California Dental Practice Pays $23,000 Settlement For Potential HIPAA Privacy Violations Involving Yelp Posts

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

On December 14, 2022, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) settled with New Vision Dental (NVD) over a potential HIPAA Privacy violation. The California-based dental practice paid $23,000 to OCR and agreed to implement a corrective action plan after allegedly including protected health information (PHI) in its responses to reviews on Yelp.

The Complaint and Investigation.

On November 29, 2017, the Office for Civil Rights (OCR) received a complaint alleging New Vision Dental had posted responses to several unfavorable reviews by patients on Yelp and frequently disclosed confidential protected health information (PHI) in its responses. For example, in some posts, patients were allegedly identified, and NVD revealed their full names when the patient may have only chosen to use a made-up name on the platform. Other information allegedly posted included detailed information about the patient’s visits, treatment, and health insurance, when that information had not been posted publicly by the patient.

The federal agency’s investigation found potential violations of the HIPAA Privacy Rule, including impermissible uses and disclosures of PHI and failures to provide adequate Notice of Privacy Practices and implement Privacy policies and procedures. “This latest enforcement action demonstrates the importance of following the law even when you are using social media. Providers cannot disclose protected health information of their patients when responding to negative online reviews. This is a clear ‘NO,’” said OCR Director Melanie Fontes Rainer in a statement.

To read more, click here for the press release from the HHS.

In addition to the settlement, NVD agreed to implement a corrective action plan (CAP) that will be monitored for two years by OCR. As part of its CAP, the dental practice agreed to develop, revise, and maintain written policies and procedures to comply with federal privacy and security standards. All workforce members will also receive training on those policies and procedures, and NVD is required to remove all social media postings that include PHI.

The resolution agreement and CAP can be viewed here.

Guidelines for Appropriate use of Social Media and Social Networking.

Healthcare professionals are discouraged from interacting with current or past patients on personal social networking sites and should never, under any circumstances, reveal personal information about the patient or the patient’s treatment or care. Online interaction with patients should only occur when discussing the patient’s medical treatment within the physician-patient relationship and with written, signed consent by the patient to use e-mail or other online services for such messaging. These interactions should never occur on personal social networking or social media websites.

Patient privacy must be protected at all times, especially on social media and social networking websites. Breaches in patient confidentiality could harm the patient and violate federal privacy laws such as the Health Insurance Portability and Accountability Act of 1996 and applicable state privacy laws.

Failure to Comply With HIPAA Can Result in Both Civil and Criminal Penalties.

This penalty was the 21st financial penalty to be imposed by OCR in 2022 to resolve HIPAA violations, more than in any other year since it was given the authority to enforce HIPAA compliance. With the increased popularity and availability of social media platforms also comes an increase in potential privacy violations. To read a previous blog I wrote on this, click here.

If Notified of a HIPAA Investigation or Audit, Consult an Experience Health Law Attorney Immediately.

If you receive notice that you have a HIPAA Privacy Complaint, are suspected of a HIPAA breach, or are subject to a HIPAA audit, consult with an experienced health care attorney immediately. There are many technicalities to these laws and regulations, and what may initially seem like a violation may be proven to be nothing. Many defenses can be raised, and often a complaint may be dismissed by the OCR once the correct facts are shown to it by your attorney.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, nurses, and other healthcare providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

Alder, Steve. “OCR Fines California Dental Practice for PHI Disclosures on Yelp.” HIPAA Journal. (December 14, 2022). Web.

McKeon, Jill. “OCR Settles Potential HIPAA Violation After Dental Practice Discloses PHI on Yelp.” Health Care It News. (December 14, 2022).

Health News Weekly. “California Dental Practice Pays $23,000 to Resolve Potential HIPAA Violations Involving Social Media Posts.” AHLA. (December 16, 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 the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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

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

By |2024-04-10T20:00:49-04:00April 12, 2024|Categories: Dental Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on California Dental Practice Pays $23,000 Settlement For Potential HIPAA Privacy Violations Involving Yelp Posts

Florida Pharmacy Sues Claiming HHS Wrongly Terminated it from Federal PrEP Program

