DOH Releases Quarterly Report Covering Through March 2021

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

The Florida Department of Health’s Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021.

Scope of the Florida DOH’s Control.

First, note that Florida’s Department of Health regulates 22 health care practitioner boards and four health professional councils. This makes it one of the largest such organizations in the country. Second, this also means that the practice of health care in Florida is one of the most heavily regulated anywhere in the U.S., with each professional board, as well as the Department of Health, having specific Florida statutes governing their professions, as well as the different boards each enacting different sets of administrative rules regulating those professions.

The Quarterly Performance Report contains financial and statistical information concerning licensed health professionals.

Key Emphasis on Unlicensed Practice of Health Care Professions.

The key emphasis of this report is the Department of Health’s ongoing efforts to reduce and eliminate the unlicensed practice (UP) of health care professions in the state. This is often referred to generically as the “unlicensed practice of medicine,” but it applies to any health profession for which a license in Florida is required, for example, massage therapy.

A large Number of Health Care Professionals in Florida.

The Report points out that the Department of Health issued 29,651 professional licenses to new applicants just in the Third Quarter of the fiscal year, from January 1, 2021, through March 31, 2021.

The Medical Quality Assurance (MQA) division of the Department of Health issued 102 cease and desist orders to unlicensed individuals whose unregulated and illegal activities were reported to it. It referred 98 complaints to law enforcement agencies for potential criminal violations.

The unlicensed practice of a health profession in Florida is a felony.

It would be interesting to imagine how many additional applicants there might have been for licensed and how many additional complaints and prosecutions for unlicensed practice there might have been if the COVID-19 pandemic hadn’t been in full bloom. The QPR shows overall enforcement support down for the Fiscal Year 2020-2021, undoubtedly because of this.


Which Professions Have the Most Unlicensed Violations?

Although the QPR does not discuss this, from my own personal experience, the ere are three top runners: massage therapy, nursing, and dentistry; note, however, that this is my opinion, only.

It seems to me that there are many cases of mistaken unlicensed practice brought against massage therapists because of mistakes in identity by investigators. We have experienced cases where investigators arrest several different individuals of foreign origin who happen to be present at a massage establishment and accuse them of practicing there without a license when that person was only there visiting a friend or relative and did not touch any client. Often the visitor and even the licensed professionals there will speak little or no English, therefore being unable to clear up any confusion.

Dentistry is another profession where there is a great deal of unlicensed practice. Often this arises when an individual was a dentist in a foreign county and relocates to the U.S., but is unable to obtain a license. They may set up shop in a home or garage and hold themselves out to a certain group speaking the same foreign language, as able to provide skilled dental services. To me, the number of unlicensed practice cases I have encountered in this profession is largely due to the absence of qualified licensed dentists providing care in our communities, especially to the indigent and immigrant communities.

Charges of unlicensed practice of nursing often arise because of nurses who may have been trained abroad failing to make sure that everyone they work with refers to them as “medical assistants” or whatever other role they are filling. It is very common in doctors’ offices and medical practices to refer to anyone who assists the doctor in any way as “the nurse.” One must be careful if one is not a licensed nurse to correct this mistitling whenever it occurs. We have had multiple cases of a doctor’s competitor or a disgruntled patient filing a complaint that the doctor’s medical assistant was holding himself out to be a nurse when they were not.

To Read the entire DOH Third Quarterly Performance Report for 2020-2021, click here:

http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/qpr3-2021.pdf

Remember the Mission of the Florida Department of Health; It is Not to Help YOU.

The QPR emphasizes the same thing you will hear at every professional board meeting if you attend it. That is, the mission of the Florida Department of Health is to protect, promote, and improve the health of all people in Florida and to protect the public. It is not to advocate for or help any individual licensed health professional.

That is one of the reasons I continually tell licensed health professionals that if you want advice on what to do or how to do it legally, don’t call and ask the Department of Health.

First, there is no individual who is authorized to give you advice on what to do or not to do on behalf of any profession, board, or council. Second, there is no individual who is authorized to make decisions on behalf of any professional board or council. A professional board speaks when it meets, discusses an issue, and votes on that issue. That is how decisions are made; not by what one employee may think.

You may send all of your complaints and other hate mail to me at one of the addresses given below.

Contact Health Law Attorneys Experienced with Department of Health Matters and Investigations.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment (DME) suppliers, medical students and interns, chiropractors, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider

Our attorneys provide legal representation in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, Federal Bureau of Investigation (FBI) investigations, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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

Keywords: Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, healthcare license representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

“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 © 2021 The Health Law Firm. All rights reserved.

 

 

 

Department of Health Quarterly Report Released Covering Through March 2021

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

The Florida Department of Health’s Quarterly Performance Report (QPR) for the Third Quarter of Fiscal Year 2020-2021, was recently released. It provides information and statistics on actions involving licensed health professionals through March 2021.

Scope of the Florida Department of Health’s Control.

First, note that Florida’s Department of Health regulates 22 health care practitioner boards and four health professional councils. This makes it one of the largest such organizations in the country. Second, this also means that the practice of health care in Florida is one of the most heavily regulated anywhere in the U.S., with each professional board, as well as the Department of Health, having specific Florida statutes governing their professions, as well as the different boards each enacting different sets of administrative rules regulating those professions.

The Quarterly Performance Report contains financial and statistical information concerning licensed health professionals.

Key Emphasis on Unlicensed Practice of Health Care Professions.

The key emphasis of this report is the Department of Health’s ongoing efforts to reduce and eliminate the unlicensed practice (UP) of health care professions in the state. This is often referred to generically as the “unlicensed practice of medicine,” but it applies to any health profession for which a license in Florida is required, for example, massage therapy.

Large Number of Health Care Professionals in Florida.

The Report points out that the Department of Health issued 29,651 professional licenses to new applicants just in the Third Quarter of the fiscal year, from January 1, 2021, through March 31, 2021.

