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 locate an attorney or law firm that accepts this type of insurance. We have offices in Florida and Colorado, but we have attorneys licensed in Florida, Colorado, Louisiana, the District of Columbia, Virginia and other states.

Additionally, we can provide legal advice and representation in license investigations and administrative proceedings in many other states.

If you have HPSO Insurance, do not go without an attorney or with a lawyer that has little or no experience where you need it. Contact us, and we will help you.

Don’t Worry About Legal Bills While Your Case is Going On.

Call us first. We can assist you in determining if your legal problem is covered by your insurance, and we can help you file a claim to have your legal defense expenses and costs covered. In most cases, we will accept the assignment of your insurance so that you do not have to worry about legal bills while your case is going on.

Contact Experienced Health Law Attorneys That Will Work with Insurance Companies.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. 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.

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. We will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company, if your insurance company will allow this. Many of these insurers will pay our firm to represent you in the legal defense of an investigation or complaint against your professional (nursing, medical, dental, psychology, mental health counselor) license or for an administrative hearing involving professional discipline.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

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 attorney or law firm that accepts this type of insurance. We have offices in Florida and Colorado, but we have attorneys licensed in Florida, Colorado, Louisiana, the District of Columbia, Virginia and other states.

Additionally, we can provide legal advice and representation in license investigations and administrative proceedings in many other states.

If you have TDC Insurance, do not go without an attorney or with a lawyer that has little or no experience where you need it.
The Health Law Firm Will Work with You and Your Insurance Company.

Call us first. We can assist you in determining if your legal problem is covered by your insurance, and we can help you file a claim to have your legal defense expenses and costs covered. In most cases, we will accept the assignment of your insurance so that you do not have to worry about legal bills while your case is going on.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses, dentists and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. 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.

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. We will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company, if your insurance company will allow this. Many of these insurers will pay our firm to represent you in the legal defense of an investigation or complaint against your professional (nursing, medical, dental, psychology, mental health counselor) license or for an administrative hearing involving professional discipline.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

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 (52%) of adult Americans back making marijuana legal.

To read all of the poll results from Pew Research, click here.

The Pew Research polled 1,501 American adults from March 13 to 17, 2013, for this survey.

Demographics on Adults Who Support Legal Marijuana.

According to the survey results, forty-eight percent (48%) of poll respondents said they have used marijuana at some point in their life. Younger Americans are more likely to support legalization than their elders. However, the poll does show legalization gaining support among all generations. According to the survey, fifty percent (50%) of baby boomers support legalized marijuana.

Two Big Shifts in Opinion to Support Legalizing Marijuana.

According to an article in the Los Angeles Times, there are two big opinion shifts Americans have gone through that have swayed their way of thinking. The first thought is most Americans no longer see marijuana as a gateway drug, and the second is most adults no longer see the use of marijuana as immoral.

In fact, according to the survey results, most respondents feel the federal government’s efforts to criminalize marijuana “cost more than they are worth.”

Government’s Stance on Marijuana.

Currently, 24 states and the District of Columbia either have decriminalized personal use of medical marijuana, legalized it or allowed it to be used for medical purposes. These state laws clash with federal law that treats marijuana as a dangerous drug with no legitimate medical uses, according to the Los Angeles Times.

Click here to read the article from the Los Angeles Times.

Florida’s Fight for Medical Marijuana.

According to an article in the Orlando Sentinel, Florida attorney John Morgan of Morgan & Morgan recently jumped behind an effort to legalized medical marijuana in Florida. Morgan’s reputation throughout the community and his personal story on why he is lobbying for medical marijuana has people listening.

Morgan’s father suffered from emphysema and cancer, according to the Orlando Sentinel. His appetite was suppressed apparently due to the medicine he was on near the end of his life, and medical marijuana gave him some relief. Morgan said he was motivated to join this cause when he saw a poll that stated seven out of ten Floridians would support a constitutional amendment to support legalized medical marijuana. According to the Orlando Sentinel, Morgan has seen the benefits of medical marijuana firsthand.

