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

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

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

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

Administrative Proceedings Can be Complex.

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

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

Procedural Mistakes Can Be Damaging To Your Legal Defense.

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

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

Professional Liability Insurance May Pay Legal Fees for Deposition Coverage.

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

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

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

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

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

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

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

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

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

By The Health Law Firm|2024-03-14T10:00:09-04:00October 10, 2019|Categories: Pharmacy Law Blog|Tags: administrative procedure act, administrative proceeding, ALJ, Board of Pharmacy, Board of Pharmacy hearing, defense attorney, defense lawyer, department of health, deposition coverage, disciplinary charges, disciplinary complaint, FAC, final hearing, Florida Administrative Code, Florida Board of Pharmacy, formal hearing, health law firm, health professional, hearing representation, Informal hearing, last minute deposition coverage, legal defense for pharmacists, legal representation, legal representation for pharmacist, legal representation for pharmacy, local deposition coverage, negligence lawsuit, noticed of a deposition, pharmacist, pharmacy, Pharmacy and tagged Administrative Law Judge, professional liability insurance, rights for an appeal, Rules of Civil Procedure, Rules of Evidence, short notice of representation of pharmacy, short notice representation of pharmacist, subpoena, the health law firm|Comments Off

Ready or Not, It’s Irregular Behavior Season Once Again…

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

Every year, our firm receives calls from panicked medical students and residents about a recent letter they have received, alleging irregular behavior on standardized medical examinations.

This letter may come from the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE), or the Educational Commission for Foreign Medical Graduates (ECFMG). No matter the organization, if you receive a letter alleging irregular behavior, it will typically say the following:

A bulletin or policy related to the exam stating that Irregular Behavior is not permitted.

The facts alleging irregular behavior in this case.

You have an opportunity to respond to the allegations, in person, with counsel.

Often there is a very short window of time to respond to such allegations. While this is important because it is urgent that you get your results test results, it also gives a limited time to prepare to defend yourself.

What is Irregular Behavior?

Although irregular behavior is not the same thing as cheating, it is often thought of as the same by medical school officials and residency program directors. A notice of irregular behavior may hold up and delay your entry into a residency program, your graduation from medical school, and your job opportunities. Your examination scores will be held up while the matter is reviewed by a USMLE Committee on irregular behavior or until a hearing can be held.

What Should You Do?

Once you receive an irregular behavior letter, begin to compile documents to defend yourself. Write out your version of events in order to recall what happened. Collect character reference letters from professors and administrators that attest to your integrity.

Place the personal appearance date listed in your letter on your calendar. It is of upmost importance that you attend in person, preferably with representation. Hearings are usually held in Philadelphia, Pennsylvania, so plan accordingly.

Why Hiring an Attorney Matters.

An attorney can provide the following services to someone accused of irregular behavior:
Review documents, videos, photographs, and all other information that pertains to your case.

Recommend other documents that you should obtain in your defense.

Prepare you for a personal appearance before the respective board or committee making the allegations, and will also make a personal appearance with you at hearing.

Prepare you to answer questions under pressure and on the day of your hearing.

The takeaway message is that retaining an attorney to represent you against irregular behavior allegations could be the difference between a clear record and a mark that will follow you for the rest of your career. Don’t risk jeopardizing your future as a healthcare practitioner. Consult with an attorney as soon as you receive notice of allegations against you regarding irregular behavior.

Consequences of an Irregular Behavior Finding.

If a finding of irregular behavior is made against you, then this usually means that your best score is voided, and you must retake it. The USMLE Committee may require you to wait a year or more to retake the examination. This can prevent you from obtaining or entering a residency program or it may delay you from graduating. Furthermore, the notation that you were found to have committed irregular behavior will be placed on your Step exam transcript. This will be reported out when your test scores are reported.

As indicated above, many medical decision makers view this as similar to cheating. It may disqualify you for many jobs or residency programs that you would otherwise be considered for. If you are accused of irregular behavior, immediately consult with an attorney who has actual experience in dealing with this matter. You can find more information about irregular behavior by clicking here to watch our informational video blog. Click here to read one of my prior blogs on USMLE.

