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.

CMS Woes: Zone Program Integrity Contractors (ZPICs) Criticized for Oversight in Fraud Investigations

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

Zone Program Integrity Contractors (ZPIC) are private companies or business entities, that have contracted with the Centers for Medicare and Medicaid Services (CMS). Their purpose is to carry out certain functions related to auditing for possible fraud, that Medicare regional carriers (now called Medicare Administrative Contractors or “MACs”) performed in the past. They are specifically charged by CMS to data mine, identify, and investigate potentially fraudulent behavior in Medicare providers.

Because of this, health care providers that receive a letter from the ZPIC often see it as a potential death sentence, and certainly an eye-opening event, because it involves investigating for fraudulent activity. However, in recent years CMS has been criticized about its oversight (actually, lack of oversight) of these fraud-detection contractors.

Taking a Closer Look at the ZPIC.

ZPIC audit letters are required to comply with regulations and guidelines established by CMS when it comes to making additional documentation requests (ADRs) for pre-payment and post-payment reviews, initiation of Medicare suspension of payments and other areas for which they have authority to investigate under the direction of CMS.

Studies have found many failures of their obligations to comply with guidelines and regulations adopted by CMS and the Department of Health and Human Services (HHS). There has been so much concern over their borderline “unethical behavior” and violations of Medicare regulations that the United States Senate Committee on Finance, as well as the Office of the Inspector General (OIG) of HHS, have both issued scathing reports on them. These reports often warn against what they see as destructive and harmful behavior toward physician practices and smaller medical businesses.

In 2012 a report was issued at the request of the Senate Finance Committee and included the following quote: “CMS and its contractors often cultivate an environment of mistrust and suspicion that all providers of certain services are inherently fraudulent. The sentiment is widely shared by anyone that has worked with CMS contractors in the area of program integrity and a similar environment is probable within the CMS Program Integrity Group. This type of environment leads investigators, contractors, and CMS to pursue providers in an aggressive manner, sometimes unfairly, based on little evidence or collaboration of any wrongdoing.”

According to the OIG: “Often the ZPIC contractors have had no experience in the areas of fraud and abuse for which they should be accountable. The result is a loss to CMS of fraud and abuse funds and providers, many of which are small – medium sized businesses, are forced to spend thousands of dollars to address unfounded audits and investigations.”

To read the OIG report to Congress in full, click here.

Make sure to visit our website’s ZPIC articles and documents section to learn more.

What To Do If You Are Notified of a ZPIC Audit.

When a physician, medical group or other health care provider receives a notice of an audit and site visit from a ZPIC, things happen fast with little opportunity to prepare. A ZPIC will routinely fax a letter to the practice shortly before the end of a business day the day before a site visit/audit to that practice. Auditors will request to inspect the premises, will photograph all rooms, equipment, furniture, and diplomas on walls. They will usually request copies of several patient records to review later. They will request copies of practice policies and procedures, treatment protocols, all staff licenses and certifications, drug formularies, medications prescribed, and medications used in the office. ZPIC auditors will inspect any medication/narcotic lockers or storage cabinets and will request drug/medication invoices and inventories. You will usually be contacted for follow-up information and documentation after the audit and will eventually be provided a report and, possibly, a demand for repayment of any detected overpayments.

For a checklist on what to do after you receive initial notification of a ZPIC audit, read our two-part blog. Click here for part one and click here for part two.

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

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

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

Additional Sources:

Waesch, Amanda; Cohen, Frank and Weiss, Sean. “The Truth about ZPICs – Why Oversight is Needed.” Brennan Manna & Diamond Law firm. (August 29, 2017). Web.

Carlson, Joe. “Review notes ZPIC oversight woes.” Modern Healthcare. (November 14, 2011). 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.

