physician lawyer

Home/Tag: physician lawyer

Always Provide Complete Records in Response to Government Subpoenas

Headshot of The Health Law Firm's attorney George F. Indest IIIBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
At a recent Florida Board of Dentistry meeting, a dentist was charged with violations of her practice act and standard of care violations. This happened because her prior practice had provided incomplete patient records to an investigator when it received a subpoena. The records that had been provided were missing written notes and other documentation, along with copies of the prescriptions the dentist had written. This is just one example of what can happen if patient records are not provided in an orderly and complete manner to investigators.

Important Points for Board Hearings.

The dentist attended the Board meeting, having requested an informal administrative hearing. To obtain this type of hearing means that the dentist agrees that there are no disputed issues of fact; this equates to a “guilty” plea. The dentist is waiving her right to have a formal hearing, present a defense and contest the allegations made against her. When questioned by the Board, it was clear that the dentist did not understand this. She also stated that she had an attorney, but the attorney was not present to represent her or to advise her during the Board hearing.

Even though this was a dental case, the same principles of administrative law apply in the case of a physician, nurse, mental health counselor, pharmacist or any other licensed health care professional.

Most importantly, the dentist testified that her prior practice had failed to provide a complete copy of the patient’s health record to the Department of Health (DOH) investigator. The prosecuting attorney showed the Board where the records had been subpoenaed from the prior practice twice, and they had been provided to the DOH twice, along with affidavits from the practice that these were complete copies of the entire record. (These affidavits were false.)

Fortunately for the dentist, the Board members reviewed the records that had been provided and could see for themselves that key portions were missing. Also, fortunately, the Board decided to table the case and send it back for more investigation.

If the Board had decided to go forward, the dentist would likely have received discipline on her license forever.

Important Lessons for Mental Health Care Professionals, Dentists, Physicians, and Other Licensed Health Care Professionals.

Valuable lessons that all licensed health professionals can learn from this case include:

1. Hire an experienced health law attorney as soon as you know you are under investigation. Many times your malpractice (professional) liability insurance will pay your legal defense expenses in these cases.

2. Your experienced attorney will obtain a copy of the complete investigation file (including all documents it contains) shortly after it is completed and long before any hearings. If your attorney doesn’t, then you should do so. You can review it and supplement any incomplete records, documents or information.

3. Do not hire an attorney who is unable to attend the hearing with you. Continuances can be routinely requested and granted if the attorney has a conflicting hearing somewhere else, is ill or is otherwise unable to attend. Don’t attend the hearing without your attorney, if you have one.

4. Know the difference between an informal hearing and a formal hearing. If you request an informal hearing, you are admitting the charges against you are true and you are guilty. (There are only one of two very limited exceptions to this rule) You are only there to argue about how much discipline you should receive.

5. If you are investigated, personally make sure a complete copy of the patient’s record is sent to the DOH investigator. This includes everything: demographics, insurance info, financial responsibility forms, treatment plans, orders, prescriptions, lab reports, periodontal charts, informed consent forms, patient instructions, office visits, telephone notes, operative reports, sedation charts on notes, history and physical, medical clearances from outside physicians, and dental or medical records from other providers. Even if you are no longer employed at that practice, you have the right to request and receive a copy of all of the records you generated when you treated the patient under Section 456.057, Florida Statutes. At least obtain these.

For more information on this topic and to find out more about how The Health Law Firm can assist you in matters like this, 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 dentists, dental technicians, 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 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.

KeyWords: administrative procedure act defense, representation for administrative hearing, Board of Dentistry defense lawyer, representation for Board of Dentistry investigation, representation for Board of Dentistry hearing, Board hearing defense attorney, Board of Medicine defense lawyer, dental hygienist defense lawyer, dentist defense lawyer, representation for dentists Department of Health (DOH) representation, DOH defense attorney, representation for DOH hearings, representation for DOH investigations, representation for disciplinary charges, representation for disciplinary complaint, representation for Florida Administrative Codes, physician lawyer, representation for doctor, representation for healthcare professionals, representation for deposition coverage, last-minute deposition coverage, short notice representation of physician, short notice of representation of doctors, hearing representation for healthcare professional, Board of Medicine defense, Board of Medicine hearing defense lawyer, representation for administrative procedure act, representation for Rules of Civil Procedure, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“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. Altamonte Springs, Florida.

