Stryker Orthopaedics Facing Dozens of Hip Implant Lawsuits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law As of February 2013, more than 80 lawsuits have been consolidated into multicounty litigation (MCL) in the Superior Court in New Jersey against Stryker Orthopaedics. Patients are claiming the company’s Rejuvenate and ABG II modular-neck femoral hip systems […]
Optometrists and Ophthalmologists Not Seeing Eye to Eye Over Proposed Law Allowing Prescribing
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This year Florida House Bill 239 and Florida Senate Bill 278 has been reignited in the Florida Legislature. This legislation is pitting optometrists and ophthalmologists against each other in what is being called the “eyeball wars,” according to […]
First Trial Over DePuy Hip Implants Finished – Plaintiff Receives $8.3 Million
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm On March 8, 2013, a California jury ruled that Johnson and Johnson’s DePuy unit designed a defective metal-on-metal ASR XL hip implant and was negligent, according to Bloomberg News. The […]
Two National Recalls Prompt Food and Drug Administration (FDA) to Update Metal-on-Metal Hip Implant Safety Concerns
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm On January 17, 2013, the Food and Drug Administration (FDA) issued an updated public health communication about hip replacement components that have both a metal ball and a […]
Medical Negligence – An Accidental Overdose of Prescription Pain Pills Can Lead to Lawsuits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Carole C. Schriefer, R.N., J.D., The Health Law Firm In February 2009, a 30-year-old male patient was prescribed, all together, 180 pills of Dilaudid and Xanax from a South Florida pain clinic. Sometime within the next 24 […]
Two More Compounding Pharmacies Recall Drugs
By Carole C. Schriefer, R.N., J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Two different compounding pharmacies have recently recalled products due to concerns from the Food and Drug Administration (FDA). The New Jersey compounding pharmacy, Med Prep Consulting, and Clinical […]
Tips for Responding to a Medicaid Audit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. The most important thing is that […]
Tips for Medical Students and Medical Residents Accused of Irregular Behavior on the USMLE
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We frequently receive calls for consultations from students who receive a letter from the National Board of Medical Examiners (NBME) accusing the medical student or medical resident of “Irregular Behavior” on the United States Medical Licensing Examination (USMLE). […]
It’s the End to the Eyeball Wars-Optometrists and Ophthalmologists Come to an Agreement: Optometrists Allowed to Prescribe
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On April 4, 2013, the Florida Senate passed Florida Governor Rick Scott a hard-fought bill that would expand the drug-prescribing practices of optometrists, according to the Associated Press. House Bill 239 has pitted optometrists against ophthalmologists for years […]
Speech Therapist Arrested for Billing Medicaid $500,000 for Work at Florida Day Care Centers While Living in Illinois
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A speech therapist was arrested on March 29, 2013, for allegedly billing Medicaid more than $500,000 for services that she did not provide, according to the Florida Office of the Attorney General (AG). The speech therapist now faces […]
Number of Oxycodone-Related Deaths Down in Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law It looks like Florida’s prescription drug legislation, the statewide prescription drug monitoring database and the prescription drug crackdowns by law enforcement may be working, according to the Florida Department of Law Enforcement (FDLE). The FDLE states in its […]
Colorado Surgeon Accused of Botching Multiple Robotic Arm Surgeries
By Carole C. Schriefer, R.N., J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Colorado surgeon allegedly faces 14 counts of unprofessional conduct associated with the use a robotic arm used during surgeries, according to the formal administrative complaint. The Colorado […]
Florida Man Sentenced to Prison for Role in Florida Hospital Data Theft
By Lance O. Leider, J.D., The Health Law Firm A Davenport, Florida, man was sentenced to four years in prison for paying off two Florida Hospital employees to illegally access patient records, according to the Department of Justice (DOJ). A judge sentenced Sergie Kusyakov on April 10, 2013. He was charged with conspiracy and wrongful […]
Poll Shows Majority Supports the Legalization of Marijuana
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For the first time in four decades, a majority of Americans support the legalization of marijuana, according to a national survey conducted by Pew Research. The results from the survey, released on April 4, 2013, show fifty-two percent […]
Healthcare Providers Service Organization (HPSO) Attorneys, Lawyers and Defense Council in Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Often we learn after the fact that a health professional such as a mental health counselor, psychologist, or pharmacist has received Healthcare Providers Service Organization (HPSO) insurance, has had a legal problem, and has not been able to […]
