U.S. District Court in Texas Orders Hospital to Void Report to National Practitioner Data Bank

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

On February 8, 2017, the U.S. District Court for the Eastern District of Texas, issued a Memorandum Opinion and Order directing Memorial Health System of East Texas (Memorial Health) to submit a Void Report to the National Practitioner Data Bank (NPDB). In the case Walker v. Memorial Health System, the court found the initial report, submitted after 30 days of an uncompleted proctoring requirement, to be improperly submitted because the Hospital had not specified that the proctoring take not less than 30 days.

Following a peer review process, Memorial Health ordered Dr. Walker to “have five bowel surgery cases proctored,” specifying no time limit. After a month, when the surgeon hadn’t met the five-case requirement, the hospital filed an adverse report with the NPDB. Dr. Walker filed suit and requested a preliminary injunction mandating that the Data Bank report be voided.

Was the Proctoring Requirement Reportable?

Memorial Health argued that because there is no private right of action under the Health Care Quality Improvement Act (HCQIA), the court was without authority to issue injunctive relief as to the Data Bank report. The court disagreed, finding “the premise that Dr. Walker is asserting a private right of action under HCQIA is not supported by the complaint.” Dr. Walker sought a preliminary injunction requiring the hospital to submit a retraction—a “Void Report”—to the Data Bank, on the grounds that his proctoring requirement wasn’t reportable.

The court ruled that because the duration of the proctoring was not specified, the action was not reportable. The proctoring requirements are reportable only if affirmatively imposed for more than 30 days. There is no such explicit requirement in the statute: section 11133(a)(1)(A) requires a report from an entity which “takes a professional review action that adversely affects the clinical privileges of a physician for a period longer than 30 days.”

Responding to Memorial Health’s argument that the injunction would cause it to violate NPDB rules requiring reporting after 30 days, the court disagreed, stating “It is the province of the federal courts – not the Hospital – to determine the requirements of HCQIA, a federal statute.” The court concluded that while the proctoring requirement was necessary, the Hospital could have easily drafted a sanction against Dr. Walker which required that proctoring “shall not be completed within less than 30 days.”

Although the order for injunctive relief is still pending the outcome of trial, the ruling raises issues of interest to lawyers working with hospitals and physicians about reportable proctoring requirements. To see the Memorandum Opinion and Order in full, click here.

Editor’s Comments.

This is certainly a precedential case of great interest to those of us who represent physicians, Nurse practitioners, dentists and other licensed health professionals who may get reported to the NPDB. Unless this case is appealed and reversed, it gives some hope to the many licensed health practitioners who find themselves wrongfully reported to the NPDB by a health institution. We have found this most frequently to have occurred with military physicians (Army, Navy, Air Force) and with Veterans Administration (VA) physicians who are given little or no due process of law before such reports are made.

For more information on the NPDB and how The Health Law Firm can help you, click here to visit our webpage.

Contact Experienced Health Law Attorneys.

The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. 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.

Sources:

Harrison, Robert. “Texas Court Orders Hospital to Void National Practitioner Data Bank Report.” AHLA. (February 8, 2017). Web.

Tabler Jr., Norman. “When 30 Days is not 30 Days.” Faegre Baker Daniels. (February 20, 2017). Web.

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

KeyWords: Hospital clinical privileges hearings, Medical staff fair hearings, Medical staff peer review, National Practitioner Data Bank (NPDB) reports, Medical Staff clinical privileges hearings, Appeal of National Practitioner Data Bank (NPDB) reports, Physician probation, Veterans Administration (VA) National Practitioner Data Bank (NPDB) reports, Military physician National Practitioner Data Bank (NPDB) reports, Army Physician National Practitioner Data Bank (NPDB) reports, Air Force Physician National Practitioner Data Bank (NPDB) reports, Navy Physician National Practitioner Data Bank (NPDB) reports, legal representation for medical professionals, health law defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Doctor Agrees To Split Fees In $785M Pfizer FCA Deal

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

On November 29, 2016, Dr. William LaCorte, M.D., a whistleblowing physician in Metairie, Louisiana, helped win a $785 million False Claims Act settlement with Pfizer, Inc., one of the World’s largest pharmaceutical companies.  Dr. LaCorte agreed with his former lawyers on a split of attorney’s fees, which resolves one of the several disputes about paying multiple attorneys.

