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.

Copyright © 2016 The Health Law Firm. All rights reserved.

Texas Federal Court Rules Dentists Can Advertise As “Specialists” in Dentistry

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

On January 21, 2016, the United States District Court for the Western District of Texas, Austin Division, ruled that the Texas State Board of Dental Examiners could not prohibit dentists from advertising themselves to the public as “specialists” in dentistry.

The court found this to be unconstitutional, as it violated the defendants’ First Amendment rights to engage in truthful, non-misleading commercial speech. As a result of the decision, dentists who have earned board certification from the Certifying Board sponsored by the American Academy of Implant Dentistry (AAID) or those of the other plaintiff organizations may now advertise that they are specialists in the state of Texas.

The Ruling.

Judge Sam Sparks ruled that a Texas Administrative Code §108.54 , that restricted specialties in Texas to only those recognized by the American Dental Association (ADA) was unconstitutional. The AAID, along with three other dental organizations and five individual Texas dentists, filed suit challenging the Texas regulation.

“This is a great victory for patients throughout the state of Texas. They now can have more information available to them to help them decide who to use for their dental needs,” said Dr. Richard Mercurio, President of AAID. “No longer will patients need to guess whether a dentist who is trained in treating gum disease or extracting teeth is also experienced in the complex and comprehensive field of implant placement and restoration. Patients will now be able to seek out specialists in implant dentistry, such as those certified by AAID’s Certifying Board, the American Board of Oral Implantology/Implant Dentistry (ABOI/ID),” he pointed out.

To read the court’s decision in this case, click here.

To find out more on how The Health Law Firm can assist you in legal issues, click here.

Consult With An Attorney Experienced in the Representation of Dentists.

We routinely provide deposition coverage to dentists, dental hygienists and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists and other health professionals in investigations and at Board of Dentistry hearings. Call now or visit our website www.TheHealthLawFirm.com.

Sources:

Davis, Michael. “United States District Court ruling sets stage for expansion of ‘dental specialties’, practitioner independence from ADA restrictions.” Dentistry IQ. (January 25, 2016). Web.

Recker, Frank. “Texas U.S. District Court Sides with AAID on Specialization Lawsuit.” American Academy of Implant Dentistry. (January 25, 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: American Academy of Implant Dentistry (AAID), American Dental Association (ADA), Texas State Board of Dental Examiners, dentists advertising as specialists, First Amendment rights to engage in truthful, non-misleading commercial speech, legal representation for dentists, dental industry defense attorney, dentist defense attorney, Board of Dentistry, Board of Dentistry defense lawyer, 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 © 2016 The Health Law Firm. All rights reserved.

Dentists File Lawsuits Against Supply Distributors Alleging Violations of Antitrust Statues

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

Several dentists have joined together to file suits against leading dental supply distributors in New York and Texas federal courts alleging the companies jointly conspired to keep prices artificially inflated. Five lawsuits have been filed since Wednesday, January 20, 2016, against Patterson Cos. Inc. (Patterson), Henry Schein Inc. (Henry Schein) and Benco Dental Supply Co. (Benco). These companies are alleged to have control over 80 percent of the distribution channel for dental supplies. Among other allegations, lawsuits allege that the established dental supply distributors schemed to intimidate and squelch newer distributors that offer better (lower) prices in order to maintain exclusive control over the market.

Law360 reported that the suits seem to be partially triggered by a recent settlement reached with Benco announced by Texas Attorney General Ken Paxton, on April 10, 2015. The settlement cost Benco a good amount totaling $300,000, in order to avoid further participation in anticompetitive activities and instituted an antitrust training program for the company.

To read the Plaintiff’s Original Petition filed by the state of Texas against Benco, click here.

To read the full Agreed Final Judgement and Stipulated Injuction Between the State of Texas and Benco Dental Supply, click here.

To read the press release issued by the Texas Attorney General’s office, click here.

Alleged Antitrust Violations and Intimidation Tactics.

