Florida Medicaid Audits Dental Claims

MLS02PJGBy Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations Handbook. AHCA’s audits are focused on claims that are billed too frequently, claims that are billed on the same date of service as a redundant code, and claims that have been unbundled when they should have been billed as part of a comprehensive code.

Specific Dental Codes Being Audited.

Dental providers that are the subject of these audits may not learn of the audit until they receive the Preliminary Audit Report. It is extremely important to immediately retain experienced health care counsel if you receive a Preliminary Audit Report so that a timely rebuttal with additional documents can be submitted. The audits are performed by the AHCA based entirely on the claims submitted by the provider.

Some of the specific procedure codes included in the audits are:

- D0120,
- D0272,
- D1110,
- D1120,
- D1203,
- D1330,
- D0150,
- D0210,
- D0330,
- D4355, and
- D4341.

Take Preliminary Audit Reports Seriously.

Every dental provider that receives a Preliminary Audit Report from AHCA has a limited time to respond to the audit. AHCA may also impose sanctions and assess costs against dental providers in these audits. Any dental provider that receives notice of an audit by the Agency should contact legal counsel experienced in these matters without delay.

Click here for a previous blog on tips for responding to an AHCA audit.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in AHCA investigations, audits and recovery actions, as well as Medicare and Medicaid 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.

Comments?

Have you ever received a Preliminary Audit Report from the AHCA? Did you know how to respond? Please leave any thoughtful comments below.

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He 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 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 © 1996-2014 The Health Law Firm. All rights reserved.

Florida Board of Dentistry Warns About Responding to or Consulting with Individuals Over Internet About Dental Issues

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

At the Florida Board of Dentistry meeting held on November 15, 2013, one of the committee chairs discussed an issue that has arisen nationally that is causing dentists legal problems. The issue arises when individuals contact a dentist over the internet seeking “information” on a dental condition or problem, and possible treatment or procedures that can resolve these issues.

The concern is that the dentist may actually be diagnosing a dental condition or problem the individual has. The bigger concern arises if the individual contacting the dentist is in a different state from the one in which the dentist is licensed. Then the dentist is actually practicing dentistry in the state in which the individual is located.

In this blog I will discuss some of the issues a dentist can encounter when diagnosing a condition or problem over the internet. I will also talk about ways a dentist can reduce his or her risk.

Issues Dentists Can Face When Diagnosing a Condition Over the Web.

Diagnosing a non-patient over the internet can cause a myriad of different problems for the dentist involved, including these situations:

1. By diagnosing in a state in which the dentist is not licensed, he or she is engaging in the unlicensed practice of dentistry in that state. This can lead to criminal charges in that state and disciplinary actions in the state where the dentist is licensed.

2. Cases have arisen where incorrect diagnoses have been rendered because the individual failed to provide complete information, and the dentist failed to physically examine the individual or follow other procedures normally followed.

3. There have been instances where such individuals have filed complaints or claims against dentists for providing them information upon which they relied.

4. In most cases, a dentist’s professional liability (dental malpractice) insurance will not cover professional negligence in another state.

Recommendations to Reduce Risk.

I recommend that dentists take the following steps to help reduce risk if involved in providing information to non-patients over the internet or in the media (radio, television, newspaper, etc.):

1. Make sure that you have proper warnings and disclaimers that are included in every such e-mail communication or listserv communication you make.

A. Include the state in which the dentist is licensed/practicing and explain that the communication is not considered to be diagnosing, prescribing, treating or practicing any profession in any other state or jurisdiction.

B. Include a disclaimer or statement in every e-mail listserv or other communication with non-patients that you are providing general information for educational purposes only, and the individual must seek and follow the advice of a dentist in his or her geographic area to make any diagnoses.

C. Include that the person receiving the information cannot rely on it for treatment purposes since an actual physical examination must take place before any reliable information/recommendations can be made in any individual’s case.

2. Inquire with your professional liability insurer or agent to ask about “broad form coverage” and attempt to obtain coverage that includes educational activities, marketing activities and other similar activities. Make sure the “broad form coverage” also covers these activities in different states.

