act violations and civil monetary penalties (CMP).
Our attorneys represent physicians, mental health counselors, behavior therapists, professional counselors, occupational therapists, social workers, medical groups, home health agencies, pharmacies, pharmacists, home nursing care providers, and other healthcare providers and institutions.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Redmond, Nell. “Centene to pay $33.3 million to settle Washington Medicaid fraud claims.” Reuters. (August 25, 2022). Web.
Elletson, Grace. “Centene Strikes $33M Deal To End Wash. Medicaid Fraud Suit.” Law360. (September 2, 2022). Web.
Health Law Weekly. “Centene Will Pay $19 Million to Resolve Medicaid Fraud Allegations.” AHLA. (September 2, 2022). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
KeyWords: Medicare Medicaid audit defense lawyer, legal representation in Medicaid managed care plan audit defense, Medicaid managed care plan audit legal defense attorney, Medicare Medicaid overpayment demand defense attorney, legal representation in Medicaid managed care plan overpayment demand, Medicaid managed care plan audit appeal attorney, legal representation in Medicaid managed care plan audit appeal, Medicare Medicaid audit appeal lawyer, Medicare Medicaid audit overpayment demand defense attorney, Centene Sunshine State Health Plan audit legal defense attorney, legal representation in Centene Sunshine State Health Plan audit, Centene Sunshine State Health Plan audit overpayment demand defense lawyer, legal representation in Centene Sunshine State Health Plan audit overpayment demand, Centene Sunshine State Health Plan audit overpayment appeal lawyer, legal representation in Centene Sunshine State Health Plan audit overpayment appeal, healthcare fraud defense legal representation, Medicare Medicaid audit defense attorney, Medicare Medicaid investigation defense lawyer, legal representation in Medicaid managed care plan HMO audit, Medicaid managed care plan HMO audit defense attorney, Medicaid managed care plan HMO audit appeal attorney, Medicaid managed care plan HMO overpayment defense lawyer, Centers for Medicare & Medicaid Services (CMS) defense attorney, CMS legal defense representation, health insurance audit defense attorney, CMS defense attorney, CMS legal defense lawyer, legal representation for CMS investigation, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Office of Inspector General (OIG) investigation defense attorney, civil monetary penalty hearing, reviews of The Health Law Firm, The Health Law Firm attorney reviews, False Claims Act (FCA) suit defense attorney, Office of Inspector General (OIG) interview defense attorney, Department of Health and Human Services (HHS) subpoena defense attorney, Department of Health and Human Services (HHS) civil investigative demand (CID) defense attorney, legal representation for healthcare professionals, Florida health law defense attorney
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
Follow These Simple Rules To Keep Your License & Avoid Complaints If You Are a Counselor or Psychotherapists
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
I represent many mental health counselors, social workers, psychologists, and professional counselors, defending them on complaints being investigated against their professional licenses. Many complaints and investigations arise because the therapist has strayed over the line and crossed the therapist-client boundary. In reviewing these cases, I have drawn up a list of a few simple “bright line” rules that can help save you many hours of stress and mental anguish as well as thousands of dollars in attorney’s fees and costs defending yourself
These “rules” may seem to be common sense, but there they are, anyway:
1. DO NOT ever meet the client at an outside social activity or attend a social event with the client. This includes “just dinner” or “just-drinks.”
2. DO NOT text the client. Texting is not secure and leads to casual and unprofessional thinking and conversation with the client. Many health care institutions prohibit their physicians and employees from texting with clients because of the HIPAA Security and Privacy Rules. You can use that as an excuse if you need one.
3. DO take a screenshot and print out the text when you violate the above rule. Place it in the client’s health record because you will probably be seeing it again, attached to a complaint.
4. DO send an e-mail or, better yet, a professional letter to the client, instead of texting the client. Print out a copy and place it in the client’s health record, because you will probably see it again.
5. DO NOT EVER make any suggestive or sexual remarks to the client in any communications, oral or written or text, or e-mail. In fact, DON’T even think about it. This includes off-color jokes and comments.
6. DO immediately terminate the relationship with the client, transferring care to a different therapist, if the client suggests anything of a sexual nature involving you.
7. DO NOT talk about other clients with the client.
8. DO NOT talk about your own personal life with the client. Especially DO NOT let the client have your personal home address or personal e-mail address.