The Medical Quality Assurance (MQA) division of the Department of Health issued 102 cease and desist orders to unlicensed individuals whose unregulated and illegal activities were reported to it. It referred 98 complaints to law enforcement agencies for potential criminal violations.

The unlicensed practice of a health profession in Florida is a felony.

It would be interesting to imagine how many additional applicants there might have been for licensed and how many additional complaints and prosecutions for unlicensed practice there might have been if the COVID-19 pandemic hadn’t been in full bloom. The QPR shows overall enforcement support down for the Fiscal Year 2020-2021, undoubtedly because of this.

Which Professions Have Most Unlicensed Violations?

Although the QPR does not discuss this, from my own personal experience, the ere are three top runners: massage therapy, nursing, and dentistry; note, however, that this is my opinion, only.

It seems to me that there are many cases of mistaken unlicensed practice brought against massage therapists because of mistakes in identity by investigators. We have experienced cases where investigators arrest several different individuals of foreign origin who happen to be present at a massage establishment and accuse them of practicing there without a license when that person was only there visiting a friend or relative and did not touch any client. Often the visitor and even the licensed professionals there will speak little or no English, therefore being unable to clear up any confusion.

Dentistry is another profession where there is a great deal of unlicensed practice. Often this arises when an individual was a dentist in a foreign county and relocates to the U.S., but is unable to obtain a license. They may set up shop in a home or garage and hold themselves out to a certain group speaking the same foreign language, as able to provide skilled dental services. To me, the number of unlicensed practice cases I have encountered in this profession is largely due to the absence of qualified licensed dentists providing care in our communities, especially to the indigent and immigrant communities.

Charges of unlicensed practice of nursing often arise because of nurses who may have been trained abroad failing to make sure that everyone they work with refers to them as “medical assistants” or whatever other role they are filling. It is very common in doctors’ offices and medical practices to refer to anyone who assists the doctor in any way as “the nurse.” One must be careful if one is not a licensed nurse to correct this mistitling whenever it occurs. We have had multiple cases of a doctor’s competitor or a disgruntled patient filing a complaint that the doctor’s medical assistant was holding himself out to be a nurse when they were not.

To Read the entire DOH Third Quarterly Performance Report for 2020-2021, click here:

http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/qpr3-2021.pdf

Remember the Mission of the Florida Department of Health; It is Not to Help YOU.

The QPR emphasizes the same thing you will hear at every professional board meeting if you attend it. That is, the mission of the Florida Department of Health is to protect, promote, and improve the health of all people in Florida and to protect the public. It is not to advocate for or help any individual licensed health professional.

That is one of the reasons I continually tell licensed health professionals that if you want advice on what to do or how to do it legally, don’t call and ask the Department of Health.

First, there is no individual who is authorized to give you advice on what to do or not to do on behalf of any profession, board, or council. Second, there is no individual who is authorized to make decisions on behalf of any professional board or council. A professional board speaks when it meets, discusses an issue, and votes on that issue. That is how decisions are made; not by what one employee may think.

You may send all of your complaints and other hate mail to me at one of the addresses given below.

Contact Health Law Attorneys Experienced with Department of Health Matters and Investigations.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment (DME) suppliers, medical students and interns, chiropractors, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider

Our attorneys provide legal representation in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, Federal Bureau of Investigation (FBI) investigations, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

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

Keywords: Department of Health investigation representation, DOH defense lawyer, DOH investigation, representation for DOH investigations, DOH investigation defense attorney, DOH representation, representation for board licensing complaint, board licensing complaint representation, board licensing complaint lawyer, board representation for healthcare professionals, licensure defense, licensure defense attorney, licensure defense representation, representation for administrative complaint, administrative licensure investigation representation, healthcare license representation, administrative hearing attorney, Agency for Health Care Administration (AHCA) representation, AHCA attorney, AHCA defense lawyer, nurse attorney, representation for nurses, nurse defense lawyer, healthcare attorney, representation for healthcare professionals, Drug Enforcement Administration (DEA) agents, FBI agents, OIG special agents, Medicaid Fraud Control Unit (MFCU) investigators, representation for physicians, The Health Law Firm reviews, reviews for The Health Law Firm

“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 © 2021 The Health Law Firm. All rights reserved.

 

 

 

Types of Disciplinary Actions Taken By the Board of Massage Therapy

By Castillana F. Duvernay, J.D.

The Florida Board of Massage Therapy can take disciplinary actions against you and your massage establishment if you are not adhering to the rules and regulations set forth by the Board of Massage Therapy and the statutes that govern the practice of massage.

We see common themes and issues that arise at Board of Massage Therapy meetings. This blog will highlight some of these issues and provide tips on how you can avoid being disciplined.

The Practice Act for Massage Therapists Requires Disclosure of Prior Disciplinary History.

If you did not disclose your prior disciplinary history (prior criminal conviction, prior discipline on a professional license) on your application, this may subject you to an administrative complaint by the Florida Department of Health and the Board of Massage Therapy.

Not disclosing disciplinary history information is a violation of Section 480.046(1)(p), Florida Statutes, and Section 480.041(6), Florida statutes. It is imperative that you answer the history questions on your application truthfully. Answering the questions truthfully will help speed up your application.

Licensed Massage Establishment.

In Florida, the practice of massage therapy is governed by Florida Statutes. The Department of Health is the umbrella agency that is charged with enforcing the laws and rules and is over the Board of Massage Therapy.

It is a felony offense to practice, attempt to practice, or offer to practice a regulated healthcare profession, including massage therapy, without possessing a valid license. Reflexology is included under massage therapy and requires a license in Florida.

Working at a massage parlor that isn’t duly licensed is a violation of Section 480.043(1), Florida Statutes, which states: “No massage establishment shall be allowed to operate without a license granted by the department in accordance with the rules adopted by the board.”

Before working for a massage establishment or opening up your own massage parlor, it is imperative that you have the proper documentation to show that you are a duly licensed massage establishment as required by Section 480.043, Florida Statutes. If you do not have the proper documents, the ramifications can be severe. This can lead to complaints being filed against you and the establishment which may lead to arrest by law enforcement, a Uniform Unlicensed Activity Citation (fine), or the subject will be issued a Cease and Desist letter.