An Agreement Was Reached.

U.S. District Senior Judge Douglas P. Woodlock signed off on the agreement between whistle blower Dr. LaCorte and the doctor’s attorneys at Boone & Stone and Vezina & Gattuso LLC, on November 29, 2016. This gives Dr. LaCorte 62 percent of the relator’s share and 38 percent to three law firms.

Lawsuit Was First Filed In 2002.

This lawsuit first started back in 2002 when whistle blower Dr. LaCorte filed a lawsuit against Wyeth, Inc. Wyeth had received millions of dollars from filing false-claims lawsuits against multiple health care companies in July 2014, or so it was alleged.

The lawsuit was first filed in 2002, before Pfizer had purchased Wyeth.  The case was consolidated with a lawsuit from another whistle blower, Lauren Kieff. The U.S. Department of Justice intervened in 2009. The dispute was recently settled in earlier 2016 without an admission of wrongdoing hy the pharmaceutical companies.

The DOJ said that the LaCorte and Kieff case focused on discounts that Wyeth offered to hospitals that purchased oral and intravenous versions of Protonix. Wyeth did not offer that same discounts to Medicaid, which violated the program’s “best price” provision requiring all suppliers to give the Medicaid Program the best price it gives to anyone else.

Dr. LaCorte, the qui tam plaintiff or “relator,” had alleged in his earlier lawsuit that Pfizer’s unit Wyeth, Inc., had overbilled Medicaid for Protonix, a heartburn medication.  Dr. LaCorte was offered a $64 million relator’s share, and the states offered him a $34 million relator’s share.

Boone & Stone and Vezina & Gattuso were looking to receive approximately 40 percent of the award, which is fairly standard in qui tam cases. They also wanted the award to be split equally between the two firms, as well as with the Sakla Law Firm.

Still Problems After The Settlement.

Even though a settlement was reached, it does not solve all of the disputes about the ten of millions of dollars that the attorneys will share as part of their contingency fee.  The Sakla Law Firm is currently disputing with Boone & Stone and Vezina & Gattuso about their own subdivision of the award. The dispute continues to play out in federal court.

The Sakla Firm, which routinely handles FCA cases argued in a different lawsuit that Boone & Stone and Vezina & Gattuso did not deserve any attorney’s fees because they did not do any of the “important” work. The Sakla Law Firm claims that it did 95 percent of the work in this case.

Disputes Over Legal Fees.

Dr. LaCorte has a separate dispute with Wyeth, Inc., about legal fees which he claims the company owes him from the FCA suit.  According to Dr. LaCorte, Wyeth owes him $7.7 million in legal fees, in addition to $300,000 in costs.  Judge Woodlock apparently indicated that the parties should mediate their dispute.

A spokeswoman for Pfizer, Neha Wadhwa, stated in an e-mail dated November 29, 2016, “Given the limited role relator LaCorte and his counsel played in bringing about the ultimate settlement in this mater, and the deficient records supporting the latter’s fee request, as Pfizer indicated in its court papers, Pfizer believes his request is excessive and should be reduced.”

In motion papers in June 2016, Dr. LaCorte’s attorneys had said that $7.7 million was a reasonable amount under the law for a complex contingency case that required a vast amount of expenses.

Attorney’s Fees Reasonable or Not?

Knowing what goes into a major qui tam case, given the extremely large recovery for the government, it seems that $7.7 million is imminently reasonable.  This case extended over a 14 year period and.  I’m sure, the attorneys and their staffs did a tremendous amount of work on it.  In fact, I would query whether or not a Lode Star multiplier might be in order given the recovery made.

Contact Experienced Health Law Attorneys.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case.  This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities.  However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties.  We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:
Elfin, Dana. “Wyeth to Pay $785M to End Medicaid False Claims Case.” Bloomberg BNA. (February 7, 2016). Web.

Loftus, Peter. “Pfizer to Pay $785 Million to Settle Medicaid Claims.” The Wall Street Journal (February 16, 2016). Web.

