Helpful Tips For Avoiding HIPAA Violations on Social Media

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Digital mediums are a popular great way to connect, but they can also pose a great risk for Health Insurance Portability And Accountability (HIPAA) violations. When it comes to guarding against accidental revelations of patient identity and sensitive information, Ophthalmologists, Optometrists and all medical staff should adopt various measures to protect themselves.

In this day and age, almost everyone has some type of social media platform. Don’t end up like many health care providers who find themselves chastised, fined and fired over HIPAA violations due to common mistakes.

Protect Yourself and Your Practice.

All ophthalmologists, optometrists and medical staff should take the following steps to protect against HIPAA violations due to social media:

-Keep personal social media accounts separate from professional accounts;

-Avoid requesting or accepting friend requests from patients or professional associations;

-Be aware that even posts that have been deleted can still exist in cyberspace;

-Be aware that posts on a private personal page can be accessed by users who are not friends or followers;

-HIPAA lists 18 identifiers including photos, neighborhoods, birth dates and vehicle identifiers. All of these must stay private. Small details can reveal patient identity, especially in small communities;

-Even if a patient posts personal medical information, no health care professional can re- post any information;

-You do not have the right to take or post any image of your patients;

-You are required to report any breach of privacy committed by any fellow employee.

For more tips on social media for health care providers, click here.

Guidelines for Appropriate use of Social Media and Social Networking.

Ophthalmologists and Optometrists are discouraged from interacting with current or past patients on personal social networking sites. Online interaction with patients should only occur when discussing the patient’s medical treatment within the physician-patient relationship. These interactions should never occur on personal social networking or social media websites.

Patient privacy must be protected at all times, especially on social media and social networking websites. Breaches in patient confidentiality could be harmful to the patient and in violation of federal privacy laws such as the Health Insurance Portability and Accountability Act of 1996 and applicable state privacy laws.

Failure to Comply With HIPAA Can Result in Both Civil and Criminal Penalties.

There has been an increase in penalties regarding HIPAA violations. With an increase in the popularity and availability of social media platforms, also comes an increase in potential privacy violations. To read a previous blog I wrote on this, click here.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent ophthalmologists, optometrists and other health care providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).

For more information about HIPAA violations, electronic health records or corrective action plans (CAPs) please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Veatch, Kyna. “A Checklist For Avoiding HIPAA Violations.” Law360. (January 8, 2016). Web.

Martin, Jonathan. “Tips on social media for health care providers.” Law360. (January 8, 2016). Web.

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

KeyWords: Health Insurance Portability and Accountability Act (HIPAA), HIPAA Omnibus Rule, HIPAA compliance, data security, protected health information (PHI), Patient privacy, U.S. Department of Health and Human Services (HHS), Office of Civil Rights (OCR), patient rights, HIPAA compliance audit, HIPAA violation, penalties for HIPAA violation, criminal penalties for HIPAA violation, civil penalties for HIPAA violation, HIPAA compliance, privacy, defense attorney, defense lawyer, Medicare exclusion, HIPAA defense attorney, HIPAA violation help, American Recovery and Reinvestment Act of 2009 (ARRA), Department of Justice (DOJ), HIPAA attorney, HIPAA lawyer, compliance plans, health law firm, The Health Law

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2016 The Health Law Firm. All rights reserved.

OIG Flags Questionable Billing for Ophthalmology Services Totaling $171 Million in Medicare Pay-Outs to Various Providers

2 Indest-2009-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Department of Health and Human Services Office of Inspector General (OIG) flagged various Medicare providers as having questionable billing practices for ophthalmology services rendered in 2012. The services billed for and flagged as questionable include the diagnosis and treatment of wet age-related macular degeneration (wet AMD) and complex cataract surgery. Medicare paid a total of $171 million for the services now warranting further scrutiny according to OIG.

Questionable Does Not Necessarily Mean Improper.

