6 Charged In Florida Chiropractic PIP Insurance 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 October 4, 2017, federal prosecutors charged six Florida residents with running a multi-million dollar insurance fraud scheme through a dozen chiropractic clinics. The alleged scheme involved paying kickbacks to chiropractors and tow truck companies to refer accident victims and then fraudulently billing insurers for services the victims did not need.
An indictment unsealed in Fort Lauderdale charges three of the individuals involved with racketeering, conspiracy to commit fraud and making false statements relating to health care matters.  Three additional people were also charged with conspiracy to commit fraud.


Insurance Fraud Scheme.

Prosecutors claim that beginning in 2010, two of the individuals charged, ran a scheme through chiropractic clinics in South Florida that were used to commit automobile insurance fraud.  They are alleged to have set up the clinics using licensed chiropractors as fake owners and then paid illegal kickbacks of between $500 and $2,100.  Those who received the illegal kickbacks included tow truck drivers, who could solicit car crash victims for the clinics, according to the indictment. Unnamed tow truck drivers and others were paid $2,100 to visit either Yonover’s clinics or Dalley’s law office after they were involved in car accidents.

The accident victims were encouraged to visit the clinics at least 30 times so the clinic owners could receive the largest personal injury protection (PIP) insurance reimbursement, prosecutors said.  Prosecutors also claim that two of those charged told employees to falsely inflate the pain levels of accident victims in order to get the insurance companies to pay for the treatments.

If convicted, those involved could receive sentences of up to 80 years in prison in addition to massive fines.

Florida is Serious in Combating PIP Fraud.

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

Florida specifically prohibits the corporate practice of dentistry. The key provision in Florida law that establishes this is Section 466.028, Florida Statutes, but the Florida Board of Dentistry has also adopted administrative rules on this topic as well.
Chiropractors have a statutory provision, Section 460.4167, Florida Statutes, that places stringent limits on who may own or control a clinic that involves the delivery of chiropractic services. As a general rule, it prohibits anyone who is not a Florida licensed chiropractor, M.D., D.O. or podiatrist from owning in any part a clinic that employs a chiropractor.

Physicians who are “partners,” “shareholders” or “co-owners” with unlicensed personnel need to ensure they are in full compliance with the Florida HCCLA and all other applicable Florida laws and regulations. Consult with an experienced health lawyer before making an expensive mistake.

To read a prior blog I wrote on a very similar case involving PIP fraud, click here.

Clinics Setting up Phoney Physician Owners Violate the Laws.

We have been consulted by many different dentists, medical doctors and chiropractors who have found themselves involved in clinics owned by or controlled by individuals who do not have any license or any Florida license.  Often these situations result in complaints, investigations and prosecutions being initiated against the physician who is unwittingly involved.  In one case we were called upon by a radiologist who was sued by the U.S. Food and Drug Administration (FDA) for over six million dollars ($6,000,000) in civil monetary penalties because the real unlicensed owners of an independent diagnostic treatment facility (IDTF) had falsely listed him as the owner to illegally avoid obtaining the correct licensed they needed.

Licensed physicians, chiropractors, dentists and other health professionals must be diligent and make sure that a dental or health care clinic or practice does not list her or him as an “owner” (including a shareholder or member) or officer (including “president” or “managing member”) of a corporation, limited liability company or other business entity unless he or she actually is one.  Allowing your name to be used as the owner “for paperwork reasons only” or “for licensure reasons only” or “for insurance purposes only” is just an indication that you are actually aware of and involved in the fraud.  An owner “in name only” is merely a “phony owner” or a “straw man owner,” all terms meaning the same thing:  for the purpose of defrauding someone.

How can you tell if you are a real owner (shareholder or member), and not merely a “straw man” or “phony owner”?  Here are some indicators:

1. You actually paid money to obtain the ownership interest (shares or membership interest).

2. You have a written, signed, dated shareholders agreement or membership agreement.

3. You have stock certificates or membership certificates showing your ownership interest in the business interests.

4. You receive a shareholders or members distribution each year that is reported to the Internal Revenue Service (IRS).

5. You receive a tax document (usually a form K-1 or Form 1099-DIV) annually as a result of the corporate or limited liability company income tax return that shows your percentage interest in the corporation or company and what percentage of the income was paid to you.

