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Texas Hospital’s COVID-19 Vaccine Mandate Upheld by Federal Court

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

As some states lift COVID-19 restrictions, the business community is still grappling with the dynamic between the COVID-19 vaccine and workplace operations. To address this, some U.S. employers have elected to adopt mandatory vaccination policies. These policies, in essence, require that, subject to a few exceptions, all employees must receive the COVID-19 vaccine as a condition of continued employment.

Not surprisingly, we see various legal challenges to mandatory COVID-19 vaccination policies across the country. On June 12, 2021, a federal court in Texas became the first to rule on the permissibility of such policies enforced by private employers. In a landmark ruling, the court stated that mandatory workplace vaccination policies are lawful under Texas and federal law and may be enforced as a condition of continued employment.

The Court’s Ruling on Mandatory Vaccination Policies.

The lawsuit, Bridges v. Houston Methodist Hospital, was initially filed on behalf of 117 employees after their employer, Houston Methodist Hospital, instituted a policy requiring employees to receive a COVID-19 vaccine as a condition of continued employment. Employees who were not vaccinated by the deadline were to be placed on a two-week unpaid suspension to allow them to comply with the policy. Under the policy, those who ultimately did not comply would be terminated.

In the law suit challenging the employer’s policy, the Plaintiffs asserted: (1) the employees whose employment was terminated as a result of this policy were wrongfully terminated in violation of Texas law, and (2) the vaccine mandate violated public policy of the state of Texas.

Texas Wrongful Termination Claim.

Under Texas law, the court found that firing an employee who is unwilling to comply with an employer’s mandatory COVID-19 vaccine policy does not constitute wrongful termination. Texas law only protects employees who are fired for refusing to commit an illegal act at the request of their employer. The court reasoned that receiving the vaccine is not an illegal act given the U.S. Supreme Court’s rulings upholding involuntary quarantines and mandatory vaccines.

Violation of Public Policy.

The court dismissed the plaintiffs’ public policy arguments because, according to the court, Texas law does not recognize a public policy exception to the at-will employment doctrine. Additionally, the court noted that a mandatory vaccine requirement is consistent with public policy. The Supreme Court has previously held that state-imposed quarantine and vaccination requirements do not violate due process of law.

The court held that the plaintiffs were not being coerced to get the vaccine but were being given a basic choice by its employer: get the vaccine so the hospital could safely continue its business of saving lives or seek employment elsewhere.

Lastly, the court also cited recent Equal Employment Opportunity Commission (EEOC) guidance in its decision. The guidance states that employers can require employees to be vaccinated, subject to the obligation to provide reasonable accommodations to employees with legitimate medical or religious reasons for not being vaccinated. Click here to view.

To view the court’s order in full, click here.

Important Takeaway From This Court Decision.

While there are sure to be future legal challenges to mandatory workplace vaccination policies, this decision provides strong support for their use and permissibility. However, even with this ruling, employers with policies need to be mindful of their obligations and potentially provide reasonable accommodations to employees with disabilities or sincerely held religious beliefs that prevent them from receiving the COVID-19 vaccine. Of course, we will see numerous legal challenges of all kinds to these decisions.

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, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations. We do NOT represent plaintiffs in COVID-19 injury suits, however.

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

Sources:

Downie, Alex. “Federal Court Upholds Employer’s COVID-19 Vaccine Mandate.” The National Law Review. (June 15, 2021). Web.

Brown, Amanda, Goldstein, Mark. “In first-of-its-kind decision, federal court rules that mandatory workplace COVID-19 vaccine policies are lawful.” Employment Law Watch. (June 16, 2021). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999. Copyright © 2021 The Health Law Firm. All rights reserved.

University of Colorado Sued For Denying COVID-19 Vaccine Religious Exemptions

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

On September 29, 2021, a pediatrician and medical student sued the University of Colorado Anschutz Medical Campus (CU) for denying COVID vaccine religious exemptions. The U.S. District Court lawsuit argued that school administrators judge the validity of personal religious beliefs in violation of the First Amendment.

