Be Sure To Review ABIM's New List of Overused and Unnecessary Medical Tests and Procedures

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

This year, seventeen (17) medical specialty societies added their names and recommendations to a list of medical procedures that are overused and often unnecessary. This updated list was released in February 2013, and includes ninety (90) new tests and procedures. The first version of the list was released in April 2012, with recommendations from nine (9) leading medical groups. It was created as part of the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign to help reduce healthcare spending and improve patient care.

An article I previously wrote on the first list was published in Medical Economics. Click here to read the entire article.


List Designed to Promote Education.
In 2011, the ABIM found that the United States spends more than $2.5 million a year on healthcare, which is more than $8,000 a person. Studies have suggested that the high cost of healthcare in the U.S. is driven largely by the price of tests and procedures.



The motive behind this list is to promote an educational dialogue between physicians and patients. These medical societies are urging patients to actively question their doctors when listed tests and procedures are recommended. It’s believed that reducing the amount of unnecessary tests and procedures will help decrease medical spending and medical costs.


Patient Protection.
This situation also may have the side effect of promoting additional litigation against doctors, healthcare clinics, and hospitals that provide the unnecessary tests and procedures. Many states have laws that prohibit unnecessary tests and procedures and sanction those who provide them. For instance, Section 766.111, Florida Statutes, which was enacted in 1985, states:

Engaging in unnecessary diagnostic testing; penalties:

1. No healthcare provider licensed pursuant to chapter 458 [medical doctors], chapter 459 [osteopathic physicians], chapter 460 [chiropractic physician], chapter 461 [podiatrist], or chapter 466 [dentist], shall order, procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the healthcare provider in arriving at a diagnosis and treatment of a patient's condition.
2. A violation of this section shall be grounds for disciplinary action...
3. Any person who prevails in a suit brought against a healthcare provider predicated upon a violation of this section shall recover reasonable attorney's fees and costs.

This Florida law not only provides a private cause of action by a patient against a health provider who orders or furnishes such "unnecessary" diagnostic tests, but unlike other tort and medical malpractice statutes, it allows the prevailing party in such a case to recover attorney's fees and costs. This law may by itself promote litigation in the face of the lists of tests from the specialty groups.


Some Procedures and Tests That are Now Considered Unnecessary.
Some of the items the societies suggest avoiding include:

1. American Academy of Pediatrics (AAP): Antibiotics for apparent viral respiratory illnesses, such as sinusitis or bronchitis;



2. American Academy of Neurology (AAN): Electroencephalography for headaches;



3. American Academy of Ophthalmology (AAO): Antibiotics for pink eye;



4. American Society for Clinical Pathology (ASCP): Population-based screening for vitamin D deficiency;



5.  American Urological Association (AUA): Routine bone scans in men with a low risk of prostate cancer;



6 Society of Nuclear Medicine of Molecular Imaging (SNMMI): PET/CT scans for cancer screening in healthy individuals.

A number of recommendations were made by multiple groups.

1. The American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG): both urged against scheduling elective labor inducements or cesarean deliveries before 39 weeks. This action is associated with an increased risk of learning disabilities, respiratory issues and other possible problems in infants.



2. The American Academy of Hospice and Palliative Medicine (AAHPM) and the American Geriatrics Society (AGS): both recommended against percutaneous feeding tubes in advanced dementia patients because studies have shown the tubes don’t result in better patient outcomes. Oral feeding is recommended instead.

The ABIM hopes to release a third list later in 2013, which will include thirteen (13) more healthcare societies.
A full list of the current recommendations can be found on the “Choosing Wisely” website.


Expect to See  More False Claims and Qui Tam Cases.
I believe that with this updated list will come more qui tam or “whistleblower” and false claims cases.
Qui tam cases have been brought under the federal False Claims Act for the recovery of Medicare payments from hospitals, physicians, medical groups, nursing homes, insurance companies, diagnostic testing facilities, clinical laboratories, radiology facilities and many other types of healthcare providers. These cases allege that a false claim was submitted to the government. If the test or procedure was unnecessary, then it seems almost axiomatic that a claim for it is false. The plaintiff bringing such cases receives a percentage of the recovery, which often amounts to millions of dollars in successful cases.

Most states now have similar false claims act or qui tam laws providing similar causes of action and recoveries to individual plaintiffs in the case of state Medicaid payments as well.

Because medical necessity is a requirement for practically every Medicare and Medicaid service, as well as most services paid by private health insurers, the lists provided by the specialty may very well be exhibit one in future lawsuits.


A Lawyer's Perspective.
I do not disagree with, and am not critical of, the specialties providing this valuable information to the public. If anything, such information makes for a more educated patient populace and provider group and serves to eliminate tests and procedures that have no proven medical efficacy.

