Florida Substance Abuse Center Owner Gets 27 Years for Multi-Million Dollar Fraud Scheme

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

On May 17, 2017, a Florida man who pled guilty to running a health care fraud scheme out of substance abuse treatment facilities he owned was sentenced to 27 years in prison. U.S. District Judge Donald M. Middlebrooks, handed down the sentence to Kenneth Chatman who pled guilty in March 2017 to conspiracy to commit health care fraud, conspiracy to commit money laundering and one count of sex trafficking conspiracy.

Chatman admitted making millions of dollars by taking bribes and kickbacks to treat patients, fraudulently billing insurance companies and providing drugs to addicts so they would relapse in order to seek more treatment. His wife, Laura Chatman, was also allegedly in on the fraud scheme.

Details of the Scheme.

According to prosecutors, Chatman bribed owners of other sober homes to send their residents to get treatment at Reflections Treatment Center LLC in Margate, Florida, and Journey to Recovery LLC in Lake Worth, Florida. The payments were disguised as “case management fees, consulting fees, marketing fees and commissions.” The kickbacks were paid weekly, based on how many insured patients got treatment at the two facilities.

Prosecutors also said that patients were given unnecessary treatments and tests. These included DNA and allergy testing, even when there were no complaints of allergies, urine drug testing and saliva drug testing that was repetitive.

Illegal Kickbacks.

Patients received kickbacks in the form of reduced rent or other benefits to live in the sober homes. The benefits included treatments and drug tests that could be billed to their insurance, even though some of the residents continued to use drugs, the U.S. Department of Justice said.

If patients didn’t comply with the illegal processes, they were kicked out of the sober homes or otherwise intimidated or threatened with legal action, according to the Department of Justice. Kenneth Chatman also confiscated residents’ belongings, such as car keys, telephones, medications and food stamps.

Sex Trafficking Charge.

Additionally, Chapman was accused of forcing female patients and residents into prostitution, prosecutors said. He made them have sex at the facilities, hotels or motels for money and used that money as rent. Chatman provided drugs to the women to induce and encourage the prostitution.

Kenneth Chatman was ordered to register as a sex offender and given five years of probation following his incarceration for the sex trafficking charge. The judge also sentenced his wife, Laura Chatman, to three years in prison for her role in the scheme.

To read more on a similar case of health care fraud, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Fraud and Illegal Kickback Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

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

Sources:

Bolado, Carolina. “Fla. Sober Home Owner Gets 27 Years For Fraud Scheme.” Law360. (May 18, 2017). Web.
“Florida sober homes owner gets 27+ years’ prison for fraud.” Fox 35 News. (May 18, 2017). 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: Health Care Fraud defense attorney, legal representation for health care fraud scheme, Medicare fraud defense attorney, legal representation for Medicare fraud, Medicaid fraud defense attorney, legal representation for Medicare investigation, legal representation for Medicaid investigation, legal representation for illegal kickbacks, illegal kickback scheme defense attorney, legal representation for accepting illegal kickbacks, legal representation for health care facility, legal representation for health care professionals, health care facility defense attorney, submitting false claims to the government, legal representation for submitting false claims, health law defense attorney, reviews of The Health Law Firm attorneys, The Health Law Firm 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.

Accused Dental Supply Manufacturers Argue Antitrust Suit Belongs In Arbitration

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 March 21, 2017, accused dental suppliers in an antitrust suit told the U.S. Fifth Circuit Court of Appeals that a Texas federal judge was wrong to override an arbitration agreement. The antitrust suit involves a dental supply manufacturer as a plaintiff. It accused six others of unfairly pushing it out of the market. U.S. District Judge Rodney Gilstrap overturned a magistrate’s decision to send the case to arbitration. But the six suppliers argued that the district court judge improperly relied on unspecified injunctive relief which is only a minor part of the case.

Does the Case Belong in Court?

The plaintiff, Archer and White Sales, Inc. (Archer), first filed its suit against Henry Schein Inc., the Danaher Corp., Instrumentarium Dental Inc., Dental Equipment LLC, Kavo Dental Technologies and Dental Imaging Technologies Corp. in August 2012. Most of these are names that any dentists would recognize.

