Take this Quick and Easy Quiz to See If You Might Be a “Disruptive Physician”

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
I often have consultations with and represent physicians from across the country who are in trouble with their hospital medical staff or their licensing board because a complaint has been filed against them alleging they are a “disruptive physician.” This is often the result of an alienated member of the nursing staff or even an economic competitor trying to make trouble for or get rid of the physician.

A disruptive physician is one whose “obnoxious” behavior upsets patients or other staff members. The American Medical Association defines this in its Code of Medical Ethics as “personal conduct, whether verbal or physical, that negatively affects or that potentially may affect patient care.” This type of behavior is disfavored in hospitals and health systems because it is thought to negatively affect patient care by decreasing morale, teamwork, collaboration and communication among health professionals.

The Joint Commission Gets Involved.

Starting in 2008 the Joint Commission began urging hospitals to incorporate provisions to rein in disruptive behavior in the hospitals by physicians. The Joint Commission started requiring hospitals in 2009 to have a written code of conduct addressing the issue. This code of conduct must define acceptable, disruptive, and unacceptable behavior in the workplace, the latter two of which are usually lumped together.

Take This Quiz to See if You Are a “Disruptive Physician.”

Having represented physicians in hearings before medical staff peer review committees, resident physicians before academic conduct committees and appeal review committees, and physicians in hearings before the board of medicine, I have put together the following quiz from the types of misconduct such bodies use to denote a “disruptive physician.”

DISRUPTIVE PHYSICIAN QUIZ

Check “Yes” or “No” for each statement or question. Each “Yes” answer counts for one (1) point.

 

Add up all your “yes” answers above and see where you fall on the following chart:

SCORE
0 to 1 You are not a disruptive physician. You may be dead, however.
2 to 32 You may be a disruptive physician.

Although the quiz above is tongue-in-cheek, all of the questions or statements on it come from actual cases where a physician had to defend himself or herself against charges that they were a “disruptive physician.”

Legal Defenses To Disruptive Physician Charges.

Allegations against a physician for “disruptive behavior” are often vague and impossible to properly defend. It is imperative that if such charges are made against you, you obtain legal counsel who can get involved right away. Such vague, subjective allegations often are relatively easy to defend against, when the true facts are ascertained.

In the case of Fahlen v. Sutter Central Valley Hosp., 58 Cal. 4th 655 (2014), the physician’s hospital clinical privileges were terminated because of a claim of disruptive behavior. The California Supreme Court reversed the hospital’s decision and allowed the physician the right to proceed with a whistleblower case alleging substandard nursing care by the hospital’s nursing staff and the presence of risk to patient safety. In effect, the Court ruled that the doctor was merely a valid whistleblower complaining about quality of care issues. There are similar cases from other jurisdictions.

One can defend such a case by showing that the doctor’s actions are objectively reasonable under the circumstances. Other times you may have a defense you can show because an economic competitor is filing complaints or causing them to be filed against you. Sometimes complaints are generated by hospital staff as a result of a physician’s complaining about incompetent nursing staff or lack of proper equipment. In some cases, we have seen a single nurse generate enough animosity towards a physician so as to have charged with being disruptive.

Read one of my past blogs titled, “Disruptive Physicians: Nobody Likes a Nuisance” to learn more about this topic.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

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: Physician representation, hospital, and medical staff peer review hearings, representation for medical staff fair hearings, medical board representation, Professionals Resource Network (PRN) legal representation, “physician health program” and peer assistance representation, PRN attorney, representation for peer review hearings, disruptive physician representation, disruptive physician defense lawyer, peer review defense attorney, Board of Nursing representation, Board of Pharmacy representation, Board of Medicine representation, Board of Medicine defense lawyer, representation for board matters, healthcare board representation, representation for healthcare professionals, physician defense lawyer, medical license defense, healthcare license defense, 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 © 2020 The Health Law Firm. All rights reserved.

