Nursing Malpractice Insurance

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

There are articles out there on why nurses should not buy professional liability insurance. However, in our opinion, there are many excellent reasons why every practicing nurse should carry professional liability insurance.

Most articles on this issue take the side that if a nurse has a professional liability insurance policy, this will give her a “deep pocket” and make her more likely to be sued in a medical malpractice case against a physician or a hospital. The authors of those articles also look at these issues as nurses are usually employees of hospitals and other healthcare entities and, therefore, their employers will provide a legal defense for them. This latter theory relies, in part, on the legal principle of vicarious liability or respondent superior, which means that the employer is liable for the negligence of the employee; therefore, the employer has a vested interest in defending the nurse from civil claims.

There are several important facts which these articles often overlook which, in our experience, strongly indicates that a practicing nurse should purchase her own professional liability insurance policy.

The Primary Reason for Coverage: To Provide Legal Defense for a Complaint Against the Nurse’s License.

The primary reason that a nurse should purchase a professional liability insurance policy is that this type of insurance usually includes coverage for legal defense of licensing and disciplinary action commenced against a nurse. Although most nursing liability insurance includes this coverage automatically, some policies may not. Some insurance companies may offer this type of coverage separately to be purchased for a small additional premium payment.

License defense coverage pays the legal fees and costs associated with defending a nurse when an investigation is initiated that may result in action against her nursing license or disciplinary action against the nurse. Coverage is usually available from the time the nurse receives written notice than an investigation by a state agency has been initiated. It will also cover formal complaints made against the nurse, informal hearings before the Board of Nursing, and formal administrative hearings before an administrative law judge.

Since such investigations, complaints, and administrative action may be opened based on such events as patient complaints, hotline calls, Code 15 reports, nursing home and home health agency surveys, abuse investigations by the Department of Children and Families (DCF), newspaper articles, copies of lawsuits, and many other sources. It is far more likely that a nurse will be involved in one of these types of actions than that a nurse will ever be sued for nursing negligence.

How A Professional Liability Policy Protects the Nurse.

As noted above, an investigation against a nurse’s license may arise from a number of different sources. Statistics provided by the Medical Quality Assurance Division of the Department of Health (DOH) indicate that for the one year period from July 1, 2001 through June 30, 2002, a total of 1,142 investigations were initiated against nurses. For the one year period from July 1, 2002 through June 30, 2003, a total of 1,302 DOH investigations were initiated. Figures were not available on the number of nursing malpractice lawsuits that were initiated during the 2001-2002 period. However statistics obtained from the Department of Health indicate that during the period from 2002 through 2003, only 51 suits for nursing negligence were filed against nurses. We could locate no statistics that indicated the number of notices of intent to initiate malpractice litigation that may have been served on nurses during this period of time; however, a defense for the nurse in these cases would also be covered by such policies. These statistics indicate that a nurse is more likely to be involved in one of these types of licensing actions rather than a lawsuit alleging nursing negligence. These figures show that a DOH investigation is 26 times more likely against a nurse than a malpractice lawsuit.

Professional liability policies which provide coverages for licensure defense will usually provide compensation to the nurse for her out-of-pocket expenses (travel, postage, etc.) that she herself incurs as well as lost wages because of working time missed for hearings, depositions, etc. However, the maximum coverage available under such policies for licensure defense is usually limited. Usually coverage for licensure defense in most policies for nurses is between $10,000 and $15,000. This amount will usually be sufficient to provide for most of the legal fees and costs involved in defense of such a case and will usually be enough for the nurse to be able to afford to hire a highly qualified, experienced healthcare attorney, familiar with nursing law, to represent her.

Does Vicarious Liability Actually Absolve the Nurse From Liability?

The assumption that vicarious liability or the legal doctrine of respondeat superior protects a nurse against a medical negligence claim is a mistaken one. If the employer provides legal representation, the attorney representing the nurse will almost always be the same attorney representing and being paid by the hospital or employer.

In many circumstances, the nurse may conclude that her interests are contrary to those of the hospital or employer, which could result in the attorney hired by the hospital withdrawing from further representation of the nurse. Additionally, it may be necessary for the nurse to raise evidence showing that the injury was caused by another nurse or hospital employee, in order to defend herself. It is doubtful that an attorney representing the employer or hospital would raise this defense since it would prove liability against the employer hospital.

