Follow These Steps to Challenge OIG Exclusion From Medicare

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

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

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

How to Challenge OIG Exclusion Actions.

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

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

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

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

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

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

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

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

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

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


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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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The Administrative Process to Challenge OIG Exclusion Actions

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

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

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

How to Challenge OIG Exclusion Actions.

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

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

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

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

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

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

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

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

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

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


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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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Steps to Challenge OIG Exclusion Action from Medicare Program

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

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

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

The Administrative Process to Challenge OIG Exclusion Actions.

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

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

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

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

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

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

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

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

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

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


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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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How to Challenge an OIG Exclusion Action from Medicare

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

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

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

The Administrative Process to Challenge OIG Exclusion Actions.

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

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

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

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

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

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

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

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

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

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


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

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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So, the ZPIC Medicare Auditor Wants to Talk to You? What You Should Expect

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

You are a physician, nurse or other health care provider who bills Medicare. You have received that dreaded letter from the Zone Program Integrity Contractor (ZPIC) for Medicare advising you that it is auditing you for the Centers for Medicare and Medicaid Services (CMS). You know that the words “Program Integrity” by themselves mean that possible fraud is being investigated, at least that is the suspicion giving rise to this particular audit.

To read an earlier blog which I wrote on tips for responding to ZPIC audits, click here.

You have dutifully contacted an experienced health law attorney to aid you in responding to the ZPIC’ s request for records and information. You have obtained all of the requested medical records documentation, authoritative medical journal articles and other information that may be useful in supporting the care you delivered and for which you billed, added explanatory notes (clearly and contemporaneously dated, of course) where necessary or where records were missing, and done all you can to fully and completely respond to the audit.

After the Initial Audit Response and Site Visit.

Now, several weeks later, the ZPIC auditor/investigator contacts you and advises you that he would like you to come to his office to answer a few questions. The ZPIC auditor/investigator states that this is “just routine” and should only take approximately 20 minutes.

After discussing this with your attorney, knowing that you have committed no fraud and that your medical records are in pretty good shape to support your billing, you decide to go to the ZPIC office for the interview. (Note: I know that many attorneys would recommend against this action, but often we advise a client, with the right set of facts, of course, to do this.) What should you expect?

What to Expect When You Show up to Be Interviewed by the ZPIC Auditor.

Although we cannot guarantee you that you will experience the same as we have in the past, this is what happened often enough with us where it seems to be somewhat common practice in such audits.

1. Expect the ZPIC office to be in a building with good security, including magnetic/electronic scanning for guns and weapons, like at the airport or court house. Do not attempt to take any type of weapon inside the building, including pen knives on key chains and tear gas or pepper spray canisters.

2. Bring a valid government identification card with your photograph. If you are with an attorney or a consultant, that person will also need one. One of the first things that will happen is that you will be asked to show your identification cards to prove you are who you say you are.

3. Be sure you have your correct office address on file with Medicare. If the auditors show up at an address you have listed and your practice is not there, you will either get a letter automatically terminating your Medicare billing privileges or you will be called down for this interrogation by the ZPIC. This is a primary reason for such ZPIC interrogations. Be sure your physical office address, including suite number, apartment number, office number, etc., are correctly reflected in the Provider Enrollment and Chain/Ownership System (PECOS), the electronic portal through which Medicare providers enroll in Medicare.

4. You aren’t going to be interviewed by just one person and it isn’t going to be just “20 minutes.”

5. In most cases, there will be three or more auditors/investigators involved in the interview with you. This is why it is a good idea to bring your attorney and her paralegal so that you also have some support, as well. The least number of auditor/investigators that we have ever seen involved in such interviews is two. Don’t be surprised if there are three or four.

6. The questioning and interviewing will take much longer than you expected. Plan on taking the rest of the day off so that you are not rushed and do not feel pressured to get it over with fast. It is not going to be over with fast.

7. Don’t joke around with the ZPIC auditors. This is a very serious matter. Many talented government investigators will attempt to joke and make light of things in order to get you to let your guard down. Do not play into this. Be serious and act seriously at all times.

8. You are not in an endurance contest. Ask for bathroom breaks, water breaks or just a break to talk with your attorney, as many times as you desire. Do this at least once each hour. This will help to keep your blood circulating and keep you alert.

