About thehealthlawfirm

The Health Law Firm was established in 1999, bringing together a team of top attorneys with decades of experience in the legal and healthcare fields. Based in Orlando, Florida, the firm provides legal representation for healthcare providers. The services we provide include reviewing and negotiating contracts, business transactions, defense of professional licensing cases, representation in investigations, defense in credentialing matters, Medicare and Medicaid audits, opinion letters, commercial litigation, covenants-not-to-compete, restrictive covenant litigation, incorporation, formation of corporations and limited liability companies (LLCs), Board of Medicine hearings, peer review actions, Board of Dentistry cases, Department of Health investigations, pain management and pain medicine physician defense, pain management clinic defense, Zone Program Integrity Contractor (ZPIC) audit defense, Recovery Audit Contractor (RAC) audit defense, Medicaid Fraud Control Unit (MFCU) defense, Medicaid Fraud Control Unit (MFCU) search warrant and subpoena defense, Department of Health (DOH) subpoena defense, representation in clinical privileges hearings, representation before the Education Commission for Foreign Medical Graduates (ECFMG), National Board of Medical Examiners (NBME) representation, United States Medical Licensing Examination (U.S.M.L.E.) challenges and representation, all types of commercial and business litigation, administrative hearings, negotiation of contracts and other matters of Health Law and legal representation of health care professionals.

Your Professional Therapist License Is a Valuable Asset; Insure It!

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

Time and time again, I am contacted by mental health counselors, social workers, and other therapists who have worked hard for years, have paid tens of thousands of dollars for tuition, fees, books, and board, and made sacrifices in order to obtain a professional degree and a professional license. Yet they have not purchased professional insurance to protect their licenses.

Your professional license is arguably your most valuable asset. Yet, I am continuously surprised to learn the number of health professionals who come to our firm in serious trouble because a complaint has been filed against them. Complaints can come from anyone, including an unhappy patient, patient’s family, former employer, vengeful co-worker, or disgruntled former spouse, boyfriend, girlfriend, etc. Often the issues are complex. The legal procedures surrounding administrative complaints and administrative hearings are certainly complicated and confusing. Hiring an experience attorney is your best line of defense. However, it can also be costly.

Hypothetical Situation to Consider.

Here is a hypothetical situation to consider: You want to buy a particular item that is extremely expensive, such as a large piece of manufacturing equipment or a luxury stretch limousine. This item could not only produce an income for you for years to come, but it may also add to your prestige and self-esteem, knowing that you have achieved something that few others ever do.

Would you insure your expensive item? I certainly would and I expect you would, too.

Why You Need Professional Liability Insurance.

When I am writing this, I am speaking of insurance to cover your legal defense expenses in case a complaint is filed against you that could jeopardize your professional therapist license.

In my experience, health professionals such as mental health counselors, social workers, and other psychotherapists are more likely to have a complaint filed against them that results in an investigation. That is why I say that you should purchase professional liability insurance because of the professional licensure defense coverage it provides; not because it pays in the event of a lawsuit.

Furthermore, given that most popular liability insurance, such as Healthcare Providers Service Organization (HPSO) Insurance, CPH & Associates Insurance, Chicago Insurance, Affinity Insurance, is cheap, it is foolish not to be insured.

You have an extremely valuable asset that could easily produce a million dollars in income during your lifetime. Don’t you think a few hundred dollars a year is worth paying to help protect it? That is why I say, “Buy professional liability insurance. Buy it now! Be sure you are covered for at least $25,000 in professional license defense expense coverage and preferably more, if you can get it. But buy it!”

Comments?

Have you dragged your feet in purchasing professional liability insurance? If so, why? Did reading this blog change your mind? Please leave any thoughtful comments below.

Contact A Lawyer Experienced in the Representation of Psychiatrists, Mental Health Counselors, Social Workers, Licensed Marriage and Family Therapists and Other Mental Health Professionals.

We routinely provide deposition coverage to psychiatrists, mental health counselors, social workers, licensed marriage and family therapists and other mental health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals. The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing psychiatrists, mental health counselors, social workers, licensed marriage and family therapists and other mental health professionals in investigations at the Board of Medicine, Board of Psychology, or the Board of Clinical Social, Marriage and Family, and Mental Health Counseling.

Call now or visit our website http://www.TheHealthLawFirm.com.

