Thursday, January 24, 2013

Part 1 - Burden of Proof in Professional Licensing Disciplinary Cases

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

I am often asked about the burden of proof that must be met by the state Department of Health (DOH) in professional licensing disciplinary cases.  This could be a complaint against a physician, dentists, mental health counselor, nurse, psychologist, pharmacist or anyone else.  It also includes, for example, engineers, general contractors, school teachers, architects, cosmetologists, or any other professional holding a professional license in Florida.  However, since we routinely represent health professionals, I will concentrate on those licenses by the state DOH in this blog.


Overview.
What few people (even attorneys) know is that cases which involve discipline against a professional's license are treated as "punitive" or "penal" cases.  This means the standards applied to them, at least in Florida, are the same that are applied to criminal cases.

Therefore, if the statute that is being charged is unclear or ambiguous, the courts apply a "strict scrutiny" standard.  If the language of the statute does not clearly prohibit the acts being charged or is unclear about being covered by the statute, then there should be a ruling in favor of the one charged.

Additionally, rights that apply in criminal cases, such as the right to have an attorney and the right to not be compelled to be a witness against oneself found in the Fifth Amendment of the U.S. Constitution, also apply to administrative cases involving discipline against a license holder.

The state has a higher burden of proof in an administrative licensure case, as well.  The burden of proof that applies in a civil case, "preponderance of the evidence" (also described as the greater weight of the evidence, the preponderance of the evidence or more than fifty percent), does not apply in administrative discipline cases.  Instead a higher burden, "clear and convincing evidence" applies.  Therefore, if the evidence supports the license holder's position, just as much as it supports the state's case, the state loses.


Know Your Constitutional Rights.

The Fifth Amendment of the United States Constitution provides individuals protection against self-incrimination, stating:
No person . . . shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law. . . .
Note that in Florida, as in most states, a professional license is considered to be a property right which cannot be taken by the state without due process of law.
Article I, Section 9 of the Constitution of Florida also provides similar protections stating:
No person shall be deprived of life, liberty or property without due process of law . . . or be compelled in any criminal matter to be a witness against oneself.
In addition, case law in Florida has upheld as a protected right the individual's ability to practice a profession of choice if otherwise so qualified.  To take away this right requires due process of law and reviewing courts will apply a strict scrutiny standard.

Under some states’ constitutions or state statutes there is a right to work or a right to practice the profession of one’s choice;  this further lends credibility to an argument that agency actions which take away this substantial right should require a greater burden than that required in a mere civil case (i.e., preponderance of the evidence”).  However, even without such a provision in the state constitution, a professional license (or the right to practice a profession) is a substantial right and to take it away should require a higher burden of proof (e.g., clear and convincing).

Cases that are "Penal" Receive A Higher Degree of Protection.

The law is settled through U.S. Supreme Court cases that “penal statutes are to be construed strictly, Commissioner v. Acker, 361.U.S. 87, 80 S. Ct. 144, 4. L. Ed. 2d 127 (1959), Fed'l Comm. Comm’n v. Am.  Broadcasting Co., 347  U.S. 284, 296.  One “is not to be subjected to a penalty unless the words of the statute plainly impose it,” Keppel v. Tiffin Savings Bank, 197 U.S. 356, 362.  See, e.g., Tiffany v. National Bank of Missouri, 18 Wall. 409, 410;  Elliott v. RR Co., 99 U.S. 573, 576.

Penal statutes must be construed narrowly and are interpreted against the state.  Any part or term that is vague will not be enforced or will be stricken.  Warren v. State,  16 Fla. L. Week 1346 (Fla. 1991).  Accord, Riley v. Georgia,  219 Ga. 345, 133 S.E. 2d 367 (Ga. 1963);  State v. Morrison, 25 N.J. Super. 534, 96 A. 2d 723 (Essex Cty. Ct., N.J., 1953);  U.S. v. Ortiz, 24 M.J. 164 (CMA 1987), at 168.


Florida Courts Apply Criminal Law Rights and Protections to Cases Involving Administrative Penalties.

