Category Archives: Our Firm

Wow! Did You Know That There Were All of These Different Medical and Dental Examination and Specialty Boards out There?

Patricia's Photos 013By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Did you know there are many different medically-related examination and specialty boards out there screening applicants’ credentials and administering national examinations required for licensure? What is more, if an applicant is accused of some type of wrongdoing by that board (which may include allegations of “irregular behavior or conduct,” “cheating,” “compromising examination materials,” or other similar allegations) each has different procedures and appeals for handling investigations.


Types Of Medical Specialty Boards.

I have recently had to advise clients on or become involved in hearings or appeals for:

  • The Educational Commission for Foreign Medical Graduates (ECFMG);
  • The National Board of Osteopathic Medical Examiners (NBOME);
  • The National Board of Chiropractic Examiners (NBCE);
  • The National Board of Pediatric Medical Examiners (NBPME);
  • The National Board of Medical Examiners (NBME);
  • The Joint Commission on National Dental Examinations (JCNDE)
    (which administers the National Board Dental Examination (NBDE));
  • The National Association of Boards of Pharmacy (NABP);
  • The American Board of Internal Medicine; and the
  • American Board of Obstetrics and Gynecology (ABO+G).

These are just the recent ones and don’t count the regular medical specialty boards about which we routinely consult clients.


The Intricacies of These Types of Boards.

Some of the boards don’t even have hearing procedures or appeal procedures set forth in a written policy or handbook. This makes it somewhat challenging to dispute an adverse decision against a client.

Nevertheless, because we have had such broad experience with such different boards, we are able to synthesize and extrapolate from the experiences we have had to obtain favorable results for clients, even when we are called upon to deal with a board with which we have not previously dealt.


Comments?

Were you aware that such specific boards existed? Do you have any experience or personal insight with any of these boards? Please leave any thoughtful comments below.


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 accusations of disruptive behavior, 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.


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 © 1999-2015 The Health Law Firm. All rights reserved.

 

Disruptive Physicians: Nobody Likes a Nuisance

IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Christopher E. Brown, J.D., The Health Law Firm

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. Disruptive behavior can impact staff morale and can increase the risk of liability to all employers.

A recent New York case demonstrates this. According to a journal for surgeons, a New York doctor is being held responsible for an ongoing worker’s compensation bill as the result of a violent outburst he directed toward a physician assistant (PA). The physician allegedly lost his temper during an open-heart surgery when the physician assistant accidentally suctioned some heart tissue. The physician allegedly threatened that he would “throw the physician assistant through the wall” if it happened again.

The physician assistant has claimed that the threat deeply affected her ability to perform her job, as well as put the patient’s safety at risk. A psychologist diagnosed the PA with post traumatic stress disorder (PTSD) caused by the incident. Unable to work because of the trauma allegedly caused by the disruptive physician, the PA now reportedly collects $2,415 a week in workers’ compensation.

To read the full article from Outpatient Surgery, click here.

Implications of Disruptive Behavior.

Disruptive behavior from a physician can lead to dire consequences for both the physician and his or her employer. Lawsuits and liabilities, such as those in the New York case discussed above, can detract from a safe, cooperative, and professional healthcare environment.

Disruptive behavior can negatively affect the quality of patient care. Hospitals claim that this happens because of conduct that:

–    Disrupts or impedes the operations of the hospital;

–    Adversely affects the ability of others on the healthcare team to do their jobs;

–    Creates an unprofessional or hostile work environment for hospital employees;

–    Interferes with coworkers’ ability to practice competently;

–    Prevents effective communications among healthcare providers and staff;

–    Disrupts the continuity of care a patient receives; and

–    Adversely affect the community’s confidence in the hospital’s ability to provide quality patient care.

Being accused of being a disruptive physician may lead to adverse action against clinical privileges, action to drop the physician from insurance panels, consequential action by the state medical board or licensing authority, loss of specialty certification, termination of employment contracts and other various consequences.

What Conduct May Cause One to be Labeled a Disruptive Physician?