Religious Exception For COVID Vaccine.

Both plaintiffs are challenging the denial of their requests for religious exemptions from the school’s COVID vaccination mandate. The lawsuit alleges that the university arbitrarily grants religious exemptions to its vaccine requirement for all staff and students. It also claims that CU is approving requests that are based on organized religious beliefs that oppose vaccinations while subjecting requests based on personal religious beliefs to “intrusive religious inquisition to test the veracity of students’ and employees’ asserted religious beliefs.”

Details of the Denials.

Neither plaintiff is named in the lawsuit ostensibly to protect them from retaliation. Instead, the pediatrician is referred to as “Dr. Jane Doe,” and the first-year medical student as “John Doe.”

According to the complaint, Dr. Jane Doe requested a religious exemption based on her Catholic beliefs and opposition to “abortion-derived cell lines” used in the three available U.S. vaccines. However, she did not oppose other vaccines, such as the flu shot.

Because of this, CU denied her request, stating that campus policy “only recognizes religious exemptions based on a religious belief whose teachings are opposed to all immunizations,” according to the complaint. Jane Doe argues that her pending termination will harm her reputation and stain her record as a licensed medical professional.

According to the complaint, the second plaintiff, John Doe, a first-year medical student, requested a religious exemption citing his Buddhist beliefs and avoidance of “products developed through the killing or harming of animals (including human beings).”

CU officials also denied the exception request, stating that John Doe’s objections to the vaccine “are all of a personal nature and not part of a comprehensive system of religious beliefs.”

The lawsuit says John Doe’s pending termination from CU would bar him from transferring to a different medical school under guidelines issued by the Association of American Medical Colleges and that he would have to reapply to attend a different U.S. medical program.

In response to the lawsuit, a spokesperson for the university said their mandatory vaccine policy “offers the best way to protect” the more than two million patients that the university faculty serve annually.

Both plaintiffs seek approval of their requests for religious exemptions and money for court costs and personal damages. This lawsuit is just one example of the fight over a growing number of COVID vaccine mandates nationwide. As a result, businesses need to be mindful and provide reasonable accommodations to employees with disabilities or religious beliefs that prevent them from receiving the COVID vaccine.

To read about another recent case regarding a hospital’s COVID vaccine mandate, 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, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, medical groups, institutions, and individual health professionals in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health and DORA investigations. We represent medical students and resident physicians in disputes with their medical education programs. We do NOT represent plaintiffs seeking to avoid vaccinations or in COVID-19 injury suits, however.

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

Sources:

Nieberg, Patty. “University of Colorado faces COVID religious exemption suit.” AP News. (September 29, 2021). Web.

“Pediatrician, medical student sue University of Colorado over denial of COVID vaccine religious exemption.” The Colorado Sun. (September 30, 2021). Web.

Humana Agrees To Pay $11.2 Million to End Nurses’ Overtime Suit

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

On September 27, 2021, Humana agreed to pay $11.2 million to end claims that the health insurance company denied a group of nurses overtime pay by misclassifying them as exempt employees. A Wisconsin federal judge approved the deal with Humana, and a group of more than 200 nurses reached, securing a $36,000 average payment for each nurse involved in the suit.

A Violation of the Fair Labor Standards Act (FLSA).

This dispute stems from a class-action lawsuit filed in 2017 alleging that Humana misclassified its clinical nurse advisers as exempt employees and denied them overtime compensation, violating the Fair Labor Standards Act. Many professionals and supervisors or managerial employees are considered to be exempt from overtime laws.

In the suit, the company faced allegations from nurses who claimed they were never paid for overtime even though they were required to work more than 40 hours per week to meet Humana’s production goals and expectations.

The Settlement.

