The Health Law Firm Blog: October 2012

Tuesday, October 30, 2012

North Carolina Woman Admits to a $6.1 Million Medicaid Scheme That Targeted Children

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

A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly obtained at least $6.1 million in fraudulent reimbursement payments, according to the Federal Bureau of Investigation (FBI).

Click here to see the press release from the FBI.

Medicaid Beneficiaries Were Primarily Children.
An article in the Gaston Gazette stated the former licensed professional counselor, who was enrolled with North Carolina Medicaid, allegedly claimed in the fraudulent billings that she was the attending clinician for provided services. The woman also allegedly supervised a network of co-conspirators who billed for false and fraudulent claims through the woman’s provider number.

To read the entire article from the Gaston Gazette, click here.

According to the FBI, filed documents indicate that the claimed Medicaid beneficiaries were primarily children, whose parents thought they were enrolling in after school programs owned and operated by the woman and her co-conspirators.

Woman Pleaded Guilty.
According to the FBI, the woman pleaded guilty to one count of health care fraud conspiracy and two counts of money laundering. She faces 10 years in prison and a $250,000 fine apiece for the health care fraud conspiracy and money laundering charges.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare 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, medical groups, clinics, pharmacies, assisted living facilities (AFLs), 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 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:
FBI. “Shelby Woman Pleads Guilty to Defrauding Medicaid of $6.1 Million.” FBI Charlotte Division. (September 13, 2012). From: http://www.fbi.gov/charlotte/press-releases/2012/shelby-woman-pleads-guilty-to-defrauding-medicaid-of-6.1-million

Banks, Alicia. “Judge Candidate’s Wife Admits to $6.1 Million Fraud.” Gaston Gazette. (September 14, 2012). From:
http://www.gastongazette.com/news/medicaid-75457-department-justice.html

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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Thursday, October 25, 2012

Florida Group Home Manager Arrested for Stealing from Disabled Adults

By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A former employee of an organization that provides services to developmentally disabled adults in Alachua County, Florida, was arrested on June 15, 2012, according to the Attorney General’s (AG) Office. The woman was arrested for allegedly stealing money from 11 clients in 2010 and 2011.

To see the press release from the AG, click here.

Investigation Was Led by the Medicaid Fraud Control Unit (MFCU).
The woman was a group home manager at the organization that provides support to developmentally disabled adults. She was allegedly responsible for her clients’ money. In a Gainesville Sun article the associate director of the organization said it’s a policy to make monthly audits of its clients’ money. One month, at the house where this woman worked, the money did not add up.

According to the AG, the arrest came after an investigation by the Medicaid Fraud Control Unit (MFCU). She was arrested on allegations of exploiting 11 disabled adults and has been allegedly charged with stealing more than $1,300 from her clients.

If convicted, she faces up to 60 years in prison and a $60,000 fine.

To see the entire article from The Gainesville Sun, click here.

Responding to Auditing Agencies.
The MFCU receives referrals from many other state and federal agencies. Sometimes, matters that could be resolved as simple billing errors get escalated to criminal charges when Medicaid providers are interviewed and give evidence against themselves. Admitting to any misconduct, no matter how slight, may lead to far more serious criminal charges.

Click here for tips on how to respond to an audit by the Medicaid Fraud Control Unit.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare 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, medical groups, clinics, pharmacies, assisted living facilities (AFLs), 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 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:
Meale, Jenn. “Attorney General Bondi Announces Arrest of Alachua County Woman for Exploiting 11 Disabled Adults.” My Florida Legal. (June 15, 2012). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/6D12D500A38B755D85257A1E006389E5

Smith, Chad. “Former Arc Employee Arrested on Exploitation Charges.” The Gainesville Sun. (June 15, 2012). From: http://www.gainesville.com/article/20120615/articles/120619706?template=printart

About the Authors: Dr. Thu Pham, O.D., is a law clerk with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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

Tuesday, October 23, 2012

Part 2: You Might be a Disruptive Physician If...