Contact Experienced Health Law Attorneys For Irregular Behavior or USMLE Issues Today.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Keywords: National Board of Medical Examiners (NBME), medical students, medical resident, irregular behavior, United States Medical Licensing Examination (USMLE), Examination Committee for Foreign Medical Graduates (ECFMG), cheating, USMLE preparation course , USMLE hearings, USMLE appeals, defense attorney, defense lawyer, legal representation, medical student lawyer, medical student attorney, medical resident lawyer, medical resident attorney, medical intern lawyer, medical intern attorney, accused of irregular behavior, The Health Law Firm reviews

“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 © 2018 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:23-04:00August 29, 2018|Categories: The Health Law Firm Blog, Uncategorized|Tags: accused of irregular behavior, cheating, defense attorney, defense lawyer, Examination Committee for Foreign Medical Graduates (ECFMG), irregular behavior, legal representation, medical intern attorney, medical intern lawyer, medical resident, medical resident attorney, medical resident lawyer, medical student attorney, medical student lawyer, medical students, National Board of Medical Examiners (NBME), The Health Law Firm reviews, United States Medical Licensing Examination (USMLE), USMLE appeals, USMLE hearings, USMLE preparation course|Comments Off

Phony Medical Equipment Supplier will Spend 30 months in Prison for Medicare Fraud

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

A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The claims were almost all for expensive, high-end power wheelchairs. The man was sentenced on October 5, 2012.

To see the press release from the Department of Justice (DOJ), click here.

Man Owned and Operated a Phony Durable Medical Equipment Supply Company.

In February 2012, the defendant in this case pleaded guilty to owning and operating a fake durable medical equipment (DME) supply company, which he used to submit false claims to Medicare. He would allegedly pay kickbacks to co-conspirators for prescriptions and other documents needed to pull off the fraud. About ninety-five percent (95%) of all of his claims were for power wheelchairs. The wheelchairs were allegedly supplied to Medicare beneficiaries who were illegally solicited by recruiters.

Feds Taps the Brakes on Wheelchair Medicare Fraud.

In September of 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration. Durable Medical Equipment Suppliers (DMES) protested the program because it requires advanced approval prior to the delivery of a power wheelchair to the consumer.

Federal health officials argue that these changes are necessary because eighty percent (80%) of the power wheelchair claims that were submitted in 2011 to Medicare did not meet program requirements, according to the government. That error rate means more than $492 million of improper payments.

I recently wrote on blog on this hot-button topic, click here to read it.

Beware of Patient Recruiters.

We have seen several big cases recently involving prosecution for Medicare fraud in which patient recruiters were involved. It would probably be a good idea, if you are a legitimate Medicare provider, to have nothing to do with patient recruiters. If you are not a legitimate Medicare provider, you don’t care about this anyway.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.
The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid Program and administrative hearings.

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

Comments?

What do you think about this story? Please leave any thoughtful comments below.

Sources:

U.S. Department of Justice. “Los Angeles Medical Equipment Supplier Sentenced to 30 Months in Prison for Medicare Fraud Scheme.” FBI. (October 5, 2012). Press Release. From: http://www.justice.gov/opa/pr/2012/October/12-crm-1213.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.

Department of Justice Seeks up to $600 Million in Whistleblower Case Against Halifax Health in Daytona Beach, Florida

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

The U.S. Department of Justice (DOJ) is asking for between $350 million and $600 million in damages and penalties from Halifax Health Medical Center in Daytona Beach, according to The Daytona Beach News-Journal. A Halifax employee filed the whistleblower lawsuit in 2009, accusing the hospital of illegal kickbacks to doctors, improper admissions and unnecessary spinal surgeries. The DOJ joined the case in 2011. Click here to read a previous blog on the DOJ joining the lawsuit.

If the government wins this case, it would amount to the largest whistleblower case of its kind in the nation.

Claims Against Halifax.

Halifax is accused of overbilling Medicare by inappropriately admitting patients and having financial arrangements with some of its doctors that violated a federal anti-kickback law.

