By Lance O. Leider, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
It’s no surprise that the government is aggressively pursuing Medicare fraud. Recently, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), made a surprising discovery. An audit uncovered that more than three-quarters (3/4) of all Medicare claims for the breast-cancer drug Herceptin were billed incorrectly, according to Modern Healthcare. This was found during an audit conducted on physicians and hospitals from around the country between January 1, 2008, and December 31, 2010.
To read the entire Modern Healthcare article, click here.
Audit Results Not Uncommon.
Three different audits were released to the public by the HHS OIG. All of these audits showed roughly the same information. Health care providers have been billing Medicare for full multiuse vials of the drug Herceptin, when patients actually only need a smaller portion. Medicare does not pay healthcare providers for any part of the drug that is discarded, because it can be preserved for up to 28 days and reused. The auditors suggest that payment from Medicare for an entire multiuse vial is likely to be incorrect. We saw a similar situation with the drug Avastin and Lucentis being used by ophthalmologists several years ago.
The results of the audits were released in January 2013. One audit found eighty-five percent (85%) of 1,073 Herceptin vials used in Ohio and Kentucky were billed incorrectly. In Illinois, Indiana, Michigan and Wisconsin, the government auditors found that seventy-eight (78%) of 713 claims investigated were wrong. The overpayment amount was around $682,000, for these audits.
Florida Overcharged Amost 80% of Bills.
According to the report, HHS auditors found overcharges in seventy-eight percent (78%) of bills for 1,330 vitals of Herceptin submitted to First Coast Service Options, Inc. This company serves as the Medicare Administrative Contractor (MAC) for HHS District Nine, which primarily includes providers in Florida, Puerto Rico, and the U.S. Virgin Islands. The overcharges for Herceptin were $1,325,409.
In the report, the government recommends that First Coast Service Options, Inc., do a number of things. The first is to recover the more than one million dollars in overpayments. It’s also recommended that First Coast Service Options, Inc., implement system edits that review multiuse vial drugs that are billed with units of service equivalent to the dosage of an entire vial. The government also suggests that these audit results be used as an educational tool for teaching correct billing practices to physicians and hospitals.
Click here to read the entire report on District Nine.
Responding to a Medicare Audit.
Remember, there is no such thing as a “routine” Medicare audit. The fact is that if you find yourself or your practice at the center of a Medicare audit, there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused the audit. We’ve come up with a list of actions that we use and recommend you take when responding to a Medicare audit. Click here to view that list.
Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Investigations.
The best time to respond to and defeat an allegation of overpayment is at the very beginning. That is why it is essential that you obtain qualified counsel to help you through the process. The attorneys of The Health Law Firm represent healthcare 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.
Comments?
Why do you think hospitals and physicians incorrectly bill for Herceptin? Are audits like these necessary? Please leave any thoughtful comments below.
Sources:
Carlson, Joe. “OIG Finds Widespread Herceptin Overcharges.” Modern Healthcare. (January 21, 2013). From: http://www.modernhealthcare.com/article/20130121/NEWS/301219959/oig-finds-widespread-herceptin-overcharges
Jarmon, Glorida. “The Medicare Contractor’s Payments to Providers in Jurisdiction 9 for Full Vials of Herceptin were often Incorrect.” Office of Inspector General (January 2013). From: http://www.thehealthlawfirm.com/uploads/Herceptin%20FL%20Overcharges.pdf
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.
Showing posts with label defense lawyer. Show all posts
Showing posts with label defense lawyer. Show all posts
Tuesday, March 26, 2013
Friday, March 8, 2013
Stryker Orthopaedics Facing Dozens of Hip Implant Lawsuits
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
As of February 2013, more than 80 lawsuits have been consolidated into multicounty litigation (MCL) in the Superior Court in New Jersey against Stryker Orthopaedics. Patients are claiming the company’s Rejuvenate and ABG II modular-neck femoral hip systems are defective, according to a number of news sources. The case is on track to becoming one of the largest mass-tort litigations in the country.
In July 2012, Stryker issued a voluntary recall of the Rejuvenate and ABG II modular-neck femoral hip systems. (Click here to see the press release from Stryker.) The company is currently in the process of sending out letters to surgeons urging them to perform clinical exams, such as blood work and cross sectional imaging, on patients who had implants installed. The letters state that Stryker will compensate patients for any tests or work that has to be done.
Click here to read a letter from Stryker to a surgeon.
Unfortunately, for some, this notice is too late. Hundreds of patients are already experiencing pain from the Stryker hip implants, which has forced them to have the implants removed. Even after surgery some patients alleged they have permanent damage and are demanding compensation.
Early Lawsuit Filed from Florida Patient.
According to the Palm Beach Post, one of the first lawsuits against Stryker came from a Boca Raton retiree. Her hip replacement came with a promise to last for decades. The device allegedly failed within months. Click here to read the patient’s entire story.
According to Drug Watch, most patients who received Stryker’s devices allegedly suffered from muscle, nerve and bone damage as the metallic components of the device rub against each other, causing metallic elements to be released into the body and be absorbed into the blood stream and body tissue. To read the entire article from Drug Watch, click here.
More Lawsuits to Come - Contact an Experienced Health Lawyer.
Since the implants were recently recalled, it’s expected that there are many more cases out there.
Many of the people who have already filed lawsuits claim Stryker marketed and sold a defective device and failed to warn the public, among other issues.
If you or a family member received a Stryker Rejuvenate or ABG II hip implant and suffered complications, you don’t have to face the medical issues alone. Contact an experienced attorney that is board certified in health law. Before you talk about settling, call an attorney.
Stryker Lawsuits Similar to DePuy.
According to an article in The Records, similar mass-tort cases in New Jersey include hundreds of lawsuits filed against DePuy Orthopaedics. More than 2,500 plaintiffs in that case alleged similar complaints due to a metallic hip part. DePuy’s product, ASR, was recalled by the company in August 2010. The cases being heard involve potentially hundreds of millions of dollars in settlements or verdicts. Click here to read the entire article from The Records.
Contact Experienced Health Law Attorneys.
If you or a family member received a Stryker Rejuvenate or ABG hip implant and suffered complications you don’t have to face the medical issues alone. Our attorneys are available seven days a week to answer your questions. We can help you decide whether filing a lawsuit is the right option for you. Our attorneys include those who are board certified by The Florida Bar in Health Law, as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?
Did you or someone you know have a Stryker Rejuvenate or ABG II modular-neck femoral hip implant? What has been your experience? Did you know about the recall? Are you in need of legal assistance? Please leave comments below.
Sources:
Markos, Kibret. “Mahwah-based Stryker Orthopaedics Faces Hip Implant Lawsuits.” The Records. (February 28, 2013). From: http://www.northjersey.com/mahwah/Over_80_lawsuits_on_hip_implants_filed_against_Mahwah-based_Stryker_Orthopaedics_.html?c=y&page=3
Singer, Stacey. “Artificial Hips Corrode, Poisoning Some Patients, Local Lawsuits Say.” The Palm Beach Post. (January 27, 2013) From: http://www.palmbeachpost.com/news/lifestyles/health/artificial-hips-corrode-poisoning-some-patients-lo/nT7jf/
Hooks, Beau. “Stryker Hip Replacement Lawsuits.” Drug Watch. (February 2013). From: http://www.drugwatch.com/stryker/lawsuit-hip-replacement/
Guilfoyle, Jeanine. “Stryker Initiates Voluntary Product Recall of Modular-Neck Stems.” Stryker. (July 6, 2012). From: http://www.stryker.com/stellent/groups/corporate/documents/web_prod/147504.pdf
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.
As of February 2013, more than 80 lawsuits have been consolidated into multicounty litigation (MCL) in the Superior Court in New Jersey against Stryker Orthopaedics. Patients are claiming the company’s Rejuvenate and ABG II modular-neck femoral hip systems are defective, according to a number of news sources. The case is on track to becoming one of the largest mass-tort litigations in the country.
In July 2012, Stryker issued a voluntary recall of the Rejuvenate and ABG II modular-neck femoral hip systems. (Click here to see the press release from Stryker.) The company is currently in the process of sending out letters to surgeons urging them to perform clinical exams, such as blood work and cross sectional imaging, on patients who had implants installed. The letters state that Stryker will compensate patients for any tests or work that has to be done.
