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.

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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.

Keywords: legal representation for disruptive physician, allegations of disruptive physicians, legal representation for disruptive physician allegations, disruptive physician defense attorney, health care professional defense attorney, legal representation for health care professionals, health law defense attorney, Florida health law attorney, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, medical staff peer review attorney, clinical privileges legal counsel, medical staff fair hearing defense attorney, peer review legal counsel, hospital fair hearing 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.

Responding to a Medicaid Audit: Important Tips You Should Know

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

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid Program Integrity, is the Florida agency responsible for routine audits of Medicaid health care providers. Each state has a similar state agency, though it may have a different name.  The agency’s job is to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving large payments from Medicaid or who practice in areas that typically see the most abuse or fraudulent billings, are the ones most likely to be audited.  These include pediatricians, Ob/Gyns, family practice physicians and pediatric dentists.

A different state agency that may also conduct Medicaid audits is the state Medicaid Fraud Control Unit (MFCU).  However, by definition, the MFCU is investigating allegations that there is substantial fraud going on.  You should know that if you are contacted by the MFCU, this is a very serious matter.  This is not a routine audit.
However, on the “routine” audits conducted by the Medica agency, the Medicaid audit usually requests information in a questionnaire that the medical practice is required to complete. Additionally, copies of medical records (including x-rays and other diagnostic studies) on the list of Medicaid patients selected for the audit.

If AHCA (or the state Medicaid agency) determines that Medicaid overpaid for services, it will use a complex mathematical extrapolation formula to determine the repayment amount. The amount of the repayment to the Medicaid Program can be considerably greater than (30 to 100 times as much as) the actual amount of overpayment disclosed by the sample of records audited. Additionally, fines and penalties can be added by the Medicaid Program. However, you can eliminate or reduce the amount of any such repayment by actions taken both before and during the Medicaid audit.

 

General Practice Tips:
There are various ways to manage your practice that will help you in the event that you are selected for a Medicaid Audit.

1. Every patient record entry should be clearly dated and signed or initialed by the provider. Make sure this is always done.

2. When documenting in the patient’s record, make sure that you document exactly what services were needed and completed in order to support what was billed to Medicaid.

3. Communicate with the person responsible for your billing so that the actual services provided are billed for. Do not bill in advance for anticipated services needed as indicated in the appointment calendar or on a treatment plan.

4. Keep the patient records organized and ready for copying if necessary. Use only one sided documents and securely fasten small forms (prescriptions, telephone memos, small sticky notes) onto 8-1/2″ by 11″ paper. Scan all such documents into the patient record if using an electronic health record (EHR).

5. Services provided by a physician who is not enrolled in the Medicaid Program to a Medicaid patient may not be billed to or paid by the Medicaid Program. Therefore, never allow any other physician associated with your practice who is not enrolled as a Medicaid provider to provide services to Medicaid patients. Do not allow a new physician coming into your practice to treat Medicaid patients until he or she actually has received his or her Medicaid provider number. The group may not bill for the services nor may another physician bill for the services.

6. Ensure that all health care professionals’ licenses and permits are kept up to date. Ensure that all x-ray, clinical, lab and diagnostic equipment is permitted and kept up to date. Ensure that any CLIA license or exemption certificate is correct and kept up to date. Services billed by unlicensed personnel or services provided by improperly licensed facilities may not be paid by the Medicaid Program.

7. Use only standard abbreviations in your medical records, documentation, orders, and reports. While an abbreviation may seem common to you or your practice, if it is not a universally accepted abbreviation, the auditors may not recognize it.

8. Make sure all records are timely made, accurate and legible. Safeguard them and never let the original leave your office. Illegible records are treated as a non-record, and payment completely disallowed for an illegible note or order. A missing record, x-ray or chart entry will result in a complete repayment being directed for those services.

The Medicaid Audit:

If you are being audited, AHCA will send you a letter notifying you of the audit. AHCA will also supply you with a list of patients to be sampled a standard sample will include a list of anywhere from 30 to 150 patient names, depending on the size of the practice. Regular audits routinely request 30 to 50 patient records. The audit letter will also include a questionnaire to be completed (Medicaid Provider Questionnaire) and a “Certification of Completeness of Records” form to complete and return with the copies of the patient records. (Please note: this will be used against you in the future if you attempt to add to or supplement the copies of the records you provided).