The federal Stark Law prohibits Medicare and Medicaid payments for hospital services that are prescribed by doctors who have profit-sharing agreements with the hospital. The law was made to ensure that referrals are made for medical reasons only, without financial motives. However, according to the lawsuit, Halifax had agreements with its doctors that gave them a financial incentive to generate hospital revenues.

The whistleblower was recently interviewed in an Orlando Sentinel article. She claims neurosurgeons at Halifax allegedly received illegal kickbacks tied to their performance. The whistleblower claims a similar pattern existed with six of the hospital’s oncologists. The suit also alleges one surgeon performed spinal fusion surgeries that were not medically necessary.

Halifax Denies All Claims.

Halifax denies all of the DOJ’s allegations. The hospital has filed two motions to dismiss the case. However, both have been denied. According to The Daytona Beach News-Journal, the case is set for trial in November 2013. Click here to read the entire article from The Daytona Beach News-Journal.

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

Since the Halifax whistleblower filed her action under a federal law, she is entitled to recoup fifteen percent (15%) to twenty-five percent (25%) of the damages. Similarly, individuals working in the health care industry, whether for hospitals, 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, 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 what is needed to be a successful whistleblower. Click here for part one, and click here for part two.

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

In addition to our other experience in Medicare, Medicaid and Tricare 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 learn more on our experience with Medicaid and Medicare quit tam or whistleblower cases, visit our website.

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 this qui tam/whistleblower lawsuit? Please leave any thoughtful comments below.

Sources:

Swisher, Skyler. “Justice Department Seeks up to $600 Million in Lawsuit Against Halifax.” The Daytona Beach News Journal. (June 3, 2013). From: http://www.news-journalonline.com/article/20130603/NEWS/306039975/1040?p=1&tc=pg

Jameson, Marni. “Halifax Hospial Whistleblower at Forefront of $200M Alleged Fraud.” Orlando Sentinel. (April 15, 2013). From: http://articles.orlandosentinel.com/2013-04-15/news/os-halifax-hospital-whistleblower-20130415_1_marlan-wilbanks-illegal-kickbacks-halifax-health

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.

Medical Students and Residents Must Fight Allegations of “Irregular Behavior” on the USMLE Step Exams

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

I am constantly taking calls from medical students and residents (or future residents) relating to allegations brought against them of “irregular behavior” in connection with the United States Medical Licensing Examination (USMLE) exams. Although the term “irregular behavior” is equated by many with the word “cheating,” it is actually defined by the USMLE to mean:

Irregular behavior includes any action by applicants, examinees, potential applicants, or others when solicited by an applicant and/or examinee that subverts or attempts to subvert the examination process.

The notice that a person has been accused of irregular behavior may come in a letter from the USMLE, National Board of Medical Examiners (NBME), or Examination Committee for Foreign Medical Graduates (ECFMG). In serious cases, one might be approached by a private investigator or law enforcement authority, for example in the case of an alleged theft of an examination or illegal use of examination questions.

Regardless, any notice that you are suspected or accused of irregular behavior should be treated as an extremely serious matter that can suspend your medical education or residency and place your medical career on hold. You should immediately contact an attorney familiar with health and medical law and, especially, one familiar with USMLE, NBME and ECFMG proceedings.

Examples of What Not To Do.

A few examples of irregular behavior we have consulted on include:

1. A student soliciting information about the contents of a USMLE step examination in an online blog.

2. Individuals blogging online regarding a certain step exam preparation course they took when the course instructor allegedly used actual examination questions to teach it.

3. An individual allegedly using an iPhone during a step examination.

4. Someone setting a fire in a bathroom in the testing center where the examination was given.

5. An individual who allegedly had written notes on his arm to use during the exam.

6. Someone who wrote down notes about the exam on a piece of tissue paper after the exam was over.

No matter how trivial the matter may initially seem, it can have devastating effects. The reporting of your test results will be held up until the matter is completely resolved, thereby delaying entry into or continuation of a residency program or, in some cases, medical school graduation. Choice residencies can be lost and a promising medical career can be placed on hold.

