Tag Archives: the health law firm

A Prescription for Love Fraud

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In May of 2015, Tricare began screening all compound medication prescriptions to ensure approval of each ingredient with the Food and Drug Administration (FDA). This decision came after a finding of a significant increase in compound drug prescriptions reimbursed by Tricare over the last year.

In April 2015, just four months into the fiscal year, it was already determined that total costs for compound drug prescriptions filled for Tricare recipients were likely to come close to $1 billion. If the trend continues, the Defense Health Agency expects it may need to reallocate funds at the end of this year to cover the prescription drug benefit, which is currently set at $8.25 billion.

For more on this new screening process and its effect on compound medication prescriptions, click here.

With prescription drug costs at an all-time high, the government is cracking down on health care fraud. This includes the implementation of data mining for fraud detection and prevention.

It was during one of these routine mining expeditions of reimbursement data that the United States Attorney’s Office identified MediMix, a compounding pharmacy in Jacksonville, Florida, as the top-biller of compounding pain prescriptions. More importantly, upon further investigation, it was found that Ankit Desai, M.D. was the top referring physician for MediMix.

The significance in the correlation between the two is that, according to reports, Dr. Desai happens to be married to one of the top executives (Senior Vice President) of Medimix.

To read the press release on this story, click here.

When Marriage and Money Clash.

Health care providers are generally prohibited from referring patients to another medical-related business in which they hold a financial interest of some kind, if there are payments made with federal funds.

The prohibition on certain physician referrals is established under Section 1395nn, 42 United States Code (otherwise known as the Stark Law). The Stark Law states in pertinent part:

“…if a physician (or an immediate family member of such physician) has a financial relationship with an entity specified in paragraph (2), then–

(A) the physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made under this subchapter, and

(B) the entity may not present or cause to be presented a claim under this subchapter or bill to any individual, third party payor, or other entity for designated health services furnished pursuant to a referral prohibited under subparagraph (A).” Section 1395nn (a)(1)(A)(B), 42 United States Code.

Paragraph (2) of Section 1395nn (a), 42 United States Code, defines “a financial relationship of a physician (or an immediate family member of such physician) with an entity specified in this paragraph” as:

(A) except as provided in subsections (c) and (d) of this section, an ownership or investment interest in the entity, or

(B) except as provided in subsection (e) of this section, a compensation arrangement (as defined in subsection (h)(1) of this section) between the physician (or an immediate family member of such physician) and the entity.

An ownership or investment interest described in subparagraph (A) may be through equity, debt, or other means and includes an interest in an entity that holds an ownership or investment interest in any entity providing the designated health service.” Section 1395nn (a)(2)(A)(B), 42 United States Code.

The Stark Law was specifically enacted to place limitations on physician referrals so as to avoid:

(1) conflicts of interests;

(2) self-referrals;

(3) overutilization of services;

(4) increased health care costs;

(5) a limit on competition by other medical providers;

(6) to prevent ineffective and unsafe treatment; and, ultimately-

(7) fraudulent practices.

Click here for more information on the most common Federal fraud and abuse laws in health care.

 

Tricare Regulations Similar to Stark and Anti-Kickback Regulations.

In support of its position, the United States Attorney’s Office relied on Section 199.9, 32 Code of Federal Regulations, which provides “administrative remedies for fraud, abuse, and conflict of interest.” More specifically, Section 199.9(c)(12) defines fraud as:

“Arrangements by providers with employees, independent contractors, suppliers, or others which appear to be designed primarily to overcharge the [Tricare program] through various means (such as commissions, fee-splitting, and kickbacks) used to divert or conceal improper or unnecessary costs or profits.”

Furthermore, due to the application of this more open-ended regulation, whistleblowers that may come forward as a result of the allegations made in this False Claims Act (FCA) case, may be granted more latitude in making arguments. Alternatively, under the Stark Law, the same arguments might have been moot as a result of its explicit exceptions not found in Tricare regulations.

