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.

Walgreens To Expand Mental Health Services to Raise Awareness

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

On May 10, 2016, Walgreens announced it will expand mental health services, including access to behavioral health treatment via telemedicine, to expand customer options for treatment, screenings and awareness. To improve overall mental health treatment, Walgreens will offer access to 1,000 therapists and psychiatrists via Breakthrough, an MDLive telemedicine company. Walgreens recently began a relationship with MDLive, a telemedicine company, to provide customers with around-the-clock access to physicians, as well as Mental Health America.

Mental Health Conditions.

According to the National Alliance on Mental Illness, about one in five Americans suffers mental health conditions, which is greater than medical conditions like diabetes and heart disease. But patient adherence to prescriptions is worse for mental health conditions than physical illnesses, so Walgreens is hoping that its pharmacists and nurse practitioners can have an impact.

“In mental health, in particular, adherence (to prescriptions) is a major, major challenge,” Walgreens chief medical officer Dr. Harry Leider said in an interview. Less than 50% of Americans who are prescribed medications to treat mental health conditions take them as directed, if at all, Walgreens said. “Pharmacies have always been oriented around supporting patients who are on medications for mental health conditions, but we are providing even more training around medication issues,” Leider said.

The Push for Expansion of Mental Health Care.

Walgreens is one of several large drugstores, like CVS and Wal-Mart, to push further beyond a pharmacy chain’s traditional role of dispensing and managing customer prescription needs. The pharmacy giant believes it can make a difference given six million Americans shop at the drugstore chain’s stores each day and some two million people come to digital properties like the company’s web site and mobile.

In further the expansion, Walgreens is working with Mental Health America, a nonprofit that will help the drugstore giant connect its customers to free community-based screenings for mental health conditions that include depression, anxiety and bipolar disorders. Walgreens will also work with other experts in the field to improve training and education of its more than 27,000 pharmacists and more than 1,100 nurse practitioners and physician assistants employed at its drugstores. To read more on Mental Health America, click here.

Mental Health America and Walgreens has set a goal to screen three million people by the end of 2017 to improve care and patient awareness.

 

Mental Health Parity Act.

The law has finally recognized that mental illness is as serious as physical illness, through passage of the Mental Health Parity Act.  This is long, long overdue.  The problem now is the shortage of psychiatrists, psychologists, mental health counselors and social workers it will take to treat the greater number of patients covered by insurance paying for such treatment.  The effort by Walgreens to address this issue shows great business planning foresight and insightful planning by one of the largest healthcare providers in our nation. Cudos to Walgreens.
Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s 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 and visit our website at www.TheHealthLawFirm.com.

Sources:

Japsen, Bruce. “Walgreens To Expand Mental Health Services.” Forbes. (May 10, 2016). Web.

Johnson, Steven. “Walgreens aims to promote greater mental health awareness.” Modern Healthcare. (May 10, 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: Mental health care, Mental Health America, MD Live, Walgreens increases treatment for mental health care, mental health awareness, National Alliance for Mental Illness, legal counsel for mental health care professionals, mental health law attorney, legal counsel for pharmacists and pharmacies, psychiatrist attorney, psychologist defense attorney, mental health counselor lawyer, social worker defense counsel, pharmacy law attorney, Mental HEalth Parity Act, health law, The Health Law Firm

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 © 2016 The Health Law Firm. All rights reserved.

New OIG Guidance Publishes on Permissive Exclusions from Federal Health Care Program Participation May Interest Mental Health Care Professionals

Miles Indest HeadshotBy Miles Indest, J.D./M.B.A candidate at Tulane University: Law Clerk, The Health Law Firm

On April 20, 2016, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released updated non-binding criteria that disclosed when a company or individual can be barred from participating in Medicare, Medicaid, and other federal health care programs.

The OIG has permissive authority to exclude a person or company from participation in federal health care programs for engaging in certain prohibited conduct, such as false claims or kickbacks. The OIG has consistently asserted that there is a presumption in favor of exclusion. The new guidance updates the OIG’s position by stating that its presumption in favor of exclusion is rebuttable in certain situations. Importantly, the OIG guidance outlines those situations and the risk factors that trigger an exercise of its permissive authority.

Four Factors May Affect OIG’s Decision to Exclude an Individual or Entity.