Key Words: Zone Program Integrity Contractors (ZPICs), ZPIC audit defense attorney, ZPIC defense lawyer, Medicare audit defense legal counsel, Medicare audit attorney, legal representation for ZPIC letters, legal representation for ZPIC audits, Medicare and Medicaid audits, legal representation for Medicare and Medicaid audits, health care fraud defense attorney, preparing for ZPIC audit, legal representation for health care fraud, Centers for Medicare and Medicaid (CMS), legal representation for CMS investigations, Office of Inspector General (OIG), health care professional defense attorney, legal representation for health care professionals, legal representation for fraud investigations, reviews for The Health Law Firm, The Health Law Firm attorney reviews, additional documentation requests (ADRs) for pre-payment and post-payment reviews, initiation of Medicare suspension of payments lawyer

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

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First Medical Marijuana Dispensary in Hawaii Gets Green Light From DOH

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 August 8, 2017, after waiting 17 years, Hawaii will begin dispensary sales of medical marijuana to patients. Maui Grown Therapies got the green light from the Hawaii Department of Health (DOH) to begin selling medical cannabis. I know (from reliable sources, that is) that Hawaiian grown marijuana has always been a favorite with the connoisseur.

Maui Grown Therapies.

The Maui dispensary has been pre-registering patients and will begin selling medical cannabis to patients by appointment only, said Freitas Gorman, director of community relations and patient affairs. Walk-in sales will start in about a week.

In 2000, Hawaii was among the first states to legalize medical marijuana. But the state didn’t legalize dispensaries until 2015, so the state’s 18,000 patients had to grow or obtain the drug on their own.

“This is an important day for qualified patients and caregivers on Maui who now have assurance the medical cannabis they purchase at Maui Grown Therapies has been thoroughly tested and is safe for them to use,” said Virginia Pressler, director of the state Department of Health, in a statement. “Implementing a new health program is always challenging, and the dispensary program was no exception.”

To read the press release from the DOH, click here.

To read more on the status of medical marijuana in Florida, click here to read my prior blog.

To learn more about how the attorneys of The Health Law Firm can assist you in legal matters involving medical marijuana, click here.

To stay on top of medical marijuana issues, be sure to check out our Medical Marijuana Law Blog regularly.

Contact Experienced Health Law Attorneys for Medical Marijuana Concerns.

The Health Law Firm attorneys can assist health care providers and facilities, such as doctors, pharmacists and pharmacies, wanting to participate in the medical marijuana industry. We can properly draft and complete the applications for registration, permitting and/or licensing, while complying with Florida law. We can also represent doctors, pharmacies and pharmacists facing proceedings brought by state regulators or agencies.

Sources:

Bussewitz, Cathy. “FIRST MEDICAL MARIJUANA DISPENSARY OPENING IN HAWAII.” The Associated Press. (August 8, 2017). Web.

Department of Health. “First dispensary receives approval from Department of Health to
begin sales of medical cannabis for Hawai‘i patients.” State of Hawaii, DOH. (August 8, 2017). Web.

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

KeyWords: Medical marijuana legislation, medical marijuana defense attorney, legal representation for medical marijuana, legal representation for Department of Health issues, medical marijuana representation in Florida, Medical and recreational marijuana use, legal counsel for medical marijuana, marijuana defense attorney, complex health related business transactions, legal opinions on medical issues, legal representation for medical marijuana growers and distributors, legal counsel for medical marijuana, DOH defense attorney, The Health Law Firm attorney reviews, The Health Law Firm reviews, Florida medical marijuana defense attorney, Board of Medicine defense lawyer, reviews of The Health Law Firm, access to medical marijuana in Florida, The Health Law Firm, legal representation for applicants of marijuana dispensary license, legal representation for marijuana dispensary medical directors, legal representation for contracts for marijuana related matters, legal representation for physicians and medical director agreements, legal representation for licensure and regulatory matters involving growers, legal representation for dispensaries and medical directors

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

Florida Department of Health and Law Enforcement Investigate School Providing Nurse Practitioner Courses

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

A subpoena purportedly issued by the Clerk of Court for Seminole County, Florida, recently requested academic records on advanced registered nurse practitioner (ARNP) students, including preceptorship agreements for clinical courses they had taken. A follow-up inquiry revealed that the Florida Department of Health was behind the subpoena, seeking evidence concerning possible fraudulent practices involving the supervision of those clinicals.

