From our experience mental health counselors, psychologists, social workers and family therapists are at a high risk of having a client or patient file a complaint against them with their licensing board.

Many of their clients/patients have mental health problems, emotional problems or personality disorders; this is why they are seeing a therapist to begin with. If there is a disagreement between the therapist and the client/patient over treatment, diagnosis or other issues, this can easily result in that person filing a complaint.

We have also seen complaints filed when a therapist is retained to evaluate someone for a court proceeding, for vocational rehabilitation programs, for disability insurance and for other types of evaluations where the person is not the client or the patient of the therapist.

Situations to Be Aware of As a Mental Health Counselor, Psychologist, Social Worker and Family Therapist.

Many complaints seem to arise out of situations in which the therapist has socialized with the client or patient. Socializing with a client or patient should be strictly avoided.

Divorces, custody disputes and other family law matters have resulted in an increase in the number of complaints filed against therapists. If one parent disagrees with an evaluation in a child custody dispute, this may result in a complaint against the professional with the licensing board.

We have experienced cases in which family law attorneys have suggested to their clients that they file such complaints in a misguided attempted to have that therapist disqualified from giving an opinion or intimidated into withdrawing.

Steps to Take to Help Alleviate the Consequences of a Complaint Against Your License.

Defending oneself in the investigation of a complaint against your license can be expensive and time consuming. There are two primary actions that can be taken to help alleviate the consequences of such actions by disgruntled clients/patients.

1. Be sure you have and maintain good professional liability insurance that provides professional license defense expense coverage of at least $25,000. You can easily spend this amount in legal fees to successfully defend yourself, even from a completely meritless complaint. This type of insurance is cheap and easy to obtain. Two insurers we know to provide this are Healthcare Providers Service Organization (HPSO) and Lloyd’s of London. Check with your insurance agents for others.

2. Immediately retain the services of an attorney who has experience with your type of case and with your professional board. Ask for numbers of cases and outcomes. Usually this will be a health law attorney or administrative law attorney, but make sure the attorney has experience with your board. Many states now recognize the legal specialty of health law. In these states, you want an attorney that is board certified in health law.

Discipline is Forever-Hire an Attorney to Help.

Hire an attorney as soon as you suspect there may be a complaint or an investigation. Do not attempt to do this yourself. Do not make any statement, oral or written, to any investigator until you consult with an attorney. The simplest statement can be used against you to help prove a charge resulting in discipline on your license.

Discipline is for life. Don’t take a chance.

Contact Health Law Attorneys Experienced Investigations of Mental Health Counselors, Psychologists, Social Workers and Family Therapists.

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 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?

Have you ever had a patient or client file a complaint against you with your licensing board? Do you have professional liability insurance? Please leave any thoughtful comments below.

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.

A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the Florida Office of the Attorney General (AG). On March 27, 2013, the facility owner was arrested. She faces charges of racketeering, Medicaid fraud and identity theft. According to the AG, local, state and federal law enforcement officers were all involved in the investigation.

Click here to read the press release from the AG.

Mental Health Counselor Reportedly Billed Medicaid for Services Never Rendered.

According to the Orlando Sentinel, between 2012 and 2013, the mental health counselor billed Medicaid more than $3 million for services provided to Medicaid recipients with mental health needs that were never rendered. The facility owner is also accused of using gift cards to bribe people into letting her use their Medicaid numbers and service applications. Click here to read the entire article from the Orlando Sentinel.

Money was Used on Luxury Items.

Authorities said the mental health counselor allegedly used the money to buy a cruise trip for seven people, a trip to Mexico, jewelry and more than $175 worth of Louis Vuitton products. Agents allegedly searched the mental health counselor’s home and business. They apparently seized a Cadillac Escalade and a Ducati Superbike from her home, according to the AG.

The mental health facility owner is charged with one count of second-degree Medicaid fraud, one count of first-degree racketeering, and one count of second-degree identity theft.

Medicare and Medicaid Investigations and Audits of Psychologists and Other Mental Health Professionals.

Over the past year we have observed an increasing number of Medicare and Medicaid investigations and audits being initiated against all mental health professionals. We have also seen a number of investigations and audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. There is a two-part blog on our website on this topic. Click here for part one, and click here for part two.