Amaral, Brain. “Whistleblower In $785M Pfizer FCA Deal Agrees To Fees Split.” Law360. (November 29, 2016).Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: False Claims Act (FCA), overbilling Medicaid, The Health Law Firm reviews, False Claims Settlement, Medicaid fraud defense attorney, reviews of The Health Law Firm, False Claims Act defense lawyer, qui tam attorney, Medicaid false billing,False Claims Act defense lawyer, FCA attorney, illegal kickbacks, DOJ settlement attorney, government health care fraud, health fraud and abuse allegations, health fraud attorney, FCA legal representation, relator attorney, FCA original source requirement, AKS safe harbor, FCA subject matter jurisdiction, FCA first to claim requirement, whistle blower defense attorney, Florida qui tam whistle blower attorney, Colorado qui tam whistle blower lawyer, Louisiana qui tam whistle blower attorney, Kentucky qui tam whistle blower lawyer, Virginia qui tam whistle blower attorney, District of Columbia (D.C.) qui tam whistle blower lawyer, Florida False Claims Act (FCA) and civil monetary penalties attorney, Colorado False Claims Act (FCA) and civil monetary penalties lawyer, Louisiana False Claims Act (FCA) and civil monetary penalties attorney, Kentucky False Claims Act (FCA) and civil monetary penalties lawyer, Virginia False Claims Act (FCA) and civil monetary penalties attorney, District of Columbia (D.C.) False Claims Act (FCA) and civil monetary penalties lawyer

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

Finding an Attorney/Lawyer Who Takes Healthcare Providers Service Organization (HPSO) Insurance for Assisted Living Facility (ALF) Owners

PS 3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

We often hear from callers and clients in professional licensing complaints, Department of Health investigations and the Agency for Health Care Administration (AHCA), that they had good insurance coverage with Healthcare Providers Service Organization (HPSO) Insurance, but could not find an attorney that would accept it. Often these professionals retain us after action has been taken to appeal or attempt to reverse an adverse disciplinary action taken against their license.

This should not be a difficult task. Our firm and its attorneys have accepted HPSO Insurance for over 25 years.

Our firm has attorneys that are licensed in and can defend ALFs and owners in Florida, Colorado, Louisiana, Virginia and the District of Columbia. Additionally, there are many states, such as Tennessee, Georgia, Oregon, Pennsylvania, New York, Delaware, and others, which allow us to appear before their boards and represent clients in these state under their “multi-jurisdictional practice” rules, because this is an area in which we routinely practice.

Legal areas in which we can represent an HPSO insured that HPSO will pay for include: administrative hearings, complaints against a professional license, an investigation of a complaint made against your professional license, a deposition you may be subpoenaed for, a complaint made for violation of HIPAA or patient privacy, and many others.

Regardless of the state, contact us at:

The Health Law Firm, Main Office
1101 Douglas Ave.
ALtamonte Springs, FL 32714
Phone: (407) 331-6620
Fax: (407) 331-3030
Website: http://www.TheHealthLawFirm.com
Internet Contact: http://www.TheHealthLawFirm.com/contact-us/

One last word, regardless of whether you are covered by HPSO Insurance or not, if an investigator contacts you to obtain a statement from you, whether orally or in writing, always, always, always, consult with an experienced attorney in this area BEFORE giving any statement or talking to the investigator about anything.

Contact Health Law Attorneys Experienced in Assisted Living Facility Cases.

The Health Law Firm and its attorneys represent assisted living facilities (ALFs) and ALF employees in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

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

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Assisted Living Facilities (ALFs), legal representation for ALF owners, Agency for Health Care Administration (AHCA) investigation defense attorney, ALF defense attorney, legal counsel for AHCA investigations and hearings, health care professional defense attorney, legal representation for medical professionals, Florida HPSO health law attorneys, legal representation for cases dealing with HPSO insurance, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida health law attorney, legal representation for administrative hearings, legal representation for complaints against a professional license, licensure defense attorney, legal representation for a complaint made for violation of HIPAA or patient privacy, legal representation for Assisted Living Facilities (ALFs) and owners in Florida, legal representation for Assisted Living Facilities (ALFs) and owners in Colorado, legal representation for Assisted Living Facilities (ALFs) and owners in Louisiana, legal representation for Assisted Living Facilities (ALFs) and owners in Virginia and legal representation for Assisted Living Facilities (ALFs) and owners in the District of Columbia