Click here to read a letter from Stryker to a surgeon.
Unfortunately, for some, this notice is too late. Hundreds of patients are already experiencing pain from the Stryker hip implants, which has forced them to have the implants removed. Even after surgery some patients alleged they have permanent damage and are demanding compensation.
Early Lawsuit Filed from Florida Patient.
According to the Palm Beach Post, one of the first lawsuits against Stryker came from a Boca Raton retiree. Her hip replacement came with a promise to last for decades. The device allegedly failed within months. Click here to read the patient’s entire story.
According to Drug Watch, most patients who received Stryker’s devices allegedly suffered from muscle, nerve and bone damage as the metallic components of the device rub against each other, causing metallic elements to be released into the body and be absorbed into the blood stream and body tissue. To read the entire article from Drug Watch, click here.
More Lawsuits to Come - Contact an Experienced Health Lawyer.
Since the implants were recently recalled, it’s expected that there are many more cases out there.
Many of the people who have already filed lawsuits claim Stryker marketed and sold a defective device and failed to warn the public, among other issues.
If you or a family member received a Stryker Rejuvenate or ABG II hip implant and suffered complications, you don’t have to face the medical issues alone. Contact an experienced attorney that is board certified in health law. Before you talk about settling, call an attorney.
Stryker Lawsuits Similar to DePuy.
According to an article in The Records, similar mass-tort cases in New Jersey include hundreds of lawsuits filed against DePuy Orthopaedics. More than 2,500 plaintiffs in that case alleged similar complaints due to a metallic hip part. DePuy’s product, ASR, was recalled by the company in August 2010. The cases being heard involve potentially hundreds of millions of dollars in settlements or verdicts. Click here to read the entire article from The Records.
Contact Experienced Health Law Attorneys.
If you or a family member received a Stryker Rejuvenate or ABG hip implant and suffered complications you don’t have to face the medical issues alone. Our attorneys are available seven days a week to answer your questions. We can help you decide whether filing a lawsuit is the right option for you. Our attorneys include those who are board certified by The Florida Bar in Health Law, as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?
Did you or someone you know have a Stryker Rejuvenate or ABG II modular-neck femoral hip implant? What has been your experience? Did you know about the recall? Are you in need of legal assistance? Please leave comments below.
Sources:
Markos, Kibret. “Mahwah-based Stryker Orthopaedics Faces Hip Implant Lawsuits.” The Records. (February 28, 2013). From: http://www.northjersey.com/mahwah/Over_80_lawsuits_on_hip_implants_filed_against_Mahwah-based_Stryker_Orthopaedics_.html?c=y&page=3
Singer, Stacey. “Artificial Hips Corrode, Poisoning Some Patients, Local Lawsuits Say.” The Palm Beach Post. (January 27, 2013) From: http://www.palmbeachpost.com/news/lifestyles/health/artificial-hips-corrode-poisoning-some-patients-lo/nT7jf/
Hooks, Beau. “Stryker Hip Replacement Lawsuits.” Drug Watch. (February 2013). From: http://www.drugwatch.com/stryker/lawsuit-hip-replacement/
Guilfoyle, Jeanine. “Stryker Initiates Voluntary Product Recall of Modular-Neck Stems.” Stryker. (July 6, 2012). From: http://www.stryker.com/stellent/groups/corporate/documents/web_prod/147504.pdf
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, March 5, 2013
Department of Health and Human Services Introduces HIPAA Omnibus Rule
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Lance O. Leider, J.D., The Health Law Firm
With the popularity of electronic health records (EHRs), social media and everything in between, the U.S. Department of Health and Human Services (HHS) has released stronger rules and protections governing patient privacy. On January 17, 2013, the HHS announced the omnibus rule to strengthen the privacy and security protection established under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Click here to read the entire 563-page rule.
Now, I can’t say that I’ve had enough free time to read the entire document yet, but I can tell you about the major parts of the omnibus rule, and what it means for healthcare providers.
Protecting a Patient's Information During Data Exchanges.
HHS is expanding the government’s jurisdiction over healthcare providers, health plans and other entities that process health insurance claims to include their contractors and subcontractors with whom providers share protected health information. As the industry embraces new care delivery models, including accountable care organizations (ACOs) and integrated delivery systems, data is exchanged between physicians, hospitals and additional providers to improve care and reduce costs. This all has to be done while keeping patient data safe. According to the HHS, some of the largest breaches involve business associates and not the covered entities themselves.
The government is committed to doing more HIPAA compliance audits and collecting more fines. The fines the government collects will help to fund the audit process. Because of this rule, we will see audits of business associates and their subcontractors, not just covered entities.
Under the new rule, penalties have been increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation.
Don’t Land on the Office for Civil Rights’ “Wall of Shame.”
The changes also improve the Health Information Technology for Economic and Clinical Health (HITECH) breach notification requirements by making it clear when breaches must be reported to the Office for Civil Rights (OCR), according to the HHS.
Once reported to the OCR, the breaches are then placed on what is commonly known in the healthcare industry as the “Wall of Shame.” It’s a comprehensive list of privacy breaches each affecting more than 500 people. We’re currently working on a “Wall of Shame” blog, so more on that later.
Take Notes of New Regulations Regarding Patient Information in Marketing.
One part of the final rule also sets new regulations for how patient information can be used for marketing and fundraising. It ensures that such information cannot be sold without a patient’s permission. According to an article in Fierce Healthcare, this provision is a huge win for patient advocates and privacy groups who blast hospitals for mining patient data to target affluent or privately insured patients. Hospitals using health and demographic data from patients’ records to target advertising could be in hot water.
Click here to read the entire Fierce Healthcare article.
If You are Unsure of Your Policies and Procedures, Get a HIPAA Risk Assessment.
Since the HIPAA laws have changed, you need to edit your privacy forms and procedures. Many health providers simply don't have the time to re-review their policies and revise documents. A HIPAA risk assessment is a thorough review and analysis of areas where you may have risk of violating the HIPAA laws. Federal regulations require that covered entities have this assessment done. A HIPAA risk assessment can significantly reduce, if not entirely eliminate, your exposure to regulatory and litigation sanctions.
When the OCR auditor comes to visit your office to check for HIPAA compliance, they will ask for your risk assessment. Do you have one? Does your staff know who your HIPAA compliance officer is? Call an experienced health law attorney to complete a risk assessment of your practice today. To learn more on HIPAA risk assessments, click here to read a blog we wrote.
Update Notice of Privacy Practices.
Healthcare providers, now is the time to revise your Notice of Privacy. The final rule will be effective on March 26, 2013. Covered entities and their business associates will have until September 21, 2013, to comply.
Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.
The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).
For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.
What Do You Think?
What do you think about the new HIPAA rules? Do you think these updates were necessary? Do you think it will be difficult for health professionals to comply? Please leave any thoughtful comments below.
Sources:
HHS Press Office. “New Rule Protects Patient Privacy, Secures Health Information.” U.S. Department of Health and Human Services. (January 17, 2013). From: http://www.hhs.gov/news/press/2013pres/01/20130117b.html
Struck, Kathleen. “HIPAA Rules Fortify Patient Privacy.” MedPage Today. (January 21, 2013). From: http://www.medpagetoday.com/PracticeManagement/InformationTechnology/36940
Conn, Joseph. “New Rule: Hospital, Physician Partners Face Penalties for Privacy Leaks.” Modern Healthcare. (January 17, 2013). From: http://www.modernhealthcare.com/article/20130117/NEWS/301179957/new-rule-hospital-physician-partners-face-penalties-for-privacy&utm_source=home&utm_medium=web&utm_campaign=most-popular-box
Caramenico, Alicia. “New HIPAA Rule a Delicate Balance Between Privacy, Sharing.” Fierce Healthcare. (January 18, 2013). From: http://www.fiercehealthcare.com/story/new-hipaa-rule-delicate-balance-between-privacy-sharing/2013-01-18
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
With the popularity of electronic health records (EHRs), social media and everything in between, the U.S. Department of Health and Human Services (HHS) has released stronger rules and protections governing patient privacy. On January 17, 2013, the HHS announced the omnibus rule to strengthen the privacy and security protection established under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Click here to read the entire 563-page rule.
Now, I can’t say that I’ve had enough free time to read the entire document yet, but I can tell you about the major parts of the omnibus rule, and what it means for healthcare providers.