Attorney and Author George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 25, 2024, a pharmacy in Celebration, Florida, alleged HHS abruptly terminated it from a federal program that provides free access to preexposure prophylaxis HIV-prevention (PrEP) medication. Turner Brothers Inc., which does business as Turner Drugs, filed a motion in its lawsuit in the U.S. District Court for the District of Columbia for a temporary restraining order and preliminary injunction.  In the motion, Turner Drugs asked a D.C. federal judge to force the U.S. Department of Health and Human Services (HHS) and two contractors to reinstate it to the program. To view the motion, click here.
The pharmacy says it is owed $3.1 million for nearly 1,500 already-approved prescriptions, but the payments have been withheld following its termination. The lawsuit accuses HHS, Mercalis Inc., and Pharmacy Data Management Inc. (PDMI) of breaching a contractual obligation to give participating pharmacies 40 days to fix any alleged breach before terminating them.  Additionally, the suit contends the allegedly overdue payments constitute a breach of contract.
The “Ready, Set, PrEP” Program. 
Turner Drugs, in Celebration, Florida, is a pharmacy providing services to underprivileged patients that need access to free medications, including HIV medication.  Turner Drugs was contracted with a Florida nonprofit, Advanced Health Access Inc., and Continuous Care LLC to operate free medical clinics.  The pharmacy alleges in the motion that it was suddenly terminated from the “Ready, Set, PrEP” program on March 12, 2024. The national program provides people without prescription drug coverage access to HIV-prevention medication as part of an HHS initiative to end the HIV epidemic in the United States.
Details of the Lawsuit.
Even though Turner Drugs claims it has diligently complied with its contractual terms, on March 12, 2024, it was suddenly terminated from the program without warning or written notification. The pharmacy claims it first learned of the termination because its requests for PrEP prescription approvals were denied based on their “nonparticipation” in the program, much to its surprise!
The pharmacy later learned from an attorney at PDMI that it had been “blocked due to suspicious activity” and would be audited at a later date. The alleged suspicious activity was possibly due to Turner Drugs being acquired by Advancing Health as its in-house pharmacy.  The pharmacy said this resulted in an uptick in Ready, Set, PrEP prescriptions.
“Turner Drugs [claims it] attempted to negotiate an amicable resolution by responding to an audit of prescriptions in only one day, offering to make all its records and procedures available to defendants for inspection, and to cooperate with defendants in any other manner they might request,” the complaint states. When the defendants made no attempt to explain the alleged “suspicious activities” and no resolution could be reached, Turner Drugs claims it had “little choice but to prepare” the lawsuit and the motion and file them.
To view the complaint in this case, click here.
For more information on the “ready, Set, prEP” program, click here. 
Consult With A Health Law Attorney Experienced in the Representation of Pharmacists and Pharmacies.
The attorneys of The Health Law Firm routinely provide legal representation to pharmacists, pharmacies, physicians, medical clinics, and other health providers who have received complaints against their licenses, notices of investigations, Medicare or Medicaid audits, Drug Enforcement Administration (DEA) audits, investigations, subpoenas, search warrants, and orders to show cause (OSC) or who are facing formal or informal administrative hearings.
The lawyers of The Health Law Firm are experienced in complex healthcare litigation in both state court and federal court, and in both formal and informal administrative hearings, and represent pharmacists, physicians, physician assistants, nurse practitioners, and other health professionals in investigations and at Board of Pharmacy, Board of Medicine and Board of Nursing hearings. To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
Sources:
Florida Health. “PrEP/PEP Program.” The Florida Department of Health. (August 15, 2024). https://www.floridahealth.gov/diseases-and-conditions/aids/PrEP/index.html
U.S. Department of Health and Human Services. “Ready, Set, PrEP: Find Out If You Qualify to Enroll for Free PrEP Medications.”  https://readysetprep.hiv.gov/#how-to-enroll
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.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.
By |2024-04-09T13:21:22-04:00April 9, 2024|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Pharmacy Sues Claiming HHS Wrongly Terminated it from Federal PrEP Program

Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples

Author headshot standing in dark suit with red tie against a dark grey backgroundBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are constantly being contacted by physicians, nurse practitioners and other licensed health professionals seeking to appeal adverse National Practitioner Data Bank (NPDB) reports.  Often, we find that an adverse report has been made when the matter should not have been.  Federal regulations and NPDB guidelines establish the types of incidents that are authorized to be reported to the NPDB.  When an employer or other organization makes an improper report, it should be challenged and removed.
Types of Matters That Are Not Authorized for NPDB Reports.
Following are some of the incidents for which we have seen adverse NPDB reports that were improperly made:
–Physician or nurse practitioner employed by hospital fired.
–Physician’s contract with a medical group or hospital terminated for cause.
–Hospital medical staff takes action against a physician or nurse practitioner requiring that individual to take continuing education courses on a certain subject.
–Physician’s clinical privileges are administratively suspended because of late medical records or notes.
–Physician or nurse practitioner has clinical privileges summarily suspended for less than 30 days while an investigation or inquiry occurs.
–Adverse action against or findings of substandard care made against an intern or resident physician are not reportable because they do not have clinical privileges.
–Withdrawal of an initial application for clinical privileges in order to avoid a denial (note: not a renewal application, an initial application).
–Adverse action a hospital takes based on the individual’s fees or advertising.
–Payment of a medical malpractice settlement because a hospital, nurse or different individual was negligent.
–Termination of clinical privileges because of inability to obtain board certification or failure to meet other eligibility criteria.
–Withdrawal of an initial application for a state license to avoid a denial (note: not a renewal application, an initial one).
–Resigning from or allowing membership in a professional association to expire before a final adverse decision by that association is made is not reportable (note:  this is unlike the situation from hospital clinical privileges or action by a state licensing board).
–Termination of clinical privileges or state license because of medical reasons.
There are many others. We see them all the time.
Improperly Reported to the NPDB?  Get a Lawyer and Challenge It!
If you are reported improperly to the NPDB, you need to retain the services of a good health lawyer experienced with NPDB issues.  An adverse NPDB report can follow you for life and can make future employment very difficult.  An experienced health lawyer will know exactly what to do to have the improper report removed.
Click here to read one of my prior blogs on how to fight back against adverse NPDB reports.
Don’t Wait Until It’s Too Late, Contact Experienced Health Law Attorneys.
The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. 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 Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
Current Open Positions with The Health Law Firm. The Health Law Firm always seeks qualified individuals interested in health law. Its main office is in the Orlando, Florida, area. If you are a current member of The Florida Bar or a qualified professional who is interested, please forward a cover letter and resume to: [email protected] or fax them to (407) 331-3030.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024, George F. Indest III, The Health Law Firm. All rights reserved.
No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder.  The copyright holder reserves the exclusive right to have his name associated with this work.
By |2024-03-14T09:59:09-04:00April 1, 2024|Categories: Dental Law Blog, Health Facilities Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples