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

This is the second blog dedicated to physicians who are accused of being a disruptive.

To read part 1 on the types of conduct that might make you a "disruptive physician," click here.

Effects of Disruptive Physician Behavior.
According to one article on the subject by a physician leader, the consequences of disruptive behavior by a physician in a hospital are as follows:

Disruptive physicians undermine morale, diminish productivity and quality of patient care, and cause work environment distress leading to heightened employee turnover. One survey found that most nurses believe physician disruptive behavior causes stress, frustration, impaired concentration, reduced collaboration and communication, and potentially negative patient outcomes. Another survey found that nurses see a direct link between physician disruptive behavior and nurse satisfaction, retention, and the quality of the nurse-physician relationship. Other consequences of disruptive physician behavior include disciplinary actions, dysfunctional physician colleague activities (e.g., coverage, leadership, peer review, referral, etc), and compromised communication within and efficiency of healthcare teams. (References omitted.)

To see the entire article, click here.

"Disruptive Conduct" by the Physician Will be Linked to Patient Safety.
Hospitals and medical staffs are being inculcated with the idea that "disruptive behavior" by a physician undermines patient safety and is a risk to patient care. This will be the basis to support action against a physician's medical staff membership and clinical privileges in a privileging action by the medical staff. It will also be relied upon by the state medical board if a complaint is filed against the physician's medical license. It will also be the basis of upholding a legal challenge if the physician challenges the medical staff action in court. The courts will usually defer to the medical staff of the hospital in such matters and not want to overturn its decision.

If you want to see what hospital and physician executives think about disruptive physicians and how to deal with them, click on this article.

Keep Yourself on Track.
Know what is considered to be conduct that exemplifies a "disruptive physician." Avoid outbursts of anger; they may make you feel better in the short run, but in the long run, you are hurting yourself. Hold your tongue. Avoid sayings anything that one could take offense to. If you are so weak willed that you cannot control yourself, maybe you do have a problem.

No one lives in a glass house, but pretend you do. Always think that someone can overhear or oversee what you do or say in the hospital. Everyone is human; everyone has shortcomings, even you. If you become known as a disruptive physician, everyone will be looking for anything you do wrong, and they will find it.
If you receive any complaints or reports insinuating that you are being tagged as a disruptive physician, whether it is informal counseling by a colleague or a formal warning in writing, take immediate actions to address the concerns. This may include, for example:

1. Educating yourself about the issue with the articles that appear on the internet.

2. Seek professional counseling; maybe you do have too much stress or an anger management problem.

3. Seek assistance from an experienced health attorney; you may be being set up for subsequent adverse clinical privileging action.

4. Avoid every type of conduct listed above.

5. Respond to the complaint or counseling, but do so with your attorney. You must keep an even, objective, neutral, non-accusatory tone to your response and not attempt to point a finger at others. Avoid the temptation to do so.

6. Read our other blogs and articles on this on our website.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

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

Thursday, October 18, 2012

Florida Man Arrested for Allegedly Hiding Human Body Parts in Self-Storage Facility

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

A former medical examiner, who is accused of keeping the body parts of more than 100 people in his Pensacola storage facility, was arrested September 7, 2012. He now faces a felony charge of improper storage of hazardous waste, a misdemeanor charge of “nuisance injurious to public health” and driving with a suspended license, according to a number of sources.

To see the case against the former medical examiner, click here.

It is reported that he had previously been fired as a medical examiner in Jackson County, Missouri. His medical license was allegedly revoked in Missouri. A check of the Florida Department of Health (DOH) licensing website lists his license as null and void. To see his license verification, click here. He could also have some serious points added to his driving license, making his auto insurance premiums go up (if convicted of the traffic offense).
Discovery in Storage Facility Right Out of A Horror Movie.