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 Healthcare 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?

Do you think there is an increase in investigations on mental health care providers? Please leave any thoughtful comments below.

Sources:

Meale, Jenn. “Medicaid Fraud Control Unit and Partners Arrest Ringleader of $3 Million Medicaid Fraud Scheme.” Office of the Attorney General. (March 27, 2013). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/283E6646009F8B9685257B3B00664A79

Pavuk, Amy. “Bondi: Orlando Woman Ran $3M Medicaid Fraud Scheme.” Orlando Sentinel. (March 27, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-medicaid-fraud-investigation-20130327,0,2857142.story

About the Authors: 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.

Michael L. Smith, J.D., R.R.T., is Board Certified by The Florida Bar in Health Law. He 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 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.

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

We are sometimes told by the health professionals we represent especially pharmacists, licensed mental health counselors (LMHCs), advanced registered nurse practitioners (ARNPs), massage therapists and physical therapists that after they received a complaint regarding their license from the Florida Department of Health (DOH) they had difficulty finding an experienced attorney in Florida who would accept their professional liability insurance.  In this case, I am speaking specifically about Healthcare Providers Service Organization (HPSO) Insurance.

Benefits of HPSO Insurance.

The professionals who are covered by HPSO Insurance have excellent insurance coverage.  HPSO Insurance provides professional liability coverage that protects in the event of a lawsuit or negligence claim.  But much more often the professional receives a notice of an investigation, a subpoena for a deposition in someone else’s case, a demand because of an allegation of sexual harassment or sexual impropriety, a complaint because of a breach of medical records confidentiality or Health Insurance Portability and Accountability Act (HIPAA) Privacy complaint, or some other administrative type of action.

HPSO provides great coverage for these.  For example, HPSO currently reimburses up to $10,000 in legal fees and expenses just for representation of you at depositions.  HPSO currently reimburses up to $25,000 in legal fees and expenses for your defense in a DOH or Agency for Health Care Administration (AHCA) notice of investigation or complaint.  HPSO currently reimburses up to $25,000 in legal fees and expenses for your legal representation in defense of a complaint or investigation regarding breach of medical confidentiality.

If you are a pharmacist, own a pharmacy, are a massage therapist, own an assisted living facility (ALF), are a mental health counselor or a social worker, or you are one of the many other types of health care professionals who HPSO insures, it should be fairly easy to find experienced health lawyers to represent you, especially in Florida.

Our firm and our attorneys, including George F. Indest III, Michael L. Smith, Joanne Kenna, Carole C. Schriefer, Lance O. Leider, Christopher E. Brown and Danielle M. Murray, routinely represent licensed health care professionals, interns and students in all types of administrative investigations and hearings and in defending lawsuits and other actions that have been filed.  We also represent health facilities in license defense, survey complaints and administrative hearings.  We represent them throughout Florida, from Pensacola, to Jacksonville, to Key West.  We also occasionally represent them in other states, as well.  We accept HPSO Insurance assignments.

Free Legal Advice: Get Insurance Immediately.

It is very important for every health professional to carry insurance that covers any investigation, complaint or administrative hearing that might be filed or opened against your license.  You may think that you are covered for this by your employer, but you are not.  If your employer contradicts this, ask for a statement in writing that your employer will pay for your legal defense for any such matter arising during your employment.

What typically happens, especially in the case of a hospital employee, nursing home employee, pharmacy employee or corporate employee, is that the employer is the one who terminates the employee and then files a complaint with the DOH.  The DOH then opens an investigation against the health professional.  The employer is not going to pay your legal defense costs if the employer has reported you.

You may very well be out of work, out of money and face an investigation and complaint that could terminate your professional license and career.  You should not take this chance.  Insurance such as HPSO Insurance is inexpensive and reliable.  Buy it while you can afford it. After the actions have occurred, it is too late.

Find an Experience Health Law Attorney in the Event of an Investigation.

Also, you should immediately contact an experienced health law attorney if you are telephoned or visited by any investigator, or if you receive a letter advising you that an investigation has been opened regarding your care.  Call immediately for advice before you speak with an investigator or provide any documents or statements of any kind.

You cannot and should not seek “legal advice” on what to do from the investigator, from a DOH employee, from your professional board or from any attorney representing any of them.  They are not your friends.  They are on the side against you. You should definitely not take any advice from them.