The Doctors Company (TDC) Attorneys, Lawyers and Defense Council in Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Often we learn after the fact that a health professional such as physicians, dentist and other health professionals has received The Doctors Company (TDC) Insurance, has had a legal problem, and has not been able to locate an […]
American Medical Association Joins Minnesota Medical Staff in Its Fight for Autonomy
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The American Medical Association (AMA) and several other physician organizations announced support of a court appeal by physicians at Avera Marshall Regional Medical Center in Minnesota. The medical staff at Avera alleged the hospital’s governing board amended the […]
Two Separate Lawsuits Against Novartis Pharmaceuticals Corporation Allege Illegal Kickbacks and False Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Novartis Pharmaceuticals Corporation (NPC) is currently fielding two different lawsuits, filed just days apart from each other, by the U.S. Department of Justice (DOJ). The first lawsuit was filed on April 23, 2013, alleging the company gave illegal […]
Strike Force Busts 89 People, Mostly Health Care Professionals, in Nationwide Crackdown on Medicare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In a nationwide takedown nearly 100 people, including doctors, nurses and other medical professionals, in eight cities were all allegedly charged in separate Medicare fraud schemes. These individual scams involved approximately $223 million in false billing, according to […]
Internal Revenue Service Decides Electronic Health Record Incentive Payments are Taxable
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Internal Revenue Service (IRS) has taken the position that electronic health record (EHR) incentive payments are taxable. Previously it was not specified how EHR incentive payments were to be treated or reported to the IRS. On January […]
The Affordable Care Act Offers the Government New Tools to Fight Healthcare Fraud
By Catherine T. Hollis, J.D., The Health Law Firm In 2013, the government reported recovery of a record-breaking $10.7 billion in healthcare fraud in the past three years, according to the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ). The HHS credits the Affordable Care Act’s tough stance […]
Department of Justice Seeks up to $600 Million in Whistleblower Case Against Halifax Health in Daytona Beach, Florida
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Department of Justice (DOJ) is asking for between $350 million and $600 million in damages and penalties from Halifax Health Medical Center in Daytona Beach, according to The Daytona Beach News-Journal. A Halifax employee filed the […]
Health Care Professionals and Providers Beware: The Health Care Fraud Prevention and Enforcement Action Team (HEAT) Is Catching Fire
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In May 2009, the Department of Health and Humans Services (HHS) and the Department of Justice (DOJ) created the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT’s mission is to focus its efforts on preventing and […]
Texas Oncologist Accused of Poisoning Coworker/Boyfriend’s Coffee
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Houston, Texas, doctor is accused of spiking her co-worker’s coffee with a toxic chemical. Both the female doctor and the male co-worker she allegedly tried to poison worked as oncologists at The University of Texas M.D. Anderson […]
Drug Enforcement Administration Agents Raid Central Florida Pain Management Clinic
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Drug Enforcement Administration (DEA) agents along with local police and sheriffs’ deputies raided a Longwood, Florida, pain management clinic on June 14, 2013. According to the Orlando Sentinel, agents searched for evidence at the clinic associated with multiple […]
Supreme Court Rules that Government Regulators Can Sue Over Pay-for-Delay Agreements Between Brand and Generic Drug Manufacturers
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Supreme Court ruled on June 17, 2013, that pay-for-delay agreements between brand name and generic drug manufacturers are subject to anti-trust scrutiny. These pay-for-delay agreements, or reverse payments, are usually a form of settlement between the […]
Medical Students and Residents Must Fight Allegations of “Irregular Behavior” on the USMLE Step Exams
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law I am constantly taking calls from medical students and residents (or future residents) relating to allegations brought against them of “irregular behavior” in connection with the United States Medical Licensing Examination (USMLE) exams. Although the term “irregular behavior” […]
Terrible Things That Can Happen after Discipline on Your Professional License or Resignation of a License after Notice of Investigation
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Do you have a medical, pharmacy or nursing license in several different states? Do you have a license in more than one health profession? Have you been notified that an investigation has been opened against you? Are you […]
New Details Released on Drug Enforcement Administration’s Investigation of Central Florida Pain Management Clinic
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Drug Enforcement Administration’s (DEA) investigation into a Longwood, Florida, pain management clinic continues. More details are being revealed about the case. DEA agents along with local police and sheriffs’ deputies raided the pain management clinic on June […]
Top Medicare Prescribers Collect Speaking Fees from Drug Makers-Coincidence?