3. Make sure your professional liability insurance provides coverage for legal expenses involved in defending against administrative complaints and investigations initiated by any state or federal agency that could result in disciplinary action against you or your license. You probably need at least $25,000 in coverage for this. However, $50,000 or $75,000 in coverage for such matters is preferred. Buy this coverage separately if necessary. Lloyd’s of London provides such coverage separately.

4. Find out where the individual contacting you resides or is communicating from. Require complete information, including complete name, address and telephone numbers.

5. Be extremely reluctant to criticize care, services, procedures, materials or appliances used or prescribed by other dentists.


Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry 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.

Comments?

Have you ever been asked to consult with a patient over the internet? Did you know all of these issues could up? 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.

Connecticut Dentist Gets Drilled in Huge Medicaid Fraud Case

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

A dentist and owner of a number of clinics in Connecticut is feeling the pain of justice. According to a number of news sources, Gary Anusavice will spend the next eight (8) years in prison for targeting poor patients, performing unnecessary dental procedures and collecting $21 million in fraudulent Medicaid claims. He was sentenced on October 9, 2013.

To read an article on the dentist’s sentencing from The Hartford Courant, click here.

Dentist Must Forfeit Luxury Items.

On top of prison time, the dentist will have to pay $3.3 million in restitution and $1.9 million to the Internal Revenue Service (IRS) as a result of his Medicaid fraud scheme, according to The Hartford Courant. He was also ordered to forfeit his mansion, a 2008 Mercedes-Benz, a yacht and more than $91,000 in cash that was found in his home.

According to news reports, this is far from the first time he has been accused of defrauding the Medicaid program.

Dentist Previously Barred from Practicing in Massachusetts and Rhode Island.

According to an article in the Connecticut Post, the dentist had previous run-ins with authorities in Massachusetts and Rhode Island involving health care fraud. Both states allegedly stripped him of his dental licenses. He was also allegedly barred from participating in Medicaid in those states.

Since the dentist could no longer practice in those states, in 2008, he opened three dental groups in Connecticut, according to the Connecticut Post. In these new practices, it’s alleged he hired other dentists and offered them commissions for performing expensive procedures, paid patient recruiters to solicit poor neighborhoods, and provided shuttle services for patients. In two years, his Connecticut clinics received $21 million in Medicaid payments, according to the Connecticut Post.

Click here to read the Connecticut Post article.

In June 2013, the dentist pleaded guilty to health care fraud and tax evasion.

Being Barred from the Medicare and Medicaid Program Can have Devastating Effects.

Few health care practitioners really understand the significance of being excluded from the Medicare or Medicaid programs. Exclusion usually occurs as a direct result of disciplinary action being taken by the state board of medicine, board of nursing, board of dentistry, board of pharmacy or other health care licensing entity. To read more on the effects of exclusion from the Medicare or Medicaid programs, click here.

Take Fraud Charges Seriously.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Often Fraud Claims Can Give Rise to Large Rewards Paid to Whistleblowers.

Practically every state now has statues which allow a monetary recovery to be a person bringing a claim on behalf of the state for false Medicaid payments. These are modeled after the federal False Claims Act, used to reward whistleblowers or qui tam relators for recovers in Medicaid fraud cases.

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

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 (AFLs), 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 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Why was it so simple for the dentist to move to another state and continue to defraud Medicaid after being previously reprimanded for the same crime? Please leave any thoughtful comments below.

Sources:

Mahony, Edmund. “Dentist in Massive Medicaid Fraud Case Sentenced to 8 Years.” The Hartford Courant. (October 9, 2013). From: http://www.courant.com/health/connecticut/hc-medicaid-fraud-1010-20131009,0,1388813.story

Mayko, Michael. “Fraudulent Dentel-Group Owner Sentenced.” Connecticut Post. (October 9, 2013). From: http://www.ctpost.com/local/article/Fraudulent-dental-group-owner-sentenced-4883112.php
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.

Florida Law Prohibits Control of a Dental Practice by a Nondentist

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

Florida has long been a state that does not prohibit the corporate practice of medicine, unlike many other states. However, it does prohibit 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 also adopted administrative rules on this topic, as well.

