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

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

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

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

Administrative Proceedings Can be Complex.

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

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

Procedural Mistakes Can Be Damaging To Your Legal Defense.

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

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

Professional Liability Insurance May Pay Legal Fees for Deposition Coverage.

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

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

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

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

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

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

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

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

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

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.

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.

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.

Office of Inspector General (OIG) Scrutinizes Billing at South Florida Mental Health Clinics

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

On August 16, 2012, the Office of Inspector General (OIG) released a report on questionable billing by mental health centers. The report focuses on the nation’s mental health clinics that overbilled Medicare in 2010, some by tens of millions of dollars. The majority of these clinics were located in South Florida, Texas and Louisiana.

To see the full report from the OIG, click here.

Two Big Busts in Florida Mental Health Clinics for Medicare Fraud.

According to an article in the Miami Herald: “No area of the country cheats Medicare quite like South Florida.” To see this article from the Miami Herald, click here.

In the report, the OIG specifically named a bust of two Miami-area doctors, one Miami-area therapist and two others for their participation in a Medicare fraud scheme. The case involved the nation’s biggest mental health chain and more than $205 million in fraudulent billing. Executives of the company were sentence in June 2012, to anywhere from 50 years to 91 months.

We previously blogged about this news story. Click here to read that blog. To see a copy of the press release on this case from the Department of Justice (DOJ), click here.

The Miami Herald article outlines the case of another South Florida mental-health clinic. The clinic’s owner, his son, his daughter and five others were found guilty on August 31, 2012, of conspiring to cheat $57 million from the federal program for the elderly and disabled. The owner, his son, an operating officer and another manager were also convicted of conspiracy to commit health care fraud by collecting $11 million in Medicare payments for therapy services that were not needed or provided from 2007 to 2011.

Click here to see the full press release on this case from the DOJ.

OIG Scrutinizes Medicare for Lack of Regulations.

In the report, the Inspector General (IG) said these two instances of Medicare fraud are examples of the federal program’s “vulnerabilities.” The report scrutinizes the Medicare program for it’s lack of regulating about 200 mental health centers in 25 states that received an estimated $218.6 million in 2010.

Medicare Officials Admit Mental Health Services are Susceptible  to Fraud and Abuse.

In the Miami Herald article, Medicare officials responded to the OIG by acknowledging that mental health services have been vulnerable to fraud and abuse in the past, but said Medicare is currently taking steps to address these issues. These steps include adopting a computer program that will screen prospective clinic operators; it will perform criminal background checks and closely examine claims which are paid within 14 days.

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 health care 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.

Sources:

Weaver, Jay. “Feds Spotlight South Florida Mental Health Clinics for Medicare Fraud.” The Miami Herald. (August 28, 2012). From: http://www.miamiherald.com/2012/08/28/2972637/feds-spotlight-south-floridas.html

Levinson, Daniel. “Questionable Billing By Community Mental Health Centers.” Office of Inspector General. (August 2012). From: /uploads/OIG on Medicare fraud in Mental Health Clinics.pdf

Department of Justice. “Eight Individuals and a Corporation Convicted at Trial in Florida in $50 Million Medicare Fraud.” United States Department of Justice. (August 24, 2012). From: http://www.justice.gov/opa/pr/2012/August/12-crm-1048.html.

Valle, Alicia. “Doctors, Therapist and Recruiters from Miami-Area Mental Health Care Corporation Convicted for Participating in $205 Million Medicare Fraud Scheme” U.S. Attorney’s Office for the Southern District of Florida. (June 1, 2012). From: http://www.justice.gov/usao/fls/PressReleases/120601-03.html

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

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.

Specialty Pharmacy Agrees to Pay A $11.4 Million Settlement in Whistleblower Case

Lance Leider headshotBy Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Department of Justice (DOJ) announced on December 27, 2012, that a specialty pharmacy, based in San Diego, California, has agreed to pay a $11.4 million settlement. That payment is to resolve allegations that the company used kickbacks to persuade doctors to write prescription for its products. The allegations came from a whistleblower lawsuit filed by a former employee.

Click here to read the press release from the DOJ.

Specialty Pharmacy Allegedly Used Expensive Kickbacks to Bribe Doctors.

An article in Modern Healthcare states that the specialty pharmacy allegedly used tickets to sporting events, concerts, plays, spa outings, golf games and ski trips to bribe doctors to write prescriptions for its products. The company also had representatives schedule paid “preceptorships,” where the reps would follow doctors in their offices in an attempt to increase prescriptions written for their products.

