Massachusetts Mental Health Centers Submitted False Claims According to Suit

7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.

The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.

The Complaint.

The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.

The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”

According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.

The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.

Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.

There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.

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

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.

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

Sources:

Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.

Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 2018). 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: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, psychiatrist and psychologist defense attorney, medical group defense attorney, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense counsel, psychiatrist and psychologist defense counsel, Board of Medicine and Psychology license defense attorney, Board of Medicine and Psychology license defense lawyer, Board of Medicine and Psychology license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, mental health facilities defense counsel, mental health facilities defense attorney, mental health facilities defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, mental health counselor and social worker defense attorney, mental health counselor and social worker defense lawyer, mental health counselor and social worker defense counsel.

The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2018 The Health Law Firm. All rights reserved

Advertisements

Pennsylvania Nursing Home Settles Wrongful Death Suit, Agrees to Pay $800,000

7 Indest-2008-4By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 21, 2017, the Devereux Foundation in Philadelphia, agreed to pay $800,000 to end a wrongful death suit against staff at The Devereux Pocono Center. The suit accused staff at the organization’s residential behavioral health facility in northeast Pennsylvania of failing to recognize symptoms of an infection in a developmentally disabled resident.

Details of the Wrongful Death Suit.

The family of Megan Ramsey, who died in the care of the Devereux Pocono Center in July 2014, asked a Pennsylvania federal judge to sign off on the settlement to end allegations that staff failed to detect symptoms of a perforated bowel and infection. According to court records, the patient had suffered from a rare genetic disorder known as Cornelia de Lange syndrome. Her symptoms included slow growth, small stature, gastroesophageal reflux disease, and issues with behavior and communication.

In July 2014, Ramsey complained of shoulder pain, a symptom of bowel perforation, according to the complaint. She was administered a pain reliever and observed to be uncharacteristically irritable and aggressive and was treated with doses of an anti-anxiety medication, the suit said. Ramsey asked staff members to be taken to the hospital. A residential manager at the facility, however, said only to monitor her closely, offer her fluids, and advise nursing staff of any worsening of her symptoms.

She was found dead the next morning.

The Settlement.

The patient’s family filed a pretrial memorandum in September 2017, in which investigations by state agencies resulted in findings of neglect, intentional or reckless failure to provide treatment, and intentional use of a chemical restraint or isolation.

The settlement of $800,000 includes fees for the plaintiff’s counsel of just under $267,000, the filing said. Click here to read the settlement in full.

To read one of my prior blogs about a similar case involving 14 deaths at a Florida nursing home, click here.

Contact Health Law Attorneys Experienced with Nursing Home Cases.

The Health Law Firm and its attorneys represent nursing homes, nursing home employees, mental health facilities and mental health professionals, including psychologists, social workers and mental health counselors, in a number of different matters including incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

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

Sources:

Fair, Matt. “Pa. Nursing Home Settles Patient Death Suit.” Law360. (December 21, 2017). Web.

The Meyer Law Firm. “Wrongful Death in Nursing Homes.” NursingHomeAbuseGuide.org. (December 22, 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: Legal representation for nursing home, nursing home defense attorney, legal representation for home health care facilities, home health care defense attorney, legal representation for health care facilities, health care facilities defense attorney, legal representation for American Health Care Association (AHCA) investigations, legal representation for nurses, legal representation for physicians, legal representation for licensure issues, legal representation for U.S. Department of Health (DOH) investigations, employment law defense attorney, legal representation for employment issues, legal representation for patient negligence, legal representation for health care negligence, legal representation for wrongful death suits, legal representation for wrongful death allegations, wrongful death suit defense attorney, legal representation for health care professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, health law defense attorney, mental health facility defense counsel, mental health professional defense attorney, psychologist defense counsel and legal representation, social worker legal counsel and mental health counselor 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 © 2018 The Health Law Firm. All rights reserved.

The 20 Major Mistakes Physicians Make After Being Notified of a Department of Health Investigation

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 investigation of a complaint which could lead to the revocation of a physician’s license to practice, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the physician who receives it. Yet, in many cases, attorneys are consulted by physicians after the entire investigation is over and the damage is already done. Often, the mistakes that have been made severely compromise an attorney’s ability to achieve a favorable result for the physician.

These are the ten biggest mistakes we see in the physician cases we are called upon to defend after a Department of Health investigation of them is commenced:

1. Contacting the Department of Health (DOH) investigator and providing him/her an oral statement or oral interview.

2. Making a written statement in response to the “invitation” extended by the DOH investigator to do so.

3. Providing a copy of their curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so.

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

5. Failing to submit a timely objection to a DOH subpoena, when there is a subpoena, and there are valid grounds to do so (e.g., patient does not want records released, patient privacy).

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

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

8. Failing to keep an exact copy of any document, letter or statement provided to the investigator.

9. Believing that the investigator has knowledge or experience in the medical or health care matters being investigated.

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

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

12. Believing that because they haven’t heard anything for six or eight months (or even years in some instances) that the matter has “gone away.”

13. Believing that the case is indefensible so there is no reason to even try to advocate for getting it dismissed.

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

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

16. Taking legal advice from their non-lawyer colleagues regarding what they should do in defending themselves in the investigation.

17. Attempting to defend themselves without the assistance of an attorney.

18. Believing that, because they know someone on (or previously on) the Board of Medicine, with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.

19. Providing copies of medical records to the DOH Investigator and signing a “Certificate of Completeness” so that the DOH can use these against them in its future disciplinary proceedings against them.

20. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them and to communicate with the DOH investigator for them.

The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Medicine in such cases and does so on a regular basis.

To learn more about how The Health Law Firm can assist you if you are being investigated by the DOH, click here.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Physicians.

The attorneys of The Health Law Firm provide legal representation to osteopathic physicians in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations and other types of investigations of health professionals and providers.  To contact The Health Law Firm, please call (407) 331-6620 or 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 Department of Health (DOH) investigations, DOH attorney, DOH investigation attorney, DOH defense attorney, Legal representation for DOH complaints, legal representation for licensure issues, legal representation for health care professionals, DOH complaint attorney, legal representation for Board of Medicine investigations, Board of Medicine attorney, Board of Medicine investigation attorney, Board of Medicine defense attorney, legal representation for Board of Medicine complaints, legal representation for licensure issues, legal representation for physicians, Board of Medicine complaint attorney, health law attorney, health law defense attorney, legal representation for physicians, doctor attorney, legal representation for complaints against physicians, The Health Law Firm, Florida health law defense attorney, 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.

 

 

 

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.

 

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.

 

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.