We’ll Call it the Honeymoon Fund.

MediMix reached a settlement agreement with the government which has avoided a determination of liability. However, the Jacksonville-based compounding pharmacy did not get off without a significant penalty. The settlement will cost MediMix an impressive $3,775,458.

Click here to read more about the government cracking down on what they determine to be “a significant threat to the [Department of Defense] DoD healthcare system.”

Avoiding the”Dog House.”

The FCA has been highly effective in exposing fraudulent practices of pharmaceutical companies. Whistleblower cases brought under the FCA have assisted the government in recovering more than $19 billion in stolen funds due to varying pricing, billing and marketing schemes.

Here are the most common pharmaceutical practices that may land you in the “dog house” for a FCA violation:

(1) Off-label marketing of drugs;

(2) Illegal kickbacks;

(3) Inflating the price of pharmaceuticals;

(4) Best price fraud; and

(5) Pharmaceutical benefits manager fraud.

Click here to read more information about these common pharmaceutical schemes and how to identify and consequently avoid them.

If you find yourself in a tricky situation with possible allegations of a FCA violation, it’s best to contact an experienced health attorney immediately to properly evaluate your case and inform you of your rights.

For more about your right to consult with a lawyer prior to speaking with an investigator, please read one of our previous blogs here.

Comments?
Are you currently engaged in a questionable financial relationship? Do you agree with the law on prohibiting certain referrals in which there is a financial interest? Why or why not?

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s 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.


Sources:

Department of Justice, The United States Attorney’s Office, Middle District of Florida. Press release. “United States Settles False Claims Act Allegations Against Jacksonville-Based Compounding Pharmacy.” 1 June 2015. Web. 11 Sept. 2015.

Kime, Patricia. “Tricare to Start Screening Compound Medications Friday.” Military Times. A TEGNA Co., 1 May 2015. Web. 10 Sept. 2015.

“Pharmaceutical Fraud” Web blog post. False Claims Act Resource Center. Pietragallo Gordon Alfano Bosick & Raspanti, LLP, 2015. Web. 11 Sept. 2015.

Rumph, Alan, and Donna Lee Yesner. “When Referrals And Marriage Don’T Mix: MD, Pharmacy Settle Case.” Report on Medicare Compliance. Washington: Atlantic Information Services, Inc., 8 June 2015. Web. 11 Sept. 2015.

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.

Keywords: False Claims Act defense attorney, FCA, pharmaceutical fraud, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, whistleblowers lawyer, FCA violations, fraud detection, data mining, financial interest in physician referrals, Stark Law, Department of Defense, DoD, Tricare fraud attorney, health attorney, defense attorney, The Health Law Firm, health law firm, fraud investigations, conflict of interest in physician referrals, compound medication prescriptions, compounding pharmacy lawyer, prescription reimbursement, qui tam attorney, financial relationship with physician

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“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 © 1996-2015 The Health Law Firm. All rights reserved.

New Recreational Marijuana Amendment Being Pushed in Florida

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

There is a new effort to legalize the use of marijuana for adults in Florida and not just for medical purposes. The two groups, The Florida Cannabis Action Network and Floridians For Freedom, are pushing for a new recreational marijuana amendment in Florida. Petitions will soon hit the streets for a proposed constitutional amendment that would completely legalize use, possession and cultivation of marijuana by Florida adults.

Getting on the 2016 Ballot.

The Florida Cannabis Action Network, along with a committee called Floridians For Freedom, stated that it had received state approval to begin seeking signatures which would get their measure on the ballot in November 2016. This measure is distinct from a previous amendment led by Orlando Lawyer John Morgan, who wanted to legalize marijuana for medical purposes only.

Floridians For Freedom will have to gather more than 67,000 valid signatures to get the effort to the next phase which is Florida Supreme Court review. Then the group will have to gather an additional 600,000 valid signatures to get it qualified for the ballot next fall. To visit their website, click here.