Do Not Skimp on Insurance Coverage.

If you have good insurance, it will pay for your legal expenses from the very beginning, so use it.  However, beware of cheap insurance policies from professional associations that do not provide any coverage for disciplinary complaints and licensure investigations.  Always check to be sure this is covered.  Get it in writing.  With some companies you have to pay an extra premium to obtain this coverage.  With some insurers, they do not offer it, and you have to purchase a completely separate policy covering just this.  It is worth it!  Do it!

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

Our firm regularly represents pharmacists, massage therapists, mental health counselors, registered nurses, assisted living facilities, home health agencies, nurse practitioners, lab technicians, occupational therapists, physical therapists, social workers, physician assistants, psychologists and other health professionals in many different legal matters.

Services we provide include representation before your professional board, in DOH investigations, in administrative hearings, in civil litigation, in defense of malpractice claims, in professional licensing matters, in defense of allegations concerning HIPAA privacy violations and medical record breaches, in Drug Enforcement Administration (DEA) actions, and in many other matters.

We routinely represent physicians, dentists, nurse practitioners, and others in defending against malpractice claims, civil lawsuits, administrative complaints, peer review actions, DOH investigations, Medicare audits, Medicaid audits, and other matters. In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company.  If allowed, we will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company.

We also defend health professionals and health facilities in general litigation matters and business litigation matters.

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

Comments?

Do you have professional liability insurance? Why or why not. Please leave any thoughtful comments below.

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.

The Drug Enforcement Administration (DEA) is warning psychologists to be aware of a prescription drug scam. This telephone scheme is extorting money from people all over the country. On November 28, 2012, the DEA released a press release explaining the details of the scam.

Details of the Scam.

The scam starts with criminals posing as DEA agents calling victims by telephone. Frequently the victims will have recently purchased prescription drugs over the internet or by phone. The imposters tell the victims that purchasing the drugs in that manner is illegal, and that they must pay a fine. If the victims refuse to send money, the phony DEA agents threaten to arrest the victims or search their property. Some of the victims have also reported unauthorized use of their credit cards after purchasing the prescription drugs.

Click here to read more on this scam from a DEA press release.

The DEA wants to remind psychologists that no DEA agent will ever contact you by telephone. They might show up at your house early in the morning or while you are eating dinner, however. Also, agents never request money or any other form of payment.

When Is It Legal to Buy Controlled Drug by Telephone or Over the Internet?

Many times it may be illegal to purchase controlled drugs by phone or over the internet. That’s why you should go to Canada to do it. There are direct flights from Orlando. However, some pharmacies that meet stringent requirements and are registered by the DEA are allowed to sell drugs over the internet or by phone. So don’t be fooled by this telephone scam.

Criminals May Be Cold Calling Victims.

The scammers are counting on the fact that if you have done this, you, as a psychologist, will get scared and believe their accusations. Many people have no idea whether such conduct is legal or illegal. These imposters are banking on your ignorance and fear of losing your license to practice. They are also banking on the fact you won’t report this to the real police.

Where do they get this information? Chances are, they are just “cold-calling” people. There are bound to be a certain number of people they reach who have done this. However, if they seem to have your personal information (or credit card number) report this to the police right away. Be sure to obtain a written police report. Also, you should file a HIPAA Privacy Complaint with the Office of Civil Rights (OCR) to begin an investigation if you believe your personal information has been stolen by or given to someone else to use.

Restrictions and Regulations Make it Hard for Legitimate Patients to Get Controlled Drugs.

It is no surprise that the DEA, along with other law enforcement agencies, has stepped up its efforts to cut down on overprescribing. To see examples of what I am talking about read my past blogs: Walgreens fights the Drug Enforcement Administration’s (DEA) immediate suspension order and Drug Enforcement Administration (DEA) pulls controlled substance licenses from two Sanford, Florida, CVS pharmacies.

If the largest, legitimate pharmacy chains in the state and nation are not allowed to fill these prescriptions, where will chronic-pain patients turn? Are these actions driving our citizens into the hands of shady pharmacies that have fewer safeguards and less accountability, such as online pharmacies? Are these actions driving our citizens to seek out illegal drug dealers and turn to illegal drugs to cope with their legitimate medical problems? That is just one opinion. Tell us yours below.