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.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

Mother and Daughter-In-Law Arrested for Allegedly Defrauding Medicaid Out of More Than $70,000

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A mother and daughter-in-law duo each face up to 30 years in prison for allegedly defrauding the Florida Medicaid program out of more than $70,000. According to a press release from the Florida Attorney General (AG), released February 20, 2014, the pair was arrested for allegedly running a scheme that involved billing the Medicaid program for services never rendered.

Click here to read the press release from the AG.

Mother and Daughter-In-Law Claimed to Provide Services to Developmentally Disabled Child.

According to the AG, the mother and daughter-in-law allegedly ran a scheme that involved billing the Medicaid program for services that were not actually provided to the mother’s developmentally disabled son. It’s alleged the mother submitted timesheets for work that was not provided. The press release did not state how the daughter-in-law was specifically involved in the scheme.

The mother and daughter-in-law are each charged with one count of Medicaid fraud, which is a first-degree felony. If convicted, the pair could face up to 30 years in prison and up to $10,000 in fines and restitution. Additionally, if convicted, this would be a crime of health care fraud. The collateral consequences could be devastating.

According to the AG, the Florida Medicaid Fraud Control Unit (MFCU) and the Tampa Police Department arrested the mother of the child, and the Chesterfield County Sheriff’s Department in South Carolina arrested the daughter-in-law.

When the MFCU is Involved, the Investigation is Serious.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Medicare and Medicaid Audits Should Not Be Dismissed.

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

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

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

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

The Health Law Firm’s attorneys routinely represent speech therapists, occupational therapists, vocational therapists, therapy groups, physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Source:

Jenn, Meale. “Attorney General Pam Bondi’s Office Announces the Arrest of Mother and Daughter-in-Law Duo for More Than $70,000 of Medicaid Fraud.” My Florida Legal. (February 20, 2014). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/5A11AC9DE5E6269A85257C85006D7EE3


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

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000

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

The two owners of a Minneola, Florida, ministry that helps provide counseling therapy and case management for children and families, each face up to 15 years in prison for allegedly defrauding Medicaid. According to the Florida Attorney General (AG), the pair was arrested on December 11, 2013. The owners were arrested after an investigation by the AG’s Medicaid Fraud Control Unit (MFCU) revealed that they allegedly bilked the Medicaid program out of $80,000.

Click here to read the press release from the AG.

Pair Charged With Participating in an Organized Scheme to Defraud Medicaid.

According to a Daily Commercial article, the two owners ran a counseling center that was suppose to link Medicaid recipients with a mental health condition to state-approved mental health counseling centers in the community. However, the MFCU’s investigation uncovered that the owners allegedly billed Medicaid for services that were never rendered. According to the investigation, the duo also instructed their employees to bill for entire families when only one family member received services. Employees of the ministry also allegedly billed for unauthorized expenses. Additionally, it is alleged the ministry received reimbursements for services provided to children who did not have any documented mental health condition.

The two owners are both charged with one count of participating in an organized scheme to defraud Medicaid, according to the Daily Commercial. If convicted, they each face up to 15 years in prison, up to $10,000 in fines, and restitution. Click here to read the article from the Daily Commercial.

Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Take Fraud Charges Seriously.

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

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

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully. Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

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

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Ray, Whitney. “Attorney General Bondi’s Office Announces Arrest of Lake County Couple for Nearly $80,000 Medicaid Fraud.” Florida Attorney General. (December 11, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/7BAB936C94315B3885257C3E006F8895

Daily Commercial. “Ministry Owners Charged with Medicaid Fraud.” Daily Commercial. (December 12, 2013). From: http://www.dailycommercial.com/news/article_cc247b13-5771-5da4-9cab-545c5614aa91.html

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

 

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

Department of Health and Human Services Announces Mental Health Parity Final Rule

Lance Leider_smBy Lance O. Leider, J.D., The Health Law Firm

On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system has openly discriminated against Americans with behavioral health problems.”

The purpose of the regulations is to close the gaps in coverage that permit insurance carriers to treat mental and substance-abuse related treatment different from traditional medical and surgical benefits.

Among the key provisions of the regulations are the elimination of separate mental health deductibles, co-insurance, etc.; elimination of limits on lifetime benefits; as well as several other measures insuring that mental health benefits are treated on par with traditional medical and surgical benefits.