Many employers will not provide legal representation if the matter involves licensing or disciplinary action against the nurse. This could force the nurse to fund all the fees and costs associated with her defense. However, some larger corporations with good risk management programs will provide the nurse with legal representation for such matters.

For example, the authors of this article have represented large national hospital chains and nursing home chains, as well as a local independent nursing home, which routinely provide legal representation for nurses accused of wrong-doing who have a complaint filed against them with the Board of Nursing, Department of Health, or the Department of Children and Families. The authors have also been retained as independent outside counsel to represent nurses by large national nursing home chains and hospital chains when it was felt that there might be a conflict of interest between the corporation and the nurse. This situation might arise, for example, if the nurse is suspected of having committed a criminal act or an intentional act that might also result in civil liability or discipline against the nurse.

If you are an agency nurse, a home health agency nurse, a nursing home nurse, an independent duty nurse, or you are not employed by a large hospital chain, then you should consider nursing liability insurance mandatory. It appears that complaints of negligence against nurses working in these positions are far more likely. This may be because of the high turnover of nurses in some types of healthcare facilities (such as nursing homes), or because when the incident is investigated, the nurse is no longer employed there (for example, in the case of an agency nurse). Additionally, agency nurses may only work in facility for a short period of time making them less familiar with the facility’s policies and procedures, and not a part of the permanent team of nurses who may have established relationships with each other and are more likely to cover for each other.

As mentioned above, a number of different proceedings may be covered by the licensure defense coverage provided for in professional liability insurance. These proceedings may include an investigation by the Department of Health based on a patient complaint or Code 15 report; an abuse investigation (abuse of a child, abuse of a developmentally disabled or vulnerable person, or abuse of an elderly person) by the Department of Children and Families (DCF); allegations of nursing negligence or abuse being investigated by a state “surveyor” by the Agency for Health Care Administration (AHCA); an investigation into allegations of Medicaid over-billing or fraud; an investigation by the Agency for Health Care Administration or on the Attorney General’s State-wide Medicaid Task Force; and allegations of improper Medicare billing or fraud.

A nurse might be involved in a Medicaid fraud investigation, for example, in the case of an Advance Registered Nurse Practitioner (ARNP), Certified Registered Nurse Anesthetist (CRNA) or Certified Nurse Midwife (CNM) who has her own provider identification number and is allowed to bill as part of a group practice or independently. This might also occur, for example, in the case of a nurse working for a home health agency which receives its reimbursement for the nurse’s services from Medicare or Medicaid. We have represented nurses in each of these types of cases.

Cost of Professional Liability Coverage is Minimal.

High limits of coverage for nursing malpractice insurance coverage are usually available. Most nursing liability insurance policies provide at least $1,000,000 in coverage. If sought by physicians, this high limit of coverage may be very expensive or often is not available, at all. This professional liability coverage should afford the nurse ample protection in any malpractice case that might be filed against her. When counseling physician clients regarding asset protection, we routinely advise them that the best asset protection is having and maintaining good professional liability insurance coverage. There is no reason that this should not apply to a nurse who may have property, savings or other assets she desires to protect.

Nurses can purchase liability coverage rather inexpensively. For example, an excellent insurance policy providing coverage for nurses is available through the Nurses Service Organization (N.S.O.) for less than $100 per year. Professional liability coverage provided by this type of insurance represents a bargain at these rates.

Focusing on Protecting the Nurse’s Individual Interests.

Perhaps most importantly, the nurse should have an attorney focusing on her interests only in defending her against any type of negligence or licensing complaint. A nurse with her own professional liability insurance coverage will be able to hire a separate, independent attorney, and often the insurer will allow her to pick her own attorney.

Additionally, it has been our experience that it is better to have several different defense attorneys actively involved in a case rather than to have only one, when defending multiple parties. Having several defense attorneys involved means that the attorney representing the plaintiff (or person filing the claim) has to work much harder in order to prove her case. During the discovery process, each defense attorney is allowed to separately question both fact and expert witnesses. Each separate defense attorney is allowed to file discovery requests. Each separate defense attorney participates in the filing of motions. Relevant facts or issues that are overlooked by one attorney may be picked up by other defense attorneys. A cohesive defense with a unified strategy stands a greater chance of prevailing both before and at trial.

Important Considerations When Purchasing Liability Protection.