9th Circuit Says Former Federal Nurse Can Proceed With Medical Malpractice Suit Against VA Hospital

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

On September 29, 2021, the U.S. Court of Appeals for the Ninth Circuit ruled that a former federal employee can sue the United States under the Federal Tort Claims Act (FTCA). The suit alleges medical negligence that occurred during psychiatric treatment for a non-workplace-related injury.

As a result, the three-judge panel of the appeals court said that U.S. Navy veteran and VA nurse S.H.s’ lawsuit against a Seattle VA hospital can proceed. (Please note: we are not providing the nurse’s name out of respect for her privacy.)

In 2019, the district court dismissed S.H.’s federal tort lawsuit because the alleged malpractice occurred when doctors were treating an injury she said she sustained at her workplace. The district court reasoned that all existing or exacerbated injuries stemming from a federal workplace injury must be dealt with through the Federal Employees Compensation Act (FECA), even malpractice claims.

Click here to view the district court’s order for the motion to dismiss in full.


Background Details.

The plaintiff in the suit is a veteran of the U.S. Navy who suffered a mental breakdown at work in October 2011. She sought follow-up psychiatric care at a VA hospital, where she allegedly received negligent treatment. At the time the treatment was sought, she was an employee of the federal government. She claimed years of workplace bullying and harassment by her supervisor caused her mental breakdown. She sued in 2016.

The FTCA authorizes plaintiffs to sue the U.S. for “personal injury or death caused by the negligent or wrongful act or omission of any employee of the Government while acting within the scope of his office or employment, under circumstances where the United States, if a private person, would be liable to the claimant in accordance with the law of the place where the act or omission occurred.” 28 U.S.C. § 1346(b)(1). Any individual employee of the government acting within the course and scope of her job duties is immune from liability; the United States is substituted for that person in the suit.

The Big Question: Does the FTCA Authorize Suit by a Plaintiff in This Set of Circumstances?

Two factors complicate the answer in this case. First, when the plaintiff sought treatment, she was an employee of the federal government, working as a registered nurse at the VA hospital. Second, she claimed that her mental breakdown, the event that prompted her to seek medical care, was caused by workplace bullying and harassment at the hands of her supervisor. Hence, this would qualify as a work-related injury.

These facts bring into play another federal statute: the Federal Employees’ Compensation Act. FECA establishes a workers’ compensation blueprint that covers most federal employees. It is similar to state workers’ compensation laws.

When an employee sustains an injury covered by FECA, the remedy is to seek compensation under the act; they may not sue for damages under any other provision of law, including the FTCA. Therefore, had the plaintiff sued the U.S. under the FTCA to recover damages for workplace bullying and harassment, the district court would have been required to dismiss the action as barred by FECA.

In this case, however, the plaintiff is not suing for the injuries caused by workplace bullying and harassment. Instead, she is seeking to recover damages for the alleged medical malpractice by the individual doctors treating her.

Based on these facts, the appellate court reversed the district court’s judgment against the plaintiff in her Federal Tort Claims Act action. It held that the district court erred in dismissing the action on the grounds that it was barred by the FECA.

To view the ninth circuit court’s opinion in full, click here.

Consult a Health Law Attorney Who Is Familiar with Army, Navy, and Air Force Health Care Professionals and Their Problems.

