Florida Man Admits to Fraudulently Working as a Pharmacist for Nine Years

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

On July 24, 2012, a 49-year-old man from Ruskin in South Fla., pleaded guilty in federal court to fraudulently working as a Central Florida pharmacist from 2000 to 2009, according to the Department of Justice (DOJ) in a press release.

Fake Pharmacist was Working at Pharmacies in Central Florida .

Prosecutors said this man worked at pharmacies throughout Central Florida, including CVS pharmacy and Walgreens. According to the Orlando Sentinel, while working at one of the pharmacies, he gave a customer the incorrect medication, causing that person to suffer a severe reaction and stroke.

How He Obtained His False Identity.

Allegedly, the man fraudulently obtained a pharmacist license in September of 2000 from the State Department of Health (DOH) by using the name, date of birth, Social Security number and pharmacy education information of a licensed pharmacist.

The fake pharmacist was able to renew the license and was allegedly receiving paychecks from pharmacies through the mail.

The Real Pharmacist Reports His Identity Stolen.

Local authorities began investigating the South Florida man after a legitimate pharmacist in Arizona reported that his identity had been stolen.

The legitimate pharmacist first learned in 2007 that someone was using his identity in Florida when the Internal Revenue Service (IRS) contacted him about undeclared earnings. He had never worked in Florida and learned someone was posing as him and working as a pharmacist under his name, according to the court records.

To see the full press release on this case, click here.

Fraudulent Pharmacis Faces More Than 30 Years in  Prison.

The fraudulent pharmacist pled guilty to mail fraud, aggravated identity theft, and money laundering in Orlando. He faces up to 20 years in federal prison for the mail fraud charge, 10 years for the money laundering charge, and a minimum of two years for any other sentence for the aggravated identity theft charge, the Justice release said.
The Federal Bureau of Investigation (FBI) and the Drug Enforcement Administration (DEA) investigated the case with assistance from the Florida Department of Health’s Division of Medical Quality Assurance.

Click here to see our experience representing pharmacists and pharmacies.

Contact Health Law Attorneys Experienced with Representing Pharmacists and Pharmacies.

The attorneys of The Health Law Firm provide legal representation to pharmacists and pharmacies in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI 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.

Sources:
FBI.gov. “Pharmacist Impersonator Charged with Mail Fraud, Identity Theft, and Money Laundering.” FBI, Tampa Division. (July 24, 2012). From Press Release: http://www.fbi.gov/tampa/press-releases/2012/pharmacist-impersonator-pleads-guilty-to-mail-fraud-identity-theft-and-money-laundering

TBO.com. “Ruskin Man Admits Identity Theft in Fake Pharmacist Case.” Tampa Bay Online. (July, 24, 2012). From: http://www2.tbo.com/news/health-4-you/2012/jul/24/ruskin-man-admits-identity-theft-in-fake-pharmacis-ar-440248/

Pavuk, Amy. “Feds: Man Stole Pharmacist's Identity, Worked at Pharmacies Across Metro Orlando.” Orlando Sentinel. (July 24, 2012). From: http://articles.orlandosentinel.com/2012-07-24/news/os-pharmacist-stolen-identity-20120724_1_pharmacies-illinois-court-federal-court

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.

25 Mistakes Dentists Make After Being Notified of a Department of Health Complaint

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

The investigation of a complaint which could lead to the revocation of a dentist's license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the dentist who receives it. Yet, in many cases, attorneys are consulted by dentists after the entire investigation is over, and they have attempted to represent themselves throughout the case. Often, the mistakes that have been made severely compromise an attorney's ability to achieve a favorable result for the dentist.

Here are the 25 biggest mistakes we see dentists make in cases after a DOH investigation has been initiated:

1.   Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.

2.   Contacting the DOH investigator and providing him/her an oral statement or oral interview. (Note: There is no legal requirement to do this.)

3.   Making a written statement in response to the "invitation" extended by the DOH investigator to do so. (Note: There is no legal requirement to do this.)

4.   Failing to carefully review the complaint to make sure it has been sent to the correct dentist. (Note: Check name and license number).

5.   Failing to ascertain whether or not the investigation is on the "Fast Track" which may then result in an emergency suspension order (ESO) suspending the dentist's license until all proceedings are concluded. (Note: This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, or failure to comply with PRN instructions.)

6.   Providing a copy of the dentist's curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so. (Note: There is no legal requirement to do this.)

7.   Believing that if they "just explain it," the investigation will be closed and the case dropped.

8.   Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.

9.   Failing to forward a complete copy of the patient dental record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.

10. Delegating the task of providing a complete copy of the patient dental record to office staff, resulting in an incomplete or partial copy being provided.

11. Failing to keep an exact copy of any dental records, documents, letters or statements provided to the investigator.

12. Believing that the investigator has knowledge or experience in health care matters or procedures being investigated.

13. Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.

14. Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.

15. Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.

16. Believing that because they haven't heard anything for six months or more the matter has "gone away." The matter does not ever just go away.

17. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

18. Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case.

19. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of your licensing board for a decision.

20. Taking legal advice from their colleagues regarding what they should do (or not do) in defending themselves in the investigation.

21. Retaining "consultants" or other non-lawyer personnel to represent them.

22. Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel.

23. Attempting to defend themselves.

24. Believing that because they know someone with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.

25. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.

Bonus Point: 26. Communicating with the Department of Health about the pending case.
Not every case will require submission of materials to the Probable Cause Panel after the investigation is received and reviewed. There will be a few where the allegations made are not "legally sufficient" and do not constitute an offense for which the dentist may be disciplined.
In other cases, an experienced health care attorney may be successful in obtaining a commitment from the DOH attorney to recommend a dismissal to the Probable Cause Panel. In other cases (usually the most serious ones), for tactical reasons, the experienced health care attorney may recommend that you waive your right to have the case submitted to the Probable Cause Panel and that you proceed directly to an administrative hearing. The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Medicine in such cases and does so on a regular basis.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Dentists.
 
The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI 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

Investigation Links Two Central Florida Physicians to Statewide Pill-Mill Network

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

An Orlando and Jacksonville physician have been linked to a statewide pill-mill operation that brought in millions of dollars to pain clinic owners and doctors, according to the Orlando Sentinel.

On June 27, 2012 seven doctors and seven pain clinic owners were arrested in the raid that was dubbed "Operation Pill Street Blues.” The two-year, multiagency investigation into the pill-mill operation spanned from Miami to Pensacola. The investigation included the Drug Enforcement Agency (DEA) and Florida law enforcement.

To view the DEA's press release concerning the investigation, click here.

Pompano Firefighter Alleged Head of Pill Mill.

Investigators named a 32-year-old Pompano Beach firefighter as the pill-mill’s ring leader. He allegedly used his image as a city firefighter and paramedic to develop a clean reputation with the local law enforcement.

He allegedly told his co-conspirators how to turn in other rogue doctors, pain clinics, and patients who abused drugs to authorities, so that their business would appear legitimate.

Pill-Mill Recruits Prescribed More than Two Million Oxycodone Pills in One Year.

Doctors recruited by the pill-mill network would allegedly write prescriptions to patients who did not have a medical need for the drugs or would prescribe excessive amounts of pills.

The seven doctors in the organization allegedly dispensed more than two million oxycodone tablets in one year. The Orlando and Jacksonville doctors allegedly prescribed more than 930,000 oxycodone pills between the two of them in a nine-month period.

Both Local Doctors Examined Undercover Detectives Posing as Patients During the Investigation.

Both doctors were visited by undercover detectives posing as patients. The Jacksonville doctor examined a detective who complained of minor back pain. She allegedly issued prescriptions for oxycodone and other drugs, even though the detective had no observable medical issues.

The affidavit details other undercover doctor visits, including those with the Orlando doctor at a pain management clinic in Fort Meyers. The initial exam between the doctor and the undercover detective allegedly lasted less than three minutes, before he gave the detective a prescription for oxycodone and other drugs.

Charges Range from Racketeering to Manslaughter.

Those arrested for alleged involvement in the pill-mill scheme face charges ranging from racketeering, to trafficking of a controlled substance, to manslaughter.

On June 26, 2012, the day before authorities announced the charges, the Department of Health suspended the doctors’ licenses.

Pain management doctors click here to see if you’re in compliance with the recent changes to Florida’s pain management laws.

Patients with Severe Pain Conditions Cannot Find Relief.

A former patient of a Vero Beach doctor arrested in the sting is one of hundreds who were prescribed strong narcotic pain medications at the alleged pill mills. Now she’s having a hard time finding the medications she needs to treat her conditions, including: a herniated disk, osteoarthritis and fibromyalgia. All of her conditions are listed in medical records and cause her severe pain. She is trying to find another doctor that is willing to prescribe her the medications she needs to function.

This situation is familiar to many patients in Florida with true medical need for prescription pain medications. These patients are finding it increasingly difficult to even locate a physician to treat them. Medical ethicists have commented on this problem, saying it is an issue that will become increasingly problematic for the foreseeable future.

To read more on operation “Pill Street Blue,” click here.

Contact Health Law Attorneys Experienced with DEA Cases.

The Health Law Firm represents pharmacists, pharmacies, physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH), and other law enforcement agencies.
If you are aware of an investigation of you or your practice, or if you have been contacted by the DEA or DOH, contact an experienced health law attorney immediately.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Pavuk, Amy. "Authorities Link Orlando doctor, Daytona Clinic to Pill-Mill Network." Orlando Sentinel. (July 14, 2012). From: http://articles.orlandosentinel.com/2012-07-14/news/os-fernando-valle-pill-mill-network-20120714_1_pain-clinics-pill-mill-network-clinic-owners

Gordon, Lynn. “Former Patient of Vero Beach Doctor Arrested in Pill Mill Bust Talks."WPEC-TV. (July 17, 2012). From:http://www.cbs12.com/news/top-stories/stories/vid_1092.shtml

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.