When deciding on which professional liability to purchase, the nurse should inquire as to the extent of coverage for licensing in disciplinary defense coverage. Some professional liability insurers have a “broad form” of coverage which may provide legal defense for the nurse in almost any type of administrative action. This might include, for example, defense of a discrimination complaint filed against the nurse with the Florida Commission on Human Relations (FCHR) or the U.S. Equal Employment Opportunity Commission and for Medicare and Medicaid complaints. Other companies limit coverage to only actions that may result in disciplinary action against the nurse’s license. The nurse should always attempt to get the broadest coverage available for disciplinary defense and licensure defense coverage.

Additionally, the nurse should inquire as to whether or not she will be allowed to select her own attorney. Many insurance companies have contracts with certain law firms to provide legal services on their cases for a reduced fee. The insurance company may require you to use one of its own contracted attorneys, or even one of its in-house attorneys which it employs directly. Given the limited number of attorneys with experience at handling nursing law issues and trying malpractice cases, the nurse should attempt to obtain coverage through a company which allows her to choose her own attorney.

The most important reason to purchase professional liability insurance is for the licensure defense coverage. A nurse does not want to risk losing her nursing license because she was unsuccessful at defending an investigation against her license or did not have the resources to do so. Since there are far more complaints filed each year against nurses’ licenses than here are nursing malpractice lawsuits, it is far more likely that a working nurse will need legal defense of a licensure complaint investigation.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords:  Healthcare Providers Service Organization (HPSO) Insurance, HPSO Insurance, Massage therapy, massage therapist insurance, massage therapists, investigation of massage therapist, Florida massage laws, massage therapy board licensing complaints, Department of Health, DOH, investigation, investigator, licensure defense, defense lawyers, defense attorney, administrative complaint, administrative licensure investigation, administrative hearing, Florida health law attorney, health care attorney, massage therapist lawyer, massage therapist 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 © 2016 The Health Law Firm. All rights reserved.

Don’t Take Away From Your Professional Reputation. Make Sure Your Correspondence Is Professional: 30 Tips (Part 3 of 3)

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

This is Part 3 of a 3 part series on this issue.

I continue with my tips for preparing good, professional correspondence.

19.    In longer correspondence, use section headings (in bold or underlined) or headings for each issue, to better organize it. Think of these as road signs on a long road.  They help the reader to know where he or she is at any given time.

20.    When using headers, skip two lines before the header and one line after the header. This helps to set off the new section and header and show a definite division.

21.    Keep your language objective and professional.  Do not ever use profanity [Oops, I just went back and removed the word “damn” I used above.]  Do not ever use any comments even remotely resembling racism, sexism, or antisemitism or prejudice.  Do not be sarcastic.

22.    Be direct and concise in your language.  To the greatest extent possible, use the same terminology and wording that the other party uses, or has used, or whatever statutes, regulations or governing documents with which you are dealing use (but also, be sure you know what the words and terms mean).

23. If you intend to request a formal hearing say “I request a formal hearing.”  If you want a refund, state:  “I request a full refund.”  If you want to appeal the decision, state:  “I want to appeal the decision.”  Don’t be wishy-washy or vague.  For example, don’t say, “I am looking for an attorney to file an appeal for me,” when what you mean to say is “I appeal the decision” or “I request an appeal.”

24.    If there are any deadlines by which you must respond, be aware of these and make sure your response is received by that date.  Remember “received” means “actually received” by the correct person (or office) at the correct address.  It does not mean “mailed by” or “postmarked by.”  If you have correspondence or a document to which you a response must be received by a certain date, you need to make sure it is in the receiving person’s hands by that date, even if you must hand carry it.

25.    In closing your correspondence conclude by stating what action is next, whether this is action you intend to take, or action you are requesting the other party to take.  For example:  “I expect to hear from you within ten days as to whether you grant my request or not.”  “Please contact me with hearing dates within the next fourteen days.”  “I will forward you a refund within five days.”  “I will send you my records within five days.”

26.    Always advise the other party of exactly how they should contact you;  provide multiple means of contacting you.  If you are very busy or have an assistant who is authorized to act for you, provide that person’s name and contact information, as well.  Then be available to receive the return communication(s).  Don’t give telephone numbers you never answer.

27.    In dealing with dates and deadlines, remember that ten days is ten days;  fourteen days is fourteen days, twenty-one days is twenty-one days.  Made up rules such as “weekends and holidays don’t count” are just that, made up (outside of formal legal proceedings).  If the other party has given you “fourteen days to respond,” this means fourteen days from the date on the letter, unless specifically stated otherwise.  Fourteen days means fourteen days, unless it is specifically stated otherwise (e.g., “you have fourteen business days to reply”).