The magistrate had ruled that because the case involves more than just a request for injunctive relief, it should be referred to arbitration and the arbitrator should decide whether the case belongs in court. The agreement between the two parties does incorporate the American Arbitration Association’s (AAA) rules, which state that arbitrators have the right to decide questions of arbitrability. To read the brief from this case in full, click here.

Click here to visit our website and learn more about the specifics of arbitration.

To read one of my prior blogs involving cases of arbitration, click here.

Contact Experienced Health Law Attorneys 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 http://www.TheHealthLawFirm.com.
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:

Kass, Dani. “Dental Supply Cos. Say Antitrust Suit Belongs In Arbitration.” Law360. (March 21, 2017). Web.

Kass, Dani. “Dentists Say Small Supplier Joined Price-Fixing Conspiracy.” Law360. (February 17, 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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Legal representation in antitrust suits, legal representation ofr dentists, antitrust defense attorney, legal representation for alternative dispute resolution proceedings, legal counsel for informal mediations and formal mediations, complex litigation attorney, lawyer in complex health litigation, legal representation for arbitration, legal counsel for dentists, American Arbitration Association (AAA), arbitration defense attorney, legal representation for judicial arbitration, legal representation in federal cases, health care facility arbitration defense attorney, dental law attorney, health care professional arbitration defense attorney, health law defense attorney, The Health Law Firm reviews, reviews of 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.

Medical Students, Residents and Fellows Need to Properly Disclose Medical Disabilities in advance of problems

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

We are often retained to provide legal representation to medical school students, residents and fellows who run into difficulties and have disputes with their medical schools or programs. This may be after they are required to repeat a year, terminated from the program, or have other adverse action taken against them. When this occurs and we investigate the details, occasionally we find that the individual we are representing has a medical history of mental health issues that may have caused or contributed to the problems they are facing.

In many situations, the troubles that are faced could have been avoided if the student or resident had disclosed their medical condition to the school, program, or institution, and requested reasonable accommodations. However, after the adverse action has been taken it is often (but not always) too late to do this.

Use the institution’s forms to report a medical condition or disability.

All major medical schools, universities, residency programs, and hospitals in the United States have offices or departments to receive reports of medical conditions and disabilities and to assist the student/resident in obtaining support, resources and reasonable accommodations to help the student/resident be successful. However, if the institution is never notified of the medical condition or disability and is never given the opportunity to provide reasonable accommodations, then the student/resident has failed to take advantage of an opportunity that exists which may have helped prevent the adverse action that was taken.

If you have a medical condition or disability of any kind, especially one such as depression, learning disability, bipolar disorder, anxiety disorder, ADHD, a disease or illness which may affect your performance, or other condition that classifies as an illness or disability, you should be sure that this is diagnosed by the appropriate physician. You must also have that physician formulate reasonable accommodations that your institution, program, school or hospital can take that would help you to accommodate your condition. You should then complete the forms that your institution uses to report this and request reasonable accommodations to help you.

Don’t fear stigma from reporting a medical condition or illness.

We most often find that our clients have failed to report a medical condition or illness and request reasonable accommodations out of a fear that their program, professors, attendings and colleagues will discriminate against them and see them in a lesser light. Actually, the opposite is true. If a medical student our resident is failing academically, is unable to pass exams, or does not appear to be able to handle clinical rotations, it is more likely that the institution will feel that the person does not have the capability or motivation to succeed. However, by disclosing the medical condition or disability, this helps to explain such matters.

Illegal to discriminate based on disability or illness.

There are a number of federal laws and often state laws which protect a student or resident who has a medical disability or illness against discrimination. Additionally, almost all major colleges, universities and institutions have policies and procedures in place which prevent this. However, if the resident or student has not disclosed the medical condition or disability to anyone, there can be no argument made that the person was discriminated against because of this. Therefore, disclosure and a request for reasonable accommodation may be a big benefit in challenging adverse actions.

