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Need Last Minute Deposition or Hearing Representation? Call The Health Law Firm

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

Our office often takes phone calls from pharmacies and pharmacists needing short-notice representation at a Board of Pharmacy hearing or at a deposition related to a health care matter.

In our experience, many other law firms refuse to represent clients at hearings unless the firm is given plenty of advance notice. We always prefer to have sufficient time to obtain documents, review files, interview witnesses, conduct research and prepare, in order to provide the best possible representation to our client. However, we realize that in certain cases, the alternative is that the client either gets legal representation on little or no advance notice or has to suffer the consequences of having no legal representation.

Administrative Proceedings Can be Complex.

In some cases, individuals may be fooled into believing that they can effectively represent themselves. They later find out that they have gotten in over their heads. Laypersons (meaning, in this case, nonlawyers) who are not aware of such complex matters as the Administrative Procedure Act, the Rules of Civil Procedure, the Rules of Evidence, the Florida Administrative Code (F.A.C.) Rules which the Board of Pharmacy and the Department of Health (DOH) have enacted, may quickly be confused.

The inexperienced individual, or even the inexperienced attorney, in these matters, can fall into a number of procedural traps that damage an effective defense. This can be advising the individual to talk to the DOH investigator, filing an unnecessary answer to an Administrative Complaint, forgetting or not knowing that the client’s right to be free of self-incrimination applies in this type of case and many, many others.

Procedural Mistakes Can Be Damaging To Your Legal Defense.

Often you will find that merely having an experienced attorney to represent you at a hearing or Board meeting will assist you in avoiding mistakes that damage your case and assist you in preserving your rights for an appeal. In other cases, it may even be possible to obtain a change in the forum to obtain a better result. For example, many laypersons do not know that if you elect an informal hearing before the Board of Pharmacy, you have waived your right to prove you are innocent by contesting the facts alleged against you.

What few know or think of in the heat of the moment is that you can ask at the informal hearing before the Board of Pharmacy to contest the facts, to prove you are not guilty of the charges, and to have the hearing converted to a formal hearing. A formal hearing will be in front of a neutral Administrative Law Judge (ALJ), and you have a great many more procedural rights than you have at an informal hearing. However, we still recommend that you have an experienced health lawyer represent you at a formal hearing.

Professional Liability Insurance May Pay Legal Fees for Deposition Coverage.

If you are a pharmacist or pharmacy that has professional liability insurance, these often provide legal coverage for depositions. This is primarily because the outcome of the deposition may include having you named as a defendant in a professional liability or negligence lawsuit or having disciplinary charges filed against you.

One of the first things you should do if you receive a subpoena or a notice of a deposition is to contact your professional liability insurance carrier and see if it will pay for an attorney to represent you. For example, Healthcare Providers Service Organization (HPSO), CPH & Associates, Nurses Service Organization (NSO), Dentists Advantage and many other malpractice insurance companies provide excellent deposition coverage.

The second thing you should do is to call an experienced attorney and schedule a consultation. Even if you cannot afford to retain the services of the attorney for the actual deposition, a consultation may assist you in properly preparing. Click here to read our blog on this matter and learn more.

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

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

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

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Florida Board of Pharmacy, Legal Defense for Pharmacists, Pharmacist, Pharmacy and tagged Administrative Law Judge, administrative procedure act, administrative proceeding, ALJ, Board of Pharmacy, Board of Pharmacy hearing, defense attorney, defense lawyer, Department of Health, deposition coverage, disciplinary charges, disciplinary complaint, FAC, final hearing, Florida Administrative Code, formal hearing, health law firm, health professional, hearing representation, Informal hearing, last-minute deposition coverage, legal representation, legal representation for pharmacist, legal representation for pharmacy, local deposition coverage, negligence lawsuit, noticed of a deposition, pharmacist, pharmacy, professional liability insurance, rights for an appeal, Rules of Civil Procedure, Rules of Evidence, short notice of representation of pharmacy, short notice representation of pharmacist, subpoena, The Health Law Firm

“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.

Are You Worried About Health Care Compliance Consequences? Have They Gone Too Far?

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

From large hospital systems to solo practitioners, there is no escaping health care compliance in the industry. The concept of compliance can spark different thoughts in different people. For example, some believe it is an unnecessary government intrusion and others believe it’s a way to improve the quality and costs of health care.

No matter your thoughts on health care compliance and government oversight, regulation of the health care industry will never be eliminated. In fact, we expect it to increase as more quality-based requirements are implemented.