It is crucial that you retain the services of an expert consultant or experienced health care attorney in correctly and accurately completing the questionnaire. The letter will also request that you provide copies of the patient records for the list of patients included with the letter. You will only be given a short time to provide these documents.

1. When receiving a notice of a Medicaid audit, time is of the essence. Be sure to calendar the date that the records need to be in the AHCA office and have the records there by that date. Note: the due date is not the last date on which you can mail the records but rather is the date that the records must be received at AHCA.

2. Obtain and review a copy of the claims you submitted and what Medicaid has paid on each of the patients being audited. This information can be found in the Medicaid portal, in your billing system, or in the Explanation of Benefits. Compare this information to the medical records to see if any issues may arise when AHCA reviews the records. (Keep this for your use, do not provide it as part of the audit records).

3. Provide a complete copy of the entire record, not just the parts from the period of time covered by the audit. Remember that other physician records obtained as history, including reports and consultations should be included. Consent forms, medical history questionnaires, histories, physicals, and other physicians’ orders, may be a crucial part of the record.

4. If you suspect that an issue may arise with a particular patient, prepare a separate explanation to submit with the patient’s file. AHCA will have an expert review the records, so an explanation in advance will help the expert to assess if there is in fact an issue. Any explanatory notes or other explanations should be clearly labeled as such and dated as of the date actually prepared, so there is no confusion as to whether or not it was part of the original record.

5. If your practice involves taking x-rays or using other diagnostic studies, these procedures are part of the patient’s record. If the x-rays are digital, they can be submitted on a compact disc. Be sure to include the number of x-rays on the compact discs in the Certification of Completeness of Records.
6. Complete the Medicaid Provider Questionnaire in its entirety to send with the patient records. Do not leave any section blank. Use “not applicable” or “none” if necessary. Attach all required documents. Consult with an experienced health law attorney to assist in completing the form.

To learn more about the Medicaid audit process and how The Health Law Firm can assist you, click here to watch our short video blog.

Don’t Wait Until It’s Too Late, Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
If you or your practice has been sent notice of a Medicaid or Medicare audit, please contact us at (407) 331-6620 or (850) 439-1001 or visit our website at www.TheHealthLawFirm.com for more information.

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: Legal representation for Medicaid audits, Medicaid audit defense attorney, health care fraud defense attorney, health care fraud investigation defense attorney, legal representation for health care fraud investigation, legal representation for health care fraud, Medicaid fraud defense attorney, legal representation for Medicaid fraud, legal representation for fraudulent billing, legal representation for submitting false claims to the government, legal representation for overbilling, health care fraud attorney, The Health Law Firm, reviews of The Health Law Firm attorneys, reviews of The Health Law Firm
“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.

What You Need to Know About Preparing and Responding to an Initial Medicaid Audit Request

1 Indest-2008-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Health care providers in Florida who service Medicaid patients are at a higher risk for audits than anywhere else in the country. The unfortunate truth is that Florida has become synonymous with health care fraud. As a result, auditing and subsequent overpayment demands are very real possibilities.

The Health Law Firm and its legal professionals represent health care providers in virtually every aspect of Medicaid program audits, investigations and litigation. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities.

Facts You Should Know About the Medicaid Audit Process.

Should you find yourself, your facility or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. The most important thing to remember is that just because you are being audited, it does not mean that you or your business have done anything wrong. State and federal governments conduct audits for several different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing and complaints of possible fraud.

If You Are the Subject of an Audit.

A Medicaid audit will usually begin with the provider receiving an initial audit request, usually by letter or fax. This request will serve to notify the recipient that it is the subject of an audit. The initial letter will not always identify the reason for the audit. It will, however, contain a list of names and dates of service for which the auditors want to see copies of medical records and other documentation.

Once the records are compiled and sent to the auditor, the process shifts and you are now going to have to dispute the auditor’s findings in order to avoid overpayment.