9. DO NOT ever have sex with a client or former client. DO NOT even think of it. If you start to think of it, see Rule 6, above. Consider clients and former clients “off-limits” no matter how much you are tempted. If you are religious, just consider this as an attempt by Satan to seduce you. If it works, you are going to be in Hell, even before you die.
10. DO know what professional boundaries are and DO NOT cross them. This includes allowing a personal relationship to grow between you and the client, and includes selling anything to the client (e.g., Girl Scout cookies, tickets to a charitable event, Amway products, candy bars for your kids’ school band, etc.), agreeing to meet the client at any outside event, accepting gifts from the client, hiring the client to work for you, accepting “voluntary” services from the client (including volunteering to work in your office). If you need a friend that bad, terminate the therapist-client relationship and see Rule 6, above.
11. DO know that if you have even a suspicion that your therapist-client relationship is getting out of bounds, then it already is out of bounds. See Rule 6, above.
12. DO call a professional therapist colleague who is more senior to you and consult her or him about the “situation” if you think there may be a “situation.”
These may sound like “no-brainers” to you, but you would be surprised at how many complaints against licensed counselors and psychologists there are as a result of violating one or more of these “rules.”
(Note: These “rules” are just guidelines meant to help you keep out of trouble; these are not meant to be enforced against anyone, nor do they create or represent any “standard of care.”)
For additional information on how our firm can assist you in matters like this, click here to read one of our prior blogs.
Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.
The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers, and family therapists in Department of Health (DOH) investigations, Department of Regulatory Agencies (DORA) investigations, board hearings, FBI investigations, and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
We also defend health professionals and health facilities in general litigation matters and business litigation matters.
To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.
Centene Will Pay $19 Million Settlement to Washington State For Medicaid Fraud Allegations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.
The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.
Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s office. In addition, a whistleblower who sued the company on behalf of the state will also receive $1 million. It is the second-largest Medicaid fraud settlement in Washington’s history.
An Investigation and a Whistleblower.
According to the press release, the Washington AG’s office began investigating pharmacy benefit managers in 2019 after a whistleblower said the company failed to disclose actual pharmacy benefits and service costs. Furthermore, Centene allegedly failed to pass on discounts it received to the state Medicaid program, causing inflated fees, according to the release.
Washington sued Centene in July 2022, alleging the company and a subsidiary, Coordinated Care of Washington, violated the state’s Medicaid False Claims Act. Coordinated Care of Washington contracts with Washington’s Health Care Authority to manage its Medicaid program, Apple Health.
Shelling Out Big Bucks For Settlements.
Centene did not admit to any wrongdoing in this case, as is usual with settlement agreements. “This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making healthcare delivery local, simple and transparent,” Centene’s spokesperson said.
But, while denying any wrongdoing, it has settled claims over similar alleged conduct in ten other states for more than $260 million. Additionally, it said last year that it was still in negotiations with more states and had set aside $1.25 billion to settle such claims. Click here to learn more.
To view the settlement agreement in full, click here.
Similar Patterns of Misconduct?
We need to ask: “Is this the business model of Centene and its different owned subsidiary companies?” We note that on March 22, 2022, the Centers for Medicare and Medicaid Services (CMS) assessed civil monetary penalties (CMP) against Centene Corporation for similar alleged wrongful activities involving the states of California, South Carolina, Texas, Ohio, Michigan, and others. And in a letter dated March 11, 2022, the Florida Agency for Health Care Administration issued a $9.1 million fine over Centene/Sunshine Health’s improper failure to pay benefits to Florida’s neediest, sick children. We have not found any report that Centene challenged or appealed either government penalty.
When multiple billions of dollars in government contracts are handed out to one contractor, and it is the subject of so many allegedly wrongful acts, one must ask if it is just treating such penalties and fines as the routine costs of doing business. Considering that $9.1 million is less than three (3) hundredths of a percent (.0003) of its $31 billion in contracts with the state of Florida, this cost may not even be significant enough for it to post on its profit ad loss statements.
Contact Health Law Attorneys Experienced with Medicare and Medicaid Audits, Healthcare Audits, and Insurance Payment Disputes.
The attorneys of The Health Law Firm represent counselors, therapists, physicians, healthcare providers and healthcare facilities in defense of Medicare and Medicaid audits, audits by insurance companies and managed care, and demands for repayment of overpayments. They represent healthcare providers in audits, audit appeals and repayment disputes against Centene Corporation and Sunshine Sate Health Plan d/b/a Sunshine Health. They also represent healthcare providers in defense against allegations of false billing, overbilling, False Claims Act violations and civil monetary penalties (CMP).