By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A recent investigation by ProPublica found that certain doctors who prescribed certain drug brands the most, also have financial ties to the companies that manufacture those prescription drugs. Using […]
Fifty-Five Hospitals Around the Country to Pay the Government $34 Million Settlement for False Claims Allegations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Fifty-five (55) hospitals in twenty-one (21) states have agreed to pay the Department of Justice (DOJ) more than $34 million to settle allegations of Medicare fraud in a whistleblower case, according to the DOJ on July 2, 2013. […]
Central Florida Pain Management Clinic Falls Victim to Civil Forfeiture
By Christopher E. Brown, J.D., The Health Law Firm On June 14, 2013, Drug Enforcement Administration (DEA) agents, along with local police and sheriffs’ deputies raided a Longwood, Florida, pain management clinic. In addition to criminal charges, the physicians and employees associated with this clinic face another lesser known threat, the civil forfeiture of their […]
Enforcing Your Right to Access Public Records
By Lance O. Leider, J.D., The Health Law Firm Citizens of the state of Florida enjoy broad access to the public records created by state agencies. Those records range from information on state contracts to certain police records to information on state licensees. Almost all records created by or held by state agencies on you […]
Cardiologists Face Higher Scrutiny by CMS
By Lance O. Leider, J.D., The Health Law Firm As the U.S. population ages and heart disease continues to be a leading cause of health issues, cardiologists and cardiology practices are finding themselves billing Medicare for more and more visits and procedures. Along with that increase in reimbursement from Medicare comes an increase in scrutiny. […]
Relocating, Selling or Closing Your Medical Practice? Be Sure to Comply with Florida Law
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Relocating, selling or retiring is never an easy decision for a physician. On top of patients’ anxiety about their doctor leaving, there are also legal hoops you will be required to jump through. It’s important to know what […]
Medicaid Fraud Control Unit Arrests Three Florida Women for Allegedly Bilking Medicaid Out of $27,000
By Lance Leider, J.D., The Health Law Firm Three Central Florida women were arrested by the Attorney General’s (AG) Medicaid Fraud Control Unit (MFCU) on July 18, 2013, for allegedly defrauding Medicaid out of $27,000. According to the AG, the owner and two managers of Destiny TCM Corporation are accused of billing Medicaid for services […]
Florida Hospice to Pay $1 Million to Settle Whistleblower Lawsuit Over False Billing Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Hernando-Pasco Hospice (HPH Hospice) in Hudson, Florida, agreed to pay $1 million to resolve allegations that it violated the False Claims Act by submitting false claims for services to the Medicare and Medicaid Programs. According to the […]
CMS Fights Medicare Fraud With Ban on New Home Health Agencies and Ambulance Suppliers in Three Cities
By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) announced it will temporarily ban new home health providers and ambulance suppliers from enrolling in Medicare, Medicaid and the Children’s Health […]
First Year Pioneer ACO Results: Medicare Money Saved But Some Physicians Leave Program
By Lance O. Leider, J.D., The Health Law Firm On July 16, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a press release summarizing the performance results for the first year of the Pioneer Accountable Care Organization (ACO) Model. Made possible by the Patient Protection and Affordable Care Act (PPACA), the Pioneer ACO […]
Physician Payment Sunshine Act Deadline is Here-Are You Ready?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Lance O. Leider, J.D., The Health Law Firm As of August 1, 2013, the Physician Payment Sunshine Act (Sunshine Act) goes into effect. The Sunshine Act, contained in Section 6002 of the Patient Protection and Affordable Care […]
Orlando Health’s Restructuring Efforts Might Mean Pay Cuts and Layoffs for Employees
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Many employees at Orlando Health might be getting hit hard in the wallet with pay cuts schedule for later this year. According to the Orlando Sentinel, the eight-hospital health system notified its night-shift workers that their differential pay […]