Click here to read the entire Orlando Sentinel article.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. 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 (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think marijuana should be legalized? Do you think Florida will legalize medical marijuana? Please leave any thoughtful comments below.

|Sources:

“Majority Now Supports Legalizing Marijuana.” Pew Research. (April 4, 2013). From: http://www.people-press.org/2013/04/04/majority-now-supports-legalizing-marijuana/#comfort-level

Kassab, Beth. “John Morgan Could Take Medical Marijuana Mainstream.” Orlando Sentinel. (March 18, 2013). From:
http://www.orlandosentinel.com/news/politics/os-beth-kassab-medical-marijuana-20130318,0,2558234.column

Lauter, David. “Marijuana Legalization Wins Majority Support in Poll.” Los Angeles Times. (April 4, 2013). From:
http://www.latimes.com/news/politics/la-pn-marijuana-legalization-majority-support-20130404,0,2533952.story
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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Why You Should Not Voluntarily Relinquish Your Medical License or DEA Registration Number

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

I am often contacted by clients who are health professionals or own businesses in the health care industry who have been approached by government agents or investigators regarding possible complaints or charges. In many cases, the individuals involved do not think to consult with an attorney until many months later, and this may be too late to save the business or professional practice involved. This holds for physicians, dentists, nurses, pharmacists, pharmacies, pain management clinics, physician assistants, group homes, assisted living facilities (ALFs) and home health agencies, among others.

“Voluntary” Relinquishment Treated the Same as a Revoked License.

We have seen a trend recently, especially here in Florida, of investigators immediately offering the person being investigated the option to voluntarily relinquish his or her professional license. This is offered as an option to being investigated, even in the event of very minor or frivolous complaints. The problem is that once an investigation has been opened, then a voluntary relinquishment of a license is treated the same as if it were revoked for disciplinary reasons. It will be very difficult, if not impossible, to ever get a new license under the circumstances.

Furthermore, if the professional has other licenses or similar licenses in other states, then this will be reported to the other states and disciplinary action will probably be initiated against those other licenses.

We have heard horror stories of investigators, accompanied by police or sheriff’s deputies or Drug Enforcement Administration (DEA) agents, making all sorts of threats against a health professional in order to intimidate him or her into giving up a DEA registration number or professional license, including medical licenses, nursing licenses and pharmacy licenses.

In the case of such an incident occurring in Florida, the “voluntary” relinquishment must still be presented to the applicable professional Board and voted on at a scheduled meeting, since it is considered to be disciplinary. It may be possible to withdraw the “voluntary” relinquishment before it is voted on, so all may not be lost.

Think Long and Hard About Relinquishing DEA Registration Number.

However, in the case of the DEA, a DEA registration number is considered gone as soon as the “voluntary” relinquishment paper is signed. This is one of the reasons it is crucial to talk with a knowledgeable health law attorney before making such a decision. The ones putting pressure on you to do this will do everything they can to persuade you not to talk to an attorney. But it is your right to do so. Don’t be rushed or intimidated into making a foolish decision you will regret.

We have represented clients attempting to obtain a new DEA registration number or a new professional license many years after they did a voluntary relinquishment. In most cases, it is an extreme uphill battle and is often not successful.

Additional Consequences of Voluntary Relinquishment of a Professional License or DEA Registration Number.

The following are some of the additional consequences of voluntary relinquishment of professional license or DEA number after notice of an investigation:

1. Disciplinary action will be commenced against any other professional licenses in the state.

2. Disciplinary action will be commenced against any similar licenses in other states.

3. The matter will be reported to any national certification boards of which you are a member and they will most likely commence action against you to revoke your national certification.

4. You will be placed on the Office of the Inspector General’s (OIG) List of Excluded Entities and Individuals (LEIE) and excluded from the federal Medicare Program.

5. You will be terminated from the state’s Medicaid Program, if you are a Medicaid provider.

6. You will be terminated from the panels of any health insurers or managed care plans of which you are a provider member.