Apparently South University, which has its main campus and headquarters located in Savannah, Georgia, but offers courses in Florida, had agreements with one or more physicians in the Orlando area to furnish training for nurse practitioner students within their medical practices. Under the terms of the agreement, the physician was required to provide a nurse practitioner to supervise the student taking the clinicals.

However, what is being investigated is the allegation that no nurse practitioners were actually used to supervise those clinicals and the students. Instead, it is apparently being alleged that the names of various licensed advanced registered nurse practitioners (ARNPs) were used without their knowledge and put down as the supervisors for those students’ clinicals. Supposedly at least 20 names of nurse practitioners have been fraudulently used in this manner. Apparently the names of the nurse practitioners were also fraudulently signed to attestations that the students had actually completed the hours of clinical training. Usually there were four quarters or rotations of clinicals required of each student, encompassing hundreds of hours of clinical time.

It is estimated that over 100 advanced registered nurse practitioner (ARNP) students went through this program and graduated. Based on their advanced degrees, they were licensed as advanced registered nurse practitioners (ARNPs) by the Florida Department of Health.

Will those unsupervised student clinical hours be disallowed?

The question is whether action will be taken by the Florida Department of Health, or another organization, to disallow those clinical nurse practitioner hours gained by students in this manner. If so, many who are currently licensed as nurse practitioners who went through this program may lose their licenses and be required to retake required clinical hours. Both the students and the college were apparently unaware of the fraudulent activity.

This case is reminiscent of the massage therapist cases rising in 2012.

This situation seems somewhat similar to the situation that over 180 Florida licensed massage therapists (LMTs) found themselves during 2012. Click here to read one of our prior blogs on this story.

In the case of the massage therapists, each of them had taken courses and graduated from a school in another state. However, when they moved to Florida they had to have the courses re-certified by a Florida approved college and take the additional required courses for Florida licensure. They went to a well known, reputable private college offering massage therapy courses. They paid their tuition and were provided documentation showing that their out of state credits had been transferred in. They were provided other documents by the college showing that they had completed all course requirements and met the standards for licensure. They received their Florida licenses based on this.

Later it was discovered that the registrar at that college had actually been stealing the tuition money paid by these massage therapists and not enrolling them in the college. She was falsifying college documents, including course completion certificates, diplomas, transcripts and other documents using the college’s official seal on them. To see a class action law suit filed discussing this scheme in greater detail, click here.

When the Florida Department of Health found out about this situation, it reacted in a “knee-jerk” fashion and did an emergency suspension of hundreds of massage therapist’s licenses, many of them with no advance notice to the massage therapists. To see a blog I wrote on this, click here.

Hundreds of massage therapist who could not afford to pay a lawyer to mount a legal defense wound up having their licenses revoked or felt compelled to voluntary relinquish their licenses. They lost their national certification in massage therapy because of this.

However, the massage therapists who challenged the revocation and demanded a formal administrative hearing on it, many of whom we represented, were successful in keeping their licenses, mainly because they were not at fault and did not know what the crooked registrar was doing.

Actions to take if you are a nurse practitioner notified of licensure action or that you are under investigation:

Following are the recommendations we would make to any potential client contacting us who has been notified that he or she may be under investigation by the Florida Department of Health or law enforcement authorities:

1. Do not talk to or make any statement, oral or written, to any investigator without first consulting with an experienced health law attorney.

2. Immediately obtain the services of an experienced health law attorney to represent you in the case.

3. Check with your professional liability insurance carrier for any professional liability insurance you had at the time or currently have to see if they will cover the matter. Your current policy may not cover it unless you had it when the events occurred. However, it might.

4. Do not respond to any subpoena for records for testimony until you have consulted with an experienced health law attorney. Even a current professional liability insurance policy should cover you in responding to a subpoena or if a deposition is sought.