A hospital’s creed, ethical statement, or code of conduct, as well as Joint Commission Standards, and medical staff bylaws can define what constitutes disruptive behavior. Case reports, hospital policies and actual cases in which we have defended physicians demonstrate the types of acts that can be used to label a person as “disruptive.” Disruptive behavior includes, but is not limited to:

–    Verbal attacks that are personal, irrelevant to hospital operations, or exceed the bounds of professional conduct;

–    Shouting, yelling, or the use of profanity;

–    Verbally demeaning, rude or insulting conduct, including exhibiting signs of disdain or disgust;

–    Inappropriate physical conduct, such as pushing, shoving, grabbing, hitting, making obscene gestures, or throwing objects;

–    Inappropriate comments or illustrations made in patient medical records or other official documents, impugning the quality of care in hospital facilities, or attacking particular medical staff members, personnel, or policies;

–    Belittling remarks about the patient care provided by the hospital or any healthcare provider in the presence or vicinity of patients or their families;

–    Non-constructive criticism that is addressed to the recipient in such a way as to intimidate, undermine confidence, belittle, or imply stupidity or incompetence;

–    Refusal to accept, or disparaging or disgruntled acceptance of, medical staff assignments;

–    Inappropriately noisy or loud behavior in patient areas;

–    Making sexual or racial jokes;

–    Physically touching another professional, nurse or staff member, especially those of the opposite sex;

–    Making sexually suggestive remarks;

–    Commenting on another person’s body parts;

–    Threatening violence to another;

–    Throwing surgical equipment, medical supplies, charts, or anything else at or around anyone else; or

–    Other disruptive, abusive, or unprofessional behavior.

I previously wrote a two-part blog series detailing the types of conduct considered disruptive, as well as the consequences associated with disruptive behavior and how you as a physician can avoid such pitfalls. To read part one of the blog series, click here. To read part two of the blog series, click here.

Physicians: Proactively Educate Yourself.

It’s wise to review your hospital’s or institution’s policies on disruptive behavior. Arming yourself with the knowledge necessary to avoid such accusations is imperative in protecting your reputation and career.

No one lives in a glass house, but pretend you do. Someone can always observe your actions in the office or hospital. Once you have been labeled a disruptive physician, others may be closely, at times, scrutinizing you for anything you may do wrong. You will make yourself a target for possible false allegations and accusations. The healthcare industry is a demanding and stressful field. It’s understandable that potential outbursts can occur; control yourself and don’t let them.

Comments?

Have you ever been accused of being a disruptive physician? Have you ever been around one? What are some proactive tactics physicians can take to prevent any outbursts or behavioral conduct that would be deemed as disruptive? Please leave any thoughtful comments below.

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 accusations of disruptive behavior, 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.

Source:

Burger, Jim. “Doc Threatens Physician’s Assistant During Open Heart Surgery: I’m Going to Put Your Through the Wall.” Outpatient Surgery. (July 14, 2014). From: http://www.outpatientsurgery.net/surgical-facility-administration/legal-and-regulatory/doc-threatens-physician-s-assistant-during-open-heart-surgery-i-m-going-to-put-you-through-the-wall–07-14-14

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 © 1996-2014 The Health Law Firm. All rights reserved.

Kansas Cancer Treatment Center and Owner Pay $2.9 Million Settlement for Alleged False Claims Act Violations

IndestBy 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 the False Claims Act by defrauding Medicare, Medicaid and the Federal Employee Health Benefits Program. According to the complaint, it is alleged that the cancer treatment facility submitted false claims for drugs and services that were not provided to beneficiaries.

Click here to read the entire whistleblower complaint filed in 2012.

The complaint identifies three former employees of Hope Cancer Institute as the plaintiffs or “relators” in this case.

Owner Allegedly Instructed Employees to Submit Inflated Claims and Altered Medical Records.

According to the Department of Justice (DOJ), between 2007 and 2011, the Hope Cancer Institute’s owner allegedly instructed employees to bill for a predetermined amount of cancer drugs at certain dosage levels. However patients were allegedly given lower dosages of these drugs. This resulted in the center submitting false claims to federal health care programs for drugs that were not actually provided to beneficiaries. The three plaintiffs also stated they watched the owner use a paper cutter and tape to alter medical records before faxing them to Medicare. The employees’ investigation allegedly turned up altered documents for 13 patients.