9. You will be confronted with what the ZPIC auditors believe they have found that violates Medicare regulations. This may include, for example, billing services for patients who were dead at the time, billing for services on dates after the patient was no longer qualified to receive them, billing for services that were billed by another provider, etc. Do not guess at why this happened if you did not know for a fact. You can advise the investigator that you will take down the investigation, look into it and provide the information to him or her at a later date.

10. Don’t be surprised if the ZPIC auditor has incorrect information. Often the ZPIC will have confused information on two different Medicare beneficiaries with the same names or whose Medicare numbers were incorrectly recorded. For example, in one recent ZPIC investigator interview with my client, the investigator accused the physician of billing for services provided to a patient who had been deceased for two years. The physician had just seen the patient on a follow-up visit a month prior to the interview. The ZPIC had confused a dead patient who had the same name with the live patient. This is not uncommon.

11. Don’t be surprised if the ZPIC auditor asks you about other Medicare provider’s billings for the same patient. This also happened to a client of mine in a recent case. The ZPIC investigator questioned why the XYZ company would have billed for the same services as those provided by my client, a solo practitioner. My client did not know. He correctly told the auditor that he did not know why the other party had billed Medicare for the same services, but he had provided the services to his patient and he had billed for the services. He could not know whey someone else did something.

12. If there have been intervening factors affecting your billing practices, disclose these to the investigator. In one case, my client had changed software for her electronic health records and billing. One of the reasons this was necessary was because of bugs that made the billings sometimes unreliable. Records more than four (4) years old were no longer available. The client disclosed this.

13. Be sure you are able to reconcile the number of patients seen per day, the number of hours the CPT codes billed to Medicare are supposed to reflect, and that these seem reasonable. If you are billing time-based CPT codes for patients that it would take you 27 hours to see in a day, you are in trouble. You must know this ahead of time and either have a reasonable answer to address the problem (e.g., an incorrect date entry in the billing software caused two days worth of services to accidentally be billed for the same date of service) or correct the over-billing error.

14. Know what rules, regulations and guidelines apply to the billings for the CPT codes you are billing. Check to see if there are local coverage decisions (LCDs) from your area Medicare Administrative Carrier (MAC) or National Coverage Decisions (NCDs) from CMS and know them. Be sure you have followed them and are following them.

15. Know the licensure rules and regulations for your profession, as well as the Medicare guidelines for billing for your profession. Sometimes billing for what an assistant, trainee, or ancillary provider does is allowed, and sometimes it isn’t. If you bill for what an assistant does, be sure you know the rules and are properly billing. The ZPIC investigator certainly will ask questions about this.

16. Your health record entries, assessments, evaluations, progress notes, etc., are required to be made contemporaneously with your delivery of the services. This generally means within 24 hours, as a rule of thumb. Records made a week or a month later are not considered to be reliable or accurate. So be sure you have made and are making your records contemporaneously with seeing the patient or providing the services.

17. Check the location code for the claims you have submitted. Make sure they reflect the correct site that the services were delivered. There could be differences in payments based on the site/location code. You will be asked about this if there are discrepancies.

18. If you identify problems and issues when preparing for your ZPIC interview, go ahead and correct them. This way you will be able to show you have made an honest mistake, have changed your procedures and the mistake(s) will not happen again in the future. Sometimes this may require terminating your billing company, purchasing new software, retaining a professional consultant, asking for an educational site visit from the MAC, and obtaining additional continuing education on billing practices and procedures for you and your staff (some of which CMS offers online).

We have many helpful resources on our webpage and YouTube page. Click here to view our video Q&A on ZPIC audits for more information.

To read an additional blog I wrote on preparing for an audit, click here.

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

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

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

Keywords: Zone Program Integrity Contractors (ZPICs), ZPIC audit defense attorney, ZPIC defense lawyer, representation for ZPIC investigations, representation for ZPIC audit, ZPIC audit lawyers, ZPIC representation, ZPIC investigation representation, Medicare audit defense legal counsel, Medicare audit attorney, legal representation for ZPIC letters, legal representation for ZPIC audits, Medicare and Medicaid audits, legal representation for Medicare and Medicaid audits, health care fraud defense attorney, preparing for ZPIC audit, legal representation for health care fraud, Centers for Medicare and Medicaid (CMS), legal representation for CMS investigations, Office of Inspector General (OIG), health care professional defense attorney, legal representation for health care professionals, legal representation for fraud investigations, reviews for The Health Law Firm, The Health Law Firm attorney reviews, additional documentation requests (ADRs) for pre-payment and post-payment reviews, initiation of Medicare suspension of payments lawyer, healthcare fraud representation, allegations of healthcare fraud, representation for CMS investigations, representation for healthcare investigations, representation for overbilling, False Claims attorney, FCA lawyer, FCA attorney, representation for submitting False Claims

