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

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

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

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

Facts You Should Know About the Medicaid Audit Process.

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

If You Are the Subject of an Audit.

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

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

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

Compiling a Response to an Initial Audit Request.

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

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

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

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

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

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

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

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

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

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

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

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

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

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

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
KeyWords: Medicaid fraud defense attorney, Medicaid audit defense attorney, legal representation for false billing, legal representation for Medicaid overpayment, legal representation for Medicaid audit, legal representation for Medicaid investigation, health care fraud defense attorney, Medicaid fraud attorney, Centers for Medicare & Medicaid Services (CMS) , legal representation for allegations of overbilling, audit defense attorney, ZPIC audit defense attorney, legal counsel for responding to Medicaid audits, legal representation for Medicaid fraud allegations, legal counsel for Medicaid audits, reviews of The Health Law Firm, The Health Law Firm attorney reviews

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

What is the corporate practice of optometry and what does it prohibit?

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

The legal doctrine called the “corporate practice of medicine or optometry” actually refers to the legal prohibition that prevents a doctor or an optometrist from working for a corporation (or other business entity) that is owned, operated or controlled by non-physicians or, in the case of optometrists, non-optometrists.

In the context of such laws, the term “non-physician” or “non-optometrist” almost always refers to one who is not licensed in the same state as the practice. Such prohibitions are entirely subject to each state’s laws. Some states have statutes that prohibit the corporate practice of a profession. Others have case law that has developed over the decades. So it depends on what state you are in whether or not the law prohibits the relationship.

The principle behind having such a prohibition is to prevent a business from controlling a medical or optometry practices. The idea is that decisions involving patient care should be made solely and completely in the best interest of the patient, based on the patient’s actual medical needs, by the physician providing the services. Fears are that business people or corporations might scrimp on supplies and equipment, purchase inferior grade products to use, or order unnecessary tests and procedures to increase income.

Florida has no corporate practice of medicine prohibition for medical doctors (MDs) or osteopathic physicians (DOs). However, it does have prohibitions that apply to optometrists, dentists and chiropractors. The optometry statute, Section 463.014, Florida Statutes, is similar to the ones for dentistry, Section 466.0285, Florida Statutes, and for chiropractors, Section 460.4167, Florida Statutes, perhaps being more similar to the latter. Although the optometry statute does not provide the strict consequences for violation that the latter two statutes above provide, nevertheless, it does prohibit the corporate practice of optometry, except if the corporation or business entity is owned and controlled by other licensed health professionals. The statutes prohibiting the corporate practice of dentistry and chiropractic, both make it a felony to violate the prohibition, a very serious matter.

Section 463.014(1)(a), Florida Statutes, does conclude with “Nothing in this section shall be deemed to prohibit the association of a licensed practitioner [meaning “optometrist”] with a multidisciplinary group of licensed health care professionals, the primary objective of which is the diagnosis and treatment of the human body.” To me, this language specifically authorizes an optometrist to “associate with” (meaning be employed by, contract with, form a partnership with, be a member with, be a shareholder with, etc.) a group or entity composed of other licensed health professionals (e.g., MDs, DOs, ARNPs, etc.). Therefore the optometrist could join with or be employed by any type of “group” of other licensed health professionals, whether that group is a P.A., Inc., LLC, etc.

Under Florida law, unless the licensed health professionals are the same profession (i.e., licensed by the same board) then they cannot form a “professional association” (a misnomer, actually it is a “professional service corporation” or “professional corporation” which the Florida Statutes allow to be shown by the abbreviation “P.A.;” see, Section 621.12(2), Florida Statute) nor a professional limited liability company (PLLC). See Section 621.03(2), Florida Statutes. So, for example, an MD could not legally form a P.A. (meaning a professional association or professional service corporation) with an advanced registered nurse practitioner (ARNP) as a shareholder (different professions). A chiropractor (DC) cannot legally be in a P.A. with a dentist (different professions).
However, I don’t believe there is any prohibition in Florida on licensed health professionals forming a non-professional service corporation (i.e., a “business corporation”) or other types of business entities, with other licensed health professionals. Except, of course, the prohibition that applies to optometrists, chiropractors and dentists, discussed above.

Despite the absence of teeth from the optometry statute, Section 463.014, Florida Statutes, I would never recommend to a client ignoring it. You risk having someone sue to have any contracts or arrangements made that violate it declared void and unenforceable. I have been involved in a number of these cases with medical doctors and with dentists.