“Ending Prohibition” of Marijuana Under State Law.

According to Jodi James, chair of Floridians For Freedom and executive director of the Florida Cannabis Action Network, the commercial aspects of marijuana would be controlled by rules and regulations set by the Florida Legislature and Department of Commerce. “We want it to be legal. We want it to be regulated. We want it controlled. We want people to have safe access,” James said.

The Florida Cannabis Action Network currently has 20,000 members that it will call on to help collect valid signatures. To read one of our previous blogs on marijuana policy, click here.

Be sure to check The Health Law Firm’s Medical Marijuana Law Blog regularly to stay updated on this hot topic.

Comments?

What are your thoughts on making marijuana completely legalized? Please leave any thoughtful comments below.

Contact Experienced Health Law Attorneys for Medical Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting and/or licensing, while complying with Florida law. We can also represent doctors, pharmacies and pharmacists facing proceedings brought by state regulators or agencies.

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

Source:

Powers, Scott. “Group to push amendment that would completely legalize marijuana.” Orlando Sentinel. (September 2, 2015). Print.

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.

KeyWords: Legalize marijuana, Florida medical marijuana, medical cannabis, medical marijuana, medical marijuana lawyer, medical marijuana license, defense attorney, defense lawyer, health lawyer, marijuana, recreational cannabis, recreational marijuana, marijuana cultivation, Floridians For Freedom, Florida, Cannabis Action Network, commercial use of marijuana, Florida Legislature, Department of Commerce, The Health Law Firm

“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 © 1996-2015 The Health Law firm. All rights reserved.

Employers are Liable in Tort Actions for HIPAA Violations

2 Indest-2009-1By Shelby Root and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule, implemented in 2013, modified HIPAA’s privacy and security rules. However, solutions aimed at health privacy challenges such as data and information collected by mobile apps generally lie outside the scope of HIPAA. To solve this problem, some states are working on a solution to the problem of patients not having a private right of action. One solution is to hold employers liable for privacy torts resulting from a breach of confidential medical information through the legal doctrine of respondeat superior.

Walgreen Co. v. Hinchy.

In the recent case, Walgreen Co. v. Hinchy, 21 N.E.3d 99 (Ind. Ct. App. 2014), Withers, the defendant’s employee-pharmacist, accessed a patient’s prescription profile for personal reasons. The patient, Hinchy, filed claims against Walgreen and Withers for breach of privacy. Hinchy filed claims against Walgreen claiming vicarious liability and direct negligence. A jury verdict of $1.8 million was awarded to Hinchy for breach of privacy in this case.

The Doctrine of Respondeat Superior.

Vicarious liability will be imposed upon an employer through the doctrine of respondeat superior when “the employee has inflicted harm while acting ‘within the scope of employment.'” For an act to fall within an employee’s scope of employment, “the injurious act must be incidental to the conduct authorized or it must, to an appreciable extent, further the employer’s business.” An employer is not held liable because it did something wrong, but rather “because of the employer’s relationship to the wrongdoer.”

Court’s Decision in Walgreen Co. v. Hinchy.

The court pointed out in Hinchy that Withers was authorized to use Walgreen’s computer system and printer, handle prescriptions for customers, look up the customers information on the computer system, review a patient’s prescription history, and make prescription-related printouts. When Withers committed the confidentiality violation she was at work, on the job, and using the company’s equipment. Withers owed the plaintiff a duty of privacy protection by virtue of her employment as a pharmacist. The court concluded that Withers caused harm to the plaintiff while acting within the scope of her employment.

Editor’s Comments.

This case is good law. An employer should be held liable when it places an employee in a position where the employee can injure another. Employers have a separate duty to closely supervise their employees, as well.

Healthcare employers must take precautions to prevent such breaches as occurred in the Hinchy case. Under traditional tort analysis, the employer is in the best position to prevent the injury. Under HIPAA, the employer has a number of additional duties including training its employees properly and securing information.