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:15-04:00May 10, 2019|Categories: The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on So, the ZPIC Medicare Auditor Wants to Talk to You? What You Should Expect
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Miami Man to Remain Jailed for Trial in Nation’s Largest Medicare Fraud Case

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

On December 3, 2018, a Florida judge ruled that a Miami businessman who has been jailed for more than two years on $1 billion health care fraud charges, must remain in custody through his trial next year. U.S. District Judge Robert N. Scola Jr. found no violation of his due process rights and denied Philip Esformes’ motion to dismiss several money laundering charges.

Trial Date is Set.

A February 11, 2019, trial date has been set for one of the nation’s biggest Medicare fraud cases that Esformes allegedly orchestrated through nursing homes and assisted living facilities he owned. According to the government, the scheme resulted in $1 billion in false billing and at least $464 million in improper reimbursement payments from Medicare and Medicaid.

Esformes, has been in federal custody since his arrest in July 2016, and prosecutors voiced concerns early on about him being a risk for flight, possible witness tampering and his substantial resources enabling him to live comfortably overseas.

Judge Scola found that the bid for release deserved reconsideration, but ultimately found delays in the case were more attributable to giving the defense time to review the overwhelming quantity of evidence than time spent addressing the government’s conduct. He also agreed with the government that the duration of Esformes’ detention is not grounds for release under binding precedent.

Additionally, the judge rejected Esformes’ motion to dismiss nine counts of alleging money laundering concealment. Esformes had argued that the government improperly based transactions cited in other counts as alleged payments or receipts of kickbacks. You can read more about that here.

Despite problems with the conduct of prosecutors and agents, the judge is keeping the fraud case on track. The Miami businessman is charged with conspiracy, obstruction, money laundering and health care fraud. Click here to read the U.S. Department of Justice’s press release on this case.

Click here to read one of my prior blogs about a billion dollar fraud scheme in Florida.

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

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S., as well as in civil and administrative litigation attempting to recoup claims that have been paid. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from Medicare and Medicaid Program.

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

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

Hale, Nathan. “Miami Man To Remain Jailed For Trial In $1B Medicare Fraud.” Law360. (December 3, 2018). Web.

Weaver, Jay. “Miami federal judge keeps massive Medicare fraud case on track for trial in January.” Miami Herald. (November 14, 2018). Web.

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

Keywords: Medicare fraud defense representation attorney, legal representation for defense of Medicare fraud charges, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, Medicaid fraud defense attorney, legal representation for Medicaid fraud, audit defense lawyer, healthcare fraud representation, healthcare fraud lawyer, legal representation for Medicaid audit, Medicaid audit defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, Department of Justice (DOJ) investigations, DOJ representation, representation for DOJ investigations, licensure defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, 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 © 2019 The Health Law Firm. All rights reserved.[/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

By |2024-03-14T10:00:17-04:00February 7, 2019|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Miami Man to Remain Jailed for Trial in Nation’s Largest Medicare Fraud Case
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Walgreens Agrees to Pay $269 Million to Settle Two FCA Suits

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

On January 22, 2019, Walgreens agreed to pay more than $269 million to settle allegations of False Claims Act (FCA) violations for overbilling of various drugs. The deals are some of the largest pay-outs ever by a retail pharmacy, according to the United States Department of Justice (DOJ).

The Two Settlements.

There were two separate complaints involving Walgreens to settle federal and state lawsuits that accused the pharmacy of overbilling federal healthcare programs. Both were unsealed by U.S. District Court judges in Manhattan, according to the DOJ.

In the first settlement, Walgreens agreed to pay $209.2 million to the U.S. and several state governments for improperly billing Medicare, Medicaid and other federal healthcare programs. The pharmacy is accused of excessive dispensing of insulin pens to beneficiaries who didn’t need them, according to U.S. officials. It reaped improper payments by understating the amount of treatment days covered by supplies of insulin pens. That allowed it to bill for prescriptions that should have been denied as premature, the DOJ said. Click here to visit our website and read the complaint and the stipulation for the first settlement.