To read the Modern Healthcare article, click here.

Specialty Pharmacy Will Pay More Than $11 Million.

The specialty pharmacy company agreed to a forfeiture of $1.4 million to resolve the anti-kickback statue allegations. It will also pay $9.9 million to resolve false claims allegations, according to the DOJ. Representatives with the DOJ said that by entering the deferred prosecution agreement the company was able to avoid criminal and civil liability for the kickback and false claims violations.

Whistleblower Gets $1.7 Million Reward.

According to the DOJ, the settlement resolves a False Claims Act lawsuit that was filed by a former sales representative for the specialty pharmacy. As part of the resolution, that whistleblower will receive $1.7 million.

Whistleblowers stand to gain substantial amounts, sometimes as much as thirty percent (30%), of the amount the government recovers under the False Claims Act (31 U.S.C. Sect. 3730). Such awards encourage employees and contractors to come forward and report fraud. You can learn more on the False Claims Act on the DOJ website.

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 the settlement agreement? As a health professional are you tempted with kickbacks? Please leave any thoughtful comments below.

Sources:

Department of Justice. “Victory Pharma Inc. of San Diego Pays $11.4 Million to Resolve Kickback Allegations in Connection with Promotion of Its Drugs.” Department of Justice. (December 27, 2012). From: http://www.justice.gov/opa/pr/2012/December/12-civ-1547.html

Kutscher, Beth. “$11.4 Million Settlement in Pharma Kickback Case.” Modern Healthcare. (December 27, 2012). From: http://www.modernhealthcare.com/article/20121227/NEWS/312279957/

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

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.

Duke University Health System Pays $1 Million to Settle Allegations of False Claims in Whistleblower Lawsuit

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

On March 21, 2014, Duke University Health System in Raleigh, North Carolina, settled a whistleblower/qui tam lawsuit, according to the Department of Justice (DOJ). The lawsuit, filed in 2012, stated that the three-hospital academic medical center is alleged to have fraudulently inflated its Medicare bills by unbundling a number of cardiac services and billing for physician assistants’ (PAs) time illegally. Duke University Health System agreed to pay $1 million to resolve these allegations.

Click here to read the press release from the DOJ.

Duke University Health System Accused of Submitting False Claims to Federal Health Care Programs.

According to the complaint, the lawsuit was originally filed by a former health care bill coder and quality-control auditor for Duke’s revenue-cycle subsidiary, Duke Patient Revenue Management Organization. The former employee accused Duke University Health System of allegedly making false claims to Medicare, Medicaid and TRICARE by billing the government for services provided by PAs during coronary artery bypass surgeries when the PAs were acting as surgical assistants, which is not allowed. The whistleblower also alleged the medical center increased billing by unbundling claims when the unbundling was not appropriate. These unbundled claims were associated with cardiac and anesthesia services, according to the complaint.

To read the whistleblower’s complaint filed in December of 2012, click here.

According to the DOJ, the claims resolved by the settlement are allegations only, and there has been no determination of liability.

Whistleblowers Who Report Fraud and False Claims Against the Government Are Usually Employees.

Doctors, nurses or staff employees working for hospitals, nursing homes, medical groups, home health agencies or others, often become aware of questionable activities. They are sometimes even asked to participate in it. In many cases the activity may amount to health care fraud.

It does not matter who you are. You may even be actively involved in the wrongdoing. This does not disqualify you from reporting the false claims activity or receiving a reward for doing so. In order to encourage employees with knowledge of fraudulent activity to come forward, the government will usually not seek to prosecute or punish that person in any way.

Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Of course, the larger the amount of money the government has been defrauded the more likely it will be that the government will be interested in pursuing the case and the larger the reward the whistleblower will receive if there is a recovery.

To read more on whistleblower cases, read my previous blogs. Click here for part one, and click here for part two.

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 both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Comments?

What do you think of this settlement? Do you think whistleblower lawsuits are becoming more common? Please leave any thoughtful comments below.

