Extensive Bribery Scheme At Dallas’ Forest Park Medical Center, 21 Charged

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

Founders and investors of a physician-owned health care facility in Dallas, Texas, known as the Forest Park Medical Center, were charged in a bribery and kickback scheme on December 1, 2016. The range of felony offenses stem from their payment or receipt of roughly $40 million in bribes and kickbacks for referring patients to Forest Park Medical Center (FPMC), according to a federal indictment in Texas federal court.

21 Took Part In Conspiracy Scheme.

The indictment was returned by a federal grand jury in November 2016, identifying 21 defendants including executives, physicians, surgeons and other individuals associated with FPMC who allegedly took part in a bribery scheme that cheated federally funded health care programs and other insurance plans for their personal financial gain.

The defendants named included, Forest Park co-founder of FPCM, CEO Alan Andrew Beauchamp, anesthesiologist and president of its board of directors Richard Ferdinand Toussaint, Jr., surgeon and board of directors member Wade Neal Baker, and Forest Park managing partner and investor Wilton McPherson Burt. However, there were many others involved in addition to these few.  It must be remembered that those named have been charged but have not been convicted in a court of law.  Often in this type of case, a defendant is acquitted or dismissed.

FPMC was an out-of-network hospital.  According to the indictment, the patients that were referred there were primarily ones with high reimbursing out-of-network private insurance benefits or benefits under certain federally-funded programs.  FPMC’s owners, managers, and employees also tried  to sell patients with lower reimbursing insurance coverage, namely Medicare and Medicaid beneficiaries, to other facilities in exchange for cash.

According to a press release from the U.S. Department of Justice, because FPMC is an out-of network hospital, it is free to set its own prices, resulting in a higher reimbursement rate than in-network providers.

Park Over Billed Patient’s Insurance Companies.

The indictment alleges that Forest Park billed patients’ insurance plans more than half a billion dollars and collected around $200 million in paid claims from 2009 to 2013 as a result of the bribes and kickbacks.

According to the DOJ, several co-defendants operated shell entities where the defendants funneled bribes and kickbacks payments though to surgeons in exchange for referrals.

“Medical providers who enrich themselves through bribes and kickbacks are not only perverting our critical health care systems, but they are committing a serious crime. Massive, multifaceted schemes such as this one, built on illegal financial relationships, drive up the cost of health care for everyone and must be stopped,” said U.S. Attorney John Parker of Texas’ Northern District in a statement.

FPCM Investors Referred Patients In Return For Kickbacks.

According to the indictment, primary care physicians who were investors in the facility and referred patients to FPCM for surgery and other specialized treatments received kickbacks ranging anywhere from $100,000 to $7 million. Those enriched funds where used to market their own personal medical practices or for personal goods and expenses.

There were several government health care programs that were affected by the alleged bribery scheme such as Tricare, The U.S Department of Labor’s FECA health care program, who was  billed $25 million; the U.S. Department of Defense’s health care program, who was billed over $10 million; and federal and retirees FEHBP health care program, who was billed over $60 million.

Each of the defendants have been charges with one count of conspiracy to pay and receive health care bribes and kickbacks. This gives the defendants a chance to be sentenced to five years in prison and a $250,00 fine.

Others involved in the scheme have been charged with violating the federal Travel Act and aiding and abetting a conspiracy to commit money laundering.

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 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 http://www.TheHealthLawFirm.com.

Sources:
Lee, Suevon. “21 At Texas Med. Center Charged In Massive Bribery Scheme.” Law360. (December 1, 2016). Web.

Krause, Kevin. “Doctor-owners, Execs of Bankrupt Forest Park Hospital Chain Indicted In Massive Kick-back Scheme.” Dallas News. (December 2, 2016). Web.