Before entering into any business venture in Florida (or any state, for that matter) involving a medical business, dental practice, optometry practice, or chiropractic practice, be sure to consult with a board certified health lawyer or other experienced attorney knowledgeable in health law and corporate law. Be sure to conduct adequate due diligence to know and understand the entire business arrangement. Obtain a written opinion letter to advise you and protect you from the consequences of a poor decision.

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., 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: Legal representation for optometrists, corporate practice attorney, corporate practice defense attorney, Board of Optometry investigation defense attorney, Optometrist defense attorney, legal counsel for Board of Optometry investigations and hearings, health care professional defense attorney, legal representation for medical professionals, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida health law attorney, legal representation for administrative hearings, legal representation for complaints against a professional license, licensure defense attorney, legal representation for a complaint made for violation of HIPAA or patient privacy, legal representation for Optometrists in Florida, legal representation for Optometrists in Colorado, legal representation for Optometrists in Louisiana, legal representation for Optometrists in Virginia and legal representation for Optometrists in the District of Columbia

“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

Jury Convicts Doctor and Medical Billing Company Owner for $28 Million Medicare Fraud Scheme

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

On May 1, 2017, a federal jury in Michigan found a Detroit-area doctor and owner of a medical billing company guilty of perpetrating a $28 million health care fraud scheme. The scheme involved billing Medicare for pain treatments that weren’t actually provided, the U.S. Department of Justice (DOJ) said.

Health Care Fraud Scheme.

Dr. Johnny Trotter and Elaine Lovett were both convicted after a four-week jury trial on one count of conspiracy to commit health care and wire fraud and three counts of health care fraud. In addition to the fraud scheme, both Trotter and Lovett also worked to dodge Medicare’s investigation into Trotter, according to the DOJ.

Evidence at the trial showed that between May 2008 and May 2014, both Trotter and Lovett fraudulently billed for services that were never provided. These services were predominantly nerve block injections, which treat pain by numbing groups of nerves.

In 2009, Medicare grew suspicious and began to require that claims submitted by Trotter satisfy a medical review prior to payment pre-payment review). As a result, both Trotter and Lovett conspired to dodge this investigation by starting fake medical centers, according to the prosecution said.

Trotter and Lovett attempted to hide their involvement by recruiting family members and employees to serve as “straw owners” of the companies. Meanwhile, the two fraudsters continued receiving payment for services that weren’t provided, the government said.

To learn more about health care fraud and the repercussions of Medicare fraud, click here to read one of my prior blogs.

Watch our short video blog on Medicare fraud and the audit process here.

 

Contact a Health Care Attorney Experienced in the Representation of Medicare and Medicaid Fraud.

The Health Law Firm and its attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicare and Medicare investigations, audits and recovery actions.

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

Sources:

Kennedy, John. “Jury Convicts 2 Over $28M Medicare Pain Treatment Fraud.” Law360. (May 1, 2017). Web.

“Jury Convicts 2 Over $28M Medicare Pain Treatment Fraud.” Lexis Nexis. (May 1. 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: Medicare audit defense attorney, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare fraud investigation, Medicare Strike Force, legal representation for fraudulent claims, prepayment review attorneys, legal representation for submitting false claims, Medicare overbilling defense attorney, Medicare audit defense lawyer, legal representation for allegations of Medicare fraud, health care fraud defense attorney, Medicare fraud defense attorney, legal representation for Medicare termination, Medicarelegal representation for Medicare exclusion, OIG exclusion defense attorney, The Health Law Firm, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

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

 

Finding an Attorney/Lawyer Who Takes Healthcare Providers Service Organization (HPSO) Insurance for Optometrists

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

We often hear from callers and clients in professional licensing complaints, Department of Health investigations and Board of Optometry, that they had good insurance coverage with Healthcare Providers Service Organization (HPSO) Insurance, but could not find an attorney that would accept it. Often these professionals retain us after action has been taken to appeal or attempt to reverse an adverse disciplinary action taken against their license.

This should not be a difficult task. Our firm and its attorneys have accepted HPSO Insurance for over 25 years.

Our firm has attorneys that are licensed in and can defend optometrists in Florida, Colorado, Louisiana, Virginia and the District of Columbia. Additionally, there are many states, such as Tennessee, Georgia, Oregon, Pennsylvania, New York, Delaware, and others, which allow us to appear before their boards and represent clients in these state under their “multi-jurisdictional practice” rules, because this is an area in which we routinely practice.

Legal areas in which we can represent an HPSO insured that HPSO will pay for include: administrative hearings, complaints against a professional license, an investigation of a complaint made against your professional license, a deposition you may be subpoenaed for, a complaint made for violation of HIPAA or patient privacy, and many others.