We believe compliance and regulations are necessary, but we have to wonder if sometimes these laws go too far.

Those Cute Baby Photos Can Cost You.

As an example of laws going too far, photos of cooing newborn babies used to cover the bulletin boards of doctors’ offices. However, under the Health Insurance Portability and Accountability Act (HIPAA), these baby photos are considered protected health information, along the same lines as a medical chart or social security number. A report by The New York Times indicates many offices have removed these types of photos or moved them to private portions of the office. According to the Office for Civil Rights (OCR) Department of Health and Human Services (HHS), doctors’ offices are not allowed to post these photos without a specific written authorization from the parent.

To read more on this topic, click here.

Health Care Compliance Overview.

Health care compliance is the ongoing process of meeting or exceeding the legal, ethical and professional standards applicable to a particular health care organization or provider. Health care compliance requires health care organizations and providers to develop effective processes, policies, and procedures to define appropriate conduct, train the organization’s staff, and then monitor the adherence to the processes, polices and procedures.

Health care compliance covers numerous areas including patient care, billing, reimbursement, managed care contracting, OSHA, and HIPAA privacy and security to new a few.

To read a basic overview of health care compliance for organizations and providers, click here.

How to Deal with Compliance Overkill.

The primary purpose of health care compliance is to improve patient care. It is nearly impossible to overstate the complexity of health care compliance. Health care organizations and providers are not only required to comply with Medicare rules and regulations, but they are also required to comply with numerous other federal and state health care laws, rules and regulations.

When dealing with compliance issues, our recommendation is to use your common sense and best judgment. Fear usually leads to absurd situations. With all the fear and propaganda out there it is important to stick to your instincts and put patient care first.

Health care compliance is cumbersome, many may agree too cumbersome. However, it is here to stay.

Do you think health care compliance has gone too far? How do you try to keep up with health care compliance laws and regulations? Are you worried about compliance consequences?

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Hartocollis, Anemona. “Baby Pictures at the Doctor’s? Cute, Sure, but Illegal.” The New York Times. (August 9, 2014). From: http://www.nytimes.com/2014/08/10/nyregion/baby-pictures-at-doctors-cute-sure-but-illegal.html?_r=0

Kirsch, M.D., Michael. “The Consequences of Zero Tolerance: Why HIPAA is Overkill.” Kevin M.D. (January 1, 2014). From: http://www.kevinmd.com/blog/2014/01/consequences-tolerance-hipaa-overkill.html

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Health Insurance Portability and Accountability Act (HIPAA), HIPAA Omnibus Rule, HIPAA compliance, HIPAA lawyer, HIPAA compliance attorney, data security lawyer, protected health information (PHI), Patient privacy, U.S. Department of Health and Human Services (HHS), Office of Civil Rights (OCR), patient rights, HIPAA compliance audit, privacy defense attorney, health care compliance lawyer, compliance defense attorney, healthcare compliance defense lawyer, health care defense lawyer, HIPAA attorney, HIPAA lawyer, compliance plans, health law firm, The Health Law Firm, health law defense attorney, health care professional defense attorney, legal representation for healthcare professionals, 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 © 2018 The Health Law Firm. All rights reserved.

California Doctor To Pay $562,500 Fine and Spend 5 Days in Jail for Balance Billing Patients Covered by Managed Care Plans

MLS Blog Label 2By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A California doctor was fined $562,500 and ordered to spend five days in jail for illegally balance billing patients covered by health plans, according to a Los Angeles Times posted in December 2013. The doctor, Jeannette Martello, M.D., is a plastic and reconstructive surgeon practicing in the Los Angeles area. She was accused of balance billing patients covered by managed care health plans that were provided emergency treatment in several hospitals in Los Angeles. The doctor had very aggressive collection practices and allegedly sued her patients frequently to collect the fees not covered by the managed care health plans.

Click here to the entire Los Angeles Times article.

What is Balance Billing?

Balance billing is the practice of doctors charging the patient the difference between what the managed care plan pays and doctor’s regular charges. A physician who is in-network is usually prohibited from balance billing patients by the health plan’s contract with the physician. The problem of balance billing arises most often in the context of emergency services where the patient may go to an in-network hospital, but the specialist physician providing services to the patient may be out-of-network. Most states require the managed care plan to pay the out-of-network physician a “reasonable fee” for the services. The physicians and the managed care plans rarely agree on the “reasonable fee” for a particular service. This often results in litigation between the physician and the health plan. The situation also arises when a patient goes to an in-network hospital for surgery, but the anesthesiologist is not in-network.