In its release, the OIG outlined four non-binding factors that signal a compliance risk and can affect its decision to pursue an exclusion: (1) the nature and circumstances of the prohibited conduct; (2) the conduct during the Government’s investigation; (3) any significant ameliorative efforts; and (4) the history of compliance.

First, the OIG will evaluate the nature and circumstances of the bad actor’s conduct. For instance, conduct that causes physical, mental, or financial harm to others increases compliance risk, thereby increasing the likelihood that the OIG will pursue an exclusion. Similar to the Department of Justice’s heightened focus on individual accountability, the OIG stressed that it will scrutinize an individual’s role in planning or leading unlawful conduct, which increases compliance risk.

Second, the OIG will assess the bad actor’s conduct during the Government’s investigation. If that person obstructed or impeded the investigation of the unlawful conduct, then the OIG will be more likely to pursue an exclusion. Notably, the OIG stated that a prompt response to a subpoena is “expected” and will not favorably affect the risk assessment.

Third, the OIG will weigh the bad actor’s ameliorative or remedial steps taken after the prohibited conduct occurred. For example, an entity that takes disciplinary action against individuals responsible or the conduct will lower its compliance risk. Similarly, individuals that receive new training or retain a mentor to improve their health care practice will face a lower risk of exclusion.

Finally, the OIG will focus on the bad actor’s history of compliance with the OIG. Importantly, the existence of a compliance program will not affect the risk assessment— likely another “expected” requirement of health care organizations. In contrast, the absence of a compliance program will increase compliance risk and the likelihood that the OIG will pursue an exclusion.

The OIG update ultimately reflects the government’s increased expectations of compliance programs and heightened scrutiny of individual wrongdoing. As federal agencies continue to prioritize the prosecution of fraud and abuse, health care organizations and practitioners would be wise to proactively address these concerns internally.

Contact Health Law Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare Program and Assisting in Reinstatement Applications.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare Program, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

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: Miles Indest, J.D./M.B.A. candidate, will graduate in May 2016 from Tulane University Law School and the Freeman School of Business. He has served three years as a member of Tulane Law Review, and currently serves as the Writing Skills Chair of Tulane Moot Court.

Sources:

“Criteria for Implementing Section 1128(b)(7) Exclusion Authority.” U.S. Department of Health and Human Services Office of Inspector General. (2016). Web.

Dani Kass. “HHS Watchdog Lays Out New Grounds For Exclusion List.” Law360. (2016). Web.

KeyWords: Health law, Office of Inspector General, exclusion list, defense lawyer, exclusion, OIG, OIG exclusion list, Florida defense attorney, reinstatement, application for reinstatement, OIG hearing,Medicare exclusion, Medicare reinstatement, Removal from List of Excluded Individuals and Entities, LEIE, Florida defense lawyer, defense attorney, The Health Law Firm

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 © 2016 The Health Law Firm. All rights reserved.

Three Central Floridians Charged in Medicaid Fraud Involving Stolen Student Identities and False Mental-Health Diagnoses

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On April 19, 2016, three individuals from Central Florida were arrested and charged in a Medicaid fraud case using the stolen identities of students and false mental-health evaluations, according to the Florida Attorney General’s Office. The three allegedly assisted Orlando-based companies to defraud Medicaid out of more than $500,000 for services that were never rendered. The companies that were fraudulently billed were Revive Athletics, Divine Consulting and Durden Consulting, according to the Attorney General’s Office.

The Details of the Scheme.

One of the arrested was the head of an Orange County Schools mentoring program, Young Men of Promise. According to officials, he allegedly took and sold students’ identities and also fraudulently diagnosed students with mental health issues to illegally bill Medicaid. According to the report, he does not hold any licenses with the Florida Department of Health and isn’t authorized to diagnose mental-health disorders. He faces charges of Medicaid fraud, criminal use of personal information and organized scheme to defraud.

The other two individuals reportedly worked as case-management supervisors with the consulting company and would bill Medicaid for services the students never received, according to the arrest report. They each face one count of organized scheme to defraud. Only one individual has been arrested, the other is still at large.

To read the press release on this case from the state attorney general, click here.

Fake Mental-Health Evaluations.