There are many other possible repercussions to such actions, so it is extremely important to be prepared if such an event occurs. To prepare you can:

1. Purchase professional licensing defense insurance coverage through Lloyd’s of London, Healthcare Provider’s Service Organization (HPSO), Nurses Service Organization (NSO) or one of the other reputable insurance companies that provide such coverage.

2. Have the names, telephone numbers and other information on good, reputable criminal defense and health law attorneys at hand at all times. Make sure your practice manager has this information as well.

3. Call as soon as an investigator walks in. Don’t wait.

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

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, 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 (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you ever been approached by government agents or investigators about possible complaints or changes? What was the experience like? Please leave any thoughtful comments below.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

“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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

You Must Challenge Overpayment Demands from Medicare and Medicaid Audits

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

We have recently received numerous communications from health care professionals, including physicians, physical therapists, occupational therapists, mental health counselors, durable medical equipment (DME) providers, assisted living facilities (ALFs), group homes, and psychologists, who have been placed on prepayment review after failing to challenge Medicare or Medicaid audit results. The problem is that these providers, once placed on prepayment review, have their payments held up for many months and are often forced out of business. Sometimes it appears that this may actually be the goal of the auditing contractor or agency.

What Happens on Prepayment Review.

Failing to challenge, follow-up on, and appeal any adverse audit determinations can be very detrimental. An error rate in excess of fifteen percent (15%) will usually result in the provider being placed on prepayment review. While on prepayment review, the provider will be required to submit the documentation for medical records by mail to support each claim submitted and have that claim and its supporting medical records’ documentation audited, prior to any claims being paid. Often the auditing agency will come back to the provider again and again to demand additional information and documentation on claims instead of immediately processing them. This can hold up processing of the claim for months. Often the resulting termination of income flow will force the provider out of business. This saves the government lots of money, because the provider has then provided services to Medicare or Medicaid recipients for many months without ever getting paid for it.

These are some of the reasons why we recommend that physicians, physical therapists, occupational therapists, podiatrists, optometrists, psychologists, mental health counselors, respiratory therapists, and others always hire the Board Certified Health Law Attorney experienced in audits from the very beginning.

A Real-Life Example of the Trouble Caused by a Medicare Audit.

In one case we know of, a therapist was audited by Medicare. The audit by the Medicare administrative contractor (MAC) requested only 30 records. The therapist provided copies of the records he thought the auditors wanted. He did not number the pages or keep an exact copy of what he provided. The MAC came back and denied one percent (1%) of the claims audited. However, since the amount demanded back by the MAC was only a few thousand dollars, the therapist never hired an attorney and never challenged the results. Instead of retaining legal counsel and appealing the results, the therapist paid the entire amount, thinking that was the easy way out.

Unfortunately, because of the high error rate, the MAC immediately placed the therapist on prepayment review of all claims, assuming the prior audit had disclosed fraud or intentional false coding. Every claim the provider submitted from that point on had to be submitted on paper with supporting medical records sent in by mail. The MAC refused to make a decision on any of the claims, instead, holding them and requesting additional documentation and information from time to time. The therapist currently has most of his claims tied up in prepayment review, some for as long as five months with no decision. No decision means no review or appeal rights.

The therapist conveyed to me that he recently contacted the auditor to attempt to obtain decisions on some of his claims so that he could at least begin the appeal process if the claims are denied. He advised me that the auditor at the MAC expressed surprise that he was still in business.

Challenge Improperly Denied or Reduced Claims.

These situations are very unfair and unjust, especially to smaller health care providers. The reduced cash flow even for a month or two may be enough to drive some small providers out of business. Larger health care providers have vast resources sufficient to handle such audit situations on a routine basis. They may have similar problems but are better equipped and have more resources to promptly handle it. Rather than immediately pay whatever amount is demanded on an audit and waive any appeal/review rights, the provider should review each claim denied or reduced and challenge the ones that have been improperly denied or reduced. Otherwise you may wind up with a high error rate which will cause you to be placed into prepayment review. Once placed in prepayment review, it is difficult to get out of it. Often it takes six months or longer.

Don’t Get Caught Up in the Audit Cycle.