“Executives, Surgeons, Physicians and Others Affiliated with Forest Park Medical Center (FPMC) in Dallas Indicted in Massive Conspiracy.” United Stated Department of Justices. (December 2, 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: The Health Law Firm reviews, health care fraud audit. Medicare audit defense attorney, reviews of The Health Law Firm, health care fraud scheme, Medicare fraud defense lawyer, health law criminal defense attorney, Medicaid audit defense attorney, health law, health law criminal representation, Forest Park Medical Center (FPMC), Medicaid fraud defense attorney, Tricare, U.S. Department of Defense, health care programs, U.S. Department of Labor, The Health Law firm, conspritator in health care fraud scheme, Florida physician defense attorney, Colorado physician defense lawyer, Kentucky doctor defense legal counsel, Louisiana physician defense attorney, District of Columbia (D.C.) doctor defense 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.

Hospital Negligence Suit Dismissed by Florida High Court

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

On November 30, 2016, The Florida Supreme Court announced the decision to drop a negligence suit filed against a hospital over the death of patient Ashley Lawson.  Lawson was able to escaped from Shands Teaching Hospital and Clinic, Inc.  The Shands psychiatric hospital is located in Gainesville, Florida and is now known as the UF Health Shands Psychiatric Hospital.

The major legal issue in this case was whether the conduct of the hospital was ordinary negligence or was medical negligence (medical malpractice).  In Florida, if the facts alleged constitute a claim for simple negligence, then there are no pre-suit proceedings required, no medical expert witnesses required, and it is usually much easier and much less expensive to try the case.  However, if the facts stated in the suit are medical negligence allegations, then there are a number of procedural hurdles that a plaintiff must overcome.  Additionally, the case is usually much more expensive and time consuming to try.

Patient Was Mentally Ill.

Ashley Lawson was admitted to the hospital on November 1, 2012, because of a psychiatric illness, impulsive behavior, drug abuse and several suicide attempts, according to reports.  According to her estate’s initial jurisdictional brief, Lawson was transferred to the locked impatient unit at Shands for her own safety.

Lawson Allegedly Freed Herself.

According to reports, an employee’s badge and keys were left unattended, which gave Lawson the opportunity to free herself and escape on January 23, 2013.  Lawson died soon after she had escaped.  She was struck and killed by a tractor trailer on Interstate 75.

A Request To Reconsider The Ruling.

On November 15, 2016, the Florida Supreme Court abandoned its denial of a motion from defendant-appellee Shands Teaching Hospital and Clinics, Inc. asking it to reconsider its ruling from September 13, 2016.  The earlier ruling denied a motion for voluntary dismissal filed by the plaintiff, the Estate of Ashley Lawson.  The court’s earlier denials had decided not to dismiss the case by a 4 to 3 split decision, with Chief of Justice Jorge Labarga and Justices Barbara J. Pariente, James F.C. Perry and R. Fred Lewis in the majority and Justices Ricky Polston, Charles Canady and Peggy Quince dissenting.

Since the ruling on November 15, 2016, Lawson’s estate had relinquished its right to file a brief on the merits, noting that the parties are “contractually prohibited from further litigation in this matter.”  This language seems to indicate that a settlement had been reached between the parties.  Shands Hospital filed a motion on November 27, 2016, looking for instructions on its due process rights and its counsel’s duty to proceed.  Shands stated:  “Respondent believes it should be entitled to submit a merits brief to this court and present oral argument since, as this court has made apparent through its orders, it views this case as involving an important issue of statewide impact.”

Where Do You Draw The Line?

This case in particular has raised questions on where the line should be drawn between medical negligence and ordinary negligence.  However, in the motion for reconsideration, Shands Hospital stated that there was no certification of a question of great public importance or a certified district conflict made in the lower court’s decision in the case.

Shands Hospital’s motion to dismiss the case had been denied by the trial court.  Shands then appealed the Florida First District Court of Appeal. The three-judge panel on the Court of Appeal was unable to come up with a definitive result, so the entire Court of Appeal decided to review the case and final reached a 8-6 decision to trump the lower court’s denial.

After that, Lawson’s estate brought the case to the Florida Supreme Court, seeking reversal based on its argument that the First District Court of Appeal’s decision allegedly conflicted with two Fifth District Court of Appeal decisions on what constitutes ordinary negligence verus medical malpractice (medical negligence).  The estate asked for an extension to file its initial merits brief, stating that the parties were discussing a settlement. On July 28, 2016, the estate filed a notice for voluntary dismissal because a deal was in place.