The Florida Supreme Court has affirmatively extended the proscription against self-incrimination to any administrative proceeding of a "penal" character.  This could be one in which the state seeks revocation or suspension of a license or one in which the state seeks a fine on a licensee.  Kozerowitz v. Fla. Real Estate Comm'n, 289 So. 2d 391 (Fla. 1974).
Any administrative proceeding in which the state seeks to inflict a penalty against the license or the licensee would invoke these rights.  An action to revoke a professional license is penal.  So, too, is an action which results in the loss of income or a fine.


Check Blog for More on the Burden of Proof.

Be sure to check our blog regularly to learn more on the burden of proof in administrative cases involving discipline of professional licenses. Part two of this blog series will be posted soon.


Contact The Health Law Firm. We are Experienced in Representing Health Care Professionals and Providers.

At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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



"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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

Tuesday, January 22, 2013

Department of Justice Settles Lawsuit with Specialty Pharmacy in California

By Lance O. Leider, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
The Department of Justice (DOJ) announced on December 27, 2012, that a specialty pharmacy, based in San Diego, California, has agreed to pay a $11.4 million settlement. That payment is to resolve allegations that the company used kickbacks to persuade doctors to write prescription for its products. The allegations came from a whistleblower lawsuit filed by a former employee.
Click here to read the press release from the DOJ.


Pharmacy Allegedly Used Expensive Kickbacks to Boost Business with Physicians.
An article in Modern Healthcare states that the specialty pharmacy allegedly used tickets to sporting events, concerts, plays, spa outings, golf games and ski trips to bribe physicians to write prescriptions for its products. The company also had representatives schedule paid “preceptorships,” where the reps would follow physicians in their offices in an attempt to increase prescriptions written for their products.
To read the Modern Healthcare article, click here.


How the Lawsuit was Settled.
The specialty pharmacy company agreed to a forfeiture of $1.4 million to resolve the anti-kickback statue allegations. It will also pay $9.9 million to resolve false claims allegations, according to the DOJ. Representatives with the DOJ said that by entering the deferred prosecution agreement the company was able to avoid criminal and civil liability for the kickback and false claims violations.


Former Employee Receives $1.7 Million for Filing Lawsuit.
According to the DOJ, the settlement resolves a False Claims Act lawsuit that was filed by a former sales representative for the specialty pharmacy. As part of the resolution, that whistleblower will receive $1.7 million.
Whistleblowers stand to gain substantial amounts, sometimes as much as thirty percent (30%), of the amount the government recovers under the False Claims Act (31 U.S.C. Sect. 3730). Such awards encourage employees and contractors to come forward and report fraud. You can learn more on the False Claims Act on the DOJ website.


Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.
Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases. 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.

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


What Do You Think?
What do you think of the settlement agreement? As a health professional are you tempted with kickbacks? Please leave any thoughtful comments below.


Sources:
Department of Justice. “Victory Pharma Inc. of San Diego Pays $11.4 Million to Resolve Kickback Allegations in Connection with Promotion of Its Drugs.” Department of Justice. (December 27, 2012). From: http://www.justice.gov/opa/pr/2012/December/12-civ-1547.html

Kutscher, Beth. “$11.4 Million Settlement in Pharma Kickback Case.” Modern Healthcare. (December 27, 2012). From: http://www.modernhealthcare.com/article/20121227/NEWS/312279957/


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


"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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

Thursday, January 17, 2013

A Closer Look at the Three-Year Medical School Degree

By Danielle M. Murray, J.D., The Health Law Firm


To combat the nationwide shortage of primary care physicians and the increase in student debt, several medical schools around the country are offering the chance for students to finish school in three years, instead of four. According to a number of news articles, these programs are geared specifically toward medical students looking to practice primary care. The hope is that these programs will be cost less for students and add more primary care physicians to under-served areas.


Degrees Offered at Some Schools Around the U.S.
According to an article in The New York Times, a small number of students are currently participating in the three-year degree program. There are about 16 incoming students in the program at New York University (N.Y.U.), nine students at Texas Tech Health Science Center School of Medicine and an even smaller number are at the Mercer University School of Medicine campus in Georgia. In an interview in The New York Times, the dean at Texas Tech said if this approach works, the schools will open up the program to a larger number of students.
To read the entire New York Times article, click here.