 

 

By |2024-03-14T10:00:03-04:00March 13, 2020|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Take this Quick and Easy Quiz to See If You Might Be a “Disruptive Physician”
Read More

Patient-supplied Respiratory Equipment in the Hospital

The Health Law Firm Michael L. SmithBy Michael L. Smith, JD, RRT

Hospitals and respiratory therapists regularly receive requests from patients asking to use their own respiratory therapy equipment in the hospital. Chronic pulmonary patients are generally reluctant to change their treatment regimen and may request they be permitted to continue using their home ventilators or positive airway pressure units in the hospital. Generally, hospitals should not allow patients to use their own medical equipment.

Patient-supplied medical equipment poses numerous risks for hospitals and their RTs. Patient supplied equipment may be a different model than what the hospital’s RTs and other staff routinely use, which can contribute to errors in the equipment and alarm settings. The hospital may not have compatible parts to ensure that the patient-supplied equipment remains functional during the patient’s hospital stay.

Another risk for the hospital and its staff exists because the patient may not have properly maintained the medical equipment. The hospital and its staff cannot easily determine whether the patient-supplied medical equipment has been regularly serviced, including any necessary modifications based upon recalls. While a particular piece of equipment may appear well maintained on the surface, it could have numerous deficiencies that are almost impossible to detect by the hospital and its staff.

The hospital and its staff may be assuming significant legal liability by allowing patients to use their own medical equipment. Patient-supplied medical equipment that malfunctions could conceivably cause injury to multiple patients and hospital staff. Consequently, hospitals should avoid allowing patients to use their own medical equipment in the hospital.

Despite the risks, most hospitals still allow the use of at least some patient-supplied medical equipment under certain circumstances.

Whenever the hospital elects to allow patient-supplied medical equipment, it should involve the hospital’s counsel, risk manager, and all the necessary hospital departments in the process.

Most hospitals that allow patient-supplied medical equipment have some type of policy on the use of that equipment. Those policies should require written approval from the patient’s physician stating that the patient-supplied equipment is suitable based upon the patient’s current medical condition. Every policy also should require notice to all the clinical and non-clinical departments necessary to ensure the equipment is in good working order and safe to operate. Every piece of electrical equipment must be thoroughly checked for electrical safety, usually by the hospital’s biomedical department.

Whenever the hospital agrees to allow patient-supplied medical equipment, the hospital should have the patient sign a waiver that explicitly states that the hospital is not assuming any liability for the equipment. The waiver also should permit the hospital to use substitute equipment in the event the patient-supplied equipment fails or the patient’s condition changes. Unfortunately, the hospital probably cannot completely absolve itself of any liability for patient-supplied medical equipment, even when the patient signs a waiver.

In the event the patient-supplied equipment fails, the hospital staff will need to intervene and provide appropriate care to the patient, even if the patient assumed all responsibility for the equipment. The hospital staff also will need to regularly check to confirm that the equipment is functioning properly and that the medical equipment remains appropriate for the patient’s condition. Of course, the hospital staff must document their regular assessment of the patient-supplied medical equipment.

Michael L. Smith, JD, RRT is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Florida. This article is for general information only and is not a substitute for formal legal advice.

This article was originally published in Advance for Respiratory Care and Sleep Medicine.

By |2024-03-14T10:00:25-04:00June 1, 2018|Categories: In the Know, The Health Law Firm Blog|Tags: , , , , , , |Comments Off on Patient-supplied Respiratory Equipment in the Hospital
Read More

Two Separate Lawsuits Against Novartis Pharmaceuticals Corporation Allege Illegal Kickbacks and False Claims

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

Novartis Pharmaceuticals Corporation (NPC) is currently fielding two different lawsuits, filed just days apart from each other, by the U.S. Department of Justice (DOJ). The first lawsuit was filed on April 23, 2013, alleging the company gave illegal kickbacks to pharmacists. A second lawsuit was filed on April 26, 2013, alleging illegal kickbacks were paid by NPC to health care providers. According to the DOJ, the government’s complaint seeks damages and civil penalties under the False Claims Act, and under the common law for paying kickbacks to doctors to induce them to prescribe NPC products that were reimbursed by federal health care programs.

Click here to read the entire press release from the DOJ.

NPC Accused of Treating Health Care Professionals to Expensive Dinners, Product Discounts and Fishing Trips.