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved

Texas Appeals Court Affirms$1.37 Million in Sanctions Against Doctor who Sued Hospital Former Employers

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 16, 2016, an appeals court in Texas affirmed a $1.37 million sanction against a doctor. The physician was ordered to pay the fine after the dismissal of a defamation lawsuit he filed against his former employers. The decision affirmed that the actions of his former employers, Baylor College of Medicine (Baylor) and Texas Children’s Hospital, did not cause the litigation fees which the court assessed to the doctor as sanctions.

The case had previously made its way up to the Texas Supreme Court, which makes the November 16, 2016, opinion the second time the Texas Fourteenth Court of Appeals has weighed in on the case. Additionally, it is the second time it has held the sanctions were merited for Dr. Rahul K. Nath.

The Back Story of the Case.

According to the opinion, Dr. Nath was employed by Baylor as a plastic surgeon and was affiliated with Texas Children’s Hospital. He was fired in 2004 and in February 2006 filed a lawsuit against his former supervisor at Baylor and Texas Children’s. According to court documents, Dr. Nath had accused his former supervisor of making defamatory statements about him after he stopped working. The alleged defamatory statements included that Dr. Nath had been fired, was unqualified and lacked professional ethics and integrity. (Note: We are just stating what was alleged in the lawsuit.)

To read the opinion in full, click here.

Were the Former Employers Responsible for the Accumulated Attorney and Litigation Fees?

The court was considering whether the behavior of Baylor or Texas Children’s was ultimately responsible for the fees accumulated litigation fees and expenses in the case. Previously, the trial court found that both Texas Children’s and Baylor’s actions had not caused the expenses for which Dr. Nath was sanctioned. The trial court wrote that the amount was appropriate as it was “far less” than the actual fees incurred by either party in defending Dr. Nath’s claims.

On appeal, Dr. Nath argued that the trial court hadn’t held a proper evidentiary inquiry, that it had based its sanctions award on “conclusory and self-serving” affidavits. Dr. Nath claimed that he was wrongly denied discovery in the case. To learn more about Dr. Nath’s challenge, click here.

Despite Dr. Nath’s arguments, the Fourteenth Court disagreed, holding that the trial court followed the exact instructions from the Supreme Court before deciding to impose the sanctions. Additionally, the court found that there was evidence in the record to support the conclusion that neither Texas Children’s nor Baylor’s conduct caused the expenses that were passed on to Dr. Nath as sanctions.

Adequate Supporting Evidence.

The first time the case came before the Fourteenth Court of Appeals, it affirmed the sanctions against Dr. Nath. The high court held that there was evidence to support the trial court’s finding of bad faith and improper purpose on Dr. Nath’s part with regard to certain filings in the case.

Dr. Nath appealed, and the Texas Supreme Court held that the trial court didn’t abuse its discretion in finding the doctor had exercised bad faith and improper purpose in certain filings. The high court remanded it back to the trial court to consider to what extent, if any, Texas Children’s and Baylor’s actions may have “caused the expenses for which recovery is sought.”

After a hearing, the trial court determined that neither employer’s behavior caused the expenses, and again imposed the sanctions against Nath. In appealing that ruling to the Fourteenth Court of Appeals, Dr. Nath argued that the trial court had made procedural errors in hearings and evidence submission in reaffirming the sanctions.

The trial court granted Texas Children’s and Baylor’s motions in June 2010, and also sanctioned Dr. Nath $726,000 for a portion of Texas Children’s fees in defending the suit and $644,500 for a portion of Baylor’s. The Fourteenth Court of Appeals affirmed that ruling, and Dr. Nath appealed to the state Supreme Court.
To learn more about defamatory statements and how to handle such claims, click here to read one of my prior blogs.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, 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.

Sources:

Knaub, Kelly. “Texas Appeals Court Affirms Doc’s $1.3M Sanction.” Law360. (November 16, 2016). Web.

