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.

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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.

Keywords: Florida health attorney, qui tam lawyer, health law attorney, Florida health lawyer, The Health Law Firm, health law defense lawyer, health care fraud attorney, whistle blower attorney, AKS lawyer, Anti-Kickback Statute attorney, 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 The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2016 The Health Law Firm. All rights reserved

East Texas Lab Agrees to Pay $3.75 Million to Settle False Claims Suit

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 14, 2016, owners of an East Texas clinical laboratory who overcharged Medicare for falsified driving mileage bills have agreed to pay the U.S. government $3.75 million to settle a whistle blower’s False Claims Act (FCA) lawsuit. The suit was brought by a former employee, the U.S. attorney’s office announced.

Submitting False Claims.

Texas-based Elite Lab Services LLC (Elite) and its owners, Gerard and Suzanne Dengler, reportedly settled claims brought under the False Claims Act (FCA) by plaintiff Karen Malcolm. The Denglers admitted that from approximately 2010 to 2014 they submitted inflated employee mileage claims to Medicare and billed the government health agency knowing it does not pay for mileage claims in excess of actual miles driven.

According to court documents, the defendants employed phlebotomists who traveled around East Texas to collect blood samples and transport those samples back to Elite for lab services. For several years, the defendants at Elite knowingly submitted or caused to be submitted inflated mileage calculations beyond the actual distances driven by the employees.

The Whistle Blower.

In 2014, the whistle blower Malcolm, filed the suit alleging that Elite had defrauded Medicare. She claimed that she approached the Denglers in the spring of that year to voice concerns about the billing practices, but the issue was not corrected. She then resigned from the company as a result. The U.S. Attorney’s Office revealed that the government intervened in the suit for purposes of the settlement.

In an agreed final judgment, the parties said that the defendants relinquished and waived all right and title to more than $2.5 million in cash held in a collection of several financial accounts and sales of real property that they owned to satisfy the settlement in the instant case.

As a result of the deal, Malcolm will receive a 21 percent share of the recovery, totaling $787,500, authorities said.

Medicare and Medicaid fraud cases brought on by whistleblowers are unfortunately becoming more common. To read about the serious repercussions of cases like this, click here to read one of my prior blogs.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistle blower/qui tam cases, in which we represent the person who files the claim, as well as in defending them in certain cases.

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

Sources:

Wolf, Alex. “East Texas Lab Pays $3.75M For Falsified Medicare Billing.” Law360. (December 14, 2016). Web.

“Tyler lab, owners to pay $3.75 million for filing false Medicare claims.” Longview Business Journal. (December 14, 2016). Web.

“East Texas lab company, owners to pay $3.75M for false Medicare claims.” KLTV-ABC. (December 14, 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: False Claims Act (FCA) attorney, legal representation for submitting false claims to the government, defense attorney, Medicare false claims defense lawyer, allegations of false billing, Medicare and Medicare fraud investigation defense attorney, consumer reports of false claims, Medicare audit defense lawyer, health care fraud defense attorney, whistle blower attorney, qui tam defense lawyer, legal representation for whistle blower suits, reviews of The Health Law Firm attorneys, The Health Law Firm reviews, qui tam relator’s attorney, qui tam defense attorney, Florida whistle blower case, Virginia Whistle blower case, Colorado whistle blower case, Louisianan Whistle blower case, complex healthcare litigation 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.



 

Doctor Indicted In Home Health Medicaid Fraud Suit Hit With 3-Year Prison Sentence

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, Banio Koroma was convicted in a northern Illinois court of falsely certifying elderly patients for in-home care will spend the next three years in prison and be forced to reimburse the government for the $1.5 million in losses he caused, an Illinois federal judge ruled.

Paying For His Crimes.

In June 2016, Banio Koroma, 67, appeared in court in an orange jumpsuit after being jailed for violating his bond when it was discovered that he had again committed fraud by mailing fake checks to strangers. On December 7,2016, he was told he would spend a total of 40 months in prison for the crime that placed him on that bond. The crime committed included cheating Medicaid out of at least $1.5 million during his employment with home health care provider Mobile Doctors USA (Mobile Doctors).

“That sentence would be substantially higher were it not for his age,” U.S. District Judge John J. Tharp said. The judge also ordered restitution of $1.5 million and said that Dr. Koroma would be under three years of supervised probation following his release from prison.
The Fraudulent Scheme.