6. You will have access to and some control over the books, records and accounts of the business.

Contact Experienced Health Law Attorneys in Matters of Fraud.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses, chiropractors and other health providers in fraud investigations, regulatory matters, licensing issues, litigation, denials and demands for repayment from insurance companies, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. It also represents shareholders, members and business entities in corporate and business litigation in state or federal court.  Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

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

Sources:

Musgrave, Jane. “Delray lawyer, Boca man charged in million-dollar PIP fraud scheme.” The Palm Beach Post. (October 4, 2017). Web.

Bolado, Carolina. “6 Charged In Florida Chiropractic Insurance Fraud Scheme.” Law360. (October 4, 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: Personal Injury Protection (PIP) fraud, legal representation for PIP claims, legal representation for PIP fraud, legal representation for chiropractors, chiropractor defense attorney, legal representation for licensed health care professionals, “straw man owner,” “phony owner of health care clinic,” medical practice legal representation for health care clinic owners, health fraud defense lawyer, legal representation for health care fraud, health care clinic attorney, litigation over ownership of clinic, corporate practice of medicine, health fraud defense attorney, false claims lawyer, insurance fraud defense attorney, Florida Division of Insurance Fraud, legal representation for allegations of false claims, legal representation for submitting false claims to the government, false claims defense attorney, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, attorney for health care clinic license, medical business dispute attorney, proprietorship of dental practice attorney, proprietorship of chiropractic practice attorney

“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.

 

Advertisements

Embezzling Administrator of Pediatric Clinic Faces Health Care Fraud Sentencing

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

An administrator of a Louisiana pediatric clinic has recently pleaded guilty in a health care fraud case. She faces up to 10 years in prison and over $200,000 in fines. The charges allege embezzling more than $500,000 of the clinic’s money and diverting it to her personal account, from approximately August through September of 2014. She allegedly used this massive amount of money to purchase luxury items for herself including jewelry, custom artwork and a motorcycle. Much of the money came from reimbursement the clinic received from the state’s Medicaid program.

The Investigation.

The administrator was investigated by the Federal Bureau of Investigations (FBI) and Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). The investigation disclosed that the administrator used a business credit card to charge approximately half a million dollars in personal charges. To pay the credit card bills, teh administrator used money from the clinic’s bank accounts, which included its Medicaid reimbursements. She maintained her front by hiding the monthly statement from the clinic and disguising payments. Her sentencing is set for September 7, 2017.

Embezzlement by Employees Should Be Reported to Law Enforcement and Prosecuted.

We have been consulted by health care practices who have had employees embezzle from them. These should always be reported to law enforcement and prosecuted. Employees that do this will also falsify claims to Medicare, medicaid and health insurers, multiplying your problems.

To read an article I published on embezzlement by health care employees, click here.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

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

Sources:

“Louisiana Woman Pleads Guilty in Health Care Fraud Case.” The Eagle. B.H. Media Group Inc., (01 June 2017). Web.

“Louisiana Woman Pleads Guilty in Health Care Fraud Case.” The Washington Times. The Washington Times. (01 June 2017). Web.

McKnight, Laura. “Marrero Pediatric-clinic Administrator Pleads Guilty to over $536K in Health-care Fraud.” NOLA.com. (31 May 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: Legal representation for health care embezzlement, legal representation for allegations of health care embezzlement, legal representation for health care employment issues, employment law defense attorney, legal representation for employment conflicts, legal representation for health care professionals, legal representation for work place investigations, legal representation for investigations against health care professionals, health care fraud attorney, health care fraud defense attorney, reviews of the Health Law Firm, The Health Law Firm attorney reviews, Health law defense attorney, legal representation for OIG investigations, legal representation for HHS investigations, legal representation for false billing, legal representation for health care fraud investigations

“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.