In the second settlement, Walgreens agreed to pay $60 million to settle claims of overbilling Medicaid programs through bogus Medicaid price reporting. The retail pharmacy never disclosed or charged the lower drug prices it offered the public through a pharmacy discount program.

According to the DOJ, Walgreens obtained inflated reimbursement amounts because it failed to disclose discounted drug prices in its “Prescription Savings Club.” However, federal prosecutors said Walgreens didn’t disclose the discounted drug price when filing for reimbursement from Medicaid. Click here to visit our website and read the complaint and stipulation for the second settlement.

There are two whistleblowers in the insulin pen case, they will receive a roughly 19 percent cut of the $41 million portion of the settlement that will go to state, a reward of close to $8 million for blowing the whistle. The whistleblower in the Medicaid price reporting case, will receive a $11.4 million reward, according to his attorney. Not bad for a days work!

Walgreens released a statement, saying it was glad to have the matters resolved but admitted to no wrongdoing.

This isn’t the first time Walgreens has been involved in an FCA lawsuit. Click here to read one of my prior blogs on a similar case.

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

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. 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 whistle blower 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.

Sources:

Overley, Jeff. “Walgreens Pays $269M In Milestone FCA Deals.” Law360. (January 22, 2019). Web.

Thomas, Patrick. “Walgreens to Pay $269 Million on Claims It Overcharged Federal Programs.” WSJ. (January 22, 2019). Web.

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

Keywords: healthcare fraud, healthcare fraud representation, healthcare fraud defense lawyer, Medicare Fraud, legal representation for Medicare fraud, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for Medicare audits, Medicaid fraud defense attorney, legal representation fr Medicaid fraud, legal representation for Medicaid audit, Medicaid audit defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, False Claims Act (FCA), FCA attorney, FCA representation, FCA defense lawyer, whistleblower representation, whistleblower defense attorney, qui tam lawyer, qui tam defense attorney, qui tam representation, legal representation for pharmacies, legal representation for pharmacists, pharmacy representation, pharmacists defense attorney, pharmacy defense lawyer, Board of Pharmacy representation, Board of Pharmacy defense lawyer, reviews of the Health Law Firm, The Health Law Firm attorney reviews, 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 © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:18-04:00January 29, 2019|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Walgreens Agrees to Pay $269 Million to Settle Two FCA Suits
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The Most Common Cases The Health Law Firm Takes

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

One of the most common questions we get asked by doctors and lawyers alike, is about the types of cases our firm takes. They often mistake the practice of health law as medical malpractice defense. However, this is an incorrect assumption. Likewise, if we had a penny for every time we have heard “Yikes, an attorney! I hope I never need you,” we could close our doors and all retire.

As a general health law practice, we concentrate on both proactive and defensive legal issues and clients involved in the health care industry. To a certain extent our law firm does practically everything a physician, medical group, health facility or health care professional could need in the legal arena.

The types of cases we most commonly see are the following:

1. Sales, mergers and acquisitions of medical practices, health care clinics, and health facilities. We represent buyers, sellers and lenders at any stage of the process.

2. Contracts for medical and health care transactions. We prepare contracts, review contracts, negotiate contracts, help to terminate or break contracts, and we litigate contracts. We can be on either side of these transactions. Our litigation can take place in state court or federal court. We review and analyze quite a few employment contracts for medical residents and fellows going to new positions.

3. We research and prepare complex legal opinion letters on proposed health care transactions. The health care industry is the most regulated industry in the United States. There are complex layers of both federal and state laws and regulations as well as numerous federal and state agencies regulating it. Often, legal opinion letters are sought by purchasers and lenders for healthcare transactions for these reasons. We have several board certified health lawyers in our firm who have written dozens of these.

4. We represent health professionals and health facilities in Medicare audits, including fraud audits by the Zone Program Integrity Contractors (ZPICs) and by Recovery Audit Contractors (RACs). This includes representation in the appellate process, including requests for reconsideration, request for redetermination, and federal administrative law judge hearings. Preparation of the response to the audit request, completion of the audit questionnaire, response to the preliminary audit report (PAR), and defense of any repayments demanded, through administrative hearings before federal administrative law judges and appeals if necessary.

5. We represent health professionals and health facilities in Medicaid audits, including fraud audits by the zone program integrity contractors (ZPICs). This includes preparation of the initial response to the audit request, completion of the audit questionnaire, response to the preliminary audit report (PAR), and defense of any repayments demanded, through administrative hearings and appeals if necessary.