Sources:

Carlson, Joe. “Duke Pays $1 Million to Settle Whistle-Blower Case.” Modern Healthcare. (March 25, 2014). From: http://bit.ly/1g3W7yw

Department of Justice. “Duke University Health System, Inc. Agrees to Pay $1 Million For Alleged False Claims Submitted to Federal Health Care Programs.” Department of Justice. (March 21, 2014). From: http://www.justice.gov/usao/nce/press/2014/2014-mar-21.html

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

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

Hospice of the Comforter Inc., Faces Whistleblower Lawsuit

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

On September 6, 2012, the Department of Justice (DOJ) announced it will join in a whistleblower lawsuit alleging false Medicare billings against Hospice of the Comforter Inc., (HOTCI). The hospice is located in Altamonte Springs, a suburb of the Orlando area, and provides hospice services to local patients.

To read the entire whistleblower complaint filed, click here.

Allegations in the Lawsuit Against HOTCI.

According to the DOJ, the lawsuit was filed by the former vice president of finance for HOTCI. The case alleges HOTCI submitted false claims to Medicare for hospice care patients who were not terminally ill. The lawsuit also claims an executive at the hospice told employees to admit Medicare recipients for hospice care even before there had been a determination that the patients were eligible for the hospice benefit.

Initial Medicare Audit Allegedly Triggered Discharges.

In an Orlando Sentinel article, the plaintiff states that in an initial audit, in 2010, the government found HOTCI had a billings error rate of eighteen percent (18%), which triggered a second review. The plaintiff is accusing HOTCI of then creating an internal committee to review the eligibility of its Medicare patients. The committee discharged at least 150 patients between 2009 and 2010 as being ineligible for the Medicare hospice benefit.

According to the Orlando Sentinel, a representative from HOTCI said the discharges show that the hospice was taking actions to resolve of the situation on its own and only indicates some hospice patients should have been discharged at a previous point in time – not that they shouldn’t have been admitted at all.

To read the entire Orlando Sentinel article, click here.

Details of the Medicare Hospice Benefit.

According to the DOJ, the Medicare hospice benefit is available to patients who choose palliative treatment (medical care focused on providing patients with relief from pain and stress) for a terminal illness, and are expected to live six months or less. When an individual is admitted to a hospice facility, that individual is no longer entitled to receive services designed to cure the illness, or curative care.

Under the False Claims Act, Whistleblowers Can Make a Profit.

Should the government win this case, HOTCI could face up to $33 million in penalties, according to the Orlando Sentinel.

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 on the False Claims Act on the DOJ website.

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.

Sources:

Santich, Kate. “Feds Join Whistleblower Lawsuit Against Hospice of the Comforter” Orlando Sentinel. (August 28, 2012). From: http://articles.orlandosentinel.com/2012-08-28/health/os-whistleblower-lawsuit-hospice-of-the-comforter-20120828_1_hospice-board-members-hospice-care-hospice-founder

Department of Justice. “United States Intervenes in False Claims Act Lawsuit Against Orlando, Florida-area Hospice.” DOJ. (September 6, 2012). From: http://www.justice.gov/opa/pr/2012/September/12-civ-1080.html

U.S. ex rel. Stone v. Hospice of the Comforter, Inc., No. 6:11-cv-1498-ORL-22-AAB (M.D. Fla) United State District Court for the Middle District of Florida Orlando Division. (September 12, 2012), available at http://www.thehealthlawfirm.com/uploads/US%20v%20Hospice%20of%20the%20Comforter.pdf

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.

Ohio Hospital Settles Whistleblower Case to Resolve False Claims Act Allegations

Lance Leider headshotBy Lance O. Leider, J.D., Attorney, The Health Law Firm

A group of doctors accused of performing an unusually high number of heart procedures on patients at an Ohio hospital has settled a whistleblower lawsuit, according to the Department of Justice (DOJ). The settlement agreement covers accusations that the doctors and the hospital billed Medicare for unnecessary cardiac procedures from 2001 to 2006.

Click here to read the press release from the DOJ.

The Ohio hospital agreed to pay the U.S. government $3.9 million, and the physician group agreed to pay $541,870 to settle the accusations.

Former Hospital Manager Speaks Up.

In October of 2006, the hospital’s former manager of the catheterization lab filed a whistleblower complaint. In the lawsuit the former employee said doctors at the Ohio hospital would allegedly encourage nurses and other staff to falsify complaints of chest pain to justify angioplasties.

In the same year, The New York Times found that in Elyria, Ohio, which is where the hospital in question is located, Medicare patients received angioplasties at a rate that was nearly four times the national average. This story prompted insurers to question the doctors’ treatment methods. To read the entire article from the New York Times, click here.