What this means is that any corporation (or other type of business entity) that owns or operates a dental practice, under Florida law, must be one solely owned by and controlled by dentists. In this context, the term “dentists” means those licensed to practice dentistry in the state of Florida, with an active license.  Someone licensed in another state or who has a suspended or revoked license in Florida, would not meet that requirement.

Dentists Entering into Certain Types of Contracts Needs to Be Sure They Comply with the Law.

There may be certain types of contracts and agreements that a dentist or dental practice may legally enter into, especially ones that would provide administrative services or other types of non-professional services to the dentist.  These might include, for example, payroll services, staffing services (except for professional staff such as dental technicians), billing and collections services (provided the dentist retains final authority over such matters), marketing services, equipment leases (provided the dentists retains all control over the equipment), office leases, management services, or combinations of the above.  However, since any of these types of agreements may be worded so as to violate the law, a dentist should always have such an agreement reviewed in advance by his or her own experienced health attorney.  The dentist entering into any such contract must make sure he or she complies fully with the law.

Section 466.028(2), Florida Statutes, states that the purpose of the statute is to prevent any nondentists from attempting to influence or interfere with the professional judgment of the dentist.

Acts Prohibited by Law.

Acts specifically prohibited by the law include allowing a nondentist or business entity owned by a nondentist to:

1.    Employ a dentist or dental hygienist in the operation of a dental office;

2.    Control the use of any dental equipment or material while such equipment or material is being used for the provision of any dental services;

3.    Direct, control or interfere with a dentist’s clinical judgment;  and, specifically,

4.    Allowing any nondentist or organization owned by a nondentist to exercise control over:

a.    The selection of a course of treatment for a patient, the procedures or materials to be used as part of such course of treatment, and the manner in which such course of treatment is carried out by the dentist;

b.    The patient records of a dentist;

c.    Policies and decisions relating to pricing, credit, refunds, warranties and advertising; or

d.    Decisions relating to office personnel and hours of practice.

Violating Law is a Felony.

Any of these acts can result in disciplinary action against any licensed dental professional involved. More importantly, violation of this law is also a felony which may result in criminal prosecution for any person involved.  Contracts which violate the law are null and void.

Always have any contract relating to the operation of your dental practice reviewed by an experienced board certified health lawyer before signing it.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry 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.

Comments?

Did you know about this Florida Law that prohibits control of a dental practice by a nondentist? 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.

NAS Insurance (NAS) Attorneys, Lawyers and Defense Council in Florida

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

Often we learn after the fact that a health professional such as physicians, dentists and other health professionals has received NAS Insurance, has had a legal problem, and has not been able to locate an attorney or law firm that accepts this type of insurance. We have offices in Florida and Colorado, but we have attorneys licensed in Florida, Colorado, Louisiana, the District of Columbia, Virginia and other states.

Additionally, we can provide legal advice and representation in license investigations and administrative proceedings in many other states.

If you have NAS Insurance, do not go without an attorney or with a lawyer that has little or no experience where you need it.

The Health Law Firm Will Work with NAS Insurance or Your Insurance Company.

Call us first. We can assist you in determining if your legal problem is covered by your insurance, and we can help you file a claim to have your legal defense expenses and costs covered. In most cases, we will accept the assignment of your insurance so that you do not have to worry about legal bills while your case is going on.

Contact Health Law Attorneys Experienced in Representing Dentist.

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

In cases in which the health care professional has professional liability insurance or general liability insurance which provides coverage for such matters, we will seek to obtain coverage by your insurance company and will attempt to have your legal fees and expenses covered by your insurance company. We will agree to take an assignment of your insurance policy proceeds in order to be able to submit our bills directly to your insurance company, if your insurance company will allow this. Many of these insurers will pay our firm to represent you in the legal defense of an investigation or complaint against your professional (nursing, medical, dental, psychology, mental health counselor) license or for an administrative hearing involving professional discipline.

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.

 

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.