Comments?

What are your thoughts on respondeat superior? Please leave any thoughtful comments below.

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Terry, Nicolas. “Employer Liability for Privacy Torts.” Health Law Professor Blog. (Dec. 21, 2014). From:
http://lawprofessors.typepad.com/healthlawprof_blog/2014/12/employer-liability-for-privacy-torts.html

Walgreen Co. v. Hinchy, 21 N.E.3d 99 (Ind. Ct. App. 2014). From:

http://scholar.google.com/scholar_case?case=14802759292316058625&q=Walgreen+Co.+v.+Hinchy,+21+N.E.3d+99+(Ind.+Ct.+App.+2014).&hl=en&as_sdt=40006

About the Authors: Shelby Root is a summer associate at The Health Law Firm. She is a student at Barry University College of Law in Orlando.

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.

Keywords: Health Insurance Portability and Accountability Act (HIPAA), Walgreen Co. v. Hinchy, HIPAA Omnibus Rule, HIPAA compliance, data security, protected health information (PHI), patient privacy, patient rights, HIPAA violation, privacy, defense attorney, defense lawyer, HIPAA defense attorney, HIPAA attorney, HIPAA lawyer, health law firm, The Health Law Firm

“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 © 1996-2015 The Health Law firm. All rights reserved.

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Appeals Court Upholds Medical Malpractice Law Changes

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

On July 21, a state appeals court in Tallahass2 Indest-2009-1ee upheld the constitutionality of a controversial change in Florida’s medical malpractice law. It ruled that some privacy rights are waived when patients pursue medical malpractice lawsuits. A federal appeals court last year also upheld the change in Florida’s law.

The decision by a three-judge panel of the First District Court of Appeal resulted from a 2013 change in the medical malpractice law. The Republican-controlled Florida Legislature passed the amendments to the laws after a lobbying dispute between groups like doctors and plaintiffs’ attorneys.

Ex Parte Communications Play a Major Role.

The disputes in whether the changes were constitutionally valid centered around what is known as “ex parte communications.” The amended statute allowed doctors being sued for malpractice (or their attorneys) to speak with the patients’ other physicians, whether the patient consents or not. The new law also requires patients to sign forms authorizing the release of medical information before filing malpractice claims.

Ex parte communications allow a patient’s personal health information be obtained and used in a case. Other doctors who have treated the patient could provide the information. Additionally, without the patient’s knowledge or the patient’s attorney present, a disclosure of medical information could occur.

This Ruling Stemmed From a 2013 Case in Escambia County.

In 2013, Emma Gayle Weaver of Escambia County, Florida wanted to file a medical-malpractice lawsuit against a physician. According to court documents, her concern was about the constitutionality of the ex parte provision of the law. She challenged having to disclose her medical information to the other physician she was suing in order to bring her case.

The challenge raised legal questions about privacy rights given to all citizens by the Florida Constitution. But the panel of appeal judges disagreed that the ex parte provision violates her privacy rights.

The appeal decision, written by Judge James Wolf, stated: “It is well-established in Florida and across the country that any privacy rights that might attach to a claimant’s medical information are waived once that information is placed at issue by filing a medical malpractice claim. Thus, by filing the medical malpractice lawsuit, the decedent’s medical condition is at issue.”

To read more about the Weaver v. Myers decision, click here.

Another Issue Was Addressed.

Another issue questioned whether the ex parte change violated the constitutional separation of powers. The contention dealt with whether the Legislature overstepped the role of the Florida Supreme Court. But the appeals court ruled that the change was not procedural but rather was “integral to the substantive pre-suit notice” requirements that are in the law and mandated before the filing of a medical malpractice case.

The Federal Appeals Court Also Said the Law Doesn’t Violate HIPAA.