Education Discrepancies.

Prior to attending a massage school, make sure it is a Board-approved massage school. One of the ways to do this is to request information about the accreditation of the school from the school staff or its designated accrediting agency. Alternatively, you may go to the Florida Massage Therapy website and search for a list of Florida approved Massage Schools.

The Board of Massage Therapy has a Massage School Approval Requirements Checklist and Information on their website that you can use as guide to help you decide if the school is following the guidelines set forth by the Board of Massage Therapy. In addition, the Board of Massage Therapy has a closed program list showing you which schools are closed and no longer operating. Furthermore, they also have a list of approved schools. Of course with each of these options, it is always best practice to contact the board of massage therapy to inquire about a school that you may be interested in attending.

Sexual Misconduct and Sexual Activity.

Sexual misconduct and sexual activity has been a hot topic for the board for several years. Engaging in sexual misconduct with a client or patient is a violation of Section 480.0485, Florida Statutes.

It is important that you do not exceed the boundaries of the massage that you are performing. Follow the generally accepted treatment of massage therapy patients. Do not accept offers from anyone, and don’t offer extra services to anyone that is not a part of the listed services offered by the massage establishment. Exceeding the scope of the massage will not only lead to disciplinary action by the board of massage therapy, but it may lead to a criminal record.

Displaying Licensure.

Failure to conspicuously display establishment license and massage therapist license may lead to disciplinary action. It is extremely important that upon opening your own massage parlor that you place all of your licenses in a place where it can be seen.

Procedures for Reporting Human Trafficking.

Not having procedures in place for reporting suspected human trafficking may lead to disciplinary action. Pursuant to Section 480.043(13), Florida Statutes, massage establishments must implement a procedure for reporting suspected human trafficking to the National Human Trafficking Hotline or to a local law enforcement agency. A sign detailing this reporting procedure must be posted in a conspicuous place in the establishment that is accessible to employees.

Contact Health Law Attorneys Experienced in Representing Massage Therapists and Other Healthcare Professionals.

The attorneys of The Health Law Firm provide legal representation to massage therapists in Department of Health investigations and other types of investigations of health professionals and providers. The Health Law Firm routinely represents massage therapists, dentists, nurses, physicians, medical groups, clinics, and other healthcare providers in personal and facility licensing issues.

To contact The Health Law Firm, please call (407) 331-6620 or toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: Castillana F. Duvernay, J.D. is a new lawyer 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, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

Sources:

“Closed School List.” https://floridasmassagetherapy.gov/forms/mt-closed-schools-11-14.pdf

“Florida Approved Massage Schools List.” https://floridasmassagetherapy.gov/forms/massage-list-school.pdf

Florida Board of Massage Therapy. “Are massage establishments required to have procedures for reporting human trafficking?” https://floridasmassagetherapy.gov/help-center/are-massage-establishments-required-to-have-procedures-for-reporting-human-trafficking/

Florida Board of Massage Therapy. “Education and Training Programs.” https://floridasmassagetherapy.gov/education-and-training-programs/

Florida Board of Massage Therapy. “Unlicensed Activity (ULA).” https://floridasmassagetherapy.gov/latest-news/unlicensed-activity-ula/

 

“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 © 2024. The Health Law Firm. All rights reserved. No part of this work may be published in any form in any medium without the written permission of the copyright owner. The copyright owner asserts its right to be associated with the content of this work.

By |2024-03-14T09:59:14-04:00January 2, 2024|Categories: Massage Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Types of Disciplinary Actions Taken By the Board of Massage Therapy

Florida Dentist Convicted of First-Degree Murder of Florida Statue University Law Professor

Attorney & Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm

On November 6, 2023, a jury convicted a South Florida dentist of conspiracy to commit murder, solicitation of murder, and first-degree murder in the killing of his former brother-in-law. After more than three hours of deliberations, the jury delivered the verdict in the Second Judicial Circuit Court in Tallahassee, Florida.

The Relationship Between the Dentist and the Professor.

The Florida dentist’s sister was previously married to the Florida State University (FSU) Law professor. The couple separated in 2012 and divorced in 2013.

The couple battled in divorce court and for custody of their two children. The proceedings were very contentious. They argued over every detail of their children’s lives. The parents had 50/50 custody, and there was a court order that prevented the ex-wife from moving away.

The prosecution argued that the ex-wife’s family was desperate to get her and the children to move back to South Florida.

The Schemes For Relocation.

The ex-wife’s family allegedly concocted schemes that would allow the wife and children to move closer to them in South Florida.

One reported scheme was to convince the FSU Law professor to move to South Florida with the children by paying him $1,000,000. The ex-wife’s parents allegedly agreed to split the payment of the million dollars with the brother, the dentist. The ex-wife’s mother allegedly also told the dentist to threaten the devoutly Jewish father that they would enroll the children in a Catholic private school if he did not relocate to South Florida. Unfortunately for the FSU professor, the scheme that would ultimately occur was a murder-for-hire.

The Murder-For-Hire.

The dentist was then dating a woman who had connections to a criminal gang in North Miami. The dentist’s girlfriend testified against him, stating that the dentist first asked her about connecting him with a hit man in October 2013. She also said that he pressured her to move forward with the murder-for-hire in June and July 2014.

Two men were hired to execute the hit on the FSU Law professor. One was the father of the dentist’s girlfriend’s children, and the other was a gang leader in Miami.

The gang leader took a plea deal concerning the murder-for-hire. He is serving 19 years concurrent with a federal racketeering charge he previously served. He testified in the dentist’s trial. He said that he and his accomplice drove to Tallahassee and stalked the professor on July 18, 2014. When the professor returned to his home, the accomplice shot him twice. The professor was transported to the hospital after a neighbor called 911 but he died the next day in the hospital.