28.    Include a professional closing above your signature.  This should be “Sincerely,” “Sincerely yours,” “respectfully submitted,” or some other professional closing.

29.    In your signature block, include your full typed name, with credentials and title or position listed.  For example, your full name, followed by your degree and other credentials (e.g.,  “John J. Smith, M.D., F.A.A.C.P.”) should be on the line immediately below where you sign.  Next should be listed your position within your organization (if applicable) (e.g., “Chair, Pediatrics Department”).

30.    If you have enclosures, list them at the end of the correspondence, giving a brief or shortened description and numbering them.  List and number them in the order you discuss them in your correspondence.  Be sure they are properly organized, labeled and divided, especially if any are lengthy.

Following these simple rules most people learn in middle school will help to keep your correspondence professional looking and in conformity with what most professionals see on a daily basis.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, 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.

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

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

KeyWords: The Health Law Firm, legal representation for health care physicians, reviews of The Health Law Firm, tips for professional correspondence, The Health Law Firm attorney reviews, legal representation for nurses, professional correspondence for a legal dispute, owners of health care businesses defense attorney, physicians defense lawyer, 30 tips for professional correspondence, The Health Law Firm reviews

“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.

Don’t Take Away From Your Professional Reputation. Make Sure Your Correspondence Is Professional: 30 Tips (Part 2 of 3)

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

This is Part 2 of a 3 part series on this issue.

I continue with my tips for preparing good, professional correspondence:

5.    Use titles or honorifics.  In the “business address” of your correspondence, always use the complete name of the person to whom you are writing (if known) together with that person’s honorific or professional title (e.g., Mr., Ms., Dr., Nurse, Prof., Dean, etc.).  This shows both respect and professionalism.

6.    Always use the complete mailing address, including title, of the person to whom you are sending it.  In the business address of your correspondence include not only the person’s name and honorifics, but title or position and division within the institution or organization to which you are sending it.  In the case of large organizations, you should include the building and suite or room numbers and any internal routing codes, designations, “mail stops” or other organizational routing codes, that the agency or business you are writing requires to route its mail internally.  Large organizations, especially government agencies, all have large mail rooms which sort and route all mail the organization receives from any source.  Correct internal routing codes will help ensure that your correspondence gets to the correct person or official in a timely manner.

7.    Always use a salutation.  This is self-explanatory, but see below.

8.    In your “salutation,” always use the person’s last name with a title or honorific.  It is customary to use the term “Dear” in a salutation in formal writing, so this is permitted.  But you may leave it out.  For example, “Dear Secretary Jones:” or “Secretary Jones:” or “Dear Dr. Johnson:” is correct.  Never refer to the person by that person’s first name in any type of formal correspondence or correspondence that anyone else might read.  Never say:  “Dear Sue:” or “Sharon:”.  Even if you know these people well enough to call them by their first names, don’t do it in this situation;  it’s unprofessional and may be interpreted as “talking down” to the person.

9.    Always end your “salutation” with a colon, not a comma.  A comma is only used in informal communications to those you know well or socially, such as a letter to your mother or a note to your girlfriend.  Unless this is your mother or your girlfriend to whom you are writing, use a colon.  For example, “Dear Secretary Jones,” or “Dear Sue,” is incorrect.  “Dear Secretary Jones:” or “Ms. Smith:” is correct.

10.    Type your correspondence or have it typed for you.  Do not send handwritten letters in formal or professional matters.  Do not write on the other person’s correspondence or documents and send it back.  Prepare and send a professional looking letter or e-mail, even if you must pay someone to type it for you (and if you are sending an e-mail, I know you can type a little bit yourself, anyway).  To do otherwise is to show laziness, disrespect and unprofessionalism.

11.    Always use a type font in your correspondence (inlcuding e-mails) of at least 12 points (10 characters per inch).  Do not use a small, difficult to read type fonts, for example, the size of the type font that most e-mail software defaults to.  Smaller type fonts than 12 points become difficult to read, especially if scanned/rescanned, faxed/refaxed or copied/recopied.  Change the default font in your e-mail software or computer word processing software, if necessary.  You can do this, regardless of how difficult it may seem at first;  I know you can do it, because I can do it.  Make your professional correspondence easier to read, not more difficult to read.