The Young Men of Promise program usually consisted of between 15 and 22 students and met at an Orange County Florida high school. Investigators spoke with one student who was part of the mentoring program and detected “suspicious billing” on his Medicaid account, up to $6,000. He claimed that group meetings were not counseling sessions; he had no idea why his Medicaid account would have been billed for that amount. He was also reported as stating he was “upset to learn that he has a mental diagnosis.” He intends to have this removed from his record.

Authorities called the scheme “sophisticated,” saying many children are low labeled with mental-health disorders they don’t have and the suspects “only desired to financially benefit from tax dollars they were not entitled to.”
Click here to read one of my prior blogs on Medicaid fraud.

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.

Sources:

Allen, Stephanie. “False mental-health evals part of Medicaid scam, officials say.” Orlando Sentinel. (April 21, 2016). Web.

Harris, David. “Three charged in Medicaid fraud scheme involving student identities.” Orlando Sentinel. (April 19, 2016). Web.

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

KeyWords: Medicaid, Medicaid fraud, Medicaid investigation, Florida Medicaid Program, Medicaid audit, services never rendered, false mental-health diagnosis, false mental-health evaluations, stolen student identities, Medicaid claims, fraudulent claims, false billing, Attorney General (AG), Agency for Healthcare Administration (AHCA), Medicaid Fraud Control Unit, defense attorney, defense lawyer, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Florida attorney, Florida lawyer, The Health Law Firm

“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 © 2016 The Health Law Firm. All rights reserved.

CONSTITUTIONAL LAW: Involuntary Commitment Scheme Violates Due Process

Our guest author of this is article is John Stone, a Senior Attorney with National Legal Research Group in Charlottesville, Virginia.
A state must release a person who is involuntarily committed if the grounds for his commitment no longer exist. See O’Connor v. Donaldson, 422 U.S. 563, 574-75 (1975); cf. Jackson v. Indiana, 406 U.S. 715, 738 (1972) (“[D]ue process requires that the nature and duration of commitment bear some reasonable relation to the purpose for which the individual is committed.”). If the requirement to release the committed when they deserve to be let out is to have any meaning, a state must also periodically review whether the grounds for commitment are still met. Otherwise, a state could circumvent the timely release requirement by simply refusing to ever consider the continued propriety of commitment. To effectuate that requirement, then, the state must undertake some form of periodic review. See Parham v. J.R., 442 U.S. 584, 607 (1979).

Periodic review of continuing involuntary commitments need not consist of an adversarial proceeding involving a judge or even an administrator. Nonetheless, the person charged with periodically reviewing continuing involuntary commitments must be required to consider the propriety of ongoing commitment. That person must also be authorized to order a release if the criteria for commitment are no longer met. See id. (“It is necessary that the decision maker have the authority to refuse to admit any child who does not satisfy the medical standards for admission.”).

The Eleventh Circuit Court of Appeals was recently asked to consider the constitutionality of Florida’s involuntary commitment scheme on behalf of J.R., an intellectually disabled man with an IQ of 56 who functions as a seven-year-old. J.R. v. Hansen, No. 12-14212, 2015 WL 5973269 (11th Cir. Oct. 15, 2015). As found by a lower court, J.R.’s intellectual disability would always exist, but his potential for dangerousness could change. In 2000, J.R. was charged with sexual battery in Florida, found incompetent to stand trial, and involuntarily admitted to the appropriate Florida agency. In 2004, he was involuntarily admitted to nonsecure residential services under a Florida statute. The order involuntarily admitting J.R. contained no end date.

J.R. lived in several different settings after his admission. While his commitment was characterized by the statutes as “non-secure,” his liberty was substantially limited. If he were to have left his facility without permission, the police would probably have been called to return him to his group home. He was subject to a daily curfew of 10 p.m.; he could not drink alcohol; he had to “earn” the right to leave his group home, and when he did leave he had to always inform the staff exactly where he was going, the purpose of his trip, and when he would return. If he did not comply with these requirements, he could lose his right to freedom of movement. While the precise restrictions on J.R.’s liberty changed and could continue to change with the annual revision of his support plan, the circuit court had not held a hearing about J.R.’s commitment since 2005.