The attorneys of The Health Law Firm have represented federal physicians, nurses, dentists, and other health professionals in the Army, Navy, and Air Force, active duty and retired, as well as physicians, nurses, and other health professionals working for the Veterans Administration (VA) in the U.S. and around the world. They represent physicians and other health professionals with the Indian Health Service (IHS) and the Public Health Service (PHS). Representation has included disciplinary action, investigations, peer review investigations, clinical privileges actions, fair hearings, National Practitioner Data Bank (NPDB) actions, and appeals.

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

Sources:

Capriel, Jonathan. “9th Circ. Revives Psychiatric Med Mal Suit Against VA Hospital.” Law360. (September 29, 2021). Web.

Pazanowski, Mary Ann. “Former Federal Nurse Gets New Shot at Injury Suit Against US.” Bloomberg Law. (September 29, 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 the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“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.

By |2024-03-24T20:02:06-04:00March 26, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on 9th Circuit Says Former Federal Nurse Can Proceed With Medical Malpractice Suit Against VA Hospital

Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme

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

On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts. The fraud was allegedly perpetrated through two Florida companies the man owned, Expansion Media, LLC, and Hybrid Management Group, LLC. According to federal prosecutors in Boston, the scheme involved utilizing telemedicine and telemarketing enterprises to create fabricated orders for medical equipment, particularly knee braces. The scheme allegedly lasted from March 2016 to January 2023.

Specifics on this Medicare Fraud Scheme.

The Florida businessman and owner of Expansion Media, LLC, and Hybrid Management Group, LLC, allegedly sold medically unnecessary Durable Medical Equipment (D.M.E.) to medical staffing companies. According to the government, he used telemedicine and telemarketing companies to create false leads. The telemarketers would pay the Florida man’s companies to generate orders for the medical groups that signed off on them, even though they had no contact with any of the Medicare beneficiaries. The medical devices ordered resulted in $110 million in fraudulent claims, of which Medicare paid $52.5 million.

Prosecutors say the Florida man took many steps to conceal the scheme, including changing his business names, creating fictitious e-mails tied to those companies, and using third-party pass-through payment options.

The Florida man was ordered by the court to pay back $15.7 million and a laundry list of expensive jewelry purchases, such as multiple Patek Philippe watches and Tiffany & Co. jewelry. He agreed to plead guilty, and his deal includes a ten-year prison sentence with supervised releases for three years and fines up to $250,000.

No mention was made about what happened to the Patek Phillippe watches or the Tiffany jewelry, but I have asked the FBI to keep me advised. I have an anniversary coming up.

To view the press release from the U.S. Attorney’s Office, District of Massachusetts, click here.

Florida Man: Joyfully Spreading Florida’s Crime All Over the Place

This blog relates one of my biggest pet peeves. That scurrilous, underhanded Florida Man. Now he has spread his disease of fraud and theft all the way up to the beautiful city of Boston. Why don’t they finally lock him up once and for all?

Is Florida really going to make Florida Man the official state bird, replacing the beautiful Northern Mockingbird? Maybe that’s what he was doing up north in Massachusetts, mocking them.

This case also points out Florida’s reputation as a state which shelters and promotes the use of shell corporations and limited liability companies used to defraud the public and its protection of conmen and fraudsters.

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

The attorneys of The Health Law Firm represent physicians, pharmacists, durable medical equipment (DME) suppliers, and other health care providers in Medicare audits, investigations and subpoenas, Medicaid audits and subpoenas, Medicare and Medicaid investigations, Department of Health (DOH) subpoenas and investigations, Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) subpoenas and investigations, and Medicaid Fraud Control Unit (MFCU) subpoenas, audits and investigations, in Florida, Colorado, Louisiana, the District of Columbia, Virginia, and across the U.S. They also represent healthcare providers in actions to terminate billing privileges, termination from the Medicare or Medicaid programs, and state and federal administrative hearings and litigation.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

DOM. (February 16, 2024). Owner of telemedicine companies charged with $110 million medicare fraud scheme. United States Attorney’s Office. Retrieved from https://www.justice.gov/usao-ma/pr/owner-telemedicine-companies-charged-110-million-medicare-fraud-scheme#:~:text=BOSTON%20%E2%80%93%20The%20owner%20of%20Expansion,as%20back%20and%20knee%20braces.

Dowling, B. (February 16, 2024). Telemedicine exec admits $110 Medicare fraud scheme. Law360. Retrieved from https://www.law360.com/articles/1803737/telemedicine-exec-admits-110m-medicare-fraud-scheme

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 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.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme

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

On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy to commit healthcare fraud charges.

Esformes, who then owned more than 30 Miami-area nursing and assisted living facilities, was first charged in July 2016 with what the Department of Justice (DOJ) called a $1 billion, decades-long Medicare fraud and money-laundering scheme. Click here to read the DOJ’s press release. (https://www.justice.gov/opa/pr/three-individuals-charged-1-billion-medicare-fraud-and-money-laundering-scheme)

The Fraudulent Health Care Scheme.