In 2013, Dr. Koroma was indicted along with Mobile Doctors’ Chief Executive Officer, Dike Ajiri, who pled guilty and was sentenced in May 2016 to 15 months in prison. Dr. Koroma had worked for Mobile Doctors, a company that contracted with physicians to arrange home health care services in Illinois, Michigan, Indiana and elsewhere before its 2013 closure due to the indictment.

According to the government, Dr. Koroma, signed off on documents authorizing the in-home care treatment of elderly patients who were not confined to their homes and could in fact leave their houses to see a doctor.

Prosecutors allege that Dr. Koroma did so without first verifying that the patients were in fact homebound and was motivated purely by greed. A jury convicted him in January 2016 of four counts of Medicare fraud. Click here to read more on his conviction.

To learn more about the repercussions of Medicaid fraud such as this, click here to read one of my prior blogs on a similar case.

Health Care Fraud Should Not Be Taken Lightly.

We have been consulted by many individuals, both before and after criminal charges were brought for fraud or related offenses. In many cases, those subject to Medicare and Medicaid fraud audits and investigations refuse to acknowledge the seriousness of the matter. Some may even decide not to spend the money required for a highly experienced health attorney to defend them.

Click here to read one of my previous blog posts regarding Medicare and Medicaid audits.

The government is serious about combating health care fraud. It created a Medicare Fraud Strike Force in March of 2007, in an effort to further prevent and eliminate fraud and abuse of government health care programs. False claims are a growing problem in the program, costing the government billions of dollars each year. Accordingly, punishments for defrauding the system can be quite severe.

If you are accused of Medicare or Medicaid fraud, realize that you are in a fight for your life. Your liberty, property/possessions and profession are all at stake. Often it is possible to settle allegations of fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the provider should consider whether it is worth the risk of facing decades in prison. Be prepared to give up whatever you need to in order to avoid a conviction and preserve your liberty.

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

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

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

Sources:

Corso, Jessica. “Doctor In Home Health Fraud Hit With 3-Year Sentence.” Law360. (December 9, 2016). Web.

Robeznieks, Andis. “Mobile Doctors CEO, physician arrested in alleged Medicare fraud scheme.” Modern Healthcare. (August 27, 2013). 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 audit defense, legal representation for Medicare and Medicaid fraud allegations, legal representation for home health care agencies, health care clinic fraud audit, Medicare and Medicaid fraud defense attorney, Florida health attorney, Florida health lawyer, health care fraud defense lawyer, health care fraud scheme, Medicaid fraud scheme, The Health Law Firm, Medicaid fraud defense lawyer, legal representation for Medicare and Medicaid fraud investigation, co-conspirator in Medicaid fraud scheme, restitution for health care fraud offense, Medicaid reimbursement claims, improper Medicaid billing claims, false claims defense attorney, medical director defense attorney, The Health Law Firm reviews, Florida physician defense attorney, Colorado physician defense lawyer, Kentucky doctor defense counsel, Louisiana physician defense legal representation, District of Columbia physician defense attorney, Virginia physician defnse legal counsel, Florida home health agency (HHA) defense attorney, Colorado home health agency (HHA) defense lawyer, Kentucky home health agency (HHA) defense counsel, Louisiana home health agency (HHA) defense legal representation, District of Columbia home health agency (HHA) defense attorney, Virginia home health agency (HHA) 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.

Florida Court Denies Motion to End Patient Wrongful Death Suit Despite Settlement

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 15, 2016, The Florida Supreme Court refused to dismiss a lawsuit over the death of an escaped psychiatric hospital patient for the second time. The suit questions the thin line between medical and ordinary negligence, even though the parties settled their dispute several months ago.

The justices offered no explanation when they denied a motion from defendant-appellee Shands Teaching Hospital and Clinics Inc. (Shands) asking them to reconsider that ruling. Additionally, the court also maintained the same 4-3 split across both orders.

The Background.

The ongoing case stems from the January 23, 2013, death of Ashley Lawson. She escaped from Shands Psychiatric Hospital in Gainesville, and was struck and killed by a tractor trailer on Interstate 75.

According to the facts from the case that was filed, Lawson was admitted to the hospital on November 1, 2012, with a history of psychiatric illness, drug abuse, impulsive behavior and multiple suicide attempts. She was later transferred to the locked inpatient unit for her own safety, according to her estate’s initial jurisdictional brief.