Appeal Court Rules AHCA Was Justified in Withdrawing Home Health Agency's License Application

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

The First District Court of Appeal has ruled that the Agency for Health Care Administration (AHCA) had substantial justification to withdraw a home health agency's application for licensure in a recent case. To view the opinion, click here.

Home Health Agency Challenged AHCA's Decision to Withdraw Application.

AHCA withdrew the home health care facility's license application because the application allegedly contained insufficient information. The application did not provide enough information for AHCA to verify actual ownership of the facility.

The home health agency challenged AHCA's decision. The administrative law judge (ALJ) ruled that AHCA incorrectly withdrew the application. According to the ALJ, the application was complete, and the home health agency met all the requirements for licensure at the time the application was submitted. To view the recommended order, click here.

ALJ Awarded Home Health Agency Attorney's Fees.

After receiving this favorable order, the home health agency moved for attorney's fees pursuant to section 57.111(4)(a), Fla. Stat. The home health agency argued that AHCA had no justification for withdrawing its license application. At a separate hearing, the ALJ awarded attorney's fees to the home health care facility.

Appeal Court Reverses ALJ's Ruling.

AHCA appealed this decision. On its license application, the home health agency had allegedly claimed that one person had sole ownership of the facility. However, a letter informing AHCA of litigation contesting the sole ownership claim was included with the license application. According to the court of appeal, given the uncertainty the home health agency created concerning its ownership, there was substantial justification for AHCA's action. The ALJ's ruling was reversed by the court of appeal.

Contact Health Law Attorneys Experienced in Home Health Agency Cases.

The Health Law Firm and its attorneys represent home health agencies and home health agency 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:

Agency for Health Care Administration v. MVP Health, Inc. 74 So. 3d 1141 (Fla. 1st DCA 2011)
Smallwood, Mary F. "Attorney's Fees." Administrative Law Section Newsletter. (Apr. 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.

How to Respond to an Initial Medicaid Audit Request

By Lance O. Leider, J.D., M.P.A., LL.M., Board Certified by the Florida Bar in Health Law

Florida healthcare providers servicing Medicaid patients are at a higher risk for audits than anywhere else in the country.  The unfortunate truth is that Florida has become synonymous with healthcare fraud.  As a result, auditing and subsequent overpayment demands are some very real possibilities.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong.  State and federal governments conduct audits for many different reasons.  Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

How to Know If You Are the Subject of an Audit.

An audit will usually begin with the provider receiving an initial audit request, usually by letter or fax.  This request will serve to notify the recipient that it is the subject of an audit.  The initial letter will not always identify the reason for the audit.  What it will contain, however, is a list of names and dates of service for which the auditors want to see copies of medical records and other documentation.

This stage of the process is crucial because it is the best opportunity to control the process.  Once the records are compiled and sent to the auditor, the process shifts and you are now going to have to dispute the auditor's findings in order to avoid a finding of overpayment.

The biggest mistake that someone who is the subject of an audit can make is to hastily copy only a portion of the available records and send them off for review.  The temptation is to think that since the records make sense to you, they will make sense to the auditor.  Remember, the auditor has never worked in your office and has no idea how the records are compiled and organized.  This is why it is so important to compile a thorough set of records that are presented in a clearly labeled and organized fashion that provide justification for every service or item billed.

Steps to Respond to an Initial Audit Request. 

The following are steps that you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process:

1. Read the audit letter carefully and provide everything that it asks for.  It's always better to send too much documentation than too little.

2. If at all possible, compile the records yourself.  If you can't do this, have a compliance officer, experienced consultant, or experienced health attorney compile the records and handle any follow-up requests.

3. Pay attention to the deadlines.  If a deadline is approaching and the records are not going to be ready, contact the auditor and request an extension before it is  due.  Do this by telephone and follow up with a letter (not an e-mail).  Send the letter before the deadline.

4. Send a cover letter with the requested documents and records explaining what is included and how it is organized as well as who to contact if the auditors have any questions.

5. Number every page of the records sent from the first page to the last page of documents.

6. Make a copy of everything you send exactly as it is sent.  This way there are no valid questions later on as to whether a particular document was forwarded to the auditors.

 7. Send the response package using some form of package tracking or delivery confirmation to arrive before the deadline.

Compiling all of the necessary documentation in a useful manner can be an arduous task.  If you find that you cannot do it on your own, or that there are serious deficiencies in record keeping, it is recommended that you reach out to an attorney with experience in Medicaid auditing to assist you in the process.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing 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 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

Hospital Agrees to Pay $3.59 Million to Settle False Claims Act Allegations Concerning Ambulance Services

By Miles Indest

A hospital, located in Columbia, Tennesse, has agreed to pay the federal government over $3.5 million to settle False Claims Act allegations that occurred between 2004 and 2009. The hospital voluntarily self-reported to the U.S. Attorney's Office and the Department of Health and Human Services (DHHS) Office of Inspector General (OIG).