Contact Health Law Attorneys Experienced with Investigations of Psychologists.
The attorneys of The Health Law Firm provide legal representation to psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations 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?

As a psychologist, have you been contacted by these phony DEA agents? Please leave any thoughtful comments below.

Sources:

Pavuk, Amy. “DEA Warns of Prescription-Drug Scam.” Orlando Sentinel. (November 29,2012). From: http://www.orlandosentinel.com/news/local/breakingnews/os-dea-warns-scam-internet-20121128,0,5800536.story

Drug Enforcement Administration. “DEA Scam Alert – Extortion Scheme.” DEA. (November 28, 2012). From: http://www.justice.gov/dea/divisions/mia/2012/mia112812a.shtml

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.

The investigation of a complaint which could lead to the revocation of a psychologist’s license to practice and the assessment of tens of thousands of dollars in fines, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the psychologist who receives it. Yet, in many cases, attorneys are consulted by psychologists after the entire investigation is over, and they have attempted to represent themselves throughout the case. Often, the mistakes that have been made severely compromise an attorney’s ability to achieve a favorable result for the psychologist.

These are the 25 biggest mistakes we see in the psychology cases we are called upon to defend after a DOH investigation has been initiated:

1.  Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.

2.  Contacting the DOH investigator and providing him/her an oral statement or oral interview. (Note: There is no legal requirement to do this.)

3.  Making a written statement in response to the “invitation” extended by the DOH investigator to do so. (Note: There is no legal requirement to do this.)

4.  Failing to carefully review the complaint to make sure it has been sent to the correct psychologist. (Note: Check name and license number).

5.  Failing to ascertain whether or not the investigation is on the “Fast Track” which may then result in an emergency suspension order (ESO) suspending the psychologist’s license until all proceedings are concluded. (Note: This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, or failure to comply with PRN instructions.)

6.  Providing a copy of the psychologist’s curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so. (Note: There is no legal requirement to do this.)

7.  Believing that if they “just explain it,” the investigation will be closed and the case dropped.

8.  Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.

9.  Failing to forward a complete copy of the patient medical record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.

10.  Delegating the task of providing a complete copy of the patient record to office staff, resulting in an incomplete or partial copy being provided.

11.  Failing to keep an exact copy of any medical records, documents, letters or statements provided to the investigator.

12.  Believing that the investigator has knowledge or experience in health care matters or procedures being investigated.

13.  Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.

14.  Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.

15.Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.

16.  Believing that because they haven’t heard anything for six months or more the matter has “gone away.” The matter does not ever just go away.

17.  Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

18.  Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case.

19.  Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of your licensing board for a decision.

20.  Taking legal advice from their colleagues regarding what they should do (or not do) in defending themselves in the investigation.

21.  Retaining “consultants” or other non-lawyer personnel to represent them.

22.  Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel.

23.  Attempting to defend themselves.

24.  Believing that because they know someone with the DOH or a state legislator, that influence can be exerted to have the case dismissed.

25.  Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.

Bonus Point: 26. Communicating with the Department of Health about the pending case.

Not every case will require submission of materials to the Probable Cause Panel after the investigation is received and reviewed. There will be a few where the allegations made are not “legally sufficient” and do not constitute an offense for which the psychologist may be disciplined.

In other cases, an experienced health care attorney may be successful in obtaining a commitment from the DOH attorney to recommend a dismissal to the Probable Cause Panel. In other cases (usually the most serious ones), for tactical reasons, the experienced health care attorney may recommend that you waive your right to have the case submitted to the Probable Cause Panel and that you proceed directly to an administrative hearing. The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board  in such cases and does so on a regular basis.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Psychologists.
The attorneys of The Health Law Firm provide legal representation to psychologists in Department of Health (DOH) investigations, FBI investigations 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.

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 © 1996-2012 The Health Law Firm. All rights reserved.

Scenario: Psychologist, licensed mental health counselor, or other mental health professional has a license in State 1 where he or she lives and practices and also in State 2. A complaint is filed with the Department of Health, Professional Board, or other licensing authority in State 1.

