Tag Archives: termination

Practicing Medicine Without a Medical License Lands Miami Couple Behind Bars

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

By now, you have heard stories of fake doctors and dentists in South Florida working on patients and causing severe injuries.

Usually, these are solo efforts. However, according to CBS Miami, a couple was arrested back in August of 2011, for practicing medicine without a license. The wife owned a clinic where the husband treated patients. The majority of the patients were children, but the fake doctor also apparently performed gynecological exams on female patients.

Click here to see the story from CBS Miami.

Phony Doctor’s Clinic Fooled Customers.

The clinic apparently looked legitimate to its customers, and other facilities would even refer patients there. A legitimate licensed physician, listed as the clinic supervisor, claims he was duped by the clinic and believed that the fake doctor was a nurse practitioner. The real physician also accuses the fake doctor of forging his signature.

The fake doctor holds only a license to operate x-ray machines. From a check on the Department of Health (DOH) website, that license expired seven years ago.

Real Physician Faces Charges for Assisting Fake Doctor.

The real physician was under investigation for his alleged involvement with the fake doctor and the clinic. Though the arrests happened in November 2011, the real physician was served with a complaint by the DOH just recently, on May 29, 2012.

Click here to see the real physician’s administrative complaint.

The real physician is accused by the DOH of assisting the fake doctor in his unlicensed practice of medicine. The outcome of the proceedings has yet to be seen.

Practicing Medicine Without A Legitimate 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, 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 DOH that the other providers are legitimate.  You can verify a license for free on the DOH’s website.

Remember, 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.

More Stories on Fake Physicians and Other Health 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 South Florida dentist and the damage he inflicted on a teenage girl, click here. To read a blog on an infamous Florida teen impersonating a physician’s assistant (PA), click here. You can also read the story of a fake plastic surgeon in New York by clicking here.

Comments?

What do you think if this story? Leave a comment below.

Contact a Health Law Attorney Experienced in Representing Health Care Providers in DOH Cases.

If you find yourself working for or supervising someone that does not have a valid Florida license, your own license may be at risk. If and when the Department of Health (DOH) becomes involved, do not sign anything, do not speak to the investigators and do not make any statements. Contact an experienced health law attorney immediately to review your case.

The Health Law Firm represents dentists, pharmacists, pharmacies, physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Agency (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.

Sources:

CBS Miami. Accused Fake Doctor, Wife Bond Out of Jail. CBS Miami online. (August 25, 2011). From: http://miami.cbslocal.com/2011/08/25/police-arrest-accused-fake-doctor-in-miami/

About the Authors: 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.

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.

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Assisted Living Facilities (ALFs) Allowed to Terminate a Resident For Almost Any Reason

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

Currently, Florida law and regulations allow an assisted living facility (ALF) to relocate or terminate a resident for almost any reason. However, the administrator must provide a 45-day notice and document the reason for termination or relocation.

Section 429.28(k), Florida Statutes (2011), states that an ALF resident must receive:

At least 45 days’ notice of relocation or termination of residency from the facility unless, for medical reasons, the resident is certified by a physician to require an emergency relocation to a facility providing a more skilled level of care or the resident engages in a pattern of conduct that is harmful or offensive to other residents. In the case of a resident who has been adjudicated mentally incapacitated, the guardian shall be given at least 45 days’ notice of a nonemergency relocation or residency termination. Reasons for relocation shall be set forth in writing. In order for a facility to terminate the residency of an individual without notice as provided herein, the facility shall show good cause in a court of competent jurisdiction.

A reason for termination or relocation can be as broad as “the patient isn’t happy here,” as long as a reason is given.

To view Chapter 429, Florida Statutes, which details Florida law relating to assisted living facilities, click here.

In Florida, assisted living facilities are licensed and regulated by the Agency for Health Care Administration (AHCA).

Although there have been consumer complaints and lobbying to change the law, at the present time the ALF is at liberty to do this. No hearing or other rights are required by law.

Contact Health Law Attorneys Experienced with Assisted Living Facility Cases.

The Health Law Firm and its attorneys represent assisted living facilities (ALFs) and ALF employees in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

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:

Crochet, Jim. “ALF Residents Lack Protection.” Miami Herald. (April 2, 2012). From: http://www.miamiherald.com/2012/04/02/2723745/alf-residents-lack-protection.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.

Have You Received a Notice of Termination of Your Medicare Provider Number?