Protecting a Patient's Information During Data Exchanges.
HHS is expanding the government’s jurisdiction over healthcare providers, health plans and other entities that process health insurance claims to include their contractors and subcontractors with whom providers share protected health information. As the industry embraces new care delivery models, including accountable care organizations (ACOs) and integrated delivery systems, data is exchanged between physicians, hospitals and additional providers to improve care and reduce costs. This all has to be done while keeping patient data safe. According to the HHS, some of the largest breaches involve business associates and not the covered entities themselves.
The government is committed to doing more HIPAA compliance audits and collecting more fines. The fines the government collects will help to fund the audit process. Because of this rule, we will see audits of business associates and their subcontractors, not just covered entities.
Under the new rule, penalties have been increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation.
Don’t Land on the Office for Civil Rights’ “Wall of Shame.”
The changes also improve the Health Information Technology for Economic and Clinical Health (HITECH) breach notification requirements by making it clear when breaches must be reported to the Office for Civil Rights (OCR), according to the HHS.
Once reported to the OCR, the breaches are then placed on what is commonly known in the healthcare industry as the “Wall of Shame.” It’s a comprehensive list of privacy breaches each affecting more than 500 people. We’re currently working on a “Wall of Shame” blog, so more on that later.
Take Notes of New Regulations Regarding Patient Information in Marketing.
One part of the final rule also sets new regulations for how patient information can be used for marketing and fundraising. It ensures that such information cannot be sold without a patient’s permission. According to an article in Fierce Healthcare, this provision is a huge win for patient advocates and privacy groups who blast hospitals for mining patient data to target affluent or privately insured patients. Hospitals using health and demographic data from patients’ records to target advertising could be in hot water.
Click here to read the entire Fierce Healthcare article.
If You are Unsure of Your Policies and Procedures, Get a HIPAA Risk Assessment.
Since the HIPAA laws have changed, you need to edit your privacy forms and procedures. Many health providers simply don't have the time to re-review their policies and revise documents. A HIPAA risk assessment is a thorough review and analysis of areas where you may have risk of violating the HIPAA laws. Federal regulations require that covered entities have this assessment done. A HIPAA risk assessment can significantly reduce, if not entirely eliminate, your exposure to regulatory and litigation sanctions.
When the OCR auditor comes to visit your office to check for HIPAA compliance, they will ask for your risk assessment. Do you have one? Does your staff know who your HIPAA compliance officer is? Call an experienced health law attorney to complete a risk assessment of your practice today. To learn more on HIPAA risk assessments, click here to read a blog we wrote.
Update Notice of Privacy Practices.
Healthcare providers, now is the time to revise your Notice of Privacy. The final rule will be effective on March 26, 2013. Covered entities and their business associates will have until September 21, 2013, to comply.
Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.
The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).
For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.
What Do You Think?
What do you think about the new HIPAA rules? Do you think these updates were necessary? Do you think it will be difficult for health professionals to comply? Please leave any thoughtful comments below.
Sources:
HHS Press Office. “New Rule Protects Patient Privacy, Secures Health Information.” U.S. Department of Health and Human Services. (January 17, 2013). From: http://www.hhs.gov/news/press/2013pres/01/20130117b.html
Struck, Kathleen. “HIPAA Rules Fortify Patient Privacy.” MedPage Today. (January 21, 2013). From: http://www.medpagetoday.com/PracticeManagement/InformationTechnology/36940
Conn, Joseph. “New Rule: Hospital, Physician Partners Face Penalties for Privacy Leaks.” Modern Healthcare. (January 17, 2013). From: http://www.modernhealthcare.com/article/20130117/NEWS/301179957/new-rule-hospital-physician-partners-face-penalties-for-privacy&utm_source=home&utm_medium=web&utm_campaign=most-popular-box
Caramenico, Alicia. “New HIPAA Rule a Delicate Balance Between Privacy, Sharing.” Fierce Healthcare. (January 18, 2013). From: http://www.fiercehealthcare.com/story/new-hipaa-rule-delicate-balance-between-privacy-sharing/2013-01-18
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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.
"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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.
Tuesday, February 12, 2013
Part 2 - Burden of Proof in Professional Licensing Disciplinary Cases
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
I am often asked about the burden of proof that must be met by the state Department of Health (DOH) in professional licensing disciplinary cases. This could be a complaint against a physician, dentists, mental health counselor, nurse, psychologist, pharmacist or anyone else. It also includes, for example, engineers, general contractors, school teachers, architects, cosmetologists, or any other professional holding a professional license in Florida. However, since we routinely represent health professionals, I will continue to concentrate on those licenses by the state DOH in this blog.
Click here to read part one.
Fifth Amendment Protection Against Self-Incrimination Applies.
Because potential license revocation proceedings are penal in nature, a respondent or license holder in such an investigation or administrative hearing has the right to remain silent under the Fifth Amendment of the United States Constitution and under the Florida Constitution.
Otherwise, this would defeat the spirit and intent of the constitutional protections guaranteed by the Fifth and Fourteenth Amendments to the United State Constitution. See, State v. Caballero, 396 So. 2d 1210, 1213 (Fla. 3d DCA 1981) ("A coerced confession offends due process of law."); Dickerson v. U.S., 530 U.S. 428, 434, 120 S. Ct. 2326, 2331 (2000) ("We have never abandoned this due process jurisprudence, and thus continue to exclude confessions that were obtained involuntarily"); Chambers v. State of Fla., 309 U.S. 227, 228, 60 S. Ct. 472, 473 (1940) ("[U]se by a state of an improperly obtained confession may constitute a denial of due process of law as guaranteed in the Fourteenth Amendment"); and Barnes v. Merrill, 2002 WL 1313123 (D. Me. 2002) ("Involuntary statements are inadmissible under the Fifth Amendment requirement that no person can be compelled to be a witness against himself in a criminal case.").
For Florida cases on point, see, Chancellor Media Whiteco Outdoor v. Fla. Dep't of Transport., 26 Fla. L. Weekly D627 (Fla. 5th DCA March 2, 2001), substitute opinion entered on rehearing, 795 So. 2d 991, 26 Fla. L. Weekly D1894 (Fla. 5th DCA July 30, 2001). See also, State ex rel. Vining v. Fla. Real Estate Comm'n, 281 So.2d 487, 491 (Fla. 1973); Best Pool & Spa Service Co., Inc. v. Romanik, 622 So. 2d 65, 66 (Fla. 4th DCA 1993) ("We agree that requiring Kassover to answer . . . questions does violate his right against self-incrimination which applies not only to criminal matters but also administrative proceedings such as licensing").
Florida Courts Require Higher Standard for Administrative Licensure Cases.
In Florida, the courts have adopted and have required the “clear and convincing” standard to be used in any case involving a professional license, finding that such action by the state is punitive or penal in nature and affects a substantial right of the respondent. The key Florida cases that discuss this are two Florida Supreme Court cases, Florida Bar v. Rayman, 238 So. 2d 594 (Fla. 1970) and Ferris v. Turlington, 510 So. 2d 292 (Fla. 1987). See also, Kozerowitz v. Fla. Real Estate Comm'n, 289 So. 2d 391 (Fla. 1974).
Any case in which a state administrative agency seeks a penalty, a fine or action affecting the status of a professional license, would require the application of a "clear and convincing standard." An action to revoke a professional license is definitely considered to be penal. So too is an action which results in the loss of income, such as by suspending a license (so there is no professional income), a fine, or an order to refund professional fees. McDonald v. Dep't of Prof. Reg., Bd. of Pilot Commissioners, 582 So. 2d 660 (1st DCA 1991).
Although these are all Florida cases, if you read them and follow their rationale, they go back to basic constitutional principles of due process of law and the taking away of rights or property without due process.
For example, in one case in which I defended a nursing home's license, the state had evidence that contradicted itself. There were certain facts at issue and the state put forth two different sets of facts. The state could not prove either set of facts by "clear and convincing evidence." Therefore, by law, the administrative law judge had to rule in favor of the license holder.
Penal Statutes, Such as Professional Discipline Statutes and Professional Practice Acts Must Be Narrowly Interpreted.