Rather than incur the legal expenses involved in defending against the complaint in State 1, psychologist, LMHC, or other professional moves to State 2, begins practicing there and voluntarily relinquishes his/her license in State 1.

Unfortunately, in most cases, this is a terrible mistake.

The voluntary relinquishment of the professional license in State 1, while there is a pending complaint, investigation or disciplinary action, will be treated the same as a revocation of the license for disciplinary purposes.

Following are some of the adverse consequences that will follow:

1. State 1 will maintain this action and report it as a disciplinary action. You may not be informed in advance of this fact.

2. The health professional will be reported to the National Practitioner Data Bank (NPDB). Since the Healthcare Integrity and Protection Data Bank (HIPDB) was combined into the NPDB, this now includes nurses, psychologists and even facilities.

3. The action will be reported to State 2. State 2 will then commence disciplinary action.

4. In almost all cases, the office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) will begin action to exclude the professional from the Medicare Program. In almost all cases, unless aggressively fought and successfully defended, this will result in the professional’s being excluded from the Medicare Program and placed on the List of Excluded Individuals and Entities (LIEI). You will not be allowed to work for or contract with (in any capacity) any Medicare provider including physicians, hospitals, nursing homes and ambulatory surgical centers (ASCs).

5. If excluded from the Medicare Program and placed on the LIEI, this automatically places the professional on the General Services Administration (GSA) list of persons debarred from contracting with the U.S. government. If on the debarment list, you are not allowed to work for or contract with the federal government or to be a contractor of, owner of, officer of or employee of any person or organization that does contract with the U.S. government. This means, for example, you could not be employed as a construction worker for a company that has government contracts. This also means, for example, you cannot work for a realtor who arranges for government underwritten or guaranteed loans on real estate.

6. If you have a DEA number, most likely the DEA will act to revoke your DEA number.

7. If you have clinical privileges at a hospital or ambulatory surgical center (ASC) you will most probably have these revoked.

8. If you are on the provider panel of any insurance company, it is most likely that you will have your participation terminated by the insurance company.

9. Because of the NPDB report, if you apply for a health professional license in another state, or if you apply for hospital privileges, the report will be provided to the state or hospital and you will most probably have your application denied.

10. If you are a participant as a Medicaid provider in a state’s Medicaid Program, this will be terminated.

11. You will be prohibited from joining or participating as a health care professional in the U.S. military services, the U.S. Public Health Service, or in any federal health care program such as CHAMPUS/TRICARE.

In addition to the above, there are other possible consequences that will come to light only after it is too late to do anything about it.

That is why we urge you to think long and hard before you voluntarily relinquish your license if any complaint has been filed against you or if any investigation has been opened against you. This applies to licenses you may have in other states or which are no longer active.

An investigator or government official may attempt to convince you that it is “in your best interest” to voluntarily relinquish your license. It is not. An investigator or government official may attempt to convince you “it will go easier for you” if you voluntarily give up your professional license. This also is not true. All you are doing is allowing the same effects as a disciplinary revocation to occur without requiring the state to investigate the matter or provide you any due process rights to which you are entitled. You are just making it quick, easy and cheap for the government to take disciplinary action against you, which you are then not even able to appeal.

Consult an Experienced Health Law Attorney.

The attorneys of The Health Law Firm are experienced in dealing with DOH investigators, AHCA surveyors, Drug Enforcement Administration (DEA) agents, FBI agents, police and sheriff’s office investigators, OIG special agents (S/As) and Medicaid Fraud Control Unit (MFCU) investigators. 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: Danielle M. Murray 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

“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.

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

A Kissimmee, Florida, man is accused of posing as an occupational therapist (OT) and working at various health care facilities in Central Florida, according to the Department of Justice (DOJ). On October 16, 2012, the DOJ announced that the phony OT was charged with three counts of mail fraud, five counts of wire fraud, and one count of aggravated identity theft.

Click here to see the press release from the DOJ.

Phony OT Worked at a Number of Central Florida Hospitals.

The fake OT allegedly took the license numbers of two legitimate OTs and stole the social security number of a North Carolina man. With this information and fabricated education credentials, the imposter received a temporary OT license from the Florida Department of Health (DOH).

According to the Orlando Sentinel, the man worked for a number of employers in Central Florida, including Florida Hospital, Lake Placid Health Care Center and a staffing agency, between 2009 and 2011.