12.    Never use unprofessional looking type fonts for your communications.  Stay away from script type fonts, italics or novelty type fonts.  These are notoriously more difficult to read and look unprofessional.  You are not publishing a flyer for a high school bake sale.  Times New Roman, CG Times and similar type fonts are more professional looking and easier for a person to read.  Use Courier or Letter Gothic type fonts if necessary.

13.    Keep the correspondence to which you are responding unmarked.  One reason to not write on or mark up the other person’s documents or correspondence is that you may need them as evidence in a court of law or a hearing some day.  Nothing looks less professional than a document you are trying to use as evidence when a different person has made handwritten marks all over it.  The impression is similar to one in which a child with a box of crayons has gotten to it.  You don’t want this or need this.  Show respect and self-control.  Keep the other side’s documents pristine.  They will look much better that way as your “Exhibit 1” in the court hearing.

14.    Use a good concise, descriptive reference line or subject line (often called the “re:” line).  Make it a very brief summary.  State what the content of your letter is about.  State if you are responding to a letter or document that you received from the “addressee” (the person to whom you are addressing your correspondence) of your letter.

15.    Include the recipient’s routing information.  If the intended receiver of your letter or correspondence (the “addressee”) included reference numbers, file numbers, account numbers, case name and numbers, a policy number, a routing number, or other similar information on its letter to you, repeat these back in the reference line of your correspondence.  This will help make sure that your correspondence gets routed to the correct file and recipient more timely.  This is especially crucial in large organizations and government agencies.

16.    The contents of the body of your correspondence should be easy to read and easy to understand.  To this end, be sure to use short sentences and short paragraphs.  Each paragraph should convey one idea. Use headers and section titles, if necessary, to organize your correspondence, especially if it is lengthy.  Remember, headings within your letter that help to organize it are like street signs in a busy city.  They will really help any subsequent reader (and this may be a judge or jury) to navigate his or her way through your letter.

17.    Be sure to skip a line between each paragraph and, preferably, indent the first line of each paragraph.  [Note:  Some writers will tell you not to indent the first line of each paragraph in professional correspondence.  However, I feel that this makes the correspondence more difficult to read, so I encourage indenting or tabbing in on the first line of each paragraph.]  This makes it easier on the reader and more likely that your ideas will not get lost in a crowd of words.

18.    Keep your paragraphs short and to the point.  Nothing turns readers off as much as a single lengthy paragraph written from margin to margin taking up the whole page.  I suppose some people may have never been taught what paragraphs are.  However, I am willing to bet that most were.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, 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.

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

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

KeyWords: The Health Law Firm, legal representation for health care physicians, reviews of The Health Law Firm, tips for professional correspondence, The Health Law Firm attorney reviews, legal representation for nurses, professional correspondence for a legal dispute, owners of health care businesses defense attorney, physicians defense lawyer, 30 tips for professional correspondence, The Health Law Firm reviews

“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.

 

Don’t Take Away From Your Professional Reputation. Make Sure Your Correspondence Is Professional: 30 Tips (Part 1 of 3)

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

I review numerous letters, e-mails, memoranda, and other kinds of correspondence prepared by my physician and nurse clients over the span of my legal representation of them.  Frequently this is the result of a dispute with a hospital, a dispute with their peers or the medical staff, a dispute with an insurance company, a law suit filed by a patient, a complaint being investigated by the licensing agency, or another serious legal matter.

In several cases, way too many cases, such correspondence is unprofessional and defeats the purpose of the reason you are sending the correspondence.  At times it is so bad, it will be disregarded by the reader to whom it was directed. I have seen this from doctors, nurses, dentists, psychologists, owners of health care businesses, and many, many other highly educated professionals who really should know better.

When these documents are dictated and transcribed by a professional medical transcriptionist, they are usually formatted correctly and many of the errors I see are avoided.  However, when the health professional types his or her own document, that is when I see the most errors.

To avoid these errors that make your correspondence and professional communications look unprofessional, follow these tips.

Remember Why You Are Writing.

Remember, the basic purpose of your correspondence is to communicate ideas effectively.  In many cases, it will be to invoke your legal rights in certain situations (such as an appeal or a hearing request).  Sometimes it will be to attempt to persuade your hospital, your peers, or your employer to take certain action or to refrain from certain action.  Remember that your correspondence is often the first impression that the other side will have of you.  Do you want it to be an impression that you are sloppy, lazy, unprofessional, not knowledgeable, uneducated, or confused?