OIG acknowledged that flags for questionable billing do not necessarily mean impropriety has occurred. OIG utilizes nine measures when considering potential indicators of fraud and abuse. If questionable billing is demonstrated on at least one of these nine measures, then it is flagged for further review.

In 2012, Medicare paid $6.7 billion to 44,960 providers for wet AMD and cataract-related services. Approximately 4% of those providers, or 1,726, demonstrated questionable billing on at least one of the nine measures. OIG reported that another 4% of that number of providers exceeded the threshold for two measures and nine providers exceeded thresholds for three, four or five measures.

While these findings do not conclusively establish the commission of fraud, OIG has advised the Centers for Medicare and Medicaid Services (CMS) to review the identified healthcare providers and take action if necessary.

To read one of our previous blog posts on the OIG increasingly issuing investigative subpoenas to ophthalmologists, click here.

Unusually High Levels of Billing for a Specific Service May Indicate Fraud.

While only about 15% of providers demonstrated questionable billing for wet AMD treatments, Medicare payments for these services totaled more than half ($91 million) of all payments associated with questionable billing. Many providers were also indicated in questionable billing for complex cataract surgery. However, the total Medicare payments for the cataract procedures at $39 million was much lower than that of wet AMD treatments.

OIG identified 355 providers with unusually high billing related to the diagnosis of wet AMD costing Medicare a total of $23 million. Another 586 providers were reported with unusually high billing for ophthalmology claims using certain modifiers totaling $18 million in Medicare payments.

The OIG observed that when providers bill for certain procedures at unusually higher levels than their peers it may be because such services are not medically necessary, thereby indicating possible fraudulent activity. On the other hand, our experience in defending ophthalmologists and optometrists has shown that it might also just be a case of a certain physician being the best around in performing that procedure.

To read one of our previous blog posts regarding billing for the performance of unnecessary ophthalmology treatments and services, click here.

More Troubling Trends in OIG’s Report.

According to OIG’s report, and in comparison to the national average of 2.6%, seven metropolitan areas had at least double the percentage of Medicare payments associated with the measures of questionable billing. Miami, Florida made the list as one of the seven areas, along with: Huntington, West Virginia; Vineland, New Jersey; Salisbury, Maryland; Grand Rapids, Michigan; Fresno, California; and Cincinnati, Ohio.

Furthermore, OIG indicated that $2 million paid by Medicare for ophthalmology services performed, was paid to 821 various providers that were not listed as eye specialists in government databases. OIG asserts that this calls into question the quality and appropriateness of services rendered by these individuals if, in fact, they were not properly trained to perform such services.

To read the full report by the OIG, click here.

Comments?

Are you an ophthalmologist who has been flagged by OIG for questionable billing? Please leave any thoughtful comments below.

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 ophthalmologists and other 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.

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: OIG defense attorney, OIG flagged for questionable billing, ophthalmologists flagged by OIG, billing Medicare for ophthalmology services, Medicare audits defense lawyer, OIG report on questionable billing, high levels of billing for wet AMD treatments, OIG scrutiny defense, flagged by OIG for exceeding threshold of measures, Medicare defense attorney, ophthalmologist defense attorney, health law attorney, eye specialist defense lawyer, potential indicators of fraud, Medicare fraud defense lawyer, Medicare payment flags, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law Firm. All rights reserved.

Eye Doctor Faces Maximum of 200 Years in Prison for Medicare Fraud

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A central Florida ophthalmologist with offices in Windermere and Leesburg, was found guilty of 20 counts of Medicare fraud on September 29th. He faces a maximum of ten years in prison for each count. David Ming Pon, M.D., was convicted of health care fraud this past Tuesday by a Jacksonville federal jury. Following trial, Dr. Pon was turned over to the United States Marshals Service. He will remain in custody as he awaits his sentencing which is currently scheduled for March 14, 2016.

To read my previous blog posts as I followed this story from indictment to conviction, click here.

The Egregious Nature of the Crime.