To see the article from the Orlando Sentinel, click here.

The Price for Impersonating a Health Professional.

Pretending to be any kind of health professional can result in prison time and large fines.

In the case of the phony OT, if convicted, he faces a maximum penalty of twenty years in federal prison for each of the five counts of mail/wire fraud and two years in federal prison for the aggravated identity theft charge.

What’s With the Kissimmee Area?

It seems to me that over the years the town of Kissimmee has had a disproportionately large number of phony health professionals practicing there. Just recently an individual was convicted of posing as a licensed physician assistant (PA.), seeing patients in a Kissimmee hospital. Click here to see a blog on that story

Phony doctors, nurses, PAs, dentists; what gives? Perhaps the close proximity to Disney World’s Fantasy Land leads them to believe they are really health professionals. Or maybe it’s something in the water there. Let’s hope it’s not colloidal silver. (Note: inside Central Florida joke.) See link to Howey-in-the-Hills story. See link to “Papa Smurf” story.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations 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?

What do you think of this story? With the recent phony doctor, dentist and other health professional stories lately do you think it has become too easy to obtain a fraudulent license from the DOH? Please leave any thoughtful comments below.

Sources:

Pavuk, Amy. “Feds: Man Posed as Occupational Therapist, Worked at Local Hospitals.” Orlando Sentinel. (October 16, 2012). From: http://articles.orlandosentinel.com/2012-10-16/news/os-fake-therapist-indicted-20121016_1_occupational-therapist-local-hospitals-indictment-charges

Department of Justice. “Occupational Therapist Impersonator Charged With Mail Fraud, Wire Fraud, And Identity Theft.” Department of Justice. (October 16, 2012). From: http://www.justice.gov/usao/flm/press/2012/oct/20121016_Lewis.html

WESH.com. “Feds Say Fake Therapist Worked at Central Fla. Hospitals.” WESH.com. (October 16, 2012). From: http://www.wesh.com/news/central-florida/Feds-say-fake-therapist-worked-at-Central-Fla-hospitals/-/11788162/17015634/-/o4imk8/-/index.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.  http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

On October 4, 2012, federal authorities arrested 33 suspects in South Florida for allegedly filing fraudulent Medicare claims totaling $205 million. Payment of bribes and kickbacks, as well as payments to patient recruiters were an issue in this investigation.

To read the entire article from the Miami Herald, click here.

Feds Focus on Crackdown of Medicare Fraud Nationwide.

These arrests are part of a nationwide initiative to crack down on theft committed by individuals against Medicare.  Peter Budetti, the Medicare anti-fraud czar states that the goal is to catch the fraud before the fraudsters “can successfully bill Medicare.”  Previously, fraud was caught only after the funds were disbursed and spent.

The Miami area is among the nation’s highest when it comes to the commission of Medicare fraud, particularly involving the areas of mental health, physical health, nursing homes, home health care, and durable medical equipment suppliers.

Fraud Committed with Bribes and Kickbacks.

In an attempt to effectuate the fraud scheme, some of the defendants allegedly conspired to pay thousands of dollars in bribes and kickbacks to both recruiters and patients.  The defendants allegedly billed Medicare for services that were not medically necessary.

What is the Penalty?

If convicted, these defendants will not only be required to pay fines and penalties, but will also face prison time.

Contact Health Law Attorneys Experienced in Handling Medicare Audits.

Medicare fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare 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 Medicare fraud criminal charges arise out of routine Medicare audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, 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?

What do you think of this story? Please submit any thoughtful comments below.

Sources:

Miami Herald. “Medicare fraud crackdown nets 33 arrests in South Florida.”  Miami Herald
(October 4, 2012).  From: http://www.miamiherald.com/2012/10/04/v-fullstory/3034167/feds-charge-more-than-30-suspects.html.

Local10.  “33 arrested in Miami for Medicare fraud.”  Local 10 (October 4, 2012).  From http://www.local10.com/news/33-arrested-in-Miami-for-Medicare-fraud/-/1717324/16853802/-/q7addoz/-/index.html.