Hospital Self-Disclosed After Compliance Program Revealed Billing Errors.

The hospital self-disclosed after its own compliance program revealed billing problems for ambulance services. The hopsital's audit of billings reported faulty claims and payment for:

• Ambulance services that were billed with incorrect mileage units;
• Ambulance services that were not medically necessary or for which medical necessity was not documented;
• Ambulance services for which a physician certification statement (PCS) was not obtained;
• Ambulance services for which the requisite signatures were not obtained; and
• Ambulance services that were assigned an incorrect transport level.

Hospital Works With U.S. Attorney's Office to Resolve Billing Errors.

After notifying the U.S. Attorney's Office that billing issues had been discovered, the hospital outlined a plan to determine the scope of these issues. The hospital then worked with the U.S. Attorney's Office to bring the matter to resolution.

Ambulance Services Flagged for Medicare Audits.

In a Medicare audit of a hospital or ambulance company, ambulance services are frequently chosen for review. Ambulance services companies have increasingly become a target for Medicare audits and are often accused of billing Medicare for unnecessary services. Ambulance companies should have a compliance plan in place to assist in detecting any errors. Ambulance companies should also take all measures to prepare for a Medicare audit, before notice of an audit is received. To learn more about preparing for Medicare audits, click here.

Contact Health Law Attorneys Experienced with Medicare Audits and False Act Claims Cases.

The Health Law Firm represents ambulance companies, emergency transport services, physicians, medical practices, pharmacists, pharmacies, home health agencies, nursing facilities, hospitals, 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:

Humbles, Andy. "Maury Regional to Pay $3.5 Million to Settle False Claims Act Allegations." Tennessean. (June 29, 2012). From: http://www.tennessean.com/article/20120629/NEWS21/306290078/Maury-Regional-pay-3-5-million-settle-False-Claims-Act-allegations

Staff. "Maury Regional Hospital to Pay $3.59 Million to Settle False Claims Act Allegations." The Daily Herald. (June 29, 2012). From: http://www.columbiadailyherald.com/sections/news/local/maury-regional-hospital-pay-359-million-settle-false-claims-act-allegations.html

Florida Nurse Allegedly Abuses Patient During Medication Administration

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

A Florida State Hospital licensed practical nurse (LPN) has been arrested and charged with one count of abuse of a disabled adult at the hospital. The nurse was arrested on a felony warrant by the Attorney General’s Medicaid Fraud Control Unit (MFCU). The arrest was announced by the Florida Attorney General on June 29, 2012.

Nurse Allegedly Abused Patient During Medication Administration.

The nurse allegedly struck a disabled woman at the mental health facility, while trying to administer medication. The nurse attempted to administer medications to the patient by holding her nose closed in an attempt to force her mouth open, slapping her across the face, and pulling the patient’s hair, according to the charges filed.

The nurse has been charged with one count of abuse of a disabled adult, which is a third degree felony. If convicted she faces up to five years in prison and a $5,000 fine.

Medicaid Fraud Control Unit (MFCU) Conducted Investigation of Nurse.

Investigators with the Medicaid Fraud Control Unit (MFCU) received information regarding the alleged abuse from the Florida Department of Children and Families’ (DCF) Adult Protective Services Program. The Calhoun County Sheriff’s Office assisted in the arrest. The case will be prosecuted by the State Attorney’s Office for the Second Judicial Circuit of Florida.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm's attorneys routinely represent nurses in Department of Health investigations, before the Board of Nursing, in appearances before the Board of Nursing in licensing matters, and in administrative hearings.

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

Sources Include:

Lucas, John. "Attorney General Pam Bondi Announces Arrest of Nurse for Abusing a Disabled Adult at Florida State Hospital." Florida Office of the Attorney General. (June 29, 2012). Press Release. From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/AF6292E44D8579B685257A2C0069ED2D

WCTV. "Nurse at Florida State Hospital Arrested for Abuse." WCTV.com. (June 29, 2012). From:
http://www.wctv.tv/home/headlines/Nurse_at_Florida_State_Hospital_Arrested_for_Abuse_160893645.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.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Pennsylvania Man Creates Ambulance Company with "Straw Owner" and Gets Charged with Medicare Fraud

By Miles Indest

A Pennsylvania man has been charged in relation to an alleged scheme to defraud Medicare by billing for fraudulent ambulance services. The charges were announced by the Department of Justice (DOJ) on June 29, 2012.

Man Allegedly Started Ambulance Company With "Straw" Owner .

According to the indictment, the man allegedly used a "straw" owner (someone who was not actually the owner) to fraudulently open Starcare Ambulance because he was otherwise ineligible to own the company. Between 2006 and 2011, the man allegedly billed Medicare for transporting kidney dialysis patients who did not medically need ambulance service. This indictment seeks forfeiture of over $5 million in cash as well as a GMC Hum-V ("Hummer") vehicle.