Doctor Plans to Appeal.

According to the Los Angeles Times article, Dr. Martello plans to appeal the ruling. Dr. Martello and her attorney claim the prohibition on balance billing did not apply to her patients because the patients were in stable condition.

Court Previously Entered Injunction Prohibiting Illegal Billing.

In 2012, The Los Angeles Superior Court entered an injunction ordering Dr. Martello to cease all illegal billing practices, according to the Department of Managed Health Care. Dr. Martello continued the billing practices, which is why the judge ordered Dr. Martello to serve five days in jail. The judge also issued a permanent injunction prohibiting Dr. Martello from illegally billing patients in the future.

To read the press release from the Department of Managed Health Care, click here.

The Medical Board of California also placed Dr. Martello on probation for five years for her illegal billing practices in August 2013.

Balanced Billing Could be Considered a Matter of Contract Law.

It is usually sound legal advice that if a court orders you to do something or to stop doing something, comply with the court’s order. It is hard to imagine legal advice to the contrary, unless the parties desire to have a test case to challenge the law or challenge such rulings.

Balance billing in such cases is usually a matter of contract law. The provider agreement between the physician and the health plan is the contract at issue. This, then, would be a breach of contract action and not a criminal matter.

However, in certain instances, such as for Medicare or Medicaid patients, laws may prohibit balance billing. It is always best to check with your experienced health attorney first.

Contact Health Law Attorneys Experienced with Investigations of Doctors.

The attorneys of The Health Law Firm provide legal representation to doctors and other healthcare providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers. The Health Law Firm also represents providers in billing disputes with third-party payers.

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

Comments?

Have you ever heard of balance billing patients? Do you think the doctor received a far punishment for her billing practices? Please leave any thoughtful comments below.

Sources:

Terhune, Chad and Brown, Eryn. “Doctor Gets Jail Time, $562,500 Penalty in Improper-Billing Case” Los Angeles Times. (December 6, 2013). From: http://articles.latimes.com/2013/dec/06/business/la-fi-mo-doctor-balance-billing-case-20131205

Green, Marta. “Department of Managed Care Director Brent Barnhart Issues Statement on Preliminary Injunction Granted in People v. Martello.” Department of Managed Health Care. (June 13, 2012). From: http://www.dmhc.ca.gov/library/reports/news/pr061312.pdf

The Pathology Blawg. “Dr. Jeannette Martello Gets Five Years Medical Probation for Aggressive Balance Billing.” The Pathology Blawg. (August 20, 2013). From: http://pathologyblawg.com/medical-news/balance-billing/jeannette-martello-five-years-medical-probation-aggressive-balance-billing/

About the Authors: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Florida Attorney General Targets Targeted Case Management Fraud

DPP_12By Christopher E. Brown, J.D., The Health Law Firm

Due to increased fraud throughout the system, the Florida Attorney General (AG), through the Medicaid Fraud Control Unit (MFCU), is focusing its attention on Medicaid targeted case management (TCM) services.

TCM services were created to assist children with documented mental health conditions in gaining access to medical, social, educational, and other support services. To be eligible for such services a child must meet very strict criteria.

Eligibility Criteria for Children’s Mental Health TCM Services:

1. Must be enrolled in a Department of Children and Families (DCF) children’s mental health target population (birth through 17 years);
2. Has a mental health disability (i.e., serious emotional disturbance) that requires advocacy for and coordination of services to maintain or improve level of functioning;
3. Requires services to assist in attaining self sufficiency and satisfaction in the living, learning, work, and social environments of choice;
4. Lacks a natural support system for accessing needed medical, social, educational, and other services;
5. Requires ongoing assistance to access or maintain needed care consistently within the service delivery system;
6. Has a mental health disability (i.e., serious emotional disturbance) that, based upon professional judgment, will last for a minimum of one year;
7. Is in out-of-home mental health placement or at documented risk of out-of-home mental health treatment placement; and
8. Is not receiving duplicate case management services from another provider.

Unfortunately, many of the children TCM providers assist and bill Medicaid for do not meet these criteria. In addition, a lack of oversight by the Medicaid program has led to numerous improper and fraudulent payments to TCM providers.

Florida TCM Fraud Cases.

Improper and fraudulent payments are often related to TCM providers billing for services that were never performed and paying kickbacks for client referrals.

