Call: (407) 331-6620 or (850) 439-1001
Toll-free: (888) 331-6620
Call: (407) 331-6620 or (850) 439-1001
Toll-free: (888) 331-6620
Seven Things To Know When You Receive A Notice Of Investigation From The Department Of Health
Healthcare Provider Regulatory Process Enforcement Process Flowchart (click to review)
This flowchart, flow diagram, disciplinary guideline, or algorithm was originally published by the Medical Quality Assurance (MQA) Division of the Florida Department of Health (DOH) in the early 2000s to better explain and illustrate the processing of disciplinary complaints against licensed health professionals in the State of Florida. It does a great job of showing the process. However, it does not contain the information on how long each step of the process can take. Some steps can take months or even years. The chart is a summary of the process that is required by state statutes, including the Florida Administrative Procedure Act (APA), Chapter 120, Florida Statutes. It is a useful guide to locate where your case is in the process.
Florida Emergency Suspension of the License of Alexis Backer Lawler, R.N., January 28, 2026 (click to review)
(Florida Department of Health vs. Alexis Backer Lawler, R.N., D.O.H. Case No. 2026-09960, entered January 28, 2026)
This is an Emergency Suspension Order issued by the Florida Department of Health (DOH) against a registered nurse, immediately suspending the individual’s nursing license due to allegations of unprofessional conduct in retaliation for her exercising her First Amendment right to make statements critical of the present administration on January 22, 2026. The order details findings related to inappropriate and offensive social media activity, including statements that allegedly raised concerns about patient safety, professional judgment, and the nurse’s ability to provide competent care. The document outlines the DOH’s factual findings, legal conclusions, and authority under Florida law to take emergency action to protect public health and safety. It also includes notice of the nurse’s right to judicial review and the initiation of formal disciplinary proceedings.
Guide to the MQA Disciplinary Process: Discretionary Emergency Orders – 3 Things to Know (click to review)
This Guide is published by the Florida Department of Health (DOH) and discusses Emergency Restriction Orders (EROs) and Emergency Suspension Orders (ESOs) issued against licensed health professionals like doctors, mental health counselors, dentists, nurse practitioners, and others. It only discusses the grounds for discretionary orders. There are many circumstances for which Florida law requires a mandatory emergency suspension or order. EROs and ESOs can be lifted if a properly supported, convincing petition to do so is filed. If not lifted, an ESO or ERO may be grounds for an emergency or expedited administrative hearing.
Form Documenting Completion of Clinical Rotation for Nursing Course from a Florida Nursing School (click to review)
This is a sample of what we consider to be excellent documentation from a legitimate, accredited Florida nursing school to document the actual completion of a valid clinical rotation for one nursing course. Please note that this firm did not create this form. We are just using it to demonstrate good documentation. Also, please note the following:
1. The name/location of the clinical site is provided.
2. The instructor/supervisor is named.
3. The course for which the clinical rotation was performed is specified.
4. The exact semester and year are specified.
5. Grades and comments on performance are assigned.
6. The instructor signs and dates the form.
7. The student signs and dates the form and should be given a copy for their own records.
8. Although the number of clinical rotation hours performed for this course are not included on this document (which we believe they should), they are stated on the actual grade transcript.
Florida Department of Health Notice of an Investigation for an Operation Nightingale Nursing School (click to review)
This is a sample notice from the Florida Department of Health (DOH) regarding an Operation Nightingale investigation. The Florida DOH notified a licensed registered nurse that it had opened an investigation based on information received from the FBI and the National Council of State Boards of Nursing (NCSBN). The DOH alleged that the nurse may have obtained a Florida nursing license through fraudulent misrepresentation by using a diploma or transcript associated with a nursing school identified in the Operation Nightingale investigation. The notice also advised that the DOH was investigating potential violations of Florida’s Nursing Practice Act and provided the nurse with an opportunity to submit a written response, participate in an interview, or voluntarily relinquish the nursing license. In many cases, the nurse has been defrauded by the owner and operator of the nursing school. However, that may not be of use to the nurse if the nursing school has submitted transcripts or diplomas with false information on them or if the school did not require the nurse to perform the correct number of hours of coursework or actual clinical rotations.
Nurses who receive a Department of Health investigative letter should respond carefully and seek experienced legal guidance before providing statements or documentation or appearing before hearings or committees.
Decision by the Florida Agency for Health Care Administration (AHCA) granting an application for an exemption from disqualification from employment in an AHCA-licensed facility (click to review)
Disqualification from employment and a Florida Medicaid Program letter sent out by the Florida Agency for Health Care Administration (AHCA) because of prior arrests, to health professionals (doctors, nurses, dentists, mental health counselors, pharmacists, physical therapists, etc.) licensed by Florida. Immediate action should be taken to apply for an exception, starting with obtaining copies of all police reports and criminal court records. An experienced attorney can assist with the detailed exemption application.