If convicted of all charges, the defendant faces a statutory maximum sentence of ten years in prison on each of the health care fraud and conspiracy counts. He also faces five years in prison for aiding and abetting in false statements relating to health care fraud, a three year term of supervised release, and a fine of up to $250,000.

Ambulance Services Companies Are Target for Medicare Audits.

In recent years, and especially in 2012, ambulance services companies have become the target of Medicare audits and are frequently accused of billing Medicare for unnecessary services. Medicare and Medicaid audits can result in overpayment demands reaching into hundreds of thousands of dollars and assessment of fines. Ambulance services were included in the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) work plan for fiscal year 2012 as an area that would be subject to scrutiny. Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) are launching audits of ambulance service providers and emergency medical transportation companies.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don't wait until its 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.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, ambulance services companies, durable medical equipment (DME) suppliers, home health agencies, nursing 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 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

"Pennsylvania Man Charged With $5.4 Million Medicare Fraud." San Francisco Chronicle. (June 29, 2012). From:
http://www.sfgate.com/news/article/Pa-man-charged-with-5-4-million-Medicare-fraud-3674333.php

Department of Justice, Office of Public Affairs. "Pennsylvania Man Charged with Fraud in Ambulance Scheme." Department of Justice. Press Release. (June 29, 2012). From: http://www.justice.gov/opa/pr/2012/June/12-crm-840.html

AHCA Justified in Withdrawing Home Health Agency's License Application According to Appeal Court

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

The First District Court of Appeal ruled that the Agency for Health Care Administration (AHCA) had substantial justification to withdraw a home health agency's application for licensure in a recent case.

To view the opinion, click here.

AHCA Withdrew Home Health Agency's License Application.

AHCA withdrew the home health care facility's license application because the application allegedly contained insufficient information. The application did not provide enough information for AHCA to verify actual ownership of the facility.

Home Health Agency Challenges AHCA's Decision to Withdraw License Application.

The home health agency challenged AHCA's decision. The administrative law judge (ALJ) ruled that AHCA incorrectly withdrew the application. According to the ALJ, the application was complete, and the home health agency met all the requirements for licensure at the time the application was submitted.

To view the recommended order, click here.

Home Health Agency Awarded Attorney's Fees by ALJ.

After receiving this favorable order, the home health agency moved for attorney's fees pursuant to section 57.111(4)(a), Fla. Stat. The home health agency argued that AHCA had no justification for withdrawing its license application. At a separate hearing, the ALJ awarded attorney's fees to the home health care facility.

Appeal Court Reverses ALJ's Ruling.

AHCA appealed the ALJ's decision. On its license application, the home health agency had allegedly claimed that one person had sole ownership of the facility. However, a letter informing AHCA of litigation contesting the sole ownership claim was included with the license application. According to the court of appeal, given the uncertainty the home health agency created concerning its ownership, there was substantial justification for AHCA's action. The ALJ's ruling was reversed by the court of appeal.

Contact Health Law Attorneys Experienced in Representing Home Health Agencies.

The Health Law Firm and its attorneys represent home health agencies and home health agency 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 http://www.thehealthlawfirm.com/.

Sources Include:

Agency for Health Care Administration v. MVP Health, Inc. 74 So. 3d 1141 (Fla. 1st DCA 2011)
Smallwood, Mary F. "Attorney's Fees." Administrative Law Section Newsletter. (Apr. 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.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Florida Participates in Largest Healthcare Fraud Settlement in U.S. History

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

GlaxoSmithKline (GSK), a prescription drug manufacturer, has agreed to pay $3 billion in fines to resolve healthcare fraud allegations in what has become largest healthcare fraud settlement in U.S. history. The settlement was announced by federal prosecutors on July 1, 2012, and in a press release from the Florida Attorney General on July 2, 2012.

Florida to Receive $56 Million In Settlement.

Florida will receive more than $56 million as part of the settlement with GSK. Florida Attorney General, Pam Bondi, announced the state's participation in the settlement on July 2, 2012.

Settlement Resolves List of Allegations Related to Healthcare Fraud.

The settlement resolves allegations that GSK:

• Marketed the depression drug Paxil for off-label uses, such as use by children and adolescents; 
• Marketed the depression drug Wellbutrin for off-label uses, such as for weight loss and treatment of sexual dysfunction, and at higher-than-approved dosages; 
• Marketed the asthma drug Advair for off-label uses, including first-line use for asthma;
• Marketed the seizure medication Lamictal for off-label uses, including bipolar depression, neuropathic pain, and various other psychiatric conditions; 
• Marketed the nausea drug Zofran for off-label uses, including pregnancy-related nausea; 
• Made false representations regarding the safety and efficacy of Paxil, Wellbutrin, Advair, Lamictal, Zofran, and the diabetes drug Avandia;
• Offered kickbacks to healthcare professionals to induce them to promote and prescribe certain prescription drugs; and
• Submitted incorrect pricing data for various prescription drugs, thereby underpaying rebates owed to Medicaid and other federal healthcare programs.