Healthcare Professionals Should Ensure Records Provided in Response to Government Subpoenas are Complete

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
At a recent Florida Board of Dentistry meeting, a dentist was charged with violations of her practice act and standard of care violations. This happened because her prior practice had provided incomplete patient records to an investigator when it received a subpoena. The records that had been provided were missing written notes and other documentation, along with copies of the prescriptions the dentist had written. This is just one example of what can happen if patient records are not provided in an orderly and complete manner to investigators.

Important Points for Board Hearings.

The dentist attended the Board meeting, having requested an informal administrative hearing. To obtain this type of hearing means that the dentist agrees that there are no disputed issues of fact; this equates to a “guilty” plea. The dentist is waiving her right to have a formal hearing, present a defense and contest the allegations made against her. When questioned by the Board, it was clear that the dentist did not understand this. She also stated that she had an attorney, but the attorney was not present to represent her or to advise her during the Board hearing.

Even though this was a dental case, the same principles of administrative law apply in the case of a physician, nurse, mental health counselor, pharmacist or any other licensed health care professional.

Most importantly, the dentist testified that her prior practice had failed to provide a complete copy of the patient’s health record to the Department of Health (DOH) investigator. The prosecuting attorney showed the Board where the records had been subpoenaed from the prior practice twice, and they had been provided to the DOH twice, along with affidavits from the practice that these were complete copies of the entire record. (These affidavits were false.)

Fortunately for the dentist, the Board members reviewed the records that had been provided and could see for themselves that key portions were missing. Also, fortunately, the Board decided to table the case and send it back for more investigation.

If the Board had decided to go forward, the dentist would likely have received discipline on her license forever.

Important Lessons for Dentists, Physicians, and Other Licensed Health Professionals.

Valuable lessons that all licensed health professionals can learn from this case include:

1. Hire an experienced health law attorney as soon as you know you are under investigation. Many times your malpractice (professional) liability insurance will pay your legal defense expenses in these cases.

2. Your experienced attorney will obtain a copy of the complete investigation file (including all documents it contains) shortly after it is completed and long before any hearings. If your attorney doesn’t, then you should do so. You can review it and supplement any incomplete records, documents or information.

3. Do not hire an attorney who is unable to attend the hearing with you. Continuances can be routinely requested and granted if the attorney has a conflicting hearing somewhere else, is ill or is otherwise unable to attend. Don’t attend the hearing without your attorney, if you have one.

4. Know the difference between an informal hearing and a formal hearing. If you request an informal hearing, you are admitting the charges against you are true and you are guilty. (There are only one of two very limited exceptions to this rule) You are only there to argue about how much discipline you should receive.

5. If you are investigated, personally make sure a complete copy of the patient’s record is sent to the DOH investigator. This includes everything: demographics, insurance info, financial responsibility forms, treatment plans, orders, prescriptions, lab reports, periodontal charts, informed consent forms, patient instructions, office visits, telephone notes, operative reports, sedation charts on notes, history and physical, medical clearances from outside physicians, and dental or medical records from other providers. Even if you are no longer employed at that practice, you have the right to request and receive a copy of all of the records you generated when you treated the patient under Section 456.057, Florida Statutes. At least obtain these.

For more information on this topic and to find out more about how The Health Law Firm can assist you in matters like this, 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 dentists, dental technicians, 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 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: administrative procedure act defense, representation for administrative hearing, Board of Dentistry defense lawyer, representation for Board of Dentistry investigation, representation for Board of Dentistry hearing, Board hearing defense attorney, Board of Medicine defense lawyer, dental hygienist defense lawyer, dentist defense lawyer, representation for dentists Department of Health (DOH) representation, DOH defense attorney, representation for DOH hearings, representation for DOH investigations, representation for disciplinary charges, representation for disciplinary complaint, representation for Florida Administrative Codes, physician lawyer, representation for doctor, representation for healthcare professionals, representation for deposition coverage, last-minute deposition coverage, short notice representation of physician, short notice of representation of doctors, hearing representation for healthcare professional, Board of Medicine defense, Board of Medicine hearing defense lawyer, representation for administrative procedure act, representation for Rules of Civil Procedure, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“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. Altamonte Springs, Florida.

 

Top Medicare Prescribers Collect Speaking Fees from Drug Makers-Coincidence?

LOL Blog Label 2By Lance O. Leider, 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

A recent investigation by ProPublica found that certain doctors who prescribed certain drug brands the most, also have financial ties to the companies that manufacture those prescription drugs. Using Medicare payment data, ProPublica and National Public Radio (NPR) researched physicians who prescribed the most heavily promoted drugs of 2010 and 2011. It was discovered that many of the doctors allegedly had financial relationships with prescription drug manufacturers. ProPublica states that they initiated this investigation out of fear that pharmaceutical payments are influencing doctors to prescribe an expensive, brand name drug over a cheaper, generic version.

