11th Circuit Court of Appeals Rejects Florida Eye Doctor’s Request for New Medicare Fraud Trial

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

On July 31, 2020, a panel of U.S. Eleventh Circuit Court of Appeal judges upheld a 17-year prison sentence for a Florida ophthalmologist found guilty of Medicare fraud. The three-judge panel rejected an appeal in which Salomon Melgen claimed prosecutors mishandled his 2017 criminal trial.

It upheld the conviction on all 67 counts, deemed the 17-year-sentence to be even-handed, and denied him a new trial.

Details of the Case and Why the Former Ophthalmologist Requested a New Trial.

To understand how the panel reached their decision, it helps to understand the details of the scheme and the accusations. Back in April 2017, a jury in the Southern District of Florida convicted Melgen of carrying out systemic billing fraud at his South Florida medical offices. He stood accused of routinely administering unnecessary, invasive treatments and profiteering off the macular-degeneration drug Lucentis.

Additionally, he was charged with running millions of dollars’ worth of unnecessary diagnostic tests, often using outdated technology that allowed him to bill at higher rates.

According to the opinion, Melgen presented a list of perceived reasons for reversal, including the sufficiency of the evidence and reasonableness of his sentence. He argued that charts comparing his billing rates to his peers were not covered by Federal Rule of Evidence 1006 and, therefore, amounted to inadmissible hearsay in violation of the Confrontation Clause of the U.S. Constitution. To learn more, click here to view his appeal.

Unfortunately for the doctor, the alleged errors in the trial did not persuade the judges.

Other Alleged Errors and How the 11th Circuit Judges Came to Their Decision.

One issue was whether any of the witnesses’ communications with others had tainted their testimony at the trial. In the opinion, the appellate panel stated that Melgen failed to show that the witness interactions affected testimony. The trial court did not abuse its discretion by continuing the trial after the witness intimidation came to light. Lastly, the sentence length the district court imposed was “more than reasonable,” the panel stated.

U.S. Circuit Judge Britt C. Grant, said on behalf of the panel, “The scope of the scheme was easily enough for the jury to conclude that Melgen had engaged in systematic fraud, rather than committing isolated mistakes. We find the evidence sufficient to uphold the jury’s verdict.” You can read the opinion in full here.

Contact Health Law Attorneys Experienced with Investigations of Optometrists and Ophthalmologists.

The attorneys of The Health Law Firm provide legal representation to optometrists, ophthalmologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

Sources:

Kapnick, Izzie. “11th Circuit Upholds Doctor’s Massive Fraud Conviction.” Courthouse News. (July 31, 2020). Web.

Jarvis, Sarah. “11th Circ. Won’t Grant Menendez-Linked Doc New Fraud Trial.” Law360. (July 31, 2020). 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.

“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 |2021-02-17T14:04:29-05:00April 17, 2021|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

11th Circuit Court of Appeals Rejects Florida Eye Doctor’s Request for New Medicare Fraud Trial

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

On July 31, 2020, a panel of U.S. Eleventh Circuit Court of Appeal judges upheld a 17-year prison sentence for a Florida ophthalmologist found guilty of Medicare fraud. The three-judge panel rejected an appeal in which Salomon Melgen claimed prosecutors mishandled his 2017 criminal trial.

It upheld the conviction on all 67 counts, deemed the 17-year-sentence to be even-handed, and denied him a new trial.

Details of the Case and Why the Former Ophthalmologist Requested a New Trial.

To understand how the panel reached their decision, it helps to understand the details of the scheme and the accusations. Back in April 2017, a jury in the Southern District of Florida convicted Melgen of carrying out systemic billing fraud at his South Florida medical offices. He stood accused of routinely administering unnecessary, invasive treatments and profiteering off the macular-degeneration drug Lucentis.

Additionally, he was charged with running millions of dollars’ worth of unnecessary diagnostic tests, often using outdated technology that allowed him to bill at higher rates.

According to the opinion, Melgen presented a list of perceived reasons for reversal, including the sufficiency of the evidence and reasonableness of his sentence. He argued that charts comparing his billing rates to his peers were not covered by Federal Rule of Evidence 1006 and, therefore, amounted to inadmissible hearsay in violation of the Confrontation Clause of the U.S. Constitution. To learn more, click here to view his appeal.