The gang leader testified that the dentist paid $100,000 for the hit men to kill the FSU Law professor. The payment was split between the gang leader, the accomplice and triggerman, and the girlfriend.

The girlfriend was sentenced to life in prison in 2022 for her involvement in the murder. In 2019, the triggerman was also sentenced to life in prison for his role in the killing of the professor. The gang leader is serving 19 years in prison for his involvement in the murder.

The Trial.

In his defense, the dentist testified that he played no role in the murder-for-hire. He claimed that he was the victim of an elaborate extortion scheme masterminded by the girlfriend.

The prosecution argued that the dentist and his family were so desperate to have the sister and her children back in South Florida that the dentist masterminded a murder-for-hire scheme.

After only approximately three hours of deliberation, the jury returned a guilty verdict to each charge: conspiracy to commit murder, solicitation of murder, and first-degree murder.

It is expected that the dentist will also lose his license to practice dentistry as a result of the conviction.

Contact Health Law Attorneys Experienced with Investigations of Dentists and Health Professionals Today.

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

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

Sources:

Bridges, C. A. “FSU professor Dan Markel’s killing: Everything to know about the murder-for-hire case.” Tallahassee Democrat. (25 October 2023) https://www.tallahassee.com/story/news/local/2023/10/25/dan-markel-florida-murder-case-brother-in-law-charlie-adelson-tallahassee-homicide-trial/71298187007/

Burlew, Jeff. “Man found guilty of murdering FSU law professor Dan Markel.” FSU News. (7 November 2023) https://www.fsunews.com/story/news/2023/11/07/man-found-guilty-of-murdering-fsu-law-professor-dan-markel/71487542007/

Royal, Denise. “Man charged in murder-for-hire of FSU law professor convicted on all counts.” CNN. (7 November 2023) https://www.cnn.com/2023/11/07/us/fsu-professor-charles-adelson-murder-conviction/index.html

Minksy, David. “Dentist Found Guilty of Murdering Fla. Law Professor.” Law360. (6 November 2023) https://www.law360.com/articles/1751533/dentist-found-guilty-of-murdering-fla-law-professor-

About the Authors: 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. Hartley Brooks is a law clerk with The Health Law Firm. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or toll-free: (888) 331-6620.

Attorney Positions with The Health Law Firm. The Health Law Firm is always looking for qualified attorneys interested in health law practice. Its main office is in the Orlando, Florida, area. If you are a member of The Florida Bar and are interested, forward a cover letter and your resume to: [email protected] or fax to: (407) 331-3030.

“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 © 2024. George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be published or used in any medium for any purpose without the copyright owner’s written permission. The copyright owner/creator reserves the right to have his name associated with all parts of this work.

Are You the Target of a Medicaid Audit? Tips Health Professionals Should Be Following

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

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), and Bureau of Medicaid Program Integrity is the Florida agency responsible for routine Medicaid audits The agency ensures that the Medicaid program was billed correctly for services by health care professionals. Those receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited.

These include pediatricians, Ob/Gyns, family practice physicians, and dentists. The Medicaid audit usually requests information in a questionnaire form. It also includes a request for copies of medical records (including X-rays and other diagnostic studies) for the patients selected for the audit.

If AHCA determines that Medicaid overpaid for services, it will use a complex mathematical extrapolation formula to determine the repayment amount. Additionally, fines and penalties can be added by the Medicaid program. However, you can eliminate or reduce the amount of any such repayment by actions taken both before and during the Medicaid audit.

Practical Tips for Your Practice.

There are ways to run the everyday practice that will help you if you are selected for a Medicaid audit.
1. Every patient record entry should be clearly dated and signed or initialed by the provider. Make sure this is always done.

2. When documenting the patient’s record, make sure that you document exactly what services were needed and completed to support what was billed to Medicaid.

3. Communicate with the person responsible for your billing so that the actual services provided are billed for. Do not bill in advance for anticipated services needed as indicated in the appointment calendar or on a treatment plan.

4. Keep the patient records organized and ready for copying, if necessary. Using only one-sided documents and securely fastening small forms (prescriptions, telephone memos, small sticky notes) onto 8-1/2″ by 11″ paper will help those still using paper charts. Scan all such documents into the patient record using an electronic health record (EHR).

5. Services provided by a physician not enrolled in the Medicaid program to a Medicaid patient may not be billed to or paid by the Medicaid program. Therefore, never allow any other physician associated with your practice who is not enrolled as a Medicaid provider to provide services to Medicaid patients. Do not allow a new physician coming into your practice to treat Medicaid patients until he or she actually has received his or her Medicaid provider number. The group may not bill for the services, nor may another physician bill for the services.

6. Ensure that all health care professionals’ licenses and permits are updated. Ensure that all X-rays, clinical lab, and diagnostic equipment are permitted and kept up to date. Ensure that any CLIA license or exemption certificate is correct and kept up to date. Services billed by unlicensed personnel or services provided by improperly-licensed facilities may not be paid by the Medicaid program.

7. Use only standard abbreviations in your medical records documentation, orders, and reports. While an abbreviation may seem familiar to you or your practice, the auditors may not recognize it if it is not a universally accepted abbreviation.

8. Make sure all records are timely made, accurate and legible. Safeguard them, and never let the original leave your office. Illegible records are treated as a non-record, and payment is wholly disallowed for an illegible note or order. A missing record, X-ray, or chart entry will result in a complete repayment being directed for those services.


The Medicaid Audit.

If you are on the receiving end of an audit, AHCA will send you a letter notifying you. AHCA will also supply you with a list of patients to be sampled. A standard sample will include a list of anywhere from 30 to 150 patient names, as a general rule, depending on the size of the practice. Regular audits routinely request 30 to 50 patients’ records. The audit letter will also include a questionnaire to be completed (Medicaid Provider Questionnaire) and a “Certification of Completeness of Records” form to complete and return with the copies of the patient records. (Please note: This will be used against you in the future if you attempt to add or supplement the copies of the records you provided.)