5. Do not, under any circumstances, voluntarily relinquish your license, without retaining any experienced health law attorney familiar with this matter to represent you. Such a relinquishment may be the equivalent of a revocation and reported to national reporting bodies as such.

6. If charges arise and you are offered the right to a hearing, always elect a formal administration hearing at which you dispute the issues. Do not elect an informal hearing. In an informal hearing, you have to agree that the charges against you are true, in effect, admitting you are guilty. Do not make that common mistake.

If you desire to see information on emergency suspension orders and emergency restriction orders, click here.

 

Contact Health Law Attorneys Experienced with Department of Health (DOH) Investigations of Nurse Practitioners.

The attorneys of The Health Law Firm provide legal representation to nurses, nursing students and ARNPs in Department of Health (DOH) investigations, licensure defense representation, investigation representation, Department of Health investigations, Board of Nursing investigations , administrative hearings, emergency suspension orders, emergency restriction orders 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.

KeyWords: Legal representation for nurses, legal representation for nursing students, legal representation for ARNPs, legal representation for ARNP students, Licensure Defense Representation, Investigation Representation, Department of Health Investigations, Board of Nursing Investigations , Administrative Hearings, Emergency Suspension Orders, Emergency Restriction Orders, nurse attorney, legal representation for health care professionals, health law defense attorney, nursing student defense attorney, ARNP defense attorney, legal representation for licensure issues, legal representation for medical students, legal representation for investigations of health care professionals, DOH investigation defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2017 The Health Law Firm. All rights reserved.

 

 

Inmates Family Sues Jail After Improper Care

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

Orange Country Jail Sued.

A wrongful death suit has been filed against Orange County Jail due to what some are saying was a preventable death.  The suit was filed directly against Robert Buck, the head of the jails health services department, along with four nurses that cared for the late inmate.

Dog Bites Leads to Death In Jail.

In 2015, Max Gracia was arrested. During his arrest, he sustained many bites from one of the police dogs. He was treated in the hospital until he was stable. Once he was moved to the jail cell he was found unconscious and later died in the hospital. The autopsy reported that he died from an E Coli infection that stemmed from the dog bites. His mother, Willine Gracia, has filed the wrongful death suit claiming that her son received subpar care and as a result died.

Claimants Allege “A Culture of Neglect.”

Reportedly the medical staff of the jail stated that Garcia was exaggerating or faking the illness. The lawsuit claims the jail has a “culture of neglect”and this was really what was at work here.  Willine Gracia states that she hopes that this lawsuit will bring attention to the wrongful health care services so many inmates receive.

Providing Representation For All Health Care Professionals.

Our firm has represented a number of nurses, physicians and other health care professionals who provide care in jails and prisons, as well as in other government facilities and institutions.  We routinely represent physicians, nurses and advance practice nurses who work for the VA, the Department of Health, the county, the military, the Indian Health Service and other government agencies.  Although government employees may have personal immunity from civil suits, they are not protected against termination and other employment actions, complaints against their professional license, National Practitioner Data Bank reports, and other types of administrative actions;  our firm represents them in all of these.  The government is not going to represent you in these.  Call us at the first sign of a legal problem.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at http://www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., 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.

Sources:

Hayes, Christal. “Family Sues Orange County Jail, Nursing Staff after Inmate’s Death from Police-Dog Bite.” OrlandoSentinel.com, 1 Aug. 2017. (Print).

Walden, Tiffany. “Inmate Son Suffered Seizure before Death, Mom.” Orlando Sentinel. (16 Aug. 2016). Web.

Key Words: Legal representation for government physicians, legal representation for government nurses, legal defense of professional licensure cases, legal representation for Board of Nursing cases, legal representation for Board of Medicine cases, Board of Nursing investigation defense attorney, legal representation for peer review, legal representation for administrative actions, legal representation for VA physicians, legal representation for VA nurses,  health care lawyer, The Health Law Firm reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

 

Florida Government Officer Charged in Billion Dollar Medicare Fraud

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

Health Care Administrator Accepts Bribes.
An alleged $1 billion health care scheme has lead to the first known prosecution against a Florida Agency for Health Care Administration official.  Bertha Blanco faces a wide range of charges including accepting bribes to tip off individuals when state wide investigations were to begin.