A statute is unconstitutionally void for vagueness if it fails to give a personal of ordinary intelligence fair notice of what conduct is forbidden by the Statute. Papachristou v. City of Jacksonville, 405 U.S. 156, 92 S. Ct. 839, 31 L. Ed. 2d 110 (1972). United States v. Harriss, 347 U.S. 612, 74 S. Ct. 808, 98 L. Ed. 989, (1954). Criminal statutes must be written with sufficient specificity so that citizens are given fair warning of the offending conduct, and law enforcement officers are prevented from engaging in arbitrary and erratic enforcement activity. Papachristou; Thornhill v. Alabama, 310 U.S. 88, 60 S. Ct. 736, 84 L. Ed. 1093 (1940); Lanzetta v. New Jersey, 306 U.S. 451, 59 S. Ct. 618, 83 L. Ed. 888 (1939).
Florida case law has long upheld this principle of the common law as well. Statutes must be written well enough so as to provide fair notice to ordinary citizens as to their exact meaning. State v. Warren, 558 So. 2d 55 (Fla. 5th DCA 1990), aff’d. Warren v. State 16 Fla., L. Week 28 (Fla. 1991).
When First Notified of a Pending Investigation Seek the Advice of an Experienced Health Law Attorney.
When you receive any notice, by telephone, by mail, by hand delivery or by information passed along by your employer, that an investigation has been opened against your professional license, immediately contact an attorney experienced in such matters. Do not talk to the investigator. Do not talk to the prosecuting attorney. Do not call the state agency and ask for advice on what you should do. Do not send a written statement explaining your side of the story.
You have important constitutional rights that protect you. But you have to exercise the common sense required to use these rights. Part of this is by obtaining competent legal counsel who can advise you and protect your rights. Again, we remind you that unless an attorney routinely handles this type of case, he or she may be unfamiliar with what your rights are in such a situation or how to handle it.
Contact Experienced Health Law Attorneys.
At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.
The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
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.
I am often asked about the burden of proof that must be met by the state Department of Health (DOH) in professional licensing disciplinary cases. This could be a complaint against a physician, dentists, mental health counselor, nurse, psychologist, pharmacist or anyone else. It also includes, for example, engineers, general contractors, school teachers, architects, cosmetologists, or any other professional holding a professional license in Florida. However, since we routinely represent health professionals, I will continue to concentrate on those licenses by the state DOH in this blog.
Click here to read part one.
Fifth Amendment Protection Against Self-Incrimination Applies.
Because potential license revocation proceedings are penal in nature, a respondent or license holder in such an investigation or administrative hearing has the right to remain silent under the Fifth Amendment of the United States Constitution and under the Florida Constitution.
Otherwise, this would defeat the spirit and intent of the constitutional protections guaranteed by the Fifth and Fourteenth Amendments to the United State Constitution. See, State v. Caballero, 396 So. 2d 1210, 1213 (Fla. 3d DCA 1981) ("A coerced confession offends due process of law."); Dickerson v. U.S., 530 U.S. 428, 434, 120 S. Ct. 2326, 2331 (2000) ("We have never abandoned this due process jurisprudence, and thus continue to exclude confessions that were obtained involuntarily"); Chambers v. State of Fla., 309 U.S. 227, 228, 60 S. Ct. 472, 473 (1940) ("[U]se by a state of an improperly obtained confession may constitute a denial of due process of law as guaranteed in the Fourteenth Amendment"); and Barnes v. Merrill, 2002 WL 1313123 (D. Me. 2002) ("Involuntary statements are inadmissible under the Fifth Amendment requirement that no person can be compelled to be a witness against himself in a criminal case.").
For Florida cases on point, see, Chancellor Media Whiteco Outdoor v. Fla. Dep't of Transport., 26 Fla. L. Weekly D627 (Fla. 5th DCA March 2, 2001), substitute opinion entered on rehearing, 795 So. 2d 991, 26 Fla. L. Weekly D1894 (Fla. 5th DCA July 30, 2001). See also, State ex rel. Vining v. Fla. Real Estate Comm'n, 281 So.2d 487, 491 (Fla. 1973); Best Pool & Spa Service Co., Inc. v. Romanik, 622 So. 2d 65, 66 (Fla. 4th DCA 1993) ("We agree that requiring Kassover to answer . . . questions does violate his right against self-incrimination which applies not only to criminal matters but also administrative proceedings such as licensing").
Florida Courts Require Higher Standard for Administrative Licensure Cases.
In Florida, the courts have adopted and have required the “clear and convincing” standard to be used in any case involving a professional license, finding that such action by the state is punitive or penal in nature and affects a substantial right of the respondent. The key Florida cases that discuss this are two Florida Supreme Court cases, Florida Bar v. Rayman, 238 So. 2d 594 (Fla. 1970) and Ferris v. Turlington, 510 So. 2d 292 (Fla. 1987). See also, Kozerowitz v. Fla. Real Estate Comm'n, 289 So. 2d 391 (Fla. 1974).
Any case in which a state administrative agency seeks a penalty, a fine or action affecting the status of a professional license, would require the application of a "clear and convincing standard." An action to revoke a professional license is definitely considered to be penal. So too is an action which results in the loss of income, such as by suspending a license (so there is no professional income), a fine, or an order to refund professional fees. McDonald v. Dep't of Prof. Reg., Bd. of Pilot Commissioners, 582 So. 2d 660 (1st DCA 1991).
Although these are all Florida cases, if you read them and follow their rationale, they go back to basic constitutional principles of due process of law and the taking away of rights or property without due process.
For example, in one case in which I defended a nursing home's license, the state had evidence that contradicted itself. There were certain facts at issue and the state put forth two different sets of facts. The state could not prove either set of facts by "clear and convincing evidence." Therefore, by law, the administrative law judge had to rule in favor of the license holder.
Penal Statutes, Such as Professional Discipline Statutes and Professional Practice Acts Must Be Narrowly Interpreted.
A statute is unconstitutionally void for vagueness if it fails to give a personal of ordinary intelligence fair notice of what conduct is forbidden by the Statute. Papachristou v. City of Jacksonville, 405 U.S. 156, 92 S. Ct. 839, 31 L. Ed. 2d 110 (1972). United States v. Harriss, 347 U.S. 612, 74 S. Ct. 808, 98 L. Ed. 989, (1954). Criminal statutes must be written with sufficient specificity so that citizens are given fair warning of the offending conduct, and law enforcement officers are prevented from engaging in arbitrary and erratic enforcement activity. Papachristou; Thornhill v. Alabama, 310 U.S. 88, 60 S. Ct. 736, 84 L. Ed. 1093 (1940); Lanzetta v. New Jersey, 306 U.S. 451, 59 S. Ct. 618, 83 L. Ed. 888 (1939).
Florida case law has long upheld this principle of the common law as well. Statutes must be written well enough so as to provide fair notice to ordinary citizens as to their exact meaning. State v. Warren, 558 So. 2d 55 (Fla. 5th DCA 1990), aff’d. Warren v. State 16 Fla., L. Week 28 (Fla. 1991).
When First Notified of a Pending Investigation Seek the Advice of an Experienced Health Law Attorney.
When you receive any notice, by telephone, by mail, by hand delivery or by information passed along by your employer, that an investigation has been opened against your professional license, immediately contact an attorney experienced in such matters. Do not talk to the investigator. Do not talk to the prosecuting attorney. Do not call the state agency and ask for advice on what you should do. Do not send a written statement explaining your side of the story.
You have important constitutional rights that protect you. But you have to exercise the common sense required to use these rights. Part of this is by obtaining competent legal counsel who can advise you and protect your rights. Again, we remind you that unless an attorney routinely handles this type of case, he or she may be unfamiliar with what your rights are in such a situation or how to handle it.
Contact Experienced Health Law Attorneys.
At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.
The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
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, December 18, 2012
New Regulations Coming to Seminole County Pain Management Clinics
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Seminole County, Florida, is the latest county to adopt tightened regulations for pain management clinics. On November 13, 2012, County Commissioners unanimously voted to adopt the ordinance enacting Chapter 186 of the Seminole County Code to establish regulations regarding pain management clinics.
Click here to read the entire Seminole County ordinance.
County Commissioners hope these new regulations will aid law enforcement in fighting illegal pill mill operations in Florida.
Restrictions to Prevent Overprescribing.