The Supreme Court took the position that the settlement notwithstanding, the Supreme Court should move forward with the case.  Court’s will often do this when they expect that the legal question will come up again and again in the future, unless they go ahead and decide it.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. 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.  We represent medical students, interns, residents, and fellows in disputes with their graduate medical education (GME) programs.  We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters and other disputes with their employers.  We often act as the physician’s personal counsel in medical malpractice litigation.

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:
“Shands Teaching Hospital and Clinic Inc. v. Estate of Ashley Lawson.” FindLaw. (August 28, 2015). Web.

Hale, Nathan. “In Shift, Fla. High Court Drops Hospital Negligence Suit.” Law360. (November 30, 2016). Web.

“Justice Won’t Drop Case In Shands Vista Patients Death.” The Gainesville Sun. (September 16, 2016). Web.

“Court Sides With Hospital In Death of Escaped Patient.” Health News Florida. (August 31, 2015). 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:  Reviews of The Health Law Firm, health care lawyer, legal representation for mental health professionals, The Health Law Firm reviews, health law attorney, legal representation for health care professionals, medical malpractice defense lawyer, health care provider defense attorney, The Health Law Firm, mental health counselor defense attorney, psychologist defense attorney, physician defense lawyer, mental health professional defense attorney, board of mental health counselors defense lawyer, board of psychology defense attorney, health law, complex mental health litigation attorney, psychiatrist defense counsel, Florida physician defense attorney,
Colorado physician defense lawyer, Virginia doctor’s defense attorney, Louisiana physician defense legal counsel, Kentucky doctor’s defense lawyer, District of Columbia (D.C.) physician defense attorney

“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.

Appeals Court Affirms $1.37 Million in Sanctions Against Doctor for Dismissed Defamation Suit Against Former Employers

7 Indest-2008-4By 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 assessed against a doctor. The doctor was ordered to pay the sanction after the dismissal of a defamation lawsuit he filed against his former employers. The doctor’s former employers were Baylor College of Medicine (Baylor) and Texas Children’s Hospital.

The case had previously been appealed to the Texas Supreme Court. This makes the November 16, 2016, opinion the second time the Texas Fourteenth Court of Appeals has had to rule on the case. Additionally, it is the second time that it has held that the sanctions against Dr. Rahul K. Nath were justified.

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 allegedly terminated in 2004. In February 2006 he 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 there. The alleged defamatory statements included that Dr. Nath had been fired, was unqualified and lacked professional ethics and integrity.

To read the court opinion, click here.

Was the Former Employer Responsible for Accumulated Fees?

The Texas high court was considering whether the behavior of Baylor or Texas Children’s was ultimately responsible for the attorney’s fees that had been accrued in the case. Previously, the trial court found that both Texas Children’s and Baylor’s actions had not caused the litigation expenses which Dr. Nath was assessed. 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 and 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 legal challenge, click here.

Despite Dr. Nath’s arguments, the court of appeals disagreed, holding that the trial court followed the Supreme Court’s instructions in 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 legal 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.

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 physicians, pharmacists, dentists, nurses, medical groups, health facilities, nurses and other health providers in complex litigation, 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 physicians, complex health care litigation attorney, business litigation lawyer, health care professionals legal representation, physician lawyer, 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, legal fees expert witness, attorney’s fees and sanctions expert witness, health care litigation expert witness, health law expert witness
“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.

Forest Labs Agree to Pay $38 Million Settlement to End Whistle Blower’s FCA Suit

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 15, 2016, Forest Laboratories agreed to pay $38 million to resolve a whistle blower’s False Claims Act (FCA) suit involving allegations that it paid kickbacks to doctors who prescribed three of the company’s drugs, the U.S. Department of Justice (DOJ) announced.

The lawsuit contends that Pharmaceuticals Inc. (Forest), targeted physicians who had a high prescription writing potential and large Medicare and Medicaid patient populations. They also allegedly paid those physicians to attend lavish speaking events where the company had the opportunity to give incentives to health care providers to prescribe their products.