Both lawsuits allege NPC violated the Anti-Kickback Statute. In the April 23, 2013, complaint against NPC the lawsuit alleges the company gave kickbacks, in the form of rebates and discounts to pharmacies in exchange for the pharmacies’ cooperation in switching patients from competitors’ drugs to NPC products.

The April 26, 2013, lawsuit accuses NPC of paying doctors to speak about certain drugs at events that were allegedly social occasions. Many of the programs were allegedly held in circumstances in which it would be impossible to have a presentation. According to the DOJ, this included fishing trips off the Florida coast and meetings in Hooters restaurants. NPC is also accused of treating health care professionals to expensive dinners. The payments and dinners were apparently kickbacks to the doctors for writing prescriptions for NPC drugs.

Florida Doctors Involved.

The lawsuit alleges at least six Florida doctors of participating in the bogus conferences and taking thousands of dollars in kickbacks, according to the Tampa Bay Times. The doctors are not named or charged in the civil lawsuit.

To read the allegations listed in the lawsuit against Florida doctors, click here for the Tampa Bay Times article.

NPC Denies All Claims.

In a press release, NPC disputes all of the government’s allegations. The pharmaceutical company states that discounts and rebates by pharmaceutical companies are a customary and legal procedure, as recognized by the government. It also addresses the physician speaker programs by saying the programs are also acceptable practices designed to inform physicians about the uses of different types of medicines. Click here to read the entire press release from NPC.

The Law Against Using Bribes in Exchange for Selling a Drug or Service.

For years drug companies have paid doctors to speak about new drugs at educational conferences with other health care professionals. The practice is legal, but considered questionable.

Under the Anti-Kickback Statute, it’s a felony for health care professionals to accept bribes in exchange for recommending a drug or service covered by Medicare, Medicaid, TRICARE or the Department of Veterans Affairs health care program.

Whistleblowers Who Report Fraud and False Claims Against the Government Stand to Receive Large Rewards.

The original complaint against NPC was allegedly filed under the qui tam, or whistleblower, provisions of the False Claims Act by a former sales representative.

Individuals working in the health care industry, whether for hospitals, pharmacies, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government.

In a two-part blog series on whistleblower/qui tam lawsuits I explain types of false claims, the reward programs for coming forward with a false claim, who can file a whistleblower/qui tam lawsuit, and more. Click here to read the first part of this blog, and click here for the second part.

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

Attorneys with The Health Law Firm represent plaintiffs, patients, health care professionals and health facilities in qui tam or whistleblower 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.

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 of these lawsuits? Please leave any thoughtful comments below.

Sources:

Masow, Julie. “Novartis Pharmaceuticals Corporation Disputes Allegations in Two US Government Lawsuits and Looks Forward to a Fair Discussion of the Facts.” Novartis Pharmaceuticals. (April 26, 2013). From: http://www.pharma.us.novartis.com/newsroom/pressreleases/137176.shtml

Davis, Brittany Alana. “Lawsuit: Pharmaceutical Company Gave Kickbacks to Florida Doctors.” Tampa Bay Times. (May 3, 2013). From: http://www.tampabay.com/news/courts/lawsuit-pharmaceutical-company-gave-kickbacks-to-florida-doctors/2119133

Department of Justice. “United States Files Complaint Against Novartis Pharmaceuticals Corp. for Allegedly Paying Kickbacks to Doctors in Exchange for Prescribing Its Drugs.” Department of Justice. (April 26, 2013). From: http://www.justice.gov/opa/pr/2013/April/13-civ-481.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 © 1996-2012 The Health Law Firm. All rights reserved.

By |2024-03-14T10:00:48-04:00June 1, 2018|Categories: Health Care Industry, In the News, Medicare, Medicare Fraud, The Health Law Firm Blog, Whistleblower|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Two Separate Lawsuits Against Novartis Pharmaceuticals Corporation Allege Illegal Kickbacks and False Claims
Read More

Fifty-Five Hospitals Around the Country to Pay the Government $34 Million Settlement for False Claims Allegations

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

Fifty-five (55) hospitals in twenty-one (21) states have agreed to pay the Department of Justice (DOJ) more than $34 million to settle allegations of Medicare fraud in a whistleblower case, according to the DOJ on July 2, 2013. The false claims allegations involve a back procedure called a kyphoplasty. The kyphoplasty can be performed safely and effectively as an outpatient procedure. However, it is alleged that hospitals were using more expensive, inpatient procedures to increase Medicare billings.