If irregular behavior is confirmed, test scores will be voided, your transcript of USMLE tests will be annotated with the fact that you were found to have committed irregular behavior and you may not be allowed to retake the exams for a period of time. This can really screw up your life.

Ask for a Hearing and Be Prepared.

If you are accused of irregular behavior, you will be given the right to have a hearing before a committee of the USMLE which will hear evidence on the matter. Ask for the hearing! Do not waive it.

You will have the right to submit documents on your own behalf. Do this. Use any favorable document that supports your side of the story, shows your good character, shows your academic and clinical performance and mitigates from the seriousness of the alleged conduct.

Attend the hearing in person and with your attorney. You have this right. Do not expect to win a hearing if you do not attend it yourself to answer any questions the committee may have. These committee hearings are all held at MBE headquarters in Philadelphia, Pennsylvania, so it may be a challenge to attend. But you must do so; this may be the most important hearing of your life.

Retain expert witnesses to support you if appropriate. In matters where a statistical extrapolation is used against you, a statistics expert can be a valuable asset.

Many times the facts of the situation turn out to be far different from what the USMLE secretarial has initially reported. But you must avail yourself to the procedures and opportunity to prove this.

Don’t delay. At your first notice, contact an experienced attorney to represent you. The stakes are too high to gamble on handling it yourself.

Contact Experienced Health Law Attorneys Today.

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

Comments?

Have you faced the Committee? What was the experience like? Did you retain experienced legal counsel? 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 The Health Law Firm|2024-03-14T10:00:49-04:00June 1, 2018|Categories: Administrative law, Medical Students, NBME, The Health Law Firm Blog, USMLE|Tags: administrative law, administrative proceeding, cheating, civil proceeding, criminal proceeding, defense attorney, defense lawyer, Examination Committee for Foreign Medical Graduates (ECFMG), health care attorney, health care lawyer, irregular behavior, legal representation, medical administrative hearings, medical intern attorney, medical intern lawyer, medical resident, medical resident attorney, medical resident lawyer, medical student attorney, medical student lawyer, medical students, National Board of Medical Examiners (NBME), the health law firm, United States Medical Licensing Examination (USMLE), USMLE appeals, USMLE hearings, USMLE preparation course|Comments Off

OCR Releases Results From First Round of HIPAA Audits

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

The Office for Civil Rights’ (OCR) has release information on the initial round of mandated audits of Health Insurance Portability and Accountability Act (HIPAA) covered entities. The OCR announced official details concerning the audits at an OCR and National Institute of Standards and Technology (NIST) conference held June 6, 2012.

Initial HIPAA Audits Started November 2011.

As required by the HITECH Act, the OCR began auditing selected covered entities’ compliance with the privacy and security provisions of HIPAA and its implementing regulations in November 2011. The OCR selected 150 covered entities to be audited in the pilot phase by KPMG LLP (KPMG). KPMG is the audit contractor chosen by the OCR to perform HIPAA audits. The first 20 audits concluded in March 2012. More audits will continue to occur this year.

HIPAA Audit Process.

The HIPAA audit process was drafted by the OCR and KPMG in November 2011. Entities selected for an audit receive a notification letter from OCR and are asked to provide documentation to the auditor. Every audit includes a site visit. After the site visit and initial investigation, KPMG recommends suggested modifications for the entity to meet compliance standards in a draft audit report. The entity will have an opportunity to respond to the draft audit report, citing any findings made by KPMG that may be incorrect. KPMG then summarizes final results in a final audit report. The final audit report details how the audit was conducted; what the findings were and; what actions the covered entity is taking in response to those findings.

HIPAA Audit Results.

The results of the initial round of audits revealed that small covered entities had a lot more issues than large ones. Six of the 20 audited entities were small entities (e.g., $50 million or less in revenue). However, these small entities represented 66% of the deficiency findings. Additionally, the OCR reported that health care providers had more problems than plans or clearinghouses. A disproportionate number of the deficiencies were by health care providers. While providers represented 50% of the 20 audited entities, they were responsible for 81% of the deficiency findings.