Knaub, Kelly. “Doc To Challenge $1.3M Sanction Before Texas High Court.” Law360. (January 15, 2014). Web.

“Texas Appeals Court Affirms Doc’s $1.3M Sanction.” LexisNexis. (November 16, 2016). Web.

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

KeyWords: Legal representation for health care professionals, health law defense attorney, legal representation for defamatory statements against health care professionals, legal representation for defamation lawsuit against a healthcare professional, healthcare litigation defense attorney, legal counsel for health care professionals, Legal representation for clients involved in the health care industry, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Owner of Louisiana Health Care Company To Pay Nearly $7 Million for Medicaid Fraud

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

On December 20, 2016, the owner of Louisiana-based Millennium Health Care Services (Millennium) must pay the state nearly $7 million in restitution and will spend 10 years behind bars for his role in a scheme to defraud the Medicaid system, according to Louisiana Attorney General Jeff Landry.

Millennium’s owner, Dwaine Woods, was ordered to pay $6,985,249 in restitution after his wife and the company were all found guilty of engaging in a criminal conspiracy to create multiple fake CPR cards for Millennium staff. The staff did not undergo training to be properly certified in CPR, Landry said.

The Dangerous Scheme.

Millennium operated from 2004 to 2010 and was solely funded by the government program Medicaid. According to Landry, the fake CPR card scheme was not only illegal but also extremely dangerous. “Instead of service workers learning necessary skills, they were fraudulently getting certifications without any training — greatly jeopardizing the health and safety of patients.”

Millennium was convicted of 19 counts of forgery, one count of theft by fraud, and one count of conspiracy to commit forgery. In addition to the restitution payment, the company was also ordered to pay $17,500 in fines.

Dynetta Woods was also convicted of 19 counts of forgery and one count of conspiracy to commit forgery. She was reportedly sentenced to five years of supervised probation and ordered to pay $54,730 in restitution and $5,000 in fines. Additionally, she is forever barred from doing business with the state of Louisiana, according to Landry. Dwaine Woods was convicted of theft by fraud.

To learn about a similar case of Medicaid fraud and the repercussions, click here to read one of my prior blogs.

Never Falsify Any Documents if You Are a Medicare or Medicaid Provider.

We have represented a number of owners of Medicare and Medicaid providers that were investigated, charged and convicted of fraud because they had falsified, forged, created or changed documents that were in their employees’ files. These have included items so simple as the expiration date on a CPR card, but have also included forging diplomas and other qualifying credentials. State Medicaid programs and the Medicare Program takes such matters very seriously. Often prison time will result for the owners of the company.

This can also be the basis for large recoveries under federal and state whistle blower (false claims act) laws. Submission of a false statement or false document to a federal official is a felony. Employees of Medicare and Medicaid providers who are aware that their employers have falsified documents can blow the whistle on them and collect large rewards under one of the applicable false claims acts (whistle blower laws).

Fraud Investigations Are a Very Serious Matter.

We have been consulted by many individuals similar to the subject of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required to retain the services of an experienced attorney to help defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.
Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

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

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

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

Sources:

Kennedy, John. “La. Medicaid Fraudster Will Pay Nearly $7M In Restitution.” Law360. (December 20, 2016). Web.

Gyan, Joe. “Prairieville couple sentenced in $7 million Medicaid fraud scheme.” The Advocate. (December 20, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Medicaid fraud defense attorney, Medicaid investigation defense attorney, legal representation for conspiracy to commit Medicaid fraud, legal counsel for Medicaid audits, legal representation for Medicaid audits, health care fraud defense attorney, legal representation for Medicaid fraud, health care fraud investigation defense lawyer, legal representation for conspiracy for defraud the government, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida Medicaid Fraud defense attorney, Colorado Medicaid Fraud defense attorney, Louisiana Medicaid Fraud defense attorney, Kentucky Medicaid Fraud defense attorney, Virginia Medicaid Fraud defense attorney, District of Columbia (D.C.) Medicaid Fraud defense attorney, legal representation for whistleblower suits, whistleblower defense attorney, legal counsel for whistleblower, legal represenation for qui tam cases, qui tam defense attorney, legal representation for qui tam/whistblower investigations

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2017 The Health Law Firm. All rights reserved

CMS Issues Final Rule to Revise Home Health Conditions of Participation

mlb-headshot-resizedBy Michelle Bedoya, J.D., The Health Law Firm

On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in the Medicare and Medicaid. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards and eliminate unnecessary procedural requirements. The provisions of this rule will go into effect on July 13, 2017.
Patient Centered Process.