Hospital Addresses Settlement in Blog Post.

The Ohio hospital paying the settlement posted a statement on its website stating the doctors who performed these procedures felt confident they were making the right decisions for their patients. It’s explained that the settlement is not an admission of wrongdoing, but a platform to move forward. You can read the entire statement from the hospital by clicking here.

Unnecessary Cardiac Procedures are Under the Microscope.

This settlement is just one example of the government going after cardiologists and hospitals for performing unnecessary and expensive procedures. In August 2012, we wrote a blog about the investigation into the cardiology services performed at Florida HCA hospitals. Click here to read that blog.

The Health Law Firm’s President and Managing Partner, George F. Indest III, wrote an article on the legal ramifications for performing unnecessary tests and procedures. You can read that article by clicking 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 about this settlement? Are cardiologists and hospitals being unfairly targeted? Please leave any thoughtful comments below.

Sources:

Abelson, Reed. “U.S. Settles Accusations That Doctors Overtreated.” New York Times. (January 4, 2013). From: http://www.nytimes.com/2013/01/05/business/us-settles-accusations-that-doctors-overtreated.html?_r=0

Department of Justice. “EMH Regional Medical Center and North Ohio Heart Center to pay $4.4 million to resolve False Claims Act Allegations.” Department of Justice. (January 4, 2013). From: http://www.justice.gov/usao/ohn/news/2013/04janemh.html

North Ohio Heart. “North Ohio Heart Reaches Settlement; Continues to Provide High-Quality Cardiac Care.” Ohio Medical Group. (January 4, 2013). From: http://blog.partnersforyourhealth.com/Blog/bid/93734/North-Ohio-Heart-Reaches-Settlement-Continues-to-Provide-High-Quality-Cardiac-Care
About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

“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.

Use Caution in USMLE Step Exam Preparation

CTH Blog LabelBy Catherine T. Hollis, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The United States Medical Licensing Examination (USMLE) Bulletin of Information outlines several examples of conduct that is deemed to be irregular behavior.  On February 27, 2014, the USMLE posted an Announcement listing the types of alleged irregular behavior recently reviewed by the Committee for Individualized Review (CIR).  Some of the cases reviewed involved individuals who were accused of soliciting unauthorized access to examination materials or communicating about specific test items, cases, or answers with other examinees.  This particular type of irregular behavior seems to be increasingly alleged against individuals who have participated in online forum discussions requesting assistance with examination preparation.

Click here to read the entire February 27, 2014, USMLE Announcement.

Do Not Seek Specific Examination Materials or Attempt to Communicate With Other Examinees.

The USMLE is taking a hard line stance on enforcing its irregular behavior policies concerning soliciting test materials and communicating about specific test items.  We have recently seen a number of individuals accused of engaging in irregular behavior because of posts on forum websites that appear to be solicitations for specific examination materials or cases.  Some examples of these posts include:

–    Joining in requests from others for information on recent test questions after another individual’s post requesting Step 2 Clinical Skills  (CS) cases;
–    Requesting that others provide information about some of the cases at a specific test center;
–    Suggesting approaching examinees as they leave the exam center to ask about the exam; and
–    Requesting a list of CS cases for a specific test center.

Know the Rules.

All USMLE applicants are required to be familiar with the USMLE’s Bulletin of Information.  By signing a Step Exam application, an applicant is certifying that he or she has read and is familiar with all information contained in the Bulletin. You will still be held responsible for this whether you read it or not.

According to the Bulletin, irregular behavior includes any action that subverts or attempts to subvert the examination process.  As noted above, the Bulletin contains a non-exhaustive list of examples of conduct that is deemed to be irregular behavior.

Click here to read our previous blog about irregular behavior.

Irregular Behavior Has Serious Potential Consequences.

If an examinee is found to have engaged in irregular behavior, the CIR will impose sanctions.  These sanctions can include an annotation on an individual’s USMLE transcript, invalidation of scores, a report to the Federation of State Medical Boards, and even a bar from taking future USMLE examinations.

Appropriate Test Preparation.