Among allegations of defrauding Medicare out of millions of dollars, Dr. Pon is also said by the prosecution to have intentionally misdiagnosed and subsequently treated (unnecessarily) hundreds of patients. Dr. Pon provided several patients (most elderly) with phony diagnoses of macular degeneration, an eye disease that gradually progresses to vision loss. He then performed unnecessary laser treatments on his patients and billed Medicare for the services.

While the laser was set on low so as not to have caused any permanent damage per witness testimony, Dr. Pon was also found to have injected some of his patients with dangerous dyes that did have the potential to cause serious side effects.

To read the full press release from the FBI, click here.

Paying Back the Government.

Aside from the criminal charges, the federal government has filed suit against Dr. Pon in an effort to seize his assets as restitution for the Medicare funds he fraudulently acquired. Dr. Pon owns several pieces of property in the central Florida area which are vulnerable to government seizure per federal law.

Section 981, 18 United States Code details property subject to civil forfeiture. More specifically, section 981(a)(2)(A) states:

“For purposes of paragraph (1), the term “proceeds” is defined as follows:
(A) In cases involving illegal goods, illegal services, unlawful activities, and telemarketing and health care fraud schemes, the term “proceeds” means property of any kind obtained directly or indirectly, as the result of the commission of the offense giving rise to forfeiture, and any property traceable thereto, and is not limited to the net gain or profit realized from the offense.”

For more information on civil forfeiture of property, read one of our previous blog posts here.


No Small Matter.

Health care fraud is a big deal resulting in big consequences. If you find yourself facing allegations of Medicare or Medicaid fraud, immediately contact an experienced health attorney to advise you of your rights.

Furthermore, if you suspect Medicare or Medicaid fraud, do not hesitate to contact a knowledgeable attorney who can assist you in reporting the illegal activity.

To read one of my previous blogs on another recent health care fraud scheme, click here.

Tips Regarding Settling Medicare Fraud Cases.

Often it is possible to settle allegations of Medicare fraud by agreeing to pay civil monetary penalties and fines. If given such an opportunity, the Medicare provider should consider whether it is worth the risk of facing decades in prison. After all, you can’t spend your millions if you’re in prison for life.

The Health Law Firm has been successful in negotiating such deals with the United States Attorneys’ Offices.

Comments?

Have you ever been a victim or suspect of Medicare fraud? Please leave any thoughtful comments below.

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

The attorneys of The Health Law Firm represent retina surgeons and ophthalmologists on many different legal issues.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Stutzman, Rene. “Eye Doctor Convicted of Medicare Fraud.” Local News: Orlando Sentinel. 30 Sept. 2015: B1-B3. Print.

United States Attorney’s Office, Middle District of Florida. “Federal Jury Finds Doctor Guilty on 20 Counts of Health Care Fraud.” Jacksonville Division: The FBI Federal Bureau of Investigation. Press Release. 29 Sept. 2015. Web. 1 Oct. 2015.

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


Keywords:
Medicare audit defense, Medicare billing, civil forfeiture of property, Medicare fraud, defense attorney, defense lawyer, false claims act representation, false diagnosing, Florida health attorney, Florida health lawyer, health care fraud, health care fraud scheme, health law, insurance fraud, Medicare fraud scheme, The Health Law Firm, Medicare fraud defense lawyer, Medicare investigation, defense counsel, Medicare False Claims Act lawyer, retina surgery fraud, retina surgeon attorney, ophthalmologist legal counsel defense lawyer, macular degeneration misdiagnosis, health law criminal defense, health law criminal representation, OIG Medicare investigation, Medicare False Claims Act attorney, Medicare overpayment demand, Florida Contraband Forfeiture Act attorney, civil forfeiture defense lawyer

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law Firm. All rights reserved.