The biggest mistake that someone who is the subject of an audit can make is to hastily copy only a portion of the available records and send them off for review. The temptation is to think that because the records make sense to you, they will make sense to the auditor. Remember, the auditor has never worked in your office and has no idea how the records are compiled and organized. This is why it is so important to compile a thorough set of records. The records should be presented in a clearly labeled and organized fashion that provide justification for every service or item billed.

Compiling a Response to an Initial Audit Request.

The following are steps that you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process:

1. Read the audit letter carefully and provide everything that it asks for. It’s always better to send too much documentation than too little.

2. If at all possible, compile the records yourself. If you can’t do this, have a compliance officer, experienced consultant, or experienced health attorney compile the records and handle any follow-up requests.

3. Pay attention to the deadlines. If a deadline is approaching and the records are not going to be ready, contact the auditor and request an extension before it is due. Do this by telephone and follow up with a letter (not an email). Send the letter before the deadline.

4. Send a cover letter with the requested documents and records explaining what is included and how it is organized as well as who to contact if the auditors have any questions.

5. Number every page of the records sent from the first page to the last page of documents.

6. Make a copy of everything you send exactly as it is sent. This way there are no valid questions later on as to whether a particular document was forwarded to the auditors.

7. Send the response package using some form of package tracking or delivery confirmation to arrive before the deadline.

Compiling all of the necessary documentation in a useful manner can be an arduous task. If you find that you cannot do it on your own, or that there are serious deficiencies in record keeping, it is recommended that you reach out to an attorney with experience in Medicaid auditing to assist you in the process.

To learn how The Health Law Firm can assist you with a Medicaid audit, click here.

If you have been accused of Medicaid fraud and need to prepare for an audit, click here to watch our informational video blog.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing 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 http://www.TheHealthLawFirm.com.

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: Medicaid fraud defense attorney, Medicaid audit defense attorney, legal representation for false billing, legal representation for Medicaid overpayment, legal representation for Medicaid audit, legal representation for Medicaid investigation, health care fraud defense attorney, Medicaid fraud attorney, Centers for Medicare & Medicaid Services (CMS) , legal representation for allegations of overbilling, audit defense attorney, ZPIC audit defense attorney, legal counsel for responding to Medicaid audits, legal representation for Medicaid fraud allegations, legal counsel for Medicaid audits, 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.

Florida’s Baker Act: What You Need to Know – Part 2

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

Our firm is frequently retained to act to obtain the release of individuals erroneously confined and held involuntarily under the Baker Act. We hope to share some of the lessons we have learned in representing such individuals and obtaining their release.

This is Part 2 of our blog on Florida’s Baker Act. To read Part 1 of this blog, click here.

Selected Examples of Some of Our Prior Cases.

Here are examples of actual cases in which we have been retained to obtain the release of a Baker Act patient. We have changed the facts somewhat to protect the identities of the individuals and the facilities involved.

Case #1: An independent elderly woman who still worked and was completely independent tripped and fell in her apartment, injuring herself. Her roommate took her to the local hospital emergency room to be examined and treated for the physical injury. The emergency room staff had her involuntarily confined in the hospital’s Baker Act unit and would not release her. She was not a danger to herself or to others. She was completely independent and held a good paying job. Her roommate drove her around and to medical appointments. She had never been diagnosed with a mental illness before and had never been Baker Acted before. Because of the Baker Act confinement, she missed several of her regular medical appointments which she had scheduled.

Case #2: The president of a medium-sized manufacturing company in another state came to Florida for a business conference at which his company had a display. On the last night of the conference, he partied late, drank too much and a friend took him to a hospital emergency room. He had a plane ticket to leave the next day. The hospital emergency room staff diagnosed him with depression and had him involuntarily confined under the Baker Act. He missed his flight home, and one of his company officials had to come to Florida to try to get him released.

