Prosecutors Push to Keep Florida TeleMedicine Suspect in Jail for $424 Million Fraud Scheme

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
On March 19, 2020, federal prosecutors in New Jersey federal court pushed to keep a suspect involved in a $424 million telemedicine scheme in jail.  Authorities called him an “unrepentant conman” who carried out one of the largest health care fraud schemes in U.S. history and is likely to flee the country if released.

Telehealth Fraud & Illegal Kickbacks.

The defendant, who owns telehealth companies, has been locked up for nearly 11 months since he was charged last year with running an international fraud and kickback scam. He allegedly paid doctors to order unnecessary orthotic braces for Medicare beneficiaries and solicited bribes and kickbacks from brace suppliers in exchange for patient referrals.

Prosecutors say he went to great lengths to hide his scheme, including lying to obtain legal opinion letters bolstering his claim that he ran legitimate companies that profited from patient subscription fees. In reality, he was concealing the fact that most of those payments were kickbacks from brace suppliers.

A Possible Flight Risk?

In an opposition brief, prosecutors said that there aren’t any suitable bail conditions for the suspect, given his risk of flight and the danger he poses to the community. According to the government, he has a long history of deception and scheming involving foreign businesses, residences, and assets, including a $1 million yacht. Additionally, he claimed to control several foreign bank accounts and once told a cooperating witness that if the government started investigating him, he would flee to Venezuela.

The defendant argued that he’s not a flight risk because he has no criminal history and has close ties to his South Florida community.

Florida’s Involved in a Major Fraud Case, Shocker!

Another scenario that seems to be right out of a Carl Hiaasen or Tim Dorsey novel.  Why does Florida continue to attract and protect the assets fo fraudsters, conmen, and deadbeats?  Does it go back to our history of being the wintering ground for carnies and traveling circuses?

In 2019, the defendant was charged along with 23 other individuals in a crackdown on telehealth fraud schemes in New Jersey, Pennsylvania, South Carolina Texas, Florida, and California, involving over $1.2 billion in losses.

Given his close community ties and its reputation, it comes as no surprise that getting doctors to sign off on fraudulent prescriptions was a part allegedly played by telehealth company owners in Florida. Click here to view the indictment.

For years, Florida has been the home to health care fraudsters and ranked number one in terms of fraud cases. So, it’s not shocking that three Florida telehealth executives were also charged in what appears to be the biggest case in the takedown.
Click here to learn more about this case.

Therefore, to prevent flight and protect the public, prosecutors requested that the Court deny the
defendant’s motion to revoke the detention order and keep him detained. Click here to read the opposition brief.

To read about a similar telehealth case in Florida, click here to read my prior blog.

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 health care provider. We represent facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 or (970) 416-7456 or visit our website at www.TheHealthLawFirm.com.

Sources:

Bishop, Stweart. “Feds Push To Keep Telehealth Fraud Suspect Locked Up.” Law360. (March 19, 2020). Web.

Godoy, Jody. “Execs, MDs Charged In $1.2B Medicare Fraud Scheme.” Law360. (April 9, 2019). Web.

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

KeyWords: Registered agent for telehealth provider, telehealth provider investigation defense lawyer attorney, telemedicine representation, Florida telemedicine defense lawyer, telehealth expansion, representation for telehealth investigations, representation for telemedicine investigations, Florida Department of Health (DOH) representation, DOH defense lawyer, representation for DOH investigations, representation for Agency for Health Care Administration (AHCA) investigations, AHCA defense lawyer, AHCA investigation attorney, health care defense attorney, health care compliance defense lawyer, Florida health care attorney, representation for health care professionals, defense lawyer for health care providers, doctor lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Medicare audit defense attorney, Medicare inspection defense lawyer, Medicare subpoena defense lawyer, Medicare search warrant defense attorney, legal representation on Medicare fraud investigation, legal representation for Medicare fraud inspection, Medicare overpayment demand defense attorney, Department of Justice Health and Human Services subpoena defense attorney, legal representation for Department of Justice (DOJ) Health and Human Services subpoena, RAC audit defense attorney, ZPIC audit defense lawyer, Medicare fraud defense attorney, health care subpoena defense attorney

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

Pediatric Group in Florida Claims EHR Program Not Compliant in Suit

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 16, 2020, a pediatrics group in Altamonte Springs, Florida, filed a proposed class-action lawsuit against a health care technology company called Greenway Health LLC (Greenway). Altamonte Pediatric Associates PA (Altamonte Pediatrics) says Greenway sold it an electronic health records (EHR) program that did not comply with federal standards and cost them a bundle in federal incentive payments.