The settlement agreement will allocate almost $3 million to cover attorney fees and costs. Additionally, the 221 nurses that are part of the settling class will get nearly $8 million based on the number of full-time weeks the nurses worked. According to the motion, the average payment per nurse for unpaid overtime and liquidated damages will be over $36,000.

The case is O’Leary v. Humana Insurance Co., et al., case number 17-cv-1774, in the U.S. District Court for the Eastern District of Wisconsin. Click here to view the court’s brief in full.

To read about another case dealing with alleged pay discrimination in the healthcare field, click here to read one of my prior blogs.

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

The Health Law Firm’s attorneys routinely provide legal representation to nurses, pharmacists, pharmacy technicians, dentists, dental assistants, physicians, physician assistants, mental health counselors, and other health providers. We also provide legal representation for employers in EEOC complaints, workplace discrimination complaints, and suits involving harassment or discrimination complaints. We also provide legal representation in Department of Health, Board of Medicine, Board of Nursing investigations and complaints, DORA investigations and complaints. We provide litigation services in state and federal courts and state and federal administrative hearings. We provide legal representation across the U.S., not just in Colorado, Florida, Louisiana, Virginia, and Washington, D.C.

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

Sources:

Spezzemonte, Irene. “Humana To Pay $11.2M To End Nurses’ Misclassification Suit.” Law360. (September 27, 2021). Web.

Webster, Katherine. “Court OKs $11.2M Overtime Settlement Between Humana, Nurses.” Top Class Actions. (September 30, 2021). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.

The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2021 The Health Law

Rapper 50 Cent Sues Florida Plastic Surgeon Over “Penile Enhancement” Ads & Social Media Photos

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

On September 16, 2022, 50 Cent, the rapper and entrepreneur, sued a plastic surgeon and her Sunny Isle Beach, Florida, medical practice in federal court. The suit alleges that the doctor used photographs she took with 50 Cent to promote her business on social media. without his consent. The suit also alleges that the ads and social media falsely implied that 50 Cent had received penile enhancement treatment from the doctor’s practice when he had not.

A 32-page complaint (lawsuit) was filed in federal court in the Southern District of Florida by 50 Cent, whose real name is Curtis J. Jackson III. It was filed against Angela Kogan, M.D., and Perfection Plastic Surgery and Medspa.

And whoever said the practice of health law wasn’t fun and interesting?

Allegations Made in the Complaint.

According to the complaint, the plaintiff is a “world-famous celebrity and entrepreneur.” In February 2020, according to the complaint, 50 Cent agreed to take a photograph with Dr. Kogan. He thought she was a fan. Once she had taken the picture, the complaint states, she allegedly used it as promotional content for Perfection Plastic Surgery, touting 50 Cent as a client and insinuating his endorsement.

50 Cent claims that since the defendant took the photo, it’s also been featured in a news article opposite an image of a faceless male allegedly undergoing a penile enhancement procedure. He argues that this made the implication of the article clear, stating that “not only were [plaintiff’s] image and name linked to a sexual enhancement treatment he never had, but Kogan also falsely implied that [plaintiff] was her client for plastic surgery.”

Between February 2020, when the photos were taken, and August of 2022, the complaint alleges, Dr. Kogan and her business posted the images on her business accounts seven times, along with multiple hashtags for users to find them. However, the posts did not include disclaimers that 50 Cent was not a client/patient, the suit says.

Causes of Action Include Invasion of Privacy, Lanham Act Violations and More.

The complaint states that 50 Cent never received plastic surgery from the defendants. The complaint concludes by asserting that the defendants “opportunistically misappropriated Jackson’s (50 Cent’s) name and image for their own promotional and commercial advantage,” in violation of the Lanham Act and the plaintiff’s right to publicity.

The six-count complaint cites right of publicity, common law invasion of privacy, two violations of the Lanham Act, conversion, and unjust enrichment. 50 Cent is seeking punitive, treble, and exemplary damages, a permanent injunction preventing the defendants from further misconduct, litigation fees, interest, disgorgement of profits, and any other relief deemed proper by the court.
Read the complaint in full here.