A doctor should have the knowledge, skill, training, and confidence to know when such tests and procedures are not warranted. If a physician persists in ordering these tests solely for the means of increasing profits, he or she should be penalized. If not, the physician should be able to justify them.


Contact Experienced Health Law Attorneys.
 The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its 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.


Sound off.
Have you reviewed this new list of tests and procedures that have been deemed unnecessary? As a healthcare professional, what do you think of the list? How important is it for patients to be educated on their options for medical care? Please leave any thoughtful comments below.


Sources:
Levey, Noam. “Doctors List Overused Medical Treatments.” Lose Angeles Times. (February 20, 2013). From: http://www.latimes.com/health/la-na-medical-procedures-20130221,0,6234009.story
Indest III, George. “Beware Legal Ramifications of Unnecessary Tests.” Medical Economics. (July 25, 2013). From: http://medicaleconomics.modernmedicine.com/news/beware-legal-ramifications-unnecessary-tests
Lee, Jamie. “Choosing Wisely Campaign Expands List of Questionable Tests, Procedures.” Modern Healthcare. (February 231, 2013). From: http://bit.ly/YLFVtu
Pittman, David. “17 Doc Groups Add to ‘Overused’ Test List.” MedPage Today. (February 21, 2013). From: http://bit.ly/VAW2g6


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.

Locating a Healthcare Providers Service Organization (HPSO) Insurance Defense Attorney in Florida

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
We are sometimes told by the health professionals we represent especially pharmacists, licensed mental health counselors (LMHCs), advanced registered nurse practitioners (ARNPs), massage therapists and physical therapists that after they received a complaint regarding their license from the Florida Department of Health (DOH) they had difficulty finding an experienced attorney in Florida who would accept their professional liability insurance.  In this case, I am speaking specifically about Healthcare Providers Service Organization (HPSO) Insurance.


HPSO Insurance Helps Cover Costly Legal Fees.
The professionals who are covered by HPSO Insurance have excellent insurance coverage.  HPSO Insurance provides professional liability coverage that protects in the event of a lawsuit or negligence claim.  But much more often the professional receives a notice of an investigation, a subpoena for a deposition in someone else's case, a demand because of an allegation of sexual harassment or sexual impropriety, a complaint because of a breach of medical records confidentiality or Health Insurance Portability and Accountability Act (HIPAA) Privacy complaint, or some other administrative type of action.
HPSO provides great coverage for these.  For example, HPSO currently reimburses up to $10,000 in legal fees and expenses just for representation of you at depositions.  HPSO currently reimburses up to $25,000 in legal fees and expenses for your defense in a DOH or Agency for Health Care Administration (AHCA) notice of investigation or complaint.  HPSO currently reimburses up to $25,000 in legal fees and expenses for your legal representation in defense of a complaint or investigation regarding breach of medical confidentiality.
If you are a pharmacist, own a pharmacy, are a massage therapist, own an assisted living facility (ALF), are a mental health counselor or a social worker, or you are one of the many other types of health care professionals who HPSO insures, it should be fairly easy to find experienced health lawyers to represent you, especially in Florida.
Our firm and our attorneys, including George F. Indest III, Michael L. Smith, Joanne Kenna, Carole C. Schriefer, Lance O. Leider and Christopher E. Brown represent licensed health care professionals, interns and students in all types of administrative investigations and hearings and in defending lawsuits and other actions that have been filed.  We also represent health facilities in license defense, survey complaints and administrative hearings.  We represent them throughout Florida, from Pensacola to Jacksonville, to Key West.  We also occasionally represent them in other states, as well.  We accept HPSO Insurance assignments.


Don't Wait to get Insurance.
It is very important for every health professional to carry insurance that covers any investigation, complaint or administrative hearing that might be filed or opened against your license.  You may think that you are covered for this by your employer, but you are not.  If your employer contradicts this, ask for a statement in writing that your employer will pay for your legal defense for any such matter arising during your employment.
What typically happens, especially in the case of a hospital employee, nursing home employee, pharmacy employee or corporate employee, is that the employer is the one who terminates the employee and then files a complaint with the DOH.  The DOH then opens an investigation against the health professional.  The employer is not going to pay your legal defense costs if the employer has reported you.
You may very well be out of work, out of money and face an investigation and complaint that could terminate your professional license and career.  You should not take this chance.  Insurance such as HPSO Insurance is inexpensive and reliable.  Buy it while you can afford it. After the actions have occurred, it is too late.


If You are Contacted by an Investigator, Call a Health Law Attorney First.
Also, you should immediately contact an experienced health law attorney if you are telephoned or visited by any investigator, or if you receive a letter advising you that an investigation has been opened regarding your care.  Call immediately for advice before you speak with an investigator or provide any documents or statements of any kind.
You cannot and should not seek "legal advice" on what to do from the investigator, from a DOH employee, from your professional board or from any attorney representing any of them.  They are not your friends.  They are on the side against you. You should definitely not take any advice from them.