The suit was filed in the U.S. District Court for the Middle District of Florida.

EHR Compliance.

According to the complaint, Greenway’s Intergy electronic health records software failed to comply with the federal government’s Meaningful Use program that sets nationwide standards for EHR. The errors allegedly cost the pediatrics group at least $68,000 in missed incentive payments from the U.S. Department of Health and Human Services.

Altamonte Pediatrics says that in the contract Greenway guaranteed that any systems would “remain compliant with federal regulations,” according to the complaint. Additionally, it claims that Greenway waited more than four months to respond to their communications about the $68,000 in lost incentive payments. When Altamonte Pediatrics they finally did get a response, Greenway allegedly only offered to pay less than half that amount.

Additional Troubles for Greenway.

The lawsuit with Altamonte Pediatrics is not the first time that Greenway has faced legal troubles for its EHR program. In 2019, it paid $57.25 million to resolve a False Claims Act suit alleging that they caused users to submit false claims to the government by misrepresenting the capabilities of its EHR product “Prime Suite.” The government also alleged that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers. You can read the United States Department of Justice’s press release on this case here for more information.

The DOJ said Greenway got a bogus certification by concealing aspects of its program that were not compliant and set it up so its clients could provide inaccurate data.

The Altamonte Pediatrics group claims the same thing happened to it after Medicaid denied $68,000 in incentive payments for eight of its doctors and nurses due to Intergy’s errors. After it’s FCA settlement in 2019, Greenway assured Altamonte Pediatrics and other customers that it would fix flaws in its EHR programs, according to the suit.

The pediatrics group is asking for actual damages, punitive damages, restitution, and attorney fees and expenses. Click here to read the class action complaint filed by Altamonte Pediatrics.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians and medical groups on EHR issues. It also represents pharmacists, pharmacies, physicians, 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. 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:

Bolado, Carolina. “Doctors Say Greenway E-Records Software Not Up To Snuff.” Law360. (March 16, 2020). Web.

Simpson, Dave. “Health Records Co. To Pay $57.2M Over FCA Allegations.” Law360. (February 6, 2019). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Electronic Health Records (EHRs) litigation, legal representation for EHR matters, EHR legal representation, electronic medical records litigation, legal representation for EMRs, EHR defense litigation lawyer, representation for complex healthcare litigation, legal representation in complex medical litigation, healthcare facility legal representation, legal representation for healthcare investigations, DOJ defense lawyer, representation for DOJ investigations, healthcare fraud defense lawyer, representation for health care fraud, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Anti-Kickback Statute defense attorney, AKS lawyer, representation for AKS matters, AKS defense attorney, False Claims Act defense lawyer, FCA representation, representation for FCA investigations, FCA attorney, DOH defense lawyer, representation for DOH investigations, representation for DOH matters, DOH investigation defense attorney, representation for health care professionals, health law defense attorney

“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.

Florida Prosecutors Want Telehealth Suspect to Remain in Jail For $424 Million Fraud Scheme

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
On March 19, 2020, federal prosecutors in New Jersey federal court pushed to keep a suspect involved in a $424 million telemedicine scheme in jail.  Authorities called him an “unrepentant conman” who carried out one of the largest health care fraud schemes in U.S. history and is likely to flee the country if released.

Telehealth Fraud & Illegal Kickback Scheme.

The defendant, who owns telehealth companies, has been locked up for nearly 11 months since he was charged last year with running an international fraud and kickback scam. He allegedly paid doctors to order unnecessary orthotic braces for Medicare beneficiaries and solicited bribes and kickbacks from brace suppliers in exchange for patient referrals.

Prosecutors say he went to great lengths to hide his scheme, including lying to obtain legal opinion letters bolstering his claim that he ran legitimate companies that profited from patient subscription fees. In reality, he was concealing the fact that most of those payments were kickbacks from brace suppliers.