According to the Florida AG, the three owners of Destiny TCM Corporation in Central Florida were arrested by the MFCU for $27,000 worth of Medicaid fraud. The corporation is accused of falsely billing the Medicaid program for illegitimate targeted case management services and bribing individuals in order to obtain Medicaid recipient numbers. Click here to read the press release from the AG.
In another similar case, the owners of Kingdom Builders Ministries in Lake County, Florida, were also arrested for allegedly defrauding Florida Medicaid out of $80,000. The MFCU revealed that the two owners allegedly directed employees to bill for an entire family when only one member received services. Employees were also allegedly instructed to bill for unauthorized expenses, such as travel time, employee staff meetings and phone calls. Additionally, records indicate that Kingdom Builders Ministries received payment for services allegedly provided to young children who did not have any documented mental health condition and continued to submit invoices months after terminating services. Click here to read more from the AG.

Tips for Responding to a Medicaid Fraud Control Unit Investigative Subpoena.

The MFCU has become aware of these improper payments and has begun to investigate TCM providers, aggressively. The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to an MFCU subpoena.

Defend Yourself from Fraud Charges.

We have been consulted by many individuals similar to the subjects of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have in order to avoid a conviction.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent speech therapists, occupational therapists, vocational therapists, therapy groups, physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Did you know the eligibility criteria for children’s mental health TCM services? Were you aware that the AG is targeting these services? Please leave any thoughtful comments below.

About the Author: Christopher E. Brown, J.D., is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Doctors’ Medicare Payment Data to be Released Spring 2014

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For years, the Centers for Medicare and Medicaid Services (CMS) has kept private its records on Medicare claims payments made to individual physicians. However, beginning March 18, 2014, the government may disclose the payment data on a case-by-case basis. According to CMS, this directive is a push by the Obama Administration to crack down on doctors who are making a habit out of repeatedly overcharging Medicare. On January 15, 2014, CMS stated that recalcitrant providers could face civil fines and exclusion from Medicare and other federal health care programs. According to CMS, a recalcitrant provider is defined as one who is abusing the program and not changing inappropriate behavior even after extensive education to address these behaviors.

Data Made Public to Fight Healthcare Fraud.

According to The New York Times, federal officials estimate that 10 percent (10%) of payments in the fee-for-service Medical program are improper. Supporters of releasing the data say it could help identify patterns of waste and fraud. The Medicare payment data, combined with data from other sources, could be enormously useful to consumers, researchers and whistleblowers analyzing patterns of health spending.

Physician groups express caution in Medicare releasing individual payment information, saying it could lead to public misunderstanding and unintended consequences, according to The New York Times.

Click here to read the entire article from The New York Times.

Data Prohibited From Being Release for Past Thirty Years.

In 1979, a federal district judge in Jacksonville, Florida, issued an injunction that prohibited Medicare officials from releasing what Medicare pays individual doctors. The ruling, in a lawsuit filed by doctors, said such disclosure would violate the Privacy Act and constitute a clearly unwarranted invasion of personal privacy. In May 2013, the judge lifted the injunction.

According to a MedPage Today article, the decision does not require the wholesale release of Medicare payment data but allows Medicare officials and courts to consider the merits of each request.

To read the entire article from MedPage Today, click here.

Healthcare Providers Should Prepare for Possible Public Scrutiny.

Although it remains to be seen how CMS will implement its new policy, health care providers should be prepared for the possibility that their coding, billing and reimbursement patterns will become the subject of public scrutiny, particularly those providers in specialized areas including internal medicine, radiation oncology and ophthalmology.

Contact Health Law Attorneys Experienced with Healthcare Fraud Cases.

Attorneys with The Health Law Firm 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. We also handle Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.

Our attorneys also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. 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 doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Comments?

What do you think about the decision to release payment data for physicians? How will this effect health care providers? Please leave any thoughtful comments below.

Sources:

Pear, Robert. “Doctors Abusing Medicare Face Fines and Expulsion.” The New York Times. (January 25, 2014). From: http://nyti.ms/1cpIaOg

Pittman, David. “Medicare to Release Doc Pay Data This Spring.” MedPage Today. (January 14, 2014). From: http://bit.ly/1ndaCHu

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.

 

 

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

What Happens in the VA System Has Implications for all Health Care Professionals; FBI Investigates VA

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Veterans Administration healthcare system is at a crossroads. After the recent revelations about long wait times for veterans and systematic cover-ups, it is clear that reforms in the Veterans Health System are needed.