To read the ProPublica analysis released June 25, 2013, click here.

According to ProPublica, the company is an independent, nonprofit newsroom that produces investigative journalism in the public interest.

By The Numbers.

The ProPublica analysis looked at a number of drug companies. Until now, doctors’ prescribing practices have not been made public. Disclosure of these records is now mandated in the Affordable Care Act.

According to NPR, at least 17 of the 20 doctors who prescribed the blood pressure medicine Bystolic the most often collected money from the maker, Forest Laboratories. Forest paid those doctors speaking fees for promoting Bystolic at seminars to other doctors. These fees allegedly ranged from $1,250 to $85,750. Additionally, seven of the speakers allegedly received at least $1,000 for meals. Nine of the top 10 prescribers of Exelon, an Alzheimer’s drug, collected speakers’ fees from Novartis. Eight of the top 10 Nucynta prescribers were paid by the painkiller’s manufacturer, Johnson & Johnson, for similar services, according to NPR.

Click here to read the entire NPR article.

Drug Makers Shell Out Millions in Fines for Using Illegal Kickbacks.

Federal whistleblower lawsuits against several pharmaceutical companies have alleged that these speaking payments are little more than “thinly veiled kickbacks,” which are illegal. According to NPR, three years ago Forest paid $313 million to the federal government to settle allegations about its marketing of drugs. The lawsuit alleged the company made cash payments disguised as consulting fees to doctors.

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

Individual providers are also liable for accepting prohibited remunerations from drug companies. The use of these databases for mining prescribing/promoting practices is likely to lead to increased scrutiny on physicians.

What the Law Says About Using Kickbacks.

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

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

Relationship Between Physicians and Pharmaceutical Companies Allegedly Does Not Influence Prescribing Practices.

In a survey, doctors said they are not influenced by relationships with pharmaceutical companies, according to a FiercePharma article. The doctors with a relationship to Forest state a number of reasons for prescribing Bystolic versus other blood pressure dugs. None of the reasons for prescribing Bystolic related to the money they received from Forest.

In the same FiercePharma article, drug makers said they do not choose speakers based on a doctor’s prescribing habits. Click here to read the FiercePharma article.

So is this all a coincidence?

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, pain management doctors, dentists, 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.

Comments?

Is it a coincidence that top prescribers also collect from drug makers? As a health care professional, would you be influenced to prescribe one drug if you were getting paid by the drug maker? Please leave any thoughtful comments below.

Sources:

Staton, Tracy. “Top-Prescribing Docs Collect Cash From Drugmakers.” FiercePharma. (June 25, 2013). From: http://www.fiercepharma.com/story/top-prescribing-docs-collect-cash-drugmakers/2013-06-25

Ornstein, Charles, Weber, Tracy and Lafleur, Jennifer. “Top Medicare Prescibers Rake In Speaking Fees From Drugmakers.” National Public Rado. (June 25, 2013). From: http://www.npr.org/blogs/health/2013/06/25/195232541/top-medicare-prescribers-rake-in-speaking-fees-from-drugmakers

Ornstein, Charles, Weber, Tracy and Lafleur, Jennifer. “Top Medicare Prescibers Rake In Speaking Fees From Drugmakers.” ProPublica. (June 25, 2013). From: http://www.propublica.org/article/top-medicare-prescribers-rake-in-speaking-fees-from-drugmakers

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.

Cardiologists Face Higher Scrutiny by CMS

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

As the U.S. population ages and heart disease continues to be a leading cause of health issues, cardiologists and cardiology practices are finding themselves billing Medicare for more and more visits and procedures.

Along with that increase in reimbursement from Medicare comes an increase in scrutiny.  According to the Centers for Medicare and Medicaid Services (CMS), more than sixteen percent (16%) of total Medicare spending in 2010, was for cardiovascular care.

Some experts predict that this number will increase as cardiologists continue to adopt state-of-the-art technology and procedural techniques when treating their patients.

All of this means that whistleblowers, Recovery Audit Contractor (RAC) auditors, Zone Program Integrity Contractor (ZPIC) auditors, and CMS’s data mining services are going to be more incentivized to come after cardiovascular reimbursements.

To read more on the high scrutiny cardiologists face, click here to read an article on Modern Healthcare.

The Audits Are Coming.