Is He a Flight Risk?

In an opposition brief, prosecutors said that there aren’t any suitable bail conditions for the suspect, given his risk of flight and the danger he poses to the community. According to the government, he has a long history of deception and scheming involving foreign businesses, residences, and assets, including a $1 million yacht. Additionally, he claimed to control several foreign bank accounts and once told a cooperating witness that if the government started investigating him, he would flee to Venezuela.

The defendant argued that he’s not a flight risk because he has no criminal history and has close ties to his South Florida community.

Florida’s Involved in a Major Fraud Case, Shocker!

Another scenario that seems to be right out of a Carl Hiaasen or Tim Dorsey novel.  Why does Florida continue to attract and protect the assets fo fraudsters, conmen, and deadbeats?  Does it go back to our history of being the wintering ground for carnies and traveling circuses?

In 2019, the defendant was charged along with 23 other individuals in a crackdown on telehealth fraud schemes in New Jersey, Pennsylvania, South Carolina Texas, Florida, and California, involving over $1.2 billion in losses.

Given his close community ties and its reputation, it comes as no surprise that getting doctors to sign off on fraudulent prescriptions was a part allegedly played by telehealth company owners in Florida. Click here to view the indictment.

For years, Florida has been the home to health care fraudsters and ranked number one in terms of fraud cases. So, it’s not shocking that three Florida telehealth executives were also charged in what appears to be the biggest case in the takedown.
Click here to learn more about this case.

Therefore, to prevent flight and protect the public, prosecutors requested that the Court deny the
defendant’s motion to revoke the detention order and keep him detained. Click here to read the opposition brief.

To read about a similar telehealth case in Florida, click here to read my prior blog.

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 health care provider. We represent facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 or (970) 416-7456 or visit our website at www.TheHealthLawFirm.com.

Sources:

Bishop, Stweart. “Feds Push To Keep Telehealth Fraud Suspect Locked Up.” Law360. (March 19, 2020). Web.

Godoy, Jody. “Execs, MDs Charged In $1.2B Medicare Fraud Scheme.” Law360. (April 9, 2019). Web.

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

KeyWords: Registered agent for telehealth provider, telehealth provider investigation defense lawyer attorney, telemedicine representation, Florida telemedicine defense lawyer, telehealth expansion, representation for telehealth investigations, representation for telemedicine investigations, Florida Department of Health (DOH) representation, DOH defense lawyer, representation for DOH investigations, representation for Agency for Health Care Administration (AHCA) investigations, AHCA defense lawyer, AHCA investigation attorney, health care defense attorney, health care compliance defense lawyer, Florida health care attorney, representation for health care professionals, defense lawyer for health care providers, doctor lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Medicare audit defense attorney, Medicare inspection defense lawyer, Medicare subpoena defense lawyer, Medicare search warrant defense attorney, legal representation on Medicare fraud investigation, legal representation for Medicare fraud inspection, Medicare overpayment demand defense attorney, Department of Justice Health and Human Services subpoena defense attorney, legal representation for Department of Justice (DOJ) Health and Human Services subpoena, RAC audit defense attorney, ZPIC audit defense lawyer, Medicare fraud defense attorney, health care subpoena defense attorney

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

By |2024-03-14T09:59:59-04:00May 8, 2020|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Prosecutors Want Telehealth Suspect to Remain in Jail For $424 Million Fraud Scheme

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.

 

Prosecutors Push To Keep Florida Telehealth Fraud Suspect in Jail for $424 Million Scheme

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
On March 19, 2020, federal prosecutors in New Jersey federal court pushed to keep a suspect involved in a $424 million telemedicine scheme in jail.  Authorities called him an “unrepentant conman” who carried out one of the largest health care fraud schemes in U.S. history and is likely to flee the country if released.


Fraud and Kickback Telehealth Scheme.

The defendant, who owns telehealth companies, has been locked up for nearly 11 months since he was charged last year with running an international fraud and kickback scam. He allegedly paid doctors to order unnecessary orthotic braces for Medicare beneficiaries and solicited bribes and kickbacks from brace suppliers in exchange for patient referrals.