On June 11, 2014, the Federal Bureau of Investigation (FBI) announced it has opened a criminal investigation of the Department of Veterans Affairs (VA). The investigation stems from allegations that officials with the VA have been manipulating medical waiting lists and delaying care for thousands of veterans. On the same day, the U.S. Senate approved a bill that would allow veterans who experience long delays for appointments or live far away from a VA facility to get care at nearby private hospitals and medical facilities. In addition the bill would provide money for the VA to hire more doctors and nurses. According to Modern Healthcare, it is believed a compromise version of the bill will soon make its way to President Barack Obama’s desk for signature.

Click here to read more from Modern Healthcare.

What few people understand is that any false statement of any kind made to a federal official is a crime under the United States code.

The Alleged Scandal that Rocked the U.S.

Last month, it was revealed that a VA clinic in Phoenix was delaying treatment for veterans waiting to see a doctor. The clinic is accused of making official lists that showed patients were getting timely care, while covering up secret waiting lists showing it took much longer. As many as 40 military veterans may have died waiting for treatment. Due to these allegations the head of the VA stepped down. The investigation is being led by the FBI’s field office in Phoenix, the location of the primary focus of the allegations.

To read more on the FBI’s investigation, click here.

AMA Volunteers to Provide Help.

While waiting for a solution, the American Medical Association (AMA) states that it will seek the help of private sector physicians to provide health care for veterans still waiting for care. The AMA is proposing that state and local medical societies formulate registries of physicians who are ready and willing to provide care for veterans, according to an AMA press release.

Click here to read the press release from the AMA.

What This Means for Private Sector Health Providers.

Few would disagree that the VA needs help. Specifically, the VA needs to improve access to care for the growing numbers of new veterans joining the system. However, there is a bigger issue regarding whether the VA has even been given proper resources to do its job.

Until a permanent resolution is agreed upon, private sector healthcare providers that take military insurance such as TRICARE can expect to see an influx of VA patients. Note, there may be a delay in receiving reimbursement payments. There are also concerns as to how long it would take a private healthcare provider to obtain the medical records of a patient from the VA for follow up treatment. The shortage of VA administrative staff affects this, as well.

When seeing VA patients, keep in mind, the logistics of care are different in the private sector. VA patients will not be used to having labs, x-ray centers, pharmacies, etc., in different places and transportation may be more difficult. Providers should be aware of these challenges and have policies and procedures in place to ensure their veteran patients receive complete care. Having an open line of communications with these patients about their care will be essential.

The VA Needs More Resources, Congress!

The most important issue is that the VA needs more resources. It needs more physicians. It needs more ancillary health care professionals. It needs more administrative staff. It’s all good and fine for Congressional members to weep and gnash their teeth about VA shortcomings and failures. But Congress needs to put up the money the VA actually needs to provide the amount of care our existing veterans need.

Until Congress gets off the dime and funds the VA properly this type of situation, or worse, is bound to happen over and over. Republican governors can make idle threats against the VA, posturing for re-election. Congressmen and Senators can kowtow to Tea Party dogma. But if they aren’t going to fund the VA properly, it’s Congress’s fault and no one else’s.

Comments?

What do you think about the VA scandal? As a private sector healthcare provider, do you think you will see more VA patients in your office? Please leave thoughtful comments below.

Contact Experienced Health Law Attorneys.
The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, NPDB actions, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Sources:

Kahn, Randi. “AMA Encourages the Federal Government to Utilize Private Sector Physicians to Help Solve VA Crisis.” American Medical Association. (June 10, 2014). From: http://www.ama-assn.org/ama/pub/news/news/2014/2014-06-10-private-sector-physicians-va-crisis.page

Kizer, Kenneth and Jha, Ashish. “Restorying Trust in VA Health Care.” New England Journal of Medicine. (June 11, 2014). From: http://www.nejm.org/doi/full/10.1056/NEJMp1406852

The New York Times. “F.B.I. Begins Criminal Inquiry in V.A. Scandal.” The New York Times. (June 11, 2014). From: http://nyti.ms/UwTXow

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.

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Dermatology Practice Settles with Government After Stolen USB Drive Results in HIPAA Breach

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), and Adult & Pediatric Dermatology (APDerm), reached a $150,000 settlement for privacy and security violations of the Health Insurance Portability and Accountability Act (HIPAA). The alleged violations related to an unencrypted USB drive that was stolen. The thumb drive contained the protected health information (PHI) of around 2,200 patients, according to a press release posted December 26, 2013, on the HHS website.