Students on a Fast and Rigorous Schedule.
According to an article in American Medical News, the condensed medical school eliminates breaks and electives and allows students to begin clerkship training in their second year. This is a full year earlier than the traditional four-year curriculums. In the same article, medical experts warn these accelerated programs are not for everyone, saying it takes a mature person to go through rotations earlier and at a quicker pace.
Students are given a chance to opt out if they decide to pursue a different career path. The American Medical News article explains that at Mercer, students who decide that family medicine is not for them are integrated into the traditional four-year program.
Click here to read the article from American Medical News.


More Doctors, Less Debt.
This three-year program is expected to save a quarter of the cost of medical school, which is more than $49,000 a year in tuition and fees at N.Y.U., according to The New York Times. The money saved helps primary care physicians lessen their debt as they go to work in a lower paying field. This program is expected to attract more students to practice in fields such as pediatrics and internal medicine.
According to the Association of American Medical Colleges, the physician shortage is expected to reach 91,500 physicians by 2020. This program, as it grows, can help alleviate the shortage and bring more doctors to areas in need.


Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants.
The Health Law Firm and its attorneys represent medical school students in disputes with their medical schools, internship supervisors, and in dismissal hearings. We have represented residents, interns and fellows in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and on other matters.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?
What do you think of a three-year medical school degree for doctors? Do you think the fourth year of medical school is necessary for primary care physicians? Please leave any thoughtful comments below.


Sources:
Hartcocollis, Anemona. “N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition.” The New York Times. (December 23, 2012). From: http://www.nytimes.com/2012/12/24/education/nyu-and-others-offer-shorter-courses-through-medical-school.html?pagewanted=all&_r=0
Krupa, Carolyne. “Med School on the Fast Track: A 3-Year Degree.” American Medical Association. (May 7, 2012). From: http://www.ama-assn.org/amednews/2012/05/07/prl20507.htm


About the Author: Danielle M. Murray is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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

Tuesday, January 15, 2013

Department of Health Licensees Have to Maintain Continuing Education Requirements

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

Those who are licensed by the Department of Health (DOH) must be sure they are maintaining their continuing education requirements by taking the required courses in a timely manner.  We have attended at least one professional board meeting recently where there was concern expressed about licensees failing to meet their continuing education requirements.  One estimate was that approximately sixty percent (60%) were deficient in one profession.

Failing to obtain the required courses during the time period set forth by statute and by board regulation can result in disciplinary action being taken against a licensee.  Disciplinary action in one state can lead to disciplinary action commenced against a license held in another state, if the licensee holds multiple licenses.

11 Problems We See Among Licensed Health Care Professionals Arising Out of Continuing Education:
1. Failure to take courses from a continuing education provider properly approved by the state board. When in doubt, ask, in writing.
2. Failure to take and complete all required courses and hours within the period of time established by the board.
3. Failure to take the exact subject matter courses required by law (such as HIV awareness, domestic violence, prevention of medical errors, etc.).
4. Failing to maintain documents proving that the provider took the courses (such as registration, payment receipt, course attendance certificate, etc.).
5. Failing to apply for or request an exemption from continuing education requirements at the time the grounds for them first arise (e.g. hardship, medical problems, not practicing).
6. Failing to respond to an audit of continuing education completion requirements (you will then be assumed to have not completed them and a DOH investigation will be opened).
7. Failing to respond in a succinct, organized manner, by letter, with proper documentation, sent to the correct address that auditor states, via certified mail, return receipt requested.
8. Assuming that the office manager, practice manager or administrative secretary is going to take care of such matters so you do not have to be concerned with them.
9. Arguing with or being demeaning to the auditor who requests information or who advises you that you are short of hours or courses.
10. Failing to immediately make up any missing hours or courses from prior periods, in addition to fully meeting all current continuing education requirements.
11. Failing to respond to citations, complaints or letters sent to you by the DOH regarding this matter.
Often consulting an experienced health law attorney on such matters can save a great deal of turmoil, mental anguish, cost and damage to your professional license and professional reputation.


Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.
At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.