More Than 7,000 Patients of Oklahoma Dentist Are Being Asked to Get Tested for HIV and Hepatitis

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

The unsanitary practices of an Oklahoma dentist may have exposed more than 7,000 patients to HIV and hepatitis, according to a number of media sources and the Oklahoma Department of Health (DOH). Currently officials with the Oklahoma DOH are contacting all of the dentist’s patients since 2007, and urging them to get tested for blood-borne diseases. Since the news broke on March 28, 2013, the dentist has voluntarily closed his two offices and surrendered his dental license for 30 days.

Click here to read a copy of the letter from Oklahoma DOH warning the dentist’s patients to get tested.

We want to point out that these are just allegations made against the dentist at this point in time and have not been proven by the state.

Dentist Accused of Being a “Menace to the Public” in Complaint.

According to the complaint filed with the Oklahoma Board of Dentistry, the dentist is allegedly facing 17 allegations from The Board due to the violations against his practice.

Alleged charges against the dentist include:

1.  A patient testing positive for HIV and hepatitis C;

2.  The dental practice being unsafe, unsanitary and lacking of sterilization checks;

3.  Committing gross negligence related to decisions related to the dental health care of patients;

4.  Practicing dentistry without the proper display of licenses and certifications;

5.  Violation of provisions of the State Dental Practice Act by failing to keep a suitable record of dangerous drugs;

6.  Unlawful practices in authorizing dental assistants to practice dentistry; and

7.  Having open vials of medications and unsanitary dental materials in an unclean environment.

Click here to read the complaint.

Dentist Admitted to Not Handling Sterilization and Drugs Procedures.

According to the complaint, a device in the dentist’s office used to sterilize dental instruments wasn’t working properly. An inspector also found two separate sets of instruments. Each set was cleaned differently, one set of instruments was for patients known to have infectious diseases, and one set was for those not believed to have such diseases. Oklahoma DOH officials said the proper approach is for all instruments to be handled as if they contain viruses and infectious diseases.

According to an article in The New York Times, the dentist allegedly told officials during one inspection of his office that his staff handled all sterilization and drug procedures. Click here to read the entire article from The New York Times.

Dentist Faces Hearing at State Board of Dentistry.

According to the Oklahoma DOH, the dentist has been a state-licensed dentist since 1974, and an oral surgeon since 1977. He faces the possibility of having his license revoked, after a hearing on April 19, 2013, at the state Board of Dentistry in Oklahoma. This investigation is ongoing.

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

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

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

Comments?

What do you think of this dentist’s story? Are you curious as to how the practice got so bad? Please leave any thoughtful comments below.

Sources:

Oklahoma Board of Dentistry State of Oklahoma v. Wayne Scott Harrington, D.M.D. Case Number 13-005. Statement of Complaint. (March 28, 2013). From: http://www.thehealthlawfirm.com/uploads/OK%20Dentist%20Complaint.pdf

Ball, Brandi. “Tulsa County Dentist May Have Exposed 7,000 Patients to HIV, Hepatitis.” News on 6. (March 28, 2013). From: http://www.newson6.com/story/21820518/tulsa-county-dentist-may-have-exposed-patients-to-hiv-hepatitis

Oklahoma State Department of Health. “Tulsa Health Department, Oklahoma State Department of Health and Oklahoma Board of Dentistry Investigate Tulsa Dentist.” (March 28, 2013). From: http://bit.ly/ZwRhRT

Fernandez, Manny. “Tests Start for Patients of Dentist in Inquiry.” The New York Times. (March 29, 2013). From: http://www.nytimes.com/2013/03/30/health/dental-patients-in-oklahoma-warned-of-disease-risk.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.

Debary Dentist Served with Emergency Suspension Order for Allegedly Inhaling Laughing Gas

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

A Debary, Florida, dentist has been served with an emergency suspension order (ESO) by the Florida Department of Health (DOH) for allegedly inhaling nitrous oxide or laughing gas in front of patients. The administrative complaint filed against the dentist on November 2, 2012, by the Florida DOH stated a department-approved evaluator deemed the dentist unfit to practice dentistry and was recommended to undergo residential treatment.

Click here to read the full administrative complaint against the dentist.

We want to point out that these are just allegations made against the dentist at this point in time and have not been proven by the state.

Dentist Allegedly Did Not Finish Rehabilitation.