Don't be Cheap When it Comes to Insurance Policies.
If you have good insurance, it will pay for your legal expenses from the very beginning, so use it.  However, beware of cheap insurance policies from professional associations that do not provide any coverage for disciplinary complaints and licensure investigations.  Always check to be sure this is covered.  Get it in writing.  With some companies you have to pay an extra premium to obtain this coverage.  With some insurers, they do not offer it, and you have to purchase a completely separate policy covering just this.  It is worth it!  Do it!


Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
Our firm regularly represents physicians, dentists, nurse practitioners, pharmacists, massage therapists, mental health counselors, registered nurses (RNs), assisted living facilities (ALFs), home health agencies, nurse practitioners, lab technicians, occupational therapists, physical therapists, social workers, physician assistants, psychologists and other health professionals in many different legal matters.
Services we provide include representation before your professional board in DOH investigations, in administrative hearings, in civil litigation, in defense of malpractice claims, in professional licensing matters, in defense of allegations concerning HIPAA privacy violations and medical record breaches, in Drug Enforcement Administration (DEA) actions, and in many other matters.
In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company.  If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.
We also defend health professionals and health facilities in general litigation matters and business litigation matters.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?
Do you have professional liability insurance? Why or why not. Please leave any thoughtful comments below.


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 Closer Look at the Three-Year Medical School Degree

By Danielle M. Murray, J.D., The Health Law Firm


To combat the nationwide shortage of primary care physicians and the increase in student debt, several medical schools around the country are offering the chance for students to finish school in three years, instead of four. According to a number of news articles, these programs are geared specifically toward medical students looking to practice primary care. The hope is that these programs will be cost less for students and add more primary care physicians to under-served areas.


Degrees Offered at Some Schools Around the U.S.
According to an article in The New York Times, a small number of students are currently participating in the three-year degree program. There are about 16 incoming students in the program at New York University (N.Y.U.), nine students at Texas Tech Health Science Center School of Medicine and an even smaller number are at the Mercer University School of Medicine campus in Georgia. In an interview in The New York Times, the dean at Texas Tech said if this approach works, the schools will open up the program to a larger number of students.
To read the entire New York Times article, click here.


Students on a Fast and Rigorous Schedule.
According to an article in American Medical News, the condensed medical school eliminates breaks and electives and allows students to begin clerkship training in their second year. This is a full year earlier than the traditional four-year curriculums. In the same article, medical experts warn these accelerated programs are not for everyone, saying it takes a mature person to go through rotations earlier and at a quicker pace.
Students are given a chance to opt out if they decide to pursue a different career path. The American Medical News article explains that at Mercer, students who decide that family medicine is not for them are integrated into the traditional four-year program.
Click here to read the article from American Medical News.


More Doctors, Less Debt.
This three-year program is expected to save a quarter of the cost of medical school, which is more than $49,000 a year in tuition and fees at N.Y.U., according to The New York Times. The money saved helps primary care physicians lessen their debt as they go to work in a lower paying field. This program is expected to attract more students to practice in fields such as pediatrics and internal medicine.
According to the Association of American Medical Colleges, the physician shortage is expected to reach 91,500 physicians by 2020. This program, as it grows, can help alleviate the shortage and bring more doctors to areas in need.


Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants.
The Health Law Firm and its attorneys represent medical school students in disputes with their medical schools, internship supervisors, and in dismissal hearings. We have represented residents, interns and fellows in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and on other matters.
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 a three-year medical school degree for doctors? Do you think the fourth year of medical school is necessary for primary care physicians? Please leave any thoughtful comments below.


Sources:
Hartcocollis, Anemona. “N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition.” The New York Times. (December 23, 2012). From: http://www.nytimes.com/2012/12/24/education/nyu-and-others-offer-shorter-courses-through-medical-school.html?pagewanted=all&_r=0
Krupa, Carolyne. “Med School on the Fast Track: A 3-Year Degree.” American Medical Association. (May 7, 2012). From: http://www.ama-assn.org/amednews/2012/05/07/prl20507.htm


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

"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.

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

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

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

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

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

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


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


Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, license complaints, administrative hearings, business and commercial litigation, and other types of investigations of health professionals and providers.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Sources:
Heisig, Eric. “Charges Filed Against Doctor in Body Parts Cases.” Pensacola News Journal. (September 9, 2012). From: http://www.pnj.com/apps/pbcs.dll/article?AID=2012309080010
Associated Press. “Ex-Medical Examiner Charged After Human Organs Found in Storage Unit.” Associated Press (September 8, 2012). From: http://articles.orlandosentinel.com/2012-09-08/news/os-human-organs-storage-unit-florida-20120908_1_human-organs-storage-unit-medical-examiner


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

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