The Settlement.

The new deal settles claims that the New York City-based company and its subsidiary, provided money and meals to certain doctors in connection with programs about the drugs Bystolic, Savella and Namenda. According to the DOJ, the scheme took place between the start of 2008 and the end of 2011. Bystolic is a “beta blocker” that’s often used to treat high blood pressure, Savella is used to treat fibromyalgia and Namenda is used to treat dementia.
“Quality and patient safety must be the driving factors in the medical decision making process,” Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services’ Office of Inspector General, said in a statement. “Attempting to sway physicians to deviate from those core values with illegal inducements, as alleged in this lawsuit, debilitates their unbiased medical judgment at the expense of patients and taxpayers.”

The Speaker Programs.

The kickback scheme involved speaker programs in which Forest utilized as ways to persuade doctors to prescribe the three drugs. Forest provided payments and food even when the events were canceled, when no licensed health care professionals attended the programs, when the same people attended multiple programs within a short period of time and when the associated meals cost more than Forest generally allowed, the government said.

“Kickback schemes undermine the integrity of medical decisions and increase the costs of health care for everyone,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a statement. “Such schemes are particularly of concern when they are designed to influence drug prescriptions, and the Department of Justice will vigorously pursue companies that subvert the law at the public’s expense.”

Of the $38 million that the government was able to recover, state Medicaid programs will get about $2.5 million and the whistle blower in the case is set to receive almost $8 million.
To read about a similar case of kickback schemes involving pharmaceutical companies, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Qui Tam or Whistle blower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistle blower cases both in defending such claims and in bringing such claims. 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 whistleblower cases, as well.

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. “$38M FCA Payout Ends Kickback Suit Against Forest Labs.” Law360. (December 15, 2016). Web.

Tycko & Zavareei LLP. “Forest Laboratories and Forest Pharmaceuticals Inc. Settle Lawsuit Alleging Companies Engaged in Physician Kickback Scheme; Agree to Pay $38 Million.” The National Law Review. (December 19, 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, legal representation for FCA suit, legal representation for submitting false claims to the government, whistle blower defense attorney, qui tam defense attorney, legal representation against whistle blower claims, legal representation for qui tam suits, legal representation for kickback scheme, alleged kickback scheme defense attorney, AKS defense lawyer, Medicare and Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud, legal representation for U.S. Department of Justice investigations, DOJ investigation 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 © 2016 The Health Law Firm. All rights reserved.

This Is One Thing You Absolutely Want to Check up On: Medicare Administrative Contractor and Other Contractors Continue to Penalize Medicare Providers Who Do Not Have Correct, Current Address Information on File.

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

We continue to receive calls from physicians and other Medicare providers who have had their Medicare billing privileges revoked or terminated because their address information is not up to date or is incomplete.  It is a must that you include a physical address at which your business operates so that if the Medicare Administrative Contractor (MAC), the Recovery Audit Contractor (RAC), or the Zone Program Integrity Contractor (ZPIC) attempts a site visit, they can find you and complete the site visit.  Leaving out a suite number, having the incorrect city or suite listed, having a locked entranceway or gate so that the auditors cannot get in, have all lead to revocation of Medicare billing privileges.  This can have devastating results to the business.

Frequently the physician or other Medicare Provider has recently relocated and the record has not been updated yet.  Other times, a post office box or other address is used instead of an actual physical address.  Often moving from one hospital to a different hospital leaves your information listed incorrectly.  Sometimes the street address is not complete or is incorrect.  Sometimes it is just a matter of a typographical error being made by whoever enters your addresses.

Just having a letter returned to the contractor because of an incorrect address can initiate this action.  You will be held individually responsible, regardless of this, even if you use an independent contractor or someone else to make your Medicare filings and keep them up to date.

The basis for the revocation is 42 CFR424.535(a)(5) and 424.535(a)(9) Medicare Provider is considered to be non-operational at the practice location on record with the Centers for Medicare and Medicaid Services (CMS).