CMS’ focus on a patient-centered process is notably reflected by a restructuring of Part 484 into two parts: (1) home health patient care, and (2) HHA organization and administration. The restructured new Part 484 offers expanded patients’ rights to participate in and to set goals toward care and treatment, through new and revised rules, covering admission to discharge or transfer.

The new Patient Rights Notice (PRN) under Part 484, includes patients’ right to actively participate in their initial and follow-up assessments, to develop and update their plan of care (POC) and discharge and transfer plans. Patients may also participate in deciding care preferences as well as expected outcome and measurable goals.

Under the provisions, in order to expand patient access to the PRN, an HHA must provide the PRN to patients and their representatives. It must be laid out in a writing, in a language and manner that is clearly understood. For patients and their legal representatives, the writing must further be understandable to persons who have limited English proficiency and accessible to individuals with disabilities. For patients, this means accessible websites and auxiliary aids and language services at no cost to them. Further, an HHA must provide verbal explanation of the PRN to the patient, in the patient’s primary or preferred language and in a manner the patient understands, free of charge, using an interpreter if necessary.

According to CMS, a more comprehensive understanding of patients’ status will increase the likelihood of achieving their desired outcomes. Therefore, the POC requirements have been expanded to more accurately explain the patient’s status.

Data-Driven Solutions.

To focus on data-driven solutions, CMS implemented evidence-based health care solutions by the use of the Quality Assessment and Performance Improvement (QAPI) program. The QAPI program must further measure, analyze, and track quality indicators to assess the HHA’s care processes, services, and operations. The program may use OASIS data, measurement and tools, or other relevant sources.

Outcome-Oriented Results.

According to CMS, the restructuring will better implement home health care coordination and achieve outcome-oriented results. These changes to Part 484 are part of the CMS’s overall effort to achieve broad-based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers.

To read the final rule issued by CMS, click here.

To learn more about HHAs and compliance, click here to read one of our prior blogs.

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

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Sources:

Baxter, Amy. “CMS Issues Final Rule to Modernize Home Health Conditions of Participation.” Home Health Care News. (February 24, 2017).

Lipschitz, Benjamin. “Revised Conditions of Participation for Home Health Agencies.” AHLA. (February 24, 2017). Web.


About the Author:
Michelle L. Bedoya 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.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

Wisconsin Supermarket Violated FCA With Illegal Kickbacks, Pharmacist Claims

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 20, 2016, a pharmacist and whistle blower told an Illinois federal court that Wisconsin and Chicago-area chain of grocery stores, Roundy’s Supermarket, Inc. (Roundy’s), knew gift cards it was providing Medicare and Medicaid beneficiaries were actually illegal kickbacks. In defense of his False Claims Act (FCA) Suit, the whistle blower claims the chain proceeded to hand them out anyway despite knowing they were illegal.

The Whistle Blower and the Alleged Scheme.

The whistle blower in the suit, pharmacist Jefferey Kotwica, alleged the company was involved in illegal kickbacks, thus allegedly defrauding government health care programs, by offering gift cards to pharmacy customers that exceeded legal limits. Roundy’s enacted a Script Saver Program that gave all customers “pharmacy club coupons” for pharmacy purchases. When they reached five of those coupons, they could be redeemed for a $10 gift card, the complaint states. At some stores, the number of coupons necessary for a gift card was lowered to three, Kotwica said.

Roundy’s has mounted a defense to these allegations. Despite that defense, the whistle blower maintains the gift cards were more than the legal nominal value allowed. The whistle blower claimed additionally that the “retailer reward exception” failed because the gift cards were tied to the services the government health care programs reimbursed and were meant to induce customers to transfer prescriptions to the store.