Our attorneys represent physicians, mental health counselors, behavior therapists, professional counselors, occupational therapists, social workers, medical groups, home health agencies, pharmacies, pharmacists, home nursing care providers, and other healthcare providers and institutions.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Redmond, Nell. “Centene to pay $33.3 million to settle Washington Medicaid fraud claims.” Reuters. (August 25, 2022). Web.
Elletson, Grace. “Centene Strikes $33M Deal To End Wash. Medicaid Fraud Suit.” Law360. (September 2, 2022). Web.
Health Law Weekly. “Centene Will Pay $19 Million to Resolve Medicaid Fraud Allegations.” AHLA. (September 2, 2022). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
KeyWords: Medicare Medicaid audit defense lawyer, legal representation in Medicaid managed care plan audit defense, Medicaid managed care plan audit legal defense attorney, Medicare Medicaid overpayment demand defense attorney, legal representation in Medicaid managed care plan overpayment demand, Medicaid managed care plan audit appeal attorney, legal representation in Medicaid managed care plan audit appeal, Medicare Medicaid audit appeal lawyer, Medicare Medicaid audit overpayment demand defense attorney, Centene Sunshine State Health Plan audit legal defense attorney, legal representation in Centene Sunshine State Health Plan audit, Centene Sunshine State Health Plan audit overpayment demand defense lawyer, legal representation in Centene Sunshine State Health Plan audit overpayment demand, Centene Sunshine State Health Plan audit overpayment appeal lawyer, legal representation in Centene Sunshine State Health Plan audit overpayment appeal, healthcare fraud defense legal representation, Medicare Medicaid audit defense attorney, Medicare Medicaid investigation defense lawyer, legal representation in Medicaid managed care plan HMO audit, Medicaid managed care plan HMO audit defense attorney, Medicaid managed care plan HMO audit appeal attorney, Medicaid managed care plan HMO overpayment defense lawyer, Centers for Medicare & Medicaid Services (CMS) defense attorney, CMS legal defense representation, health insurance audit defense attorney, CMS defense attorney, CMS legal defense lawyer, legal representation for CMS investigation, Medicaid Fraud Control Unit (MFCU) defense attorney, Medicaid Fraud Control Unit (MFCU) defense legal representation, Office of Inspector General (OIG) investigation defense attorney, civil monetary penalty hearing, reviews of The Health Law Firm, The Health Law Firm attorney reviews, False Claims Act (FCA) suit defense attorney, Office of Inspector General (OIG) interview defense attorney, Department of Health and Human Services (HHS) subpoena defense attorney, Department of Health and Human Services (HHS) civil investigative demand (CID) defense attorney, legal representation for healthcare professionals, Florida health law defense attorney
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
A Criminal Offense On Your Record Can Prevent You from Obtaining Your License in Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Someone arrested for a criminal offense knows that it can lead to a criminal record that may or may not be on your record for the rest of your life. However, once you pay your fine and carry out any other disciplinary action the court has ordered, you expect the consequences to be over. In many cases, the arrest and offense can even be sealed or expunged so that it is no longer on your record. However, in the case of someone who desires to apply for a license in the health care field or who is already licensed, this is not the end of the consequences you will face.
For healthcare professionals, a criminal charge can mean being disqualified from obtaining a license or losing your license to practice. Conviction of certain criminal offenses may even mean exclusion from being a Medicare provider or termination from the state Medicaid Program, which can also be grounds for revoking your license. Criminal charges against a health professional can have serious and long-lasting consequences.
How Criminal Charges Impact Your Professional License.
Licensing authorities are charged by statute with protecting the general public, not the individuals they regulate. Most state laws regulating health practitioners include criminal convictions as one of the grounds for denial or discipline of a professional license. Some state laws (for example, Florida’s) allow the state licensing authority to impose discipline upon a nolo contendere (no contest) plea or even when adjudication is withheld or deferred by the court.
State regulatory authorities can and do impose discipline based on the facts underlying a conviction, even when the conviction itself is not directly related to the practice of a profession. For example, a conviction for driving under the influence (DUI) or reckless driving may raise the question with the licensing authority of whether the practitioner could be impaired or reckless while providing patient care. The licensing authority will likely investigate these matters and the facts underlying the offense to determine if the practitioner threatens the public.