Unfortunately for the doctor, the alleged errors in the trial did not persuade the judges.

Other Alleged Errors and How the 11th Circuit Judges Came to Their Decision.

One issue was whether any of the witnesses’ communications with others had tainted their testimony at the trial. In the opinion, the appellate panel stated that Melgen failed to show that the witness interactions affected testimony. The trial court did not abuse its discretion by continuing the trial after the witness intimidation came to light. Lastly, the sentence length the district court imposed was “more than reasonable,” the panel stated.

U.S. Circuit Judge Britt C. Grant, said on behalf of the panel, “The scope of the scheme was easily enough for the jury to conclude that Melgen had engaged in systematic fraud, rather than committing isolated mistakes. We find the evidence sufficient to uphold the jury’s verdict.” You can read the opinion in full here.

Contact Health Law Attorneys Experienced with Investigations of Optometrists and Ophthalmologists.

The attorneys of The Health Law Firm provide legal representation to optometrists, ophthalmologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

Sources:

Kapnick, Izzie. “11th Circuit Upholds Doctor’s Massive Fraud Conviction.” Courthouse News. (July 31, 2020). Web.

Jarvis, Sarah. “11th Circ. Won’t Grant Menendez-Linked Doc New Fraud Trial.” Law360. (July 31, 2020). 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.

“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 |2021-02-17T14:01:38-05:00March 17, 2021|Categories: Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

What is the corporate practice of optometry and what does it prohibit?

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The legal doctrine called the “corporate practice of medicine or optometry” actually refers to the legal prohibition that prevents a doctor or an optometrist from working for a corporation (or other business entity) that is owned, operated or controlled by non-physicians or, in the case of optometrists, non-optometrists.

In the context of such laws, the term “non-physician” or “non-optometrist” almost always refers to one who is not licensed in the same state as the practice. Such prohibitions are entirely subject to each state’s laws. Some states have statutes that prohibit the corporate practice of a profession. Others have case law that has developed over the decades. So it depends on what state you are in whether or not the law prohibits the relationship.

The principle behind having such a prohibition is to prevent a business from controlling a medical or optometry practices. The idea is that decisions involving patient care should be made solely and completely in the best interest of the patient, based on the patient’s actual medical needs, by the physician providing the services. Fears are that business people or corporations might scrimp on supplies and equipment, purchase inferior grade products to use, or order unnecessary tests and procedures to increase income.

Florida has no corporate practice of medicine prohibition for medical doctors (MDs) or osteopathic physicians (DOs). However, it does have prohibitions that apply to optometrists, dentists and chiropractors. The optometry statute, Section 463.014, Florida Statutes, is similar to the ones for dentistry, Section 466.0285, Florida Statutes, and for chiropractors, Section 460.4167, Florida Statutes, perhaps being more similar to the latter. Although the optometry statute does not provide the strict consequences for violation that the latter two statutes above provide, nevertheless, it does prohibit the corporate practice of optometry, except if the corporation or business entity is owned and controlled by other licensed health professionals. The statutes prohibiting the corporate practice of dentistry and chiropractic, both make it a felony to violate the prohibition, a very serious matter.

Section 463.014(1)(a), Florida Statutes, does conclude with “Nothing in this section shall be deemed to prohibit the association of a licensed practitioner [meaning “optometrist”] with a multidisciplinary group of licensed health care professionals, the primary objective of which is the diagnosis and treatment of the human body.” To me, this language specifically authorizes an optometrist to “associate with” (meaning be employed by, contract with, form a partnership with, be a member with, be a shareholder with, etc.) a group or entity composed of other licensed health professionals (e.g., MDs, DOs, ARNPs, etc.). Therefore the optometrist could join with or be employed by any type of “group” of other licensed health professionals, whether that group is a P.A., Inc., LLC, etc.

Under Florida law, unless the licensed health professionals are the same profession (i.e., licensed by the same board) then they cannot form a “professional association” (a misnomer, actually it is a “professional service corporation” or “professional corporation” which the Florida Statutes allow to be shown by the abbreviation “P.A.;” see, Section 621.12(2), Florida Statute) nor a professional limited liability company (PLLC). See Section 621.03(2), Florida Statutes. So, for example, an MD could not legally form a P.A. (meaning a professional association or professional service corporation) with an advanced registered nurse practitioner (ARNP) as a shareholder (different professions). A chiropractor (DC) cannot legally be in a P.A. with a dentist (different professions).
However, I don’t believe there is any prohibition in Florida on licensed health professionals forming a non-professional service corporation (i.e., a “business corporation”) or other types of business entities, with other licensed health professionals. Except, of course, the prohibition that applies to optometrists, chiropractors and dentists, discussed above.