GSK to Plead Guilty to Criminal Charges.

As part of the settlement, GSK has agreed to plead guilty to criminal charges that it violated the federal Food, Drug, and Cosmetic Act (FDCA). Allegedly, GSK introduced Wellbutrin and Paxil into interstate commerce when the drugs contained labels that were not in accordance with their FDA approvals. Additionally, GSK allegedly failed to report certain clinical data regarding Avandia to the FDA.

Settlement Originated From Whistleblower Actions.

The settlement is based on four qui tam, or whistleblower, actions brought by individuals pursuant to state and federal false claims. To view the federal False Claims Act, click here. A National Association of Medicaid Fraud Control Units team, along with several other federal agencies, investigated the matter and conducted settlement negotiations with the defendants. Florida’s civil investigation was handled by the Attorney General’s Complex Civil Enforcement Bureau, which is part of the Medicaid Fraud Control Unit.

Contact Health Law Attorneys Experienced in Healthcare Fraud Cases.

The Health Law Firm represents physicians, medical practices, pharmacists, pharmacies, and other health providers in healthcare fraud cases, including investigations, regulatory matters, litigation, and audits involving government health programs (Medicare, Medicaid, TRICARE).

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

Sources Include:

Meale, Jenn. "Attorney General Bondi's Office Reaches Historic Healthcare Fraud Settlement." Florida Office of the Attorney General. (July 2, 2012). Press Release. From:
http://www.myfloridalegal.com/newsrel.nsf/newsreleases/E494FDADFF113AC885257A2F0068F790

Schmidt, Michael S. and Katie Thomas. "GlaxoSmithKline Agrees to Pay $3 Billion in Fraud Settlement." New York Times. (July 2, 2012). From:
http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay-3-billion-in-fraud-settlement.html?pagewanted=all

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Operation "Pill Street Blues" Latest Pill Mill Bust in Florida

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

The latest pill mill raid in Florida spanned several cities throughout Florida. The Drug Enforcement Administration (DEA) and Florida law enforcement announced the statewide pill mill bust on June 27, 2012. Seven doctors and seven pain clinic owners were arrested. The raid has been dubbed "Operation Pill Street Blues" by the DEA.

To view the DEA's press release concerning the raid, click here.

Charges Against the Doctors and Pain Clinic Owners Include Manslaughter.

The doctors and pain clinic owners are facing a long list of charges. Some of the alleged offenses include: racketeering; conspiracy to commit racketeering; manslaughter; trafficking in a controlled substance; conspiracy to traffic in a controlled substance; delivery of a controlled substance; illegally prescribing a controlled substance by a practitioner; illegally prescribing a controlled substance (oxycodone hydrochloride) by a practitioner-trafficking amount; workers compensation fraud; and money laundering.

Investigation Revealed Ring of Pill Mills Scattered Throughout Florida.

The arrests follow a two year investigation led by the DEA in conjunction with the Indian River County Sheriff’s Office, Vero Beach Police Department, and the Attorney General’s Office of Statewide Prosecution. The investigation began in Vero Beach in November 2010 after the DEA received complaints about a pain clinic that was allegedly writing a large amount of narcotics prescriptions.

During the investigation, DEA agents uncovered eight more pain clinics in Miami, Daytona Beach, Jacksonville, Sarasota, Gainesville and Pensacola that were allegedly involved in the same operation. DEA agents also learned that some of the pain clinics were allegedly owned by two active Pompano Beach firemen.

Pain Clinic Owners Allegedly Reviewed Other DEA Pill Mill Busts to Avoid Detection.

According to the DEA, the pain clinic owners allegedly researched public records relating to past DEA investigations such as Operation Pill Nation and Operation Oxy Alley. One of the pain clinic owners also allegedly educated others at the clinics on how to successfully report their competition to law enforcement.

Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue in Florida.

According to the DEA, Operation Pill Street Blues is an ongoing investigation. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming, according to the DEA. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice.

Contact Health Law Attorneys Experienced with DEA Cases.

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

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

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

Sources Include:

Ro, Mia. "Federal Investigation Takes Down New Breed of Pill Mills in Florida." Drug Enforcement Administration. (June 27, 2012). Press Release. From:
http://www.justice.gov/dea/pubs/states/newsrel/2012/mia062712.html

Roberts, John. "DEA, Florida Police Arrest 14 in Pill Mill Bust." Fox News. (June 6, 2012). From
http://www.foxnews.com/us/2012/06/27/statewide-pill-mill-bust-involves-florida-municipal-workers/#ixzz1zBvQuGgC

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

HIPAA Audit Protocol Released by OCR

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

The Office for Civil Rights (OCR) released an audit protocol for audits of Health Insurance Portability and Accountability Act (HIPAA) covered entities on their website. The audit protocol covers audit procedures and requirements for assessing compliance with HIPAA's Privacy Rule, Security Rule, and Breach Notification Rule. This information is extremely valuable for covered entities. Covered entities can use the audit protocol to prepare for HIPAA audits and focus compliance efforts.