Regardless of the state, contact us at:

The Health Law Firm, Main Office
1101 Douglas Ave.
ALtamonte Springs, FL 32714
Phone: (407) 331-6620
Fax: (407) 331-3030
Website: http://www.TheHealthLawFirm.com
Internet Contact: http://www.TheHealthLawFirm.com/contact-us/

One last word, regardless of whether you are covered by HPSO Insurance or not, if an investigator contacts you to obtain a statement from you, whether orally or in writing, always, always, always, consult with an experienced attorney in this area BEFORE giving any statement or talking to the investigator about anything.

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

KeyWords: Legal representation for optometrists, Board of Optometry investigation defense attorney, Optometrist defense attorney, legal counsel for Board of Optometry investigations and hearings, health care professional defense attorney, legal representation for medical professionals, Florida HPSO health law attorneys, legal representation for cases dealing with HPSO insurance, reviews of The Health Law Firm, The Health Law Firm attorney reviews, Florida health law attorney, legal representation for administrative hearings, legal representation for complaints against a professional license, licensure defense attorney, legal representation for a complaint made for violation of HIPAA or patient privacy, legal representation for Optometrists in Florida, legal representation for Optometrists in Colorado, legal representation for Optometrists in Louisiana, legal representation for Optometrists in Virginia and legal representation for Optometrists in the District of Columbia

“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

Medicare Administrative Contractor and Other Contractors Continue to Punish Medicare Providers Who Do Not Have Current, Correct Address Information on File; You Should Check Up On This!

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

We constantly receive calls from physicians and other Medicare providers who have had their Medicare billing privileges terminated or revoked because their address information is not up to date or is incomplete.  You must include a physical address at which your business operates so that if the Medicare Administrative Contractor (MAC), the Zone Program Integrity Contractor (ZPIC), or the Recovery Audit Contractor (RAC) attempts a site visit, they can find you and complete the site visit.  Having the incorrect city or suite listed, leaving out a suite number, having a locked entranceway or gate so that the auditors cannot get in, have all been results to revocation of Medicare billing privileges.  This can have devastating results to the business.

Many times the physicians or other Medicare Providers have recently relocated and the records have not been updated yet.  Sometimes, a post office box or other address is used instead of an actual physical address.  Often moving from one hospital to a different hospital leaves your information listed incorrectly.  Sometimes the street address is not complete or is incorrect.  Sometimes it is just a matter of a typographical error being made by whoever enters your addresses.

Just having a letter returned to the contractor because of an incorrect address can initiate this action.  You will be held individually responsible, regardless of this, even if you use an independent contractor or someone else to make your Medicare filings and keep them up to date.

The basis for the revocation is 42 CFR424.535(a)(5) and 424.535(a)(9) Medicare Provider is considered to be non-operational at the practice location on record with the Centers for Medicare and Medicaid Services (CMS).

You can easily check your own information to be sure it is correct, and you should do so.  Your addresses should be located online in the Provider Enrollment, Chain and Ownership System (PECOS). Visit the website by clicking here. For more information, click here.

You can also check online at the National Plan and Provider Enumeration System (NPPES) by clicking here.
Do this now!

If you receive a letter or any other indication that your Medicare billing privileges have been revoked or terminated, you must act immediately.  Contact an experienced health lawyer to assist you immediately.  Don’t wait, you will regret it if you do.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in  Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

KeyWords: termination of Medicare billing privileges, Medicare Administrative Contractor (MAC), Centers for Medicare and Medicaid Services (CMS), Zone Program Integrity Contractor (ZPIC), Recovery Audit Contractor (RAC), reviews of The Health Law Firm, Medicare Providers, ZPIC defense attorney, Medicare billing privileges, health law, revocation of Medicare billing privileges, ZPIC audit, Medicare defense attorney, legal representation for health care providers, Medicaid defense lawyer, Medicare audit, health law firm, Medicaid audit, The Health Law Firm reviews, Medicare billing privileges revoked, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2016 The Health Law Firm. All rights reserved.

New York Optometrist Escapes Malpractice Suit for Patient’s Brain Tumor

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

On November 23, 2016, a New York appeals court freed a Madison Avenue Eye Care Ltd. optometrist Paul Kantrowich from a malpractice suit. It was alleged in the suit that Kantrowich negligently failed to diagnose a patient’s partial blindness that was caused by a brain tumor. The brain tumor was diagnosed by another doctor. The patient, Neil Flaherty, filed the suit too late, the court said, so the complaint against Kantrowich was dismissed.

Three-year Statue Limitations in New York Causes Dismissal of Case.