The government initially accused The Florida Man of bribing physicians to refer patients to the nursing homes he owned in the Miami area. He would then move the patients to his assisted living facilities once he had charged Medicare for the maximum of 100 days the government pays for skilled nursing services.

In April 2019, a federal jury convicted the nursing home mogul on various counts of paying and receiving kickbacks, money laundering, bribery, and obstruction of justice. The judge sentenced him to 20 years in prison and ordered to pay $5.5 million in restitution and to forfeit $38.7 million. Click hear to read more. (https://www.thehealthlawfirmblogs.com/the-biggest-healthcare-fraud-case-ever-prosecuted-in-2019-big-surprise-florida-wins/)

However, in December 2020, former President Donald Trump commuted his 20 year prison sentence. The conviction remained, however, and he was ordered to pay the restitution order, which the Eleventh Circuit later affirmed.

The Retrial.

During the initial trial, the jury was deadlocked on six counts of conspiracy to commit health care fraud. The DOJ announced in April 2021 that it would retry Esformes on these counts. He appealed to the Eleventh Circuit Court of Appeals arguing that a retrial was barred because it would violate Trump’s clemency order. He also argued that the prosecution’s misconduct in reviewing privileged materials barred the retrial. The Eleventh Circuit denied his appeal of the prosecution misconduct issue and did not rule on the issue of Trump’s clemency order.

He appealed to the Supreme Court of the United States which denied his appeal in December 2023.

A Plea Deal with the District Court for the Southern District of Florida.

On February 1, 2024, the judge assigned to the retrial in the case canceled a scheduled conference because the parties had reached a plea deal. A plea in the case lets the Florida man avoid another lengthy trial — and another potentially harsh prison sentence if he were convicted. The terms of the plea deal have not been made public.

Contact Health Law Attorneys Experienced in Health Care Fraud and Anti-Kickback Statute Violations.

The attorneys of The Health Law Firm represent healthcare providers in cases of medical billing fraud, overbilling, Medicare audits, Anti-Kickback allegations, and False Claims Act cases throughout Florida and across the United States. Our attorneys 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.

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:

Bolado, Carolina. “Fla. Nursing Home Mogul Reaches Plea Deal With Feds.” Law360. (1 February 2024) https://www.law360.com/health/articles/1767643?nl_pk=ab1e43aa-534e-4b86-8a5a-6b981ef7c33b&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=1767643&read_main=1&nlsidx=0&nlaidx=0

Hale, Nathan. “Esformes Told To Pay $44.2M In Massive Health Fraud Case.” Law360. (21 November 2019) https://www.law360.com/articles/1219282

Mangan, Dan. “Trump clemency recipient Philip Esformes reaches plea deal in Medicare fraud case.” CNBC. (1 February 2024) https://www.cnbc.com/2024/02/01/trump-clemency-recipient-philip-esformes-has-medicare-plea-deal.html

Office of Public Affairs. “South Florida Health Care Facility Owner Sentenced to 20 Years in Prison for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice.” United States Department of Justice. (12 September 2019) https://www.justice.gov/opa/pr/south-florida-health-care-facility-owner-sentenced-20-years-prison-role-largest-health-care

About the Authors:

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice.

Hartley Brooks is a law clerk with The Health Law Firm.

The Health Law Firm has its main office is in the Orlando, Florida, area, and can be reached at: 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.

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.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

Florida Primary Care Practice Settles HIPAA Investigation for $20,000

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

On December 15, 2022, the Department of Health and Human Services (HHS), Office for Civil Rights (OCR), announced that Health Specialists of Central Florida, Inc., will pay $20,000 to resolve alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule’s right of access standard.

The primary care provider also agreed to a corrective action plan (CAP) with two years of monitoring.

It is extremely important that Florida physicians and health professionals remember that there is a federal law requirement under HIPAA that requires the timely furnishing of a health record requested by a patient. You must be sure to meet the deadline, but, more importantly, document that you have met it. Use cover letters, obtain receipts when possible, and document the date you provided the record in the record.

Click here to view the press release issued by the OCR.

Right of Access Standard.

OCR first launched an investigation into Health Specialists of Central Florida after the daughter of a deceased patient filed a complaint in November 2019. The complainant made a written access request for her father’s medical records but did not receive them for nearly five months, and only after multiple requests.

The HIPAA right of access standard requires covered entities to respond to requests for records within 30 days of receipt or 60 days if it obtains an extension of time. OCR’s guidance on the right of access is available here.

The Settlement.

In addition to the monetary settlement, Health Specialists of Central Florida will undertake a corrective action plan (CAP) that includes two years of monitoring. The CAP requires the practice to develop, maintain, and revise its written privacy procedures and policies, distribute them to the workforce, and review and update its right of access to PHI policy.

This case marks the 42nd case resolved under OCR’s HIPAA Right of Access Initiative. To view the settlement agreement and CAP, click here.