Therefore, if you have been arrested for DUI, disorderly conduct, assault, or any other misdemeanor, you can anticipate that the state, the Department of Health (DOH), or the Department of Licensing and Regulatory Affairs will start an investigation. You must retain an attorney who can immediately defend your freedom during your criminal case and protect your livelihood during licensing proceedings.
Mandatory Report of Conviction of Felony or Misdemeanor Charge.
In the event of a conviction, this may trigger a required report to the state licensing board within a certain period. Some states only require a report at the time of renewal of the license. Other states require a report within thirty days of the disposition of the offense. Still others, like Florida, may have multiple actions the provider must take in such instances.
For example, certain licensed health professionals in Florida must maintain an online provider profile. Those who must maintain a profile in Florida include medical doctors, podiatrists, nurse practitioners, and chiropractors. State law requires that for any change in the information required on the profile (a conviction, for example), the profile must be updated within fifteen (15) days. In addition, Florida law requires a written report be made to the professional licensing board of any licensed health provider within thirty (30) days of the disposition of the offense.
Suppose you have been arrested and are facing felony or misdemeanor charges. In that case, you must seek the advice and experience of an attorney who can help you and your criminal defense attorney to analyze different outcomes to help protect your license.
Health professionals who have been arrested generally want their criminal cases resolved as quickly and quietly as possible. Unfortunately, they may inadvertently accept a plea arrangement that results in later severe discipline or revocation of their professional license. All health professionals and their criminal defense attorneys should consider the consequences of the practitioner’s license before accepting a plea arrangement and should consult with an experienced health law attorney. Click here to read one of our prior blogs for more information on this.
Remember, your health profession is probably your only means of support. You must realize that you may need additional legal help from an experienced healthcare attorney to maintain it.
The disciplinary process is often long and extremely costly. The effects of discipline on your license can follow you for the remainder of your career and is publicly available to anyone who cares to look. If you have been arrested, it is strongly recommended that you retain an experienced healthcare attorney who can advise you and your criminal counsel on the effects of a potential outcome on your license.
Contact Health Law Attorneys Experienced in Handling Licensure Matter and Disciplinary Matters.
The Health Law Firm routinely represents physicians, pharmacists, dentists, nurses, mental health counselors, social workers, and other health practitioners in licensure matters. We frequently consult with criminal defense attorneys regarding defense strategies tailored to minimizing criminal sanctions while at the same time preserving the practitioner’s license.
To contact The Health Law Firm, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
KeyWords: Health care license defense representation, professional license legal defense, representation for professional license suspension, reporting physician arrests and convictions, health care license defense attorney, medical license defense attorney, reporting criminal conviction for doctor or health professional, report arrest for physician or health professional, mental health counselor defense lawyer, representation for physician criminal charges, representation for nurse criminal charges, representation for dentist criminal charges, Department of Health (DOH) conviction report, misdemeanor offense physician lawyer, Department of Health (DOH) investigation defense attorney, DOH complaint investigation legal defense representation, DOH defense attorney, legal representation in DOH investigation, representation for license suspension, license revocation attorney, representation for health care professionals, legal representation for administrative hearing, representation for administrative appeals, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Florida health law defense attorney, Medicare exclusion defense attorney, Office of Inspector General (OIG) exclusion defense lawyer, legalrepesntatin in Office of Inspector General (OIG) exclusion, Office of the Inspector General (OIG) health care complaint, defense of relinquishment of DEA number, DEA order to show cause (OSC) hearing attorney
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
A Criminal Record Can Prevent You from Obtaining Your License in Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Someone arrested for a criminal offense knows that it can lead to a criminal record that may or may not be on your record for the rest of your life. However, once you pay your fine and carry out any other disciplinary action the court has ordered, you expect the consequences to be over. In many cases, the arrest and offense can even be sealed or expunged so that it is no longer on your record. However, in the case of someone who desires to apply for a license in the health care field or who is already licensed, this is not the end of the consequences you will face.
For healthcare professionals, a criminal charge can mean being disqualified from obtaining a license or losing your license to practice. Conviction of certain criminal offenses may even mean exclusion from being a Medicare provider or termination from the state Medicaid Program, which can also be grounds for revoking your license. Criminal charges against a health professional can have serious and long-lasting consequences.