Stay tuned for more on this interesting Florida law suit, as it unfolds.

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

At the Health Law Firm, we provide legal services, including defense in complex medical litigation, for physicians, medical groups, and other healthcare providers. This includes plastic surgeons, cosmetic dermatologists, nurse practitioners, oral and maxillofacial surgeons, psychologists, psychiatrists, mental health counselors, and many others. This includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We also represent health facilities, individuals, groups, and institutions in contracts, sales, and mergers, and acquisitions. The lawyers of The Health Law Firm are also experienced in litigation at formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

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

Sources:

Atkins, Dorothy. “50 Cent Sues Fla. Surgeon Over ‘Penile Enhancement’ Ads.” Law360. (September 20, 2022). Web.

Heebink, Kendall. “Rapper 50 Cent Sues Florida Plastic Surgeon Over False Claims.” Law Street Media. (September 19, 2022). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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

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“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 © 2022 The Health Law Firm. All rights reserved.

New Study Reveals Complex Coding Structures in U.S. For Rise in Medical Billing Costs

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

A study publicized in August 2022 revealed that the complex coding structures used in the United States drive up medical billing costs. This helps to make the U.S. one of the most expensive countries for health providers to get paid. According to the study, researchers used a micro-level accounting of billing and insurance-related (often abbreviated “BIR”) expenses in different national settings at six provider locations in five nations: Australia, Canada, Germany, the Netherlands, and Singapore. This most recent study supplements a prior study measuring such costs in the U.S.

The findings, published in Health Affairs Journal, revealed “BIR (billing and insurance-related) costs in the U.S. are generally much higher than the costs in other countries.” This means that all the extra costs of coding and billing, including the related expenses, are a significant factor in driving up health care cases in the U.S. Say what you want about doctors’ hating paperwork, but this study seems to validate that feeling.

The Findings of the Study.

The study confirmed what research has established that billing and insurance-related (BIR) costs in the U.S. are much higher than in other countries. For example, prices range from $6 in Canada to $215 in the U.S. for an inpatient surgical bill. In the U.S., that represented about 3.1 percent of the total professional revenue for the procedure. Providers also spent about 100 minutes processing the claim.

To compare, only Australia had similar billing and insurance-related costs to the U.S. Australia has a mix of publicly and privately funded payers and universal coverage. Billing and insurance-related costs were significantly less in Canada than in the other nations. The study said Germany, Singapore, and the Netherlands had equal billing and insurance-related costs.

A Common Trend: Complex Coding.

The U.S. has a coding process in which each payer has its forms and documentation requirements, creating a significant burden on providers to translate clinical documentation into billable codes for reimbursement.

Because of standardization in other countries, providers spend less time coding or do not need coders to translate documentation into billable codes. Additionally, “little physician time is spent entering billing-related information into the EHR [electronic health record] system, as charge codes are either generated automatically or entered manually by a lower-wage or nonclinical teammate,” the study stated. “As a consequence, these countries’ billing systems either require fewer labor resources or much less costly labor and physician time than the one in the U.S.”

Researchers also found that financial counseling could reduce overall billing and insurance-related costs in the U.S.

You can read the study in full and learn more by visiting Health Affairs, a leading peer-reviewed journal of health policy thought and research.

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, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and other healthcare providers. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

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

Sources:

LaPointe, Jacqueline. “Coding Drives Up Medical Billing Costs in the US.” Rev Cycle Intelligence. (August 3, 2022) Web.

Norris, Amanda. “REV CYCLE PROCESSES PUSH U.S. TO TOP OF LIST FOR HIGHEST MEDICAL BILLING COSTS.” Health Leaders Media. (August 10, 2022). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

New Study Faults Coding Structures For Increased Medical Billing Costs in U.S.

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

The Findings of the Study.

A Common Trend: Complex Coding.