The audit protocol is available as a searchable database on the OCR's website. Click here to view the OCR's audit protocol in its entirety.

First Round of HIPAA Audits Completed; Audits Continue Through December 2012.

The OCR recently announced that the first round of HIPAA audits have been completed. Official details concerning the audits were announced at an OCR and National Institute of Standards and Technology (NIST) conference held June 6, 2012. HIPAA audits will continue through December 2012. Click here to see our blog on the OCR's HIPAA audit report and preparing for HIPAA audits.

Contact Health Law Attorneys Experienced in Audits of Health Providers.

The Health Law Firm represents physicians, medical practices, hospitals, and other health providers and covered entities in audits, including Medicare audits, Medicaid audits, and HIPAA audits. The Health Law Firm also assists health providers in establishing compliance with HIPAA regulations. If you have received notification of an impending audit contact The Health Law Firm immediately.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at http://www.thehealthlawfirm.com/.

Sources Include:
Office of Civil Rights. "Audit Protocol." Office of Civil Rights. (2012). From:
http://ocrnotifications.hhs.gov/hipaa.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.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Avoid Stop-Work Orders: Do NOT Treat Employees as Independent Contractors

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

Often a business obtains faulty legal advice that it can treat its employees as "independent contractors" and avoid a number of mandatory costs associated with hiring an actual employee.  These may include paying social security, Medicare and other mandatory assessments.  Additionally, the employer may believe that it can avoid expenses, such as workers' compensation insurance coverage, that are required by law.

Stop-Work Order Ceases Business Activities Until Compliance is Established.

The Stop-Work Order is one tool that is used by the Florida Department of Financial Services (DFS) to halt an employer's business activities until it comes into compliance with the required insurance coverage mandated by Section 440.10, Florida Statutes.  The issuance of such an Order can be a death sentence to a small business due to the limitations and penalties that it places on a business owner.  To avoid this situation it is critical to understand the requirements of Chapter 440, Florida Statutes, and the penalties an employer can face when it fails to be compliant with Florida's workers' compensation laws.

Most Employees that Work in Medical Practices Do Not Qualify as Independent Contractors.

The Florida Legislature has outlined very specific requirements in Section 440.02(15)(d)(1), Florida Statutes, that must be met in order for a worker to be classified as an independent contractor.  Most regular employees that work in an office setting or medical practice setting do not qualify as "independent contractors."  Typically, everyday employees such as medical assistants, receptionists, billing clerks, nurses, and clerical staff will not meet these requirements.

Complaint May Initiate a Department of Financial Services Investigation.

Generally, the DFS will receive a complaint or a tip, often from a former employee, but sometimes from a competitor.  An investigator from the DFS will then begin an investigation, often visiting the business suspected of the infraction.  A detailed records request or subpoena, requesting all financial documents (including bank statements, tax returns, cancelled checks, payrolls, ledgers, books, and other sensitive financial documents), will be served on the business, with only a short time to produce the requested information.

Stop-Work Order Can Have Devastating Impact on Business.

The DFS may issue a Stop-Work Order if egregious violations are found.  The Stop-Work Order closes down the business down immediately. The Order applies not only to the location where the Order was served, but to all other locations where the employer may be out of compliance.  The employer's failure to abide by this Order can result in a penalty of $1,000 per day for each day that the employer continues to conduct business operations. The issuance of a Stop-Work Order can lead to tens of thousands of dollars in lost income and can force both large and small businesses to close their doors forever.

Stop-Work Order Will Not Be Lifted Until Compliance is Demonstrated and All Penalties Are Paid.

The Stop-Work Order will not be lifted until your business is in compliance and all penalties are paid.  The DFS will assess a penalty equal to 1.5 times the amount the employer would have paid in premium when applying approved manual rates to the employer's payroll during the periods for which it failed to secure payment of workers' compensation.  These penalties can be extensive and costly.

Tips to Avoid Stop-Work Orders, Fines and Penalties Assessed by the DFS.

Physicians and other health professionals, especially those just starting a new business, should avoid taking shortcuts and attempting to avoid paying taxes and assessments that the law requires.

1. Do not attempt to scrimp on taxes and expenses by treating regular employees, even part-time or hourly employees, as "independent contractors."

2. Officers and shareholders (owners) of a business may be entitled to an exemption so that they do not count as an employee of the business for the purposes of reaching the statutory minimum number (four employees);  however, they must apply for this in advance of any investigation or complaint. Do so now!

3. Use a reliable commercial payroll service to make all mandatory deductions, withholdings, tax payments and assessments.

4. If you have employees, purchase workers compensation insurance, regardless of the number of employees.  This will help protect you from liability for employee injuries on the job.

5. Consult with an experienced attorney when setting up your business or medical practice.

6. If you receive a notice that you are being investigated, a documents request, or a Stop-Work Order, consult an attorney experienced in such matters immediately.