Have you received a notice of termination of your Medicare provider number? Medicare has been revoking the Medicare provider numbers of many different Medicare providers including physicians, medical groups, home health agencies (HHAs), pharmacies, and durable medical equipment (DME) providers, based on returned mail sent to old addresses which have not been updated or based on inspection team site visits to old addresses.

Often the termination is retroactive to a much earlier date the change or move may have been determined to have occurred. Even if the mailing address is correct or was changed, the physical address of the business must have been updated, as well. It is usually an incorrect or old physical address which causes this to occur.

The effect of this termination includes:

    1. You are prohibited from reapplying to Medicare for at least two (2) years.
    2. You may have to pay back any monies received from the Medicare Program since the effective date of the termination (often many months prior to the notification letter).
    3. Other auditing agents may be notified such as the Medicare Zone Program Integrity Contractors (ZPIC) and the state Medicare Fraud Control Unit (MFCU).
    4. You may no longer contract with Medicare or anyone who does.
    5. You may and probably will be terminated from the approved provider panels of health insurance companies with which you are currently contracted.
    6. You may and probably will be terminated from skilled nursing facilities (SNFs) and home health agencies (HHAs) with which you have contracts.
    7. You may and probably will have your clinical privileges terminated by hospitals or ambulatory surgical centers (ASCs) where you have them.

What you should not do includes:

  1. Don’t bother to write letters.
  2. Don’t bother to call the Centers for Medicare & Medicaid Services (CMS).
  3. Don’t bother to call the Medicare Administrative Contractor (or MAC) (previously called the “carrier” or “fiscal intermediary”).
  4. Don’t bother to file a new CMS Form 855 (application) or a CMS Form 855C (change).
  5. Don’t bother to start communicating with CMS or the MAC about your situation and what you need to do about it.
  6. Don’t bother to complete and file the short, one-page Corrective Action Plan (CAP) form that is on the CMS or Carrier/MAC website (unless you are close to the deadline and don’t have representation; then you must.)


What we recommend is:

  1. Immediately go into the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and the National Plan & Provider Enumeration System (NPPES) NPI Registry and print out a copy of the existing information. Then update or correct any incorrect information on you or your company, if you can. Print out the information as it existed before and print out the information after you have corrected it. (Note: Medicare will act shortly after the letter to you to terminate your access to this, so it may be too late).
  2. Hire an experienced health attorney immediately to assist you in putting together and submitting a comprehensive Corrective Action Plan (CAP), a Request for Reconsideration (RFR) and a request for an Appeal Hearing.
  3. Note that there is a thirty (30) day deadline for submitting the CAP and a sixty (60) day deadline for requesting an appeal hearing. Do not miss these.
  4. Implement formal, written internal policies and procedures to prevent a recurrence of the type of error, oversight or event that caused the termination. Train your management and staff on these.


The CAP should address every element of the applicable conditions of participation (COP) contained in the Code of Federal Regulations (CFR). It should include and be supported by all relevant documents, including but not limited to:

  1. Documents showing how the error occurred or past efforts to comply.
  2. Surety bond guarantees and documents (where required).
  3. Insurance coverage documents showing current coverage (general liability, professional liability, vehicle/auto liability).
  4. Current licenses and permits.
  5. Certificates of good standing and latest annual reports for any corporation or limited liability company.
  6. Print-outs from PECOS/NPPES Registry discussed above.
  7. Accident reports, insurance claims, police reports, fire reports or other documentation showing why a relocation was required (if this was an issue).
  8. Certificates of compliance training for you and your staff, if available.
  9. Copies of policies and procedures that you have adopted to keep there from being a recurrence of the situation that led to the termination.
  10. An authorization form for your consultant or attorney to represent you in the matter.


All copies should be clear, legible, complete, straight, no corners cut off an no handwriting on them, to the greatest extent possible.


Everything should be professionally assembled, typed, indexed and labeled. It should include a table of contents or an index. Number every page. It should be submitted to the MAC (or the agency/address given in the termination letter) by two (2) reliable means that document both sending and receipt. Keep copies of everything, including postal receipts, airbills, Federal Express labels, courier receipts, etc. It must be received at the address given in the termination letter you received (usually MAC) by the deadline given above. Keep copies of online tracking reports and return receipts.

In most instances, should you show a legitimate reason for the error, show you are currently in compliance, and show what remedial measures you have taken to keep there from being a repeat, the MAC will accept your corrective action plan (CAP) and will reinstate your Medicare number, as things stand currently.