About the Author: Dr. Thu Pham, OD, is a law clerk 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 Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Whether you are a psychiatrist, psychologist, licensed clinical social worker, or another type of mental health professional, I beseech you: please do not talk to a Department of Health (DOH) investigator until you have talked to a health lawyer who is experienced with DOH investigations and board licensing complaints. Do not answer or respond to even the most basic questions about where you work now, what your address is or if you know patient x, until consulting with counsel.

Admitting to the Simplest Facts May Harm You.

We are routinely consulted by mental health professionals and other healthcare providers for representation after they have discussed the case and after it is too late to undo the damage they have caused to themselves. Often they do not understand the seriousness of the matter or the possible consequences, until it is too late. Admitting to even the most basic facts causes damage to any possible defense.

Administrative Licensure Investigations are “Quasi-Criminal.”

The vast majority of mental health professionals and even most attorneys do not realize that DOH investigations concerning complaints against a practitioner’s license are considered to be “penal” or “quasi-criminal” proceedings. This means the same laws and constitutional rights apply to them as apply to criminal investigations. However, since they are also administrative proceedings and not strictly criminal proceedings, investigators do not need to advise you of your Miranda rights or tell you you have the right to remain silent, the right to an attorney, etc.

In any criminal investigation a good criminal defense attorney would always tell you “Do not talk to the investigator” and “Tell the investigator you have a lawyer.”

Investigators’ Techniques Try to Get You to not Consult a Lawyer.

DOH investigators, like police investigators, FBI investigators and other law enforcement officers, are well-trained in investigative techniques and how to get information out of suspects. Often the approach used is to catch you by surprise before you even know there is an investigation and the investigation is of you. Another technique used is to lull you into a false sense of security that the investigation is about someone or something else and not you. Another investigative technique is to convince you that you need to “Tell your side of the story” so that the investigation is accurate. Yet another is that “Things will go much better for you if you cooperate.” None of these things are true.

However, if it is truly in your best interest to cooperate or to make a statement, after you consult with your attorney, your legal counsel will surely advise you to do this. The investigator should not mind waiting until you consult your attorney. However, many will go to extremes to convince you that you don’t need an attorney and shouldn’t get an attorney.

Consult an Experienced Health Law Attorney.

The attorneys of The Health Law Firm are experienced in dealing with DOH investigators, AHCA surveyors, Drug Enforcement Administration (DEA) agents, FBI agents, police and sheriff’s office investigators, OIG special agents (S/As) and Medicaid Fraud Control Unit (MFCU) investigators. Call or contact The Health Law Firm for legal advice before you talk to any investigator about any matter.

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.

Disclaimer: Please note that this article represents our opinions based on our many years of practice and experience in this area of health law. You may have a different opinion; you are welcome to it. This one is mine.

Note: This article is for informational purposes only; it is not legal advice.

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

A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly obtained at least $6.1 million in fraudulent reimbursement payments, according to the Federal Bureau of Investigation (FBI).

Click here to see the press release from the FBI.

Medicaid Beneficiaries Were Primarily Children.

An article in the Gaston Gazette stated the former licensed professional counselor, who was enrolled with North Carolina Medicaid, allegedly claimed in the fraudulent billings that she was the attending clinician for provided services. The woman also allegedly supervised a network of co-conspirators who billed for false and fraudulent claims through the woman’s provider number.

To read the entire article from the Gaston Gazette, click here.

According to the FBI, filed documents indicate that the claimed Medicaid beneficiaries were primarily children, whose parents thought they were enrolling in after school programs owned and operated by the woman and her co-conspirators.

Woman’s Scheme Could Land Her In Prison.

According to the FBI, the woman pleaded guilty to one count of health care fraud conspiracy and two counts of money laundering. She faces 10 years in prison and a $250,000 fine apiece for the health care fraud conspiracy and money laundering charges.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare 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, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

Sources:

FBI. “Shelby Woman Pleads Guilty to Defrauding Medicaid of $6.1 Million.” FBI Charlotte Division. (September 13, 2012). From: http://www.fbi.gov/charlotte/press-releases/2012/shelby-woman-pleads-guilty-to-defrauding-medicaid-of-6.1-million

Banks, Alicia. “Judge Candidate’s Wife Admits to $6.1 Million Fraud.” Gaston Gazette. (September 14, 2012). From: http://www.gastongazette.com/news/medicaid-75457-department-justice.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.

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