According to the HHS, this is the first settlement with a covered entity for not having policies and procedures in place to address the breach notification provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

To read the entire press release from the HHS, click here.

APDerm delivers dermatology services to patients in Massachusetts and New Hampshire.

Alleged Violations Stemmed from Stolen, Unencrypted USB Drive.

According to the HHS, the OCR initiated its investigation after being tipped off that an unencrypted thumb drive containing the PHI of about 2,200 patients was stolen from a vehicle of an APDerm staff member. According to Healthcare IT News the thumb drive was never recovered.

The investigation allegedly revealed that APDerm had not conducted an accurate and thorough analysis of the potential risks and vulnerabilities to the confidentiality of PHI as part of it security management process. It’s also alleged that APDerm failed to fully comply with the HITECH Breach Notification Rule, which requires organizations to have written policies and procedures in place and to train staff members.

According to Healthcare IT News, the settlement also includes a corrective action plan (CAP). The CAP requires the dermatology company to develop a risk analysis and risk management plan to address and mitigate any security risks and vulnerabilities. Click here to read the entire article on Healthcare IT News.

Warning to HIPAA Covered Entities Regarding Risk Assessments.

This settlement is an important reminder about equipment designed to retain electronic information. HIPAA covered entities are responsible for making sure all personal information is protected. Entities are also required to undertake a careful risk analysis to understand the threats and vulnerabilities to individuals’ data, and have safeguards in place to protect this information.

HIPAA laws have most likely changed since you last edited your privacy forms and procedures. Many health providers simply do not have the time to re-review their policies and revise documents. In a perfect practice, this would be done every six months.

To learn more on HIPAA risk assessments, click here.

Be Sensitive to Technical Equipment Containing Internal Memory.

In today’s technological society everyone must be continually vigilant about the machines and equipment used. Many different types of devices now contain internal memory chips and hard drives that may store data that is difficult to erase. These may include photocopiers, scanners and fax machines, in addition to computers and servers. Security videos and communications monitoring systems may also maintain such information. Backup tapes and modern cell phones are other possible examples. These should be professionally cleaned of all data or destroyed before discarding them, selling them or trading them in on newer models.

To read a previous blog on Affinity Health Plan settling with government in photocopier HIPAA breach incident, click here.

Practical Tips.

The following are some lessons learned from this case. Share them with others in your organization:

1. Ensure that all types of electronic media by which you transfer patient health information of any kind are encrypted. This includes thumb drives, CD ROMs, DVDs, backup tapes, mini hard drives and anything else.
2. Try not to remove any patient information from your work cite. If you need to work on it remotely, use a secure, encrypted internet connection to access your work data base. Avoid saving the work or data onto your laptop hard drive or other removable media.
3. Never leave your laptop or other media in a car you are having worked on by a mechanic, having an oil change, having the car washed, or while you run into a store. Thieves stake out such locations and are waiting for careless individuals to do this.
4. Never leave your laptop, thumb drive or other electronic media from work in your car. What can be worse than having your car stolen? Having your car stolen with your laptop in it with patient information on it.

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think of this settlement? Does your office and/or practice have an annual security risk assessment? Do you think risk analyses are important? Please leave any thoughtful comments below.

Sources:

Millard, Mike. “Lost Thumb Drive Leads to $150K Fine.” Healthcare IT News. (December 30, 2013). From: http://www.healthcareitnews.com/news/lost-thumb-drive-leads-150k-fine

U.S. Department of Health and Human Services “Dermatology Practice Settles Potential HIPAA Violations.” HHS.gov. (December 26, 2013). From: http://www.hhs.gov/news/press/2013pres/12/20131226a.html

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.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

CMS in the Hot Seat for Lax Oversight of Medicaid Managed Care Organizations

LLA Headshot smBy Lenis L. Archer, J.D., M.P.H., The Health Law Firm

For years, each state has kept an eye on its own Medicaid managed care plans, while the Centers for Medicare and Medicaid Services (CMS) is required to monitor how well each individual state is doing. However, a recent Government Accountability Office (GAO) report claims CMS is sleeping on the job. The report, released on June 20, 2014, stresses the need for more federal oversight of these plans.