Compliance with the final rule will be required by group health plans and health insurance issuers offering group health insurance coverage on the first day of the first plan year beginning on or after July 1, 2014.

Click here to read the press release from the HHS.

Effects on Healthcare Providers.

From a business perspective, this final rule may change the type of coverage that is required to be offered by a practice to its employees. Likewise, employed practitioners may see changes in the way the coverage offered by their employers works.

Also, these rules may allow primary care providers to significantly limit their exposure to civil and administrative complaints resulting from the provision of basic mental health services. Often times patients who are unable to afford mental health coverage rely on their primary care physician for assistance. This sometimes leads to primary care doctors prescribing and managing medication for which they are inadequately trained or otherwise uncomfortable with.

By ensuring parity in coverage, primary care physicians should be able to make referrals to mental health providers with confidence that their patients will not face any artificial barriers to coverage.

Additionally, mental health providers will likely see an increase in patient volume and utilization. These increases will likely come from additional referrals from physicians as well as increased self-referrals from patients seeking to take advantage of their coverage.

Finally, with increased utilization comes increased revenue, and with increased revenue comes increased scrutiny. Private insurers have undertaken an auditing protocol that is remarkably similar to that of federal payors like Medicare, Medicaid, TRICARE, etc.

Considering the abuses that have been publicized in the mental health sector and the increased scrutiny coming from federal and state governments, we expect mental health providers will receive the same or similar audit treatment from private payors.

Be Prepared for Possible Change in Mental Healthcare Field.

Should the Affordable Care Act (ACA) ultimately serve to dramatically increase the number of Americans with insurance coverage, mental health providers may find themselves at the forefront of a rapidly expanding part of the healthcare field.

Be prepared for these changes by reviewing your processes and documentation. Consult with an experienced healthcare attorney or other similarly qualified expert to make sure your practice is ready.

The Health Law Firm Supports the Mental Health Parity Rule.

The Health Law Firm fully supports the Mental Health Parity Rule. The provision of mental health services for our citizens is long overdue.

Many fail to recognize the costs paid by our society to deal with those who have mental health issues outside of the healthcare system. Jails and prisons are often the final repository for those who should receive hospital treatment. Many individuals who are homeless, who are veterans, or who have serious mental health issues could lead constructive, productive lives if they receive proper mental health treatment.

Psychologists, psychiatrists, mental health counselors and social workers should be happy for the adoption of the regulation. In addition, law enforcement officials, judges and relatives of those with mental illness must also be thankful.

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

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers and family therapists in Department of Health (DOH) 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.

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

Comments?

Were you familiar with the final mental health and substance use disorder parity rule? How do you think it will affect the mental healthcare field? Please leave any thoughtful comments below.

Source:

U.S. Department of Health and Human Services Press Office. “Administration Issues Final Mental Health and Substance Use Disorder Parity Rule.” U.S. Department of Health and Humans Services. (November 8, 2013). From: http://www.hhs.gov/news/press/2013pres/11/20131108b.html

About the Author: Lance O. Leider 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.

 

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

CMS Issues Conditions of Participation for Community Mental Health Centers

Lance Leider_smBy Lance O. Leider, J.D., The Health Law Firm

On October 28, 2013, the Centers for Medicare and Medicaid Services (CMS) announced a Final Rule establishing conditions of participation (CoPs) for Medicare-certified community mental health centers (CMHCs). The Final Rule is CMS 3202-F. These conditions are the health and safety regulations Medicare providers must meet in order to participate in the Medicare program and receive reimbursements. The stated purpose of the CoPs is to improve client care, establish requirements for staff and provider operations, and encourage clients to participate in their own treatment. According to CMS, many CMHCs are currently not required to meet any health and safety standards.

To read the Final Rule from the CMS, click here.

A CMHC is a provider that meets applicable licensure and certification requirements in the state in which it is located and provides certain care and services.

Mental Health Centers Must Meet These New CoPs.

CMS finalized six new CoPs. All clients will have a treatment team, an active treatment plan, and coordination of services providing individualized client care. Clients must be provided with an initial evaluation, a comprehensive assessment, and a discharge or transfer plan that identifies each client’s needs and how those needs will be met on a timely basis. Also, CMHCs must use outcome and client satisfaction data to identify specific program needs and improve the quality of care provided. The regulations also promote continuity of care by emphasizing the need for communication with other service providers regarding client needs at the time of discharge or transfer.