The OCR also announced that the majority of the findings were related to the Security Rule. OCR indicated that this is partially attributable to more of the audit protocol focusing on security than privacy or breach notification.

To view the OCR’s presentation on HIPAA audit findings, click here.

To view the HIPAA Privacy Rule, click here.

To view the HIPAA Security Regulation, click here.

Contact Health Law Attorneys Experienced in Audits of Health Providers.

The Health Law Firm represents physicians, medical practices, hospitals, and other health providers in audits, including Medicare audits, Medicaid audits, and HIPAA audits. The Health Law Firm also assists health providers in establishing compliance with HIPAA regulations. If you have received notification of an impending audit contact The Health Law Firm immediately.

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

Sources Include:

Greene, Adam H. and Rebecca L. Williams. “HIPAA Audits Results Released: We Still Have Work to Do.” JD Supra. (June 13, 2012). From: http://www.jdsupra.com/post/documentViewer.aspx?fid=dca67d93-c84d-4331-a327-fc394407d125

Sanches, Linda. “2012 HIPAA Privacy and Security Audits.” National Institute of Standards and Technology. (June 7, 2012). From: http://csrc.nist.gov/news_events/hiipaa_june2012/day2/day2-2_lsanches_ocr-audit.pdf

Saul, H. Carol. “Update on OCR HIPAA Audits.” Lexology. (May 29, 2012). From: http://www.lexology.com/library/detail.aspx?g=e5a886a7-1d24-4f90-a1a6-6a367e9fc3ba

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.

By The Health Law Firm|2024-03-14T10:00:32-04:00June 1, 2018|Categories: HIPAA, The Health Law Firm Blog|Tags: audit attorneys, defense attorneys, health care audits, Health Insurance Portability and Accountability Act, hipaa, HIPAA audits, HIPAA compliance, hitech, lawyers, legal representation, medical practice audit, medical records, ocr, OCR audits, Office of Civil Rights, records request|Comments Off

Sarasota Sheriff Wants Patients to Waive HIPAA Privacy Rights

By Danielle M. Murray, J.D.

Law enforcement has been working hard to bust pill mills and stop prescription drug abuse. Pharmacists and pain management doctors are under intense scrutiny by various law enforcement agencies, including the Drug Enforcement Administration (DEA) and the Department of Health (DOH), for their role in giving out controlled substances.

“Doctor shopping” is a common phrase used to describe patients who see multiple doctors in a short period of time in an attempt to dupe doctors into giving them prescriptions for controlled substances. Doctors have been hampered somewhat by HIPAA privacy laws and have been unable to report suspicious patients to law enforcement agencies.

Sarasota County has a solution for that. According to the Sarasota Herald-Tribune, the county has devised a form, entitled “Authorization for Release of Protected Health Information,” and distributed it to pain management physicians. This form is to be signed voluntarily by patients and would allow doctors to discuss concerns with law enforcement. According to the sheriff’s office, the form intended to be limited to the patient’s name and the doctor’s concerns, and not to allow the release of medical records or other protected information.

To see the form for yourself, click here.

Physicians Not In Favor of the Form.

Critics say that the form is a blatant violation of patient rights and is simply a way for law enforcement to get around constitutional protections, such as search warrants.

It appears that some physicians agree with the critics. Not a single waiver has been returned to the Sarasota Sheriff’s Office.

In a Sarasota Herald-Tribune article, a pain management clinic owner states that his clients sign a contract that waives their rights if the clinic is approached by an investigator. He states “I understand HIPAA and am a firm believer in their rights, but if they’re doing something illegal, they’re jeopardizing my license.”

To see the full article from the Sarasota Herald-Tribune, click here.

Providers are at Risk.

The clinic owner is correct. Providers are at risk for their patients’ inappropriate prescription use. We have seen cases where providers are faced with criminal and civil liability when a patient overdoses on medication, whether intentional or not.

Click here to read a previous blog post on one Florida doctor who gave up his license due to allegations of malpractice and overprescribing pills.