Cardiology physicians and practices need to understand that just because they are doing things the “right way” does not mean that they will not be the subject of an audit. Auditing can be triggered by any number of things ranging from disgruntled employees, competing practices, dissatisfied patients, random audits, above average billing for certain codes, etc. None of these triggers means that a practice is doing anything wrong, but it will have to face an audit nonetheless.

Being prepared before an audit happens can be the most effective defense.  Review some of these prior articles and blogs we have written for tips in establishing audit protocols and handling audits in general:

–  Self Audit Now to Save Your Practice Later
–  Responding to a Medicare Audit – Practice Tips
–  Checklist on What to Do When Notified of a ZPIC or Medicare Audit and Site Visit – Part 1
–  Checklist on What to Do When Notified of a ZPIC or Medicare Audit and Site Visit – Part 2

The Best Defense for an Audit is to be Prepared Before an Audit Happens.

So long as CMS employs a “pay and chase” method of reimbursement, audits will be a permanent part of the healthcare landscape.  Every medical practice should consult with an attorney experienced in handling Medicare, Medicaid and other third party audits in order to develop effective policies and procedures.  By preparing for an audit prior to its occurrence a practice is in the best position to avoid any kind of sanction or overpayment demand.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

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

Comments?

Do you think cardiologist and cardiology practices are under a higher amount of scrutiny? Please leave any thoughtful comments below.

Sources:

Carlson, Joe. “Cardiologists Enmeshed in High-Scrutiny Climate.” Modern Healthcare. (July 8, 2013). From: http://www.modernhealthcare.com/article/20130708/BLOG/307089995/cardiologists-enmeshed-in-high-scrutiny-climate

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.

Doctors’ Medicare Payment Data to be Released Spring 2014

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

For years, the Centers for Medicare and Medicaid Services (CMS) has kept private its records on Medicare claims payments made to individual physicians. However, beginning March 18, 2014, the government may disclose the payment data on a case-by-case basis. According to CMS, this directive is a push by the Obama Administration to crack down on doctors who are making a habit out of repeatedly overcharging Medicare. On January 15, 2014, CMS stated that recalcitrant providers could face civil fines and exclusion from Medicare and other federal health care programs. According to CMS, a recalcitrant provider is defined as one who is abusing the program and not changing inappropriate behavior even after extensive education to address these behaviors.

Data Made Public to Fight Healthcare Fraud.

According to The New York Times, federal officials estimate that 10 percent (10%) of payments in the fee-for-service Medical program are improper. Supporters of releasing the data say it could help identify patterns of waste and fraud. The Medicare payment data, combined with data from other sources, could be enormously useful to consumers, researchers and whistleblowers analyzing patterns of health spending.

Physician groups express caution in Medicare releasing individual payment information, saying it could lead to public misunderstanding and unintended consequences, according to The New York Times.

Click here to read the entire article from The New York Times.

Data Prohibited From Being Release for Past Thirty Years.

In 1979, a federal district judge in Jacksonville, Florida, issued an injunction that prohibited Medicare officials from releasing what Medicare pays individual doctors. The ruling, in a lawsuit filed by doctors, said such disclosure would violate the Privacy Act and constitute a clearly unwarranted invasion of personal privacy. In May 2013, the judge lifted the injunction.

According to a MedPage Today article, the decision does not require the wholesale release of Medicare payment data but allows Medicare officials and courts to consider the merits of each request.

To read the entire article from MedPage Today, click here.

Healthcare Providers Should Prepare for Possible Public Scrutiny.

Although it remains to be seen how CMS will implement its new policy, health care providers should be prepared for the possibility that their coding, billing and reimbursement patterns will become the subject of public scrutiny, particularly those providers in specialized areas including internal medicine, radiation oncology and ophthalmology.

Contact Health Law Attorneys Experienced with Healthcare Fraud Cases.

Attorneys with The Health Law Firm 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. We also handle Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.

Our attorneys 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 about the decision to release payment data for physicians? How will this effect health care providers? Please leave any thoughtful comments below.

Sources:

Pear, Robert. “Doctors Abusing Medicare Face Fines and Expulsion.” The New York Times. (January 25, 2014). From: http://nyti.ms/1cpIaOg

Pittman, David. “Medicare to Release Doc Pay Data This Spring.” MedPage Today. (January 14, 2014). From: http://bit.ly/1ndaCHu

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.

Appeals Court Affirms $1.37 Million in Sanctions Against Doctor for Dismissed Defamation Suit Against Former Employers

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

On November 16, 2016, an appeals court in Texas affirmed a $1.37 million sanction assessed against a doctor. The doctor was ordered to pay the sanction after the dismissal of a defamation lawsuit he filed against his former employers. The doctor’s former employers were Baylor College of Medicine (Baylor) and Texas Children’s Hospital.