To read the press release from the DOJ, click here.

A kyphoplasty is used to treat spinal fractures usually caused by osteoporosis.

Fourteen (14) Florida Hospitals to Pay $11 Million to Government.

According to an article on Health News Florida, fourteen (14) Florida hospitals have agreed to pay around $11 million to settle the DOJ’s false claims charges.

One of the Florida hospitals was Mount Sinai Medical Center in Miami, which will pay $1.84 million. A number of HCA hospitals in Florida were included in the settlement. These hospitals will pay $7.14 million collectively. Another group that settled was the hospitals in the Morton Plant Mease group, which is part of the Baycare Health System in Tampa Bay. This settlement was listed at $2.37 million.

To see all of the Florida hospitals allegedly involved, click here to read the Health News Florida article.

Whistleblower Lawsuit Filed by Two Former Employees.

According to the DOJ, all but four of the settling facilities were named as defendants in a whistleblower lawsuit brought under the False Claims Act. The lawsuits were filed by a former reimbursement manager for Kyphon and a former regional sales manager for Kyphon. The DOJ stated that Kyphon is the company that allegedly advised hospitals to do kyphoplasty procedures as inpatient instead of outpatient procedures. These two will receive a total of about $5.5 million from the settlements.

If you want to know more about whistleblower/qui tam lawsuits, click here to read the first part of a two-part blog, and click here for the second part.

Previous Settlements from Kyphoplasty Procedures.

A similar settlement was reached in 2012, when 14 hospitals agreed to pay a settlement of more than $12 million to the government for allegedly inflating their profits based on unnecessary hospital admissions, according to the Washington Post. Click here to read that article.

The DOJ stated that it has now reached settlements with more than 100 hospitals, for a total of about $75 million resolving allegations that the facilities fraudulently billed Medicare for kyphoplasty procedures.

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is on Fire.

These settlements are a part of the government’s fight against health care fraud and another win for the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT’s mission is to focus its efforts on preventing and deterring fraud and to enforce current anti-fraud laws around the country. It was created in 2009, by the Department of Health and Humans Services (HHS) and the DOJ. To date, the DOJ’s total recoveries in False Claims Act cases since January 2009, are more than $14.7 billion. To learn more about HEAT, click here.

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

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower 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.

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 of these settlements? Please leave any thoughtful comments below.

Sources:

Department of Justice. “Fifty-Five Hospitals to Pay U.S. More Than $34 Million to Resolve False Claims Act Allegations Related to Kyphoplasty.” Department of Justice. (July 2, 2013). From: http://www.justice.gov/opa/pr/2013/July/13-civ-745.html

Associated Press. “Justice Department, 55 Hospitals Reach $34 Million Settlement Over Medicare Fraud Claims.” Washington Post. (July 2, 2013). From: http://www.washingtonpost.com/business/justice-department-55-hospitals-reach-34-million-settlement-over-medicare-fraud-claims/2013/07/02/3d3d2356-e34e-11e2-bffd-37a36ddab820_story.html

Health News Florida Staff. “14 FL Hospitals to Pay $11 Million.” Health News Florida. (July 2, 2013). From: http://health.wusf.usf.edu/post/14-fl-hospitals-pay-11-million

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.

By |2024-03-14T10:00:50-04:00June 1, 2018|Categories: In the News, Medicare, Medicare Fraud, The Health Law Firm Blog, Whistleblower|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Fifty-Five Hospitals Around the Country to Pay the Government $34 Million Settlement for False Claims Allegations
Read More

Orlando Health’s Restructuring Efforts Might Mean Pay Cuts and Layoffs for Employees

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Many employees at Orlando Health might be getting hit hard in the wallet with pay cuts schedule for later this year. According to the Orlando Sentinel, the eight-hospital health system notified its night-shift workers that their differential pay would be trimmed by several dollars an hour. For some employees that could be a twenty percent (20%) reduction in salary. The differential pay cuts are scheduled to take effect on September 8, 2013.