The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


What Do You Think?
Are you guilty of failing to meet your continuing education requirements? Do you think the continuing education classes are worth the time invested in them? Please leave any thoughtful comments below.


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

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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

Thursday, January 10, 2013

Florida Pharmacy Owner Admits to Multi-Million Dollar Health Fraud Scheme

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

A co-owner and operator of three Miami-area pharmacies pleaded guilty on December 6, 2012, for his part in a $23 million health care fraud scheme. The pharmacy owner allegedly admitted in the Florida Southern Federal District Court to one count of conspiracy to commit health care fraud and one count of conspiracy to pay illegal health care kickbacks, according to a Department of Justice (DOJ) press release.
Click here to read the entire press release from the DOJ.


Owner and Co-Conspirators Allegedly Paid for Referrals.
According to court documents, the pharmacy owner allegedly admitted to paying illegal kickbacks to an unnamed number of co-conspirators in return for Medicare and Medicaid beneficiary information. That information was then used to submit fraudulent claims. A majority of the beneficiaries referred to the owner’s pharmacies reportedly resided at assisted living facilities (ALFs) in Miami.

The court documents state that the pharmacy owner also allegedly paid kickbacks to physicians in exchange for prescription referrals which were also billed to Medicare.


Pharmacy Owner Allegedly Submitted More Than $23 Million in False Claims.
As part of the scheme, the pharmacy owner allegedly instructed drivers working for his pharmacies to pick up unused medications from ALFs around Miami. The medications were then allegedly placed back into pill bottles. Unused and partially used medications were billed back to Medicare and Medicaid, according to court documents.
Click here to read the court documents on this case.

The pharmacy owner and his co-conspirators allegedly submitted more than $23 million in false and fraudulent claims to Medicare and Florida Medicaid programs.



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.


Sound Off.
What do you think of this case? Is the Miami area just a hotbed for Medicare and Medicaid schemes? Please leave any thoughtful comment below.


Sources:
United States of America v. Jose Carlos Morales. Case Number 12-23374, Preliminary Injunction and Supporting Memorandum of Law. (September 14, 2012). From: http://www.thehealthlawfirm.com/uploads/USA%20v%20Morales.pdf
Department of Justice. “Pharmacy Owner Pleads Guilty in Miami for Role in $23 Million Health Care Fraud Scheme.”

Department of Justice . (December 6, 2012). From:
http://www.justice.gov/opa/pr/2012/December/12-crm-1461.html


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



"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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

Tuesday, January 8, 2013

DEA Issues Warning on Nationwide Telephone Prescription Drug Scam

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

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


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

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

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


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


Scammers May Be Cold Calling Victims.
The scammers are counting on the fact that if you have done this, you will get scared and believe their accusations. Many people have no idea whether such conduct is legal or illegal. These imposters are banking on your ignorance and fear of being arrested for a criminal act. They are also banking on the fact you won’t report this to the real police.

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


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

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


Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.
The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.



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


Sound off!
Are the actions of the DEA driving our citizens into the hands of shady pharmacies that have fewer safeguards and less accountability, such as online pharmacies? Are these actions also driving our citizens to seek out illegal drug dealers and turn to illegal drugs to cope with their legitimate medical problems? Please leave any thoughtful comments below.


Sources:
Pavuk, Amy. “DEA Warns of Prescription-Drug Scam.” Orlando Sentinel. (November 29,2012). From: http://www.orlandosentinel.com/news/local/breakingnews/os-dea-warns-scam-internet-20121128,0,5800536.story
Drug Enforcement Administration. “DEA Scam Alert – Extortion Scheme.” DEA. (November 28, 2012). From: http://www.justice.gov/dea/divisions/mia/2012/mia112812a.shtml


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.
 
 
"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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

Thursday, January 3, 2013

Physicians Feel Pressured to Enforce Questionable Practices in Hospitals

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Doctors and hospitals around the country seem to be butting heads. In the past month, an article in The New York Times and a segment on the television “magazine” show 60 Minutes shed light on some questionable practices being enforced by hospitals on physicians working for them.
I previously wrote a blog on this structural shift in the practice of medicine. Click here to read that blog.
The effects of this trend are examined in these two news stories. Doctors and former employees from a number of hospitals around the country were interviewed and all seem to be dealing with the same issues. The biggest concerns addressed were: pressure to order unnecessary tests, admitting patients to fill hospital quotas and drive hospital profits, and the feeling of being controlled by hospital executives and administrators instead of practicing effective medicine.