 

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, dental practices, medical groups, nursing homes, home health agencies, pharmacies, hospitals, and other healthcare providers and institutions in investigating and defending against HIPAA investigations and complaints and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.

Sources:

Health Law Weekly. “Florida Primary Care Provider to Pay $20,000 to Resolve Right of Access Probe.” AHLA. (December 16, 2022). Web.

Giles, Bruce. “Florida primary care practice fined HHS $20K for not giving timely access to patient data.” Becker’s Hospital Review. (December 16, 2022). Web.

McKeon, Jill. “OCR Resolves HIPAA Right of Access Case With FL Primary Care Practice.” Health IT Security. (December 16, 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 the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

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

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

 

By |2024-03-21T20:00:52-04:00March 23, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Primary Care Practice Settles HIPAA Investigation for $20,000

When the DEA Comes Knocking: 15 Tips If You Find Yourself Facing a “Routine” DEA Inspection

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

As the United States continues to open back up from the COVID-19 shutdown, the Drug Enforcement Agency (DEA) is resuming on-site routine inspections.  Therefore, healthcare professionals must ensure compliance and regulatory efforts are in place.

This is part 1 of a 2-part blog series. Check back for part 2 of this blog series soon!


DEA Inspections and Site Visits:  Subpoenas.

DEA agents are often pushy, demanding, and intimidating.  They will try to use subpoenas (which are merely requests for documents that afford you at least ten days to produce the requested documents) as search warrants.  THEY ARE NOT.  They will try to use an administrative subpoena to obtain documents and get your testimony immediately. YOU DO NOT HAVE TO PRODUCE THEM RIGHT AWAY. A copy of a sample subpoena used by the DEA is on our website for reference here.


Not Just a Routine Audit, Inspection, or Investigation.

Beware the “Notice of Inspection of Controlled Premises” (DEA Form 82).   Although the DEA often treats it as one, it is not a search warrant.  Also, it is probably NOT a “Routine Inspection.”  IT WILL NOT TAKE ONLY 15 TO 20 MINUTES.

We have had several clients who have had to close down their businesses all day to try to accommodate the demands of the agents performing their “routine inspection.”  The DEA should not cause you to shut down or should not cause you to turn away patients.  It should not interfere with your patient services or your ability to provide them.  You can ask them to come back at a later date.

The DEA often refers to “routine audits” as “Accountability Investigations” and requires the pharmacy or registrant to be given certain rights in connection with it. For example, DEA Form 82 states you are given the following rights:

1.    The constitutional right not to have an administrative inspection without an Administrative Inspection Warrant (AIW),
2.    Has the right to refuse consent to such an inspection,
3.    Presented with a Notice of Inspection,
4.    Given consent voluntarily, without threats of any kind,
5.    May withdraw consent at any time during the course of the inspection, and
6.    Incriminating evidence may be seized and used in criminal prosecution.

Although the DEA agent may tell you that the site visit is “completely random,” do not believe it.  If the DEA agent has brought a list of records to obtain from you, try to keep a copy of it, as your lawyer may find it very useful later when they are defending you.


What to Do When Confronted with a DEA Inspection or Site Visit.

1.    Notify the owner right away.  If you are not the owner, don’t sign anything, give permission, or agree to anything. You probably have no authority to do so.

2.    Call your health lawyer and get them over immediately.  This is an emergency!

3.    Yes, you have the right to consult with your attorney;  do not believe them if they say you can’t (which they may do, believe it or not).

4.    Request photo identification from everyone to ensure the individuals are who they say they are.  No identification? No access. Federal agents, including DEA agents, will always have their photo ID.

5.    Obtain a business card from each person present.  DEA agents always carry business cards.  If they do not have one, you will have to write all contact information for that agent from their photo id card (or photocopy, if they will allow you to do so).

6.    Do the same as the above for anyone else the DEA brings, whether they claim to be a federal or state investigator, Department of Health investigator, or local police. Please note that our experience has been that the DEA and state agencies contend that they don’t go on joint inspections or investigations (however, we don’t believe this to be true).  Therefore, get all parties’ information at the very start, or you may never get it until they testify against you.

7.    DO NOT SIGN A VOLUNTARY AGREEMENT TO RELINQUISH YOUR DEA REGISTRATION.  Agents may try to pressure and intimidate you into signing one by telling you it will be easier if you sign it. They might even try to scare you by warnings of criminal prosecution unless you sign it.  Yes, you have the right to consult with an attorney before deciding whether or not to sign it (they may falsely tell you that you don’t). However, once you sign it, it is gone.  If you are a prescribing physician or health professional, your authority to prescribe is gone forever.  If you are a pharmacy/pharmacist, your ability to order or fill any controlled substances is forever gone. So go ahead and put a sign on the door that says “CLOSED-Out of Business.”