Meanwhile the hospital allegedly raised prices in the cafeteria, reduced the tuition reimbursement benefit, cut some workers hours and made a number of layoffs, according to the Orlando Sentinel. According to Orlando Health officials, this is all part of a restructuring effort that began in November 2012. The cutbacks will affect all eight hospitals and all departments.

Anyone who has eaten in the cafeteria at Orlando Regional knows what a bargain the food was. Now this will be the subject of reminiscence as when us old codgers fondly think back on 5 cent Coca Colas and 10 cent loaves of bread.

To read the Orlando Sentinel article, click here.

Night-Shift Workers Feel Under Paid and Under Appreciated.

Some Orlando Hospital employees spoke to the Orlando Sentinel about the pay cuts. According to the Orlando Sentinel, night-shift workers receive incentive pay on top of their base salary for their willingness to work night shifts. One worker interviewed explained the incentive pay is given to them because no one wants to work the overnight shift. Workers also get differential pay for weekend and holiday hours.

On top of the pay cuts, workers are seeing their hours drop, as well as layoffs around the hospital. In the November 2012, restructuring announcement, Orlando Health said 300 to 400 employees’ jobs were on the chopping block, according to WFTV. Some people were previously let go, while more layoffs will be coming. Hospital officials would not say how many people have been laid off so far.

To read more from WFTV, click here.

Orlando Health’s Statement.

Orlando Health reported an $8.1 million loss last quarter. That’s on top of losing money for the last four out of five quarters, according to the Orlando Sentinel. Hospital officials said the change in differential pay puts Orlando Health in line with the pay of other hospitals in the Southeast. On August 13, 2013, Orlando Health sent out an official statement, click here to read the full statement.

Petition to Block Pay Cuts Gaining Momentum.

A petition filed on August 9, 2013, on Change.org, is requesting the Orlando Health CEO block the pay cuts to the night shift workers. The petition was started by a registered nurse at Winnie Palmer Hospital for Women and Babies and is quickly picking up steam. As of August 15, 2013, the petition had more than 2,700 signatures, although not all are local. To view the petition, click here.

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

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, 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.

Comments?

What do you think of the cutbacks at Orlando Health? Are these steps necessary? If you are an Orlando Health employee, how will these changes affect you? Please leave any thoughtful comments below.

Sources:

Jameson, Marni. “Orlando Health Workers Concerned by Cutbacks in Hours and Pay.” Orlando Sentinel. (August 9, 2013). From: http://www.orlandosentinel.com/health/os-orlando-health-cutbacks-20130809,0,5234963.story?dssReturn

Hughes, Ryan. “Orlando Health Confirms Second Round of Layoffs.” WFTV. (August 2, 2013). From: http://www.wftv.com/news/news/local/orlando-health-confirms-second-round-layoffs/nZCjC/

Lewis, Kena. Orlando Health Statement. Orlando Business Journal. (August 13, 2013). From: http://www.bizjournals.com/orlando/blog/2013/08/orlando-health-pay-cuts-to-save-18m.html?page=all

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.
By |2024-03-14T10:00:51-04:00June 1, 2018|Categories: Health Care Industry, In the Know, In the News, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , |Comments Off on Orlando Health’s Restructuring Efforts Might Mean Pay Cuts and Layoffs for Employees
Read More

Feds File Two Lawsuits Against Novartis for Allegedly Giving Kickback to Pharmacists and Physicians

11 Indest-2008-8By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Novartis Pharmaceuticals Corporation (NPC) is currently fielding two different lawsuits, filed just days apart from each other, by the U.S. Department of Justice (DOJ). The first lawsuit was filed on April 23, 2013, alleging the company gave illegal kickbacks to pharmacists. A second lawsuit was filed on April 26, 2013, alleging illegal kickbacks were paid by NPC to health care providers. According to the DOJ, the government’s complaint seeks damages and civil penalties under the False Claims Act, and under the common law for paying kickbacks to doctors to induce them to prescribe NPC products that were reimbursed by federal health care programs.

Click here to read the entire press release from the DOJ.

Doctors and Pharmacists Allegedly Paid to Prescribe.