6. If there has been an action by the Centers for Medicare & Medicaid Services (CMS) to terminate the Medicare provider’s billing privileges, we aggressively represent them to have the decision reversed and have them reinstated. This includes filing requests for reconsideration and corrective action plans (CAPs). We have been very successful in obtaining relief for our clients.

7. We have represented a number of clinical investigators, primarily physicians, and defensive charges of research fraud, misconduct in science, manipulation of data, manipulating outcomes, in research investigations, and other similar proceedings brought by their institutions or and investigation review board. Whether it is at the initiation of such an investigation or in later hearings and appeals, we have navigated a number of principal investigators through these processes.

8. Our firm has represented a number of medical students, residents and fellow, including foreign medical graduates, in cases brought by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE), and the Educational Commission for Foreign Medical Graduates (ECFMG) in cases where there is an allegation of “irregular behavior” and rules violations through the hearing process and in appeals as necessary.

9. We represent physicians and other health professionals in hospital medical staff peer review proceedings and hearings. Whether it’s the initial application for clinical privileges and medical staff membership or action being taken to revoke or limit clinical privileges, we have been involved representing physicians and other health professionals at all levels. We have also done similar work for physicians in actions initiated by HMOs, professional associations, certification bodies, and other organizations. This is an area where a physician truly needs a health lawyer experienced in this type of proceeding.
10. “Disruptive physician” defense is another area where a doctor really needs an attorney who knows what he or she is doing. When your hospital or medical staff is attempting to place the label on you “disruptive physician,” you are really in trouble. This is an area in which careful navigation is required to prevent actions that result in such a label. Other wise, the physician can be pigeon-holed for life, placed into disruptive physician programs requiring years, if not a lifetime, of close monitoring and can even have discipline commenced against his or her medical license. We can assist you in taking actions to avoid having this happen.

11. When you receive a Medicare, Department of Health and Human Services (HHS), or Office of the Inspector General (OIG) subpoena or civil investigative demand (CID), you know there is serious trouble for someone in the works. We help you to respond promptly and professionally and attempt to keep you from becoming the target of serious federal investigations.

12. We represent physicians, nurses, dentists, psychologists and other licensed health professionals in responding to Department of Health (DOH) letters of investigation. Many physicians, nurses, dentists and other licensed health professionals do not understand that when they receive a letter from the Department of Health complaints advising them that they are under investigation for a complaint that is been made against them, this is a very serious matter. There is nothing that is “routine” about this. This means that there is an investigation that has been opened against your license that could ultimately result in disciplinary action being taken against you. Any disciplinary action taken against you will be on your license forever. This is the time to obtain an attorney. This is not a time to attempt to represent yourself. You should not ever speak with the investigator or provide a statement to the investigator; this is something only your attorney should do and only if it is determined to be advisable considering the facts of the case. We have represented hundreds of licensed health professionals in such investigations and in subsequent disciplinary hearings.

13. We also represent health professionals and others who have been excluded from the Medicare program and placed on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE). We have represented a number of healthcare professionals in completing and submitting applications to be removed from the LEIE and reinstated to the Medicare program.

14. We routinely counsel and represent physicians, dentists, psychologists, mental health counselors, and other health professionals in referrals to the Professionals Resource Network (PRN) for evaluation. We have found that often the health professional will not actually have any type of substance abuse problem or mental health issue. However, one referred for an evaluation to the PRN can wind up in a five year contract or even a lifetime contract for monitoring containing many mandatory requirements in order to continue practicing his/her profession and a lot of expenses associated with meeting such requirements.

15. We also routinely counsel and represent nurses and nurse practitioners (ARNPs), including certified registered nurse anesthetists (CRNAs) in similar referrals to the Intervention Project for Nurses (IPN). We have found that often the nurse will not actually have any type of substance abuse problem or mental health issue. However, one referred for an evaluation to the IPN can wind up in a five year contract or even a lifetime monitoring contract containing many mandatory requirements in order to continue practicing his/her profession and a lot of expenses associated with meeting such requirements.

16. We have been involved in a number of qui tam or whistle blower cases, either representing the whistle blower or representing an employer or institution that is being accused of wrongdoing. Whether this is pursuant to the Federal False Claims Act (FCA), a state false claims act or a private whistle blower act, we are experienced in investigating, prosecuting, defending, and litigating such cases in state or federal court.