According to an article in the Pensacola News Journal, the former medical examiner rented the self-storage unit for about three years. On August 22, 2012, he defaulted on his payments, and the unit was auctioned off.
When the storage facility was auctioned off, the new purchaser allegedly discovered 10 cardboard boxes containing human remains stored in a liquid. Garbage bags containing human remains packaged in soda cups and plastic food containers were also found.
This is one auction I doubt you are going to see on “Auction Hunters” or “Storage Wars” on television.
According to a related Associated Press article, the District 1 Medical Examiner’s Office in Pensacola said that the remains appear to have come from private autopsies that were performed between 1997 and 2007 at funeral homes in the Florida Panhandle and in Tallahassee. Allegedly 111 containers filled with body parts, including hearts, brains, a liver, and a lung were found.
Although there were lots of brains found, there were no “Abbie Normal” brains reportedly found.
For a related story regarding zombie outbreaks in Florida and the Florida Legislature’s effort to control them by banning bath salts, click here.

Former Medical Examiner Reportedly had a Problems with Former Job.
The former medical examiner reportedly worked at the District 1 Medical Examiner’s Office in Pensacola from 1997 to 2003. He was fired for allegedly having a large backlog of cases and failing to complete autopsy reports in a timely manner.Man Could Face More Charges.
Right now, the former medical examiner faces a felony charge of improper storage of hazardous waste, a misdemeanor charge of “nuisance injurious to public health” and driving with a suspended license. These charges alone could land him in prison for more than five years.
The District 1 Medical Examiner’s Office in Pensacola is contacting all the family members of the decedents whose body parts were found. If the family did not give permission to the former doctor, more charges could be coming. Exactly how these body parts are being identified has not been made clear.
Click here to read the entire Pensacola News Journal article.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, license complaints, administrative hearings, business and commercial litigation, 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:
Heisig, Eric. “Charges Filed Against Doctor in Body Parts Cases.” Pensacola News Journal. (September 9, 2012). From: http://www.pnj.com/apps/pbcs.dll/article?AID=2012309080010
Associated Press. “Ex-Medical Examiner Charged After Human Organs Found in Storage Unit.” Associated Press (September 8, 2012). From: http://articles.orlandosentinel.com/2012-09-08/news/os-human-organs-storage-unit-florida-20120908_1_human-organs-storage-unit-medical-examiner

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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Tuesday, October 16, 2012

Part 1: You Might Be A Disruptive Physician If...

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

I have never read a Jeff Foxworthy book, and I have never watched more than a minute or two of one of his comedy routines, so my apologies to him in advance.

However, I find his comedy routine about rednecks (or what I know of the little bit I have heard) to be a good vehicle for conveying what might be a joke to many, but should be taken very seriously, especially by one accused of being a disruptive physician.

Are the Complaints Unjustified?

In my decades of representing physicians, I have encountered cases where false complaints have been generated by the economic competitor of a physician with the medical staff of a hospital, in order to eliminate his competition. I have experienced cases where administrative personnel and nursing staff have conspired to generate complaints against a physician who was too demanding and unpopular with the nurses. I have seen unjustified complaints encouraged against physicians who have demanded only quality treatment for their patients. So it does not surprise me when I am consulted by a physician who claims he or she is the subject of trumped up and unjustified complaints, especially those as subjective as being "disruptive."

Unfortunately, identifying and eliminating the disruptive physician has become a recent goal of many hospitals. This has become a "hot button" among hospital administrators, medical staff leaders and credentials committees.

Being proven to be a "disruptive physician" may lead to adverse action against clinical privileges (resulting in a National Practitioner Data Bank (NPDB) report), action to drop the physician from insurance panels, adverse action by the state medical board, loss of specialty certification, and other consequences.

Conduct That Might Label You a "Disruptive Physician."