8.    Before the inspection begins, you should be given a form to read and sign. If not, request it. It will usually be a DEA Form 82 “Notice of Inspection of Controlled Premises” Form. Before the inspection, it should be read, explained, agreed to, and signed, not during or after.

9.    Read the form carefully. You have the right to fax it, scan and e-mail it, or call and read it to your attorney before you sign it. If it says you have the right to refuse the inspection, consider putting it off until a later date. Especially if you are busy and have patients you must serve.

10.    Obtain a copy of the form (inspection form or subpoena) at the beginning and keep it.  You will need this later.

11.    Obtain a complete, detailed receipt for any documents, prescriptions, or other items taken by the agents. Again, since this is not a search warrant, the DEA does not have the authority to take your only originals and leave you without a copy.

12.    You may or may not be in serious trouble and subject to future criminal charges or administrative action to revoke your DEA registration. Your attorney should be able to evaluate this and advise you. Don’t bother to ask the agents, as they will not tell you what is in your own best interest to know.

13.    If you don’t have an attorney who is experienced in health law and DEA defense,  get one NOW.  You should begin preparing now.  It often takes the DEA a year or more to work up charges against you.  Once you are served with charges, you will only have a very short time to prepare your defense.  It is a completely unfair system for the subject of charges as the government will have longer to prepare its case against you than you have to prepare your defense.  Take advantage of the time you have. Do not waste it.

14.    Be polite and do not argue with a DEA agent.

15.    Do not volunteer information, but never tell a lie. Making a false statement to any federal agent is a felony criminal offense. A subpoena for documents is not an authorization to interrogate you.  A search warrant is not an authorization to interrogate you.

Lastly, don’t forget to check back to read part 2 of this blog series.

Please remember: This blog’s statements are opinions based on our experience.  If you do not agree with it, then you are probably the DEA.

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

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

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

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


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


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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.

By |2024-03-19T20:00:14-04:00March 21, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on When the DEA Comes Knocking: 15 Tips If You Find Yourself Facing a “Routine” DEA Inspection

Under Medical Peer Review from the Military or the VA? Get Experienced Legal Representation Now

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Our firm is often consulted by military physicians, Veterans Administration (VA) physicians, and former military and VA physicians concerning matters involving peer reviews of their care. In the military, whether Army, Navy, or Air Force, peer review for all physicians is now governed by one general department. The Department of Defense (DOD) Regulation, that is, Defense Health Agency Procedures Manual (abbreviated DHA PM) 6025.13, became effective October 1, 2019. VA physicians have different, but somewhat similar regulations that apply to them.
We are often consulted by these physicians, who no longer serve with those agencies, or after action has already been taken to report them to the National Practitioner Data Bank (NPDB) for allegedly substandard care. Such reports go into the NPDB for fifty (50) years and are reported to all state licensing boards and to the Federation of State Medical Boards (FSMB).
They can haunt a physician’s career for life.
What Should You Do When Notified of a Claim, Investigation, Peer Review Action, or Quality Assurance Investigation (QAI)?
When you first notice that you are the subject of or named in a Federal Tort Claims Act (FTCA) claim or any type of inquiry or investigation related to your care, you should consult with a healthcare attorney with experience in such matters. We are few and far between, but you can find us if you look for us.
You will usually have at least two opportunities to provide input into such matters, but you need to take advantage of the earliest opportunity to influence the outcome.
1.You must obtain and review a copy of the medical record.
2.You need to have an expert in your medical field review the case for you.
3.You can request an extension of time if needed.
What Are Questions I Should Ask of an Attorney with Whom I Consult?
These are the questions that I suggest you ask any attorney you consult with:
1.What is your experience dealing with the military or VA medical system?
2.How many similar matters of this nature have you handled?
3.Are you familiar with National Practitioner Data Bank (NPDB) reports, challenges and appeals?
4.How many NPDB matters have you handled?
5.How many cases have you handled in which you assisted in making statements for input into such investigations or inquiries?
6.Are you familiar with the Memorandum of Understanding (MOU) between the DOD and the Department of Health and Human Services (DHHS) taking DOD NPDB reports out from under the regular NPDB procedures?
7.How many military or VA quality assurance investigations have you represented physicians?
8.How many VA and military peer review/clinical privileges hearings have you done?
9.How familiar are you with hospitals and health systems?
10.How familiar are you with the military medical system, the roles of the Surgeons General, and the Department of Defense Division of Health Affairs (DOD HA)?
11.How familiar are you with DOD PM 6025.13?
12.How familiar are you with:  VHA Directive 1190 (Peer Review for Quality Management), VHA Handbook 1050.01 (VHA National Patient Safety Improvement Handbook), VHA Handbook 1100.17 (National Practitioner Data Bank (NPDB) Reports), VHA Handbook 1100.19 (Credentialing and Privileging), VHA Directive 2008-077 (Quality Management (QM) and Patient Safety Activities . . . ), VHA Directive 1026 (VHA Enterprise Framework for Quality, Safety and Management), and VA Handbook 5120/14 (Employee/Management Relations)?
Don’t Wait Until After the Decision to Report You Has Been Made.
Don’t wait until the final decision has been made to report you to obtain experienced legal counsel to represent you in defending yourself against allegations of substandard care. Avail yourself of any and all opportunities to provide your concise, objective, and well-reasoned medical rationale for your care at the earliest stage you are allowed to do so.
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.
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 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.
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2024 George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any way in any medium without the written permission of the copyright owner. The author of this work reserves the right to have his name associated with any use or publication of this work or any part of it.