Researchers also found that financial counseling could reduce overall billing and insurance-related costs in the U.S.

You can read the study in full and learn more by visiting Health Affairs, a leading peer-reviewed journal of health policy thought and research.

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, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and other healthcare providers. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

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

Sources:

LaPointe, Jacqueline. “Coding Drives Up Medical Billing Costs in the US.” Rev Cycle Intelligence. (August 3, 2022) Web.

Norris, Amanda. “REV CYCLE PROCESSES PUSH U.S. TO TOP OF LIST FOR HIGHEST MEDICAL BILLING COSTS.” Health Leaders Media. (August 10, 2022). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T09:59:16-04:00November 30, 2023|Categories: Health Facilities Law Blog|Tags: billing and coding legal defense, complex civil litigation attorney, complex health care litigation attorney, complex healthcare litigation lawyer, complex medical business litigation attorney, complex medical litigation lawyer, doctor defense legal representation, Florida Louisiana District of Columbia (D.C.) administrative hearing defense lawyer, Florida Louisiana District of Columbia (D.C.) health law defense lawyer, Florida Louisiana District of Columbia (D.C.) professional license defense attorney, legal representation for Department of Health investigation defense, legal representation for health care professionals, legal representation for healthcare professionals, legal representation for healthcare providers, legal representation for physicians and health care professionals, legal representation for telemedicine issues, Medicaid HMO Defense attorney, Medicaid managed care plan audit defense, Medicaid managed care plan defense attorney, Medicare Medicaid audit legal defense, nurse defense lawyer, physician complaint defense attorneys, representation for complex medical litigation, representation for healthcare business litigation matters, reviews of The Health Law Firm attorneys, telemedicine defense lawyer, the health law firm, The Health Law Firm attorney reviews|Comments Off

Supreme Court Rules Against HHS in Hospital Medicare Reimbursement Case

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

On June 15, 2022, the U.S. Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. This came in a ruling that limits regulators’ power to control what the program pays for certain drugs. In this case, the Supreme Court justices sided unanimously with a group of hospitals suing over drug reimbursement rates for facilities that serve low-income communities. In writing for the court, Justice Brett Kavanaugh said the U.S. Department of Health and Human Services (HHS) improperly calculated reimbursement rates using a methodology Congress authorized for use only in limited circumstances.

Were the Reimbursement Cuts Unlawful?

The Supreme Court overturned a lower court’s 2020 decision that HHS had the authority to reduce the yearly Medicare reimbursement rates for a group of hospitals serving low income communities. Click here to view the July 31, 2020 decision.

The high court found the U.S. Court of Appeals for the District of Columbia Circuit erred in 2020 when it allowed the HHS to reduce Medicare payments, by roughly $1.6 billion, for outpatient drugs that had helped subsidize the operations of the hospitals. The Supreme Court’s decision did not extend so far as to undermine HHS authority, but only stated how the agency acted unlawfully in accordance with its varying rates for hospitals under the 340B Drug Pricing Program.

“In short, the statute allows HHS to set reimbursement rates based on average price and affords the agency discretion to ‘adjust’ the price up or down. But unless HHS conducts a survey of hospitals’ acquisition costs, HHS may not vary the reimbursement rates by hospital group,” Justice Kavanaugh wrote in the ruling.

Regulating Reimbursement Rates Under the 340B Program.

Under Medicare, health care providers get reimbursed by the government for expenses, including medications used in hospital outpatient departments. Previously, hospitals had been getting reimbursed at a rate based on the average price of the drugs. However, in 2018, the HHS, under then-President Donald Trump, cut payments for outpatient drugs by 28.5% to hospitals receiving money under the 340B program.

The department found that reimbursements were too high because these hospitals obtain the drugs from manufacturers at a deep discount, an issue that also resulted in excessive patient co-payments. Additionally, the resulting cut dealt “a crushing blow to providers that were already operating on razor-thin margins and to the vulnerable populations they serve,” the hospitals told the justices in a court filing.