Windermere Eye Doctor Faces Eye Opening Prison Term in $7M Medicare Fraud Case

2 Indest-2009-1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Windermere ophthalmologist charged with intentionally misdiagnosing patients and performing unnecessary surgery headed for trial in Federal Court on Tuesday. According to prosecutors, Dr. David Ming Pon, with Advanced Retina Eye Institute in Leesburg and Orlando, is charged with 20 counts of Medicare fraud.

This case is being tried in the U.S. District Court for the Middle District of Florida.


Fake Treatments for Patients.

Dr. Pon is a retina surgeon as well as a board certified ophthalmologist. Prosecutors say he lied to 250 patients, telling them they had a degenerative eye disease, then performed unnecessary laser eye treatments. This prompted Medicare to pay more than $7 million allegedly for medical treatment that was not necessary. One of his former patients, James Allen, told the Orlando Sentinel that Dr. Pon gave him monthly laser treatments for 14 years. After switching eye doctors he discovered that he didn’t have macular degeneration at all, the medical condition for which he was being treated by Dr. Pon. “Each of those treatments was a fake,” Allen is reported to have said. To find out more about Medicare fraud and the consequences, click here to read a past blog on this.

The Doctor is in.

Pon is still in practice and still seeing patients despite a federal grand jury indictment in April 2014. He was jailed but released several months later.

Federal Agents seized paperwork from his office three years ago; when Pon allegedly refused to repay a $7 million demand for repayment, Federal authorities took the case to a federal grand jury. The trial is expected to last three weeks. To read more about this case, click here.

Pon could be facing more than 100 years in prison. For more information on Dr. Pon, visit the Florida Board of Medicine website here.  To read a press release the Department of Justice released about National Medicare Fraud, click here.


Comments?

Have you ever been a victim or suspect of Medicaid fraud? Please leave any thoughtful comments below.

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

The attorneys of The Health Law Firm represent retina surgeons and ophthalmologists on many different legal issues.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (ALFs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Stutzman, Rene. “Windermere eye doctor headed for trial in $7M Medicare fraud case.”
(September 6, 2015). Orlando Sentinel. Print.

“Windermere doctor to go on trial Tuesday on Medicare fraud charges.” (September 7, 2015). WFTV. From: http://www.wftv.com/news/news/local/windermere-doctor-go-trial-tuesday-medicare-fraud-/nnZff/

Washington Examiner. “Florida Eye Doctor Held Without Bail in Fraud Case.” Associated Press. (May 6, 2014). From: http://www.washingtonexaminer.com/florida-eye-doctor-held-without-bail-in-fraud-case/article/2548119

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: Medicare fraud defense lawyer, Medicare fraud defense attorney, Medicare investigation, Medicare audit, defense lawyer, defense counsel, Medicare False Claims Act lawyer, fraudulent claims, criminal defense, retina surgeon attorney, ophthalmologist legal counsel defense lawyer, macular degeneration fraud, health law criminal defense, ZPIC audit attorney, RAC audit lawyer, health law criminal representation, criminal representation, OIG Medicare investigation, Medicare False Claims Act attorney, Medicare overpayment demand, overbill Medicare, Medicare fraud, Medicare Investigation, overbill Medicare, health care fraud, Florida Attorney General, The Health Law Firm

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“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law firm. All rights reserved.

Florida is Serious in Combating PIP Fraud: Don’t Land Yourself in Prison

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

An Orlando health clinic owner and one other person were recently arrested on charges of defrauding multiple insurance companies and payers, according to the Florida Division of Insurance Fraud. Dr. Troy Godsey of Spine Health Solutions, P.A., allegedly provided treatments to”patients” involved in auto accidents. Three insurance companies received a $300,000 bill for reimbursements under the “patients'” personal injury protection (PIP) auto insurance. The companies reportedly paid out $100,000 before realizing it was a scam.

Godsey Operated Under the Pretense That He Was the Sole Owner of the Clinic.