Letter from the OIG Terminating You from the Medicare Program? What You Need to Do!

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

Have you received a letter from the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) proposing to terminate you or exclude you from the Medicare Program? This is an extremely serious matter. You need to take action right away! For a physician or other health professional, this may be the most serious situation you have ever faced. Yes, even more serious than that jail sentence you just finished serving.

Do not let the time period to appeal or challenge this expire without filing an appeal with the appropriate official. Hire an experienced health law attorney to assist you with this right away. Make sure it gets done on time.

The Proposed Exclusion and Period of Exclusion May Not Be Appropriate in Your Case.

We often see letters from the OIG advising that the recipient healthcare professional is subject to a mandatory exclusion for a minimum of 20 years. This may not be accurate or correct.

Often a much shorter mandatory exclusion period of time is all that the law requires. By presenting the appropriate evidence at an appeal hearing, you can have the exclusion period reduced to a much shorter length of time.

Sometimes the OIG has initiated a mandatory exclusion when only a permissive exclusion (for a much shorter period of time than a mandatory exclusion) is authorized.

We have seen cases where a conviction of a criminal offense is not even one for which a Medicare exclusion is authorized at all. For example, a criminal action not involving theft, fraud or false claims and involving some technical violation of federal or state law, such as an immigration violation.

The only way to obtain relief when an inappropriate exclusion action is initiated by the OIG is to file a timely appeal and to have an appeal hearing before an administrative law judge. However, the appeal must be timely. It must be actually received by the appropriate official and agency by the deadline stated in the OIG’s letter. Not “mailed by,” not “filed by,” but “received by.”

Consequences of Medicare Termination or Exclusion from the Medicare Program Are Severe.

If you are terminated or excluded from the Medicare Program, you are automatically excluded from any state Medicaid Program. In many states, either of these are now grounds for revocation or non-renewal of a medical, nursing, dental, pharmacist, or psychotherapist license.

You will no longer be authorized to bill Medicare or Medicaid nor to order or prescribe an care or treatment paid for by Medicare or Medicaid. This means you will not be able to prescribe medications , order x-rays or lab test, or even order specialty consultations paid for by Medicare or Medicaid.

However, you will also be barred form any federal employment, contracting or subcontracting. You will be placed on the Office of Federal Contract Compliance Programs (OFCCP) Debarred List in the System for Award Management (SAM). This was previously called the “Debarred List” and was previously maintained by the General Services Administration.

SAM contains the electronic roster of debarred companies and individuals excluded from Federal procurement and non-procurement programs throughout the U.S. Government and from receiving Federal contracts or certain subcontracts and from certain types of Federal financial and nonfinancial assistance and benefits. The SAM system combines data from the Central Contractor Registration, Federal Register, Online Representations and Certification Applications, and the Excluded Parties List System.

You will be prohibited from working for or contracting with any company, organization or individual that receives any federal government funds from any source. You will be prohibited from being a shareholder, officer, employee, contractor or subcontractor of any company, organization or individual who receives any government funds from any source. This will prohibit you from almost any work for any health-related jobs, any insurance companies, any schools or colleges, any real estate agencies or brokers who are involved in any federally backed mortgages (VA or FHA), joining the military or public health service, and many, many other jobs.

Credentialing and certification organizations will revoke your credentials. Health insurance companies will terminate you from their provider panels.

Military service, forget it.

Work for the VA, forget it.

Contact an Experienced Health Lawyer to Help Eliminate or at Least Limit the Damage.

You need to immediately contact and retain an experienced health lawyer to fight this on the front end. You must try to reduce or prevent a lengthy exclusion period form being imposed from the very start. It will be too late to attempt to do this later.

You may have valid defenses to the exclusion, but only an experienced health lawyer is going to be able to assist you in finding these and effectively raising these in your defense. Don’t wait until it is too late!

Call The Health Law Firm! We area available to help you on these issues anywhere in the U.S.

Contact Health Law Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

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.

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.

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

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

Copyright © 2024, George F. Indest III, The Health Law Firm. All rights reserved. No part of this work may be reproduced in any form in any medium without the express written permission of the copyright holder. The copyright holder reserves the exclusive right to have his name associated with this work.

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