According to reported cases and our experience in these matters, you might be labeled a disruptive physician if:

1. You use profanity in the work place.
2. You "yell at" or raise your voice to a nurse.
3. You threaten a hospital employee with having him or her fired.
4. You berate or "put down" a nurse or other staff.
5. You insinuate that a hospital employee is stupid.
6. You throw anything, anywhere in the presence of anybody, in the hospital.
7. You slam down anything (chart, coffee cup, lid to photocopier, etc.), anywhere in the presence of anybody, in the hospital.
8. You knock over anything (gumball machine, lamp, computer, etc.), anywhere in the presence of anybody, in the hospital.
9. You refer to anyone else as fat, stupid, lazy, "dumb blondes" or any other demeaning label.
10. You make sexually suggestive (or sexually explicit) comments and remarks in the presence of anybody else, anywhere in the hospital.
11. If you break anything (including the glass on the photocopier, the television in the doctors' lounge, etc.).
12. If you threaten a hospital employee with filing an incident report against him or her.
13. If you pull down the television set off of the wall in the waiting room and throw it down on the floor breaking it.
14. If you push a gurney into someone else in the hospital knocking her or him down.
15. If you "accidentally" drop a scalpel and it sticks into the foot of the scrub nurse in the operating room.
16. If you accidentally kick a bucket of bloody lap pads and it "accidentally" hits the nurse in the head and cuts her head open in the operating room.
17. If you are an on-call physician and you yell at the nurse on duty when he calls you at home and wakes you up at 4:00 a.m., and tell him not to call you again.
18. If you go to a nurse's supervisor and complain that the nurse is incompetent and should be removed.
19. You throw a surgical instrument "in the direction of" an operating room nurse because she handed you the wrong one.
20. You let it be known that you refuse to refer patients to another medical staff member because you consider him or her to be incompetent.
21. You tell sexually suggestive, racist, discriminatory or off-color jokes in the presence of anyone else, anywhere, at anytime in the hospital.
22. You refuse to work with nurses or technicians on the hospital staff because they are incompetent.
23. You refuse to follow established hospital protocols, policies or procedures, whether written or informal, because you don't have to.
24. When you are confronted with a mistake, a bad outcome, a complaint by staff against you or a request for input on a peer review of one of your patients, you blame the person making the complaint or report, and point out the shortcomings and lack of skill of others on the staff.
25. Physically threatening or merely intimidating others, including by insinuating that something bad might befall them.
26. Bullying or attempting to bully or intimidate others.
27. Passive aggressive conduct like refusing to attend mandatory department meetings, refusing to complete charts, refusing to respond to phone calls and pages, refusing to answer questions of others, refusing to complete forms and reports, advising that it is not your job or that you are not on call any longer.
28. Retaliate against any other physician or hospital staff member who has reported you for violation of the code of conduct or for investigation of an incident.
29. Making negative or derogatory comments about other physicians or hospital staff members in front of any other person, at anytime, anywhere in the hospital.
30. Telling nurses, other staff members or patients that you don't care or don't want to hear what they have to say.

For other examples and a policy statement regarding disruptive physicians, see this Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

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

Friday, October 12, 2012

Central Florida Authorities Nab One Dentist and Two Pharmacists for Dispensing Prescription Drugs

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

The Lakeland Ledger reports that Polk County Sheriff’s Detectives arrested a dentist and two pharmacists on September 5, 2012, in three unrelated cases dealing with illegally prescribing and dispensing painkillers. The sheriff’s office said the three arrests are part of its efforts to target prescription drug abuse.

To read the entire Lakeland Ledger article, click here.

Dentist and His Daughter in Trouble for Controlled Narcotics.
In May 2012, the dentist’s daughter was arrested for allegedly forging more than 500 hydrocodone prescriptions. That arrest led deputies and the Department of Health (DOH) to search the dentist’s clinic. According to the Lakeland Ledger article, out of 43 patient files randomly selected, 31 patients were being prescribed hydrocodone without any documentation.

The Polk County Sheriff’s Office stated that the dentist has been charged with knowingly overprescribing controlled narcotics. To see the press release from the sheriff’s office on the dentist’s arrest, click here.