Last year, the 11th U.S. Circuit Court of Appeals upheld the ex parte change in a ruling that focused on whether the 2013 law violates the federal Health Insurance Portability and Accountability Act (HIPAA), which prevents disclose of personal medical information. The federal appeals court said the law did not violate HIPAA, a decision also cited in the First District Court of Appeal’s decision.

Comments?

Do you agree the court’s ruling? Do you think this provision violates privacy rights? Please leave any thoughtful comments below.

Consult With a Health Law Attorney Experienced in the Representation Health Care Professionals.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in academic disputes, contract negotiations, license applications, board certification applications and hearings, credential hearings and civil and administrative litigations.

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

Source:

Saunders, Jim. “Appeals court upholds waiver of privacy rights in malpractice cases.” (July 22, 2015). Palm Beach Post. From: http://www.palmbeachpost.com/news/news/state-regional-govt-politics/florida-appeals-court-backs-controversial-medical-/nm48m/

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.

KeyWords: Medical malpractice, medical malpractice defense attorney, medical malpractice defense lawyer, Florida defense attorney, Florida defense lawyer, health law attorney, health law lawyer, privacy rights, privacy rights violation, appeals court, Health Insurance Portability and Accountability Act, HIPAA, health law, The Health Law Firm

“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 © 1996-2015 The Health Law firm. All rights reserved.

Breach of HIPAA Privacy Regulations May be a Basis for Negligence Actions

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

00011_RT8Given the advances in information technology, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted by Congress as a comprehensive legislative and regulatory scheme to ensure basic protections of patients’ right of privacy regarding their health information. HIPAA, standing alone, does not provide a private right of action. It also preempts contrary state laws. A recent case in the Supreme Court of Connecticut, Byrne v. Avery Center for Obstetrics and Gynecology, P.C., 102 A.3d 32 (Conn. 2014), addressed these issues. The decision answered the question of whether HIPAA preempts state law claims for negligence and negligent infliction of emotional distress against a healthcare provider who released medical records in the course of complying with a subpoena.

The Facts of Byrne v. Avery Center for Obstetrics and Gynecology, P.C.

During May 2004, Byrne started a personal relationship with Andro Mendoza, which lasted four months. At some point during May 2004 and July 12, 2005, the Avery Center provided Byrne with gynecological and obstetrical care and treatment. During the visit she was given the center’s privacy policy regarding protected health information. The policy, and the law, state that a patient’s health information will not be disclosed without their authorization. After Byrne’s relationship with Mendoza ended she instructed the center not to release her medial records to him.

On May 31, 2005, Mendoza filed paternity actions against Byrne. The Avery Center was served with a subpoena requesting its presence, along with Byrne’s medical records, at Probate Court. The center did not alert Byrne of the subpoena, file a motion to quash or appear in court. Instead, it mailed a copy of Byrne’s medical file to the court.

The Supreme Court of Connecticut’s Holding.

The Supreme Court of Connecticut reasoned that the fact a state law that allows an individual to file a civil action to protect their privacy exist does not mean that the law conflicts with the HIPAA penalty provisions. Therefore, the court concluded that HIPAA does not preempt causes of action when they are based on a state common or statutory law due to a healthcare provider’s breach of confidentiality.

The court found that a number of federal and state courts have ruled that a breach of the HIPAA Privacy Rule may be the basis for a breach of a duty of care in state court negligence actions. A patient’s private right of action does not conflict with or complicate healthcare provider’s compliance with HIPAA. In fact, negligence claims in state courts are furthering HIPAA’s goal of deterring wrongful disclosure of patient’s healthcare information. To view a past blog on a HIPAA violation case in California, click here.

Editors’ Comments on Byrne.

This is the latest of several recent cases where state courts have allowed cases to proceed against health care providers who breached the medical confidentiality of their patients, based in part on the HIPAA Privacy Regulations. In this case, the court correctly held that, although HIPAA does not afford a private right of action by itself, it does establish the duty that is owed by a healthcare provider to its patients to protect their medical information. With this duty being established, the plaintiff can then proceed under a straight negligence tort cause of action.