Another reason to challenge overpayment demands as a result of an audit is because the audit contractors will keep you on an audit cycle for a number of future audits if they are successful in obtaining any sort of significant recovery from you on the initial audit. This is similar to what happens if your tax return is audited by the Internal Revenue Service (IRS) recovers a significant payment from you because you did not have the documentation to support your deductions, you can expect to be audited for at least the next two years.

The value of competent legal representation at the beginning of an audit cannot be overestimated. It is usually long after the audit is over, and the time to appeal the audit agency’s findings has passed, that the health care provider realizes he should have retained an audit consultation.

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

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Have you ever been audited? What was the process like? Did you retain legal counsel to help with the process? Was having legal assistance worth it? Please leave any thoughtful comments below.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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. 

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Phony Florida Physician Uses Silicone and Krazy Glue – Arrested Twice for Practicing Medicine 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 South Florida man was arrested on February 6, 2013, for allegedly injecting people with silicone in a West Palm Beach motel room. He has been charged with practicing medicine without a license. According to the Sun Sentinel, this was the man’s second arrest within two months for the same crime.

Click here to read the entire article from the Sun Sentinel.

This “Krazy” Tale.

Police say this fake physician injected his customers with buttocks-enhancing silicone injections. He would then allegedly seal up the skin wounds with Krazy Glue. Victims sayhe would not wear gloves or protective clothing during the procedures. Each victim was charged $200 for each visit. This phony health professional was also arrested in January 2013, when two victims told investigators similar stories about his illegal injections.

In each case, the side effects in patients included severe infections, and the damage is thought to be permanent.

South Florida and Phony Health Professionals.

This is by no means the first report we’ve heard of phony health professionals in South Florida injecting people with toxic chemicals. Back in 2012, a number of people became sick and deformed after a Broward County, Florida, woman allegedly injected victims’ buttocks, hips and breasts with a combination of Fix-A-Flat tire sealant, cement, mineral oil and Super Glue. One of the victims died as a result of the procedure, according to the Daily Mail Reporter. The victims claimed the woman administering the injections presented herself as a medical professional and wore a nurse’s uniform.

To read more on this story from the Daily Mail Reporter, click here.

Practicing Without a License Is a Crime.

Practicing medicine without a license is a crime. Additionally, so is helping someone practice medicine without a license. As a practitioner, you may be asked to supervise or join a practice. Remember that your license may be at stake with any wrongdoing by your subordinates. Before you join a practice or agree to supervise others, check first with the Department of Health (DOH) that the other providers are legitimate. You can verify a license for free on the DOH’s website.

Also, remember that a license to practice medicine in Venezuela, Cuba, or anywhere else, is just that: a license to practice in that country. It does not allow a person to practice medicine in the United States. A specific license from the State of Florida is required to practice in Florida, except for certain military and federal physicians. Always check the physician’s license.

More Stories on Fake Physicians and Other Phony and Fraudulent Professionals to Come.

In the near future on this blog we will include additional articles on fake doctors and health professionals, some old, some new.

To see a blog on a fake dentist in Miami, click here. You can also read the story of a fake plastic surgeon in New York by clicking here.

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

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, 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 (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of all of these news stories of phony health care professionals? Please leave any thoughtful comments below.

Sources:

Komedna, Ed. “‘Motel Surgeon’ Arrested Again for Silicone Injections, Deputies Say.” Sun Sentinel. (February 6, 2013). From:
http://www.sun-sentinel.com/news/palm-beach/fl-butler-surgery-arrest-20130206,0,2237567.story

United Press International Inc. “Man Arrested Again for Buttocks Injections.” United Press International Inc. (February 6, 2013). From:
http://www.upi.com/Top_News/US/2013/02/07/Arrest-for-illegal-silicone-injections/UPI-97251360271074/?spt=hs&or=tn