In Orlando, Florida, a drug trafficking ring used fake prescriptions to access drugs at pharmacies around the city, and the responsible pharmacists are now facing disciplinary action for filling those prescriptions. There is a major crackdown underway to stop pill mills.

Recently the Polk County Sheriff’s Office issued 25 arrest warrants in connections to a pill mill investigation (click here to read the blog on this story). The big pharmacy chains are getting hit as well. A Walgreens distribution center in Florida was recently served with an immediate suspension order from the DEA (click here for that blog), and the DEA also pulled the controlled substance licenses from two Central Florida CVS Pharmacies (click here to read more).

Do Not Violate HIPAA.

Providers must be careful not to violate HIPAA. HIPAA violations may also result in administrative and civil action against you and your license, especially if the patient can prove they were damaged by the leak. A patient who was arrested due to the provider’s HIPAA violation would likely be able to show damages and cause action against the provider’s license.

You can read more on HIPPA violations on our two-part blog series. Click here to read part one and click here to read part two.

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

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

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

Comments?

What do you think of the “Authorization of Release of Protected Health Information” form? Do you think it goes too far? Please submit any thoughtful comments below.

Source:

Williams, Lee. “Sheriff wants doctors to have patients sign away rights.” Sarasota Herald-Tribune. (October 1, 2012). From: http://www.heraldtribune.com/article/20121001/ARTICLE/121009975/2416/NEWS?p=all&tc=pgall

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

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

Florida Hospice to Pay $1 Million to Settle Whistleblower Lawsuit Over False Billing Claims

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

The Hernando-Pasco Hospice (HPH Hospice) in Hudson, Florida, agreed to pay $1 million to resolve allegations that it violated the False Claims Act by submitting false claims for services to the Medicare and Medicaid Programs. According to the U.S. Attorney’s Office for the Middle District of Florida, the hospice allegedly admitted patients that did not meet the requirements for end-of-life care. This lawsuit was originally filed in 2010, by two former hospice employees. The announcement was made on July 22, 2013.

Click here to read the entire press release from the U.S. Attorney’s Office for the Middle District of Florida.

Hospice Accused of Admitting Ineligible Patients to Meet Targets.

HPH Hospice is accused of admitting ineligible patients in order to meet targets imposed by the management team, according to federal authorities. The settlement also resolves allegations that the hospice billed the government at higher rates than it was entitled to receive. It’s also accused of providing illegal kickbacks by giving services to skilled nursing facilities at no cost, in exchange for patient referrals.

Two former employees of the hospice first stepped forward with these allegations. The employees were longtime social workers at HPH Hospice. They filed a lawsuit alleging the facility’s management instructed the staff to make false or misleading statements in patients’ medical records to make them appear eligible for hospice care. The two former employees will share $250,000 of the settlement.

HPH Hospices Claims No Wrongdoing.

According to the Tampa Bay Times, the HPH Hospice spokesperson said the allegations were completely false. The organization stated that the settlement was the better option for patients and staff. As a result of these allegations, HPH Hospice said that it has hired three registered nurses to review and monitor all admission documentation, according to the Tampa Bay Times.

To read the entire Tampa Bay Times article, click here.

Under the False Claims Act, Whistleblowers Can Come Out on Top.

Whistleblowers stand to gain substantial amounts, sometimes as much as thirty percent (30%), of the award under the False Claims Act (31 U.S.C. Sect. 3730). Such awards encourage employees to come forward and report fraud.

You can learn more read our two part blog on whistleblowers. Click here for part 1, and click here for part 2.

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

In addition to our other experience in Medicare, Medicaid and Tricare cases, attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblowers 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 learn more on our experience with Medicaid and Medicare quit tam or whistleblower cases, visit our website. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think about this settlement agreement? Do you think settling was a better option for the hospice? Please leave any thoughtful comments below.