When a civil rights lawsuit was brought on behalf of J.R. under 42 U.S.C. § 1983, the Eleventh Circuit, reversing a decision by the U.S. District Court for the Northern District of Florida, struck down Florida’s involuntary commitment scheme. The Florida provisions for the involuntary commitment of individuals with intellectual disabilities to nonsecure residential facilities facially violated the Due Process Clause of the Fourteenth Amendment by failing to require periodic review of continued involuntary commitment by a decisionmaker with the duty to consider, and the authority to order, release. Florida’s scheme did provide for annual review of support plans by the Agency for Persons with Disabilities (“APD”), which evaluated the most appropriate, least restrictive, and most cost-beneficial environment for a committee’s treatment. However, the annual review did not consider whether the committee was a danger to himself or others, which is a requirement for imposing involuntary commitment. In addition, the APD lacked the authority to order release, as that authority remained with the state circuit court that authorized the initial involuntary commitment. Further, the APD was not required to petition the state circuit court for release when it determined that the circumstances that had led to the initial admission of a person with intellectual disability to residential services had changed.

The Eleventh Circuit reached its conclusion despite expressing sympathy for Florida’s interest, as expressed in a statute, in involuntarily admitting the intellectually disabled to residential services in order to “prevent or reduce the severity of developmental disabilities” and to “enable individuals with developmental disabilities to achieve their greatest potential for independent and productive living.” These goals were “honorable,” but the court could not sanction the State’s methods for achieving them. Id. at *9.
About the Guest Author: The author of this is article is John Stone, a Senior Attorney with National Legal Research Group in Charlottesville, Virginia. This article appeared on The Lawletter Blog.

This article was originally published in The Lawletter Vol 40 No 11. It is republished here with permission.
“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 © 1996-2016 The Health Law firm. All rights reserved.

President of Miami-Based Medical Transportation Company Convicted For His Role in $70M Health Care Fraud Scheme

3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On Friday, a Florida federal jury convicted the president of a Miami-based transportation company of helping coordinate the payment of illegal kickbacks in a $70 million health care fraud scheme. The scheme involved three Miami mental health facilities.

Conspiracy to Pay Health Care Kickbacks.

According to the U.S. Department of Justice (DOJ), Damian Mayol, president of Transportation Services Providers Inc., was convicted of one count of conspiracy to pay health care kickbacks. Mayol used the company to coordinate the illegal kickbacks to recruiters, who then referred patients to three clinics: R&S Community Mental Health Inc., St. Theresa Community Mental Health Center Inc. and New Day Community Mental Health Center LLC.

According to prosecutors, the three mental health clinics billed Medicare for partial hospitalization program services that were not medically necessary or were not provided. Between January 2008 and December 2010, $70 million in false claims were submitted to Medicare.

Medicare Fraud Strike Force’s Nationwide Takedown.

The scheme was uncovered by the Medicare Fraud Strike force, during a nationwide takedown in June. Three others that were involved in the scheme already pled guilty in October. Santiago Borges, Erik Alonso and Cristina Alonso pled guilty to similar and related charges for their involvement in the scheme.

To read the DOJ’s press release on this case, click here.

Psychologists and Other Mental Health Professionals Are Not Immune to Fraud Investigation and Audits.

Facing allegations of Medicare and Medicaid fraud or other types of health care fraud is extremely serious. If you lose, it is highly likely you will spend many years in prison. You will lose your medical license. You will be excluded from Medicare and Medicaid, as well as any other government health care programs.

Be aware that when the Florida Medicaid Fraud Control Unit (MFCU) gets involved, the situation has escalated from routine to 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.


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.

Source:

“Miami Man Convicted In $70M Medicare Fraud Scheme.” Law360. (January 15, 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: Medicaid audit defense, Medicaid fraudulent billing, mental health care provider fraud audit, Medicaid fraud defense attorney, health care professional defense lawyer, Florida health attorney, Florida health lawyer, health care fraud, health care fraud scheme, health law, insurance fraud, Medicaid fraud scheme, The Health Law Firm, Medicaid fraud defense lawyer, Medicaid investigation, health care defense counsel, indictment for health care fraud, health law criminal defense, health law criminal representation, restitution for health care fraud offense, Medicaid reimbursement claims, improper Medicaid billing claims, false claims defense attorney, health care fraud sentencing defense attorney, medical identity theft defense attorney, substance abuse counseling fraud lawyer, MFCU defense attorney
“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 © 1996-2016 The Health Law Firm. All rights reserved.