Both lawsuits allege NPC violated the Anti-Kickback Statute. In the April 23, 2013, complaint against NPC the lawsuit alleges the company gave kickbacks, in the form of rebates and discounts to pharmacies in exchange for the pharmacies’ cooperation in switching patients from competitors’ drugs to NPC products.

The April 26, 2013, lawsuit accuses NPC of paying doctors to speak about certain drugs at events that were allegedly social occasions. Many of the programs were allegedly held in circumstances in which it would be impossible to have a presentation. According to the DOJ, this included fishing trips off the Florida coast and meetings in Hooters restaurants. NPC is also accused of treating health care professionals to expensive dinners. The payments and dinners were apparently kickbacks to the doctors for writing prescriptions for NPC drugs.

Doctors in the Sunshine State Allegedly Involved.

The lawsuit alleges at least six Florida doctors of participating in the bogus conferences and taking thousands of dollars in kickbacks, according to the Tampa Bay Times. The doctors are not named or charged in the civil lawsuit.

To read the allegations listed in the lawsuit against Florida doctors, click here for the Tampa Bay Times article.

Novartis Claims Discounts and Physician Speaker Programs Were Legitimate.

In a press release, NPC disputes all of the government’s allegations. The pharmaceutical company states that discounts and rebates by pharmaceutical companies are a customary and legal procedure, as recognized by the government. It also addresses the physician speaker programs by saying the programs are also acceptable practices designed to inform physicians about the uses of different types of medicines. Click here to read the entire press release from NPC.

Kickbacks and The Law.

For years drug companies have paid doctors to speak about new drugs at educational conferences with other health care professionals. The practice is legal, but considered questionable.

Under the Anti-Kickback Statute, it’s a felony for health care professionals to accept bribes in exchange for recommending a drug or service covered by Medicare, Medicaid, TRICARE or the Department of Veterans Affairs health care program.

Whistleblower or Qui Tam Lawsuits Can Results in a Big Pay Day.

The original complaint against NPC was allegedly filed under the qui tam, or whistleblower, provisions of the False Claims Act by a former sales representative.

Individuals working in the health care industry, whether for hospitals, pharmacies, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities.  Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government.

In a two-part blog series on whistleblower/qui tam lawsuits I explain types of false claims, the reward programs for coming forward with a false claim, who can file a whistleblower/qui tam lawsuit, and more. Click here to read the first part of this blog, and click here for the second part.

The Health Law Firm Lawyers are Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent plaintiffs, patients, health care professionals and health facilities in qui tam or whistleblower 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.

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

Sound Off.

Have you head about these two lawsuits? What are your thoughts? Please leave any thoughtful comments below.

Sources:

Masow, Julie. “Novartis Pharmaceuticals Corporation Disputes Allegations in Two US Government Lawsuits and Looks Forward to a Fair Discussion of the Facts.” Novartis Pharmaceuticals. (April 26, 2013). From: http://www.pharma.us.novartis.com/newsroom/pressreleases/137176.shtml

Davis, Brittany Alana. “Lawsuit: Pharmaceutical Company Gave Kickbacks to Florida Doctors.” Tampa Bay Times. (May 3, 2013). From: http://www.tampabay.com/news/courts/lawsuit-pharmaceutical-company-gave-kickbacks-to-florida-doctors/2119133

Department of Justice. “United States Files Complaint Against Novartis Pharmaceuticals Corp. for Allegedly Paying Kickbacks to Doctors in Exchange for Prescribing Its Drugs.” Department of Justice. (April 26, 2013). From: http://www.justice.gov/opa/pr/2013/April/13-civ-481.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 © 1996-2012 The Health Law Firm. All rights reserved.
By |2024-03-14T10:01:12-04:00May 15, 2018|Categories: Legal Defense for Pharmacists, Pharmacist, Pharmacy, Pharmacy Law, Whistleblower|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Feds File Two Lawsuits Against Novartis for Allegedly Giving Kickback to Pharmacists and Physicians
Read More

Traveling Nurses Must Have Appropriate Professional Liability Insurance

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

We are often asked what we consider to be the biggest problem that a nurse has in defending herself in a complaint against her license.  In our opinion, it is not having the financial resources to retain the services of an experienced attorney to defend her.  Because of this, we believe that any nurse, especially traveling nurses working at a hospital, skilled nursing facility, home health agency, assisted living facility, medical group, or any other organization must have her own personal professional liability policy that provides ample insurance coverage for professional license defense expenses.