Sample of a Health Care Subpoena Issued From the Office of Inspector General (OIG) (click to review)
This is an example of a subpoena that the OIG issued while looking into a potential False Claims Act (FCA) case. You need a lawyer if you get one of these.
Decision From National Practitioner Data Bank (NPDB) Voiding Adverse NPDB Report (click to review)
This is an example of the decision after a successful appeal of an adverse NPDB report, voiding that report and ordering it removed from the NPDB.
This is a sample of a formal written response, an advisory opinion, from the Office of Inspector General (OIG) regarding whether a proposed business arrangement for the provision of therapy services violates federal fraud and abuse laws, particularly the Anti-Kickback Statute (AKS).
OIG Removal From LEIE and Reinstatement of Eligibility for the Medicare Program (click to review)
This is a decision from the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) to grant an application from a doctor for removal from the List of Excluded Individuals and Entities (LEIE) and to reinstate his/her eligibility to participate in the Medicare Program.
Sample of Office of Inspector General (OIG) Letter Giving Notice of Exclusion From Federal Health Care Programs (click to review)
This is a sample of an OIG exclusion notice imposing a mandatory five-year exclusion from participation in all federal healthcare programs on an individual and outlining the provider’s appeal and reinstatement rights. Some exclusions are mandatory and are for required periods of time. Others are “permissive” and are subject to arguing for a shorter time or no exclusion at all. In this letter, the OIG advised that no federal healthcare program payments could be made for services furnished, ordered, or prescribed by the excluded individual and that the exclusion would be reported to state licensing agencies and published on the OIG’s List of Excluded Individuals and Entities (LEIE).
It is extremely important to respond and appeal such decisions appropriately and within the period of time required, as the consequences can be devastating.
Under the Guidance Policy, the Department may not issue guidance documents that purport to create rights or obligations binding on persons or entities outside the Executive Branch (including state, local, and tribal governments) or to create binding standards by which the Department will determine compliance with existing statutory or regulatory requirements.
Sample of a Civil Investigative Demand (CID) Issued by the U.S. Department of Justice (click to review)
This is a sample of a Civil Investigative Demand (CID) issued by the U.S. Department of Justice (DOJ) seeking documents related to a federal False Claims Act (FCA) and Anti-Kickback Statute (AKS) investigation involving healthcare provider referral and compensation arrangements. The demand also imposed strict deadlines and compliance requirements for the production of responsive materials. Providers who receive a subpoena, CID, or other government investigative request should act immediately to retain an experienced health law attorney to represent them in the matter.
Our attorneys routinely assist healthcare providers in responding to CIDs and False Claims Act/ whistleblower litigation.
Memorandum of Understanding (MOU) Between the DHHS and the VA (click to review)
This is the original Memorandum of Understanding (MOU) or agreement in which the Veterans Administration (VA) originally agreed with the Department of Health and Human Services (DHHS) to participate in reporting matters to the National Practitioners Data Bank (NPDB), as civilian hospitals are required to do.
This is the original Memorandum of Understanding (MOU) between the Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS), and the Department of Defense (DOD) that ensures the participation of the DOD in the national reporting system established under Part B of The Health Care Quality Improvement Act of 1986 (the Act). These requirements and procedures have now been incorporated into DHA PM 6025-13, so it is now obsolete.
Notice of Summary Suspension of Clinical Privileges by Military Medical Treatment Facility (click to review)
This notice will be issued if a healthcare professional has their clinical privileges summarily suspended by their Military Medical Treatment Facility (MTF). It is important to note that if the suspension lasts 30 days or more (which is typically the case), it is reported to the National Practitioner Data Bank (NPDB), where the adverse report will remain for life. Therefore, it is urgent to retain an experienced health lawyer to work with you to attempt to have the suspension lifted before the 30 days, if at all possible.
Confidentiality Agreement Used by the Defense Health Agency (DHA) and Military Medical Treatment Facilities (MTFs) (click to review)
This is a confidentiality agreement used by the Defense Health Agency (DHA) and military medical treatment facilities (MTFs) to help ensure the confidentiality of any medical records, clinical privileging documents, or peer review documents released outside the agency.