Investigation of Student Substance Abuse Counseling Center Leads to 40-Count Indictment in Alleged $50 Million Health Care Fraud Scheme

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

An investigation of a Long Beach, California-based counseling center, formerly known as Atlantic Recovery Services (ARS), revealed troubling allegations which reportedly cost the government nearly $50 million in bogus claims. The allegations resulted in an indictment charging eight defendants (all former employees of ARS) with health care fraud and aggravated identity theft.

Another eleven defendants have already pleaded guilty to health care fraud charges stemming from the same long-running ARS scheme, and one other defendant has pleaded guilty to making a false statement affecting a health care program. Those twelve defendants are awaiting sentencing by United States District Judge Paul S. Gutierrez.

The eight defendants named in the new indictment, formerly employed as counselors or management for ARS, are potentially facing decades in federal prison if convicted.

To see the full press release by the Department of Justice, click here.

The Alleged Scheme.

ARS received contracts to provide substance abuse treatment services through California’s Drug Medi-Cal program to students in Los Angeles County schools. The Drug Medi-Cal program was designed to assist underprivileged youth in drug and alcohol recovery. It is a part of the state’s federal Medicaid program, administered to qualifying low-income recipients under the California Medical Assistance Program (otherwise known as, Medi-Cal).

It is alleged that ARS submitted bogus claims for reimbursement to the Drug Medi-Cal program for an entire decade before California suspended payments to the company forcing ARS to close its doors in April of 2013.

The indictment alleged that the claims submitted to the Drug Medi-Cal program were false and fraudulent for a number of reasons, including the following:

(1) ARS billed for services provided to students who did not have substance abuse disorders or addictions and therefore did not qualify to receive Drug Medi-Cal services;

(2) ARS billed for counseling sessions that were not conducted at all;

(3) ARS billed for counseling services that were not conducted in accordance with Drug Medi-Cal regulations regarding length, number of students, content and setting;

(4) ARS personnel falsified documents, including treatment plans, group counseling sign-in sheets, progress notes and update logs (which listed the dates and times of counseling sessions); and

(5) ARS personnel forged student signatures on documents.

To read the full indictment, click here.

The Appalling Nature of the Allegations.

Defendants not only allegedly engaged in a scheme to deprive a program with already limited resources of millions, but also exploited several young individuals by improperly branding them as substance abusers and addicts. This appalling scheme allegedly assisted defendants in boosting enrollment numbers and billings, thereby profiting off of innocent youths.

To read one of our previous blogs on a similar news story, click here.

Medical identity theft can have very negative effects on the present and future quality of care for a patient. In some instances, a false diagnosis or inaccurate medical history can lead to serious illness or even death of a patient who has been provided with unnecessary medical treatments, or who has not been provided necessary medical care due to the erroneous medical records. Death of a patient due to health care fraud can result in life in prison should the health care provider be convicted. Section 1347(a)(2), 18 United States Code.

Click here, for more information on medical identity theft from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

In this investigation, Special Agent in Charge Christian Schrank for the Office of the Inspector General of the Department of Health and Human Services, stated the following regarding the concerning allegations:

“For counselors and supervisors to risk stigmatizing students as substance abusers, as alleged in this case, just to enrich themselves at taxpayer expense is outrageous. This decade-long conspiracy to defraud Medi-Cal while disregarding the true health care needs of children will not be tolerated.”

Psychologists and Other Mental Health Professionals Are Not Immune to Audits.

There have been an increasing number of Medicaid and Medicare investigations and audits being initiated against all mental health professionals. There is a two-part blog on our website on this topic. Click here for part one, and click here for part two.

Be aware that when the Florida Medicaid Fraud Control Unit (MFCU) gets involved, the situation has escalated from routine to 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.

Know that Medicaid Fraud is Serious.

Facing allegations of Medicaid or other health care fraud is extremely serious business. How serious? If you lose, it is highly likely you will spend many years in prison. You will lose your medical license. You will be excluded from Medicaid and other government health care programs. You will be a convicted felon. You will be left with nothing and will have a very difficult time in ever successfully reestablishing your life.

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 not actually 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 amount of money required for a qualified attorney to defend them.

If you are accused of Medicaid or Medicare fraud, realize that you are in a fight to preserve your livelihood. Your liberty, possessions 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 with which you can start over. Be prepared to give up whatever monetary value is necessary, if possible, to 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 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.