How Criminal Charges Impact Your Professional License.
Licensing authorities are charged by statute with protecting the general public, not the individuals they regulate. Most state laws regulating health practitioners include criminal convictions as one of the grounds for denial or discipline of a professional license. Some state laws (for example, Florida’s) allow the state licensing authority to impose discipline upon a nolo contendere (no contest) plea or even when adjudication is withheld or deferred by the court.
State regulatory authorities can and do impose discipline based on the facts underlying a conviction, even when the conviction itself is not directly related to the practice of a profession. For example, a conviction for driving under the influence (DUI) or reckless driving may raise the question with the licensing authority of whether the practitioner could be impaired or reckless while providing patient care. The licensing authority will likely investigate these matters and the facts underlying the offense to determine if the practitioner threatens the public.
Therefore, if you have been arrested for DUI, disorderly conduct, assault, or any other misdemeanor, you can anticipate that the state, the Department of Health (DOH), or the Department of Licensing and Regulatory Affairs will start an investigation. You must retain an attorney who can immediately defend your freedom during your criminal case and protect your livelihood during licensing proceedings.
Mandatory Report of Conviction of Felony or Misdemeanor Charge.
In the event of a conviction, this may trigger a required report to the state licensing board within a certain period. Some states only require a report at the time of renewal of the license. Other states require a report within thirty days of the disposition of the offense. Still others, like Florida, may have multiple actions the provider must take in such instances.
For example, certain licensed health professionals in Florida must maintain an online provider profile. Those who must maintain a profile in Florida include medical doctors, podiatrists, nurse practitioners, and chiropractors. State law requires that for any change in the information required on the profile (a conviction, for example), the profile must be updated within fifteen (15) days. In addition, Florida law requires a written report be made to the professional licensing board of any licensed health provider within thirty (30) days of the disposition of the offense.
Suppose you have been arrested and are facing felony or misdemeanor charges. In that case, you must seek the advice and experience of an attorney who can help you and your criminal defense attorney to analyze different outcomes to help protect your license.
Health professionals who have been arrested generally want their criminal cases resolved as quickly and quietly as possible. Unfortunately, they may inadvertently accept a plea arrangement that results in later severe discipline or revocation of their professional license. All health professionals and their criminal defense attorneys should consider the consequences of the practitioner’s license before accepting a plea arrangement and should consult with an experienced health law attorney. Click here to read one of our prior blogs for more information on this.
Remember, your health profession is probably your only means of support. You must realize that you may need additional legal help from an experienced healthcare attorney to maintain it.
The disciplinary process is often long and extremely costly. The effects of discipline on your license can follow you for the remainder of your career and is publicly available to anyone who cares to look. If you have been arrested, it is strongly recommended that you retain an experienced healthcare attorney who can advise you and your criminal counsel on the effects of a potential outcome on your license.
Contact Health Law Attorneys Experienced in Handling Licensure Matter and Disciplinary Matters.
The Health Law Firm routinely represents physicians, pharmacists, dentists, nurses, mental health counselors, social workers, and other health practitioners in licensure matters. We frequently consult with criminal defense attorneys regarding defense strategies tailored to minimizing criminal sanctions while at the same time preserving the practitioner’s license.
To contact The Health Law Firm, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
KeyWords: Health care license defense representation, professional license legal defense, representation for professional license suspension, reporting physician arrests and convictions, health care license defense attorney, medical license defense attorney, reporting criminal conviction for doctor or health professional, report arrest for physician or health professional, mental health counselor defense lawyer, representation for physician criminal charges, representation for nurse criminal charges, representation for dentist criminal charges, Department of Health (DOH) conviction report, misdemeanor offense physician lawyer, Department of Health (DOH) investigation defense attorney, DOH complaint investigation legal defense representation, DOH defense attorney, legal representation in DOH investigation, representation for license suspension, license revocation attorney, representation for health care professionals, legal representation for administrative hearing, representation for administrative appeals, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Florida health law defense attorney, Medicare exclusion defense attorney, Office of Inspector General (OIG) exclusion defense lawyer, legalrepesntatin in Office of Inspector General (OIG) exclusion, Office of the Inspector General (OIG) health care complaint, defense of relinquishment of DEA number, DEA order to show cause (OSC) hearing attorney
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
From the archives: A Criminal Offense Can Prevent You from Obtaining Your License in Florida
Previously published on October 14, 2022
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Someone arrested for a criminal offense knows that it can lead to a criminal record that may or may not be on your record for the rest of your life. However, once you pay your fine and carry out any other disciplinary action the court has ordered, you expect the consequences to be over. In many cases, the arrest and offense can even be sealed or expunged so that it is no longer on your record. However, in the case of someone who desires to apply for a license in the health care field or who is already licensed, this is not the end of the consequences you will face.
