Tag Archives: medical practice

Beware of These Illegal Business Arrangements in Healthcare

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

Florida does not have a corporate practice of medicine prohibition like many other states do.  In other words, a physician is allowed to work as an employee or independent contractor of a corporation or other business entity owned by nonphysicians   However, there are a number of exceptions to this rule.

For dentists, optometrists and chiropractors there are specific statutory prohibitions on any member of that profession practicing his or her specialty while working for a group, practice or organization that is owned or controlled by one who is not a member of that profession.  These laws, a different one for each specialty, make it a felony to do so, as well as grounds for discipline against the professional’s license.  It is considered to be a separate felony offense for each day.

The main exceptions for these prohibitions include, for example, working for a hospital, working for a federal health care clinic, working for a not-for-profit charity health care clinic, and other limited exceptions.

There are All Treated the Same: Revoked License, Licensed in Another State But Not in Florida and Suspended License.

We have seen cases in which a dentist or chiropractor licensed in another state, but not in Florida, owned or operated a dental or chiropractic clinic in Florida.  This would be prohibited, of course.

In other cases, we have seen health professionals who have had their licenses revoked continue to own and operate or even “lease out” their practices to others.  The ownership or control of the practice by one with a revoked license would also be illegal.

We have seen cases in which a spouse or child of a deceased physician has continued to own and operate a clinic after the health professional died, when he or she was not a health professional.  This is illegal from the day the health professional died and there is no “grace period.”

In the Cases of Health Care Clinics and Pain Management Clinics…

In cases in which a member of the profession is allowed to work for a group, practice, clinic, corporation or other business entity that is not owned by health professionals, then that organization (again, with certain exceptions) is required to obtain a health care clinic license from the Agency for Health Care Administration (AHCA).  Professionals other than dentists, chiropractors and optometrists, could work, for example, for a corporation (corp.) or limited liability company (LLC) owned by an accountant and a businessman, as long as it had a valid health care clinic license.  Owning, operating or working for an unlicensed health care clinic which would be required by Florida law to be licensed, is a felony offense.

If you are a physician, nurse practitioner, other licensed health professional, you need to check the business’s licensure status with AHCA to make sure it is current and valid, before going to work there.

Additional situations include pain clinics and other types of health practices which constitute “risky” areas of practice.  If you are not aware of the almost daily occurrences of physicians getting busted, pharmacists getting arrested, and pharmacies and pain clinics being searched, closed and shuttered, you’re not reading the newspapers or watching TV.  Usually pain clinics are required to be licensed as health care clinics by AHCA and as pain medicine clinics by the Department of Health (DOH).  However, a regular medical practice is exempt from those requirements (with certain exceptions, of course).

We have encountered situations where a good physician is recruited into a very questionable practice setting by unscrupulous nonprofessionals who are merely using him or her.  Everything is placed in the physician’s name.  On paper it appears the physician is running a legitimate medical practice.  However, behind the scenes, the physician actually controls nothing.  It is clear that the whole setup is just a shell, a phony medical practice set up to skirt the law and avoid licensure.

We have seen medical practices and dental practices where a nonprofessional business person has control of all of the billings and collections, the employees, the bank accounts and all of the records.  The physician does not have control of anything, not even the practice’s bank account.  We have encountered several situations where the physician does not even have passwords to his/her own computers and software or keys to his/her own office.  We believe that such situations are sham operations set up to avoid statutory requirements.  A physician would be well warned to stay away from such situations.

Beware of Scams to Avoid the Law.

We have seen many cases where individuals, including lawyers and business people, have attempted to get creative to come up with schemes to try to get around the laws.  Often there may be a legal way to create an arrangement between licensed health professionals and unlicensed business people, to accomplish their goals, especially related to financial arrangements.

However, we have also seen many such schemes that were clearly illegal and meant to just put a facade on an obviously illegal arrangement.  When the criminal authorities start to investigate the behind-the-scenes people disappear, leaving the physician to pay the price. A physician or health care provider should have any such business arrangement reviewed in detail by a board certified health lawyer before he or she gets involved with it.  If you are thinking about investing in such a practice or arrangement, then we strongly recommend that you obtain an opinion letter from a board certified health lawyer as to the legality of the situation or arrangement.