For more information, read a past blog that will let you know if you are the subject of an audit.

You must retain the services of an expert consultant or experienced health care attorney to correctly and accurately complete the questionnaire. The letter will also request that you provide copies of the patient records for the list of patients included with the letter. You will only be given a short time to provide these documents.

If you have been accused of Medicaid fraud and need to prepare for an audit, watch our informational video blog.

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

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health law attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

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

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

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

“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.

Finding a Lawyer Who Takes CPH & Associates Insurance

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

Our firm often gets calls from nurses and other health professionals who retain us to represent them in complaints against their licenses or in professional licensing complaints and investigations. This includes investigation letters from the Florida Department of Health (DOH), D.C. Health or Louisiana State Board. It also includes notices of hearing, administrative complaints, proposed Consent Orders, emergency restriction orders (EROs), and emergency suspension orders (ESOs). In many cases they had good insurance coverage with CPH & Associates (CPH&A) Insurance, but could not find an attorneys that accepted it or forgot that they had coverage.

Often adverse disciplinary action has already been taken against these nurses. They retain us to appeal or attempt to reverse an adverse disciplinary action against their license, including license revocations.

However, finding legal counsel accepting your liability insurance should not be difficult. Our firm and its attorneys have accepted CPH&A Insurance, and many others, for years.

Do Not Skimp On Insurance Coverage!

If you have good insurance, it will pay for your legal expenses from the very beginning, so use it. However, beware of cheap insurance policies from professional associations that don’t cover disciplinary complaints and licensure investigations. Always check to be sure this is covered. Get it in writing.

Find and Contact an Experienced Health Law Attorney.

You should immediately contact an experienced health law attorney if you are telephoned or visited by any investigator. Or, if you receive a letter advising you that an investigation has been opened regarding your care. Call immediately for advice before you speak with an investigator or provide any documents or statements.

You cannot and should not seek “legal advice” on what to do from the investigator, a DOH employee, your professional board, or any attorney representing any of them. They are not your friends. They are not on your side. Therefore, it would be best if you did not take their advice.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Board of Nursing investigations and complaints, and Department of Health (DOH) investigations and complaints. We appear before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., not just in Florida, Louisiana, Colorado, and Washington, D.C.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.

“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 © 2023 The Health Law Firm. All rights reserved.

 

By |2024-03-14T09:59:32-04:00April 13, 2023|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Finding a Lawyer Who Takes CPH & Associates Insurance

10 Biggest Mistakes Dentists Make That Cause DOH Complaints

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

In representing dentists in complaints against their licenses, we see similar cases over and over again. The dentists could have avoided many Department of Health (DOH) complaints that may wind up before the Board of Dentistry.

These are the ten biggest mistakes we see dentists make, leading to DOH complaints being filed and investigations being opened against them.

1.  Requiring patients to pay an outstanding dental bill before releasing a copy of their dental records. This is prohibited by law. However, the patient can be charged for the copy of the record, up to $1.00 per page for the first 25 pages, ($.25 per page after that), and actual costs of reproduction for other forms of dental records (X-rays, CD’s photographs).

2.  Not having the original patient x-rays or a good digitized copy. Believe it or not, many dentists we have represented either gave their x-rays to the patient or sent them to a subsequent treating dentist. Always release copies (for which you may charge). Always keep the originals. (Not having them when needed). With the expanding use of digital x-rays stored in an electronic dental record, this is not so problematic as it was in the past.

3.  Accepting a new patient who has had more than one other primary dentist within the prior five years (when the patient hasn’t relocated to a new geographical area). Unhappy, disgruntled, unrealistic patients will change dentists often. Identify these patients early and refuse to accept them as your patients or terminate them as patients as soon as you identify them. Closely related to this is accepting or failing to terminate the “disgruntled” patient. If a patient is a chronic complainer or threatens to sue or file a complaint, this is a patient who will, most likely, never be satisfied. Terminate this patient immediately.

4.  Failing to fully inform the patient of possible less-than-desirable outcomes (documenting this in writing, preferably signed by the patient). This includes but is not limited to the fact that there may be subsequent pain or infection, that the bite may be less than perfect and may have to be adjusted, that a bridge or other fixture may not fit correctly and may need to be adjusted, etc.

5.  Failing to have and use appropriate consent forms including, but not limited to:

a.  Refusal of a treatment consent form

b.  Consent for less than optimal dental treatment (to use when a patient refuses to follow dentist’s recommended treatment plan). This is also called “Refusal of Recommended Treatment.”

c.  Root Canal consent form
d.  Tooth Extraction
e.  Endodontic procedures
f.  Dentures and bridges

6.  Failing to refund dental fees when complaining patients demand it. We do not routinely recommend that you refund dental fees based solely on a patient’s demand that you do so. In many cases, the patient will have benefited from the treatment, procedure, or appliance, and should pay for it. However, in many instances, this must be a business decision based on risk management principles. It is always a good idea to weigh the amount in attorney’s fees, time, and aggravation, mental anguish, or increase in insurance premiums that will result if you fail to refund demanded fees. Base your decision on a calculation of how likely it is that a complaint will result.

7.  Failing to have good, legible, comprehensive treatment records on the patient. A documented, comprehensive written treatment plan signed by the patient is mandatory in all cases except emergency cases and specialty consults. This also includes failing to prepare and maintain a periodontal chart on a patient. If you are going to treat and follow a patient for more than an emergency visit or a specialty consultation, you should perform a periodontal exam. Just as important, the Board of Dentistry will expect you to chart this on a periodontal chart.

8.  Failing to document the type of and amount of a drug administered, a sedative used, a compound used, etc. Be sure this is accurately stated in your chart. Be sure this is accurately billed with the correct billing code.

9.  Failing to give patients a copy of their dental chart within a reasonable period of time after requested. (The courts usually define “reasonable” as 14 calendar days or ten business days; however, the Board of Dentistry allows up to 30 days. If you can reasonably provide it earlier, do so, documenting the date.