The ordinance requires clinics to get a license, produce monthly reports on how many prescriptions are issued for controlled substances and report patient information, such as a patient’s address. This only applies to practices where doctors issue prescriptions for painkillers such as oxycodone to more than 20 patients a day. It does not pertain to hospitals and other major medical facilities.
Anyone violating the regulations can be charged with a misdemeanor and lose his or her business license.
Some Physicians Not Happy.
The Orlando Sentinel interviewed a Boca Raton doctor who specializes in pain management. The doctor reportedly believes the regulations are helping to curb drug overdoses, but stated the regulations also limit legitimate board-certified medical specialists. He believes many Florida doctors are ready to move out of the Sunshine State and go to another state with fewer regulations.
To read the Orlando Sentinel article, click here.
Another Counties Putting Restrictions in Place.
At the end of October 2012, Osceola County Commissioners voted to adopt a similar ordinance. I wrote previously wrote about that story, click here to read that blog.
In addition to Osceola County, Winter Park, Sanford, Oviedo and Maitland have opted to enact ordinances that regulate pain management clinics’ location and operation.
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, pain management doctors, 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.
Comments?
As a healthcare professional, what do you think of this ordinance? Have you thought about leaving Florida due to the new regulations? Please leave any thoughtful comments below.
Sources:
Comas, Martin. “Seminole Tightens Regulations for Pain Management Clinics.” Orlando Sentinel. (November 13, 2012). From: http://www.orlandosentinel.com/news/local/seminole/os-pain-management-clinics-seminole-20121112,0,7626282.story
Seminole County Government. “Ordinance Chapter 186.” Seminole County Government. (November 13, 2012). From: http://www.thehealthlawfirm.com/uploads/Pain%20Management%20Ordinance.pdf
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.
Seminole County, Florida, is the latest county to adopt tightened regulations for pain management clinics. On November 13, 2012, County Commissioners unanimously voted to adopt the ordinance enacting Chapter 186 of the Seminole County Code to establish regulations regarding pain management clinics.
Click here to read the entire Seminole County ordinance.
County Commissioners hope these new regulations will aid law enforcement in fighting illegal pill mill operations in Florida.
Restrictions to Prevent Overprescribing.
The ordinance requires clinics to get a license, produce monthly reports on how many prescriptions are issued for controlled substances and report patient information, such as a patient’s address. This only applies to practices where doctors issue prescriptions for painkillers such as oxycodone to more than 20 patients a day. It does not pertain to hospitals and other major medical facilities.
Anyone violating the regulations can be charged with a misdemeanor and lose his or her business license.
Some Physicians Not Happy.
The Orlando Sentinel interviewed a Boca Raton doctor who specializes in pain management. The doctor reportedly believes the regulations are helping to curb drug overdoses, but stated the regulations also limit legitimate board-certified medical specialists. He believes many Florida doctors are ready to move out of the Sunshine State and go to another state with fewer regulations.
To read the Orlando Sentinel article, click here.
Another Counties Putting Restrictions in Place.
At the end of October 2012, Osceola County Commissioners voted to adopt a similar ordinance. I wrote previously wrote about that story, click here to read that blog.
In addition to Osceola County, Winter Park, Sanford, Oviedo and Maitland have opted to enact ordinances that regulate pain management clinics’ location and operation.
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, pain management doctors, 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.
Comments?
As a healthcare professional, what do you think of this ordinance? Have you thought about leaving Florida due to the new regulations? Please leave any thoughtful comments below.
Sources:
Comas, Martin. “Seminole Tightens Regulations for Pain Management Clinics.” Orlando Sentinel. (November 13, 2012). From: http://www.orlandosentinel.com/news/local/seminole/os-pain-management-clinics-seminole-20121112,0,7626282.story
Seminole County Government. “Ordinance Chapter 186.” Seminole County Government. (November 13, 2012). From: http://www.thehealthlawfirm.com/uploads/Pain%20Management%20Ordinance.pdf
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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.
Tuesday, December 11, 2012
Drug Enforcement Administration (DEA) Arrests New York Doctor on Alleged Drug Charges
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
A raid by the Drug Enforcement Administration (DEA) on November 27, 2012, at a New York home led to the arrest of an emergency room (ER) doctor, according to a number of sources. Once inside, agents allegedly found crack cocaine, crack pipes, needles and other drug paraphernalia belonging to the doctor. It’s reported by The Buffalo News that the raid came just as the alleged drug abuser was getting ready to smoke a crack cocaine pipe.
Click here to read the entire article from The Buffalo News.
Doctor's Companion Allegedly Assisted DEA Agents in Arrest.
According to a press release from the DEA, the doctor had been under investigation for weeks. Agents wanted to work quickly on this case since they knew the doctor worked at a number of hospitals in Niagara County, New York.
The press release states that DEA agents stopped a vehicle driven by the doctor’s female companion and caught her in possession of crack cocaine. The woman told agents that she purchased the drugs for the ER doctor, and that they were going to use them that night. The DEA obtained a search warrant and raided the doctor’s house the same night.
To read the entire press release from the DEA, click here.
The Doctor is Now Facing Charges.
Bond for the doctor has been set at $5,000. Possessing crack cocaine carries a maximum sentence of one year in prison and a $10,000 fine.
Other Alleged Drug Abuse.
I recently wrote a blog on a Florida dentist who had her license suspended for allegedly abusing nitrous oxide or laughing gas in front of patients. To read that blog, click here.
As in all media reports, please remember that all persons are presumed to be innocent until proven guilty in a court of law.
Contact Health Law Attorneys Experienced with DEA Cases.
The Health Law Firm represents physicians, pharmacists, pharmacies, 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.
Comments?
What do you think about this story? Is there an industry-wide problem with health providers abusing drugs? Please leave any thoughtful comments below.
Sources:
Herbeck, Dan. “DEA Raid Ends with ER Doctor in Trouble Over Crack Cocaine.” The Buffalo News. (November 28, 2012). From: http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20121128/CITYANDREGION/121129271/1003
Guggenmos, Emily. “ER Doctor Faces Crack Cocaine Charge.” WIVB. (November 29, 2012). From: http://www.wivb.com/dpp/news/crime/er-doctor-faces-crack-cocaine-charge
Drug Enforcement Administration. “Physician Charged with Possessing Crack Cocaine.” DEA New York City Division. (November 28, 2012). From: http://www.justice.gov/dea/divisions/nyc/2012/nyc112812a.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.
"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.
A raid by the Drug Enforcement Administration (DEA) on November 27, 2012, at a New York home led to the arrest of an emergency room (ER) doctor, according to a number of sources. Once inside, agents allegedly found crack cocaine, crack pipes, needles and other drug paraphernalia belonging to the doctor. It’s reported by The Buffalo News that the raid came just as the alleged drug abuser was getting ready to smoke a crack cocaine pipe.
Click here to read the entire article from The Buffalo News.
Doctor's Companion Allegedly Assisted DEA Agents in Arrest.
According to a press release from the DEA, the doctor had been under investigation for weeks. Agents wanted to work quickly on this case since they knew the doctor worked at a number of hospitals in Niagara County, New York.
The press release states that DEA agents stopped a vehicle driven by the doctor’s female companion and caught her in possession of crack cocaine. The woman told agents that she purchased the drugs for the ER doctor, and that they were going to use them that night. The DEA obtained a search warrant and raided the doctor’s house the same night.
To read the entire press release from the DEA, click here.
The Doctor is Now Facing Charges.
Bond for the doctor has been set at $5,000. Possessing crack cocaine carries a maximum sentence of one year in prison and a $10,000 fine.
Other Alleged Drug Abuse.
I recently wrote a blog on a Florida dentist who had her license suspended for allegedly abusing nitrous oxide or laughing gas in front of patients. To read that blog, click here.
As in all media reports, please remember that all persons are presumed to be innocent until proven guilty in a court of law.
Contact Health Law Attorneys Experienced with DEA Cases.
The Health Law Firm represents physicians, pharmacists, pharmacies, 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.
Comments?
What do you think about this story? Is there an industry-wide problem with health providers abusing drugs? Please leave any thoughtful comments below.