Although Godsey, a licensed chiropractor, was allegedly the sole owner of the clinic, it was employee Renata Berriel Deazevedo, a non-licensed individual, who carried out the daily operations of the business. According to the Florida Department of Financial Services, Godsey was previously granted an exemption from clinic licensing requirements with the Agency for Health Care Administration. This reportedly allowed him to run the PIP fraud scheme without having to obtain a separate health care clinic license that would make the practice subject to periodic inspections. This further violated Florida’s PIP insurance laws.

It seems Godsey was attempting to create a “straw ownership” to avoid the proper licensing of his clinic. In accordance with Florida law requirements, it should have been licensed under the Florida Health Care Clinic Licensure Act (HCCLA). To operate a clinic in violation of the HCCLA is a felony. Furthermore, every day of operation is a different felony charge. In addition, all medical bills that an illegal clinic issues are void.

To learn more about health care clinic licensing, read one of our past blogs here.

Facing Prison for Half a Century.

Godsey’s and Deazevedo’s felony charges include operating an unlicensed health care clinic and filing false and fraudulent insurance claims. These charges carry with them penalties in excess of 50 years prison time. If convicted, the pair are faced with spending more than half a century behind bars. For most individuals, this would equate to a life sentence behind bars.

Who’s Your Boss?

Physicians, especially dentists, chiropractors, and optometrists, should always be extremely wary about working for a clinic or medical group owned in any part by someone who is not a licensed health professional. If it is owned in any part, even one percent (1%) by a person or business entity that is not a Florida licenced health professional, it may be operating illegally. This includes someone licensed in another state or who has a suspended or revoked license in Florida. Dentists, optometrists and chiropractors have even more restrictions placed on their practices than other health professionals in Florida and most other states.

Florida specifically prohibits the corporate practice of dentistry. The key provision in Florida law that establishes this is Section 466.028, Florida Statutes, but the Florida Board of Dentistry has adopted administrative rules on this topic as well.

Physicians who are “partners,” “shareholders” or “co-owners” with unlicensed personnel need to ensure they are in full compliance with the HCCLA and all other applicable Florida laws and regulations. Consult with an experienced health lawyer before making an expensive mistake. To see another blog I wrote on these issues, click here.

The Effect of the New Legislation: Know the Law and Be Sure to Follow It.

Several health care clinics wholly owned by licensed practitioners, were once allowed exemptions from licensing requirements of their facilities per Section 400.9905 (4)(G) of Florida Statutes. However, if these clinics wish to collect on PIP benefits, they will no longer be eligible to maintain their exempt status. For more on this matter, see previous blog post here.

The new PIP legislation is still under fire and it is likely it will undergo additional revisions. Due to its’ ever-changing nature, a licensed dentist or other licensed practitioner needs to stay up-to-date on Florida law requirements to avoid becoming entangled in illegal activity. It’s not enough to assume your employer is following the law.

What may have started off as blissful ignorance or an honest mistake, can quickly catapult into a significant consequence. Consulting with an experienced health attorney will keep your license safe and keep at bay unwanted prison time.

Comments?

Have you ever been a victim or suspect of a PIP scam? Please leave any thoughtful comments below.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, denials and demands for repayment from insurance companies, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), 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.

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

Sources:

Chief Financial Officer’s Press Office. “Orlando PIP Clinic Owner Arrested for Defrauding Insurance Companies of More Than $100,000.” (June 25, 2015). From http://www.myfloridacfo.com/sitePages/newsroom/pressRelease.aspx?id=4520

Health News Florida Staff. “Chiropractor Caught In PIP Scam.” (June 29, 2015). Health News Florida. From http://health.wusf.usf.edu/post/chiropractor-caught-pip-clinic-scam

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: PIP fraud, PIP claims, licensed dentist, health care clinic owners, health fraud defense lawyer, Agency for Health Care Administration, Health Care Clinic Licensure Act, health care clinic attorney, litigation over ownership of clinic, corporate practice of medicine, health fraud defense attorney, false claims lawyer, insurance fraud, Florida Division of Insurance Fraud, health law firm, The Health Law Firm, fraudulent claims, false claims attorney, health care fraud, health care clinic attorney

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law firm. All rights reserved.