Case #3: The fairly new wife of a businessman who worked a lot and who already had two small children, delivered twins. About six months later, the nanny quit at during the same week that they were supposed to move to a new home. The wife went to her OB/GYN for her routine follow-up visit. She was tired and run down from the loss of her nanny, getting ready to move, taking care of all of the small children, etc. Questioning by her OB/GYN indicated that she may have been depressed. The OB/GYN had his two nurses from his office walk her over to the hospital emergency room (which was next door) to be Baker Acted. Her husband and kids were then at home without a nanny and without mom. Mom was angry and upset because she was not suicidal, felt that she had been betrayed by her doctor and was not a threat to herself, her children or anyone else. She felt she was a prisoner, confined without any rights.

Case #4: A 14-year-old girl in high school broke up with her best friend around Christmas time. She was somewhat depressed and wrote down her thoughts about “ending it all.” Several months later, at the end of the school semester someone found the anonymous note (it had been inside her textbook) and turned it into the teacher. The teacher and principal are eventually able to identify the handwriting and confront the teenager. She admitted that it was her note but denied any suicidal thoughts. The principal called the sheriff’s department and sheriff’s deputies came and took her away to a Baker Act facility over her parents’ protests. She was then involuntarily confined there.

Case #5: A happily married mother of three young adults (who were in college and lived with their mother and father) had a long history of depression for which she saw her own psychiatrist on a regular basis (for more than ten years) and received prescription medication to control it. Her psychiatrist routinely adjusted her medications as needed. Her psychiatrist had recently adjusted her medication, but then was out of town on vacation for two weeks. She had a reaction to the medication adjustment. She telephoned her psychiatrist’s office and was instructed to go to the nearest hospital emergency room to have her medications adjusted. She did this. Instead of getting her medications adjusted, she was involuntarily confined in the hospital’s behavioral health unit under the Baker Act, Her husband (a professional) and her children, who live with her and depend on her, are distraught and could not convince the hospital or its medical staff to release her.

The cases above are all based on actual cases in which we were retained by the individual or the family. We were able to obtain the individual’s prompt release from the Baker Act facility.

Serious Problems We See Over and Over Again.

– The staff and treating physician constantly pressure the patient to convert their involuntary confinement (which may be expiring shortly, or there may be no grounds to renew it) to a voluntary admission. If this occurs, then they can keep the person as long as they desire. However, they threaten that if the patient attempts to leave, even though the patient is now there voluntarily, then they will have the patient involuntarily confined under the Baker Act.

– The patient is angry and upset at being imprisoned when he or she came to the hospital voluntarily for help. As a result, he or she rants and raves and threatens the doctors and staff with litigation or refuses to talk to them. This may serve to reinforce the doctor and staff’s concerns that the patient is mentally ill or irrational.

– Some of our clients have expressed concerns that because they have excellent health insurance, Medicare, Medicaid, or TRICARE coverage (all of which cover hospitalizations), that they are being held involuntarily against their will when they should not be, while indigents who really have serious mental health issues are discharged immediately. They express concerns that they are being held involuntarily solely because the hospital and physician are getting paid to keep them.

– Individuals who have medical problems, but are successfully living independently and obtaining regular medical treatment for their ailments, may not receive the appropriate type of medical care they need when they are being confined in a psychiatric facility. Their prescription medications are at home, and they are not able to take their prescribed medications. Their regular treating physicians are not called or consulted. Their continuity of care is interrupted by the confinement.

– The regular treating physicians of those confined may not visit or see them while they are confined in a different hospital from the one(s) in which the treating physician has approved clinical privileges.

We Work to Get Victims Out Quickly.

Our firm has a process we follow to make sure that a person who should not be held under the Baker Act may be released in a very short time. If the basic criteria for a Baker Act confinement are not present, the person is not required to be held and should be released. If the person has been living independently for decades, has family and a support system available, and has had no prior mental health problems, the odds are he or she should not be involuntarily confined. We act immediately to begin our representation, to make the hospital and its physicians aware that we are representing a victim, and to take measures to obtain release. If required, we are prepared to file an emergency Petition for Writ of Habeas Corpus with the local Circuit Court to have the victim brought before the judge for an emergency release hearing. These cases can be time intensive, require a great deal of immediate work, but can yield fast results in most cases.

Contact Health Law Attorneys Experienced in Handling Victims of Involuntary Confinement Through the Baker Act Act.