Contact Experienced Health Law Attorneys Representing Medical Students, Residents and Fellows.

The Health Law Firm routinely represents medical students, residents and fellows who run into difficulties and have disputes with their medical schools or programs. We also represent 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.

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 medical students, legal representation for residents, legal representation for fellows, legal representation for disputes with medical programs and institutions, investigation by National Board of Medical Examiners (NBME), United States Medical Licensing Examination (USMLE), USMLE preparation course, USMLE hearings, USMLE appeals, foreign medical student defense lawyer, medical graduate defense attorney, defense lawyer for doctors, legal representation fro physicians, residents and intern legal representation, medical student attorney, medical resident lawyer, medical intern lawyer, civil proceeding, criminal proceeding, administrative proceeding, medical administrative hearings, administrative law, medical student legal defense counsel, medical resident lawyer, medical resident defense attorney, medical intern lawyer, medical intern attorney, accused of irregular behavior, The Health Law Firm 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.

Virginia Medical Board Wins Appeal Concerning Doctor’s Revoked Medical License

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 March 21, 2017, a Virginia appellate court ruled that a doctor’s state medical license was properly revoked for various reasons including allowing medical students to perform unauthorized medical procedures. The appellate court said the doctor’s due process rights weren’t violated because he had three months to prepare for an administrative hearing before the Virginia Board of Medicine.

Medical License Was Properly Revoked.

When the doctor originally presented his case in the trial court, the trial judge ruled that Dr. John Hagmann’s constitutional rights were violated. The trial court decided that when the Virginia Board of Medicine denied the doctor’s second request for a postponement of an administrative proceeding it erred. The trial court judge reversed the Virginia Board of Medicine’s decision revoking his license.

The court of appeals later decided that the trial judge’s decision was erroneous and reversed it. The appellate court based its ruling on the fact that Dr. Hagmann had already received one continuance and had more than three months to prepare for his hearing. According to the appellate court, the medical board’s denial of a second continuance didn’t violate Dr. Hagmann’s due process rights.

While teaching courses at a federal military school in 2012 and 2013, Dr. Hagmann allegedly allowed the students to perform invasive medical procedures on himself and on each other. These medical procedures were allegedly unapproved and had no medicinal or therapeutic purposes, according to the medical board.

According to the court’s opinion, Dr. Hagmann was also accused of encouraging students to use alcohol and various drugs in unapproved and dangerous ways. It indicated that he also provided medical treatment, including writing prescriptions, without keeping adequate records.

To read the court’s opinion in full, click here.

Conclusion.

The Virginia appellate court decided that the circuit court, the lower court in the case, erred by substituting its discretion for the Board’s discretion. However, the court of appeal also held that the circuit court did not err in rejecting Dr. Hagmann’s claims that the Board violated his due process rights.

Therefore, the court of appeal reversed the circuit court’s ruling and remanded with directions that the decision of the Medical Board revoking Dr. Hagmann’s license to practice medicine should be reinstated.

To learn more about the consequences of having your professional medical license revoked, click here to read one of my prior blogs.

Author’s Comments:

The problem I have with this decision is that the board of medicine usually takes years to investigate such cases. Once the charges are filed, they want to rush to a hearing, often without giving the defense adequate time to prepare. I have experienced this time and time again. It behooves the defense to make a clear record of the time that the port of medicine has had to prepare, the prejudice that will occur to the defense, and the lack of prejudice to the board.

Additionally, since there was a trial in a trial court decision, the trial court judge was in a much better position to weigh the credibility of the witnesses and make the decisions that were made. In a case where there is only been one prior continuance granted, for the appellate court to reverse the trial court judge, seems unfair to me, especially since the result is the revocation of the Doctor’s license. I often refer to this as the “death sentence” for the Doctor’s career. There isn’t a harsher sentence that a board of medicine can give.

Contact Health Law Attorneys With Experience Handling Licensing Issues.