Florida Law Prohibits Optometrists from Practicing with Non-Licensed Corporations or Individuals

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

Florida , unlike many other states, does not prohibit the corporate practice of medicine. This lack of prohibition, allows for a licensed physician or other health care provider to practice medicine as an employee or contractor of a corporation or other business entity owned and operated by a non-physician. This principle has been exhibited in a number of court cases and several declaratory statements issued by The Florida Board of Medicine.

However, this rule does not extend to optometrists, who are expressly prohibited by Florida law from practicing with non-licensed corporations or individuals.

Florida Statutes, Section 463.014(1)(a) and (b), state in pertinent part:

“No corporation, lay body, organization, or individual other than a licensed practitioner shall engage in the practice of optometry through the means of engaging the services, upon a salary, commission, or other means or inducement, of any person licensed to practice optometry in this state.” And–

“No licensed practitioner shall engage in the practice of optometry with any corporation, organization, group, or lay individual.”

Not Prohibited by Florida Law for the Practice of Optometry.

However, the statutes do not prohibit an optometrist from practicing under the following circumstances:

(1) “…with a multi-disciplinary group of licensed health care professionals, the primary objective of which is the diagnosis and treatment of the human body”;

(2) “…from employing, or from forming partnerships or professional associations with, licensed practitioners licensed in this state or with other licensed health care professionals, the primary objective of whom is the diagnosis and treatment of the human body”; and

(3) to practice “in or on the premises of a commercial or mercantile establishment.” Fla. Stat. §463.014(1)(a), (b), and (c) (2015).

Additionally, corporations or other business entities can employ licensed practitioners to provide optometry services to employees of the corporation or business and their immediate family members. This rule only applies so long as such services provided are incidental to the primary objective and business of the corporation or organization. This section is not to be construed as the authorization for employment of a licensed practitioner by a non-licensed corporation established primarily for such services as optometry. Fla. Stat. §463.014(2) (2015).

The Importance of Advertising.

While it is important to advertise your business to maintain traffic flow and profits, that’s not exactly the objective being discussed here. Rather, Florida law and the Florida Board of Optometry has specific requirements for advertising that must clearly distinguish between professional and lay practice.

“Advertising goods or services in a manner which is fraudulent, false, deceptive, or misleading in form or content” is grounds for disciplinary action by the Board, per Florida Statutes, Section 463.016(1)(f) (2015).

Florida law further prohibits licensed practitioners from:

(1) “…practic[ing] under practice identification names, trade names, or service names, unless any dissemination of information by the practitioner to consumers contains the name under which the practitioner is licensed or that of the professional association in which the practitioner participates. Any advertisement or other dissemination of information to consumers may contain factual information as to the geographic location of licensed practitioners or of the availability of optometric services”; and

(2) “…adopt[ing] and publish[ing] or caus[ing] to be published any practice identification name, trade name, or service name which is, contains, or is intended to serve as an affirmation of the quality or competitive value of the optometric services provided at the identified practice.” Fla. Stat. §463.014(1)(d) and (e) (2015).

An optometrist, in advertising his or her practice, should be wise not to give the appearance of being associated or affiliated with another business entity or individual which or whom itself is not a licensed practitioner.

Make Sure the Contract Protects Your Interests.

A licensed practitioner should review both the statutory law and the latest rules of the Board of Optometry before entering into any business arrangement for the provision of optometry services that includes any unlicensed person or entity.

Identifying one’s activity or practice in a manner which represents to the public that the person is a licensed practitioner or certified optometrist, when the person has not been licensed or certified per Florida law requirements, constitutes a misdemeanor. Furthermore, practicing or attempting to practice optometry without a valid license is punishable as a felony in this state.

Finally, the Florida Board of Optometry, through its rule-making authority, has enacted rather stringent requirements to separate professional optometry from control by others. For example, the Board of Optometry has implemented a rule to require that Optometrists’ contractual agreements may not limit their independent professional judgment.