As a result of a Shands employee allegedly leaving her key and badge unattended, Lawson was able to escape. Her estate, bringing the suit on her behalf, argued that the case was one of ordinary negligence and not a medical malpractice case. A medical malpractice case carries various strict presuit requirements under the Florida Medical Malpractice Act, including a presuit notice and the affidavit of a physician expert, which the estate did not provide.

Denied Motion to Dismiss.

The suit made its way to the state’s highest court as the estate sought reversal of a decision by the First District Court of Appeal to quash a lower court’s order that had denied Shands’ motion to dismiss. According to the estate’s brief, the Court of Appeal reviewed the case on its own, reaching its 8 to 6 decision, after a three-judge panel could not reach a definitive result.

Ashley Lawson’s estate argued the First District Court of Appeal’s decision stood in conflict with the Fifth District Court of Appeal’s decision on what constitutes ordinary negligence versus medical malpractice. This conflict would give the Florida Supreme Court the authority to decide what the law actually states.

In the hospital’s defense, Shands argued that the case is not a high-profile matter of great public interest, and has no effect on the “due process rights of life or liberty for a sizable group of Floridians.”

Negligence is one of the most common claims used against doctors. It is important to familiarize yourself with the repercussions and ways to avoid it from happening to you in the first place. Click here to read one of my prior blogs to learn more.

Contact Health Law Attorneys Experienced in the Representation of Psychiatrists, Mental Health Counselors, Psychologists, Social Workers, and Marital and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to psychiatrists, mental health counselors, psychologists, social workers and family therapists in Department of Health (DOH) investigations, medical malpractice investigations, business transactions, contracts, structuring business ventures, clinical privileges actions, professional licensure matters, Board hearings, business litigation, Medicare and Medicaid audits, and other types of investigations of health professionals and providers.

Often the early advice and representation of an experienced health law attorney can help avoid discipline which will be on your record for a lifetime.

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

Sources:

Hale, Nathan. “Fla. High Court Says Deal Doesn’t Stop Patient Death Case.” Law360. (November 28, 2016). Web.

Frellick, Marcia. “Florida Court Rules Physician May Be Liable in Suicide.” Medscape. (August 25, 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 medical negligence, legal representation for medical malpractice, identifying the difference between medical and ordinary negligence, legal representation for mental health professionals, mental health defense lawyer, legal counsel for mental health counselors and professionals, mental health defense lawyer, legal representation for psychiatrists, psychologist defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm, attorney for mental health counselors, psychologist defense attorney, psychiatry negligence 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.

Was Nursing Home and Hospital To Blame for Woman’s Death?

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

On December 1, 2016, the family of a mentally ill woman, Diane Rimert, who died of pneumonia, urged a Texas jury to find a nursing home and a hospital liable for her death. The family alleged that the nursing home neglected her and that the hospital wrongfully recognized a do-not-resuscitate document that she signed while unable to care for herself.

Patient Suffering From Mental Illness.

Rimert lived with severe bipolar disorder and delusions. She lived the last years of her life in a Pennsylvania rehabilitation nursing home after she was arrested and involuntarily committed to a mental hospital.

Poor Living Conditions In The Nursing Home.

Jeffrey D. Antonson of Adkerson Hauder & Benzey PC, an attorney for Rimert’s three adult children, told jurors in Dallas County that Rimert developed severe bedsores in her feet and lower half of her body, stating that this confirmed she had been neglected. The attorney claimed there was also proof that Rimert was left in her own excrement until her flesh began to decay and this took away her body’s ability to fend off pneumonia, he said.

Her Final Days.

Rimert was taken to Texas Health Harris Methodist Hospital, where she was left to die because she had signed what appeared to be a valid legal documents concerning her end-of-life decisions. She signed the documents when she first arrived at the nursing home when, it is alleged, she was mentally ill. The document stated that she did not want to be rescuscitated and gave her medical power of attorney to her neighbor rather than her children. She died in February 2012.

Attorney Anderson stated: “What makes sense here? Is a mentally ill woman — bipolar disorder, with psychosis, a woman who had delusions that she was different people — is she responsible for her own suffering and for her own death? Or is there one or more of the defendants sitting before you that is responsible for her suffering and her death?”