Executive Summary of Department of Defense (DOD) Office of Inspector General (OIG) Report No. 98-168 (Project No. 7LH-0009), dated June 26, 1998 (“DOD Implementation of the National Practitioner Data Bank Guidelines”) (click to review)
This is a summary of the investigation by the Department of Defense (DOD) Office of Inspector General (OIG) of criticisms made regarding DOD’s failure to report or timing in making reports to the NPDB on various matters. It is included here for historic purposes.
A Pocket Guide to Florida’s Administrative Procedure Act (click to review)
This is a summary of your rights when dealing with any state agency under Florida’s Administrative Procedure Act. It is written and published by Florida’s Joint Administrative Procedures Committee and updated each year. Any major decision or action by any state agency, including the Department of Health (DOH), the Agency for Health Care Administration (AHCA), the Florida Medicaid Program, Division of Administrative Hearings (DOAH), or any of the state’s many professional licensing boards, is governed by this law. The attachment to it is a copy of the actual law, the Florida Administrative Procedure Act, Chapter 120, Florida Statutes (2025). Always check to make sure you have and are using the latest version of the state law.
Joint Statement on Workplace Violence in Healthcare (click to review)
Sample of a Letter Debarring a Healthcare Professional From All Government Contracting Because of Being Excluded From Medicare (click to review)
This shows one of the consequences of being terminated from the Medicare Program or being placed on the LEIE. You will also be placed on the System for Award Management (SAM) exclusion or debarment list maintained by the U.S. Government Accountability Office. You will also be prohibited from all U.S. government contracting or employment activities.
Notice of Potential Disciplinary Sanction From American Board of Internal Medicine (ABIM) (click to review)
This is a sample of the type of letter the ABIM may send out to test takers, whether they are already board certified or not, notifying them of being suspected of cheating, irregular behavior, sharing information from an actual examination, misconduct or other violation of its rules and policies. This is a very serious matter that can lead to drastic adverse actions affecting your job, clinical privileges and career. We routinely assist physicians in preparing and submitting responses, obtaining hearings, or otherwise defending against such accusations.
Sample Letter From the American Board of Internal Medicine (ABIM) Granting One-Year Extension of Board Eligibility Period to Take Certification Exam (click to review)
This is a sample of a letter from the American Board of Internal Medicine (ABIM) granting a one-time, one-year extension of board eligibility and permitting registration for the next annual Internal Medicine Certification Examination. ABIM noted that its Board Eligibility Policy generally limits physicians to a seven-year period of eligibility following completion of training requirements. Once that period expires, additional accredited training is typically required before a physician may again become eligible to sit for the certification examination. In this case, however, ABIM exercised its discretion and approved an exception based on the circumstances presented. Our firm routinely assists physicians in applying for such extensions of time, which are usually granted based on documented hardships the physician faced that prohibited them from taking the exam.
Behaviors That Undermine a Culture of Safety (click to review)
(Note: This is a complimentary publication of The Joint Commission, Sentinel Event Alert Issue 40, July 9, 2008. Updated: June 18. 2021)
Published for Joint Commission-accredited organizations and interested health care professionals, Sentinel Event Alert identifies specific types of sentinel events, describes their common underlying causes, and suggests steps to prevent occurrences in the future.
USMLE CIR Personal Statement Submission Guidelines, February 2026 (click to review)
This document outlines the submission requirements for a personal statement to the United States Medical Licensing Examination (USMLE) Committee for Individualized Review (CIR). While submission is optional, the guidelines specify that any personal statement must be directly relevant to the allegations, limited to 20 pages, and submitted as a single PDF document by the designated deadline. The document also emphasizes that all materials provided will be reviewed and verified for authenticity by the USMLE. Adhering to these formatting, content, and submission requirements is essential to ensure that the CIR considers the statement during its review process.
The United States Medical Licensing Examination® (USMLE®) program has updated its Policies and Procedures regarding irregular behavior. These updates are now in effect as of January 15, 2026, in accordance with the USMLE Bulletin of Information (BOI) requirement. Examinees are encouraged to review these updates to understand what constitutes irregular behavior and how the USMLE works to support exam integrity.
Sample Determination Letter From the United States Medical Licensing Examination (USMLE) Secretariat Regarding Allegations of Irregular Behavior (click to review)
This is a sample of a decision letter from the United States Medical Licensing Examination (USMLE) Secretariat deciding largely in favor of the international medical graduate applicant after accusations of irregular behavior by providing false information on their application. No adverse action was taken other than to place an annotation of the irregular behavior on the physician’s USMLE record. This outcome highlights the importance of experienced legal representation when responding to allegations of irregular behavior.