Sources:
Herbeck, Dan. “DEA Raid Ends with ER Doctor in Trouble Over Crack Cocaine.” The Buffalo News. (November 28, 2012). From: http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20121128/CITYANDREGION/121129271/1003
Guggenmos, Emily. “ER Doctor Faces Crack Cocaine Charge.” WIVB. (November 29, 2012). From: http://www.wivb.com/dpp/news/crime/er-doctor-faces-crack-cocaine-charge
Drug Enforcement Administration. “Physician Charged with Possessing Crack Cocaine.” DEA New York City Division. (November 28, 2012). From: http://www.justice.gov/dea/divisions/nyc/2012/nyc112812a.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.
"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, December 4, 2012
More Than $14 Million in Cancer Drugs Missing from the University of Miami
By Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law
For three years, hundreds of life-saving cancer drugs disappeared from the shelves of the University of Miami’s (UM) Sylvester Comprehensive Cancer Center. A pharmacy technician at the center was arrested in connection to the thefts in May of 2011, and is accused of stealing more than $14 million in cancer drugs, according to the Miami Herald. The pharmacy tech faces four counts of grand theft, two counts of trafficking in contraband prescription drugs and one count of dealing in stolen property.
To read the entire article from the Miami Herald, click here.
Cancer Pharmacy Had No Inventory Controls Allegedly.
According to the Miami Herald, UM’s chief financial officer and a board member admitted that there were no controls at the cancer pharmacy to keep track of supplies. The pharmacy technician was apparently able to walk to refrigerators in the pharmacy and slip packages of Neulasta, a drug used by cancer patients, into his lab coat. Each box of Neulasta runs about $2,600 per dose. It’s obviously worth more than its weight in gold.
The fact that the pharmacy was missing hundred of syringes of drugs did not even get noticed until May 2011 when a pharmacy buyer at UM noticed something was off when she reviewed a new computer program that tracked drugs. The system showed hundreds of syringes full of Neulasta were missing from inventory. Since the new software was not reliable, the pharmacy buyer decided to hand-count the syringes. This was the first time anyone at the pharmacy noticed that drugs were missing.
Pharmacy Tech Allegedly Gets Busted with Cancer Drugs.
On June 1, 2011, hidden video surveillance cameras were installed in the pharmacy to view the refrigerators. On two separate occasions the cameras allegedly caught the pharmacy technician pocketing several boxes of Neulasta. To see the security camera footage, click here.
The second time the pharmacy technician was allegedly captured on video, he was confronted and forced to hand over his lab coat containing the cancer drugs. He immediately confessed to selling the drugs and allowed investigators to search his home. There investigators found 163 doses of Neulasta and other cancer-fighting drugs. All together the drugs found had a value of more than $700,000, according to the Miami Herald.
It is currently unknown whether he will ever get his lab coat back. He may have to exchange it for a striped one or an orange jump suit.
Audit Found Inventory Controls Now Sufficient.
As soon as the theft was confirmed, security and inventory controls of pharmaceuticals at Sylvester were reviewed and strengthened, according to the Miami Herald. A follow up audit found that the pharmacy’s inventory controls are now sufficient.
The pharmacy is seeking reimbursement for losses from the employee and the pharmacy’s insurance.
Ways to Prevent Employee Embezzlement.
George F. Indest, another health attorney with our firm, recently wrote several articles on prevention of employee embezzlement. Although the articles are written for smaller health care providers than universities, many of the general principles contained in these would apply to larger employers, as well.
To see the Medical Economics article, click here.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.
The Health Law Firm represents pharmacists and pharmacies in DEA investigations, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm's attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?
What do you think of this story? What do you think of the fact that it took the university so long to find out the inventory was missing? Have you heard of people stealing drugs from pharmacies before? Please leave any thoughtful comments below.
Sources:
Dorschner, John. “How Did $14 Million in Drugs Vanish from a UM Pharmacy?” Miami Herald. (August 6, 2012). From: http://www.miamiherald.com/2012/08/06/2936916/how-did-14-million-in-drugs-vanish.html
Creamer, Alyssa. “University of Miami Employee, Manuel Pacheco, Allegedly Looted Pharmacy For Over $14 Million In Cancer Drugs.” Huffington Post. (August 9, 2012). From: http://www.huffingtonpost.com/2012/08/09/um-employee-steals-14-million-cancer-drugs_n_1760155.html?view=print&comm_ref=false
About the Author: Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law. He 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.
For three years, hundreds of life-saving cancer drugs disappeared from the shelves of the University of Miami’s (UM) Sylvester Comprehensive Cancer Center. A pharmacy technician at the center was arrested in connection to the thefts in May of 2011, and is accused of stealing more than $14 million in cancer drugs, according to the Miami Herald. The pharmacy tech faces four counts of grand theft, two counts of trafficking in contraband prescription drugs and one count of dealing in stolen property.
To read the entire article from the Miami Herald, click here.
Cancer Pharmacy Had No Inventory Controls Allegedly.
According to the Miami Herald, UM’s chief financial officer and a board member admitted that there were no controls at the cancer pharmacy to keep track of supplies. The pharmacy technician was apparently able to walk to refrigerators in the pharmacy and slip packages of Neulasta, a drug used by cancer patients, into his lab coat. Each box of Neulasta runs about $2,600 per dose. It’s obviously worth more than its weight in gold.
The fact that the pharmacy was missing hundred of syringes of drugs did not even get noticed until May 2011 when a pharmacy buyer at UM noticed something was off when she reviewed a new computer program that tracked drugs. The system showed hundreds of syringes full of Neulasta were missing from inventory. Since the new software was not reliable, the pharmacy buyer decided to hand-count the syringes. This was the first time anyone at the pharmacy noticed that drugs were missing.
Pharmacy Tech Allegedly Gets Busted with Cancer Drugs.
On June 1, 2011, hidden video surveillance cameras were installed in the pharmacy to view the refrigerators. On two separate occasions the cameras allegedly caught the pharmacy technician pocketing several boxes of Neulasta. To see the security camera footage, click here.
The second time the pharmacy technician was allegedly captured on video, he was confronted and forced to hand over his lab coat containing the cancer drugs. He immediately confessed to selling the drugs and allowed investigators to search his home. There investigators found 163 doses of Neulasta and other cancer-fighting drugs. All together the drugs found had a value of more than $700,000, according to the Miami Herald.
It is currently unknown whether he will ever get his lab coat back. He may have to exchange it for a striped one or an orange jump suit.
Audit Found Inventory Controls Now Sufficient.
As soon as the theft was confirmed, security and inventory controls of pharmaceuticals at Sylvester were reviewed and strengthened, according to the Miami Herald. A follow up audit found that the pharmacy’s inventory controls are now sufficient.
The pharmacy is seeking reimbursement for losses from the employee and the pharmacy’s insurance.
Ways to Prevent Employee Embezzlement.
George F. Indest, another health attorney with our firm, recently wrote several articles on prevention of employee embezzlement. Although the articles are written for smaller health care providers than universities, many of the general principles contained in these would apply to larger employers, as well.
To see the Medical Economics article, click here.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.
The Health Law Firm represents pharmacists and pharmacies in DEA investigations, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm's attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?
What do you think of this story? What do you think of the fact that it took the university so long to find out the inventory was missing? Have you heard of people stealing drugs from pharmacies before? Please leave any thoughtful comments below.
Sources:
Dorschner, John. “How Did $14 Million in Drugs Vanish from a UM Pharmacy?” Miami Herald. (August 6, 2012). From: http://www.miamiherald.com/2012/08/06/2936916/how-did-14-million-in-drugs-vanish.html
Creamer, Alyssa. “University of Miami Employee, Manuel Pacheco, Allegedly Looted Pharmacy For Over $14 Million In Cancer Drugs.” Huffington Post. (August 9, 2012). From: http://www.huffingtonpost.com/2012/08/09/um-employee-steals-14-million-cancer-drugs_n_1760155.html?view=print&comm_ref=false
About the Author: Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law. He 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.
"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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.
Thursday, November 29, 2012
American Hospital Association (AHA) Sues Government for Unfair Medicare Practices
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the U.S. Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources. The AHA is seeking a court order declaring the practice invalid, saying it violates the Medicare Act.
Four hospital systems in Michigan, Missouri and Pennsylvania have joined the AHA as plaintiffs in the suit. The suit has been filed in federal court in Washington, D.C.
To read the AHA complaint against the HHS, click here.
AHA's Calls Recovery Audit Contractors' (RACs) Practices "Indefensible."