Sources:

Department of Justice, Office of Public Affairs. “Eight Indicted in Fraud Case That Alleges $50 Million in Bogus Claims for Student Substance Abuse Counseling.” Press Release: 2 Sept. 2015. Web. 2 Oct. 2015.

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, Medicaid fraudulent billing, mental health care provider fraud audit, Medicaid fraud defense attorney, health care professional defense lawyer, Florida health attorney, Florida health lawyer, health care fraud, health care fraud scheme, health law, insurance fraud, Medicaid fraud scheme, The Health Law Firm, Medicaid fraud defense lawyer, Medicaid investigation, health care defense counsel, indictment for health care fraud, health law criminal defense, health law criminal representation, restitution for health care fraud offense, Medicaid reimbursement claims, improper Medicaid billing claims, false claims defense attorney, health care fraud sentencing defense attorney, medical identity theft defense attorney, substance abuse counseling fraud lawyer, MFCU defense attorney

“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 © 1996-2015 The Health Law Firm. All rights reserved.

Florida Psychiatrist Fined $5,000 By Board of Medicine After Jail Inmate’s Suicide

3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
An psychiatrist in Ocala, Florida was fined $5,000 by the Florida Board of Medicine after a patient brought in for evaluation in 2012, later committed suicide in jail. The psychiatrist, Marc Weinbaum (M.D.), is being disciplined by the Florida Board of Medicine for allegedly failing to evaluate and assess the patient as a suicide risk.
The inmate was originally arrested and brought to The Vines in Ocala under Florida’s Baker Act, a law that authorizes involuntary mental health evaluation and treatment for up to 72 hours if there is a credible suicide threat. To find out more about the Baker Act, click here to read one of our past blogs.

Patient in Denial.

According to the administrative complaint filed by the Department of Health (DOH), the patient was given an initial assessment, during which time he told employees that he only made the suicide threat was to avoid being arrested. The patient also denied any symptoms of depression. Dr. Weisenbaum, the facility’s medical director at the time, was then brought in to write admission orders. To view the administrative complaint, click here.

After observing the patient in an apparently relaxed state, Dr. Weinbaum admitted him to the facility for further observation. The following day, Dr. Weinbaum discharged the patient to the police without completing a psychiatric assessment and examination, according to the allegations made in the administrative complaint.

The Consequences.

The day after he was discharged, the patient jumped off a second story railing at the jail, where he was not under a suicide watch. He died from his injuries later at the hospital. According to the complaint, Dr. Weinbaum “held the ultimate responsibility to ensure that the proper risk assessment was carried out.”

The Department of Health wrote that Dr. Weinbaum committed medical malpractice, citing Florida statutes directing that a physician must perform a complete examination, and must not discharge a patient without first conducting an examination in such cases. To find out how medical malpractice cases can affect your professional license, click here to read one of our past blogs.

Dr. Weinbaum entered into a settlement in which he agreed to accept the discipline awarded in order to avoid further litigation. The settlement agreement specified that he neither admitted nor denied the charges made against him.

Additionally, the final order issued by the Board of Medicine, required Dr. Weinbaum to reimburse investigation costs and attend five hours of CME risk management continuing education courses. To view the final order, click here.

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.

Comments?

Do you think that there needs to be a new protocol in place to insure patients get the proper assessment? Do you think that the DOH was fair in this punishment? Please leave any thoughtful comment below.

Sources:

Gorny, Nicki. “Ocala psychiatrist fined $5,000 after jail inmate’s suicide.” The Gainesville Sun. (September 17, 2015). From: http://www.gainesville.com/article/20150917/ARTICLES/150919725?p=2&tc=pg&tc=ar

Florida Department of Health. “Final Order and Emergency Action Search.” From: https://appsmqa.doh.state.fl.us/finalordernet/Default.aspx

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. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620. www.TheHealthLawFirm.com

KeyWords: Medical malpractice, medical malpractice defense attorney, Baker Act, psychiatric assessment, proper risk assessment, Department of Health, DOH, DOH investigations, disciplinary complaint, disciplinary investigation, legal representation for psychiatrist, Florida Board of Medicine, mental health professional, mental health lawyer, inadequate medical care, suicide risk for patients, medical treatment for inmates, suicide risk for inmates, defense attorney, health lawyer, health law, The Health Law Firm

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