10.  Producing only part of the complete dental chart to the patient, subsequent treating dentist, or DOH investigator when requested. This has become more problematic as dentists’ convert more and more into electronic dental records. Be sure to print out and produce all treatment plans, histories, physical exams, family history questionnaires, medical history questionnaires, informed consent forms, photographs, treatment plans, x-rays, periodontal charts, progress notes, daily journal entires, bills, correspondence with health insurers or other third-party payers. Also included are prior dentists’ records received, operative reports, or any other documents you have relating to the patient’s treatment.

These are not hard and fast rules. We cannot assure you that you will never receive a DOH complaint, a patient complaint, a grievance, or a lawsuit if you follow them. However, if you follow them, you will probably find your patients happier, your practice calmer and more productive, and your risks of having a complaint filed significantly reduced or eliminated.

Click here to read one of my prior blogs about DOH complaints and investigations.

Contact Health Law Attorneys Experienced with Investigations of Dentists and Health Professionals Today.

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

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

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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or toll-free: (888) 331-6620.

KeyWords: Legal representation for Department of Health (DOH) investigations, legal representation for DOH complaints, licensure defense attorney, DOH defense attorney, representation for DOH cases, DOH complaint representation, representation for dentists, dental law defense attorney, dentist representation, health law defense attorney, legal representation for health care professionals, legal representation for disciplinary actions against your license, legal representation for license revocation, licensure defense attorney, administrative complaint attorney, legal representation for administrative complaints, legal counsel for Board representation, Board of Dentistry representation, Board of Dentistry defense lawyer, The Health Law Firm, health law defense attorney, Florida health law attorney, reviews of The Health Law Firm, The Health Law Firm attorneys review

“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 © 2021 The Health Law Firm. All rights reserved.

10 Biggest Mistakes Dentists Make That Cause DOH Complaints

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

In representing dentists in complaints against their licenses, we see similar cases over and over again. The dentists could have avoided many Department of Health (DOH) complaints that may wind up before the Board of Dentistry.

These are the ten biggest mistakes we see dentists make, leading to DOH complaints being filed and investigations being opened against them.

1.  Requiring patients to pay an outstanding dental bill before releasing a copy of their dental records. This is prohibited by law. However, the patient can be charged for the copy of the record, up to $1.00 per page for the first 25 pages, ($.25 per page after that), and actual costs of reproduction for other forms of dental records (X-rays, CD’s photographs).

2.  Not having the original patient x-rays or a good digitized copy. Believe it or not, many dentists we have represented either gave their x-rays to the patient or sent them to a subsequent treating dentist. Always release copies (for which you may charge). Always keep the originals. (Not having them when needed). With the expanding use of digital x-rays stored in an electronic dental record, this is not so problematic as it was in the past.

3.  Accepting a new patient who has had more than one other primary dentist within the prior five years (when the patient hasn’t relocated to a new geographical area). Unhappy, disgruntled, unrealistic patients will change dentists often. Identify these patients early and refuse to accept them as your patients or terminate them as patients as soon as you identify them. Closely related to this is accepting or failing to terminate the “disgruntled” patient. If a patient is a chronic complainer or threatens to sue or file a complaint, this is a patient who will, most likely, never be satisfied. Terminate this patient immediately.

4.  Failing to fully inform the patient of possible less-than-desirable outcomes (documenting this in writing, preferably signed by the patient). This includes but is not limited to the fact that there may be subsequent pain or infection, that the bite may be less than perfect and may have to be adjusted, that a bridge or other fixture may not fit correctly and may need to be adjusted, etc.

5.  Failing to have and use appropriate consent forms including, but not limited to:

a.  Refusal of a treatment consent form

b.  Consent for less than optimal dental treatment (to use when a patient refuses to follow dentist’s recommended treatment plan). This is also called “Refusal of Recommended Treatment.”

c.  Root Canal consent form
d.  Tooth Extraction
e.  Endodontic procedures
f.  Dentures and bridges

6.  Failing to refund dental fees when complaining patients demand it. We do not routinely recommend that you refund dental fees based solely on a patient’s demand that you do so. In many cases, the patient will have benefited from the treatment, procedure, or appliance, and should pay for it. However, in many instances, this must be a business decision based on risk management principles. It is always a good idea to weigh the amount in attorney’s fees, time, and aggravation, mental anguish, or increase in insurance premiums that will result if you fail to refund demanded fees. Base your decision on a calculation of how likely it is that a complaint will result.

7.  Failing to have good, legible, comprehensive treatment records on the patient. A documented, comprehensive written treatment plan signed by the patient is mandatory in all cases except emergency cases and specialty consults. This also includes failing to prepare and maintain a periodontal chart on a patient. If you are going to treat and follow a patient for more than an emergency visit or a specialty consultation, you should perform a periodontal exam. Just as important, the Board of Dentistry will expect you to chart this on a periodontal chart.

8.  Failing to document the type of and amount of a drug administered, a sedative used, a compound used, etc. Be sure this is accurately stated in your chart. Be sure this is accurately billed with the correct billing code.

9.  Failing to give patients a copy of their dental chart within a reasonable period of time after requested. (The courts usually define “reasonable” as 14 calendar days or ten business days; however, the Board of Dentistry allows up to 30 days. If you can reasonably provide it earlier, do so, documenting the date.

10.  Producing only part of the complete dental chart to the patient, subsequent treating dentist, or DOH investigator when requested. This has become more problematic as dentists’ convert more and more into electronic dental records. Be sure to print out and produce all treatment plans, histories, physical exams, family history questionnaires, medical history questionnaires, informed consent forms, photographs, treatment plans, x-rays, periodontal charts, progress notes, daily journal entires, bills, correspondence with health insurers or other third-party payers. Also included are prior dentists’ records received, operative reports, or any other documents you have relating to the patient’s treatment.

These are not hard and fast rules. We cannot assure you that you will never receive a DOH complaint, a patient complaint, a grievance, or a lawsuit if you follow them. However, if you follow them, you will probably find your patients happier, your practice calmer and more productive, and your risks of having a complaint filed significantly reduced or eliminated.