Attorney George Michael Stewart of Stewart Wiegand & Owens, PC, representing the nursing home, argued that Rimert was generally an uncooperative patient and although she was mentally ill, she was deemed competent when she signed the do-not-resuscitate and medical power-of-attorney documents. “Every patient in this country has the right to refuse treatment, mentally ill or not,” he said. “The reality is, this was her choice. She decided long ago that, ‘I didn’t want to be rescuscitated, I didn’t want feeding tubes’ … even if it wasn’t a rational decision for her, it was her right to make that decision.”

Stewart also stated that Rimert’s children, who are seeking compensation for the loss of their mother, had suffered serious abuse at her hand since they were small and were mostly estranged from her. Rimert always became violent and enraged in the presence of one of her sons, and she had last seen her daughter in 1996, he said.

Stewart said they lost their mother a long time ago to the mental illness, not pneumonia.

Comment by Editor

This is certainly a tragic case. And Ms. Rimert, if she really understood what she was signing at the time (and that is a big problem if counselors and intake coordinators in these institutions are not adequately explaining end-of-life decision documents to their new residents), it was her right to make the decision. The law presumes every person is competent until a court declares her to be mentally incompetent. But as ill as she apparently was, this seems to be a real question.

 

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 http://www.TheHealthLawFirm.com.

Source:

Lowery, Brandon. “Nursing Home, Hospital Caused Woman’s Death, Jury Told.” Law360. (Dec. 1, 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: reviews of The Health Law Firm, health care lawyer, representation for mental health professionals, The Health Law Firm reviews, health law attorney, legal representation for health care professionals, health care provider defense attorney, The Health Law Firm, mental health counselor defense attorney, psychologist defense attorney, legal advice for skilled nursing facilities, nursing home defense counsel, board of mental health counselors defense lawyer, board of psychology defense attorney, complex mental health litigation attorney, psychiatrist defense counsel, complex litigation on health care issues

“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.

Millions Paid Out By Florida Orthopedic Center To End FCA Claims

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

Southeast Orthopedic Specialists (SOS), located in Jacksonville, Florida, agreed to pay $4,488 million on December 7, 2016, to settle allegations that it violated the False Claims Act (FCA) by allegedly billing federal health care programs for millions of dollars for unnecessary services.

Protection of Federal Health Care Programs.

U.S. Attorney A. Lee Bentley III of the Middle District of Florida made the announcement. In the statement he said:  “The United States Attorney’s Office is committed to taking the steps necessary to protect Medicare and other federal health care programs from fraud.  When health care practitioners submit fraudulent claims for reimbursement, we will hold them accountable.”

The U.S. Department of Justice (DOJ) said that SOS submitted claims for payment declaring that a physician had been present during the patient visits, even when there was not really one there.  The medical center also billed Medicare for ultrasound-guided injections that were unnecessary, it was alleged.

SOS Modified Its Billing.

According to the allegations, a billing modifier was used by SOS that showed separate evaluations and management (E&M) services were performed, while in reality, those services were not separate. This resulted in higher payments by Medicare.  SOS also used a modifier that showed two procedures were conducted, when the procedures should have been billed together as one.  This is known as “unbundling.”

According to the allegations, sometimes a third modifier was used by SOS to falsely surpass the Medicare cap on physical therapy, even though there was no medical need for it.

The prosecutors stated that SOS also scheduled for patient follow-ups 12 to 14 weeks after the operative visits. This allowed SOS to avoid Medicare’s 90-day diagnosis-related group charge.  Because of this, SOS was able to receive a greater reimbursements.

The Government Is More Aggressively Fighting Health Care Fraud.

This FCA settlement reveals the emphasis the government is putting on fighting health care fraud.  It marks yet another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative.  FCA recoveries reached an all time high during the previous year and the government is expected to continue to pursue these claims.

Special Agent in Charge Shimon Richmond is reported to have stated, “The Department of Health and Human Services, Office of Inspector General will relentlessly seek out those who defraud the Medicare program.  Obtaining tax dollars which Medicare providers are not entitled to impact our entire healthcare system and the OIG will hold health care providers accountable who misrepresent services to boost profits.”

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 http://www.TheHealthLawFirm.com.

Sources:
“United States Settles False Claims Act Allegations Against Orthopedic Surgery Practice For $4,488,000.” United States Department of Justice. (December 7, 2016). Web.

Pelican, Garret. “Feds Settle Health Care Fraud Case For $4.5 Million.” The Florida Times. (December 7, 2016). Web.

Kass, Dani. “Fla. Orthopedic Center Pays $4.5M To End FCA Claims.” Law360. (December 7, 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.

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