The lawsuits alleged that the three dominant distributor companies retained a firm grip on their dominance in the market by engaging in the intimidation of state dental associations. These associations were purportedly threatened by Patterson, Henry Shein and Benco in order to keep their prevalent supremacy in the supply of dental products. The associations were told that if they were to endorse startup distributors they would risk trade-show boycotts. Furthermore, the three established companies threatened to withhold their business if such manufacturers engaged in business with beginning distributors.

As stated by one class action suit filed by Dr. Keith Schwartz, D.M.D., P.A., in Texas federal court on Sunday, January 24, 2016, “At all relevant times Defendants possessed market power–the ability to profitably raise prices significantly above competitive levels while not losing sales […] Defendants abused their dominant collective market power by privately communicating and reaching an agreement to engage in an anticompetitive scheme to foreclose and impair competition, maintain and enhance market power, and artificially inflate prices of dental supplies above competitive levels.” The complaint further stated, “If new, low-cost distributors had not been unlawfully prevented from partnering with state dental associations and/or dental supplies manufacturers, they would have emerged as significant competitors.”

To read the complaint in the Texas federal suit, click here.

The complaints contain similar allegations, and all seek restitution on behalf of dentists suffering damages due to the alleged overcharging for supplies from the three monopolostic distributors since January 2012. More than 135,000 dental practices in the United States are said to be affected by the distributors’ alleged Sherman Act Violations. To read more about the Sherman Act from the Federal Trade Commission (FTC), click here. The complaints reported that investigations into one or more of the three distributors have already been initiated by the FTC.

State Regulatory Boards Have Recently Been in Hot Water Over Antitrust Laws As Well.

The North Carolina State Board of Dental Examiners recently went up against the FTC in a Supreme Court case decided on February 25, 2015. The Supreme Court justices were charged with determining whether professional regulatory boards should be exempt from federal antitrust laws and thus be allowed to eliminate low-cost competitors. Justice Kennedy concluded that immunity was not available because the Board was controlled by “active market participants” and their decision to block services was not “actively supervised” by the state.

To read my prior blog on this case, click here.

To read the full decision by the Supreme Court, click here.

Comments?

Are you currently being investigated by the FTC for possible antitrust violations?

Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers.

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

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing physicians in investigations and at Board of Medicine and Board of Osteopathic Medicine hearings. We represent physicians accused of wrongdoing, in patient complaints and in Department of Health investigations.

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

Sources:

Class Action Complaint 11:39 & 45, Jan. 24, 2016.

Overly, Jeff. “Dentists Pull Together to Sue Supply Distributors.” Law360. Portfolio Media Inc.: 25 Jan. 2016. Web. 26 Jan. 2016.

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: dental class action suit, Sherman Act, antitrust violations defense attorney, Supreme Court antitrust decision, North Carolina dental regulatory board, Board of Dentistry, dentist lawyer, dental distributor companies, dental supplies, Board of Dental Examiners, Federal Trade Commission (FTC), federal atitrust lawyer, administrative law judge (ALJ), American Medical Association, suppression of competition, state board of medicine, state board of dentistry, American Dental Association, Federation of State Medical Boards, North Carolina Board of Dental Examiners v. FTC, federal antitrust laws, health defense attorney, health defense lawyer, legal representation for dentists, health law firm, The Health Law Firm

The Health Law Firm will soon be transitioning all blogs to the website. Please visit www.TheHealthLawFirm.com to continue reading and be sure to check back regularly.

“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.

FTC Drills Dental Software Provider For Deceptive Encryption Promises

8 Indest-2008-5By: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
A leading dental office management software provider has agreed to pay $250,000 to settle the Federal Trade Commission’s (FTC) claims that it falsely advertised its product as having industry-standard encryption. This encryption would help clients meet obligations under federal health privacy law to protect patient information.

Protecting Patient Information.

The Dentrix G5 software is used by dentists to perform office tasks such as entering patient data, sending appointment reminders, submitting insurance claims and recording diagnostic information. According to the FTC, Henry Schein Practice Solutions Inc. violated  The Federal Trade Commission Act Section 5: Unfair or Deceptive Acts or Practices, by falsely claiming that its software provided adequate encryption of sensitive patient information. The FTC’s Section 5 of the Federal Trade Commission Act (FTC Act) (15 USC 45) prohibits ‘‘unfair or deceptive acts or practices in or affecting commerce.’’  PracticesHenry Schein ( or, It) also claimed that those using the product would meet regulatory obligations under the Health Insurance Portability and Accountability Act (HIPAA).