Undercover Detectives Catch Two Pharmacists.
According to the Lakeland Ledger, the two pharmacists that were arrested allegedly illegally dispensed either oxycodone or hydrocodone to undercover detectives. The pharmacists have been charged with trafficking prescription painkillers.

Click here to see the press release on the pharmacists’ arrests from the Polk County Sheriff’s Office.

Arrests Part of Ongoing Sting on Prescription Drug Abuse in Florida.
According to the Polk County Sheriff’s Office, these arrests are part of an ongoing investigation to target doctors and pharmacists that are improperly prescribing and dispensing prescription medications.

There is an article on our website on legal tips for physicians to manage pain patients. To read that piece, click here.

Criminal Arrest of Over-Prescribers May come From Many Different Agencies.
Physicians and pharmacists who are involved in schemes relating to overprescibing or trafficking in narcotics may be targeted by many different agencies. The local sheriff’s office or police department is just one of them.

We have represented physicians who have been the subjects of Drug Enforcement Administration (DEA) investigations. The DEA will often use undercover agents and informants to pose as patients, wired for audio recording. The DEA will often work with local law enforcement authorities and the Department of Health (DOH).

Other investigations and arrests may be initiated by a statewide prosecutor’s office, which is under the Attorney General. Still others have been initiated by the Medicaid Fraud Control Unit (MFCU) where Medicaid funds are used.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH 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:
Malagon, Elvia. “Lakeland Dentist and Two Pharmacists Charged with Prescription Drug Violation.” The Lakeland Ledger. (September 5, 2012). From: http://www.theledger.com/article/20120905/NEWS/120909682?template=printart
Eleazer, Carrie. “PCSO Detectives Arrest Two Pharmacists from Trafficking in Prescription Drugs.” Polk County Sheriff’s Office. (September 5, 2012). From: http://www.polksheriff.org/NewsRoom/Pages/09-05-2012PCSO%20DetectivesArrestTwoPharmacistsForTraffickinginPrescriptionDrugs.aspx
Eleazer, Carrie. “Dr. William Johnson of Sonrise Dental Clinic Arrested.” Polk County Sheriff’s Office. (September 5, 2012). From: http://www.polksheriff.org/NewsRoom/News%20Releases/Pages/09-05-2012.aspx

About the Authors: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Tuesday, October 9, 2012

The Office of Inspector General Takes a Hard Look at Medicare Fraud in South Florida Mental Health Clinics

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

On August 16, 2012, the Office of Inspector General (OIG) released a report on questionable billing by mental health centers. The report focuses on the nation’s mental health clinics that overbilled Medicare in 2010, some by tens of millions of dollars. The majority of these clinics were located in South Florida, Texas and Louisiana.

To see the full report from the OIG, click here.

Two South Florida Mental Health Clinics Get Busted for Medicare Fraud.
According to an article in the Miami Herald: “No area of the country cheats Medicare quite like South Florida.” To see this article from the Miami Herald, click here.

In the report, the OIG specifically named a bust of two Miami-area doctors, one Miami-area therapist and two others for their participation in a Medicare fraud scheme. The case involved the nation’s biggest mental health chain and more than $205 million in fraudulent billing. Executives of the company were sentence in June 2012, to anywhere from 50 years to 91 months.

We previously blogged about this news story. Click here to read that blog. To see a copy of the press release on this case from the Department of Justice (DOJ), click here.

The Miami Herald article outlines the case of another South Florida mental-health clinic. The clinic’s owner, his son, his daughter and five others were found guilty on August 31, 2012, of conspiring to cheat $57 million from the federal program for the elderly and disabled. The owner, his son, an operating officer and another manager were also convicted of conspiracy to commit health care fraud by collecting $11 million in Medicare payments for therapy services that were not needed or provided from 2007 to 2011.
Click here to see the full press release on this case from the DOJ.