You can easily check your own information to be sure it is correct, and you should do so.  Your addresses should be located online in the Provider Enrollment, Chain and Ownership System (PECOS). You can visit the website by clicking here.

For more information,  click here.

You can also check online at the National Plan and Provider Enumeration System (NPPES) by clicking here.

Do this now!

If you receive a letter or any other indication that your Medicare billing privileges have been revoked or terminated, you must act immediately.  Contact an experienced health lawyer to assist you immediately.  Don’t wait, you will regret it if you do.

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.

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: termination of Medicare billing privileges, Medicare Administrative Contractor (MAC), Centers for Medicare and Medicaid Services (CMS), Zone Program Integrity Contractor (ZPIC), Recovery Audit Contractor (RAC), reviews of The Health Law Firm, Medicare Providers, ZPIC defense attorney, Medicare billing privileges, health law, revocation of Medicare billing privileges, ZPIC audit, Medicare defense attorney, legal representation for health care providers, Medicaid defense lawyer, Medicare audit, health law firm, Medicaid audit, The Health Law Firm reviews, Medicare billing privileges revoked, 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 © 2016 The Health Law Firm. All rights reserved.

Arizona Appeals Court Affirms Dentist’s Suspension Over Questionable Prescriptions

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 13, 2016, an Arizona appeals court affirmed the suspension of a dentist who allegedly had a history of opioid addiction and who also allegedly wrote dozens of questionable prescriptions. The Arizona appeals court held that the state dental board didn’t violate his due process rights and had substantial evidence backing its decision that it wasn’t safe for him to practice.

The Arizona Court of Appeals, Division One, concluded that the Arizona State Board of Dental Examiners had acted within its authority by suspending Dr. Michael Wassef’s license to practice dentistry in the state. This was following Dr. Wassef’s refusal to submit to the dental board’s requests after it discovered evidence suggesting he had relapsed. The appeals court decision upheld a lower court’s decision affirming the dental board’s order.

History of Opioid Abuse?

Dr. Wassef’s possible relapse into opioid addiction reportedly first came to the attention of authorities in March 2014. This allegedly occurred when a pharmacist contacted the dental board to raise concerns about Dr. Wassef’s prescription-writing practices, according to the court’s decision. The board discovered that he had received prescriptions for controlled substances in increasing amounts over a six-year time period. Additionally, Dr. Wassef allegedly wrote 44 prescriptions in two years for the muscle relaxant Soma for his wife, his assistant and his assistant’s daughter, the opinion said.

After he tested positive for Soma and another medication, Dr. Wassef refused to submit to an assessment. As a result, the dental board issued an interim order that he obtain an inpatient substance-abuse evaluation, according to the opinion. He refused, and the dental board suspended his license in April 2014.

Arizona State Court Sides With Board.

Dr. Wassef contended that the board denied him due process by suspending his license without allowing him the opportunity to defend himself. Despite Wassef’s claims, the appeals court wasn’t swayed, explaining that the board didn’t have to give him a hearing before entering the interim order and can summarily suspend a licensee when it concludes.

The state board had more than enough evidence to conclude that Dr. Wassef was unsafe to practice dentistry, the appeals court panel held. “Under these circumstances, the board was not required to accept Dr. Wassef’s explanations and Dr. Wassef did not disprove the board’s suspicions,” the panel held. “Thus, the dental board had reasonable grounds to take emergency action to prevent harm to the public.”

To read the decision on this matter, click here.

To read more on the repercussions of choices such as this, click here to read one of my prior blogs.

Serious Allegations Need Serious Legal Representation.

When a dentist, physician, nurse, psychologist, pharmacist, or other licensed health professional is accused of drug abuse or alcohol abuse, this is a very serious matter. As happened in this case, your license can be suspended putting you out of work and terminating your ability to pay for a legal defense.

Several things are a must. You must have good professional liability insurance that pays for the legal defense of complaints filed against your license, preferable with $50,000 or more of coverage for this type of event. Second, you must immediately retain experience health care legal counsel who deals with these types of cases routinely. Often there are options to such a harsh remedy as a suspension. Additionally, all the time spent from initial notification of the complaint, should be used in obtaining evidence to show that the dentist is not currently impaired. This can be routine random urinalysis testing, treatment with psychiatrist and certified addictions professionals, evaluation by special physicians health programs and other actions.