If you have had a license suspended or revoked, or are facing imminent action against your license, it is imperative that you contact an experienced healthcare attorney to assist you in defending your career. Remember, your license is your livelihood, it is not recommended that you attempt to pursue these matters without the assistance of an attorney.

The Health Law Firm routinely represents physicians, dentists, nurses, medical groups, clinics, and other healthcare providers in personal and facility licensing issues. 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:

Kang, Peter. “Va. Med Board Wins Appeal Over Doc’s License Revocation.” Law360. (March 21, 2017). 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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for licensing issues, medical license defense attorney, legal representation for revoked license, legal representation for Board of Medicine investigation, Board of Medicine investigation defense attorney, medical board appeals, legal representation for administrative law hearing, administrative hearing defense attorney, legal counsel for Board of Medicine hearing, legal representation for Department of Health investigations, Department of Health investigation defense attorney, appeal of revocations, legal representation for Administrative Law Judge (ALJ) Hearings, administrative litigation defense attorney, legal representation for Federal Administrative Hearings, legal representation for Formal Administrative Hearings and Informal Administrative Hearings, legal representation for revocation hearings, The Health Law Firm reviews, reviews of 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.

Licensed Health Professionals Should Have No Trouble Locating an Attorney/Legal Counsel Who Takes CPH & Associates (CPH&A) Insurance To Represent Them in Licensing Actions and Hearings

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

We often hear from licensed health professionals who call and retain us to represent them in complaints against their professional licenses in investigations and formal licensure complaints. Often these professionals retain us after adverse disciplinary action has already been taken. In many cases they had good insurance coverage with CPH & Associates (CPH&A) Insurance, or another professional liability insurance company but could not find an attorney that would accept it.

They retain us to appeal or attempt to reverse an adverse disciplinary action taken against their license, including suspensions and revocations. Matters which may arise include letters from the Department of Health (DOH) advising them that they are being investigated, administrative complaints, a pending administrative hearing emergency restriction orders (EROs), and emergency suspension orders (ESOs).

Finding legal counsel that accepts your insurance should not be a difficult task. Our firm and its attorneys have accepted CPH&A Insurance, and many others, for years.

Our firm has attorneys that are licensed in and can defend licensed health professionals 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 professional licensing boards and authorities 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 CPH&A insured that CPH&A will pay for include: investigations commenced against a massage therapist’s license, administrative hearings, complaints against a professional license, emergency restriction orders, emergency suspension orders, administrative complaints, appeals from adverse disciplinary actions, a deposition for which you may be subpoenaed, 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 CPH&A 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 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 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. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

 

KeyWords: Legal representation for licensed health professionals, legal representation for doctors, health law defense attorney, Florida health law defense attorney, legal representation for formal licensure complaints, licensure defense attorney, legal representation for adverse disciplinary action, Department of Health (DOH) investigations and complaints, legal representation for DOH investigations, DOH investigation defense attorney, DOH complaint defense attorney, legal representation for administrative hearings, complaint investigation defense attorney for health care professionals, appeals (and variations on appeal ) of adverse license action, Virginia health law defense lawyer, Louisiana health law defense legal counsel, legal representation for physicians, legal representation for mental health professionals. Colorado health professional defense lawyer, Virginia health law defense counsel, District of Columbia health law legal representation, The Health Law Firm reviews, reviews of 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.

Home Health Provider Sues Medicare Contractor and HHS Over Unfair Audit and Denied Medicare Reimbursement Payments

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

On March 2, 2017, an Illinois home health care provider launched a class action law suit against Medicare reimbursement auditor AdvanceMed and the U.S. Department of Health and Human Services (HHS) Secretary Tom Price. MedPro Health Providers LLC (MedPro) filed the complaint in an effort to collect $300,000 it says it is owed in Medicare payments. The complaint was filed in the U.S. District Court for the Northern District of Illinois. The plaintiff, MedPro, which is a home health services provider, seeks status in the law suit as a class representative for all similarly situated health care providers.

The Complaint.