Daily Mail Reporter. “Toxic tush transgender nurse charged with manslaughter after patient DIES following ‘injection with rubber cement and tire sealant in backroom cosmetic surgery’.” (July 26, 2012). From: www.dailymail.co.uk/news/article-2179631/Toxic-tush-nurse-Oneal-Morris-charged-manslaughter-patient-DIES.html#axzz2KKi2pPmh

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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Government Discovers Extensive Overbilling of Cancer Drug to Medicare

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

It’s no surprise that the government is aggressively pursuing Medicare fraud. Recently, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), made a surprising discovery. An audit uncovered that more than three-quarters (3/4) of all Medicare claims for the breast-cancer drug Herceptin were billed incorrectly, according to Modern Healthcare. This was found during an audit conducted on physicians and hospitals from around the country between January 1, 2008, and December 31, 2010.

To read the entire Modern Healthcare article, click here.

Audit Results from Around the Country.

Three different audits were released to the public by the HHS OIG. All of these audits showed roughly the same information. Health care providers have been billing Medicare for full multiuse vials of the drug Herceptin, when patients actually only need a smaller portion. Medicare does not pay healthcare providers for any part of the drug that is discarded, because it can be preserved for up to 28 days and reused. The auditors suggest that payment from Medicare for an entire multiuse vial is likely to be incorrect. We saw a similar situation with the drug Avastin and Lucentis being used by ophthalmologists several years ago.

The results of the audits were released in January 2013. One audit found eighty-five percent (85%) of 1,073 Herceptin vials used in Ohio and Kentucky were billed incorrectly. In Illinois, Indiana, Michigan and Wisconsin, the government auditors found that seventy-eight (78%) of 713 claims investigated were wrong. The overpayment amount was around $682,000, for these audits.

Florida’s District Found to Have Overcharged 78% of Bills.

According to the report, HHS auditors found overcharges in seventy-eight percent (78%) of bills for 1,330 vitals of Herceptin submitted to First Coast Service Options, Inc. This company serves as the Medicare Administrative Contractor (MAC) for HHS District Nine, which primarily includes providers in Florida, Puerto Rico, and the U.S. Virgin Islands. The overcharges for Herceptin were $1,325,409.

In the report, the government recommends that First Coast Service Options, Inc., do a number of things. The first is to recover the more than one million dollars in overpayments. It’s also recommended that First Coast Service Options, Inc., implement system edits that review multiuse vial drugs that are billed with units of service equivalent to the dosage of an entire vial. The government also suggests that these audit results be used as an educational tool for teaching correct billing practices to physicians and hospitals.

Click here to read the entire report on District Nine.

How to Respond to a Medicare Audit.

Remember, there is no such thing as a “routine” Medicare audit. The fact is that if you find yourself or your practice at the center of a Medicare audit, there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused the audit. We’ve come up with a list of actions that we use and recommend you take when responding to a Medicare audit. Click here to view that list.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Investigations.

The best time to respond to and defeat an allegation of overpayment is at the very beginning. That is why it is essential that you obtain qualified counsel to help you through the process. The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Why do you think hospitals and physicians incorrectly bill for Herceptin? Are audits like these necessary? Please leave any thoughtful comments below.

Sources:

Carlson, Joe. “OIG Finds Widespread Herceptin Overcharges.” Modern Healthcare. (January 21, 2013). From: http://www.modernhealthcare.com/article/20130121/NEWS/301219959/oig-finds-widespread-herceptin-overcharges

Jarmon, Glorida. “The Medicare Contractor’s Payments to Providers in Jurisdiction 9 for Full Vials of Herceptin were often Incorrect.” Office of Inspector General (January 2013). From: http://www.thehealthlawfirm.com/uploads/Herceptin%20FL%20Overcharges.pdf

About the Authors: Lance O. Leider is an attorney with 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, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Orlando Physician To Pay $10,000 Fine for Prescribing Painkillers to Undercover Agents

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

On January 24, 2013, an Orlando physician pleaded no contest to racketeering charges for allegedly prescribing pain pills to undercover agents who did not need them. The physician was fined $10,000 and placed on 20 years of probation.

Physician Was One of the First Arrested in Florida’s Prescription-Abuse Crackdown.