Whether you are communicating in a letter or via e-mail, these rules hold true.  In many (if not all) situations involving legal proceedings or legal issues, it is probably best to communicate via a letter sent by U.S. mail or some other reliable service (e.g., Federal Express, Airborne Express, DHL, etc.).  Even if you are transmitting your information via an e-mail, it is my suggestion to prepare it in the form of a paper letter (if your e-mail is not set up to insert your letterhead) and then scan it in and send it electronically.

I discourage legal communications via e-mail in serious matters because they are often difficult to obtain, isolate, and authenticate when you need them for hearings.  Additionally, they are rarely secure, often available to many others who shouldn’t see them and easily susceptible to being accidentally sent to others who should not see them at all.

Horror Stories of Unprofessional Correspondence.

Why do I feel this blog is necessary?  Because of all the horrible correspondence I have seen written by allegedly highly educated professionals, mostly physicians and nurses.  That’s why.

Here are just a few:

Physician never wrote a separate response to any charges or allegations made against him on any peer review documents.  He would just hand write (scribble, actually) his remarks on the bottoms and in the margins of whatever document he was sent to him and then send it back.

Nurse practitioner was required to respond to serious charges of negligence resulting in an adverse outcome to a patient.  She hand wrote, on unlined paper, a response letter that was not addressed to anyone, not dated, not signed and did snot state who was sending it.

The physician was required to provide his analysis of a patient’s case for peer review purposes.  His typed letter of three pages, single spaced, contained one long paragraph.  I used to work for a Medical Corps Admiral when I was a Navy JAG Corps officer.  He would just glance at such correspondence and state:  “I can tell this doctor doesn’t have any idea what he is talking about.”  Failing to follow good correspondence procedures will show others your thoughts lack organization and cohesion.

A health professional was required to complete an application for clinical privileges.  He wrote all of the answers by hand, not even staying within the lines on the form, writing over the questions and around in the margins of the application.  This is what he signed and turned in.  Believe me, this did not look very professional.

Physician was requested to respond to a medical staff inquiry from the hospital.  Her response came back typed in 22 characters per inch (cpi) size type font, almost too small to read.  Perhaps she was just trying to save a sheet of paper.  But many of us would have had to pull out a magnifying glass to be able to read it.  If you are actually trying to communicate your ideas, make your correspondence easier to read, not harder to read.

A dentist was notified of a pending complaint investigation being opened against her dental license.  She wrote her response to the charges back to the investigator, without using any business address or title, and began her response statement “Dear Sharon,”.  Do not treat others informally, especially in professional or formal situations.  You will be deemed to be unprofessional when you do so.

Tips for Good Professional Correspondence.

Here are some pointers on professional communications that should be followed in all of your professional written communications about business, professional or legal matters, even in e-mails. Please note, the terms below in quotation marks have certain defined meanings.  If you don’t know what these terms mean, look them up.

1.    Always remember that the reason you are sending the correspondence is to attempt to effectively and accurately communicate your position and ideas.  If you are trying to make your message indecipherable or difficult to understand, ignore these tips.  If you are trying to come across as someone who doesn’t give a damn about how he or she is perceived, ignore these tips.  If you want to come across as unprofessional, ignore these tips.

2.    Make sure you include your complete and correct “return address” and contact information.  This includes your physical or mailing address, telephone number, telefax number and e-mail address, so that the other party knows exactly how to reach you.  In cases where you already have this on your letterhead, be sure to use your letterhead.  Also, it appears more professional to create a letter head with the information in it and to use your new letterhead instead of having a professional business letter with a typed “return address.”  However, a typed “return address” is better than none.

3.    Don’t use someone else’s letterhead.  Don’t use your hospital, medical group or institutional letterhead for your own personal communications, unless you are the owner.  Use your personal letterhead (see above), instead.  If you are being accused of poor utilization review, unprofessional conduct, or personal use of hospital (or company) property, then using someone else’s letterhead just helps prove the charge against you.

4.    Date your correspondence.  Date your correspondence.  Date your correspondence.  Nothing shows a lack of professionalism and lack of attention to detail as sharply as undated correspondence.  It will certainly be difficult to prove when your letter or document was sent if you do not have a date on it.  A year or two later, it may be completely impossible to do so.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, 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.