With the implementation of the Affordable Care Act (ACA), the Medicaid program is expected to expand significantly. Most of the new beneficiaries enrolled in managed care are covered almost entirely by federal funds. The need for federal oversight in this area is of growing importance to ensure accountability of taxpayers’ dollars.

To read the entire report from the GAO, click here.

Report Findings: MCOs Need to be Watched by the Feds.

The persistent theme of the GAO report is that CMS and the Department of Health and Human Services (HHS) have done little to control the integrity of managed care organizations (MCOs). Federal programs have delegated managed care supervision to each individual state, but fail to provide needed guidelines and resources. CMS has not updated its MCO program guidance since 2000.

The report found neither state nor federal programs are well positioned to identify improper payments made to MCOs. Further, these programs are unable to ensure that MCOs are taking appropriate actions to identify, prevent or discourage improper payments.

For example, the report looked at state program integrity (PI) units and Medicaid Fraud Control Units (MFCU) from seven states. These anti-fraud groups admitted to primarily focusing their efforts on Medicaid fee-for-service claims. Meanwhile, claims made to MCOs have flown under their radar.

GAO Recommendations.

The GAO recommends that CMS:

– Require states to conduct audits of payments to and by MCOs;

– Update its managed care guidance program integrity practices and effective handling of MCO recoveries; and

– Provide states with additional support in overseeing MCO program integrity.

The GAO also suggests that CMS increase its oversight, especially as states expand their Medicaid programs. The GAO report recommends CMS take a bigger role in holding states accountable to ensure adequate program integrity efforts in the Medicaid managed care program. If CMS does not step up to the plate, the report predicts a growing number of federal Medicaid dollars will become vulnerable to improper payments.

The Future of MCOs.

If this report is taken seriously, be assured that audits of MCOs will become more frequent and extensive. If CMS ramps up their efforts, claims could be reviewed in detail by Medicaid integrity contractors. Now is the time to verify you are in compliance and receiving proper payments; before CMS turns the magnifying glass on you or your facility .

Comments?

What do you think of the GAO’s assessment of MCOs? Do you think CMS needs to step up and provide more oversight? Please leave any thoughtful comments below.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, and the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS). Other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies often participate. Don’t wait until it’s too late. If you are concerned about possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Mullaney, Tim. “Federal Government Needs to Boost Medicaid Managed Care Oversight, GAO Says.” McKnight’s Long-Term Care & Assisted Living. (June 20, 2014). From: http://www.mcknights.com/federal-government-needs-to-boost-medicaid-managed-care-oversight-gao-says/article/356779/

Adamopoulos, Helen. “GAI Calls on CMS to Increase Medicaid Managed Care Oversight.” Becker’s Hospital Review. (June 20, 2014). From: http://www.beckershospitalreview.com/finance/gao-calls-on-cms-to-increase-medicaid-managed-care-oversight.html

Bergal, Jenni. “Advocates Urge More Government Oversight of Medicaid Managed Care.” Kaiser Health News. (July 5, 2013). From: http://www.kaiserhealthnews.org/stories/2013/july/05/medicaid-managed-care-states-quality.aspx?referrer=search

About the Author: Lenis L. Archer is as attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

 

Some Providers Billing PIP Claims No Longer Exempt From Health Care Clinic Act

MS_smBy Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

Some health care providers that were previously exempt from the requirements of the Health Care Clinic Act are now required to obtain a Health Care Clinic license in order to bill for care provided to their patients injured in car accidents.

The original purpose of the Health Care Clinic Act was to regulate health care entities that were not owned by licensed health care providers. Entities that were owned by licensed health care providers were exempt from the Health Care Clinic license requirements because those health care providers were already regulated by the Department of Health (DOH).

Effective January 1, 2013, the law changed so that every health care provider that bills personal injury protection (PIP) insurance carriers is now required to obtain a Health Care Clinic license unless the provider is exempt from that requirement under the PIP statute. The only health care providers that are still exempt under the PIP statute are medial doctors, osteopathic doctors, chiropractic doctors, and dentists. Physical therapists, nurse practitioners and doctors of podiatry must be licensed as Health Care Clinics in order to bill PIP insurance carriers. Acupuncture doctors and massage therapists are now completely prohibited from billing PIP insurance carriers.

Additional Requirements on Health Care Clinics.