Sources:

Department of Justice. “HPH Hospice to Pay $1 Million to Resolve False Claims Act Allegations.” Department of Justice. (July 22, 2013). From: http://www.justice.gov/usao/flm/press/2013/july/20130722_HPH.html

Tillman, Jodie. “Hernando-Pasco Hospice Agrees to Pay $1 Million to Settle False Billing Cliams.” Tampa Bay Times. (July 22, 2013). From: http://www.tampabay.com/news/health/hernando-pasco-hospice-agrees-to-pay-1-million-to-settle-false-billing/2132592?utm_source=twitterfeed&utm_medium=twitter

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 The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|Categories: Medicaid, Medicare, The Health Law Firm Blog, Whistleblower|Tags: audit, defense attorneys, Department of Justice (DOJ), false claims act, FCA, Florida Medicare, fraud defense, fraud prevention, fraud schemes, government health programs, hospice, hospice care, kickbacks, legal representation, medicare, Medicare fraud, Medicare overbilling, qui tam suits, settlement, the health law firm, U.S. Attorney’s Office for the Middle District of Florida, whistleblower, whistleblower protection|Comments Off

WellCare Health Plans Reaches Settlement in False Claims Act Case

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

WellCare Health Plans Inc.(WellCare) has reached a $137.5 million settlement with the federal government and nine states. The settlement resolves four lawsuits alleging violations of the False Claims Act.

WellCare is based in Tampa, Florida. The company provides managed health care services for approximately 2.6 million Medicare and Medicaid beneficiaries across the United States.

Lawsuits Allege WellCare Submitted False Claims to Medicare, Medicaid Programs.

The lawsuits allege that WellCare submitted false claims to Medicare and Medicaid programs. WellCare allegedly falsely inflated the amount it claimed to be spending on medical care. Allegedly, this was done in order to avoid returning money to Medicaid and other programs in various states, including the Florida Medicaid program and Florida Healthy Kids program. WellCare also allegedly knowingly retained overpayments it had received from Florida Medicaid for infant care. Furthermore, WellCare allegedly falsified data that misrepresented the medical conditions of patients and the treatments they received.

WellCare to Pay the United States and Nine Individual States in Settlement.

WellCare’s settlement requires the company to pay the United States and nine individual states $137.5 million. The nine states are Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York, and Ohio. The settlement also requires WellCare to pay an additional $35 million if the company is sold or experiences a change in control within three years of the agreement.

Whistleblowers Share in Settlement.

The four lawsuits against WellCare were filed by whistleblowers under the qui tam provisions of the False Claims Act. The qui tam provisions allow individuals to file lawsuits on behalf of the United States and share in any recovery.

The whistleblower whose qui tam complaint initiated the government’s investigation will receive approximately $20.75 million. The other whistleblowers will share approximately $4.66 million and will also be entitled to receive an additional share of any contingency payment.

Contact Health Law Attorneys Experienced in False Claims Act Cases.

The Health Law Firm represents physicians, medical practices, pharmacists, pharmacies, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

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

Sources Include:

Kutscher, Beth. “WellCare Agrees to Pay Over $137.5 Million in Settlement.” Modern Healthcare. (Apr. 3, 2012). From: http://www.modernhealthcare.com/article/20120403/NEWS/304039975#ixzz1yAklA7rutrk=tynt

U.S. Department of Justice, Office of Public Affairs. “Florida-Based WellCcare Health Plans Agrees to Pay $137.5 Million to Resolve False Claims Act Allegations.” U.S. Department of Justice. (Apr. 3, 2012). From: http://www.justice.gov/opa/pr/2012/April/12-civ-425.html

Voreacos, David. “WellCare to Pay $137.5 Million to Settle False Claims Case.” Bloomberg News. (Apr. 3, 2012). From: http://www.bloomberg.com/news/2012-04-03/wellcare-to-pay-137-5-million-to-settle-false-claims-case-1-.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.