The Ring Alleged Ring Leader.

It is reported that Blanco oversaw inspections by the Florida Agency for Health Care Administration or “AHCA” of Florida nursing homes owned by Phillip Esformes. Blanco was allegedly taking bribes to tip off Esformes of violations reported to the state agency before the investigation (or “survey”) even began.  This allegedly allowed Esformes to attempt to fix or remedy the deficiencies that were reported even before the investigation began and to maintain his.  Esformes is alleged to have billed the federal government for questionable patient services.  Esformes is reported to be the ring leader in this Medicare fraud case and is facing years of jail time if his defense does to prevail.

Billion Dollar Scheme Puts Many People Away.

Bertha Blanco is reported to be the first Agency for Health Care Administration official charged with allegedly accepting bribes.  Blanco, Esformes, and many more individuals are being charged in this billion dollar case.

Health Care Fraud Should Not Be Taken Lightly.

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

The government is serious about combating health care fraud and embezzlement..  False claims are a growing problem in the program, costing the government billions of dollars each year.  Accordingly, punishments for defrauding the system can be quite severe.
If you are accused of Medicaid or Medicare fraud, realize that you are in a fight for your life.  Your liberty, property/possessions and profession are all at stake.

To read further about the seriousness of health care fraud you can read additional blogs of mine here.

To read further on how the government is cracking down on health care fraud, click here to read one of my prior blogs.

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

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

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), 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:

Press, The Associated. “Florida Health Care Admin Charged in $1B Medicare Fraud Case.” WTOP. 29 July 2017

“Three Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme.” The United States Department of Justice. N.p., (22 July 2016). Web.

Keywords: Medicare Fraud, legal representation for Medicare fraud, Medicare fraud defense attorney, legal representation for allegations of Medicare fraud, legal representation for health care fraud, legal representation for fraudulent billing, legal representation for allegation of defrauding the government, legal representation for submitting false claims, Medicare audit defense attorney, Medicare billing defense attorney, health care clinic fraud audit, legal representation for false billing, legal representation for allegations of unnecessary procedures, legal representation for Medicare audits, Medicaid fraud defense attorney, legal representation fr Medicaid fraud, legal representation for Medicaid audit, Medicaid audit defense attorney, Medicare and Medicaid investigation defense attorney, legal representation for Medicare and Medicaid investigations, OIG investigation defense attorney, legal representation for OIG investigations, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

CMS Approves Five Year Extension of Florida Medicaid Managed Care Demonstration

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

On August 3, 2017, the Centers for Medicare & Medicaid Services (CMS) approved a five-year extension of Florida’s Managed Medical Assistance (MMA) section 1115 demonstration. It allows the state to operate a capitated Medicaid managed care program and a low-income pool (LIP) to provide continuing support for the safety net providers that furnish charity care to the uninsured.

CMS touted the approval as part of its efforts to give states more flexibility to design and tailor Medicaid programs to their specific needs.

Tools For More Effective Medicaid Programs.

This demonstration provides the state with new tools to help it meet the following goals:

• Provides necessary financial support to public teaching hospitals, children’s hospitals, and other hospitals for the care they furnish to low-income uninsured Floridians; and

• Strengthens the breadth of access to and quality of providers participating in Florida’s managed care program, including care provided by many Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC).

“This program gives Florida the ability to care for its most vulnerable and at-risk citizens. Its renewal also provides flexibility to use the funds in a way that meets the unique needs of the State while reducing burden by eliminating duplicative reporting and documentation requirements,” said CMS Administrator Seema Verma. “This extension has a positive and direct impact on people’s lives and their ability to access care. Florida’s program offers an innovative and realistic pathway to tackling some of Medicaid’s biggest challenges.”