Usually, suspension is only appropriate when the physicians condition makes him an immediate threat to patient safety. Being able to prove that the physician is not a threat is te key to preventing a suspension. Also, using the time and money in appealing such a decision may, in may cases, be better used in requesting an emergency hearing and getting the evidence needed for that hearing.

Consult With An Attorney Experienced in the Representation of Dentists and Other Health Professionals.

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

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists and other health professionals in investigations and at Board of dentistry hearings and other legal matters. Call now or visit our website www.TheHealthLawFirm.com.

Sources:

Posses, Shayna. “Ariz. Court Backs Dentist’s Suspension Over Dubious Scripts.” Law360. (December 13, 2016). Web.

“Arizona Court Backs Dentist’s Suspension.” Lexis Nexis. (December 13, 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 dentists, defense attorney for dentists, legal counsel for dentists and dental assistants, defense attorney for health care professionals, DEA investigation defense attorney, legal representation for DEA investigations, legal representation for board investigations, defense attorney for board of dentistry matters, reviews of The Health Law Firm, The Health Law Firm attorney reviews, dental board defense work, dental board investigations, impaired dentists, impaired professionals, physician health programs, administrative hearings, complaint investigation defense attorney for dentists, appeals (and variations on appeal ) of adverse license action, license revocation, emergency suspension orders, appeals of emergency suspension orders, Professionals Resources Network (PRN) attorney, Florida dentist defense attorney, Virginia dentist defense lawyer, Louisiana dentist defense legal counsel, Colorado dentist defense lawyer, Kentucky legal dentist defense counsel, District of Columbia dentist legal representation

“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.

South Florida Hospital Agrees To Pay $12 Million To Settle FCA Claims

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

On December 7, 2016, a Miami-area hospital will pay the federal government about $12 million to resolve allegations that it violated the False Claims Act (FCA) by submitting false claims to federal health care programs for medically unnecessary cardiac procedures, the U.S. Department of Justice (DOJ) said.

The Allegations.

The allegations against South Miami Hospital stem from procedures allegedly performed by Dr. John R. Dylewski while he worked for the hospital. “Performing medically unnecessary heart procedures is shocking to the conscience,” Shimon R. Richmond, the U.S. Health and Human Services’ (HHS) Office of Inspector General’s (OIG) special agent in charge, said in a statement. “Conducting cardiac catheterizations purely for profit, not patient care, seriously breaches the ‘do no harm’ commitment physicians pledge.”

Two Whistle Blowers Add to the Mix.

Two whistle blowers, Dr. James A. Burks and Dr. James D. Davenport, brought the suit to light and stand to receive about $2.75 million of the settlement. Dr. Burks is a vascular surgeon who started working at South Miami Hospital in 2003 and Dr. Davenport is a cardiologist who was active in various peer review committees at the hospital between 2010 and 2014.

Both whistle blowers claimed to have personal knowledge of Dr. Dylewski and the hospital performing a number of unnecessary cardiac procedures for the sole purpose of increasing the amount of reimbursements paid to the hospital and its doctors by Medicare the DOJ said. According to the two whistleblowers, the alleged wrongdoing was known throughout the hospitals’ corporate hierarchy, including top executives, department officers, medical division chiefs and members of peer review committees. Additionally, both whistleblowers claim to have witnessed “repeated and continuing instances” of the improper medical and billing practices.

Dr. Dylewski, who no longer works at the hospital, was not a party to the settlement. Click here to read the press release on the suit from the DOJ.

To learn more about FCA suit, click here to read one of my prior blogs on a similar case.

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

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 www.TheHealthLawFirm.com.

Sources:

Kennedy, John. “Florida Hospital To Pay $12M To Settle FCA Claims.” Law360. (December 7, 2016). Web.

Lincoff, Nina. “BREAKING: South Miami Hospital to pay $12M to settle false claims allegations.” South Florida Business Journal. (December 7, 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.

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