Prosecutors say he went to great lengths to hide his scheme, including lying to obtain legal opinion letters bolstering his claim that he ran legitimate companies that profited from patient subscription fees. In reality, he was concealing the fact that most of those payments were kickbacks from brace suppliers.

Flight Risk?

In an opposition brief, prosecutors said that there aren’t any suitable bail conditions for the suspect, given his risk of flight and the danger he poses to the community. According to the government, he has a long history of deception and scheming involving foreign businesses, residences, and assets, including a $1 million yacht. Additionally, he claimed to control several foreign bank accounts and once told a cooperating witness that if the government started investigating him, he would flee to Venezuela.

The defendant argued that he’s not a flight risk because he has no criminal history and has close ties to his South Florida community.

Florida’s Involved in a Fraud Case, Shocker!

Another scenario that seems to be right out of a Carl Hiaasen or Tim Dorsey novel.  Why does Florida continue to attract and protect the assets fo fraudsters, conmen, and deadbeats?  Does it go back to our history of being the wintering ground for carnies and traveling circuses?

In 2019, the defendant was charged along with 23 other individuals in a crackdown on telehealth fraud schemes in New Jersey, Pennsylvania, South Carolina Texas, Florida and California, involving over $1.2 billion in losses.

Given his close community ties and its reputation, it comes as no surprise that getting doctors to sign off on fraudulent prescriptions was a part allegedly played by telehealth company owners in Florida. Click here to view the indictment.

For years, Florida has been the home to health care fraudsters and ranked number one in terms of fraud cases. So, it’s not shocking that three Florida telehealth executives were also charged in what appears to be the biggest case in the takedown.
Click here to learn more about this case.

Therefore, to prevent flight and protect the public, prosecutors requested that the Court deny the
defendant’s motion to revoke the detention order and keep him detained. Click here to read the opposition brief.

To read about a similar telehealth case in Florida, click here to read my prior blog.


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 health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers, and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 or (970) 416-7456 or visit our website at www.TheHealthLawFirm.com.

Sources:

Bishop, Stweart. “Feds Push To Keep Telehealth Fraud Suspect Locked Up.” Law360. (March 19, 2020). Web.

Godoy, Jody. “Execs, MDs Charged In $1.2B Medicare Fraud Scheme.” Law360. (April 9, 2019). Web.


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

KeyWords: Registered agent for telehealth provider, telehealth provider investigation defense lawyer attorney, telemedicine representation, Florida telemedicine defense lawyer, telehealth expansion, representation for telehealth investigations, representation for telemedicine investigations, Florida Department of Health (DOH) representation, DOH defense lawyer, representation for DOH investigations, representation for Agency for Health Care Administration (AHCA) investigations, AHCA defense lawyer, AHCA investigation attorney, health care defense attorney, health care compliance defense lawyer, Florida health care attorney, representation for health care professionals, defense lawyer for health care providers, doctor lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Medicare audit defense attorney, Medicare inspection defense lawyer, Medicare subpoena defense lawyer, Medicare search warrant defense attorney, legal representation on Medicare fraud investigation, legal representation for Medicare fraud inspection, Medicare overpayment demand defense attorney, Department of Justice Health and Human Services subpoena defense attorney, legal representation for Department of Justice (DOJ) Health and Human Services subpoena, RAC audit defense attorney, ZPIC audit defense lawyer, Medicare fraud defense attorney, health care subpoena defense attorney

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

By |2024-03-14T10:00:02-04:00April 8, 2020|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Prosecutors Push To Keep Florida Telehealth Fraud Suspect in Jail for $424 Million Scheme

Telemedicine Company Owners Charged in $56 Million Kickback Scheme

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On February 5, 2020, the owners of two telemedicine companies were charged in New Jersey federal court with defrauding Medicare in an alleged $56 million telehealth scheme involving orthotic braces. Some of the fraud alleged to have occurred was through a Florida location. The married co-owners of Advantage Choice Care and Tele Medicare are reported to have used the companies to solicit kickbacks and bribes from patient recruiters, pharmacies, and brace suppliers. The company would then hire providers to order medically unnecessary braces that were billed to Medicare, according to the U.S. Department of Justice (DOJ).

The scheme allegedly took place from March 2017 to April 2019.