To read the entire press release from the DOJ, click here.

The claims made against the Hope Cancer Institute and its owner are allegations. There has been no determination of liability.

Most Qui Tam Claims Filed by Employees.

The plaintiffs in this case filed the lawsuit against their employer under the qui tam or whistleblower provision of the False Claims Act. This law encourages whistleblowers to file fraud claims on behalf of the government by giving them a share of whatever the government collects, usually 15 percent (15%) to twenty-five percent (25%). Under the law, the employees are also required to give the DOJ the evidence they have collected so the government can join the lawsuit.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or staff employees who have some knowledge of false billing or inappropriate coding taking place. Typically the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Physicians, nurses or staff employees usually have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation showing fraud “disappears” or cannot be located once it is known that a company is under investigation.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Department of Justice. “Government Settles False Claims Act Allegations Against Kansas Cancer Treatment Facility and Its Owner.” Department of Justice. (April 14, 2014). From: http://www.justice.gov/opa/pr/2014/April/14-civ-378.html

United States of America ex rel., Krisha Turner, Crystal Dercher and Amanda Reynolds v. Hope Cancer Institute, Inc. Case Number 2:12-cv-02122-EFM-JPO. Complaint. (March 1, 2012).

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 © 1996-2014 The Health Law Firm. All rights reserved.

OIG Audit Finds Federal Database of Terminated Medicaid Providers Needs Improvement

LLA Headshot smBy 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 health care providers from billing another state’s program. However, an audit by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), released in March 2014, states the MCSIS is not working as intended.

The MCSIS is supposed to collect data from every state Medicaid program on providers that were terminated from Medicaid for cause. However, the report found that the HHS OIG is not receiving data from 17 states or the District of Columbia. It was also found that a majority of the data does not meet the ACA criteria.

To read the entire report from the HHS OIG, click here.

Specific Issues Within Database.

According to the OIG, only 27% of the 6,439 MCSIS records involve terminated Medicaid providers. The database is filled with providers who had not been terminated, but rather had died, retired, left the state or stopped working with Medicaid of their own accord. It is also reported that about one-third of the records are not related to for-cause provider terminations. A majority of the data comes from California, Pennsylvania, Illinois and New York. According to Reuters, more than half of the records submitted did not include a National Provider Identification number, which is critical to any state trying to identify a terminated provider.

Click here to read the entire article from Reuters.

Recommendations to Improve Database.

CMS is now exploring options to implement mandatory state reporting. The agency has begun requiring that states submit termination letters for each provider entered in the MCSIS, and that CMS employees review each letter to ensure the provider belongs in the system.

What This Means for Medicaid Providers.

As CMS works to improve this database, those providers who have fallen through the cracks due to the reporting lag will now face repercussions for exclusion. Exclusion from Medicaid could mean exclusion from Medicare and other federal providers. It is important that health care providers know their status regarding exclusion, and contact an experience attorneys to assist them in having their names removed from exclusion lists.

To read more on the devastating consequences of exclusion, click here for a previous blog.

Contact Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare or Medicaid Programs.

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

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

Comments?

As a health care provider, do you know your status regarding exclusion? Are you aware of the consequences of being excluded? Please leave any thoughtful comments below.

Sources:

Pell, M.B. “U.S Database for Tracking Medicaid Fraud Fall Short, Auditor Says.” Reuters. (March 27, 2014). From: http://www.reuters.com/article/2014/03/27/us-usa-medicaid-database-idUSBREA2Q08D20140327

Levinson, Daniel. “CMS’s Process for Sharing Information About Terminated Providers Needs Improvement.” Department of Health and Human Service Office of Inspector General. (March 2014). From: http://oig.hhs.gov/oei/reports/oei-06-12-00031.pdf

About the Author: Lenis L. Archer is as 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.

“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 © 1996-2014 The Health Law Firm. All rights reserved.

Orlando Health Attorney Appointed to Health Law Certification Committee

On April 9, 2012, Gwynne A. Young, President-Elect of The Florida Bar, announced that George F. Indest III, President and Managing Partner of The Health Law Firm, has been appointed to serve on The Florida Bar’s Health Law Certification Committee. Mr. Indest will begin his three year term on July 1, 2012.