 

Michigan Dentist Accused of Million Dollar Medicaid Fraud Scheme Captured in Caribbean

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

A Michigan dentist accused of Medicaid fraud was recently captured in the Dominican Republic after evading charges for months, state authorities announced. Dr. David Johnson operated the alleged scheme through Livernois Dental in Detroit, which he owned at the time but has since sold.

27 Charges.

Dr. Johnson was charged by Michigan Attorney General Bill Schuette in May 2017, after allegedly using another dentist’s information to improperly bill Medicaid $1.7 million over a three year period of time. The charges include one count of racketeering, punishable by up to 20 years in prison; 20 counts of false Medicaid claims, punishable by up to 10 years in prison; and six counts of false health care claims, punishable by up to four years in prison.

According to the Attorney General’s press release, since the charges were issued, the dentist was living outside of the United States in an attempt to evade arrest. To read the AG’s press release in full, click here.

Unfortunately, this is not the only case of a health care professional trying to evade arrest. To read about another case, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Rahal, Sarah. “Macomb dentist accused of fraud faces 27 felonies.” The Detroit News. (October 3, 2017). Web.

“Chesterfield Township dentist accused of Medicaid fraud captured in Caribbean.” Baltimore Voice Newspaper. (October 3, 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: Legal representation for Medicaid fraud, Medicaid defense attorney, Medicaid fraud defense attorney, legal representation for health care fraud, Medicaid Fraud Control Unit (MFCU) defense attorney, dentist defense counsel, legal representation for dentist, dental board defense attorney, dental license defense attorney, legal representation for dentist, legal representation for allegations of health care fraud, legal representation for improper billing, legal representation for defrauding the government, legal representation for defrauding Medicaid, legal representation for dentists, dentist attorney, defense attorney for dentists, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, board of dentistry defense counsel, Medicaid Fraud Control Unit (MFCU) legal representation, Medicaid Fraud Control Unit (MFCU) defense counsel

“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.

 

The 20 Major Mistakes Physicians Make After Being Notified of a Department of Health Investigation

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

The investigation of a complaint which could lead to the revocation of a physician’s license to practice, usually starts with a simple letter from the Department of Health (DOH). This is a very serious legal matter and it should be treated as such by the physician who receives it. Yet, in many cases, attorneys are consulted by physicians after the entire investigation is over and the damage is already done. Often, the mistakes that have been made severely compromise an attorney’s ability to achieve a favorable result for the physician.

These are the ten biggest mistakes we see in the physician cases we are called upon to defend after a Department of Health investigation of them is commenced:

1. Contacting the Department of Health (DOH) investigator and providing him/her an oral statement or oral interview.

2. Making a written statement in response to the “invitation” extended by the DOH investigator to do so.

3. Providing a copy of their curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so.

4. Believing that if they “just explain it” the investigation will be closed and the case dropped.

5. Failing to submit a timely objection to a DOH subpoena, when there is a subpoena, and there are valid grounds to do so (e.g., patient does not want records released, patient privacy).

6. Failing to forward a complete copy of the patient medical record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.

7. Delegating the task of providing a complete copy of the patient medical record to office staff, resulting in an incomplete or partial copy being provided.

8. Failing to keep an exact copy of any document, letter or statement provided to the investigator.

9. Believing that the investigator has knowledge or experience in the medical or health care matters being investigated.

10. Believing that the investigator is merely attempting to ascertain the truth of the matter and, if the truth is known, this will result in the matter being dismissed.

11. Failing to check to see if their medical malpractice insurance carrier will pay the legal fees to defend them in this investigation.

12. Believing that because they haven’t heard anything for six or eight months (or even years in some instances) that the matter has “gone away.”

13. Believing that the case is indefensible so there is no reason to even try to advocate for getting it dismissed.

14. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

15. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of the Board of Medicine for a decision.