Despite the absence of teeth from the optometry statute, Section 463.014, Florida Statutes, I would never recommend to a client ignoring it. You risk having someone sue to have any contracts or arrangements made that violate it declared void and unenforceable. I have been involved in a number of these cases with medical doctors and with dentists.

Before entering into any business venture in Florida (or any state, for that matter) involving a medical business, dental practice, optometry practice, or chiropractic practice, be sure to consult with a board certified health lawyer or other experienced attorney knowledgeable in health law and corporate law. Be sure to conduct adequate due diligence to know and understand the entire business arrangement. Obtain a written opinion letter to advise you and protect you from the consequences of a poor decision.

Contact Health Law Attorneys Experienced in Representing Optometrists.

The attorneys of The Health Law Firm provide legal representation to optometrists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, contract matters, business law matters, business litigation 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., 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 optometrists, corporate practice attorney, corporate practice defense attorney, Board of Optometry investigation defense attorney, Optometrist defense attorney, legal counsel for Board of Optometry investigations and hearings, health care professional defense attorney, legal representation for medical professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida health law attorney, legal representation for administrative hearings, legal representation for complaints against a professional license, licensure defense attorney, legal representation for a complaint made for violation of HIPAA or patient privacy, legal representation for Optometrists in Florida, legal representation for Optometrists in Colorado, legal representation for Optometrists in Louisiana, legal representation for Optometrists in Virginia and legal representation for Optometrists in the District of Columbia

“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 © 2017 The Health Law Firm. All rights reserved

Florida Senate Health Committee Approves Change In Optometrist Certification

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

On December 5, 2017, the Florida Senate Health Policy Committee approved a bill that would allow the Florida Board of Optometry to offer practical and written “certification” examinations to applicants. The bill would assist optometrists who were licensed before July 1993 and, therefore, were not required to be “certified.”

Certified vs. Licensed.

In Florida, the law allows certified optometrists to prescribe pharmaceuticals for the treatment of glaucoma. However, licensed optometrists who aren’t certified cannot prescribe those drugs. They are required to make the public aware by posting in their offices a sign that states, “I am a Licensed Practitioner, not a Certified Optometrist, and I am not able to prescribe ocular pharmaceutical agents.”

Applicants are required to submit proof to the Department of Health (DOH) that she or he meets certain requirements and pass an exam within a specified time frame if they wish to be certified.

The Senate Health Policy Committee unanimously approved the bill (SB 520). To read more on SB 520, click here.
To stay on top of news and regulations for optometrists, check our Vision Law Blog regularly.

 

Contact Health Law Attorneys Experienced in Representing Optometrists.

The attorneys of The Health Law Firm provide legal representation to optometrists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, contract matters, business law matters, business litigation 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.

Sources:

Miller, Daylina. “Panel Approves Change In Optometrist Certification.” Health News Florida. (December 6, 2017). Web.

“Panel Approves Change In Optometrist Certification.” WLRN TV. (December 6, 2017). Web.

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 optometrists, optometrist defense attorney, ophthalmologist defense attorney, legal representation for eye doctors, medical license defense attorney, optometry license defense attorney, legal representation for optometry licensure issues, Board of Optometry investigation defense attorney, legal counsel for Board of Optometry investigations and hearings, Board of Medicine investigation defense attorney, legal counsel for Board of Medicine investigations and hearings, Department of Health investigation defense attorney, legal counsel for Department of Health investigations and hearings health care professional defense attorney, legal representation for medical professionals, Florida health law attorney, informal administrative hearing defense attorney, informal administrative hearing defense lawyer, informal administrative hearing defense legal counsel, complaint against professional license defense attorney, complaint against professional license defense lawyer, legal representation for Optometrists in Florida, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, health law defense attorney, legal representation for health care professionals, complex health litigation defense attorney, complex health care litigation legal counsel

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

Go to Top