The Florida Bar’s Health Law Certification Committee is responsible for overseeing the board certification process for all health law attorneys. Appointments to this standing committee are made by The Florida Bar’s President-Elect. There are only 116 attorneys certified by The Florida Bar in the legal specialty of health law.

Mr. Indest is a well-known attorney specializing in the representation of health professionals and health care providers throughout Florida. He is Board Certified by The Florida Bar in Health Law. His practice encompasses all aspects of health law, including defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, clinical privileges hearings, representation of medical students, and other matters of health care law and legal representation of health care professionals.

In 1999 Mr. Indest started The Health Law Firm, which has three Florida offices in Altamonte Springs, Orlando, and Pensacola. A former Navy JAG Corps attorney, he has practiced law for over 30 years.

For more information about The Health Law Firm visit http://www.thehealthlawfirm.com.

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About The Health Law Firm
The Health Law Firm was established in 1999, bringing together a team of experienced attorneys with decades of work in the legal and healthcare fields. With offices in Altamonte Springs, Orlando and Pensacola, Florida, the firm represents healthcare providers, including hospitals, nursing homes, physicians, dentists, mental health professionals and other licensed health professionals and entities. For more information about The Health Law Firm, visit http://www.thehealthlawfirm.com. 
For additional information contact:
Kara Large
klarge@TheHealthLawFirm.com
Phone: (407) 331-6620, ext. 219

Orlando Health Attorney Featured in Latest Issue of Medical Economics

Orlando, Fla. – March 15, 2012 – George F. Indest III, President and Managing Partner of The Health Law Firm, shares his knowledge of health law in the March 14 issue of Medical Economics. Mr. Indest was interviewed and quoted for an article concerning legal advice for primary care physicians who prescribe painkillers. In the article he provided information based on his experience in defending physicians charged with over-prescribing with the DEA and Florida DOH, Board of Medicine.

The article, “5 ways to avoid over-prescribing allegations,” includes tips written by Mr. Indest for physicians to follow if they practice pain management. The article can be read in its entirety here.

Mr. Indest is a well-known attorney specializing in the representation of health professionals and health care providers throughout Florida. His practice encompasses all aspects of health law, including pain management and pain medicine physician and clinic defense, defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, clinical privileges hearings, representation of medical students, and other matters of health care law and legal representation of health care professionals.

In 1999, Mr. Indest started The Health Law Firm, which has three Florida offices in Altamonte Springs, Orlando, and Pensacola. A former Navy JAG Corps attorney, he has practiced law for over 30 years.

For more information about The Health Law Firm visit http://www.thehealthlawfirm.com.

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About The Health Law Firm
The Health Law Firm was established in 1999, bringing together a team of experienced attorneys with decades of work in the legal and healthcare fields. With offices in Altamonte Springs, Orlando and Pensacola, Florida, the firm represents healthcare providers, including hospitals, nursing homes, physicians, dentists, mental health professionals and other licensed health professionals and entities. For more information about The Health Law Firm, visit http://www.thehealthlawfirm.com.

For additional information contact:
Kara Large
Office: (407) 331-6620, ext. 219
Cell: (407) 921-4322

Orlando Health Law Attorneys to Speak at Florida Hospital

Attorneys from The Health Law Firm will be presenting a seminar on contracts to Florida Hospital’s family medicine residents and medical students on Wednesday, December 7, 2011 at Florida Hospital East Orlando. The lecture aims to provide information on contract negotiations and employee contract review.

This seminar is part of a series that will be presented to Florida Hospital’s family medicine department by The Health Law Firm‘s attorneys. Other lecture topics will include top legal concerns common to doctors, such as navigating a Department of Health complaint.

Based in Altamonte Springs, Fla., The Health Law Firm concentrates in representing health care providers, exclusively. Services provided by the firm include reviewing and negotiating contracts, defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, Department of Health investigations, pain management and pain medicine physician and clinic defense, representation of medical students, and other matters of Health Law and legal representation of health care professionals.

For more information about The Health Law Firm visit http://www.thehealthlawfirm.com.