The case had previously been appealed to the Texas Supreme Court. This makes the November 16, 2016, opinion the second time the Texas Fourteenth Court of Appeals has had to rule on the case. Additionally, it is the second time that it has held that the sanctions against Dr. Rahul K. Nath were justified.

The Back Story of the Case.

According to the opinion, Dr. Nath was employed by Baylor as a plastic surgeon and was affiliated with Texas Children’s Hospital. He was allegedly terminated in 2004. In February 2006 he filed a lawsuit against his former supervisor at Baylor and Texas Children’s. According to court documents, Dr. Nath had accused his former supervisor of making defamatory statements about him after he stopped working there. The alleged defamatory statements included that Dr. Nath had been fired, was unqualified and lacked professional ethics and integrity.

To read the court opinion, click here.

Was the Former Employer Responsible for Accumulated Fees?

The Texas high court was considering whether the behavior of Baylor or Texas Children’s was ultimately responsible for the attorney’s fees that had been accrued in the case. Previously, the trial court found that both Texas Children’s and Baylor’s actions had not caused the litigation expenses which Dr. Nath was assessed. The trial court wrote that the amount was appropriate as it was “far less” than the actual fees incurred by either party in defending Dr. Nath’s claims.

On appeal, Dr. Nath argued that the trial court hadn’t held a proper evidentiary inquiry and that it had based its sanctions award on “conclusory and self-serving” affidavits. Dr. Nath claimed that he was wrongly denied discovery in the case. To learn more about Dr. Nath’s legal challenge, click here.

Despite Dr. Nath’s arguments, the court of appeals disagreed, holding that the trial court followed the Supreme Court’s instructions in deciding to impose the sanctions. Additionally, the court found that there was evidence in the record to support the conclusion that neither Texas Children’s nor Baylor’s conduct caused the legal expenses that were passed on to Dr. Nath as sanctions.

Adequate Supporting Evidence.

The first time the case came before the Fourteenth Court of Appeals, it affirmed the sanctions against Dr. Nath. The high court held that there was evidence to support the trial court’s finding of bad faith and improper purpose on Dr. Nath’s part with regard to certain filings in the case. Dr. Nath appealed, and the Texas Supreme Court held that the trial court didn’t abuse its discretion in finding the doctor had exercised bad faith and improper purpose in certain filings.

To learn more about defamatory statements and how to handle such claims, click here to read one of my prior blogs.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, pharmacists, dentists, nurses, medical groups, health facilities, nurses and other health providers in complex litigation, investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Sources:

Knaub, Kelly. “Texas Appeals Court Affirms Doc’s $1.3M Sanction.” Law360. (November 16, 2016). Web.

Knaub, Kelly. “Doc To Challenge $1.3M Sanction Before Texas High Court.” Law360. (January 15, 2014). Web.

“Texas Appeals Court Affirms Doc’s $1.3M Sanction.” LexisNexis. (November 16, 2016). Web.

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

KeyWords: Legal representation for physicians, complex health care litigation attorney, business litigation lawyer, health care professionals legal representation, physician lawyer, health law defense attorney, legal representation for defamatory statements against health care professionals, legal representation for defamation lawsuit against a healthcare professional, healthcare litigation defense attorney, legal counsel for health care professionals, legal representation for clients involved in the health care industry, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm, legal fees expert witness, attorney’s fees and sanctions expert witness, health care litigation expert witness, health law expert witness
“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 © 2016 The Health Law Firm. All rights reserved.

CVS Blacklists Second Set of Doctors Accused of Overprescribing Painkillers

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

CVS is again stepping up its own internal efforts to combat the nation’s prescription drug abuse epidemic. According to Reuters, the second largest retail pharmacy chain announced it is cutting off access to the most powerful painkillers for more than 36 doctors and health care providers around the country. The Drug Enforcement Administration (DEA) has been keeping a close eye on CVS over the past few years. According to Reuters, CVS began revoking the dispensing privileges of certain providers back in 2011. CVS disclosed this round of suspensions on August 21, 2013.

To read the article from Reuters, click here.

CVS Closely Analyzed Prescription Practices of Health Care Providers Before Suspending Dispensing Privileges.

CVS said the suspension followed an analysis of prescriptions brought to its drugstores from March 2010 through January 2012, for painkillers such as oxycondone, hydrocodone, and methadone, according to Reuters. CVS said it first identified several dozen health care providers, from its database of nearly one million, with “extreme” patters of prescribing high-risk drugs. CVS allegedly compared their prescription rates to other providers in the same specialty and geographic region, the ages of the patients, and the number of patients paying with cash for the drugs.