Filling Beds to Increase Profits.

On December 2, 2012, 60 Minutes aired an investigative segment on one of the largest for-profit hospital chains in the country. Former employees and physicians alleged this hospital system thrived by buying urban-area hospitals and turning them into profit centers by filing empty beds from emergency rooms. A former emergency medicine doctor stated that the hospital in which he worked required an admission rate of twenty percent (20%) for patients seen in the ER and fifty percent (50%) for patients who were 65 years old and older (most of whom are Medicare patients) seen in the ER.
A former hospital system employee interviewed by 60 Minutes claimed he was in charge of auditing the hospital chain in question. He stated that he was convinced that doctors were under an extraordinary amount of pressure to fill hospital beds. He stated that he personally audited hospitals in Texas, Florida and Oklahoma, and concluded there were hundreds of thousands of dollars submitted to Medicare and Medicaid for hospital stays that did not meet standards for reimbursement, including medical necessity.
Doctors interviewed for The New York Times article had similar stories. They stated in interviews that hospital administrators created quotas for how many patients should be admitted, because more admissions allegedly meant more money. Doctors who met or exceeded quotas were rewarded with increased compensation, while doctors who did not felt in danger of losing their jobs.
Click here to read the entire New York times article.


Legal Consequences of Ordering Unnecessary Tests.
The New York Times article looked at a number of lawsuits filed by former employees who allege the hospitals they worked for compensated doctors for ordering more tests than necessary.
The Department of Justice (DOJ) recently settled with a hospital group in Joplin, Missouri. According to the DOJ press release, the hospital system had to pay more than $9.3 million for rewarding doctors partly based on how many tests they ordered. This is in direct violation of the Stark Law and the False Claims Act.
Click here to read the entire press release from the DOJ.
I recently wrote an article for Medical Economics on the legal ramifications of ordering unnecessary tests. To read that article, click here.
If you want to know more on the Stark Law, click here.

Physicians Feel Controlled.
Doctors also stated they felt controlled by hospital executives. This was due, in part, to a corporate wide computer software system that was customized to automatically order an extensive battery of tests, some unnecessary, as soon as a patient walked into the hospital. It’s also stated that the software would prompt a physician to reconsider when he or she decided to send an emergency room patient home.
Most doctors interviewed were upset that the program also generated reports that evaluated each doctor’s performance and productivity.
To watch the segment from 60 Minutes, click here.
Hospitals Don't Agree with the Physicians' Stories.
The hospital system in question by 60 Minutes maintains that these allegations are not correct. The executive vice president said that as a whole admission rates haven’t changed in four years and are near or below industry averages. The hospital systems believe that by consolidating they are embracing the new model of health care and state patient care comes first.


Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers. At the Health Law Firm we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, Durable Medical Equipment suppliers, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.
The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, representation in investigations, credential defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?
Do you think there are constant battles between doctors and hospitals? As a health professional, have you experienced the pressure to admit patients, order unnecessary tests or refer a patient inside your network? Please leave any thoughtful comments below.


Sources:
Creswell, Julie and Abelson, Reed. “A Hospital War Reflects a Bind of Doctors in the U.S.” The New York Times. (November 30, 2012). From: http://www.nytimes.com/2012/12/01/business/a-hospital-war-reflects-a-tightening-bind-for-doctors-nationwide.html?pagewanted=all

Kroft, Steve. “Hospitals: The Cost of Admission.” 60 Minutes. (December 2, 2012). From: http://www.cbsnews.com/video/watch/?id=50136261n

Department of Justice. “Missouri Hospital System Agrees to Pay $9.3 Million to Resolve False Claims Act and Stark Law Violations.” DOJ. (November 5, 2012). From: http://www.justice.gov/printf/PrintOut3.jsp


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.
"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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