The pharmacist and whistle blower in the case, claimed that he heard corporate executives discussing having Medicare and Medicaid recipients excluded from the program because they were concerned their inclusion was illegal, but never acted on that concern. Therefore, Kotwica said that this shows that Roundy’s had the intent to violate the FCA. The whistle blower also claimed that the company retaliated against him for speaking out to the point where he resigned his position as a pharmacist with it.

The case was originally filed in June 2015. Like all federal False Claims Act (FCA) cases, it remained sealed until ordered unsealed by the court. It was unsealed in July 2016 after the U.S., and the states of Illinois, Minnesota and Wisconsin declined to intervene in the case. Click here to read the response in this case.

Fighting Government Fraud and Abuse.

This case was brought under the federal False Claims Act (FCA) or federal “whistle blower law.” This law contains standards for both civil and criminal penalties against those filing false claims for services paid for by the government. False Claims Act cases, such as this recent one, are typically filed in a qui tam (or whistle blower) proceeding. This type of action involves a private party filing a lawsuit on behalf of the government against a defendant who allegedly defrauded the government. The “whistle blower” receives a percentage of the money recovered by the government (if any), through any judgment or settlement of the case. Often the amounts awarded to the whistle blower are in the millions of dollars. Whistle blowers are often protected from receiving any potential civil liability or prosecution for their involvement in the matter.

Our firm has been on both sides of both federal and state whistle blower or qui tam cases. We have represented nurses, physicians, pharmacists and other health professionals in bringing such cases. We have also defended physicians, health care providers, medical groups and health facilities in such cases.

We have also represented relators or plaintiffs bringing such actions to recover money on behalf of the government. A qui tam relator can receive up to 30% of the amount recovered on behalf of the government. This means, for example, that of a defendant settles with the government paying back $5 million, the relator or whistle blower can receive up to $1.5 million, plus his attorney’s fees and costs. Usually, the biggest obstacle to bringing any such case is being able to show an actual false claim that was filed.

If you have information concerning health care fraud by overbilling federal health care programs such as Medicare or Medicaid, do not hesitate to take action. The government urges health care providers to step forward and report illegal and fraudulent activities as soon as they are uncovered. The False Claims Act provides a system of rewards that encourages whistle blowers to bring these issues to the government’s attention.

Contact Health Law Attorneys Experienced with Health Care Fraud and Qui Tam or Whistleblower Cases.

The Health Law Firm’s attorneys routinely represent physicians, nurses, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in bringing or defending against False Claims Act, whistle blower or qui tam cases. We also defend health care providers in Medicare and Medicaid investigations, audits and recovery actions. We represent plaintiffs and defendants in complex health care litigation in state or federal courts.

Attorneys with The Health Law Firm also represent health care professionals and others who may desire to file a qui tam, False Claims Act or whistle blower suit. We work with physicians, nurses and other professionals to investigate, document and file such cases. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding and other services that assist us in such matters. We have represented number of doctors and other licensed health professionals as relators in bringing qui tam or whistle blower cases. Our attorneys are also available to defend physicians, medical groups and health care providers in qui tam or whistle blower cases.

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

Sources:

Kass, Dani. “Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Law360. (December 20, 2016). Web.

“Wis. Supermarket Should Face FCA Suit, Pharmacist Says.” Make Me Feed. (December 21, 2016). Web.

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

KeyWords: False Claims Act (FCA) defense attorney, whistle blower defense attorney, qui tam defense attorney, legal representation for FCA claims, legal representation for qui tam cases, legal representation for whistle blower defense cases, Medicare and Medicaid fraud defense attorney, legal representation for Medicare and Medicaid fraud, legal representation for illegal kickback schemes, health care fraud defense lawyer, health care fraud scheme, legal representation for Medicare and Medicaid fraud investigation, Florida FCA defense attorney, Colorado FCA defense attorney, Kentucky FCA defense attorney, Louisiana FCA defense attorney, District of Columbia FCA defense attorney, Virginia FCA defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, complex health care litigation attorney, legal defense of complex health care business disputes, complex litigation defense counsel

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.