OIG Speaks Out on Medicare's Monitoring of Billing.
In the report, the Inspector General (IG) said these two instances of Medicare fraud are examples of the federal program’s “vulnerabilities.” The report scrutinizes the Medicare program for it’s lack of regulating about 200 mental health centers in 25 states that received an estimated $218.6 million in 2010.

Medicare Acknowledges Potential Vulnerabilities.
In the Miami Herald article, Medicare officials responded to the OIG by acknowledging that mental health services have been vulnerable to fraud and abuse in the past, but said Medicare is currently taking steps to address these issues. These steps include adopting a computer program that will screen prospective clinic operators; it will perform criminal background checks and closely examine claims which are paid within 14 days.

Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent health care providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:
Weaver, Jay. “Feds Spotlight South Florida Mental Health Clinics for Medicare Fraud.” The Miami Herald. (August 28, 2012). From: http://www.miamiherald.com/2012/08/28/2972637/feds-spotlight-south-floridas.html
Levinson, Daniel. “Questionable Billing By Community Mental Health Centers.” Office of Inspector General. (August 2012). From: /uploads/OIG on Medicare fraud in Mental Health Clinics.pdf
Department of Justice. “Eight Individuals and a Corporation Convicted at Trial in Florida in $50 Million Medicare Fraud.” United States Department of Justice. (August 24, 2012). From: http://www.justice.gov/opa/pr/2012/August/12-crm-1048.html.
Valle, Alicia. “Doctors, Therapist and Recruiters from Miami-Area Mental Health Care Corporation Convicted for Participating in $205 Million Medicare Fraud Scheme” U.S. Attorney’s Office for the Southern District of Florida. (June 1, 2012). From: http://www.justice.gov/usao/fls/PressReleases/120601-03.html

About the Authors: 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.

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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Thursday, October 4, 2012

Florida Man Faces Federal Charges For Accessing Patient Records

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

Federal court records from August 13, 2012, show that a former Florida Hospital employee faces fraud-conspiracy charges after he illegally accessed patient records in a solicitation scheme, according to the Orlando Sentinel. The breach in patient information was first thought to involve 2,000 patients, but according to a Federal Bureau of Investigation (FBI) affidavit, more than 700,000 patient records were accessed between 2009 and 2011.
When the news broke about a privacy breach at Florida Hospital back in October of 2011, we wrote about this incident. To read that blog, click here.

Florida Hospital Clerical Worker Accessing Medical Records.
Hospital records show a clerical worker in the emergency department of Florida Hospital’s Celebration location was fired in July 2011. According to the Orlando Sentinel, he was allegedly fired when it was discovered that he had accessed the medical records of a Florida Hospital doctor who was fatally shot in a hospital parking garage.
The FBI affidavit reveals that hospital officials found inappropriate access to 763,000 patient records between 2009 and the third quarter of 2011, by the same worker.
To read the entire FBI affidavit, click here.

Hospital Patients Would Receive Calls for Lawyer and Chiropractor Referrals.
Federal Investigators said the worker was looking specifically for information on car accident victims. He would allegedly sell that information to unnamed co-conspirators.
In the Orlando Sentinel article, some patients said about a week after their hospital visit, they would receive calls offering to refer a lawyer or chiropractor.
The FBI also allegedly found payments from co-conspirators to the worker.
Click here to read the entire article from the Orlando Sentinel.

Worker Faces Serious Charges.
The Florida Hospital worker has been indicted on charges of conspiracy to defraud the United States and payment to a non-licensed physician.

Contact Health Attorneys Experienced in the Confidentiality of Medical Records.