Sample Determination Letter From the Educational Commission for Foreign Graduates (ECFMG) Regarding Allegations of Irregular Behavior (click to review)
This is a sample decision letter that ECFMG sent, verifying the dismissal of irregular behavior charges. The physician, an international or foreign medical graduate, was cleared to continue the ECFMG certification process and remained eligible to apply for USMLE examinations after our firm represented him/her in the case.
This outcome demonstrates the importance of obtaining experienced legal representation when responding to ECFMG investigations, USMLE irregular behavior allegations, credentialing disputes, or other matters that may threaten a healthcare professional’s ability to practice medicine.
HIPAA Fines, Mobile Devices and Risk Assessments: Follow the Steps or Pay the Price
(Note: This article was originally published in Facts & Findings, March/April 2015) by Lance O. Leider, LL.M., J.D.
Autism and Access to Healthcare
(Note: This article was originally published in the Mitchell Hamline Law Journal of Public Policy and Practice: Vol. 45: Iss. 1, Article 2. 2024) by Amanda I. Forbes, J.D.
Telehealth in Respiratory Care
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Healthcare Compliance: An Overview of the Basics for Organizations and Providers
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Stopping Improper Payments
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Data Breach
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Salaries: Are Your Lips Sealed About Salaries?
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Patient-Supplied Respiratory Equipment in the Hospital
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
I’m Sorry Laws: What’s a Respiratory Therapist’s Apology Worth?
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Avoiding HIPAA Violations
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Video Surveillance in Patient Care Areas
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Help Stop Drug Diversion
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Detecting Medical Identity Theft
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Healthcare Fraud: Research Misconduct Results in Criminal Indictment
(Note: This article was originally published in Advance for Respiratory Care and Sleep Medicine) by Michael L. Smith, R.R.T., J.D.
Don’t Resign Your Professional License in the Midst of an Investigation
(Note: This article was originally published on Kevin M.D.) by George F. Indest III, J.D., M.P.A., LL.M.
A Little Known Rule in the ACA Could Pose Financial Risk to Doctors
(Note: This article was originally published on Kevin M.D.) by Michael L. Smith, R.R.T., J.D., and George F. Indest III, J.D., M.P.A., LL.M.
How to Respond to a Medicare Audit: 17 Tips from a Lawyer
(Note: This article was originally published on Kevin M.D.) by George F. Indest III, J.D., M.P.A., LL.M.
A Lawyer Provides Pain Management Tips for Doctors
(Note: This article was originally published on Kevin M.D.) by George F. Indest III, J.D., M.P.A., LL.M.
Legal Strategies For Doctors To Fight Bad Online Reviews
(Note: This article was originally published in Florida Medical Business, Special Focus: Online Pitfalls, March/April 2013) by George F. Indest III, J.D., M.P.A., LL.M.
19 Tips to Prepare You For a Medicare Audit Site Visit
(Note: This article was published in Medical Economics, December 10, 2012) by George F. Indest III, J.D., M.P.A., LL.M.
Criminal Charges Against Health Professional: The Collateral Effects of a Criminal Case on a Healthcare Licensee
by George F. Indest III, J.D., M.P.A., LL.M., November 19, 2010
How to Prevent Employee Embezzlement
(Note: This article was originally published in Medical Economics, September 25, 2012) by George F. Indest III, J.D., M.P.A., LL.M.
Why Nurses Should Buy Malpractice Insurance
by George F. Indest III, J.D., M.P.A., LL.M., and Jason L. Harr, J.D., M.P.A.
Medical Malpractice Settlement: The NPDB and Legal Ramifications of Settling Your Medical Malpractice Lawsuit
(Note: This article was originally published in The Stethoscope, Summer 2004) by George F. Indest III, J.D., M.P.A., LL.M., and Jason L. Harr, J.D., M.P.A.
Beware Legal Ramifications of Unnecessary Tests
By George F. Indest III, J.D., M.P.A., LL.M., July 25, 2012
New Business Checklist for Health Care Providers in Florida
By George F. Indest III, J.D., M.P.A., LL.M. (2005)
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Medicare/Medicaid Audits, Health Care Law, Contracts, Hospital Privileges Hearings, Investigations, DEA Defense, Board of Medicine Defense, Healthcare Fraud Defense, Medical Staff Fair Hearings, Administrative Hearings, PRN, IPN, Professional Licensing, Medicare/Medicaid Fraud Defense, Nursing Law, Hospital Peer Review, Hospital Law, Board of Dentistry, Board of Nursing Complaint Defense, Board of Pharmacy, Medicaid Fraud Control Unit (MFCU) Defense, Search Warrant and Subpoena Defense, NBME Representation, USMLE Challenges, ABIM Representation, Resident Physician Defense, VA & Military Physician Defense, Department of Health Investigation Defense, and more…
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