17. Our firm represents physicians, pharmacists, health professionals and health facilities in administrative litigation against the Drug Enforcement Administration (DEA), the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), the Agency for Health Care Administration (AHCA) and the Department of Health, among other agencies. Whether the government agency is seeking to recover civil monetary penalties (CMP), attempting to recover large Medicare overpayments, seeking to revoke your DEA registration or seeking to discipline your medical license, we have experience in litigating such matters in these administrative tribunals. This can make the difference between a favorable outcome or a devastating outcome.

18. We represent Veterans Administration (VA) physicians, Army physicians, Navy physicians, Air Force physicians, and Indian Health Service physicians, in employment disputes, peer review investigations and hearings, clinical privileging investigations and hearings, and decisions to report to the National Practitioner Data Bank (NPDB).

19. Reporting a conviction for Driving under the influence (DUI) or some other criminal offense is required by most state licensing agencies. We are experienced in making such reports when required and in such a manner that a subsequent investigation and discipline on the professional license is often avoided.

20. Complex litigation involving health professionals is another area in which we routinely practice. Whether the matter involves a dispute between the shareholders of a medical clinic or practice, restraints on trade, allegations of false claims and fraud, the enforcement or avoidance of restrictive covenants (or covenants-not-to-compete), employment, pay and bonus disputes, ownership of practices or facilities, or any other of a number of different situations, we represent either side in state court or federal court.

21. Because of our experience in mental health law, we have come to represent individuals who have been incorrectly confined in mental health facilities in Florida because of allegations of impairment, drug abuse, mental health issues and other issues in which the person is initially though to be a threat to himself or to others. Both law enforcement authorities and medical personnel are being trained to take fewer chances with an individual acting unusual who may tend to hurt herself or someone else. They often tend to err to the side of ordering confinement under the Florida Mental Health Act (also known as the “Baker Act”). When this happens, the individual may be set for a long stay unless he or she has assistance in navigating the way out. We help doing this as quickly and expeditiously as possible.
22. We routinely representing physicians, pharmacists, nurses, dentists and other licensed health professionals in attempting to avoid or in disputing or in appealing adverse National Practitioner Data Bank (NPDB) Reports. There are only limited grounds for doing this so the professional needs to obtain counsel as early in the process as possible.

23. Any type of subpoena or search warrant from a government agency or law enforcement organization seeking your patient records can herald an investigation into false claims, over-prescribing, or other serious possible charges, criminal, civil or administrative. Our representation seeks to determine the reasons for this as early in the process as feasible and to protect your rights and limit your exposure as much as possible.

24. There are many, many other types of cases which we have experience with. To see some of these others, please visit our website.

As the business of health care grows, our law firm also grows. We are always seeking to expand our areas of practice within the health law field. Be sure to check back regularly for updates.

For more information on various health law topics and how The Health Law Firm can help you, visit our YouTube page to watch our video blogs.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, 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.

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

KeyWords: Legal representation for clients involved in the health care industry, legal representation for health care professionals, defense attorney for health care professionals, health law attorney, legal representation for sales, mergers and acquisitions of medical practices and facilities, physician contract lawyer, legal representation for contracts for medical and health care transactions, Medicare and Medicaid fraud defense attorney, representation for Medicare, Medicare defense lawyer, representation for Medicaid, Medicaid attorney, Medicare audit defense lawyer, Medicaid audit defense lawyer, healthcare fraud representation, healthcare fraud defense lawyer, clinical research defense attorney, legal representation for medical students, USMLE defense lawyer, representation for irregular behavior, irregular behavior defense attorney, medical education law representation, legal counsel for peer reviews, mental health law attorney, peer review defense lawyer, representation for DOH investigations, Department of Health (DOH) investigation defense attorney, legal representation for mental health counselors and professionals, Qui Tam/Whistleblower defense attorney, representation for qui tam cases, qui tam lawyer, whistleblower defense lawyer, representation for whistblower cases, baker act lawyer, complex litigation defense attorney, licensure defense attorney, representation for licensure defense, healthcare license defense attorney, False Claims Act (FCA) attorney, FCA defense lawyer, Baker Act defense attorney, representation for OIG exclusion, representation for DOH investigations, DOH defense lawyer, nurse attorney, representation for nurses, pharmacy representation, pharmacist representation, dentist attorney, representation for dentists, representation for healthcare professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, 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.