Justice Brett Kavanaugh wrote for the court that “absent a survey of hospitals’ acquisition costs,” the HHS “may not vary the reimbursement rates for 340B hospitals. The HHS’s 2018 and 2019 reimbursement rates for 340B hospitals were therefore contrary to the statute and unlawful.”

Click here to read the Supreme Court’s Opinion in the case, American Hospital Association v. Becerra, 20-1114.

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, Medcaid 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 toll-free at (888) 331-6620.

Sources:

Stohr, Greg. “Supreme Court Sides With Hospitals on Medicare Reimbursement.” Bloomberg Law. (June 15, 2022). Web.

Chung, Andrew. “U.S. Supreme Court faults Medicare cuts to hospitals for outpatient drugs.” Reuters. (June 15, 2022). Web.

Gresko, Jessica. “High court rules against government on drug reimbursement.” Associated Press. (June 15, 2022). 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 or Toll-Free: (888) 331-6620.

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“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 © 2022 The Health Law Firm. All rights reserved.

U.S. Government Renews COVID-19 Public Health Emergency, Extending Health Benefits for Millions of Americans

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

On July 15, 2022, the United States again renewed the COVID-19 public health emergency, allowing millions of Americans special access to free tests, vaccines, and treatments. The public health emergency was initially declared in January 2020, when the coronavirus pandemic began. Since then, the Department of Health and Human Services has renewed it each quarter. HHS Secretary Xavier Becerra officially renewed the declaration extending it through October 13, 2022. View it in full here.

Ensuring Continued Access to Special Services During the Public-Health Emergency.

The declaration allows the U.S. to grant emergency authorizations of drugs, vaccines, and other medical countermeasures. As a result, it can administer those products to millions of people at no out-of-pocket cost. It’s also enabled millions of Americans to get health coverage through Medicaid, among other benefits.

It may also have additional benefits, such as allowing certain health care professionals to practice across state lines without getting a license in the state where the patient is and encouraging the continuation of video visits (telemedicine). But check your state and national regulations to be sure.

When the public health emergency expires, insured patients will be subject to co-pays or other costs, while the uninsured will lose easy access to free testing. In addition, millions could risk losing Medicaid coverage as states reinstate stricter enrollment rules that they had loosened to qualify for enhanced federal funding.

The Biden administration has ensured states it will give 60 days’ notice before ending the emergency to allow sufficient time to prepare for changes to specific programs and regulatory authorities. To learn more about Public Health Emergency Declarations, visit the Office for the Assistant Secretary of Preparedness and Response.

To read one of my prior blogs on the status of the COVID-19 pandemic in the healthcare industry, click here.

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

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

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

Sources:

Aboulenein, Ahmed. “U.S. Renews COVID-19 Public Health Emergency.” Reuters. (April 13, 2022). Web.

Griffin, Riley. “Biden Administration to Again Extend the Covid Public-Health Emergency.” Bloomberg Law. (July 11, 2022). Web.

AHLA. “US Government To Extend COVID-19 Public Health Emergency Again.” Health Law Daily. (July 13, 2022). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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 © 2022 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T09:59:18-04:00October 12, 2023|Categories: Mental Health Law Blog|Tags: complex civil litigation attorney, complex health care litigation attorney, complex healthcare litigation lawyer, complex medical business litigation attorney, complex medical litigation lawyer, doctor defense legal representation, Florida Louisiana District of Columbia (D.C.) health law defense lawyer, Florida Louisiana District of Columbia (D.C.) professional license defense attorney, healthcare legal representation, legal representation for Department of Health investigation defense lawyer, legal representation for health care professionals, legal representation for healthcare professionals, legal representation for physicians, legal representation for physicians and health care professionals, legal representation for telemedicine issues, nurse defense lawyer, physician complaint defense attorneys, representation for administrative hearing, representation for complex medical litigation, representation for healthcare business litigation matters, reviews of The Health Law Firm attorneys, telemedicine defense lawyer, the health law firm, The Health Law Firm attorney reviews|Comments Off

Female Scientist Files Suit Against Duke School of Medicine For Discrimination, Retaliation

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

On August 10, 2023, a female scientist in the anesthesiology department at Duke University’s School of Medicine filed a complaint against the school under Title VII and the Equal Pay Act. She told the U.S. District Court for the Middle District of North Carolina that Duke paid her less than her male colleagues, increased her hours without increasing her pay, and threatened her with demotions after complaining about it.