Examinees can adequately prepare for the USMLE Step exams without the need to seek further assistance that might cross the line into irregular behavior.  On April 4, 2014, the USMLE posted an Announcement on its website with information about materials available from the USMLE, the National Board of Medical Examiners (NBME) and third parties. From the USMLE website, examinees can access free orientation and practice materials, including:

–    Informational materials on the overall USMLE program and content descriptions for each of the USMLE examinations;
–    Tutorials that illustrate the USMLE Step 1, Step 2 Clinical Knowledge (CK), Step 3 multiple-choice software and the Step 3 computer-based case simulation (CCS) Primum® software;
–    Sample multiple-choice test questions with answer keys for each Step exam;
–    Sample Step 3 CCS cases with feedback; and
–    Orientation materials for Step 2 CS.

Examinees may also, for a fee, take advantage of the self-assessment services offered by the NBME.  These services are designed to familiarize examinees with USMLE questions and provide feedback on the examinee’s areas of strength and weakness.

There are also a variety of commercial test preparation materials and courses that claim to prepare examinees for USMLE Step exams.  These courses are not affiliated with or sanctioned by the USMLE program, but may be helpful to you.

Click here to read the entire April 4, 2014, USMLE Announcement.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals.

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.

Comments?

Have you ever come across these online forums? Have you ever posted in these forums? Please leave any thoughtful comments below.

Sources:

“USMLE Takes Action Against Individuals Found to Have Engaged in Irregular Behavior.” USMLE. (February 27, 2014). From: http://www.usmle.org/announcements/?ContentId=130

“Use Caution in Selecting Review Courses.” USMLE. (April 4, 2014). From: http://www.usmle.org/announcements/?ContentId=67

“USMLE 2014 Bulletin of Information.” USMLE. (2013). From: http://www.usmle.org/pdfs/bulletin/2014bulletin.pdf

About the Authors:  Catherine T. Hollis 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.

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

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

Power Wheelchair Suppliers Voice Concerns over New Government Program

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

On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration at a Senate Special Committee on Aging. Durable Medical Equipment Suppliers (DMES) protested the program because it requires the permission of a Medicare Administrative Contractor (MAC) prior to the delivery of a power wheelchair to the consumer.

To see the Power Mobility Devices (PMDs) Demonstration operational guide from the Centers for Medicare and Medicaid Services (CMS), click here.

Wheelchair Claims Have High Error Rates.

Federal health officials believe 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. That error rate means more than $492 million of improper payments, according to the Associated Press (AP).

The New Program in Detail.

The new program was initiated on September 1, 2012. It now requires all power mobility claims from Medicare patients in California, Florida, Illinois, Michigan, New York, North Carolina and Texas to be submitted for prior authorization. According to a press release by the American Association for Homecare, those seven states receive almost fifty percent (50%) of all the power wheelchairs obtained through Medicare each year.

Click here to see the press release from the American Association for Homecare.

Medicare will only pay for a power wheelchair after a physician and patient meet face-to-face, and the physician prescribes the wheelchair. A DMES is then responsible for recommending the type of wheelchair the patient needs and submitting the claim to Medicare. Under the new program, a doctor or DMES will submit a prior authorization request along with all relevant paperwork supporting the Medicare coverage. The MAC then decides whether the request meets the requirements for coverage.

Under the CMS guidelines, power wheelchairs are only covered by Medicare when patients need them for daily activities and when canes, walkers or manual wheelchairs won’t work for mobility assistance.

Medicare Beneficiaries Get a Sense of False Hope from Television Ads.

According to the AP, a ranking member of the committee suggested the television advertisements for motorized wheelchairs and scooters give consumers the wrong impression about how Medicare coverage can be obtained. He argues these commercials imply Medicare beneficiaries just need to sign a form to receive a power wheelchair. The committee discussed giving authority to regulate the television ads to the CMS.

To listen to testimony from the hearing, click here.

Comments?

What do you think of this story? Leave your comments on this blog below.

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.

Sources:

Freking, Kevin. “Wheelchair Suppliers Say Crack Down on Medicare Fraud Goes Too Far; Insurer Applauds Effort.” Associated Press. (September 19, 2012). From: http://www.washingtonpost.com/politics/health_care/wheelchair-suppliers-say-effort-to-crack-down-on-medicare-fraud-goes-too-far/2012/09/19/032ee93a-02ab-11e2-9132-f2750cd65f97_story.html

American Association for Homecare. “American Association for Homecare Expects Medicare to Move Past its Deny-at-All-Costs Culture that Routinely Denies Claims for Power Wheelchairs” The Sacramento Bee. (September 20, 2012). From: http://www.sacbee.com/2012/09/19/4835272/american-association-for-homecare.html

Swann, James. “Power Wheelchairs On the Congressional Hot Seat.” Bloomberg BNA. (September 20, 2012). From: http://www.bna.com/power-wheelchairs-congressional-b17179869795/

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.