Do Not Let Anyone Else Use Your Billing Number or Medicare Provider Number.

We have also been consulted on a number of occasions by physicians who were contacted by business people starting clinics allegedly seeking a “medical director” for their clinic, offering the physician a large amount of money without having to perform any real work.  However, they just need to use the physician’s Medicare number to bill with for a few months until their Medicare number is approved.  Such enterprises usually turn out to be Medicare billing fraud schemes.  The company uses the physician’s Medicare number to bill for hundreds or thousands of physician patient visits in patient’s homes, nursing homes or assisted living facilities (ALFs) that never occur.  When Medicare stops paying and starts investigating, the ones behind the scheme disappear and leave the physician holding the bag.

Avoid such schemes.  Avoid any situation where someone else “needs” to use your Medicare number for services that you are not actually performing yourself.  If the deal sounds too good to be true, it probably is.  You will wind up paying a heavy price later on if you fall for it,

There are Many Illegal Situations Which Carry Heavy Consequences.

Many of the above situations can result in criminal prosecutions.  In addition, these are also usually grounds for discipline on a health professional’s license.  In many cases, all fees collected while operating illegally must be refunded.  In the case where pain management is involved, the penalties are much higher than in other situations.  Where Medicare and Medicaid patients or billings may be involved, the risks of criminal prosecution and very large monetary penalties are much greater.

Contact a Health Care Attorney Experienced in Negotiating and Evaluating Physician and Health Professional’s Business Transactions.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider.

The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings.

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 about this blog? 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.

Advertisements

Walgreens Reaches Settlement in False Claims Act Case

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

Walgreens has reached a $7.9 million settlement with the United States and participating states that resolves allegations that Walgreens violated the False Claims Act. The DOJ announced the settlement on April 20, 2012. To view the DOJ’s press release concerning the settlement with Walgreens, click here. To view the False Claims Act, click here.

Walgreens Allegedly Offered Illegal Inducements to Medicare and Medicaid Beneficiaries.

The settlement was reached after Walgreens was accused of offering illegal inducements to beneficiaries of government health programs (Medicare, Medicaid, the Federal Employees Health Benefits Program (FEHBP), and TRICARE ). Walgreens allegedly offered gift cards to government health program beneficiaries when they transferred a prescription from another pharmacy to Walgreens. The government maintains that such inducements are a violation of state and federal laws.

Walgreens Pays Back Individual State Medicaid Programs.

Since the initial settlement was announced by the DOJ, Walgreens has begun to pay back individual state Medicaid programs that were impacted by the alleged inducements. State and federal laws prohibit such inducements to buy services and goods provided under Medicaid. Walgreens is now paying the states for prescription claims it submitted for reimbursement to Medicaid that were a result of the alleged inducements. Some of the states involved include California, Indiana, Michigan, and Missouri.

Whistleblowers Initiated Government Investigation of Walgreens’ Gift Card Inducements.

The allegations were brought to the government by two whistleblowers. Two separate whistleblower lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act and state False Claims Act statutes. The whistleblowers will receive $1,277,172 from the United States for their role in filing the qui tam actions.

Contact Health Law Attorneys Experienced with False Act Claims Cases.

The Health Law Firm represents physicians, medical practices, pharmacists, pharmacies, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

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

Sources Include:

Cohen, Bryan. “Whistleblower Lawsuits Against Walgreens Settled.” LegalNewsline. (June 12, 2012). From: http://www.legalnewsline.com/news/236427-whistleblower-lawsuits-against-walgreens-settled

Department of Justice, Office of Public Affairs. “Walgreens Pharmacy Chain Pays $7.9 Million to Resolve False Prescription Billing Case.” Department of Justice. (April 20, 2012). Press Release. From: http://www.justice.gov/opa/pr/2012/April/12-civ-505.html

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.