After analyzing the results, CVS said the company’s stores and mail-order pharmacy will no longer dispense controlled substances for 36 providers who it said could not justify their prescribing habits, according to the Orlando Sentinel. CVS did not disclose the names or location of the physicians blacklisted this time around.

Click here to read the Orlando Sentinel article.

Second Time CVS Has Blacked Listed Specific Doctors.

In November 2011, at least 22 Central Florida doctors received an unsigned letter from CVS telling them that the company’s pharmacists would no longer fill prescriptions they write for painkillers and other powerful drugs. The letter was called a “blacklist” and was criticized as discriminatory. One Orlando doctor tried to fight back with legal action, claiming that CVS basically called him a criminal. To read more on the previous blacklist, click here to read my blog.

So far, we have not heard of any legal action pending against CVS from providers recently added to the blacklist.

DEA Previously Pulled Controlled Substance Licenses from Two Sanford, Florida, CVS Pharmacies.

As previously stated, the DEA has had its eyes on CVS for a while. You may remember that in September 2012, the DEA revoked the registrations (controlled substance licenses) from two CVS pharmacies in Sanford, Florida. I previously wrote about this, click here to read that blog.

Who is Responsible for the Prescription Drug Epidemic?

The act of prescribing powerful, and sometimes deadly, addictive drugs inappropriately for a health care provider’s personal gain has grown. It’s argued that pharmacies have a role to play in the oversight of controlled substance prescriptions. Pharmacists, as well as physicians and all health care providers, have an ethical (and legal duty) to ensure that a prescription for a controlled substance is appropriate.

Contact Health Law Attorneys Experienced with DEA Cases.

The Health Law Firm represents physicians, pharmacists, pharmacies, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH), and other law enforcement agencies.
If you are aware of an investigation of you or your practice, or if you have been contacted by the DEA or DOH, contact an experienced health law attorney immediately.

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 CVS’ ban on filling controlled substance prescriptions from certain doctors? Do you think this will help with the national prescription drug abuse epidemic? Please leave any thoughtful comments below.

Sources:

Pavuk, Amy. “CVS Cracks Down on Doctors with ‘Extreme Patters’ of Prescribing High-Risk Drugs.” Orlando Sentinel. (August 29, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-cvs-crackdown-doctors-20130829,0,5193527.story?dssReturn

Wohl, Jessica. “CVS Cuts Access to Opiod Pain-Killers for Suspect Doctors.” Reuters. (August 21, 2013). From: http://www.reuters.com/article/2013/08/21/us-cvscaremark-painkillers-idUSBRE97K17120130821

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.

Central Florida Doctor’s Home and Offices Raided Over Alleged Improper Prescribing Practices

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In a joint operation, law enforcement officials raided the home and two offices of a Central Florida physician on November 8, 2013, according to the Osceola County Sheriff’s Office. The Osceola County Sheriff’s Office alleges that the doctor is being investigated for improper prescribing practices. According to the press release, this is not the first time the physician has been under investigation.

The raid was a collective effort between the Osceola County Investigative Bureau (OCIB), Florida Department of Health (DOH), Drug Enforcement Administration (DEA), Florida Department of Law Enforcement (FDLE), and the Metropolitan Bureau of Investigation (MBI).

Physician Not Arrested After Raid.

On November 8, 2013, law enforcement agents searched the physician’s home and his offices in Kissimmee, Florida and Orlando, Florida. The Florida DOH also issued an emergency order restricting the doctor’s privilege to prescribe narcotics. The physician was not arrested.

The physician was allegedly the target of two separate Florida DOH complaints in June 2013. Both complaints alleged the physician wrote prescriptions for painkillers to patients who did not have a medical need for the drugs. Click here to read the two previous complaints.

Doctor Previously Blacklisted by CVS.

According to an Orlando Sentinel article, this physician was previously placed on a CVS document referred to as the “blacklist.” This list identifies Central Florida’s top physicians prescribing oxycodone. When the list was released, the pharmacy chain notified the physicians that CVS pharmacists would no longer fill their patients’ prescriptions. This blacklist was an effort by CVS to step up internal efforts to combat the nation’s prescription drug abuse epidemic. So far, CVS has released two blacklists, one was released in November 2011, and the second list was released in August 2013. You can read more about the two lists on our blog. Click here for part one, and click here for part two.