Click here to read one of my prior blogs about DOH complaints and investigations.

Contact Health Law Attorneys Experienced with Investigations of Dentists and Health Professionals Today.

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

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

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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or toll-free: (888) 331-6620.

KeyWords: Legal representation for Department of Health (DOH) investigations, legal representation for DOH complaints, licensure defense attorney, DOH defense attorney, representation for DOH cases, DOH complaint representation, representation for dentists, dental law defense attorney, dentist representation, health law defense attorney, legal representation for health care professionals, legal representation for disciplinary actions against your license, legal representation for license revocation, licensure defense attorney, administrative complaint attorney, legal representation for administrative complaints, legal counsel for Board representation, Board of Dentistry representation, Board of Dentistry defense lawyer, The Health Law Firm, health law defense attorney, Florida health law attorney, reviews of The Health Law Firm, The Health Law Firm attorneys review

“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 © 2021 The Health Law Firm. All rights reserved.

 

 

 

How an American Board of Internal Medicine Policy is Robbing America of Qualified Physicians

By Achal A. Aggarwal, M.B.A., J.D.

In July 2012, the American Board of Internal Medicine (“ABIM”) implemented a policy change placing limits on how long a physician could be considered “board eligible.”  This policy nearly ended the ability of many otherwise qualified physicians to become certified in internal medicine.  In many cases, this also caused them to lose hospital clinical privileges or to not qualify for them.

Board eligibility and board certification are big deals in the medical community, as you know.  A physician who is not board eligible or board certified stands to lose a lucrative career. Insurance companies will not allow the physicians on their panels; medical groups refrain from hiring them, and hospital medical staffs refuse them privileges.  This then forces many physicians to open private practices on a cash-basis, a business model that may be impossible to sustain in today’s healthcare system.

Details of the Policy.

Prior to 2012, internal medicine physicians could practice medicine under the designation “board eligible” and still get hired by hospitals and get onto health insurance panels.  Additionally, ABIM did not have a time limit on when a physician needed to become board certified.  This allowed many safe, capable, and qualified physicians to provide health care to patients throughout the United States without having to become board certified, meeting hospital or insurance company requirements.

ABIM Sets a Deadline.

If the physician failed to become board certified within those seven years, then the physician could only regain their board eligibility by completing one-year of retraining.  ABIM’s policy provided physicians who finished an internal medicine residency before 2012 a seven (7) year time period to become board certified in internal medicine.  Many physicians did not even realize this rule applied until 2019 when the seven (7) year period ran, and applications began being denied.

With the ABIM’s policy change, many of those physicians have lost their board eligible status, lost their clinical privileges or had insurance contracts terminated.  The term “board eligible” is no longer even recognized by the ABIM.  Physicians are prohibited from even using the term any longer.

Retraining is required to be at a U.S. training program accredited by the Accreditation Council for Graduate Medical Education (“ACGME”) or at a Canadian training program accredited by the Royal College of Physicians and Surgeons of Canada (“RCPSC”).

However, no such limited retraining program appears to exist.  Many physicians who have been practicing for ten years or longer cannot apply for board certification because they are unable to find or complete an accredited training program that will retrain them for just one year.


So What Can You Do If You Missed the Time Limit?

An alternative is that a physician can submit a request for an exception from the ABIM’s 2012 policy. A physician can request that their board eligibility be extended to take the internal medicine board certification exam.  The request for such an exception must be submitted to the ABIM’s Staff Credentials Committee.  However, these exceptions are rarely granted.

If you are in a residency of fellowship program in internal medicine, be sure you do not forget about the seven (7) years limitation on applying for certification.

If you decide to petition for an exception to the time period for applying for, we recommend contacting a qualified health law attorney who has experience in dealing with the ABIM and can assist in preparing such a request.  There is no guarantee of success, but at least you will have attorneys working for you who know what they are doing.

For even more information, read my prior blog here.


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

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in investigations and hearings of all types.  This includes board certification hearings, medical board hearings, Drug Enforcement Administration (DEA) hearings, Food and Drug Administration (FDA) hearings, medical staff peer review and clinical privileges hearings, FBI Investigations, DOJ Investigations, Drug Enforcement Administration (DEA) investigations, Medicare and Medicaid overpayment demands and hearings, and other types of investigations of health professionals and providers.  We also undertake civil litigation in the same types of cases.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: Achal A. Aggarwal, M.B.A., J.D. practices health law with The Health Law Firm, which has a national practice.  Its main office in the Orlando, Florida area.   The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone:  (407) 331-6620 or Toll-Free: (888) 331-6620. www.TheHealthLawFirm.com

KeyWords: American Board of Internal Medicine (ABIM) defense lawyers, legal representation for ABIM investigations, legal representation for ABIM discipline, legal representation for ABIM certification, legal representation for Board representation, legal representation for Board investigations, defense attorney for Board investigations, attorney for Board representation, legal representation for medical students, legal representation for medical residents, legal representation for medical fellows, legal representation for physician employment agreement, physician employment contract attorney, legal representation for physician license revocation, licensure defense attorney, legal representation for health care professionals, health law defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews board certification hearings, medical board hearings

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2020 The Health Law Firm. All rights reserved.

Question: Is Exposure to COVID-19 For Nurses and Other Healthcare Workers, Causing Illness, Disability, or Death, Considered an Employment-Related Injury Under Workers’ Comp Coverage?

Attorney Amanda I. ForbesBy Amanda I. Forbes, J.D. and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In answering the question posed in the title of this blog, first, it should be noted that the World Health Organization (WHO) classifies COVID-19 as an “occupational disease.”  (Reference:  World Health Organization, “Coronavirus Disease (COVID-19) Outbreak: Rights, Roles and Responsibilities Of Health Workers. . . .”)

Click here to view the classification by the WHO on our website.