For healthcare professionals, a criminal charge can mean being disqualified from obtaining a license or losing your license to practice. Conviction of certain criminal offenses may even mean exclusion from being a Medicare provider or termination from the state Medicaid Program, which can also be grounds for revoking your license. Criminal charges against a health professional can have serious and long-lasting consequences.
How Criminal Charges Impact Your Professional License.
Licensing authorities are charged by statute with protecting the general public, not the individuals they regulate. Most state laws regulating health practitioners include criminal convictions as one of the grounds for denial or discipline of a professional license. Some state laws (for example, Florida’s) allow the state licensing authority to impose discipline upon a nolo contendere (no contest) plea or even when adjudication is withheld or deferred by the court.
State regulatory authorities can and do impose discipline based on the facts underlying a conviction, even when the conviction itself is not directly related to the practice of a profession. For example, a conviction for driving under the influence (DUI) or reckless driving may raise the question with the licensing authority of whether the practitioner could be impaired or reckless while providing patient care. The licensing authority will likely investigate these matters and the facts underlying the offense to determine if the practitioner threatens the public.
Therefore, if you have been arrested for DUI, disorderly conduct, assault, or any other misdemeanor, you can anticipate that the state, the Department of Health (DOH), or the Department of Licensing and Regulatory Affairs will start an investigation. You must retain an attorney who can immediately defend your freedom during your criminal case and protect your livelihood during licensing proceedings.
Mandatory Report of Conviction of Felony or Misdemeanor Charge.
In the event of a conviction, this may trigger a required report to the state licensing board within a certain period. Some states only require a report at the time of renewal of the license. Other states require a report within thirty days of the disposition of the offense. Still others, like Florida, may have multiple actions the provider must take in such instances.
For example, certain licensed health professionals in Florida must maintain an online provider profile. Those who must maintain a profile in Florida include medical doctors, podiatrists, nurse practitioners, and chiropractors. State law requires that for any change in the information required on the profile (a conviction, for example), the profile must be updated within fifteen (15) days. In addition, Florida law requires a written report be made to the professional licensing board of any licensed health provider within thirty (30) days of the disposition of the offense.
Suppose you have been arrested and are facing felony or misdemeanor charges. In that case, you must seek the advice and experience of an attorney who can help you and your criminal defense attorney to analyze different outcomes to help protect your license.
Health professionals who have been arrested generally want their criminal cases resolved as quickly and quietly as possible. Unfortunately, they may inadvertently accept a plea arrangement that results in later severe discipline or revocation of their professional license. All health professionals and their criminal defense attorneys should consider the consequences of the practitioner’s license before accepting a plea arrangement and should consult with an experienced health law attorney. Click here to read one of our prior blogs for more information on this.
Remember, your health profession is probably your only means of support. You must realize that you may need additional legal help from an experienced healthcare attorney to maintain it.
The disciplinary process is often long and extremely costly. The effects of discipline on your license can follow you for the remainder of your career and is publicly available to anyone who cares to look. If you have been arrested, it is strongly recommended that you retain an experienced healthcare attorney who can advise you and your criminal counsel on the effects of a potential outcome on your license.
Contact Health Law Attorneys Experienced in Handling Licensure Matter and Disciplinary Matters.
The Health Law Firm routinely represents physicians, pharmacists, dentists, nurses, mental health counselors, social workers, and other health practitioners in licensure matters. We frequently consult with criminal defense attorneys regarding defense strategies tailored to minimizing criminal sanctions while at the same time preserving the practitioner’s license.
To contact The Health Law Firm, call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
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Copyright © 2022 The Health Law Firm. All rights reserved.
Centene to Pay Washington State $19 Million to Resolve Medicaid Fraud Allegations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.
The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.
Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s office. In addition, a whistleblower who sued the company on behalf of the state will also receive $1 million. It is the second-largest Medicaid fraud settlement in Washington’s history.