According to the complaint (lawsuit), she was the first female principal investigator (PI) to work in Duke’s hyperbaric medicine center. The term “principal investigator,” as used in scientific research, means an individual with a medical degree or Ph.D. appointed directly by third parties (usually the sponsors) to lead and oversee funded scientific research projects on their behalf.

Alleged Hostile Work Environment.

Reportedly, on August 14, 2019, the scientist accepted the position of Assistant Consulting Professor in the Department of Anesthesiology at the Duke University School of Medicine. Because she was expecting to undergo several surgeries, she negotiated a part-time role in which she would work ten hours per week at a $30,000 salary, according to the suit. The federal government funded her projects. Duke clarified it paid her $70 an hour. Additionally, the lawsuit alleged that she was promised to receive more money if she exceeded 10 hours per week.

However, the plaintiff said that her supervisor began assigning her to additional work starting in December 2020 and raised her hours to 20 to 40 hours per week without any extra pay. She contacted the human resources department, but the problem went uncorrected, according to court documents.

Additionally, she began talking to her other colleagues, who were male PIs, about their pay rates and learned that they were all making more than her. The suit claimed that one male PI earned $100,000 for the same work she performed while receiving less than half that amount.

Alleged Gender Discrimination.

The scientist alleges that she complained to Duke about gender discrimination in August 2021. She said her supervisor presented her with an ultimatum two weeks later:
She could either be demoted to a staff position or be downgraded to a job assisting a male PI or resign from her current faculty position. She refused all options, the complaint said.

Subsequently, Duke allowed her contract to lapse, leaving her with 20 hours a week and unclear employment rights under the university’s internal policies, the suit said. According to the complaint, this resulted in her making far less than the $70-per-hour pay rate she was not only promised but also that the university was charging the federal government.

Therefore, she claims in the complaint Duke’s refusal to compensate her at the same pay rate as her male counterparts constitutes a violation of the Equal Pay Act.

The University’s Alleged Retaliation.

After she filed her complaints with the U.S. Equal Employment Opportunity Commission (EEOC), Duke allegedly retaliated against her, according to the suit. This occurred when Duke tried to reclassify her to a nonfaculty position and deprive her of human resources (HR) services and grievance rights.

She also claims that the university interfered with her attempts to escape the discriminatory and retaliatory environment of the anesthesiology department. The complaint states that Duke required her to apply only for staff positions and refused to allow her to be hired as faculty by another department. Still, according to the suit, her supervisor “spread malicious and false information about her” and told her she was ineligible for a transfer. And by mid-2022, she said, her supervisor had begun to refuse to speak directly to her altogether.

Her suit seeks back pay, punitive damages, and attorney fees. To read the entire lawsuit (complaint), click here.

To read other legal documents, visit our website’s Articles and Documents section.

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

The lawyers of The Health Law Firm are experienced in both formal and informal administrative
hearings and in representing physicians in investigations and at institutional review board (IRB) investigations and hearings, and university academic hearings. We represent physicians accused of wrongdoing, in patient complaints, and in Department of Health investigations. Several of our attorneys act as expert witnesses in attorney’s fee litigation and in health law litigation.