Affinity Health Plan Settles with Government in Photocopier HIPAA Breach Incident Involving Patient Medical Information
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Department of Health and Humans Services (HHS) Office of Civil Rights (OCR), and Affinity Health Plan, Inc. (Affinity), reached a settlement for more than $1.2 million for potential violations of the Health Insurance Portability and Accountability […]
Oncologist Accused of Billing Medicare for Unnecessary Chemotherapy-Employee Whistleblowers Filed First Claim
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Michigan oncologist is accused of deliberately misdiagnosing patients with cancer so he could allegedly administer chemotherapy treatments and bill the government for those treatments, according to the Department of Justice (DOJ). For more than two years the […]
Doctor Sentenced to Almost 27 Years in Prison for Pill Mill Charges
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A doctor was sentenced to almost 27 years in prison on July 24, 2013, according to the Sun Sentinel. The former doctor, Sergio Rodriguez, had worked as a pediatrician at Children Plus Health Center near Palm Beach County, […]
New York-Based MRI Company to Pay $3.57 Million Settlement to Resolve False Claims Act Allegations in Whistleblower/Qui Tam Case
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 27, 2013, the Department of Justice (DOJ) announced a settlement between the government and New York-based Imagimed LLC, its former owners and its former chief radiologist. This $3.57 million settlement resolves whistleblower/qui tam allegations of false […]
Hawaii Hospital to Pay More Than $451,000 to Resolve Whistleblower/Qui Tam Allegation of Improper Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Wahiawa General Hospital in Honolulu, Hawaii, agreed to pay $451,428 to settle two lawsuits alleging that the hospital improperly billed Medicare, Medicaid and Tricare. The settlement stemmed from a civil whistleblower/qui tam lawsuit. The lawsuit was filed by […]
Removal of Past Criminal History from Florida Department of Health Practitioner Profile
By Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law By statute, the Florida Legislature requires that the Department of Health (DOH) maintain an online practitioner profile for medical doctors, osteopathic physicians (DOs), chiropractors (DCs), advanced practice registered nurses […]
New Requirements Released for Physician Medical Records Related to Compounded Medications
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 5, 2013, the Florida Board of Medicine and the Florida Board of Osteopathic Medicine published new requirements for medical record documentation […]
Miami “Rock Doc” Arrested on Medicare Fraud Charges
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law An osteopathic physician in Miami, Florida, dubbed the “Rock Doc,” was arrested on September 30, 2013. He is charged with twelve (12) counts of health care fraud, according to the Department of Justice (DOJ). The “Rock Doc” is […]
Tuomey Healthcare System Ordered to Pay a Reduced $238 Million in Damages for Allegedly Violating Stark Law and False Claims Act
Lance O. Leider, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 30, 2013, a federal judge ordered Tuomey Healthcare System in Sumter, South Carolina, to pay $238 million in penalties and fines. The hospital system is accused of paying […]
The American Academy of Family Physicians Releases Third List for Choosing Wisely Campaign
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On September 24, 2013, the American Academy of Family Physicians (AAFP) released its third list of commonly prescribed tests and procedures that may not be necessary. This list is part of the American Board of Internal Medicine (ABIM) […]
Two Laptops Containing Information of 729,000 Patients Stolen from California Hospital Group
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The personal health information of around 729,000 patients has been compromised following the theft of two laptops. The password-protected computers were taken from an administration building of AHMC Healthcare Inc., a hospital group in Alhambra, California. According to […]