Medicare Put the Hospice Industry Under the Microscope

Patricia's Photos 013By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

It’s no surprise to anyone that Medicare is cracking down on hospices around the country. According to a report by the Office of Inspector General (OIG), eighty-two percent (82%) of hospices’ claims did not meet Medicare coverage requirements. That is why Medicare is investigating the industry as a whole. Specific details on what Medicare is looking for can be found in the 2013 OIG Work Plan. Click here to read the 2013 OIG Work Plan.

So far, Medicare has kept true to its word. During the week of January 7, 2013, the federal government announced it is suing a Central Florida hospice for Medicare fraud, according to the Orlando Sentinel. (Click here to read the Orlando Sentinel article.) Also, one of the nation’s largest and most respected hospices located in San Diego, California, is in the middle of a federal audit, according to a Kaiser Health News article. (Click here to read the Kaiser Health News article.) These are just a few examples of what hospices around the country are dealing with.

Central Florida Hospice Dealing with Qui Tam or Whistleblower Case.

The federal qui tam (whistleblower) lawsuit against the Central Florida hospice was reportedly filed by the hospice’s former vice president of finance in September 2011. The Department of Justice (DOJ) joined the whistleblower lawsuit in September of 2012.

The federal lawsuit alleges the hospice CEO ordered employees to admit patients without properly determining whether they were terminally ill, as required by Medicare. Staff was also apparently told to find ways to “edit” patients’ medical files so that the billing appeared legitimate. To learn more on this case, click here to read a blog I wrote on the hospice when the government joined the lawsuit. Click here to read the entire whistleblower complaint.

San Diego Hospice Cuts More Than Just Patients After Medicare Audit.

In 2010, federal officials audited a large hospice located in San Diego, California. Medicare is still investigating the hospice’s 2009-2010 admissions. Since the audit, the hospice has had to drop around 400 patients, due to their ineligibility for hospice care. Cutting patients meant a decrease in profits, which subsequently meant the hospice had to let 260 employees go and close a 24-bed hospital, according to Kaiser Health News.

Hospices Under Scrutiny.

According to the Kaiser Health News article, the hospice industry is booming. In 2011, it’s estimated hospices served 1.65 million people in the U.S., which is about forty-five percent (45%) of all those who died that year. Medicare paid for the hospice benefits of eighty-four percent (84%) of those patients.

Medicare is concerned with the amount of people hospices admit. Hospices normally treat patients with fewer than six months to live. If a patient recovers, Medicare expects the patient to leave the program. Patients may stay in hospice care only if they are re-certified as still likely to die within six months by a physician. It’s thought that enrollment bonuses to employees and kickbacks to nursing homes that refer patients are big factors as to why hospices accept ineligible patients.

Medicare Trying to Keep Up with Fraud and Abuse in Hospice Industry.

Currently, the Centers for Medicare and Medicaid Services (CMS) is focused on safeguarding tax payers dollars from fraud. I have recently seen a number of audits initiated against health professionals who treat assisted living facility (ALF), hospice and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because these facilities have been identified as fraught with fraud and abuse. I wrote a two-part blog this topic. Click here for part one and here for part two.

If you are being audited, click here to read some tips we recommend in responding to a Medicare audit.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, nurses, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

What Do You Think?

What do you think about Medicare targeting hospices? Do you think it is necessary? Is the hospice business going to suffer because of these investigations? Please leave any thoughtful comment below.

Sources:

Santich, Kate. “Feds Sue Hospice of the Comforter for Medicare Fraud.” Orlando Sentinel. (January 14, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-feds-sue-hospice-of-the-comforter-20130114,0,7827264.story

U.S. ex rel. Stone v. Hospice of the Comforter, Inc., No. 6:11-cv-1498-ORL-22-AAB (M.D. Fla) United State District Court for the Middle District of Florida Orlando Division. (September 12, 2012), available at http://www.thehealthlawfirm.com/uploads/US%20v%20Hospice%20of%20the%20Comforter.pdf

Dotinga, Randy. “Slowly Dying Patients, Am Audit and A Hospice’s Undoing.” Kaiser Health News. (January 16, 2013). From: http://www.kaiserhealthnews.org/Stories/2013/January/16/san-diego-hospice.aspx

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.

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