Therefore, an optometrist should always have such contractual agreements reviewed in advance by his or her own experienced health attorney as a fundamental safeguard. The optometrist entering into any such contract must make sure he or she complies fully with the law.

To read one of our past blogs with more information regarding this subject, click here.

Contact Health Law Attorneys Experienced in Representing Optometrists.

The attorneys of The Health Law Firm provide legal representation to optometrists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, contract matters, business law matters, business litigation and other types of investigations of health professionals and providers.

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

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

KeyWords: Optometrist attorney, Optometry lawyer, Opthamology lawyer, Opthalmologist attorney, Licensed Practitioner, Non-Licensed, Florida Law, Florida Statutes, Lay Practice, Board of Optometry, Florida Board of Medicine, Health Attorney, Disciplinary Action, The Health Law Firm, medical license defense attorney, Optometry license defense lawyer, Board of Medicine complaint defense, Board of Optometry Defense Lawyer

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2015 The Health Law Firm. All rights reserved.

Say Whatttt? Defamation in Florida

TTP Headshot SmBy Thu T. Pham, O.D., J.D., The Health Law Firm.

Defamation is defined as any intentional false statement that harms a person’s reputation. It encompasses both written (libel) and spoken (slander) statements. Depending on the nature of the offense, it can lead to both civil and/or criminal sanctions. But when has defamation actually been committed? Successfully proving defamation can be difficult and convoluted.

Defamation Is Not…

Let’s start by stating what defamation is NOT. Speaking one’s mind, or voicing a negative opinion, is not defamation. The Constitution protects our freedom of speech. So, for example, to say that someone has a very un-agreeable disposition, is tacky, or even bad breath, is not defamation. We are all entitled to our opinions.
So What is Defamation?

Defamation has been committed when someone knowingly makes a false accusation. For example, falsely accusing an ex-employee of committing theft in order to gain the upper hand in an unemployment hearing would be considered defamation. There are 3 elements that must be demonstrated in order to prove defamation. One, the statement made was false, the statement caused harm, and the statement was made without adequate research as to its credibility. For a celebrity or public official, to prove defamation, they must also prove there was malicious intent behind the statement.
Situations Where You May Recover Damages Without Proving Actual Damages.

There are times when a statement is so heinous and despicable in nature that actual damages need not be proven. This is known as “defamtion per se.” Such statements include but are not limited to accusations of immoral acts, criminal activity, having a sexually transmitted infection, or having a characteristic that is incompatible with the proper exercise of one’s trade or profession. Punitive damages may be awarded in these instances as a way to punish the libeller.
Defenses In a Defamation Suit.

There are special protections afforded to members of the media, government workers, politicians, and public figures, providing them certain defenses in a defamation lawsuit.

For medical doctors, optometrists, nurses, dentists, hospitals, and nursing homes that are not afforded such protections, their only defense would be “substantial truth.” This means that the statement does not have to be entirely true as long as the “gist” of the statement is true.
If You Have a Valid Defamation Action, Don’t Delay!

If you feel that you’ve been defamed, do not wait to contact an experienced attorney. In Florida, the statute of limitations for a defamation action is two years. If a claim is not brought forth in this time period, it is forfeited.
Comments?

Before this blog, did you fully understand defamation? Please leave any thoughtful comments below.
Contact Health Law Attorneys Experienced in the Representation of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, pain management doctors, dentists, optometrists, pharmacists, psychologists and other health providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: Dr. Thu T. Pham represents physicians, dentists, nurses, optometrists, and other health care providers. Her practice includes health law, nursing law, employment law, defense of Medicare and Medicaid audits, and investigations, administrative proceedings and the defense of professional licenses and prepares appeals of administrative law cases. Dr. Pham is also an active doctor of optometry.

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 © 1996-2014 The Health Law Firm. All rights reserved.