The New York appellate court said in its decision that Flaherty cannot bring up any visits he had with Kantrowich that occurred before February 2012 because his suit did not meet an exception to the three- year statute of limitations that exists in New York. The five-judge appellate court panel upheld the lower court’s September 2015 dismissal.

Kantrowich Did Not Diagnos Flaherty’s Brain Tumor.

The case dates back to 2005, when Kantrowich first examined Flaherty. Kantrowich had diagnosed Flaherty as being legally blind in his right eye, with 20/400 vision. For seven years, Flaherty returned to Kantrowich once a year to have his eyes examined as well as to get a prescription for contact lenses.

According to the allegations that were made, during the yearly visits, Kantrowich saw optic neuropathy, or damage, in Flaherty’s right eye. Kantrowich also noticed that the nerve was paler than it should have been. In February 2012, Kantrowich referred Flaherty to a neuro-opthamologist. The new physician to whom he was referred said Flaherty’s blindness was caused by a meningioma (tumor).

Flaherty’s suit against Kantrowich and Madison Avenue Eye Care, Ltd., claimed that Kantrowich should have either diagnosed the tumor earlier or referred him to a neuro-opthamologist sooner.

The appellate court said that Flaherty’s claims are subject to New York’s three-year statute of limitations because he did not come under the “continued treatment doctrine” which provides an exception to the statute of limitations. The court said that since Kantrowich only performed routine or diagnostic examinations and did not treat the neuropathy, his work cannot be considered a course of treatment.

The appellate court’s opinion states: “The measurement of plaintiff’s nerve pallor annually did not itself amount tp continuos treatment, or reflect any agreement to monitor the condition, but was part of the routine examination.”

The appellate panel stated that the February 2012 date falls within the statute of limitations, but because Flaherty did not argue that the delayed diagnosis worsened his condition or prevented him from getting better, the claim fails.

Editor’s Comments

It must be remembered that this case occurred in New York. Not every state has a statute of limitations for medical malpractice cases as long as New York’s is. For example, Florida’s statute of limitations for a medical negligence case is two years (in most cases). Most states have shorter statutes of limitations, with some as short as a year. If you suspect that you may have been the victim of malpractice, then you need to consult an experienced medical malpractice plaintiff’s attorney and follow-up on this at the earliest possible time. Any attorney will need time to investigate and follow the appropriate procedural steps required by law. Also, you may need to contact several different attorneys to find one who is interested in taking your case; but again, do this as early as possible.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians, medical doctors, optometrists and ophthalmologists in defending against board complaints against their licenses, defending malpractice suits, defending peer review actions, defending whistle blower and other types of complex litigation cases. We represent physicians in Medicare and Medicaid audits, recovery actions, litigation, inspections and audits involving the DEA, Centers for Medicare and Medicaid Services (CMS), ZPIC audits, RAC audits, Department of Health (DOH) investigations, 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.

Source:
Kass, Dani. “NY Eye Doctor Escapes Suit Over Missed Brain Tumor.” Law360. (November 23, 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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Reviews of The Health Law Firm, optometrist defense lawyer, health law, eye specialist defense attorney, Board of Optometry defense attorney, Board of Medicine defense counsel, legal representation for healthcare providers, The Health Law Firm reviews, ophthalmologist defense attorney, neuro-ophthalmologist defense counsel, health law litigation, legal representation of health professionals, The Health Law Firm, medical malpractice defense counsel suits, peer review action defense attorney, whistle blower defense litigation attorney, complex litigation attorney, Medicare audit defense counsel Medicaid audit defense attorney, DEA defense attorney, Centers for Medicare and Medicaid Services (CMS) defense counsel, ZPIC audit defense attorney, RAC audit legal counsel, Department of Health (DOH) investigation defense 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 © 2016 The Health Law Firm. All rights reserved.

Health Care Providers: PLEASE Talk to an Attorney Before You Talk to an Investigator!

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

At The Health Law firm, we often receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. It is imperative to know that in Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Department of Health (DOH) investigators (who are sometimes titled “Medical Quality Assurance Investigators” or “Medical Malpractice Investigators”), Drug Enforcement Administration (DEA) special agents, police officers, sheriff’s deputies, or criminal investigators of any type.

If you are being investigated, you will NOT be better off making a statement. You will NOT be better off explaining your side of the story. The investigator is NOT your friend. The investigator is NOT on your side.

You have a right under the U.S. Constitution to not make any statement that may be used against you. This is so important that in criminal cases government investigators are required to advise you of this by reciting to you your Miranda rights. To learn more about your Miranda rights, click here to read one of our prior blogs.

Know Your Rights.