An Investigation and a Whistleblower.
According to the press release, the Washington AG’s office began investigating pharmacy benefit managers in 2019 after a whistleblower said the company failed to disclose actual pharmacy benefits and service costs. Furthermore, Centene allegedly failed to pass on discounts it received to the state Medicaid program, causing inflated fees, according to the release.
Washington sued Centene in July 2022, alleging the company and a subsidiary, Coordinated Care of Washington, violated the state’s Medicaid False Claims Act. Coordinated Care of Washington contracts with Washington’s Health Care Authority to manage its Medicaid program, Apple Health.
Shelling Out Big Bucks For Settlements.
Centene did not admit to any wrongdoing in this case, as is usual with settlement agreements. “This no-fault agreement reflects the significance we place on addressing their concerns and our ongoing commitment to making healthcare delivery local, simple and transparent,” Centene’s spokesperson said.
But, while denying any wrongdoing, it has settled claims over similar alleged conduct in ten other states for more than $260 million. Additionally, it said last year that it was still in negotiations with more states and had set aside $1.25 billion to settle such claims. Click here to learn more.
To view the settlement agreement in full, click here.
Similar Patterns of Misconduct?
We need to ask: “Is this the business model of Centene and its different owned subsidiary companies?” We note that on March 22, 2022, the Centers for Medicare and Medicaid Services (CMS) assessed civil monetary penalties (CMP) against Centene Corporation for similar alleged wrongful activities involving the states of California, South Carolina, Texas, Ohio, Michigan, and others. And in a letter dated March 11, 2022, the Florida Agency for Health Care Administration issued a $9.1 million fine over Centene/Sunshine Health’s improper failure to pay benefits to Florida’s neediest, sick children. We have not found any report that Centene challenged or appealed either government penalty.
When multiple billions of dollars in government contracts are handed out to one contractor, and it is the subject of so many allegedly wrongful acts, one must ask if it is just treating such penalties and fines as the routine costs of doing business. Considering that $9.1 million is less than three (3) hundredths of a percent (.0003) of its $31 billion in contracts with the state of Florida, this cost may not even be significant enough for it to post on its profit ad loss statements.
Contact Health Law Attorneys Experienced with Medicare and Medicaid Audits, Healthcare Audits, and Insurance Payment Disputes.
The attorneys of The Health Law Firm represent counselors, therapists, physicians, healthcare providers and healthcare facilities in defense of Medicare and Medicaid audits, audits by insurance companies and managed care, and demands for repayment of overpayments. They represent healthcare providers in audits, audit appeals and repayment disputes against Centene Corporation and Sunshine Sate Health Plan d/b/a Sunshine Health. They also represent healthcare providers in defense against allegations of false billing, overbilling, False Claims Act violations and civil monetary penalties (CMP).
Our attorneys represent physicians, mental health counselors, behavior therapists, professional counselors, occupational therapists, social workers, medical groups, home health agencies, pharmacies, pharmacists, home nursing care providers, and other healthcare providers and institutions.
To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Redmond, Nell. “Centene to pay $33.3 million to settle Washington Medicaid fraud claims.” Reuters. (August 25, 2022). Web.
Elletson, Grace. “Centene Strikes $33M Deal To End Wash. Medicaid Fraud Suit.” Law360. (September 2, 2022). Web.
Health Law Weekly. “Centene Will Pay $19 Million to Resolve Medicaid Fraud Allegations.” AHLA. (September 2, 2022). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in the practice of health law. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
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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 © 2022 The Health Law Firm. All rights reserved.
Tele-behavioral Health: Important Legal Considerations for Mental Health Providers
Starting in 2020 and throughout the COVID-19 pandemic, tele-behavioral health services, also known as “e-counseling,” rapidly expanded. Because individuals were quarantined or fearful to venture out, remote mental health care services became very popular among patients. A study published in The Journal of the American Medical Association (JAMA), including 36 million working-age individuals, revealed that tele-health services increased by 766% in the first three months of the pandemic.
What is Tele-behavioral Health?
1. One-on-one and group therapy
2. Substance abuse counseling
3. Medication management and prescribing
4. Anxiety and depression monitoring
5. Mental health screening
6. Referrals
The Downside to Tele-behavioral Health.
1. Obtain the necessary training to provide telebehavioral health services. Take continuing education units (CEUs) in tele-behavioral health and retain any certificates of completion associated with those CEUs.