According to the DOH complaint, between 2008 and 2009, the physician allegedly saw two undercover agents six times. Each agent complained about minor pain. Both agents were allegedly prescribed pain medication by the physician.

The complaint states that each office visit between the physician and undercover agents was filmed and the audio was taped using hidden surveillance equipment. This is a common tactic used by undercover agents investigating pain management physicians.

Click here to read the entire complaint filed against the physician.

The physician was arrested in 2010. He was charged with racketeering because the six prescriptions were characterized as an “ongoing criminal enterprise.” For this criminal case he just pay a $10,000 fine and was placed on 20 years of probation.

This physician was one of the first doctors to get arrested in Florida’s prescription-abuse crackdown. In July 2012, the Drug Enforcement Administration (DEA) and Florida law enforcement announced a statewide pill mill bust that spanned several cities in Florida. Seven doctors and seven pain clinic owners were arrested. The raid was dubbed “Operation Pill Street Blues” by the DEA. To read a blog on “Operation Pill Street Blues,” click here.

Physician’s Hopes to Settle DOH Complaint.

According to an article in the Orlando Sentinel, the physician hopes to settled the Florida DOH complaint by agreeing to medical probation, which will require him to be monitored by an outside doctor, undergo continuing education and possibly pay a fine.

The physician is expected to continue practicing at his Orlando office.

Click here to read the Orlando Sentinel article.

Legal Tips for Physicians to Manage Pain Patients.

I have represented a number of physicians who have been accused of overprescribing. Some of these were criminal investigations by local law enforcement authorities, such as a county sheriff’s office. Some were investigations by the DEA. Some were investigations by the state licensing agency such as the Florida DOH.

As in this case, it’s common for undercover agents to posing as patients to make appointments with the physician, agents will usually wear a wire device, and give the physician false information.

Click here for some ideas on how physicians might protect themselves from drug-seeking patients. These are tips I give to physicians I advise on this issue.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH Cases.
The Health Law Firm represents pharmacists, pharmacies, physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH), and other law enforcement agencies.

If you are aware of an investigation of you or your practice, or if you have been contacted by the DEA or DOH, contact an experienced health law attorney immediately.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you think the physician received a harsh punishment? Is it becoming too hard for Florida doctors to prescribe pain medication? Please leave any thoughtful comments below.

Sources:

Stutzman, Rene. “Orlando Doctor Fined $10,000, Placed on 20 Years Probation in Pill Case.” Orlando Sentinel. (January 24, 2013). From:
http://articles.orlandosentinel.com/2013-01-24/news/os-roman-mosai-pill-doctor-plea-20130124_1_pain-pills-orlando-doctor-pill-mill

Department of Health v. Roman Mosai, M.D. Case Number 2009-06572. Administrative Complaint. (June 5, 2012). From:
http://www.thehealthlawfirm.com/uploads/DOH%20v%20Mosai.pdf
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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

“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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Students Graduating Medical School in Three Years

By Danielle M. Murray, J.D.

To combat the nationwide shortage of primary care physicians and the increase in student debt, several medical schools around the country are offering the chance for students to finish school in three years, instead of four. According to a number of news articles, these programs are geared specifically toward medical students looking to practice primary care. The hope is that these programs will be cost less for students and add more primary care physicians to under-served areas.

Schools Across the U.S. Offer Three-Year Degrees.

According to an article in The New York Times, a small number of students are currently participating in the three-year degree program. There are about 16 incoming students in the program at New York University (N.Y.U.), nine students at Texas Tech Health Science Center School of Medicine and an even smaller number are at the Mercer University School of Medicine campus in Georgia. In an interview in The New York Times, the dean at Texas Tech said if this approach works, the schools will open up the program to a larger number of students.

To read the entire New York Times article, click here.

Condensed Medical School Not for Everyone.

According to an article in American Medical News, the condensed medical school eliminates breaks and electives and allows students to begin clerkship training in their second year. This is a full year earlier than the traditional four-year curriculums. In the same article, medical experts warn these accelerated programs are not for everyone, saying it takes a mature person to go through rotations earlier and at a quicker pace.