Sham Contracts to Hide Kickbacks.

The fraud scheme allegedly was able to evade detection by the U.S. Department of Health and Human Services (HHS) by using sham contracts that labeled the kickbacks as “consultations” and “medical expenditures,” the government said. The illegal payments, some as much as $34,910, were all made through bank accounts that indirectly funneled cash into Advantage Choice Care.

Authorities say the pair and others transferred the brace orders to co-conspirator suppliers to support more than $56 million in false and fraudulent claims to Medicare that were submitted by brace suppliers. According to court documents, Medicare paid these brace suppliers over $28 million for these claims.

The Charges.

The husband and wife were arrested and charged with six counts, according to the indictment. They were charged with one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, one count of conspiracy to commit health care fraud and wire fraud, three counts of receiving health care kickbacks, and one count of conspiracy to commit money laundering. These charges are standard for most fraud prosecutions in federal court. Click here to view the indictment in full.

The couple owned and operated two telemedicine companies which had locations in Bayonne, New Jersey, Boca Raton, Florida, and Richmond Hill, Georgia. To view the DOJ’s press release on this case, click here.

Click here to read one of my prior blogs to learn more about Telemedicine in Florida.

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 health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers, and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 or (970) 416-7456 or visit our website at www.TheHealthLawFirm.com.

Sources:

“Telemedicine co. owners charged in $56 million Medicare fraud case.” Modern Healthcare. (February 5, 2020). Web.

Stawicki, Kevin. “Telemedicine Execs Charged In $56M Medicare Fraud Scheme.” Law360. (February 5, 2020).

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: Registered agent for telehealth provider, telehealth provider investigation defense lawyer attorney, telemedicine representation, Florida telemedicine defense lawyer, telehealth expansion, representation for telehealth investigations, representation for telemedicine investigations, Florida Department of Health (DOH) representation, DOH defense lawyer, representation for DOH investigations, representation for Agency for Health Care Administration (AHCA) investigations, AHCA defense lawyer, AHCA investigation attorney, health care defense attorney, health care compliance defense lawyer, Florida health care attorney, representation for health care professionals, defense lawyer for health care providers, doctor lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Medicare audit defense attorney, Medicare inspection defense lawyer, Medicare subpoena defense lawyer, Medicare search warrant defense attorney, legal representation on Medicare fraud investigation, legal representation for Medicare fraud inspection, Medicare overpayment demand defense attorney, Department of Justice Health and Human Services subpoena defense attorney, legal representation for Department of Justice (DOJ) Health and Human Services subpoena, RAC audit defense attorney, ZPIC audit defense lawyer, Medicare fraud defense attorney, health care subpoena defense attorney

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

Telemedicine and Telehealth Authorized by Law in Florida in 2019

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Among the major events in health law in 2019, Florida passed a comprehensive act approving telemedicine and telehealth.

Telehealth in Florida, Who and What Are Included and Excluded.

Florida’s Telehealth Act became effective on July 1, 2019. It is codified in Section 456.47, Florida Statutes (2019). It authorizes the provision of healthcare services via telecommunication methods. However, it excludes audio-only telephone calls, email, and facsimile transmissions.

Authorized healthcare services under the Florida telehealth law include, but are not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration.

The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions, still prohibiting much of the “Internet” practice of medicine.

The law defines a “telehealth provider” as one who is licensed under Sections 456.47(1) or 456.47(4), Florida Statutes (2019), or Section 456.47(4), Florida Statutes. These include physicians, psychologists, nurses, nurse practitioners, dentists, chiropractors, psychologists, mental health counselors, and social workers, among others.

What Standard of Care Applies?

It must be remembered that under general rules of law, the law of the state where the patient is located, is the law that applies to any situation concerning malpractice or other medical issues. The standard of care for a telehealth provider remains the same as for in-person healthcare providers in the state of Florida under the new law. The new law also specifies that an authorized telehealth provider must practice only within their scope of practice.

Under the new act, a telehealth provider is not required to research a patient’s medical history or perform a medical examination, after a patient evaluation and diagnosis, before providing telehealth services. However, a telehealth provider may not prescribe controlled substances, with certain exceptions indicated in Section 456.47(2)(c), Florida Statutes (2019).