In June 2012, the Florida DOH ordered the dentist to be treated for alcohol and inhalant dependence. However, while in rehabilitation, she allegedly failed drug tests for alcohol, opiates and hydrocodone. She was then later reportedly caught inhaling laughing gas again.

The dentist allegedly refused another treatment plan by writing on it that she was going to drink champagne on holidays and special occasions.

The Office May Still Be Open.

On November 27, 2012, WFTV in Orlando reported a woman that looked to be the suspended dentist drove up to the Debary office and posted a handwritten sign on the front door that read, “Office is open.”

To see the story from WFTV, click here.

The Florida DOH states that when a licensee is served with an ESO that person may not practice in Florida while his or her license is suspended. Click here to see the status of the dentist’s license from the DOH.

The Dentist’s Options – Formal Hearing or Hearing Before the Board of Dentistry.

The dentist may elect to have a formal hearing contesting the facts with the Division of Administrative Hearings (DOAH). She also may waive this right and not dispute the facts and have an informal hearing before the Board of Dentistry. The Board will then make a final decision concerning the dentist’s license and her future working in dentistry. Be sure to check this blog for updates.

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

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

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

Comments?

What do you think of this dentist’s story? Does she deserve another chance? Please leave any thoughtful comments below.

Sources:

Walsh, Michael. “Dentist Gassing Up on Nitrous Oxide No Laughing Matter.” New York Daily News. (November 27, 2012). From: http://www.nydailynews.com/news/national/dentist-gassing-nitrous-oxide-laughing-matter-article-1.1209081?print

Barber, Tim. “Dentist Accused of Using Laughing Gas on Self While Working on Patients.” WFTV. (November 27, 2012). From: http://www.wftv.com/news/news/local/dentist-accused-using-laughing-gas-while-operating/nTGJd/

Department of Health v. Sharon Ann Day-Osteen, D.D.S. Case Number 2012-13461. Administrative Complaint to the Board of Dentistry. (November 2, 2012). From: http://www.thehealthlawfirm.com/uploads/doh%20v%20Day-Osteen.pdf

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.

 

The Lone Star State’s New Task Force to Take a Bite Out of Medicaid Dental Fraud

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

There’s a new task force riding into Texas. According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children. The article, published on October 10, 2012, states the creation of the Medicaid and orthodontic task force was created in response to a significant increase in fraud by Medicaid providers.

To read the full article from The Texas Tribune, click here.

Everything is Bigger in Texas, Including Fraud.

A report released in April 2012, by the U.S. House Committee on Oversight and Government Reform, stated that in 2010 the Lone Star State spent as much on orthodontic services as every other state in the U.S. combined. In the report the state said the reason fraud was so widespread is that the organization the state hired to assess prior authorization forms was “rubber stamping” the forms for approval.

Click here to read the entire report from the U.S. House Committee on Oversight and Government Reform.

Patient Recruiting Contributing to Medicaid Fraud Problems.

An announcement on the Texas HHSC OIG website stated Texas authorities have found that some dental clinics hired representatives to stand outside retail and grocery stores and hand out gift cards in exchange for signing up for a “free” dental exam. The Inspector General said offering incentives to Medicaid clients is illegal. Those caught can be fined up to $10,000 per violation.

To see the announcement from the OIG of the HHSC, click here.

Crackdown Leaving Dentists Uneasy.

The task force and the overall crackdown on dentists and orthodontists have limited the number of dental professionals willing to take referrals for Medicaid patients. In The Texas Tribune article, the HSSC warns orthodontic providers that the Texas dental board can suspend or revoke their license for abandoning Medicaid patients.

Having a license suspended or revoked is an entirely different and very serious issue.
However, patient abandonment is very narrowly defined in the law and is difficult to prove.

What many state Medicaid regulatory authorities fail to appreciate is that indentured servitude is illegal in the United States. They seem to believe that if the professional is dumb enough to sign up for the Medicaid program, then he or she is dumb enough to be forced to provide services without pay or to be forced to see patients they don’t want to.

This may be largely an idle threat, however. I myself have had several articles published in major healthcare publications regarding what is and isn’t “patient abandonment.” Lay people and investigators bandy the term about figuring it will strike fear into the hearts of physicians (and often it does).

