Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors

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 November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.

Physician Fee Schedule Rate Reductions; Counselors Added.

The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a $1.15 decrease from 2023. Physicians’ Medicare reimbursements will fall by 3.4 percent under the PFS in 2024.

However, in a piece of good news, the 2024 final rule allows marriage and […]

By |2024-03-14T09:59:09-04:00March 25, 2024|Categories: Health Facilities Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors
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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 […]

By |2024-03-14T09:59:09-04:00March 25, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Florida Man Agrees to Plead Guilty in $110 Million Telemedicine Medicare Fraud Scheme
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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 […]

By |2024-03-14T09:59:09-04:00March 25, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , |Comments Off on Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme
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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 […]

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
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Walgreens Accused of Providing Insufficient COBRA Notices, Class Action Says

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

On November 30, 2022, a group of former Walgreens workers filed a proposed class action in Florida federal court that accuses the pharmacy chain of sending confusing, incomplete COBRA notices. The former employees sued, saying the company purposely sent former employees “haphazard and piece-meal” information about their rights to continued insurance coverage under the federal COBRA law to save itself money.

As a result, they lost access to their medical coverage when terminated and therefore had to pay out of pocket to cover medical expenses.

Details of the Class Action.

The plaintiffs filed the class action complaint against Walgreen Co. in the United States District Court Middle District of Florida Tampa Division, alleging violations of the Employee Retirement Income Security Act (ERISA) and the Consolidated Omnibus Budget Reconciliation Act […]

By |2024-03-20T20:01:55-04:00March 22, 2024|Categories: Pharmacy Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , |Comments Off on Walgreens Accused of Providing Insufficient COBRA Notices, Class Action Says
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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 […]
By |2024-03-14T09:59:09-04:00March 19, 2024|Categories: Health Facilities Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Under Medical Peer Review from the Military or the VA? Get Experienced Legal Representation Now
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What You Need to Know Right Now If the DEA is Knocking on Your Door!

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

Is the Drug Enforcement Administration (DEA) knocking at your door or, even worse, going through your files inside your office?

If so, this is what you need to know right now!

YES, you do have the right to call your attorney. Call your attorney right now. If you cannot, ask one of your employees or spouse to call your attorney. Get your attorney involved right now!

NO, do not sign a document to relinquish or voluntarily give up your DEA registration number. If you do so, this will probably be the biggest mistake you make in your life.

NO, do not sign a document waiving your right to a grand jury investigation before the DEA is authorized to charge you. Why would you voluntarily give up one […]

By |2024-03-14T20:00:41-04:00March 16, 2024|Categories: Medical Education Law Blog, Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on What You Need to Know Right Now If the DEA is Knocking on Your Door!
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Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations

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

On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.

The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a press release.

Under the deal, in addition to the $19 million payment to Washington State, the federal government will receive $13.3 million related to the settlement, according to the Attorney General’s […]

By |2024-03-14T09:59:09-04:00March 14, 2024|Categories: Nursing Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations
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Many Adverse NPDB Actions Are Reported That Should Not Be;  Here Are Examples

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

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 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 […]
By |2024-03-14T09:59:09-04:00March 12, 2024|Categories: Dental Law|Tags: , , , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Many Adverse NPDB Actions Are Reported That Should Not Be;  Here Are Examples
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Supreme Court of Pennsylvania Says Serial Killer Cannot Sue Psychiatrist for Medical Malpractice

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 and Hartley Brooks, Law Clerk, The Health Law Firm

On November 22, 2023, the Supreme Court of Pennsylvania unanimously decided that a serial killer cannot sue his psychiatrist for gross negligence because the action is barred by the Pennsylvania state law that prohibits criminals from benefitting from their crimes.

The Murderer’s Mental Health History.

In February 2016, Cosmo DiNardo was diagnosed with a major depressive disorder. Three months later, DiNardo was in an ATV accident in which he sustained head injuries. His mother reported that he began acting bizarrely a month after the accident. Additionally, DiNardo was also diagnosed with bipolar disorder and schizophrenia. He was prescribed strong antidepressants and antipsychotics.

DiNardo also had a violent […]

By |2024-03-14T09:59:10-04:00March 11, 2024|Categories: Mental Health Law Blog, The Health Law Firm Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , |Comments Off on Supreme Court of Pennsylvania Says Serial Killer Cannot Sue Psychiatrist for Medical Malpractice
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“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A.
The Health Law Firm, a Florida professional service corporation, since 1999.
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