By The Health Law Firm|2024-03-14T10:00:32-04:00June 1, 2018|Categories: Medicaid, Medicare, The Health Law Firm Blog|Tags: audit, billing, Department of Justice, DOJ, false claims act, Florida Medicaid, fraud defense attorneys, fraud prevention, fraud schemes, government health programs, health care fraud, lawyers, legal representation, managed care, medicaid, medicare, qui tam, realtor, settlement, Wellcare Health Plans, whistleblower|5 Comments

American Hospital Association (AHA) Sues U.S. Government for Denied Medicare Payments by RACs, ZPICs and Other Auditors

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

On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the U.S. Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources. The AHA is seeking a court order declaring the practice invalid, saying it violates the Medicare Act.

Four hospital systems in Michigan, Missouri and Pennsylvania have joined the AHA as plaintiffs in the suit. The suit has been filed in federal court in Washington, D.C.

To read the AHA complaint against the HHS, click here.

AHA Wants Doctors to Be Able to Focus on Patient Care.

The lawsuit alleges Recovery Audit Contractors (RACs), private auditors used by the HHS, forced hospitals to repay Medicare for the costs of in-patient services by determining that Medicare beneficiaries should have been treated as out-patients instead of being admitted into hospitals as in-patients. The services provided to out-patients are much less, of course, and the bills for out-patient services are usually much lower.

In the official press release AHA argues when patients need treatment, the first step for a doctor is to decide whether to admit the patient to the hospital or to provide care in an out-patient facility. AHA believes doctors’ decisions are often more complicated for Medicare beneficiaries because the doctor is routinely second-guessed by RACs months or even years later. The president and CEO of AHA said this practice is “indefensible.”

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

Neither the Centers for Medicare and Medicaid (CMS) nor the Department of HHS has commented on the pending litigation.

AHA Fed Up with Redundant Audits that Drain Time, Funding and Patient Care.

In October 2012, prior to the lawsuit, the executive vice president of the AHA wrote a letter to the Office of Inspector General (OIG) in response to the Work Plan for Fiscal Year 2013. In the work plan the OIG reviewed the effectiveness of various Medicare contractors, including RACs, Medicare Administrative Contractors (MACs) and Zone Program Integrity Contractors (ZPICs).

The letter states that these programs auditing payment accuracy are well intentioned, but hospitals are fed up with the RACs’ inaccuracy in determining whether the hospital received any overpayments. The letter also claims that hospitals are overwhelmed by the significant overlap and duplication of efforts between the RACs, MACs and ZPICs. These redundant audits drain time, funding and attention to patient care, according to the AHA.

According to the OIG review, hospitals reported appealing more than forty percent (40%) of all RAC denials, with a seventy-five percent (75%) success rate in the appeals process.

Click here to read the letter from the AHA to the OIG.

How to Take Action Once a Notice of a Medicare Audit Has Been Received.
When a physician, medical group or other healthcare provider receives a notice of an audit and site visit from a RAC, MAC or ZPIC, things happen fast with little opportunity to prepare. To help, read our checklist of what to do when notified of a Medicare or ZPIC audit. Click here for part one and click here for part two.

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.

Comments?

What you think about the lawsuit again the HHS? Do you support AHA’s decision to question the RACs’ auditing system? Please leave any thoughtful comments below.

Sources:

Mitchell, Alicia. “Hospitals Sue Federal Government for Unfair Medicare Practices.” American Hospital Association. (November 1, 2012). Press Release from: http://www.thehealthlawfirm.com/uploads/AHA%20Sues%20Govnt%20PR.pdf

Pollack, Richard. “Letter: AHA Supports OIG Review of Effectiveness of Medicare Contractors, Including RACs, In 2013 Work Plan.” American Hospital Association. (October 24, 2012). Letter from: http://www.thehealthlawfirm.com/uploads/AHA%20letter%20to%20OIG%20on%20RACs.pdf

Morgan, David. “Hospitals Sue Government Over Private Medicare Audits.” Reuters. (November 1, 2012). From: http://uk.reuters.com/article/2012/11/01/us-usa-healthcare-medicare-idUKBRE8A01BZ20121101

Harris, Andrew. “American Hospital Association Sues U.S. Over Medicare.” Bloomberg. (November 1, 2012). From: http://www.bloomberg.com/news/print/2012-11-01/american-hospital-association-sues-u-s-over-unpaid-medicare.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.