Additionally, a non-physician healthcare provider may practice via telehealth without violating Section 458.327(1)(a), Florida Statutes (2019), or Section 459.013(1)(a), Florida Statutes (2019), as long as that person is acting within the scope of their practice.

Record-keeping Requirements for Telehealth.

Telehealth providers are required to keep medical records of telehealth services they provide the same as required for in-person healthcare services.

Important Provisions Applying to Out-of-State Telehealth Providers.

The Florida law allows out-of-state healthcare practitioners, not licensed in Florida, to provide telehealth services to patients in Florida if the practitioner meets certain registration requirements by the relevant board or department. This seems to be a recognition of the fact that there are many states now that allow telehealth services to be provided to patients within their states by those not licensed by that state.

To legally provide telehealth services to a patient located in Florida, the health professional must:

1. Complete an application prescribed by the appropriate Florida board or the Florida Department of Health.

2. Be licensed in another jurisdiction, with that license being substantially similar to the applicable Florida license.

3. Not have been subject to disciplinary action related to their professional license in the immediate five-year period before application.

4. Designate a registered agent for service of process (note: this is usually a law firm or professional registered agent service).

5. Demonstrate possession of professional liability (malpractice) insurance or financial responsibility, as otherwise provided by Florida law.

An out-of-state licensed telehealth provider must also publish a link on their website to the relevant board’s or department’s website that contains the telehealth provider’s information. This information must include name, occupation, education, out-of-state license number, specialty, board certification, disciplinary actions, medical malpractice coverage, and the name and address of the registered agent to be served with process.

An applicant may not register if he or she is under pending disciplinary action. This would include any sort of investigation by a regulatory authority such as the Florida Department of Health (DOH) or the Colorado Department of Regulatory Agencies (DORA).

An out-of-state telehealth provider may not set up an office inside Florida, nor provide in-person healthcare services in Florida, under this statute.

The relevant Florida professional board or Department of Health may take disciplinary action against an out-of-state telehealth registrant for various infractions. Penalties may include suspension or revocation of registration, issuance of a reprimand, or a letter of concern.

Exemptions to Telehealth Provider Registration Requirements.

There are two exemptions to the out-of-state telehealth practitioner registration requirement. Telehealth services may be rendered by an unregistered, licensed out-of-state practitioner:

1. In response to an emergency medical condition whereby the absence of immediate medical attention could result in death or serious bodily harm to the patient, or fetus of a pregnant woman.

2. In consultation with a Florida licensed practitioner who has ultimate decision-making authority over the matter.

To learn more about telehealth in Florida, click here to read one of my prior blogs.

Consult Florida Health Lawyer to Assist in Filing an Application, Act as Registered Agent or If You Receive Notice of an Investigation.

The state of Florida has some of the most laws and regulations applying to health professionals, health facilities and healthcare providers. If you are confronted with any need for any legal services related to any of the issues discussed in this blog, contact The Health Law Firm right away.

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 health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers, and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. 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.

KeyWords: Registered agent for telehealth provider, telehealth provider investigation defense lawyer attorney, telemedicine representation, Florida telemedicine defense lawyer, telehealth expansion, representation for telehealth investigations, representation for telemedicine investigations, Florida Department of Health (DOH) representation, DOH defense lawyer, representation for DOH investigations, representation for Agency for Health Care Administration (AHCA) investigations, AHCA defense lawyer, AHCA investigation attorney, health care defense attorney, health care compliance defense lawyer, Florida health care attorney, representation for health care professionals, defense lawyer for health care providers, doctor lawyer, reviews of The Health Law Firm, The Health Law Firm attorney reviews

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2019/2020 The Health Law Firm. All rights reserved

Review Your Department Of Health Practitioner Profile or it Could Cost You!

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

In 1997, the Florida Legislature passed a statute that requires the Department of Health (DOH) to maintain online practitioner profiles for certain health care professionals. Practitioner profiles are required for medical doctors, osteopathic physicians (DOs), chiropractors (DCs), advanced practice registered nurses (APRNs) and podiatric physicians. The statute specified the required information to be maintained, how it was to be reported, and other requirements dealing with compiling and updating the information in the profiles.