The lawsuit alleges Recovery Audit Contractors (RACs), private auditors used by the HHS, forced hospitals to repay Medicare for the costs of in-patient services by determining that Medicare beneficiaries should have been treated as out-patients instead of being admitted into hospitals as in-patients. The services provided to out-patients are much less, of course, and the bills for out-patient services are usually much lower.
In the official press release AHA argues when patients need treatment, the first step for a doctor is to decide whether to admit the patient to the hospital or to provide care in an out-patient facility. AHA believes doctors’ decisions are often more complicated for Medicare beneficiaries because the doctor is routinely second-guessed by RACs months or even years later. The president and CEO of AHA said this practice is “indefensible.”
Click here to read the entire press release from the AHA.
Neither the Centers for Medicare and Medicaid (CMS) nor the Department of HHS has commented on the pending litigation.
AHA Agrees with the Office of Inspector General’s (OIG) Review of Medicare Contractors.
In October 2012, prior to the lawsuit, the executive vice president of the AHA wrote a letter to the Office of Inspector General (OIG) in response to the Work Plan for Fiscal Year 2013. In the work plan the OIG reviewed the effectiveness of various Medicare contractors, including RACs, Medicare Administrative Contractors (MACs) and Zone Program Integrity Contractors (ZPICs).
The letter states that these programs auditing payment accuracy are well intentioned, but hospitals are fed up with the RACs’ inaccuracy in determining whether the hospital received any overpayments. The letter also claims that hospitals are overwhelmed by the significant overlap and duplication of efforts between the RACs, MACs and ZPICs. These redundant audits drain time, funding and attention to patient care, according to the AHA.
According to the OIG review, hospitals reported appealing more than forty percent (40%) of all RAC denials, with a seventy-five percent (75%) success rate in the appeals process.
Click here to read the letter from the AHA to the OIG.
Here is What To Do If You Receive a Notice of a Medicare Audit.
When a physician, medical group or other healthcare provider receives a notice of an audit and site visit from a RAC, MAC or ZPIC, things happen fast with little opportunity to prepare. To help, read our checklist of what to do when notified of a Medicare or ZPIC audit. Click here for part one and click here for part two.
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 healthcare 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.
Comments?
What you think about the lawsuit again the HHS? Do you support AHA’s decision to question the RACs’ auditing system? Please leave any thoughtful comments below.
Sources:
Mitchell, Alicia. “Hospitals Sue Federal Government for Unfair Medicare Practices.” American Hospital Association. (November 1, 2012). Press Release from: http://www.thehealthlawfirm.com/uploads/AHA%20Sues%20Govnt%20PR.pdf
Pollack, Richard. “Letter: AHA Supports OIG Review of Effectiveness of Medicare Contractors, Including RACs, In 2013 Work Plan.” American Hospital Association. (October 24, 2012). Letter from: http://www.thehealthlawfirm.com/uploads/AHA%20letter%20to%20OIG%20on%20RACs.pdf
Morgan, David. “Hospitals Sue Government Over Private Medicare Audits.” Reuters. (November 1, 2012). From: http://uk.reuters.com/article/2012/11/01/us-usa-healthcare-medicare-idUKBRE8A01BZ20121101
Harris, Andrew. “American Hospital Association Sues U.S. Over Medicare.” Bloomberg. (November 1, 2012). From: http://www.bloomberg.com/news/print/2012-11-01/american-hospital-association-sues-u-s-over-unpaid-medicare.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.
On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the U.S. Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources. The AHA is seeking a court order declaring the practice invalid, saying it violates the Medicare Act.
Four hospital systems in Michigan, Missouri and Pennsylvania have joined the AHA as plaintiffs in the suit. The suit has been filed in federal court in Washington, D.C.
To read the AHA complaint against the HHS, click here.
AHA's Calls Recovery Audit Contractors' (RACs) Practices "Indefensible."
The lawsuit alleges Recovery Audit Contractors (RACs), private auditors used by the HHS, forced hospitals to repay Medicare for the costs of in-patient services by determining that Medicare beneficiaries should have been treated as out-patients instead of being admitted into hospitals as in-patients. The services provided to out-patients are much less, of course, and the bills for out-patient services are usually much lower.
In the official press release AHA argues when patients need treatment, the first step for a doctor is to decide whether to admit the patient to the hospital or to provide care in an out-patient facility. AHA believes doctors’ decisions are often more complicated for Medicare beneficiaries because the doctor is routinely second-guessed by RACs months or even years later. The president and CEO of AHA said this practice is “indefensible.”
Click here to read the entire press release from the AHA.
Neither the Centers for Medicare and Medicaid (CMS) nor the Department of HHS has commented on the pending litigation.
AHA Agrees with the Office of Inspector General’s (OIG) Review of Medicare Contractors.
In October 2012, prior to the lawsuit, the executive vice president of the AHA wrote a letter to the Office of Inspector General (OIG) in response to the Work Plan for Fiscal Year 2013. In the work plan the OIG reviewed the effectiveness of various Medicare contractors, including RACs, Medicare Administrative Contractors (MACs) and Zone Program Integrity Contractors (ZPICs).
The letter states that these programs auditing payment accuracy are well intentioned, but hospitals are fed up with the RACs’ inaccuracy in determining whether the hospital received any overpayments. The letter also claims that hospitals are overwhelmed by the significant overlap and duplication of efforts between the RACs, MACs and ZPICs. These redundant audits drain time, funding and attention to patient care, according to the AHA.
According to the OIG review, hospitals reported appealing more than forty percent (40%) of all RAC denials, with a seventy-five percent (75%) success rate in the appeals process.
Click here to read the letter from the AHA to the OIG.
Here is What To Do If You Receive a Notice of a Medicare Audit.
When a physician, medical group or other healthcare provider receives a notice of an audit and site visit from a RAC, MAC or ZPIC, things happen fast with little opportunity to prepare. To help, read our checklist of what to do when notified of a Medicare or ZPIC audit. Click here for part one and click here for part two.
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 healthcare 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.
Comments?
What you think about the lawsuit again the HHS? Do you support AHA’s decision to question the RACs’ auditing system? Please leave any thoughtful comments below.
Sources:
Mitchell, Alicia. “Hospitals Sue Federal Government for Unfair Medicare Practices.” American Hospital Association. (November 1, 2012). Press Release from: http://www.thehealthlawfirm.com/uploads/AHA%20Sues%20Govnt%20PR.pdf
Pollack, Richard. “Letter: AHA Supports OIG Review of Effectiveness of Medicare Contractors, Including RACs, In 2013 Work Plan.” American Hospital Association. (October 24, 2012). Letter from: http://www.thehealthlawfirm.com/uploads/AHA%20letter%20to%20OIG%20on%20RACs.pdf
Morgan, David. “Hospitals Sue Government Over Private Medicare Audits.” Reuters. (November 1, 2012). From: http://uk.reuters.com/article/2012/11/01/us-usa-healthcare-medicare-idUKBRE8A01BZ20121101
Harris, Andrew. “American Hospital Association Sues U.S. Over Medicare.” Bloomberg. (November 1, 2012). From: http://www.bloomberg.com/news/print/2012-11-01/american-hospital-association-sues-u-s-over-unpaid-medicare.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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.
Tuesday, November 20, 2012
CVS Pharmacies Possibly Under Investigation for Practice Used to Refill Prescriptions
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) has reportedly launched an investigation into CVS’ practice for refilling prescriptions. According to an article in the Los Angeles Times, authorities are looking into reports that CVS has been refilling prescriptions and submitting insurance claims without patients’ permission. The Los Angeles Times article, released October 12, 2012, names an official with knowledge of this matter as the source.
We want to emphasize that this is from an unconfirmed news story. The government rarely announces investigations of specific subjects ahead of time.
Click here to read the entire article from the Los Angeles Times.
CVS Has Not Been Notified of an Investigation.
A related article in Reuters states that CVS said it has not been contacted by the government about the investigation. The pharmacy also said, as a policy, the company does not condone unauthorized refills. Officials said to allow unauthorized prescription refills could be considered insurance fraud, especially if insurers weren’t refunded for any drugs rejected by patients.
The probe might be, in part, related to the programs offered by many drugstores that allows a pharmacy to refill prescriptions even before a refill request has been made by the patient.
Click here to read the entire article from Reuters.
So far there is no news from the OIG for the HHS officially confirming this investigation.