In cases where you might have your medical license revoked or have your nursing license revoked or have your DEA number revoked or lose your Medicare provider status or your Medicaid provider status, the investigator is not required to advise you of your rights.

In a criminal case, there may be ways to have your statement thrown out. However, in a professional licensing case or other administrative case, it may be too late to avoid the damage. You may be the best witness the government has and you may be the only witness the government needs to prove this case against you.

In the case where you could receive a $100 criminal fine, the investigators are required to read you your constitutional Miranda rights and to be sure that you understand them before you make a statement. However, in a case where you can lose your professional license, where you could lose your livelihood and ability to make a living, where you could lose everything you have worked so hard to obtain, they are not required to do this. You must protect yourself.

Many health professionals, when confronted by an investigator, who will usually call at a very inconvenient time (to catch you by surprise) and will usually flash a badge (to intimidate you), will refuse to acknowledge the seriousness of the matter and will fall for the bait to “tell their side of the story.” This can be fatal to your defense and fatal to your license.

You Cannot Talk Your Way Out Of It.

Remember, this is the investigators’ job and profession. This is what they do full time, every day. And they are very good at it. They are 1,000 times better at getting you to admit the crucial elements of a disciplinary infraction than you are in “talking your way out of it.” They will not be convinced by any excuses you make. You will help them by talking to them, explaining why your decisions are correct, explaining why what you did is excusable, etc. It will not work. You will merely be giving them enough rope to hang you with.

Hint: If it is a Medicaid Fraud Control Unit (MFCU) special agent (investigator), you are probably under investigation for Medicaid fraud.

Hint: If it is an “auditor,” “surveyor” or “investigator” from an agency or company with “integrity” or “program integrity” in its name, they are probably investigating you for “lack of integrity,” i.e., false claims or fraud.

Hint: If it is a Drug Enforcement Administration (DEA) special agent (investigator) they are probably investigating you to prosecute you or to revoke your DEA registration for drug or prescribing violations.

Hint: If it is an Office of the Inspector General (OIG) special agent (investigator), you are probably under investigation for Medicare fraud or Medicare false claims.

Hint: If it is a Department of Health Quality Assurance Investigator or Medical Malpractice Investigator, they are probably only investigating possible disciplinary action against your license that could result in large administrative fines or revocation of your license.
Do not believe for a second that you are smarter than the investigator. Do not believe for a second that you will convince the investigator (or anyone else) that there is a legal or medical justification for what you did or what they allege. If it were as simple as that, then why would there be an investigation and why would you be the one being investigated?

Additionally, do not believe for a second that you can lie your way out of it, either. Remember, if the government cannot prove the basic offense that it is investigating against you, it may be able to prove that you have committed perjury or lied to an investigator. In the case of a federal official or a federal investigation, merely making a false statement (oral or written) to an investigator is a criminal act. This is what Martha Stewart and many others have served time for in federal prisons.

Keep Silent.

It is much better to make no statement at all. Blame it on your attorney. Tell the investigator that your attorney will kill you if you were to talk to the investigator without your attorney being there ahead of time. “Speak to my attorney.” “My attorney can help you, I can’t.”

Far too often the health professional only calls us after he has given a statement. This is usually too late to avoid much of the damage that will have been be caused. Everything above applies to oral statements or written statements. Do not make either. Contact a lawyer as soon as possible, preferably before making any statement, no matter how simple, defensive, self-serving or innocuous you may think it to be.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals in Criminal Matters and Professional Licensing Matters.

If you have been arrested, it is strongly recommended that you retain an experienced attorney who can advise you on the criminal proceeding, your rights and how it may affect you. Most important to a physician, dentist, nurse, pharmacist or other health professional are what consequences may follow this. Consequences may include loss or suspension of hospital privileges, loss or suspension of your professional license, exclusion from the Medicare Program, termination from the state Medicaid Program, termination from health care insurance panels and other severe consequences.

The attorneys of The Health Law Firm routinely represent physicians, pharmacists, nurses, and other healthcare practitioners in criminal defense matters. We frequently consult with criminal defense attorneys regarding defense strategies tailored to minimizing criminal sanctions while preserving the practitioner’s license.

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: Right to remain silent, Miranda rights, criminal law defense attorney, health care investigations, investigations against health care professionals, The Department of Health (DOH) investigations, Medical Quality Assurance Investigators, Drug Enforcement Administration (DEA) investigations, medical malpractice investigators, disciplinary actions against health care professionals, health care license defense attorney, physician criminal charges, health attorney, criminal trial, criminal case defense lawyer, Fifth Amendment, plead the Fifth, administrative sanctions, administrative law judges, administrative hearing, administrative trial, administrative proceedings, 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.

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