To visit the DOH’s website and learn more about these profiles, click here.

What Information Does the Profile Include?

The profile contains required and optional information from the healthcare provider. Required
information includes:

1. education and training, including other health-related degrees, professional and postgraduate training specialty
2. current practice and mailing addresses
3. staff privileges and faculty appointments
4. reported financial responsibility
5. legal actions taken against the practitioner
6. board final disciplinary action taken against the practitioner
7. any liability claims filed against podiatric physicians which exceed $5,000
8. any liability claims filed against M.D.s and osteopathic physicians which exceed
$100,000

Optional information may include committees/memberships, professional or community
service awards, and publications the practitioner has authored.

These profiles are published on the DOH’s website. They are freely accessible by the public and are frequently used by employers, medical staff committees, and insurance panels to verify information provided by applicants.

Be Sure to Check Your Profile for Accuracy!

If you are a licensed profiled health care practitioner, you should review your profile information frequently and report any corrections to the DOH immediately! By law, you are responsible for updating your profile information within 15 days after a change of an occurrence in each section of the profile.

Unfortunately, information on practitioner profiles is not always 100 percent correct. Oftentimes, the information in a profile is outdated or misreported. The majority of the information in a profile is supposed to be entered through the website by the practitioner personally; however, the DOH is free to add information on its own.

It’s important to note that not all of the information on the practitioner profile is verified by the DOH. To view which information is self-reported, as well as reported by the DOH, click here to view the DOH’s profile guide.

Recently, The Health Law Firm had a client whose employment contract was not renewed due to misreported criminal history information on the DOH practitioner profile. Most troubling was the fact that this information appeared on the profile suddenly; it had not been on the practitioner profile in the past. Furthermore, the information was decades old and had been posted in direct violation of a court order sealing the underlying records.

We have also had cases where information was incorrect, where the same information was repeated several times, or where the information on the profile did not meet the basic requirements for reporting.

Fight False Information on Your Practitioner Profile.

The Health Law Firm has been successful in having the DOH remove criminal history information and other incorrect information from a practitioner profile.

It is imperative that you check your practitioner profile regularly to ensure that it is accurate with respect to the information that you provided and that may have been provided by the DOH. If you find that confidential or incorrect information has been posted to your profile, contact an attorney experienced with dealing with these matters immediately. You never know when your employer, a business associate or potential patient will look up your information on your profile.

Contact Health Law Attorneys Experienced with the 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 the 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 (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 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 © 2019 The Health Law Firm. All rights reserved.

You Could Face Steep Repercussions From License Discipline or Resignation After Notice of Investigation

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

Do you have a dental, medical, pharmacy or nursing license in several different states? Do you have a license in more than one health care profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following information.

First, you should never voluntarily relinquish or resign your license after you know that an investigation has been opened or that disciplinary action has been taken against you. Such resignation is considered to be a “disciplinary relinquishment” and is treated the same as if your license had been revoked on disciplinary grounds.

Second, this will be reported out to other states, agencies, to the National Practitioner Data Bank (NPDB), to any certifying bodies for certifications you have and to other reporting agencies (such as the National Council of State Board of Nursing, the National Association of Boards of Pharmacy or the American Board of Internal Medicine). Other states and other professional boards will most likely initiate disciplinary action based upon the first one.

Protect Your Professional License from These Adverse Actions.

The following is a list of some of the adverse actions that you can expect to be taken against you after discipline on your license or after you resign your professional license after receiving notice of investigation:

1. A mandatory report to the National Practitioner Data Base (NPDB) which remains there for 50 years. Note: The Healthcare Integrity and Protection Data Bank or HIPDB recently merged into the NPDB.

2. Must be reported to and included in the Department of Health (DOH) profile that is available to the public online (for those having one), and remains for at least ten years.

3. Any other states or jurisdictions in which the nurse has a license will also initiate an investigation and possible disciplinary action against him or her in that jurisdiction. (Note: I have had two clients who had licenses in seven other states and all, even ones that were inactive or not renewed years ago, initiated action).

4. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) will take action to exclude the provider from the Medicare Program. If this occurs (and most of these offenses require mandatory exclusion) the provider will be placed on the List of Excluded Individuals and Entities (LEIE) maintained by the HHS OIG.

a. If this happens, you are prohibited by law from working in any position in any capacity for any individual or business, including hospitals, nursing homes, home health agencies, physicians, medical groups, insurance companies, etc., that contract with or bill Medicare or Medicaid. This means, for example, you are prohibited from working as a janitor in a nursing home that accepts Medicare or Medicaid, even as an independent contractor.

b. If this happens, you are also automatically “debarred” or prohibited from participating in any capacity in any federal contracting, and you are placed on the U.S. General Services Administration’s (GSA) debarment list. This means you are prohibited by law from working in any capacity for any government contractor or anyone who takes government funding. This applies, for example, to prevent you from being a real estate agent involved in selling property financed by a government-backed loan, prohibited from working for an electrical company that bids on contracts for government housing projects, working as a school teacher in a public school, etc.

c. If this happens, your state Medicaid Program is required to terminate you “for cause” from the state Medicaid Program. In many states, this is also grounds for revocation of your license.

5. Any profile or reporting system maintained by a national organization or federation (e.g., NURSYS profile maintained by the National Council of State Boards of Nursing, American Medical Association physician profile, or the Federation of State Board of Physical Therapy profile) will include the adverse action in it, generally available to the public.

6. If you are a nurse practitioner or other professional with clinical privileges at a hospital, nursing home, HMO or clinic, action will be taken to revoke or suspend the clinical privileges and staff members if you have such. This may be in a hospital, ambulatory surgical center, skilled nursing facility, staff model HMO or clinic. This will usually be for physicians, physician assistants (PAs), advanced registered nurse practitioners (ARNPs), certified registered nurse anesthetists (CRNAs), nurse midwives or certified nurse anesthetists (CNAs), podiatrists, clinical psychologist or clinical pharmacists.

7. Third party payors (health insurance companies, HMOs, etc.) will terminate the professional’s contract or panel membership with that organization.

8. The U.S. Drug Enforcement Administration (DEA) will act to revoke the professional’s DEA registration if he or she has one.

9. Many employers will not hire you or will terminate your employment if they discover your license has been disciplined in another state.

So, What Should You Do?

– Don’t take the easy way out by immediately relinquishing your license if you are notified you are under investigation.

– Don’t hide your head in the sand by thinking the case will just go away on its own.

– Don’t take the easy way out. If you are innocent of the charges, request a formal hearing and contest the charges; defend yourself.

– Do not request an informal hearing or a settlement agreement in which you admit the facts alleged against you are all true. If you do this, you are “pleading guilty.”

– Do immediately seek the advice of an attorney who has experience in such professional licensing matters and administrative hearings. They are out there, but you may have to search for one. Do this as soon as you get notice of any investigation and especially before you have talked to or made any statement (including a written one) to any investigator.

– Do purchase professional liability insurance that includes legal defense coverage for any professional license investigation against you, whether it is related to a malpractice claim or not. This insurance is cheap and will provide needed legal assistance at the time when you may be out of a job and not have money to hire an attorney. Beware of the insurance policy that only covers professional license defense if it is related to a malpractice claim.

Professional Liability Insurance.

We strongly encourage all licensed health professionals and facilities to purchase their own, independent insurance coverage. Make sure it covers professional license defense under all circumstances. Make sure you have enough coverage to actually get you through a hearing. $25,000 coverage for just professional licensure defense is the absolute minimum you should purchase; $50,000 may be adequate but $75,000 or $100,000 may be what you really need in such a situation. For a few dollars more (and I do mean only a few) you can usually purchase the higher limits.

Also, I will repeat, make sure it covers your legal defense in an administrative disciplinary proceeding against your license, even if there is no malpractice claim filed against you or likely to be filed against you.

We also recommend that you purchase coverage through an insurance company that allows you to select your own attorney and does not make you use one that the insurance company picks for you.

Companies we have encountered in the past who provide an inexpensive top quality insurance product for professional license defense costs include: CPH & Associates Insurance, Nurses Service Organization (NSO) Insurance, Healthcare Providers Organization (HPSO) Insurance and Lloyd’s of London Insurance.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses, pharmacists, pharmacies, dentists, mental health counselors, massage therapists and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), 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.

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

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