2. Determine whether tele-behavioral health treatment is in the client’s best interest. The provider should consider the following: Can the client effectively use the technology required for tele-behavioral health? Does the client’s insurance cover telebehavioral health services? Is the client emotionally and cognitively compatible with this treatment modality?
3. Obtain informed consent from the client. In addition, document the purpose of the counseling, the use of technology to facilitate the tele-behavioral health services, and confidentiality and privacy. Obtain informed consent by having the client sign a consent form. Have a document record of the consent process and consent form in the client’s file.
6. Providers must check their state and third-party requirements related to tele-behavioral health services, credentialing, and licensure. Contact your respective licensing board for additional information and consult a health law attorney if unsure.
Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.
Sources:
About the Author: Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office. 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.
Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.
Mental Health Counselors and Psychotherapists: Simple Rules for Keeping Your License and Avoiding Complaints
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
I represent many mental health counselors, social workers, psychologists, and professional counselors, defending them on complaints being investigated against their professional licenses. Many complaints and investigations arise because the therapist has strayed over the line and crossed the therapist-client boundary. In reviewing these cases, I have drawn up a list of a few simple “bright line” rules that can help save you many hours of stress and mental anguish as well as thousands of dollars in attorney’s fees and costs defending yourself
These “rules” may seem to be common sense, but there they are, anyway:
1. DO NOT ever meet the client at an outside social activity or attend a social event with the client. This includes “just dinner” or “just-drinks.”
2. DO NOT text the client. Texting is not secure and leads to casual and unprofessional thinking and conversation with the client. Many health care institutions prohibit their physicians and employees from texting with clients because of the HIPAA Security and Privacy Rules. You can use that as an excuse if you need one.
3. DO take a screenshot and print out the text when you violate the above rule. Place it in the client’s health record because you will probably be seeing it again, attached to a complaint.
4. DO send an e-mail or, better yet, a professional letter to the client, instead of texting the client. Print out a copy and place it in the client’s health record, because you will probably see it again.
5. DO NOT EVER make any suggestive or sexual remarks to the client in any communications, oral or written or text, or e-mail. In fact, DON’T even think about it. This includes off-color jokes and comments.
6. DO immediately terminate the relationship with the client, transferring care to a different therapist, if the client suggests anything of a sexual nature involving you.
7. DO NOT talk about other clients with the client.
8. DO NOT talk about your own personal life with the client. Especially DO NOT let the client have your personal home address or personal e-mail address.
9. DO NOT ever have sex with a client or former client. DO NOT even think of it. If you start to think of it, see Rule 6, above. Consider clients and former clients “off-limits” no matter how much you are tempted. If you are religious, just consider this as an attempt by Satan to seduce you. If it works, you are going to be in Hell, even before you die.
10. DO know what professional boundaries are and DO NOT cross them. This includes allowing a personal relationship to grow between you and the client, and includes selling anything to the client (e.g., Girl Scout cookies, tickets to a charitable event, Amway products, candy bars for your kids’ school band, etc.), agreeing to meet the client at any outside event, accepting gifts from the client, hiring the client to work for you, accepting “voluntary” services from the client (including volunteering to work in your office). If you need a friend that bad, terminate the therapist-client relationship and see Rule 6, above.
11. DO know that if you have even a suspicion that your therapist-client relationship is getting out of bounds, then it already is out of bounds. See Rule 6, above.
12. DO call a professional therapist colleague who is more senior to you and consult her or him about the “situation” if you think there may be a “situation.”
These may sound like “no-brainers” to you, but you would be surprised at how many complaints against licensed counselors and psychologists there are as a result of violating one or more of these “rules.”
(Note: These “rules” are just guidelines meant to help you keep out of trouble; these are not meant to be enforced against anyone, nor do they create or represent any “standard of care.”)
For additional information on how our firm can assist you in matters like this, click here to read one of our prior blogs.
Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers, and Family Therapists.
The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers, and family therapists in Department of Health (DOH) investigations, Department of Regulatory Agencies (DORA) investigations, board hearings, FBI investigations, and other types of investigations of health professionals and providers. To contact The Health Law Firm, please call (407) 331-6620 or toll-free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
We also defend health professionals and health facilities in general litigation matters and business litigation matters.
To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free: (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law Firm. All rights reserved.