Contact Health Law Attorneys Experienced with Stop-Work Orders.

If you are confronted with a Stop-Work Order it is imperative to immediately contact an attorney experienced in these matters.  The Health Law Firm represents physicians, medical practices, and other health providers who have been issued a Stop-Work Order. The Health Law Firm's attorneys can assist you in producing the necessary documents and mitigating the penalties that may be assessed.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at http://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.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

CMS Medicare Providers Can Submit Documents Electronically to CMS Contractors

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

Medicare providers can submit medical documents to most of the Centers for Medicare & Medicaid Services (CMS) review contractors electronically. This includes the Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs) and will soon include several Zone Program Integrity Contractors (ZPICs).

CMS makes agreements with review contractors to identify and correct improper Medicare payments made to providers. Review contractors find the improper payments by selecting a small sample of claims and requesting medical documentation from the provider who submitted the claims. The review contractor then manually reviews the claims made against the medical documentation provided to verify the providers' compliance with Medicare's rules.

Medicare Providers Can Submit Medical Records to Many Review Contractors Electronically.

Currently, review contractors request medical documentation by sending a letter to the provider. These providers previously had two options for submitting the requested records:

1. Mail a hard copy of the records or
2. Fax the records.

Now, providers can submit medical records electronically to participating review contractors. CMS calls this new mechanism the Electronic Submission of Medical Documentation (esMD) program. For a chart illustrating how esMD words, click here.

Phase 1 of esMD Launched on September 15, 2011.

Phase 1 of the esMD program was initiated on September 15, 2011. During Phase 1 of esMD, Medicare providers still receive medical documentation requests via a letter in the mail. However, they have the option to electronically send medical records to the requesting review contractor.
During Phase 2 of esMD, providers will receive requests when their claims are selected for review electronically. CMS plans to initiate Phase 2 in the future but no specific date has been announced.

First Coast Service Options, Inc. Approved for Phase 1 of esMD.

Florida's Medicare Administrative Contractor (MAC), First Coast Service Options, Inc. (First Coast) has been approved by CMS to participate in Phase 1 of esMD. Florida Medicare providers who have been asked to submit records for review to First Coast can now submit them electronically.
Other review contractors who have been approved to participate in Phase 1 of esMD through May 2012 include:

• Region A Medicare Recovery Audit  (Diversified Collection Services, Inc. or "DCS")
• Region B Medicare Recovery Audit  (CGI Technologies and Solutions, Inc. or "CGI")
• Medicare Administrative J1 (Palmetto GBA)
• Medicare Administrative JF (J2 & J3) (Noridan)
• Medicare Administrative J4 (Trailblazer)
• Medicare Administrative J5 (Wisconsin Physicians Service or "WPS")
• Medicare Administrative J9 (First Coast Service Options Inc. "FCSO")
• Medicare Administrative J11 (Palmetto GBA)
• Medicare Administrative J12 (Novitas Solutions)
• Medicare Administrative J14 (NHIC, Corp. or "NHIC")
• Comprehensive Error Rate Testing (CERT) Contractor
• Program Error Rate Measurement (PERM) Contractor
• DME Medicare Administrative JA (NHIC, Corp. or "NHIC")
• DME Medicare Administrative JD (Noridian)
• Medicare Administrative J13 (National Government Services or "NGS")
• DME Medicare Administrative JB (National Government Services or "NGS")
• Medicare Administrative J10 (Cahaba)
• Region D Medicare Recovery Audit (Health Data Insights or "HDI")
• Medicare Administrative J15 (CGS Administrators, LLC or "CGS")
• DME Medicare Administrative JC (CGS Administrators, LLC or "CGS")
• Region C Medicare Recovery Auditor (Connolly).

Several of the ZPICs are planning on participating in the esMD program starting summer 2012. These include:

• ZPIC Zone 1 (SafeGuard Services LLC or "SGS")
• ZPIC Zone 7 (SafeGuard Services LLC or "SGS").

Providers Not Required to Submit Medical Records Electronically.

Medicare providers do not have to submit medical documentation electronically. The esMD program is completely voluntary.

If providers do want to participate in the esMD program, they must first find out if their review contractor accepst esMD transactions. Additionally, providers will have to obtain access to an esMD gateway. To obtain access to a gateway, providers can either build their own or hire a Health Information Handler (HIH) to construct the gateway system.

To find out which HIHs offer esMD gateway services to providers, click here.

To learn more about requirements for participating in the esMD program, click here.

Contact Health Law Attorneys Experienced with Medicare and Medicaid Audits.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. They also represent health providers in preparing and submitting corrective action plans (CAPs), requests for reconsideration, and appeal hearings, including Medicare administrative hearings before an administrative law judge.

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

Sources Include:

Centers for Medicare & Medicaid Services. "Electronic Submission of Medical Documentation." Centers for Medicare & Medicaid Services. (Apr. 9, 2012). From:
http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/index.html?redirect=/esmd

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  http://www.thehealthlawfirm.com/  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.