Although advertisements claimed the product would help dental providers, the product’s encryption capabilities fell short of the promises. In 2010, the company was warned that its software was “less secure and more vulnerable” than industry-standard encryption. Despite this warning, the company continued to falsely marketing its product.

The Repercussions of Deceptive Acts or Practices.

The FTC alleges that the company’s misrepresentation of its software caused harm to dentists by leading them to believe they were in compliance with federal health privacy laws. Failure to comply with HIPAA can result in both civil and criminal penalties. To read further on this, click here to read one of my previous blogs.

To read more on the importance of enforcing privacy and security rules, click here.

Comments?

Do you think the software provider was given a fair penalty? How can the FTC further eliminate cases such as this?

Contact a Health Law Attorney Experienced in Defending HIPAA Complaints and Violations.

The attorneys of The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals 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.

Source:

Grande, Allison. “FTC dings dental software prover for encryption promises.” Law 360. (January 5, 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 compliance, data security, protected health information (PHI), Patient privacy, Federal Trade Commission (FTC), penalties for HIPAA violation, defense attorney, defense lawyer, HIPAA defense attorney, health law, The Health Law Firm, dentist defense attorney, legal representation for dentists

“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.

Dentists and Dental Hygienists Beware: Know Who Actually Owns Your Clinic

2 Indest-2009-1By 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 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 Need to Be Sure That 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 collection’s services (provided the dentist retains final authority over such matters), marketing services, equipment leases (provided the dentist 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(1)(kk), Florida Statutes, states that it is unlawful for any non-dentists, including any professional corporation or business entity owned and operated by non-dentists, to influence or interfere with the professional judgment of the dentists.

Therefore, any contractual agreement entered into should not prohibit the dentist from exercising his or her own professional judgment at all times in treating patients.

Acts Prohibited by Law.

Acts specifically prohibited by the law include, allowing non-dentists or a business entity owned by non-dentists 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 non-dentist or organization owned by a non-dentist 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; and

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

Violation of this 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 a felony which may result in criminal prosecution for any person involved. Consequently, contracts which violate the law are null and void.

Always have any contracts relating to the operation of your dental practice reviewed by an experienced board certified health lawyer before signing it. To read more on this topic, read one of our past blogs here.

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 and other types of investigations of health professionals and providers.

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

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

KeyWords: Dentist, nondentist, non-dentist, non dentist, corporate practice of dentistry, Florida Board of Dentistry, dental practice, Florida dental practice, Florida dental law, opening a dentist office in Florida, administrative action, disciplinary action, ownership of dental clinic, dental practice ownership, dental practice break-up, disciplinary action against a dentist, criminal prosecution, health care clinic license, dental clinic contract lawyer, dental practice contract attorney, criminal prosecution of a dentist, dental hygienist, dental office, dental equipment, defense attorney, defense lawyer, a dentist attorney, a defense lawyer, 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.

Dentists Targeted for Billing Medicaid for Dead Patients; Okay to Treat Dead Patients, You Just Can’t Bill for It

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Two South Florida dentists are at the center of a fraud investigation after, among other things, allegedly billing Medicaid for unnecessary dentures for their patients, according to the Florida Attorney General’s Office. Married couple Marino Vigna and Beth Reinstein operate Sunrise Dental Clinic in Fort Lauderdale. They have not yet been arrested or charged, however, their billing practices are reportedly under investigation. According to the South Florida Sun Sentinel, the office of Florida’s Attorney General is focusing on the clinic’s submission of Medicare claims dating back to Jan. 1, 2010.

Hundreds of Elderly Patients Affected.

Vigna and Reinstein allegedly billed Medicaid for dentures for patients who had no need for false teeth. According to investigator Alexander Perez, many of the couple’s patients were “already deceased or unable to be interviewed due to physical and/or psychological disabilities.” Other alleged patients suffered from dementia and could not recall if they had previously received any services from Dr. Vigna.