By |2024-03-14T10:00:18-04:00January 28, 2019|Categories: Massage Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on The Most Common Cases The Health Law Firm Takes
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DOJ Announces $2.8 Billion Recovered Funds From Healthcare Cases in 2018

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

On December 21, 2018, the U.S. Department of Justice (DOJ) announced that it recovered more than $2.8 billion from False Claims Act (FCA) (also known as “qui tam” or “whistleblower cases”) cases in 2018. Of the $2.8 billion in settlements and judgments that the government obtained during the year through FCA cases, more than $2.5 billion involved health care fraud. These cases included drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical device industry. In one example, AmerisourceBergen Corporation paid a whopping $625 million to settle charges filed under the whistleblower provisions of the FCA. The charges alleged that it illegally distributed misbranded drugs for cancer patients. Of that amount, $581.8 million was paid to the federal government and $43.2 million was paid to state Medicaid programs. Click here to read more on that.

Whistleblower Complaints.

Of the $2.8 billion recovered in 2018, more than $2.1 billion arose from lawsuits filed under the qui tam provisions of the FCA. The government paid out $301 million to the whistleblowers who exposed fraud and false claims by filing these actions. There was a total of 645 qui tam suits filed in 2018. Click here to see the DOJ’s 2018 statistics.  To view the DOJ’s press release on fraud for the fiscal year 2018, click here.

Health Care Fraud is a Serious Matter.

We have been consulted by many individuals, both before and after criminal convictions for health care fraud or related offenses. In many cases, those subject to Medicare fraud audits and false claims investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding health care fraud.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of health care fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

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

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.

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

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

Sources:

Bantz, Phillip. “US Justice Department Recovered $2.8 Billion From False Claims Act Cases in 2018.” Law.com. (December 28, 2018). Web.

“Health Care Dominates FCA Judgments and Settlements in 2018.” The National Law Review. (December 31, 2018). Web.

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

Keywords: healthcare fraud, healthcare fraud representation, healthcare fraud defense lawyer, Medicare fraud, legal representation for Medicare fraud, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for Medicare audits, Medicaid fraud defense attorney, legal representation fr Medicaid fraud, legal representation for Medicaid audit, Medicaid audit defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, False Claims Act (FCA), FCA attorney, FCA representation, FCA defense lawyer, whistleblower representation, whistleblower defense attorney, qui tam lawyer, qui tam defense attorney, qui tam representation, reviews of the Health Law Firm, The Health Law Firm attorney reviews, 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 © 2019 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:19-04:00January 28, 2019|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on DOJ Announces $2.8 Billion Recovered Funds From Healthcare Cases in 2018
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DOJ Announces $2.8 Billion Recovered From Healthcare FCA Cases in 2018

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

On December 21, 2018, the U.S. Department of Justice (DOJ) announced that it recovered more than $2.8 billion from False Claims Act (FCA) (also known as “qui tam” or “whistleblower cases”) cases in 2018. Of the $2.8 billion in settlements and judgments that the government obtained during the year through FCA cases, more than $2.5 billion involved health care fraud. These cases included drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.

Health Care Fraud.

The DOJ’s largest recoveries involving the health care industry in 2018 came from the drug and medical device industry. In one example, AmerisourceBergen Corporation paid a whopping $625 million to settle charges filed under the whistleblower provisions of the FCA. The charges alleged that it illegally distributed misbranded drugs for cancer patients. Of that amount, $581.8 million was paid to the federal government and $43.2 million was paid to state Medicaid programs. Click here to read more on that.

Whistleblower Complaints.

Of the $2.8 billion recovered in 2018, more than $2.1 billion arose from lawsuits filed under the qui tam provisions of the FCA. The government paid out $301 million to the whistleblowers who exposed fraud and false claims by filing these actions. There was a total of 645 qui tam suits filed in 2018. Click here to see the DOJ’s 2018 statistics.  To view the DOJ’s press release on fraud for the fiscal year 2018, click here.

Health Care Fraud is a Serious Matter.

We have been consulted by many individuals, both before and after criminal convictions for health care fraud or related offenses. In many cases, those subject to Medicare fraud audits and false claims investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding health care fraud.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of health care fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

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

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.

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

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

Sources:

Bantz, Phillip. “US Justice Department Recovered $2.8 Billion From False Claims Act Cases in 2018.” Law.com. (December 28, 2018). Web.

“Health Care Dominates FCA Judgments and Settlements in 2018.” The National Law Review. (December 31, 2018). Web.

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

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A.
The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.
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