These changes are consistent with CMS’s commitment to lessen or remove inappropriately burdensome and/or duplicative state reporting activities.

For more information, click here.

To read the press release in full from CMS, click here.

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

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at http://www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

AHLA Weekly. “CMS Approves Florida Medicaid Demonstration Under New Era of State Flexibility.” The American Health Lawyers Association. (August 3, 2017). Web.

“CMS Approves Florida Medicaid Demonstration Under New Era of State Flexibility.” CMS.gov. (August 3, 2017). Web.

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

KeyWords: Florida’s Managed Medical Assistance (MMA) program, the Centers for Medicare and Medicaid Services (CMS), legal representation for CMS issues, legal representation for MMA issues, Medicaid and Medicare defense attorney, legal representation for Medicare and Medicaid issues, Florida Medicaid attorney, legal representation for Medicaid investigations, legal representation for Medicaid and Medicare investigations, legal representation for Medicaid programs, legal representation for Florida’s managed care program, health law defense attorney, legal representation for health care professionals, Florida health law attorneys, The Health Law Firm, reviews of The Health Law Firm, reviews of The Health Law Firm attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

Avoid Being Labeled as a “Disruptive Physician” at All Costs

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

Although “old news” at this point, on July 9, 2008, the Joint Commission (TJC) published the following alert to health care organizations:
Sentinel Event Alert;  Issue 40, July 9, 2008
Behaviors That Undermine a Culture of Safety

Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.  Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.
For the entire text and greater detail on detection, analysis, and prevention, as provided to health care organizations by the JCAHO, you may refer to:  http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

This was considered a big flag to hospitals that they should aggressively move to discipline and terminate those physicians in their facilities whose conduct could lead to a label of “disruptive physician.”  Since that time, we have seen increasing numbers of physicians having to defend themselves because they were too demanding, had too high expectations of nursing and hospital staff, had a low thresh hold for incompetence, or just were trying too hard to be sure quality care was provided to their patients.  Often we have seen this type of complaint initiated by nurses on the hospital’s staff who just did not like a physician for various reasons.
The Joint Commissions Alert was a green light to hospitals that they could use the peer review and credentialing process to punish and terminate such physicians.

Physicians Are Easily Labeled “Disruptive”.

Physicians are often unfairly labeled as “disruptive physicians” by hospitals, health care institutions, employers or economic competitors of theirs in a health care setting.  This label can be assigned to the most skilled, compassionate and innocent physician.  Unless immediate action is taken by the physician to counter this false labeling, it may result in extremely serious repercussions, loss of income and tremendous expense.

You Can Be Labeled Disruptive Even With The Best Intentions.

We have seen, first-hand, examples of physicians where attempts were made to label them as “disruptive physicians” for a number of reasons.

An individual can be labeled disruptive:

• For refusing to allow unnecessary and expensive invasive procedures to be performed on patients by another physician in a hospital setting.
• For refusing to provide a drug seeking addict (who was hospitalized after a gunfight with police) with additional narcotics.
• By an economic competitor of a physician, who had been able to obtain election as president of the medical staff in order to drive her off of the hospital staff, thereby eliminating her competition with him.
• By competing medical groups forming an alliance with administrators at a for-profit hospital to label a physician competitor as a “disruptive physician” and enlist the aid of nursing staff to document every alleged transgression of the physician.
• When hospital nursing staff are instructed to scrutinize every act of a surgeon on the staff and to write up every perceived action of this doctor that might possibly be considered to be inappropriate any respect (even “rudeness”).
• Because a surgeon cancelled an elective surgery after the scheduled surgery on their patient was delayed three hours because hospital staff did not come in on time and other surgeries started late.
• Because nursing staff desired to get rid of a foreign physician that the nurses felt did not treat nurses respectfully enough.