Tempest in a Teapot?
It is unclear to me why there would be any cause to investigate CVS, if Medicare was not being billed until the customer actually picked up the prescription. If the customer fails to pickup the prescription, every drug store I know of restocks the medication after a short period and no one is ever billed for it. It seems that it would be a quick and simple matter for the OIG to check this.
Furthermore, it could also be argued that CVS actually is promoting good health by this practice. Patients may forget to renew or refill their prescriptions or may fail to notice they are running low.
Two Sanford, Florida CVS Pharmacies in the News.
On September 12, 2012, the U.S. Drug Enforcement Administration (DEA) revoked the registrations (controlled substance licenses) from two CVS pharmacies in Sanford, Florida. The two pharmacies are no longer able to fill prescriptions for drugs such as oxycodone, Dilaudid, Vicodin, Ritalin and Xanax. This decision was in response to a government crackdown on the distribution of painkillers. Click here to read a blog on this story.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.
The Health Law Firm represents pharmacists and pharmacies in DEA investigations, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm's attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?
What do you think of this story? Do you think CVS is doing anything wrong? How is this any different from the practice of many managed care plans mailing out 90 days of medications to its patients at a time? Please leave any thoughtful comments below.
Sources:
Lazarus, David. “CVS Caremark Prescription Refills Under Scrutiny, Source Says.” Los Angeles Times. (October 12, 2012). From: http://www.latimes.com/business/la-fi-lazarus-20121012,0,1032269.column
Alawadhi, Neha, Wohl, Jessica, and Morgan, David. “CVS Unaware of Any Government Prescription Refill Probe.” Reuters. (October 12, 2012). From: http://www.reuters.com/assets/print?aid=USBRE89B19520121012
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 Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) has reportedly launched an investigation into CVS’ practice for refilling prescriptions. According to an article in the Los Angeles Times, authorities are looking into reports that CVS has been refilling prescriptions and submitting insurance claims without patients’ permission. The Los Angeles Times article, released October 12, 2012, names an official with knowledge of this matter as the source.
We want to emphasize that this is from an unconfirmed news story. The government rarely announces investigations of specific subjects ahead of time.
Click here to read the entire article from the Los Angeles Times.
CVS Has Not Been Notified of an Investigation.
A related article in Reuters states that CVS said it has not been contacted by the government about the investigation. The pharmacy also said, as a policy, the company does not condone unauthorized refills. Officials said to allow unauthorized prescription refills could be considered insurance fraud, especially if insurers weren’t refunded for any drugs rejected by patients.
The probe might be, in part, related to the programs offered by many drugstores that allows a pharmacy to refill prescriptions even before a refill request has been made by the patient.
Click here to read the entire article from Reuters.
So far there is no news from the OIG for the HHS officially confirming this investigation.
Tempest in a Teapot?
It is unclear to me why there would be any cause to investigate CVS, if Medicare was not being billed until the customer actually picked up the prescription. If the customer fails to pickup the prescription, every drug store I know of restocks the medication after a short period and no one is ever billed for it. It seems that it would be a quick and simple matter for the OIG to check this.
Furthermore, it could also be argued that CVS actually is promoting good health by this practice. Patients may forget to renew or refill their prescriptions or may fail to notice they are running low.
Two Sanford, Florida CVS Pharmacies in the News.
On September 12, 2012, the U.S. Drug Enforcement Administration (DEA) revoked the registrations (controlled substance licenses) from two CVS pharmacies in Sanford, Florida. The two pharmacies are no longer able to fill prescriptions for drugs such as oxycodone, Dilaudid, Vicodin, Ritalin and Xanax. This decision was in response to a government crackdown on the distribution of painkillers. Click here to read a blog on this story.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.
The Health Law Firm represents pharmacists and pharmacies in DEA investigations, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm's attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Comments?
What do you think of this story? Do you think CVS is doing anything wrong? How is this any different from the practice of many managed care plans mailing out 90 days of medications to its patients at a time? Please leave any thoughtful comments below.
Sources:
Lazarus, David. “CVS Caremark Prescription Refills Under Scrutiny, Source Says.” Los Angeles Times. (October 12, 2012). From: http://www.latimes.com/business/la-fi-lazarus-20121012,0,1032269.column
Alawadhi, Neha, Wohl, Jessica, and Morgan, David. “CVS Unaware of Any Government Prescription Refill Probe.” Reuters. (October 12, 2012). From: http://www.reuters.com/assets/print?aid=USBRE89B19520121012
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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.
Thursday, November 8, 2012
More Than 30 People Arrested for Medicare Fraud in South Florida
By Dr. Thu Pham, O.D., Law Clerk
On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. Payment of bribes and kickbacks, as well as payments to patient recruiters were an issue in this investigation.
To read the entire article from the Miami Herald, click here.
U.S. Cracking Down on Theft Against Medicare.
These arrests are part of a nationwide initiative to crack down on theft committed by individuals against Medicare. Peter Budetti, the Medicare anti-fraud czar states that the goal is to catch the fraud before the fraudsters "can successfully bill Medicare." Previously, fraud was caught only after the funds were disbursed and spent.
The Miami area is among the nation's highest when it comes to the commission of Medicare fraud, particularly involving the areas of mental health, physical health, nursing homes, home health care, and durable medical equipment suppliers.
Medicare Billed for Services Not Medically Necessary.
In an attempt to effectuate the fraud scheme, some of the defendants allegedly conspired to pay thousands of dollars in bribes and kickbacks to both recruiters and patients. The defendants allegedly billed Medicare for services that were not medically necessary.
What Charges Could Be Faced?
If convicted, these defendants will not only be required to pay fines and penalties, but will also face prison time.
Contact Health Law Attorneys Experienced in Handling Medicare Audits.
Medicare 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 Medicare fraud criminal charges arise out of routine Medicare audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, 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.
Comments?
What do you think of this story? Please submit any thoughtful comments below.
Sources:
Miami Herald. "Medicare fraud crackdown nets 33 arrests in South Florida." Miami Herald. (October 4, 2012). From:
http://www.miamiherald.com/2012/10/04/v-fullstory/3034167/feds-charge-more-than-30-suspects.html.
Local10. "33 arrested in Miami for Medicare fraud." Local 10 (October 4, 2012). From http://www.local10.com/news/33-arrested-in-Miami-for-Medicare-fraud/-/1717324/16853802/-/q7addoz/-/index.html.
About the Author: Dr. Thu Pham, OD, 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.
On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. Payment of bribes and kickbacks, as well as payments to patient recruiters were an issue in this investigation.
To read the entire article from the Miami Herald, click here.
U.S. Cracking Down on Theft Against Medicare.
These arrests are part of a nationwide initiative to crack down on theft committed by individuals against Medicare. Peter Budetti, the Medicare anti-fraud czar states that the goal is to catch the fraud before the fraudsters "can successfully bill Medicare." Previously, fraud was caught only after the funds were disbursed and spent.
The Miami area is among the nation's highest when it comes to the commission of Medicare fraud, particularly involving the areas of mental health, physical health, nursing homes, home health care, and durable medical equipment suppliers.
Medicare Billed for Services Not Medically Necessary.
In an attempt to effectuate the fraud scheme, some of the defendants allegedly conspired to pay thousands of dollars in bribes and kickbacks to both recruiters and patients. The defendants allegedly billed Medicare for services that were not medically necessary.
What Charges Could Be Faced?
If convicted, these defendants will not only be required to pay fines and penalties, but will also face prison time.
Contact Health Law Attorneys Experienced in Handling Medicare Audits.
Medicare 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 Medicare fraud criminal charges arise out of routine Medicare audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, 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.
Comments?
What do you think of this story? Please submit any thoughtful comments below.
Sources:
Miami Herald. "Medicare fraud crackdown nets 33 arrests in South Florida." Miami Herald. (October 4, 2012). From:
http://www.miamiherald.com/2012/10/04/v-fullstory/3034167/feds-charge-more-than-30-suspects.html.
Local10. "33 arrested in Miami for Medicare fraud." Local 10 (October 4, 2012). From http://www.local10.com/news/33-arrested-in-Miami-for-Medicare-fraud/-/1717324/16853802/-/q7addoz/-/index.html.
About the Author: Dr. Thu Pham, OD, 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.
"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.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.
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