Most state workers’ compensation laws cover the worker for occupational diseases if the worker acquires it during the course and scope of their employment.  For example, Section 440.151(2), Florida Statutes, states:

Whenever used in this section the term “occupational disease” shall be construed to mean only a disease which is due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation, process, or employment, and to exclude all ordinary diseases of life to which the general public is exposed, unless the incidence of the disease is substantially higher in the particular trade, occupation, process, or employment than for the general public. “Occupational disease” means only a disease for which there are epidemiological studies showing that exposure to the specific substance involved, at the levels to which the employee was exposed, may cause the precise disease sustained by the employee.

Section 440.151(2), Florida Statutes, (emphasis added).  Many other states have similar requirements to those of Florida.

Healthcare workers are at the front line of any outbreak response and as such are exposed to hazards that put them at an increased risk of infection with the COVID-19 virus.  Therefore, as COVID-19 meets the criteria as an “occupational disease.”

Moreover, Section 440.151(1)(a), Florida Statutes, states:

Where the employer and employee are subject to the provisions of the Workers’ Compensation Law, the disablement or death of an employee resulting from an occupational disease as hereinafter defined shall be treated as the happening of an injury by accident, notwithstanding any other provisions of this chapter, and the employee or, in case of death, the employee’s dependents shall be entitled to compensation as provided by this chapter, except as hereinafter otherwise provided; and the practice and procedure prescribed by this chapter shall apply to all proceedings under this section, except as hereinafter otherwise provided.  Provided, however, that in no case shall an employer be liable for compensation under the provisions of this section unless such disease has resulted from the nature of the employment in which the employee was engaged under such employer, was actually contracted while so engaged, and the nature of the employment was the major contributing cause of the disease. Major contributing cause must be shown by medical evidence only, as demonstrated by physical examination findings and diagnostic testing. “Nature of the employment” means that in the occupation in which the employee was so engaged there is attached a particular hazard of such disease that distinguishes it from the usual run of occupations, or the incidence of such disease is substantially higher in the occupation in which the employee was so engaged than in the usual run of occupations. In claims for death under s. 440.16, death must occur within 350 weeks after last exposure. Both causation and sufficient exposure to a specific harmful substance shown to be present in the workplace to support causation shall be proven by clear and convincing evidence.

Section 440.151(1)(a), Florida Statutes.

It is important to note that COVID 19 or any other communicable disease (TB, H1N1, etc.):  The employee has to test positive for the disease/contagion and it must be determined with a reasonable amount of certainty that their exposure to the virus occurred in the workplace and was not community-acquired.

In addition,  per Section 440.151(1)(c), Florida Statutes states:

Where an occupational disease is aggravated by any other disease or infirmity, not itself compensable, or where disability or death from any other cause, not itself compensable, is aggravated, prolonged, accelerated or in anywise contributed to by an occupational disease, the compensation shall be payable only if the occupational disease is the major contributing cause of the injury. Any compensation shall be reduced and limited to such proportion only of the compensation that would be payable if the occupational disease were the sole cause of the disability or death as such occupational disease, as a causative factor, bears to all the causes of such disability or death, such reduction in compensation to be effected by reducing the number of weekly or monthly payments or the amounts of such payments, as under the circumstances of the particular case may be for the best interest of the claimant or claimants. Major contributing cause must be demonstrated by medical evidence based on physical examination findings and diagnostic testing.

Section 440.151(1)(c), Florida Statutes, (emphasis added).

With regard to emergency medical technicians (EMTs) or paramedics Section 440.09(3), Florida Statutes, states:

If an emergency medical technician or paramedic is appointed or employed full time by a municipality, the state, or any political subdivision, is certified under chapter 401.23, in an emergency situation in this state, any such activities would be considered to be within the course of his or her employment and an emergency medical technician or paramedic and covered by the employer’s jurisdiction or area of responsibility, such activities are considered to be within the course of employment. The provisions of this subsection do not apply if the emergency medical technician or paramedic is performing activities for which he or she is paid by another employer of contractor.

Section 440.09(3), Florida Statutes (emphasis added).

Workers Compensation Benefits for Healthcare Professionals.

As of March 26, 2020, Florida has not issued any order or legislation explicitly stating that healthcare professionals exposed to COVID-19 will be entitled to Workers Compensation benefits.

By way of example, In the City of Phila. v. Workers’ Comp. Appeal Bd. (Sites), 889 A.2d 129 (Pa. Commw. Ct. 2005), a claimant was successful in proving that his hepatitis C was caused by his exposure to blood that occurred while working as a firefighter and emergency medical technician  (EMT).  Similar to COVID-19, hepatitis C was also classified as a compensable “occupational disease.”  Therefore, it is likely that a healthcare professional’s exposure to COVID-19 would result in viable workers’ compensation claim.

Federal workers’ compensation laws are similar to those quoted above. Therefore, federal health care providers and those working in federal facilities will also most probably be entitled to federal employment compensation (FECA) benefits under similar situations.

We want to emphasize that this is merely our preliminary opinion based on limited analysis and research.  It is provided for informational purposes only. It does not constitute the provision of legal advice.  Each state has different workers’ compensation laws and different case law, as does the federal government. Each individual set of circumstances may be different. Contact your local workers’ compensation plaintiff’s (claimant’s) attorney for advice and representation in your individual case.

For more information and more examples of employment compensation benefit cases for health care professionals, click here.

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

At the Health Law Firm, we provide legal services for all health care providers and professionals.  This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical student professors and clinical staff. We represent facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, in patient complaints, and in Department of Health investigations.

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

About the Authors:  Amanda I. Forbes, practices health law with The Health Law Firm in its Altamonte Springs, Florida, office.  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. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
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By |2024-03-14T10:00:00-04:00May 7, 2020|Categories: Medical Education Law Blog|Tags: , , , , , , |Comments Off on Question: Is Exposure to COVID-19 For Nurses and Other Healthcare Workers, Causing Illness, Disability, or Death, Considered an Employment-Related Injury Under Workers’ Comp Coverage?
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