The Health Law Firm represents individuals, families and friends in challenges to and hearings related to the Florida Baker Act and Marchman Act, when the basic criteria for confinement are not met and there is no medical necessity for further confinement.

Our firm has a process we follow to make sure that a person who should not be held under the Baker Act may be released quickly. We act immediately to begin our representation, to make the hospital and its physicians aware that we are representing the victim, and to take measures to obtain release. If required, we are prepared to file an emergency Petition for Writ of Habeas Corpus with the local Circuit Court to have the victim brought before the judge for an emergency release hearing. These cases can be time intensive, require a great deal of immediate work, but can yield fast results in most cases.

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

KeyWords: Legal representation for Baker Act cases, Baker Act defense attorney, legal representation for involuntary Baker Act confinement, legal representation for involuntary confinement in hospital, legal representation for confinement in Baker Act facility, legal representation for mental health confinement, petition for Writ of Habeas Corpus, Baker Act attorney, Baker Act defense lawyer, Florida Baker Act defense attorney, reviews of The Health Law Firm, The Health Law Firm attorney reviews, The Health Law Firm
“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.

It is Always a Bad Idea for a Doctor, Nurse or Health Professional to . . . .

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

My experience in representing doctors, nurses and other licensed health professionals in disciplinary cases has lead me to conclude, us to conclude, its is always a bad idea for them to:

1. Write a prescription for any medication for yourself.

2. Start a romantic relationship with a patient.

3. Take someone else’s prescription medication, ever.

4. Write a prescription for or treat a patient, especially a family member, for a condition outside the scope of his specialty (e.g., a dentist prescribing antibiotics to her children to treat a cold; a pediatrician prescribing pain medications for an adult; a dentist writing a prescription for pain medications for a patient’s back paid; an OB/GYN prescribing antidepressants for a male).

5. Write any prescription for or treat any patient who is in another state when the physician is not licensed in that state.

6. Treat or prescribe for any spouse, other family member, friend or colleague, without opening a medical record and fully documenting the treatment or prescription, as you would for any other patient.

7. Hire a patient to work for you in your office or, especially, allow a patient to “volunteer” to work in your office.

8. Pre-sign blank prescriptions for your Physician Assistant, ARNP, Medical Assistant, receptionist, or anyone else, to complete later, or have pre-signed blank prescriptions in your office.

9. Seek psychotherapy or drug/alcohol abuse treatment with a physician or HCP health professional in your own medical group, institution or the staff of your own hospital.

10. Add to, alter or change any medical/dental record entry after you know there may be a claim, investigation or litigation involving it.

11. For a mental health professional (psychiatrist, psychologist, mental health counselor, social worker, psychiatric nurse practitioner) to have any type of social relationship with a current patient.

12. Take and use your own drug samples provided by pharmaceutical companies.

13. Go into a hospital where you do not have clinical privileges and treat or “assist” in treating a patient there, even if it is your own patient.

14. Have a sexual relationship ( including “sexting” or “telephone sex”) with a patient or patient’s immediate family member.

These are actual examples from cases in which I have had to represent licensed health professionals in defending their licenses and attempting to keep their jobs. For each of the above, there have been more than one.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys. We represent medical students, interns, residents, and fellows in disputes with their graduate medical education (GME) programs. We represent clinical professors and instructors in contract disputes, employment disputes, clinical privileges matters and other disputes with their employers. We often act as the physician’s personal counsel in medical malpractice litigation.

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., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: legal representation for health professionals, legal representation for doctors, health law defense attorney, Florida health law defense attorney, Legal counsel for licensure issues, licensure defense attorney, legal representation for suspended or revoked license, legal representation for adverse disciplinary actions, administrative defense attorney, legal representation for investigations and complaints, legal representation for administrative hearings, complaint investigation defense attorney for health care professionals, appeals (and variations on appeal ) of adverse license action, Virginia health law defense lawyer, Louisiana health law defense legal counsel, legal representation for physicians, legal representation for mental health professionals. Colorado health professional defense lawyer, Virginia health law defense counsel, District of Columbia health law legal representation, The Health Law Firm reviews, reviews of The Health Law Firm
“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.