In a press release, CMS stated that the new CoPs will help raise standards for the 100 CMHCs that participate in Medicare. The conditions will supposedly ensure a higher quality of care and safety for more than 13,000 Medicare beneficiaries being treated at mental health centers.

Click here to read the press release from the CMS.

Effective Date for New Requirements is October 29, 2014.

The regulations take effect on October 29, 2014. To verify CMHCs are meeting the new requirements, CMS will survey these centers at least once every five years. However, if CMS receives a complaint on a CMHC, surveys may occur more frequently. Considering the scrutiny that has been applied recently to the provision of mental health services, we expect surveys to be much more frequent.

Contact Health Law Attorneys Experienced in the Mental Health Counselors, Therapists and Facilities.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers and family therapists in Department of Health (DOH) investigations, FBI investigations, audits and other types of investigations of health professionals and providers. Our attorneys also represent community mental health centers and other types of mental health facilities.

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

Comments?

What do you think of the new CoPs for CMHCs? How do you think these conditions will improve patient care? Please leave any thoughtful comments below.

Sources:

Centers for Medicare and Medicaid Services. “CMS Issues New Patient Safety Standards for Community Mental Health Centers.” CMS. (October 28, 2013). From: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-10-28.html

Bourque, Dianne. “CMS Finalizes Conditions of Participation for Community Mental Health Centers.” American Health Lawyers Association. (November 5, 2013).
About the Author: Lance O. Leider 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.

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

New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million

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

For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due to credible allegations of fraud, according to KUNM News. The behavioral health agencies are accused of collectively defrauding Medicaid of $36 million over three years. The findings in an audit conducted in 2012, by OptumHealth, the contractor that handles Medicaid payments for New Mexico’s behavioral health system, alarmed state officials to the point that they hired Public Consulting Group (PCG), a firm that specializes in Medicaid fraud, to conduct another audit in June 2013.

These behavioral health agencies provided services to approximately 30,000 patients. According to KUNM News, Arizona companies have been hired to step in to help patients needing treatment.

Click here to read the KUNM News article.

Audits and Whistleblower Claims Uncover Serious Accusations.

The reason for the Medicaid funding freeze, according to the HSD, was the initial audit conducted by OptumHealth, the company that manages Medicaid dollars for New Mexico’s behavioral health agencies. OptumHealth allegedly found problems with billing by the agencies in question. Then a second audit by PCG allegedly uncovered widespread overpayments for services that had never been provided. According to the New York Times, a quarter of patients’ claims were processed with mistakes.

During the PCG audit, whistleblowers also came forward with their own accusations, according to the New York Times. In one case, an employee was allegedly ordered not to inform the state that a patient had died. In another, an ex-employee at an agency reported being fired after refusing to overbill for services.

Click here to read the entire New York Times article.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Mental Health Providers Fight for Funding.

New Mexico officials state that they were obligated under federal law. Under the Affordable Care Act, states have more power to suspend payments when there is credible evidence that Medicaid dollars are being misused. All 15 mental health providers sought exceptions from the state so their Medicaid funding could be restored while the investigation continues. Only three exceptions were granted, according to the New York Times.

Mounting Pressure to Root Out Medicare and Medicaid Fraud.

Just this year, we’ve noticed the government become more aggressive in its anti-fraud and recovery efforts. The Affordable Care Act also gives investigators and prosecutors new tools to crack down on abuse. Now that the government is collecting more money, you can expect their efforts to get worse.

Since whistleblowers stand to receive up to thirty-five percent (35%) of a recovery made by the government, plus attorney’s fees and costs, you can expect more whistleblower lawsuits to be filed. Therefore, it is now more important than ever to verify accurate billing and coding.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

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

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower 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.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Frosch, Dan. “Fraud Investigation Unsettles Mental Health Care in New Mexico.” New York Times. (September 16, 2013). From: http://www.nytimes.com/2013/09/14/us/fraud-investigation-unsettles-mental-health-care-in-new-mexico.html?pagewanted=all&_r=0

Ahtone, Tristan. “A Timeline of NM’s Shakeup of Behavioral Health Providers.” New Mexico In Depth. (September 13, 2013). From: http://www.nmindepth.com/2013/09/13/a-timeline-of-nms-shakeup-of-behavioral-health-providers/#

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.