Florida Nursing Home Owner Arrested for Alleged $395,000 Medicaid Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Miami-Dade nursing home owner was arrested for allegedly committing $395,000 worth of Medicaid fraud. The Florida Attorney General (AG) accused the nursing home owner of using the billing names of non-existent businesses to submit fraudulent invoices. The […]
Grace Period Included in the Affordable Care Act Could Pose Financial Risk to Healthcare Professionals and Providers
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A little known rule published by CMS to implement the Affordable Care Act (ACA) could pose a significant financial risk for doctors, hospitals […]
MedPAC Wants to Hold Accountable Care Organizations More Accountable
By Lance O. Leider, J.D., The Health Law Firm As the Centers for Medicare and Medicaid Services (CMS) prepares to designate the next class of accountable care organizations (ACOs), the agency sought the advice and input of the Medicare Payment Advisory Commission (MedPAC) on how to proceed. MedPAC is an independent Congressional Agency established to […]
Fake Doctor in Texas Accused of Injecting Patients with Silicone Instead of Botox
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A South Texas woman was charged on October 31, 2013, for allegedly injecting people with silicone, that she claimed was Botox. The phony health professional, described in some media reports as an “unlicensed plastic surgeon,” has been charged […]
Florida Doctor Faces Administrative Hearing Over Allegations of Torturing Patient
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Lake Worth, Florida, doctor accused of “punishment therapy” that included the use of whips, blindfolds, handcuffs and other instruments of torture could have his license revoked by the Florida Board of Osteopathic Medicine. At the meeting on […]
Copying and Pasting Clinical Notes in Electronic Health Records Could Be Considered Healthcare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is concerned about healthcare providers carelessly copying and pasting clinical notes in electronic health records (EHRs). According to an audit report released on December 10, […]
ZPICs Seek “Voluntary” Agreements from Physicians for Auto-Denial Edits for Home Health Services
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law According to the Centers for Medicare and Medicaid Services (CMS), the primary purpose of Zone Program Integrity Contractors (ZPICs) is to investigate instances […]
Fake Surgeon in Florida Accused of Performing Liposuction Without a License
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Kissimmee, Florida, man was arrested on December 18, 2013, on charges that he has been allegedly performing liposuction without a medical license in a Central Florida clinic. According to the Orlando Sentinel, the Metropolitan Bureau of Investigation […]
Adventist Health System Settles Whistleblower Lawsuit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 18, 2013, Adventist Health System/Sunbelt Inc., the parent company of Orlando-based Florida Hospital, settled a whistleblower lawsuit, according to court documents. The whistleblower lawsuit, filed in 2010, stated that seven Adventist hospitals in Florida overbilled the […]
CMS Delays Stage 3 Meaningful Use for Medicare and Medicaid EHR Incentive Programs
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On December 6, 2013, the Centers for Medicare and Medicaid Services (CMS) announced a revised timeline for implementing Stage 3 meaningful use measures […]
Miami Medical Clinic Owner Pleads Guilty to $20 Million in Medicare Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The owner of a Miami-based medical clinic pleaded guilty on January 8, 2014, for her involvement in several health care fraud schemes that allegedly cost the Medicare program around $20 million. The schemes allegedly involved fraudulent billing for […]
Scribes Offer Physicians Some Relief from EHR Frustrations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In November 2013, a physician satisfaction study, sponsored by the American Medical Society (AMA), was published. In the study, physicians stated one of the most hated items in the medical industry is the electronic health record (EHR). According […]
California Doctor To Pay $562,500 Fine and Spend 5 Days in Jail for Balance Billing Patients Covered by Managed Care Plans
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A California doctor was fined $562,500 and ordered to spend five days in jail for illegally balance billing patients covered by health plans, […]