AdvanceMed is a Zone Program Integrity Contractor (ZPIC), which investigates suspected fraud, waste and abuse, according to the Centers for Medicare and Medicaid Services (CMS). Under the Medicare Act, CMS is allowed to enter into contracts with outside organizations to perform certain services, such as those of the ZPIC.

According to allegations made in the complaint, AdvanceMed contended that it found “reliable information” that MedPro had been overpaid for services and stopped reimbursements to the company. When MedPro provided a rebuttal statement to the findings, AdvanceMed allegedly ignored it.

According to the complaint, AdvanceMed’s evaluation of MedPro was not fair. MedPro did not have the opportunity to show its own evidence that its operations were in order. MedPro expended significant resources and financial capital to prepare and transmit the response to AdvanceMed. When AdvanceMed finally responded to its rebuttal, its language was “basically boilerplate” and did not address MedPro’s argument. MedPro said that new HHS Secretary Tom Price should take responsibility for AdvanceMed’s failure to reply as a ZPIC auditor.

So far, MedPro’s fraud allegation is only against AdvanceMed, not Price and HHS. However, in its complaint, it states, “The Secretary, through its ZPICs, has a plainly defined and nondiscretionary duty to properly and completely respond to MedPro’s Rebuttal Statement. MedPro has been irreparably injured because of the Secretary’s failure to carry out that duty.”

To read the complaint in full, click here.

For more information on AdvanceMed and ZPIC Audits, click here and here to read two of my prior blogs.

For a blog I wrote about a similar suit filed against Medicare contractors by the American Hospital Association several years ago, click here.

The Health Law Firm Previously Filed Similar Suit in Michigan.

Prior to MedPro’s class action suit, on September 1, 2016, New Vision Home Health Care, Inc., filed a similar suit in which The Health Law Firm now represents it. It is New Vision Home Health Care, Inc., et al. v. Anthem, Inc. (f/k/a WellPoint, Inc.), TrustSolutions, LLC, and National Government Services, Inc., U.S. District Court for the Eastern District of Michigan, case number 2:16-cv-13173. The New Vision suit did not seek class action status, but raised some of the same legal issues against CMS Medicare contractors. To see a copy of the Second Amended Complaint filed in federal court, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent health care providers in disputes with Medicare, insurance companies and complex litigation. Additionally, they represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

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

Sources:

Miesel, Hanna. “Health Provider Sues Medicare Middleman For Reimbursements.” Law360. (March 2, 2017). Web.

“Health Provider Sues Medicare Middleman For Reimbursements.” LexisNexis. (March 2, 2017). 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: Legal representation for Medicare and Medicaid audits, legal representation for Medicare and Medicaid fraud, Zone Program Integrity Contractor (ZPIC) audit lawyer, legal representation for ZPIC audit, ZPIC attorney, legal representation for CMS investigations, Medicare audit and investigation defense attorney, Medicaid audit and investigation defense attorney, CMS defense attorney, legal representation for allegations of over-billing Medicare and Medicaid, legal representation for Medicare and Medicaid reimbursements, law suit against Anthem, Inc. (f/k/a WellPoint, Inc.), law suit against ZPIC TrustSolutions, LLC, law suit against National Government Services, Inc. (NGS), Medicare reimbursement defense attorney, Medicaid reimbursement defense attorney, health care fraud defense attorney, litigation against medicare contractors, legal counsel for Medicare and Medicaid audits, The Health Law Firm reviews, reviews of 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.

 

Houston Heart Surgeon Wins $6.4 Million Defamation Case Regarding Peer Review

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

On March 29, 2017, a Houston heart surgeon was awarded $6.4 million in damages after a jury found that Memorial Hermann Health System (Memorial) defamed his reputation. The suit arose out of a peer review proceeding against Dr. Miguel Gomez. He claimed that the peer review was not about the quality of health care, but was to retaliate against him for moving his lucrative practice to a competing hospital.

Dr. Gomez sued Memorial in 2012, contending the hospital launched a “whisper campaign” to smear his reputation to keep patients from following him to his new location.

Hospitals and Peer Review.