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare 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 (AFLs), 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 or (850) 439-1001 and visit our website at http://www.TheHealthLawFirm.com.

Comments?

What do you think of the new task force? Do you think it will help put a stop to Medicaid dental fraud? Is Medicaid dental fraud a problem in your state? Should providers be charged with “patient abandonment” for not treating Medicaid patients? Please leave any thoughtful comments below.

Source:

Aaronson, Becca. “Joint Task Force Tackles Medicaid Dental Fraud.” The Texas Tribune. (October 10, 2012). From: http://www.texastribune.org/texas-health-resources/medicaid/joint-task-force-tackles-medicaid-dental-fraud/

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.

“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.

Phony Dentist Charged with Child Abuse After Injuring Teen During Procedures

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

A Miami man, his wife and their daughter have been charged with child abuse following two alleged dental procedures that left a 14-year-old girl permanently disfigured. According to a number of sources, the three were arrested on September 12, 2012, at their home-operated dental office.

Click here to see the man’s arrest affidavit from the Miami Police Department.

14-Year-Old Patient Left in Pain and Disfigured.

According to the Miami Herald, when the 14-year-old girl broke a front tooth, she and her mother went to the man, who claimed to be a dentist when he lived in Cuba. He offered to perform the dental work in the back room of his home office for $500. Instead of fixing the tooth, the article states the man filed all four of the girl’s front teeth down to the gums. He then allegedly fit her with a permanent bridge, which the mother described as an “iron bridge painted white with the form of teeth.”

The victim was allegedly left with swollen and blackened gums, according to the Miami Herald. She is now under the care of a licensed dentist at the University of Miami.

To read the entire article from the Miami Herald, click here.

All Three Family Members Face Charges of Child Abuse.

The fake dentist and his wife, who apparently witnessed the procedures, face charges of child abuse, child negligence and performing dental services without a license. The couple’s daughter faces a charge of child negligence.

The license status of almost all health care professionals can easily be checked online. In Florida, license verification for all health care professionals can be checked on the Florida Department of Health (DOH) website. Hint: If they don’t have a license, they ain’t a legitimate health professional.

This case was investigated by the Miami Police Department, the DOH and a Miami-Dade County team that fights pharmaceutical crime. Detectives suspect more victims will soon come forward.

Miami Seems to Be a Hot Spot for Phony Health Care Professionals.

We have seen many reports on phony doctors, dentists, nurse practitioners and others practicing in the Miami area over the past decade. Many of these operate surreptitiously and prey on immigrants and foreign nationals. Others operate blatantly and publicly advertise.

Plastic surgery and cosmetic procedures appear to be the most likely area to be “practiced” by the imposters. We have seen or heard reports of physicians performing surgery in hotel rooms. We have read reports of walk-in plastic surgery offices where animal sedatives were used to sedate the patient and plastic knee replacements were used as breast implants.

More Stories on Fake Physicians and Other Health Professionals to Come.

In the near future on this blog, we will include additional articles on fake doctors and health professionals, some old, some new.

To see a recent blog on a Florida teen impersonating a physician’s assistant (PA), click here. You can also read the story of a fake plastic surgeon in New York by clicking here.

Contact Health Law Attorneys Experienced in Representing Health Care Providers in DOH Cases.

The Health Law Firm represents dentists, pharmacists, pharmacies, physicians, nurses, and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Agency (DEA), Department of Health (DOH), and other law enforcement agencies.

If you are aware of an investigation of you or your practice, or if you have been contacted by the DEA or DOH, contact an experienced health law attorney immediately.

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

Sources:

Sanchez, Melissa. “Little Havana Man Accused of Injuring Girl with Illegal Dental Work.” Miami Herald. (September 12, 2012). From: http://www.miamiherald.com/2012/09/12/2999610/little-havana-man-accused-of-injuring.html

CBS Miami. “Girl Leaves Dental Dungeon With Mangled Teeth; 3 Charged With Child Abuse.” CBS Miami. (September 12, 2012). From: http://miami.cbslocal.com/2012/09/12/girl-leaves-dental-clinic-with-disfigured-teeth-3-charged-with-child-abuse/

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.