Medicaid paid a $1,198 claim for a 100-year-old woman residing in a senior care facility. Vigna billed for the extraction of 11 teeth and upper and lower dentures. When investigators interviewed the woman’s son, it was revealed that she never had any teeth extracted by Vigna and her dentures were obtained 12 years ago in another state. Another alleged patient had no need for dentures as the patient had long been restricted to a liquid diet.

Other Fun Facts (Allegations).

The clinic reportedly billed for services provided to patients while Vigna and Reinstein were vacationing out of the country. The Bureau of Immigration and Customs Enforcement (ICE) confirmed that the couple were in the Netherlands, Bahamas, Paris and Sweden, on the dates in question. Red flags were raised as clinic employees revealed to investigators that the dental office closes when Vigna goes on vacation.

Furthermore, some patients reportedly treated by the clinic were deceased at the time of their services, yet the clinic still billed Medicaid.

How Much Did the Alleged Fraud Cost Medicaid?

At this time, an estimate of the total alleged fraud cost is not available. The Sun Sentinel revealed, however, that the clinic was reportedly paid nearly $10,000 for services provided to Medicaid patients who were allegedly treated while the couple was on vacation in 2012.

To learn more about the large crackdowns on Medicaid fraud and how it may affect you, read one of our past blogs here.

To read about the oversight of the integrity of the Medicaid program click here.

Editor’s Comments.

As I’ve always said, you can treat dead people as much as you want. Just don’t try to bill Medicare or Medicaid for the treatment.

Comments?

Do you think harsher punishments are the key to counteracting Medicaid fraud? Leave any thoughtful comments below.

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.

Sources:

Alanez, Tonya. (Aug. 12, 2015). “Dentists target of false-teeth inquiry.” Orlando Sentinel.

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: dentist, dental clinic dental practice, Medicaid, Medicaid fraud, Medicaid investigation, Medicaid claims, fraudulent claims, health care fraud, Medicaid billing, Attorney General senior health care Medicaid reimbursements health law firm 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.

Administrative Final Orders Must State Findings of Fact Based on the Evidence Presented

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

Following is a summary of a recent appellate case on an issue relevant to health law:

Borges v. Dep’t of Health, 143 So. 3d 1185 (Fla. 3d DCA 2014).
Gustavo Borges (Borges) appealed a final order of the Florida Board of Dentistry that revoked his license to practice dentistry based on a conviction of the knowing receipt of child pornography under a federal statute.

At hearing, eight lay witnesses and four expert witnesses testified. In the recommended order’s discussion of the evidence presented, which was the basis for the Board’s final order, the administrative law judge (ALJ) discussed the testimony of only one witness-Borges-after concluding that a statement by Borges constituted a concession that established that his conviction was related to his ability to practice dentistry. No other testimony was discussed in the order, or even acknowledged.

On appeal, the appellate court concluded that the ALJ’s recommended order adopted by the Board did not comply with one of the requirements of section 120.57, Florida Statutes-that an ALJ’s order must contain “express findings of fact.” The court was quick to point out that, while the findings of fact did not have to address the testimony of every witness (i.e., all twelve here), the order must at least address the factual controversies at issue to the extent they are relevant to the disposition, or address why the testimony is irrelevant. Having failed to do so in this case, the appellate court reversed and remanded.

The case summary above was originally published in the Administrative Law Section Newsletter, Vol. 34, No. 2 (Dec. 2014), a publication of The Administrative Law Section of The Florida Bar.

Editor’s Comments on Case Summary.

This case demonstrates an important concept in administrative law. This is, an administrative law judge is required to discuss the evidence presented at the hearing and make specific findings of fact based on that evidence. Failing to do this in the recommended order (RO) can lead to reversal by an appellate court.


Comments?

Do you think the appellate court should have reversed? Do you think it was important to discuss all testimonies in this case? Please leave any thoughtful comments below.


Contact Health Law Attorneys Experienced in Handling Licensure Matters.

If you have been arrested, it is strongly recommended that you retain an experienced healthcare attorney who can advise you as to the effects a potential outcome could have on your license.

The attorneys of The Health Law Firm routinely represent physicians, pharmacists, nurses, and other healthcare practitioners in licensure 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.

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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.
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