To read the Orlando Sentinel article, click here.

Florida Losing War on Prescription Drug Abuse.

Despite the aggressive “war on prescription drugs” the Sunshine State reportedly ranks eleventh highest nationally in drug overdose deaths.

I have represented a number of physicians who have been accused of “overprescribing.” Some of these were criminal investigations by local law enforcement authorities, such as a county sheriff’s office. Some were investigations by the DEA. Some were investigations by the state licensing agency such as the Florida DOH. To read a previous blog, “Legal Tips for Physicians to Manage Pain Patients,” click 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 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.

Comments?

Do you think Florida’s war on prescription drug abuse is working? Please leave any thoughtful comments below.

Sources:

Lizasuain, Twis. “Dr. Ibem Borges Investigated for Over Prescribing Drugs.” Osceola County Sheriff’s Public and Medica Relations. (November 8, 2013).

Pavuk, Amy. “Agents Raid Home, Offices of Central Florida Physician Suspected of Improper Prescribing Practices.” Orlando Sentinel. (November 8, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-doctor-ibem-borges-raid-20131108,0,735835.story

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.

Appeals Court Affirms $1.37 Million in Sanctions Against Doctor for Dismissed Defamation Suit Against Former Employers

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

On November 16, 2016, an appeals court in Texas affirmed a $1.37 million sanction assessed against a doctor. The doctor was ordered to pay the sanction after the dismissal of a defamation lawsuit he filed against his former employers. The doctor’s former employers were Baylor College of Medicine (Baylor) and Texas Children’s Hospital.

The case had previously been appealed to the Texas Supreme Court. This makes the November 16, 2016, opinion the second time the Texas Fourteenth Court of Appeals has had to rule on the case. Additionally, it is the second time that it has held that the sanctions against Dr. Rahul K. Nath were justified.

The Back Story of the Case.

According to the opinion, Dr. Nath was employed by Baylor as a plastic surgeon and was affiliated with Texas Children’s Hospital. He was allegedly terminated in 2004. In February 2006 he filed a lawsuit against his former supervisor at Baylor and Texas Children’s. According to court documents, Dr. Nath had accused his former supervisor of making defamatory statements about him after he stopped working there. The alleged defamatory statements included that Dr. Nath had been fired, was unqualified and lacked professional ethics and integrity.

To read the court opinion, click here.

Was the Former Employer Responsible for Accumulated Fees?

The Texas high court was considering whether the behavior of Baylor or Texas Children’s was ultimately responsible for the attorney’s fees that had been accrued in the case. Previously, the trial court found that both Texas Children’s and Baylor’s actions had not caused the litigation expenses which Dr. Nath was assessed. The trial court wrote that the amount was appropriate as it was “far less” than the actual fees incurred by either party in defending Dr. Nath’s claims.

On appeal, Dr. Nath argued that the trial court hadn’t held a proper evidentiary inquiry and that it had based its sanctions award on “conclusory and self-serving” affidavits. Dr. Nath claimed that he was wrongly denied discovery in the case. To learn more about Dr. Nath’s legal challenge, click here.

Despite Dr. Nath’s arguments, the court of appeals disagreed, holding that the trial court followed the Supreme Court’s instructions in deciding to impose the sanctions. Additionally, the court found that there was evidence in the record to support the conclusion that neither Texas Children’s nor Baylor’s conduct caused the legal expenses that were passed on to Dr. Nath as sanctions.

Adequate Supporting Evidence.

The first time the case came before the Fourteenth Court of Appeals, it affirmed the sanctions against Dr. Nath. The high court held that there was evidence to support the trial court’s finding of bad faith and improper purpose on Dr. Nath’s part with regard to certain filings in the case. Dr. Nath appealed, and the Texas Supreme Court held that the trial court didn’t abuse its discretion in finding the doctor had exercised bad faith and improper purpose in certain filings.

To learn more about defamatory statements and how to handle such claims, click here to read one of my prior blogs.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, pharmacists, dentists, nurses, medical groups, health facilities, nurses and other health providers in complex litigation, investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Sources:

Knaub, Kelly. “Texas Appeals Court Affirms Doc’s $1.3M Sanction.” Law360. (November 16, 2016). Web.

Knaub, Kelly. “Doc To Challenge $1.3M Sanction Before Texas High Court.” Law360. (January 15, 2014). Web.

“Texas Appeals Court Affirms Doc’s $1.3M Sanction.” LexisNexis. (November 16, 2016). Web.