It is also noteworthy that the HIPAA Privacy Regulations are just one source of “evidence” or standards that can be used to establish th duty owed by medical professionals and theories.

This case also helps to put to rest the spurious defense that HIPAA might “preempt” such a cause of action that is brought under state law. We have seen this theory used by defendants just about any time a federal statute or federal regulation might come into play in a tort law suit. The court correctly determined that this defense theory was not valid.

If anything, HIPAA has better defined and strengthened a duty that has been owed to patients by physicians, nurses, health professionals and health facilities since the time of Hippocrates.

Comments?

What are your thoughts on the Supreme Court of Connecticut’s ruling? Please leave any thoughtful comments below.

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and instiuttions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Source:

Byrne v. Avery Center for Obstetrics and Gynecology, P.C., 102 A.3d 32 (Conn. 2014). From:

http://scholar.google.com/scholar_case?case=6869878125055474806&q=Byrne+v.+Avery+Center+for+Obstetrics+and+Gynecology,+P.C.,+102+A.3d+32+(Conn.+2014)&hl=en&as_sdt=40006

About the Authors: Shelby Root is a summer associate at The Health Law Firm. She is a student at Barry University College of Law in Orlando. 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.

KeyWords: Health Insurance Portability and Accountability Act, HIPAA, HIPAA Privacy Rules, HIPAA compliance, protected health information, patient privacy, patient rights, HIPAA violation, penalties for HIPAA violation, civil penalties for HIPAA violation, privacy, defense attorney, defense lawyer, HIPAA defense attorney, HIPAA violation help, HIPAA attorney, HIPAA lawyer, compliance plans, health law, The Health Law Firm

“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 © 1996-2015 The Health Law firm. All rights reserved.

Apopka Woman to Serve 18-Month Prison Sentence After $47K Medicaid Scam

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

IndestAn Apopka businesswoman was recently sentenced to 18 months in prison after she was found guilty of a Medicaid scam. According to the Florida Attorney General’s Office, Shanqual Marshall-Gunn was arrested in September on suspicion of submitting more than $47,000 in fraudulent Medicaid claims.

Company Provided Targeted Case Management Services (TCMs).

Marshall-Gunn owned Second Chances TCM, Inc. TCMs are intended to provide Medicaid recipients who have mental-health disorders with connections to resources in their community, and to assist them in leading a more normal life. Prosecutors said Marshall-Gunn gave employees and clients kickbacks when they submitted referrals to her company.

Three of her employees were also arrested in September 2014 for billing Medicaid for targeted case management services that were fraudulent or not authorized.

Marshall-Gunn Entered a No Contest Plea.

Media reported that court records show Marshall-Gunn entered a no contest (or “nolo contendere”) plea and was found guilty of Medicare fraud, a second-degree felony. Circuit Court Judge Jenifer Davis sentenced Marshall-Gunn on July 2. Davis also ordered Marshall-Gunn to serve five years of probation.

In addition, she cannot work for any Medicaid provider and must pay more than $47,000 in restitution.

The Investigation Was Conducted by the Medicaid Fraud Control Unit.

The investigation was conducted by Attorney General Pam Bondi’s Medicaid Fraud Control Unit (MFCU). And it was prosecuted by the Attorney General’s Office of Statewide Prosecution.

Bondi’s MFCU investigates and prosecutes providers that intentionally defraud Florida’s Medicaid program. According to Bondi’s MFCU press release in this case: “From January 2011 to August 2014, Attorney General Bondi’s MFCU has obtained more than $460 million in settlements and judgments.”

To read the press release, click here.

To read more about the MFCU, click here.

Comments?

Have you ever been a victim or suspect of Medicaid fraud? Please leave any thoughtful comments below.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Sources:

Attorney General’s Press Office. “Four Central Florida Residents Arrested for Medicaid Fraud.” (Sept. 5, 2014). WCTV. From: http://www.wctv.tv/home/headlines/Four-Central-Florida-Residents-Arrested-for-Medicaid-Fraud-274154191.html

Connolly, Kevin P. “Apopka woman sentenced to prison for 18 months after Medicaid scam.” Orlando Sentinel. Print.