Often physicians reacting to protect their patients from other physicians, or who may attempt to correct incompetent nursing staff, are labeled as “disruptive” because of their comments or actions.  Physicians who are somewhat demanding or who are perfectionists (as many, naturally, are), are often unfairly labeled as “disruptive.”  We have seen the most highly skilled sub-specialists, whose only major concern is their patients care and safety, branded as a “disruptive physician” by hospital staff.  We have also seen this occur in smaller, more rural hospitals where the nursing staff may be less than totally competent.

All Physicians Need To Be Aware Of The Risks Of Being Labeled “Disruptive”.

It is extremely important that a physician be sensitive to the possibility of being labeled a “disruptive physician” and the possible consequences this can bring.  It may result in the initiation of peer review proceedings to terminate clinical privileges and medical staff membership.  It may result in a complaint to the state licensing board against the physician.  We have handled a number of cases where complaints were made (even “anonymous” complaints”) to the state impaired physician program, resulting in a long, expensive battle with psychiatric experts and psychologists, in order to refute the allegations.

Immediately Seek Legal Help To Counter Allegations.

It is necessary that any allegation made that insinuates that the physician is a “disruptive physician” be immediately, but objectively, countered.  A neutral, factual rebuttal is often all that is required.  However, sometimes an economic competitor, or an unfriendly hospital administrator, will attempt to push the matter to extremes in an attempt to get rid of the physician, to make his or her job easier.  It may be advisable to obtain the services of an experienced healthcare attorney in fashioning a responsive or even formulating a strategy for a long-term defense in such situations.

It Is Critical To Gather Evidence From Professionals Of Stability.

In some cases, it may be advisable to have our client evaluated by trained psychiatrists and other health care professionals ahead of time, in order to have expert evidence immediately available that the physician does not have a personality disorder or other impairment.  This may be used to head off any complaint to or from the state licensing board or impaired physician program.

Florida Has High Number Of Incidents.

In Florida, especially, we have seen an increase in referrals to the state impaired physician program for allegedly “disruptive physicians” where a cottage industry seems to have arisen in making such diagnoses and preparing treatment and monitoring plans for them.  We have been involved in at least one case where a prominent, successful surgeon was forced to undergo testing, evaluation, and psychoanalysis, while he was excluded by a major hospital, over a course of approximately two years, with the threat of disciplinary action by his state licensing board if he refused to “cooperate.”  Finally, after spending tens of thousands of dollars on the recommended psychiatric and psychological evaluations, and after spending tens of thousands of dollars in attorney’s fees, it was decided he had no such problems, he was not a “disruptive physician” and there was no probable cause for any disciplinary action against him.

Legal Action May Be Only Way To Fix a Damaged Reputation.

In some cases, it may even be necessary for the physician to take the extreme measure of suing the hospitals or the individuals who are behind such action.  We have been required to do this on behalf of clients in a number of different cases.  Often, this is the only way to get the truth of the matter out, especially when it related to economic competitors of the physician who may be in control of the hospital’s medical staff.

Hospitals’ Role In Identifying Disruptive Physicians.

We believe that, as a result of the foregoing, we will see a much greater attempt on the part of hospitals to identify and discipline physicians on hospital staffs as “disruptive physicians” through hospital peer review procedures, and through reports to state licensing boards and the organizations that were established to monitor physicians with substance abuse problems (such as the Professionals Resource Network (PRN) in Florida).  Any correspondence, warning, letter or counseling a physician receives that mentions the word “disruptive” or makes such an insinuation, should be taken very seriously by the physician.  It should be responded to immediately, with facts, in an objective and dispassionate manner without attempting to “blame” anyone else.  When in doubt, consult with an experienced board certified health law attorney.

Being Labeled Disruptive Should Not Be Taken Lightly, Contact Health Law Attorneys Experienced In Handling All Cases of Disruptive Physician Accusations.

The Health Law Firm’s attorneys routinely represent physicians in cases of the disruptive label.  Being labeled disruptive cannot be taken lightly. This label can go on your record and affect your current and future work as a physician. Contact an experienced Health Law attorney the second allegations are made against you.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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