Our attorneys provide advice and legal opinions on confidentiality of medical records and medical information, including the HIPAA Privacy Regulation, and are available to testify as expert witnesses on these issues.
For a list of applicable Federal and Florida legal authorities on "super-confidential" medical information pertaining to certain types of medical information such as mental health, HIV and drug or alcohol treatment records click here.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:
United State of America v. Dale Munroe, No. 6:12-mj-1378 United States District Court, Middle District of Florida, Orlando Division. (August 13, 2012). available at http://www.thehealthlawfirm.com/uploads/USA_v_Munroe.pdf.
Weiner, Jeff. “Ex-Florida Employee Faces Federal Charges in Patient-Records Scheme.” Orlando Sentinel. (August 31, 2012). From: http://articles.orlandosentinel.com/2012-08-31/news/os-florida-hospital-privacy-theft-arrest-20120831_1_patient-records-medical-records-access
Kealing, Bob. “Florida Hospital Breach Affects 700,000 People.” WESH Orlando. (August 30, 2012). From: http://www.wesh.com/news/central-florida/Florida-Hospital-breach-affects-700-000-people/-/11788162/16438736/-/12x54xdz/-/index.html

About the Authors: 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.

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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Tuesday, October 2, 2012

The Polk County Sheriff’s Office Issued 25 Arrest Warrants in Connection with Alleged Pill Mill

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The Polk County Sheriff’s Office issued 25 arrest warrants in connection to an ongoing pill mill investigation involving a medical clinic in Winter Haven, Florida. On September 19, 2012, the sheriff’s office announced that ten suspects in the case have been arrested, and 15 suspects with arrest warrants remain at large.
Click here to see the press release from the Polk County Sheriff’s Office.

Suspects Were Nabbed with the Use of the Prescription Drug Monitoring Program.
Last year the state launched the Prescription Drug Monitoring Program, which requires doctors and pharmacists who dispense controlled substances to report the information to a statewide database.
According to the Polk County Sheriff’s Office, the database was used to round up those associated with the Winter Haven medical clinic.
In an article in the News Chief, deputies said 13 of the suspects were allegedly acting as “smurfs” (people hired by a drug ring to take fake prescriptions to be filled, then turning the pills over to the ring). Another 12 people were accused of “doctor shopping,” which is the practice of going to multiple doctors to get many prescriptions for narcotics.
To read the entire article from the News Chief, click here.
This case was investigated by the Polk County Sheriff’s Office, the Florida Department of Law Enforcement (FDLF), the Florida Department of Health (DOH) and the Attorney General’s (AG) Office.
“These people are giving the smurfs a bad name,” Papa Smurf state. “We should be happy that law enforcement is doing a good job rounding up the read ‘bad guys,’”added Brainy Smurf.
Free Legal Advice: Tips for Physicians to Manage Pain Patients.

Doctors, pharmacists and all healthcare professionals who are involved in schemes relating to overprescribing or trafficking in narcotics may be targeted by many different agencies.

Other investigations and arrests may be initiated by a statewide prosecutor’s office, which is under the Attorney General (AG). Still others have been initiated by the Medicaid Fraud Control Unit (MFCU) where Medicaid funds are used.
Click here to see an article on our website with tips for to help manage pain patients.

Give us your thoughts on this story below.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH Cases.

The Health Law Firm represents pharmacists, pharmacies, physicians, nurses, and other health care 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:
Parody, Clifford. “25 Warrants Issued in Ongoing Pill Mill Case.” News Chief. (September 20, 2012). From: http://www.newschief.com/article/20120920/NEWS/209205012
Pavuk, Amy. “25 Arrest Warrants Issued in Pill-Mill Probe.” Orlando Sentinel. (September 19, 2012). From: http://articles.orlandosentinel.com/2012-09-19/news/os-polk-pill-mill-arrests-20120919_1_pill-mill-probe-arrest-warrants-fraudulent-prescriptions
Eleazer, Carrie. “25 Arrest Warrants Issued in Connection to On-Going Pill Mill Investigation.” Polk County Sheriff’s Office. (September 19, 2012). From: http://www.polksheriff.org/NewsRoom/News%20Releases/Pages/09-19-2012.aspx

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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.