Students are given a chance to opt out if they decide to pursue a different career path. The American Medical News article explains that at Mercer, students who decide that family medicine is not for them are integrated into the traditional four-year program.

Click here to read the article from American Medical News.

Program Developed to Help with Student Debt and Doctor Shortage.

This three-year program is expected to save a quarter of the cost of medical school, which is more than $49,000 a year in tuition and fees at N.Y.U., according to The New York Times. The money saved helps primary care physicians lessen their debt as they go to work in a lower paying field. This program is expected to attract more students to practice in fields such as pediatrics and internal medicine.

According to the Association of American Medical Colleges, the physician shortage is expected to reach 91,500 physicians by 2020. This program, as it grows, can help alleviate the shortage and bring more doctors to areas in need.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants.

The Health Law Firm and its attorneys represent medical school students in disputes with their medical schools, internship supervisors, and in dismissal hearings. We have represented residents, interns and fellows in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and on other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of a three-year medical school degree for doctors? Do you think the fourth year of medical school is necessary for primary care physicians? Please leave any thoughtful comments below.

Sources:

Hartcocollis, Anemona. “N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition.” The New York Times. (December 23, 2012). From:
http://www.nytimes.com/2012/12/24/education/nyu-and-others-offer-shorter-courses-through-medical-school.html?pagewanted=all&_r=0

Krupa, Carolyne. “Med School on the Fast Track: A 3-Year Degree.” American Medical Association. (May 7, 2012). From:
http://www.ama-assn.org/amednews/2012/05/07/prl20507.htm
About the Author: Danielle M. Murray is an attorney with 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., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Senators Want National Investigation of State Medical Boards

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

A bipartisan effort has been initiated by three U.S. Senators to launch a national evaluation of state medical boards. Senators Charles Grassley (R-Iowa), Orrin Hatch (R-Utah) and Max Baucus (D-Mont.) sent a letter to the director of the Office of the Inspector General (OIG) for the Department of Health and Human Services (HHS) requesting an investigation into state medical boards at the end of February 2012.

In the letter the senators ask the OIG to launch a national investigation of state medical boards in which the OIG would:

• Identify challenges and process improvements for state medical boards, including those that occur across state boundaries;
• Identify legislative changes that would better facilitate the transfer of information from federal agencies to state medical boards and between state medical boards, including as it affects those physicians needing multiple state licenses such as those practicing telemedicine;
• Evaluate state medical board performance, including the timeliness and consistency of decision making; and
• Determine whether the Centers for Medicare & Medicaid Services’(CMS) Quality Improvement Organizations (QIOs) and/or Part A/Part B Medicare Administrative Contractors (MACs) report adverse information, including Medicare revocations based on felony convictions, to state medical boards or the National Practitioner Data Bank (NPDB).

The OIG has not undertaken an investigation of this magnitude of state medical boards in over fifteen (15) years.

The U.S. Senate letter dated February 15, 2012 can be seen here.

If this proposed federal investigation proceeds, it is likely that more disciplinary actions will be filed against health professionals. State medical boards may feel pressure to suspend or revoke more health care licenses, which could result in a slower administrative proceeding process.

For more information about state medical boards and disciplinary actions against health providers, visit our website at www.TheHealthLawFirm.com.

Sources Include:

Christensen, Pia. “Senators Request Inquiry Into State Medical Boards.” American Association of Health Journalists. (Feb. 15, 2012). From

http://www.healthjournalism.org/blog/2012/02/senators-request-inquiry-into-state-medical-boards/

Oh, Jaime. “U.S. Senators Call for Federal Investigation Into State Boards’ Action on Physicians.” Becker’s Hospital Review. (Feb. 22, 2012). From

http://www.beckershospitalreview.com/quality/us-senators-call-for-federal-investigation-into-state-boards-action-on-physicians.html

Walker, Emily P. “Senators Want Medical Boards Investigated.” MedPage Today. (Feb. 21, 2012). From
http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/31288

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., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.