Most Complaints Made Against Nurses are Filed by Employers.

In our experience, most of the complaints filed against nurse professionals come from employers.  In many cases, a patient will complain to the employer and the employer will file the complaint.  In others, the employer initiates the complaint because of substandard performance, documentation problems, allegations of theft or drug diversion, allegations of falsification of documents or records, etc.  When this happens, in most cases the employer terminates the nurse.  This is why we say that a nurse must have her own professional liability insurance policy.

We see a great many more complaints filed against a nurse’s license that she then must defend, than we ever see civil claims for damages.

Many nurses work under the incorrect assumption that they are “insured” by their employer or their agency or that their employer’s or agency’s insurance covers them.  This is a fallacy, especially when it comes to defending against a complaint made against one’s nursing license.  If your employer or agency is the one that files the complaint against you, you don’t really think that your employer or agency is going to cover the legal expenses associated with your defense, do you?

Some hospitals and health organizations are notorious about firing nurses who have any discrepancies in drug counts or who have documentation errors.  This often results in a complaint to the Department of Health (DOH) against the nurse’s license.

Furthermore, we are all aware of the phenomenon with the traveling nurse, the person who is no longer there, getting all of the blame for any problem or incident that come up.  The ones that are still at the facility, the ones who are conducting the investigation on the incident, are far less likely to find blame with their friends and colleagues who are still there.

Just when you need it the most, you may find yourself out of a job, with no income, and no money to pay for a legal defense.  This may ultimately lead to your losing your nursing license and your ability to ever work as a health professional again.

If You Don’t Have Personal Professional Liability Insurance-Get It.

Professional liability insurance policies for nurses are very cheap.  Often policies are only about ten dollars a month.  Usual limits of coverage for this small premium payment are one million dollars of coverage for civil suits and $25,000 or more coverage for professional license defense.

But wait, it is not as simple as just purchasing the first professional liability insurance policy you find.  Many professional liability insurance policies do not offer license defense coverage.  Or, if they do, it is limited to only complaints where there is also the threat that a patient is going to sue for money.  Still others provide such low limits of coverage for license defense expenses (e.g., $5,000 or $10,000) that it is not worth the money paid for it, while others do not allow you to choose your own attorney.

Insurance Companies We Recommend.

We usually tout insurance companies such as that provided by Nurses Service Organization (NSO) and Healthcare Professionals Service Organization (HPSO) as providing great bang for the buck.  But here lately, we’ve been seeing (and hearing) more and more about CPH & Associates insurance.  Not only does it provide one million dollars in coverage if you are sued in a civil court, but it also provides up to $35,000 in coverage for professional license defense.  Additionally, for a very small additional payment, with CPH & Associates Insurance you can increase that coverage to $100,000 for professional license defense.  The other company we hear good things about is Lloyd’s of London.

If you have a complaint filed against your nursing license and you have to prove your innocence through a formal administrative hearing (trial), this can be very, very expensive.  Additionally, if you lose at this level, you may have to appeal the results to a higher court.  These expenses can easily cost $75,000, even if you win.  And you are not ever assured that you will get any of this money paid back to you, even if you are innocent and you win the case.  Inexpensive insurance coverage is the only thing that makes since.  Buy it!

In Conclusion.

We urge all nurses, especially traveling nurses, to purchase and maintain their own personal professional liability insurance policy.  It’s tax deductible.  But check to make sure you have coverage for professional license defense, even when there is no claim for damages expected from a patient.  Additionally, pay the extra premium to purchase a higher limit of coverage for professional license defense cases, or buy a second insurance policy for this additional coverage.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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

Comments?

Do you have personal professional liability insurance? Will you consider purchasing a personal policy now? Please leave any thoughtful comments below.

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.

By |2024-03-14T10:01:58-04:00May 15, 2018|Categories: Board of Nursing, Defense, Department of Health, Discipline, Insurance, Nurse License|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |3 Comments
Read More
“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.
FacebookInstagramLinkedInTwitterYouTube
Toggle Sliding Bar Area
Go to Top