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

KeyWords: Legal representation for physicians, complex health care litigation attorney, business litigation lawyer, health care professionals legal representation, physician lawyer, health law defense attorney, legal representation for defamatory statements against health care professionals, legal representation for defamation lawsuit against a healthcare professional, healthcare litigation defense attorney, legal counsel for health care professionals, legal representation for clients involved in the health care industry, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm, legal fees expert witness, attorney’s fees and sanctions expert witness, health care litigation expert witness, health law expert witness
“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 © 2016 The Health Law Firm. All rights reserved.

Workers Can Be Fired For Using Marijuana Off-Duty

By Carole C. Schriefer, R.N., J.D., The Health Law Firm

Marijuana may be legal in Colorado, but you can still be fired for using it. Employers’ zero- tolerance drug policies trump Colorado’s medical marijuana laws, the Colorado Supreme Court ruled on Monday. In a 6-0 decision, the Supreme Court ruled that businesses can terminate an employee for the use of medical marijuana – even if it’s off-duty.

Coats v. Dish Network.

Brandon Coats became a quadriplegic after a car accident and has relied on medical marijuana to help with muscle spasms. Dish Network fired Coats after a failed drug test in 2010.  “As a national employer, Dish remains committed to a drug-free workplace and compliance with federal law,” company spokesman John Hall said in a statement.  To read about the Coats v. Dish Network case in its entirety, click here.

What is Lawful Activity?

This case was brought based on Colorado Revised Statute 24-34-402.5, Colorado’s “lawful activities statute.” The Supreme Court held the term “lawful” in the statute refers only to those activities that are lawful under both state and federal law. Therefore, employees who engage in an activity such as medical marijuana use that is permitted by state law but unlawful under federal law, are not protected by this statute.  Like Texas, Colorado law allows employers to set their own policies on drug use.  Unlike Texas, Colorado has a law that says employees can’t be fired for “lawful” off-duty activities.
To read C.R.S. § 24-34-402.5. – Unlawful prohibition of legal activities as a condition of employment, click here.

Legal Off-Duty Activity.

Coats claims that Dish Network violated C.R.S. § 24-34-402.5, by terminating him due to his state licensed use of medical marijuana at home during non-working hours. The Colorado justices ruled that because marijuana is illegal under federal law, Coat’s use of the drug couldn’t be considered legal off-duty activity.  State laws only govern the citizens within a particular state, but federal laws apply to all U.S. citizens. Therefore, federal laws trump state laws.

To read past blogs on this topic or any health law topic, visit our blog pages on our website : www.TheHealthLawFirm.com.

Visit our Colorado Health Law blog.

Comments?

Do you think medical marijuana is considered a “lawful” activity? Do you agree with Dish Network’s decision? Do you think Coats v. Dish Network was a fair case, why or why not? Please leave any thoughtful comments below.

Contact Experienced Health Law Attorneys for Medical Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting and/or licensing, while complying with Florida law. We can also represent doctors, pharmacies and pharmacists facing proceedings brought by state regulators or agencies.

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

Sources:

Linsley, Brennon. “Colorado court: Workers can be fired for using pot off-duty.” The News Herald. (June 15, 2015) From:

http://www.morganton.com/colorado-court-workers-can-be-fired-for-using-pot-off/article_f4f67447-5d36-5e6e-9a67-8548d5fc77a4.html

“24-34-402.5. Unlawful Prohibition of Legal Activities as a Condition of Employment.” Department of Regulatory Agencies. (June 15, 2015) From:

http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content-Type&blobheadervalue1=inline%3B+filename%3D%22Colorado+Anti-Discrimination+Act+statutes+-+unofficial.pdf%22&blobheadervalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251818317123&ssbinary=true

Coats v. Dish Network, LLC., CO 44. No. 13SC394. U.S. (2015)

About the Author: Carole C. Schriefer 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 also has offices in Fort Collins, Colorado and Pensacola, Florida.

KeyWords:  Employment Law, medical marijuana, medical cannabis, marijuana license, defense attorney, drug-free work place, Drug-Free Work Place Act, employee rights, employer rights, employment law, employment termination, Colorado marijuana laws, health care lawyer, health lawyer, law attorney, legalizing marijuana, licensed medical marijuana user, marijuana, medical marijuana license, medical marijuana policy, physician attorney, physician lawyer, workplace marijuana regulations, lawful activity, lawful off-duty activity, federal law, state law, Supreme Court, zero tolerance, zero tolerance drug policy, THC, compliance, Recreational drug laws and regulations, Government regulations, Courts, Colorado, health care, health issues, health law, health law attorney, health law lawyer

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Go to Top