Doctors’ Medicare Payment Data to be Released Spring 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law For years, the Centers for Medicare and Medicaid Services (CMS) has kept private its records on Medicare claims payments made to individual physicians. However, beginning March 18, 2014, the government may disclose the payment data on a case-by-case […]
Dermatology Practice Settles with Government After Stolen USB Drive Results in HIPAA Breach
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), and Adult & Pediatric Dermatology (APDerm), reached a $150,000 settlement for privacy and security violations of the Health Insurance Portability and Accountability Act (HIPAA). […]
Agency Attorney Prosecuting Case Should Not Also Be in Position of Advising The Agency; Possible Bias Denies Due Process
McAlpin appealed an order of the Criminal Justice Standards and Training Commission (“Commission”) suspending his law enforcement certification for eighteen months. The Commission filed an administrative complaint alleging misconduct during the course of a criminal investigation. A formal administrative hearing was held and a recommended order was issued. At the Commission hearing to consider the […]
After Investigation Has Ended, Even Investigator’s “Mental Impressions” Are Subject to Release Under Public Records Act
The foregoing case summary was prepared by Mary F. Smallwood, Esquire, of The Administrative Law Section of The Florida Bar. The City of Avon Park (“City”) terminated Michael Rowan’s employment as Chief of Police. In the subsequent administrative hearing, at issue was Rowan’s investigation of certain city council members and alleged deletion of certain information […]
If Denial of Licensure is Disciplinary in Nature, Then Agency Must Prove Case by “Clear and Convincing Evidence”
The foregoing case summary was prepared by Mary F. Smallwood, Esquire, of The Administrative Law Section of The Florida Bar. Davis Family Day Care Home (“Davis”) was issued a license as a family day care home in 2007. Davis applied annually for renewal of that license. In 2011, Davis applied for renewal of its license […]
Invoking Fifth Amendment by Applicant’s Personnel May Result in Denial of Their Application for a License
The foregoing case summary was prepared by and appeared in the DOAH case notes of the Administrative Law Section newsletter FACTS: The Agency for Health Care Administration (“AHCA”) denied Avalon Assisted Living III’s (“Avalon III”) application for licensure of an assisted living facility in Orlando. Avalon III challenged the denial, and the case was referred […]
AHCA Expert Not Allowed to “Use His Discretion” in Deciding Claims Were Improper in Medicaid Appeal Hearing
FACTS: The Agency for Health Care Administration’s (“AHCA”) Office of Medicaid Program Integrity audited Dr. Rao, an authorized provider of Medicaid services, for claims between July 1, 2007, and June 30, 2009, and found him to be in violation of certain Medicaid provider policies. AHCA prepared a Final Audit Letter on June 1, 2011, notifying […]
Some Providers Billing PIP Claims No Longer Exempt From Health Care Clinic Act
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law Some health care providers that were previously exempt from the requirements of the Health Care Clinic Act are now required to obtain a Health Care Clinic license in order to bill for care provided to their patients injured in car […]
Florida Respiratory Therapist Arrested for Alleged Elder Abuse
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A Lee County, Florida, registered respiratory therapist at HealthPark Medical Center in Fort Myers, Florida, was arrested and charged with battery on an elderly patient. The respiratory therapist was arrested by the Attorney General’s (AG) Medicaid Fraud Control […]
Centers for Medicare and Medicaid Services Puts Recovery Audit Contractor Program on Hold
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On February 18, 2014, the Centers for Medicare and Medicaid Services (CMS) announced it is in the procurement process for the next round of Recovery Audit Program contracts. This means the program is, for the time being, on […]
Will Florida Board of Medicine Follow Board of Pharmacy’s Lead and Recommend PRN Evaluations for Applicants Before Application is Considered?