The PIP statute also imposes additional requirements on Health Care Clinics before those clinics can bill PIP insurance carriers. In order to bill PIP, a Health Care Clinic must be:

A health care clinic licensed under Part X of Chapter 400, Florida Statutes, and is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state, or

1. Has a medical director licensed under chapter 458, chapter 459, or chapter 460;
2. Has been continuously licensed for more than three years or is a publicly traded corporation that issues securities traded on an exchange registered with the United States Securities and Exchange Commission as a national securities exchange; and
3. Provides at least four of the following medical specialties:

a. General medicine
b. Radiography
c. Orthopedic medicine
d. Physical medicine
e. Physical therapy
f. Physical rehabilitation
g. Prescribing or dispensing outpatient prescription medication
h. Laboratory services.

Click here to read 627.736(1)(a)2e, Florida Statutes.

PIP Insurance Carriers Might Deny Claims.

The Florida PIP statute also provides that a physical therapist can provide follow-up care upon the referral by a physician, which conflicts with the new Health Care Clinic license requirements in other parts of the statute. Several PIP insurance carriers are denying provider claims and demanding refunds based upon their own interpretations of these changes. A health care provider that receives denials, or demands for refunds should immediately contact an attorney experienced in these matters.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, denials and demands for repayment from insurance companies, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Comments?

Were you aware for the changes to the Health Care Clinic Act? Were you previously exempt and now required to obtain a Health Care Clinic license? Please leave any thoughtful comments below.

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

Why Have You Received a Denial on Your Medicare Enrollment Application?

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

Did you receive a denial on your Medicare enrollment application and can’t figure out why? You may be surprised to find out that even the smallest punctuation error, such as a missing comma or period, could be the reason Medicare rejected your application.

The Centers for Medicare and Medicaid Services (CMS) will deny Medicare applications of physicians, medical groups, home health agencies (HHAs), pharmacies and durable medical equipment (DME) suppliers because the name on file with the National Plan & Provider Enumeration System (NPPES) is not the same legal business name as reported to the Internal Revenue Service (IRS). The use of punctuation marks and abbreviations in your name with NPPES could produce a no match in the CMS records. It is imperative when filling out the Medicare enrollment forms that you use the exact legal business name on file with the IRS.

The easiest way for a health care provider or facility to apply for enrollment or make changes to enrollment information is to use the internet-based Provider Enrollment Chain and Ownership System (PECOS). Click here to utilize PECOS.

Other Reasons Why a Medicare Enrollment Application can be Denied.

Here are some more situations that can cause a provider’s application to be denied:

1. The form CMS-855 or PECOS certification statement is unsigned; it is undated; contains a copied or stamped signature; or for the paper form CMS-855I and form CMS-855O submissions, someone other than the physician or non-physician practitioner signed the form.
2. The submitted paper application is an outdated version.
3. The applicant failed to submit all of the forms needed to process a reassignment package within 15 calendar days of receipt.
4. The form CMS-855 was completed in pencil.
5. The wrong application was submitted (for example, a form CMS-855B was submitted for Part A enrollment).
6. If a web-generated application is submitted, it does not appear to have been downloaded from the CMS website.
7. The health care provider sent in an application or PECOS certification statement via fax or e-mail when he/she was not otherwise permitted to do so.
8. The health care provider failed to submit an application fee (if applicable to the situation).

Update All of Your Information with Medicare.

If you are already a Medicare provider, I urge you to personally go into the PECOS and NPPES and print out a copy of the existing information to check it.

If anything is incorrect, including an incorrect or incomplete name for your medical group, corporation or business, immediately fix this. Everything should be consistent. All of your state licenses and corporation/company information on file with your Secretary of State should also contain the same information as well.

Incorrect Information Could Lead to the Termination of Your Medicare Provider Number.

The consequences of not checking your information on file are severe and can include termination of your Medicare provider number and billing privileges.

The effect of this termination includes:

-You are prohibited from reapplying to Medicare for at least two years.
-You may have to pay back any money received from the Medicare program since the effective date of the termination (often many months prior to the notification letter).
-Other auditing agents may be notified such as the Medicare Zone Program Integrity Contractors (ZPICs) and the state Medicaid Fraud -Control Unit (MFCU).
-You may no longer contract with Medicare or anyone who does.
-You may and probably will be terminated from the approved provider panels of health insurance companies with which you are currently contracted.
-You may and probably will be terminated from skilled nursing facilities (SNFs) and HHAs with which you have contracts.
-You may and probably will have your clinical privileges terminated by hospitals or ambulatory surgical centers (ASCs).

To read our recommendations on what to do if your Medicare provider number is terminated, click here to read my previous blog.

 

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

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

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

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.

“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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