Dr. Gomez’s case involved peer review, a confidential process conducted by committees of physicians to detect and discipline physicians whose quality of care is not up to par. Traditionally, it had been used solely to protect patients from physicians whose medical skills are not what they should be or who have a number of adverse outcomes. Dr. Gomez alleged that Memorial completely misused the peer review process, manipulating data on the outcome of his surgeries to suggest that his patients were more likely to die than those of other surgeons.

This case may help open the eyes of the public and the courts to the many cases in which this happens. It highlighted the fierce battle among hospitals for market share and the lengths to which they may go to protect their territory. Hospitals fight hard to hold onto specialists like Dr. Gomez, who perform procedures with high profit margins and who bring in a large amount of income to the hospital.

For more information on the importance of the peer review process, click here to visit our web page.

The Jury’s Verdict in an Unusual Case.

The jury determined that a comment from a Memorial employee about Gomez’s “bad quality, high mortality rates, unnecessary surgeries,” was false and damaged Gomez’s reputation. The jury also found that another employee’s comment about Memorial’s decision to share Gomez’s peer review data with referring cardiologists was false and defamatory. Additionally, the jury also found Memorial acted with malice by making false statements about the surgical competence of Dr. Gomez.

Peer Review Privilege Difficult to Overcome for a Physician Plaintiff.
The federal Health Care Quality Improvement Act (HCQIA) provides a privilege from civil liability for hospitals and medical staff members involved in the peer review process. Additionally, most states have state laws in place which provide even greater protections from suits such as the one field by Dr. Gomez. This greatly stacks the deck against physicians who are wronged by such misconduct and makes it very hard for them to receive justice, especially in the court system. Often a physician seeking relief from the courts must plead and prove “intentional malice”or “intentional fraud” by those involved, or some other standard that is artificially high and difficult to overcome.

Dr. Gomez’s case is a rare one. Most cases such as this do not make it to trial. They are either dismissed by the courts on motions to dismiss or for summary judgment, or they are settled.

Economic Credentialing or Sham Peer Review.

What Dr. Gomez was subjected to is known as “economic credentialing.” This is when decisions are made by a hospital or medical staff to take adverse action against a physician based on monetary or income factors instead of based on quality of care standards. Given that peer review is supposed to be based on protecting patients from those with substandard medical skills, using the peer review process because of economic considerations is a corruption of the peer review process.

Most often physicians find themselves the victim of such phony or sham peer review complaints filed by a competing physician or medical group. Our firm is routinely consulted by physicians complaining of such actions. However, often the physician does not have the financial resources to fight a protracted peer review battle and then proceed in court, if necessary, as Dr. Gomez did. Hospitals and medical staff leadership need to become more sensitive to this issue and act to stop such proceedings when there is clearly little or no evidence of a physician’s incompetence. Unfortunately, they most often do not.

As Dr. Gomez’s verdict shows, hospitals do improperly use the peer review process to protect market share by targeting doctors who don’t funnel business to their facilities and networks. This verdict should send a strong message to hospitals about the consequences of misusing the peer review process for business purposes.

To read one of my prior blogs on the confidentiality of peer review, click here.

Will Dr. Gomez’s Case Survive Appeal?

The real question is whether or not Dr. Gomez’s case will survive appellate review. Other court cases have made it as far as Dr. Gomez’s case only to be reversed by an appellate court. Hopefully, the evidence and legal arguments made in this trial will be sufficient to convince any court of appeals that the jury and trial judge’s decisions were correct. Otherwise, it will stand for the proposition that individual physicians have no remedy for such egregious and intentional misconduct.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Reviews.

If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.

At the Health Law Firm we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions. We also represent physicians and health care providers in complex litigation in both state and federal courts.

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:

Sexel. L.M. “Heart surgeon wins $6.4 million verdict in defamation case against Memorial Hermann.” Houston Chronicle. (March 29, 2017). Web.

Kane Russell Coleman Logan PC. “Houston Physician Wins Defamation Suit in Connection with Peer Review.” AHLA Weekly. (March 30, 2017). 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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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