By Lance Leider, J.D., The Health Law Firm At the February 12, 2014, Florida Board of Pharmacy meeting, some board members expressed frustration with the fact that applicants for licensure with prior mental health or substance abuse related issues had not been evaluated by the Professionals Resource Network (PRN) prior to the consideration of their […]
Verifying Patients’ Affordable Care Act Exchange Insurance is Putting Doctors’ Office Employees Through the Ringer
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The ultimate goal of the Affordable Care Act (ACA) is to provide millions of previously uninsured Americans with access to health care. Open enrollment does not end until March 31, 2014; however, practices are already seeing an influx […]
Data Breach at Colorado Hospital Highlights IT Security Risks
By Lance O. Leider, J.D., The Health Law Firm A small rural hospital in Glenwood Springs, Colorado, has identified a virus on its computer network that had captured and stored screen shots of protected health information in a hidden file system. The hidden folder was created on Sept. 23, 2013, but was not discovered until […]
Florida Supreme Court Overturns Medical Malpractice Caps
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Florida’s Supreme Court ruled 5-to-2 in favor of invalidating medical malpractice caps on non-economic damages. The initial legislation was put into place in 2003 by the Florida Legislature due to an alleged medical malpractice crisis. The caps limited […]
Duke University Health System Pays $1 Million to Settle Allegations of False Claims in Whistleblower Lawsuit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On March 21, 2014, Duke University Health System in Raleigh, North Carolina, settled a whistleblower/qui tam lawsuit, according to the Department of Justice (DOJ). The lawsuit, filed in 2012, stated that the three-hospital academic medical center is alleged […]
Governor Requests the Agency for Health Care Administration to Inspect Florida’s VA Hospitals
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law In response to recent deaths at Veterans Affairs (VA) hospitals throughout Florida and the rest of the nation, on April 1, 2014, Governor Rick Scott wrote a letter to the Florida Agency for Health Care Administration (AHCA) requesting […]
Use Caution in USMLE Step Exam Preparation
By Catherine T. Hollis, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The United States Medical Licensing Examination (USMLE) Bulletin of Information outlines several examples of conduct that is deemed to be irregular behavior. On February 27, 2014, the USMLE posted […]
OIG Audit Finds Federal Database of Terminated Medicaid Providers Needs Improvement
By Lenis L. Archer, J.D., M.P.H., The Health Law Firm The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to establish a process for sharing information about terminated Medicaid providers. The federal database, called Medicaid and Children’s Health Insurance Program State Information Sharing System (MCSIS), is designed to prevent terminated […]
Kansas Cancer Treatment Center and Owner Pay $2.9 Million Settlement for Alleged False Claims Act Violations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law A whistleblower or qui tam lawsuit against a cancer treatment facility in Kansas has been settled. On April 14, 2014, the Hope Cancer Institute and its owner agreed to pay $2.9 million to resolve allegations that they violated […]
HIPAA Fines, Mobile Devices and Risk Assessments: Follow the Steps or Pay the Price
By Lance O. Leider, J.D., The Health Law Firm Two separate entities have agreed to pay the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) $1,975,220 in fines collectively. The settlements resolve potential violations of the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules involving stolen, unencrypted […]
Florida Attorney General Focuses on Targeted Case Management Fraud
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Due to a rise in fraud across the system, the Florida Attorney General (AG), through the Medicaid Fraud Control Unit (MFCU), is directing its focus toward Medicaid targeted case management (TCM) services. TCM services were established to help […]
What Happens in the VA System Has Implications for all Health Care Professionals; FBI Investigates VA
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law The Veterans Administration healthcare system is at a crossroads. After the recent revelations about long wait times for veterans and systematic cover-ups, it is clear that reforms in the Veterans Health System are needed. On June 11, 2014, […]
Say Goodbye to Physicians United Plan and Hello to Changes