16. Taking legal advice from their non-lawyer colleagues regarding what they should do in defending themselves in the investigation.

17. Attempting to defend themselves without the assistance of an attorney.

18. Believing that, because they know someone on (or previously on) the Board of Medicine, with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.

19. Providing copies of medical records to the DOH Investigator and signing a “Certificate of Completeness” so that the DOH can use these against them in its future disciplinary proceedings against them.

20. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them and to communicate with the DOH investigator for them.

The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Medicine in such cases and does so on a regular basis.

To learn more about how The Health Law Firm can assist you if you are being investigated by the DOH, click here.

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

The attorneys of The Health Law Firm provide legal representation to osteopathic physicians 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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Department of Health (DOH) investigations, DOH attorney, DOH investigation attorney, DOH defense attorney, Legal representation for DOH complaints, legal representation for licensure issues, legal representation for health care professionals, DOH complaint attorney, legal representation for Board of Medicine investigations, Board of Medicine attorney, Board of Medicine investigation attorney, Board of Medicine defense attorney, legal representation for Board of Medicine complaints, legal representation for licensure issues, legal representation for physicians, Board of Medicine complaint attorney, health law attorney, health law defense attorney, legal representation for physicians, doctor attorney, legal representation for complaints against physicians, The Health Law Firm, Florida health law defense attorney, 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.

 

 

 

Responding to a Medicaid Audit: Important Tips You Should Know

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

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG), Bureau of Medicaid Program Integrity, is the Florida agency responsible for routine audits of Medicaid health care providers. Each state has a similar state agency, though it may have a different name.  The agency’s job is to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving large payments from Medicaid or who practice in areas that typically see the most abuse or fraudulent billings, are the ones most likely to be audited.  These include pediatricians, Ob/Gyns, family practice physicians and pediatric dentists.

A different state agency that may also conduct Medicaid audits is the state Medicaid Fraud Control Unit (MFCU).  However, by definition, the MFCU is investigating allegations that there is substantial fraud going on.  You should know that if you are contacted by the MFCU, this is a very serious matter.  This is not a routine audit.
However, on the “routine” audits conducted by the Medica agency, the Medicaid audit usually requests information in a questionnaire that the medical practice is required to complete. Additionally, copies of medical records (including x-rays and other diagnostic studies) on the list of Medicaid patients selected for the audit.

If AHCA (or the state Medicaid agency) determines that Medicaid overpaid for services, it will use a complex mathematical extrapolation formula to determine the repayment amount. The amount of the repayment to the Medicaid Program can be considerably greater than (30 to 100 times as much as) the actual amount of overpayment disclosed by the sample of records audited. Additionally, fines and penalties can be added by the Medicaid Program. However, you can eliminate or reduce the amount of any such repayment by actions taken both before and during the Medicaid audit.

 

General Practice Tips:
There are various ways to manage your practice that will help you in the event that you are selected for a Medicaid Audit.

1. Every patient record entry should be clearly dated and signed or initialed by the provider. Make sure this is always done.

2. When documenting in the patient’s record, make sure that you document exactly what services were needed and completed in order to support what was billed to Medicaid.

3. Communicate with the person responsible for your billing so that the actual services provided are billed for. Do not bill in advance for anticipated services needed as indicated in the appointment calendar or on a treatment plan.

4. Keep the patient records organized and ready for copying if necessary. Use only one sided documents and securely fasten small forms (prescriptions, telephone memos, small sticky notes) onto 8-1/2″ by 11″ paper. Scan all such documents into the patient record if using an electronic health record (EHR).

5. Services provided by a physician who is not enrolled in the Medicaid Program to a Medicaid patient may not be billed to or paid by the Medicaid Program. Therefore, never allow any other physician associated with your practice who is not enrolled as a Medicaid provider to provide services to Medicaid patients. Do not allow a new physician coming into your practice to treat Medicaid patients until he or she actually has received his or her Medicaid provider number. The group may not bill for the services nor may another physician bill for the services.