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

Sources:

Freedman, Emmy. “Duke Paid Female Scientist Less Than Male Peers, Suit Says.” Law360. (August 10, 2023). https://www.law360.com/health/articles/1709732?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-08-11&read_main=1&nlsidx=0&nlaidx=18

Dalesio, Emery. “Duke University to Pay $54M to Settle Suit Over Hiring Agreement with UNC.” Insurance Journal. (June 7, 2019). https://www.insurancejournal.com/news/southeast/2019/06/07/528679.htm

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 Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T09:59:18-04:00October 11, 2023|Categories: Medical Education Law Blog|Tags: administrative complaint defense attorney near me, clinical investigation fraud misconduct defense lawyer, clinical research investigator defense lawyer, complex healthcare civil litigation attorney, complex litigation representation, complex medical litigation attorney, complex medical litigation lawyer, EEOC complaint legal representation, Equal Employment Opportunity Commission (EEOC) investigation defense, healthcare employment contract legal representation, institutional review board (IRB) investigation hearing defense attorney, legal defense in complaint investigation by institutional review board (IRB), legal defense in medical academic hearings, legal representation for discrimination in medical residency programs, legal representation for disputes with medical residency programs and institutions, legal representation for investigations against health care professionals, legal representation for medical contract review, legal representation for medical professor instructor, legal representation for Title IX hearing, legal representation of clinical professors and investigators, medical professor legal representation, medical research misconduct legal defense representation, misconduct in science defense attorney, representation for healthcare business litigation matters, research fraud defense attorney, resident physician defense legal representation, reviews of The Health Law Firm attorneys, the health law firm, university academic hearing defense lawyer, university medical school legal representation|Comments Off

Rapper 50 Cent Reaches Settlement with Floridians in Lawsuit Over Fake Penis Enlargement Ad

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

On February 21, 2023, Houston rapper 50 Cent settled a lawsuit with a publication over alleged false penis enlargement claims. The rapper, whose real name is Curtis J. Jackson III, sued The Shade Room LLC using three alternative theories of defamation, per se, per quod, and by implication.

The lawsuit revolved around a website article and social media posts, including a photo of him standing next to Angela Kogan of Perfection Plastic Surgery & Medspa in Florida. Both Kogan and Perfection are also named in the rapper’s complaint, which you can read here.

The Complaint.

The rapper initially sued Kogan in September 2022. He maintains that she stole a photo of him to promote her business under the false pretense he’d used the company’s services. In addition, he accused The Shade Room of further enlarging the story by re-posting it and opening him up to further “ridicule.” 50 Cent and his legal team claimed: “By publishing the article and falsely stating or implying that Jackson had received plastic surgery procedures from Kogan or MedSpa, or the penile enhancement or other procedures described in the article, TSR committed a clear act of defamation.

The Settlement.

According to the settlement notice, 50 Cent and the publication “are in the process of executing their respective obligations pursuant to the agreement.” Additionally, it stated that a notice of voluntary dismissal would be forthcoming. The terms of the settlement were not disclosed. You can read the notice of settlement in the case here.

For more information on this case, 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, including defense in complex medical litigation, for physicians, medical groups, plastic surgeons, cosmetic dermatologists, and other healthcare providers. This includes plastic surgeons, cosmetic dermatologists, nurse practitioners, oral and maxillofacial surgeons, psychologists, psychiatrists, mental health counselors, and many others. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We also represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are also experienced in litigation at formal and informal administrative hearings. We also represent physicians accused of wrongdoing, patient complaints, and in Department of Health investigations.

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

Sources:

Keller, Aaron. “50 Cent Settles Penile Enhancement Ad Suit With Publication.” Law360. (February 21, 2023). Web.

AllHipHop. “EXCLUSIVE: 50 Cent’s Penis Enlargement Lawsuit Grows: He’s Now Suing The Shade Room.” MSN. (January 21, 2023). Web.

Brown, Preezy. “50 Cent Settles Lawsuit With The Shade Room Over Alleged Penis Enhancement Photo.” Vibe. (February 21, 2023). 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 Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2023 The Health Law Firm. All rights reserved.