By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law As of July 1, 2014, at 12:01 a.m., Physicians United Plan (PUP) will be liquidated. The insurance company was declared insolvent by a Florida circuit judge in Tallahassee on June 9, 2013. The judge turned the company over to the […]
CMS in the Hot Seat for Lax Oversight of Medicaid Managed Care Organizations
By Lenis L. Archer, J.D., M.P.H., The Health Law Firm For years, each state has kept an eye on its own Medicaid managed care plans, while the Centers for Medicare and Medicaid Services (CMS) is required to monitor how well each individual state is doing. However, a recent Government Accountability Office (GAO) report claims CMS […]
Why Have You Received a Denial on Your Medicare Enrollment Application?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Did you receive a denial on your Medicare enrollment application and can’t figure out why? You may be surprised to find out that even the smallest punctuation error, such as a missing comma or period, could be the […]
Disruptive Physicians: Nobody Likes a Nuisance
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Identifying and eliminating disruptive physicians has become a paramount concern of many hospitals and healthcare systems. Disruptive physicians hinder the safe and orderly operation of a healthcare facility and are considered a threat to the safety of patients. […]
Pediatricians Who Are Targets of Medicaid Audits Should Request Hearings on the Final Audit Report Results
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law We have recently been contacted by several pediatric practices that were subject to Medicaid audits. In several cases, the pediatricians received the final audit reports (FARs) stating that they owed Medicaid refunds, because of overbillings, in the tens […]
Sexual Misconduct by Rogue Employees Can Cost Big Money: Your Responsibility as an Employer
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Johns Hopkins Health System agreed to shell out $190 million to more than 7,000 women and girls, in one of the largest settlements ever in the United States involving sexual misconduct by a physician. A gynecologist, practicing in […]
The RACs, They’re Back! The Return of Medicare Recovery Audits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law All good things must come to an end. This includes the two-month hiatus from Recovery Audit Contractors (RACs) that healthcare professionals enjoyed. The Centers for Medicare and Medicaid Services (CMS) is restarting audits of Medicare fee-for-service claims on […]
Watch Out for Legal Pitfalls Associated with Telemedicine
By Lance O. Leider, J.D., The Health Law Firm With all the new technologies, mobile medical applications, expansion of access to health care under the Affordable Care Act (ACA), and the emphasis on quality care, telemedicine is at the forefront of the health care industry. Now is the time to educate yourself on the new […]
Cyber Attack at Community Health Systems Affects 4.5 Million Patients-Could This be a New Trend?
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On August 18, 2014, Community Health Systems, a Tennessee-based hospital chain that has 206 hospitals in 29 states, announced that its computer system was hacked. According to a number of news reports, an outside group of hackers, originating […]
Criminal Law: Warrantless Search of Cell Phones
Our guest author of this is article is Doug Plank, a legal research attorney with National Legal Research Group in Charlottesville, Virginia. In what some commentators have described as the most important criminal law decision of its 2013-2014 Term, the U.S. Supreme Court ruled unanimously in Riley v. California, 134 S. Ct. 2473 (2014), that […]
“Doctor of Death” Trial Could Ignite Stricter Oversight in the Healthcare Industry
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On paper, one Detroit-area oncologist appeared to be a wildly successful professional with impeccable medical credentials. According to his medical practice’s website, he went to medical school at Cornell Medical College, did an internal medicine residency at Maimonides […]
Internal Medicine Specialists Should Be Aware of Impending Medicare Audits
Coming to a medical practice near you. . . It’s scary, it’s horrible, and it could cost you a lot of money! It’s the dreaded Comprehensive Error Rate Testing (CERT) audit. The Horror! The Horror! First Coast Service Options, the Medicare contractor for Florida, announced a new prepayment audit program that will impact Internal Medicine […]
CMS Extends Waivers under the ACO Shared Savings Program
By Lance O. Leider, J.D., The Health Law Firm On November 2, 2011, the Centers for Medicare and Medicaid Services (CMS) promulgated the interim final rule on fraud and abuse waivers for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. The interim rule can be found at 76 Fed. Reg. 67801. The […]