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.

KeyWords: Medicaid, Medicaid fraud, defense attorney, Medicaid investigation, defense lawyer, defense counsel, Medicaid claims, fraudulent claims, home health care, criminal defense, health law criminal defense, health law criminal representation, criminal representation, Medicaid Fraud Control Unit, MFCU, targeted case management provider, TCM, Florida’s Medicaid program, overbill Medicaid, Medicaid scam, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicare, Medicare fraud, Medicare Investigation, overbill Medicare, health care fraud, Florida Attorney General, The Health Law Firm

“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.
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Medical Staff Involved in Peer Reviewers Can Receive Compensatory and Punitive Damages for Violations of their Confidentiality: Part 1 of 2

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

6 Indest-2008-3An important decision was delivered by the Supreme Court of New Mexico involving peer reviewers’ statutory right to confidentiality. In the decision, the New Mexico court allowed peer reviewers to recover compensatory and punitive damages resulting from confidentiality violations. The court recognized that peer reviewers are members of the class protected by the peer review statute in New Mexico. Thus, the court stated, they deserve remedies for violations of their confidentiality right. To view the New Mexico Peer Review Statute, click here.

Yedidag v. Roswell Clinic Corp., the New Mexico Case.

Dr. Emre Yedidag was an employee of Roswell Clinic Corp. and Roswell Hospital Corp. During a peer review of another employee, Dr. Akbar Ali, Dr. Yedidag allegedly “verbally attacked” Dr. Ali when he questioned the physicians’ involvement in a patient’s death. The hospital subsequently terminated Dr. Yedidag’s employment for “unprofessional conduct.” In response, Dr. Yedidag filed a complaint against the hospital for utilizing confidential peer review information to support his termination.

The Supreme Court of New Mexico did not agree with the hospital’s argument that the physician’s unprofessional conduct justified the doctor’s termination. The court held that the doctor’s questions were privileged, even if they were “uncivilized.” Also, the court ruled, the hospital may not use information from a peer review proceeding as a reason to terminate his employment. The court upheld an award to Dr. Yedidag of his compensatory and punitive damages. To read the case in its entirety, click here.

The New Mexico Supreme Court Estimated that the Peer Review Statute is too Lenient.

The Supreme Court of New Mexico also estimated that the criminal penalty imposed by the New Mexico peer review statute was “too lenient” to discourage violators. Therefore, allowing peer reviewers to sue violators will result in greater deterrence, the court ruled. The court held that peer reviewers’ confidentiality is a “mandatory rule of law incorporated into physician-reviewer employment contracts.”

Comments?

What are your thoughts on the Supreme Court of New Mexico’s ruling of compensatory and punitive damages for peer review violations? Please leave any thoughtful comments below.

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Source:

Stein, Alex. “Doctors Conducting Peer Review Can Recover Compensatory and Punitive Damages for Confidentiality Violations.” (February 21, 2015). From:
http://blogs.law.harvard.edu/billofhealth/2015/02/21/doctors-conducting-peer-review-can-recover-compensatory-and-punitive-damages-for-confidentiality-violations/

About the Authors: 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. Shelby Root is a summer associate at The Health Law Firm. She is a student at Barry University College of Law in Orlando.

Keywords: Yedidag v. Roswell Clinic Corporation, peer review, defense attorney, defense counsel, defense lawyer, medical staff attorney, fair hearing attorney, peer review fair hearing, clinical privileges attorney, hospital clinical privileges, confidentiality right, compensatory damages, punitive damages, New Mexico peer review statute, healthcare law, healthcare attorney, healthcare lawyer, The Health Law Firm

“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 © 1996-2015 The Health Law firm. All rights reserved.