6. Ensure that all health care professionals’ licenses and permits are kept up to date. Ensure that all x-ray, clinical, lab and diagnostic equipment is permitted and kept up to date. Ensure that any CLIA license or exemption certificate is correct and kept up to date. Services billed by unlicensed personnel or services provided by improperly licensed facilities may not be paid by the Medicaid Program.

7. Use only standard abbreviations in your medical records, documentation, orders, and reports. While an abbreviation may seem common to you or your practice, if it is not a universally accepted abbreviation, the auditors may not recognize it.

8. Make sure all records are timely made, accurate and legible. Safeguard them and never let the original leave your office. Illegible records are treated as a non-record, and payment completely disallowed for an illegible note or order. A missing record, x-ray or chart entry will result in a complete repayment being directed for those services.

The Medicaid Audit:

If you are being audited, AHCA will send you a letter notifying you of the audit. AHCA will also supply you with a list of patients to be sampled a standard sample will include a list of anywhere from 30 to 150 patient names, depending on the size of the practice. Regular audits routinely request 30 to 50 patient records. The audit letter will also include a questionnaire to be completed (Medicaid Provider Questionnaire) and a “Certification of Completeness of Records” form to complete and return with the copies of the patient records. (Please note: this will be used against you in the future if you attempt to add to or supplement the copies of the records you provided).

It is crucial that you retain the services of an expert consultant or experienced health care attorney in correctly and accurately completing the questionnaire. The letter will also request that you provide copies of the patient records for the list of patients included with the letter. You will only be given a short time to provide these documents.

1. When receiving a notice of a Medicaid audit, time is of the essence. Be sure to calendar the date that the records need to be in the AHCA office and have the records there by that date. Note: the due date is not the last date on which you can mail the records but rather is the date that the records must be received at AHCA.

2. Obtain and review a copy of the claims you submitted and what Medicaid has paid on each of the patients being audited. This information can be found in the Medicaid portal, in your billing system, or in the Explanation of Benefits. Compare this information to the medical records to see if any issues may arise when AHCA reviews the records. (Keep this for your use, do not provide it as part of the audit records).

3. Provide a complete copy of the entire record, not just the parts from the period of time covered by the audit. Remember that other physician records obtained as history, including reports and consultations should be included. Consent forms, medical history questionnaires, histories, physicals, and other physicians’ orders, may be a crucial part of the record.

4. If you suspect that an issue may arise with a particular patient, prepare a separate explanation to submit with the patient’s file. AHCA will have an expert review the records, so an explanation in advance will help the expert to assess if there is in fact an issue. Any explanatory notes or other explanations should be clearly labeled as such and dated as of the date actually prepared, so there is no confusion as to whether or not it was part of the original record.

5. If your practice involves taking x-rays or using other diagnostic studies, these procedures are part of the patient’s record. If the x-rays are digital, they can be submitted on a compact disc. Be sure to include the number of x-rays on the compact discs in the Certification of Completeness of Records.
6. Complete the Medicaid Provider Questionnaire in its entirety to send with the patient records. Do not leave any section blank. Use “not applicable” or “none” if necessary. Attach all required documents. Consult with an experienced health law attorney to assist in completing the form.

To learn more about the Medicaid audit process and how The Health Law Firm can assist you, click here to watch our short video blog.

Don’t Wait Until It’s Too Late, 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.
If you or your practice has been sent notice of a Medicaid or Medicare audit, please contact us at (407) 331-6620 or (850) 439-1001 or visit our website at www.TheHealthLawFirm.com for more information.

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: Legal representation for Medicaid audits, Medicaid audit defense attorney, health care fraud defense attorney, health care fraud investigation defense attorney, legal representation for health care fraud investigation, legal representation for health care fraud, Medicaid fraud defense attorney, legal representation for Medicaid fraud, legal representation for fraudulent billing, legal representation for submitting false claims to the government, legal representation for overbilling, health care fraud attorney, The Health Law Firm, reviews of The Health Law Firm attorneys, reviews of 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 © 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

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.