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

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

KeyWords: The Health Law Firm, legal representation for health care physicians, reviews of The Health Law Firm, tips for professional correspondence, The Health Law Firm attorney reviews, legal representation for nurses, professional correspondence for a legal dispute, owners of health care businesses defense attorney, physicians defense lawyer, 30 tips for professional correspondence, The Health Law Firm reviews
Don’t Detract From Your Professional Reputations. Always Ensure Your Correspondence Looks Professional: 30 Tips

 

“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.

It Is Always a Bad Idea For Nurse To…

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

In my 30 plus years of practice representing physicians, dentists, nurses and mental health professionals, I have defended clients involved in many different situations. Several of these seem to be problem areas which we see repeatedly.

Following is a list of those problems which it would seem to be common sense for a mental health professional or other health care professional to avoid doing. If you do any of these you can rest assured that you will eventually be confronted with charges and an investigation by your state licensing board, the Drug Enforcement Administration (DEA), your national certification board, any facility at which you have privileges and other law enforcement agencies.

I can assure you, it is always a bad idea for a nurse or other health care professional to:

1. Write a prescription for any medication for yourself.

2. Start a romantic relationship with a patient.

3. Take someone else’s prescription medication, ever.

4. Write a prescription for or treat a patient, especially a family member, for a condition outside the scope of his or her specialty (e.g., a dentist prescribing antibiotics to her children to treat a cold; a pediatrician prescribing pain medications for an adult; an OB/GYN prescribing antidepressants for a male).

5. Write any prescription for or treat any patient who is in another state when the nurse or physician is not licensed in that state.

6. Treat or prescribe for any spouse, other family member, friend or colleague, without opening a medical record and fully documenting the treatment or prescription, as you would for any other patient.

7. Hire a patient to work for you in your office or allow a patient to “volunteer” to work in your office.

8. Pre-sign blank prescriptions for your  Medical Assistant, receptionist, or anyone else, to complete later.

9. Seek psychotherapy or drug/alcohol abuse treatment with a physician or HCP health professional in your own medical group, institution or the staff of your hospital.

10. Add to, alter or change any medical record entry after you know there may be a claim, investigation or litigation involving it.

11. Take and use your own drug samples provided by pharmaceutical companies.

12. Go into a hospital where you do not have clinical privileges and treat or “assist” in treating a patient there, even if it is your own patient.

13. Have a sexual relationship ( including “sexting” or “telephone sex”) with a patient or patient’s immediate family member.

14. For a mental health professional (psychiatrist, psychologist, mental health counselor, social worker, psychiatric nurse practitioner) to have any type of social relationship with a current patient.

If you find yourself doing any of the items listed above, don’t wait until it’s too late. An experienced health care attorney can help guide and defend against licensing issues including investigations from your state licensing board and the DEA.


Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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: Items health care professionals should avoid doing, investigation by state licensing board, Drug Enforcement Administration (DEA), licensure defense for health care professionals, legal representation for health professionals, DOH investigations, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys, 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.

Nursing Home Chain Reaches Record High False Claims Act Settlement With DOJ

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 24, 2016, the U.S. Department of Justice (DOJ) announced that Life Care Centers of America will be paying $145 million to end False Claims Act (FCA) litigation that alleged the company submitted false claims to Medicare for rehabilitation therapy services that were not necessary.  This settlement is a FCA record for the nursing industry and DOJ claims it is the largest in the Department’s history.

Who Blew The Whistle?

Tammie Taylor and Glenda Martin, the two whistle blowers and former employees of Life Care, will be splitting the $29 million cut of the payout that they receive as the persons who blew the whistle and filed the initial law suit.  The deal marks the end of two whistle blower cases and a wrongful enrichment suit brought by the DOJ against Forrest L. Preston. Preston is the owner of the Tennessee-based Life Care Center that has over 200 skilled nursing facilities.

$29 million may not be very much money to you, but it is to me.  The False Claims Act and the monetary rewards it authorizes to those who come forward and report fraudulent activities, has now become the primary tool the government has to help stamp out fraud in government programs, in my opinion.

Unnecessary Treatment Alleged.

The government joined the FCA case filed by the whistle blowers in 2012, suspecting that the company was performing excessive treatment of senior patients in order to maximize their Medicare reimbursement.  The company was accused of excessive and unreasonable treatment between January 1, 2006, and February 28, 2013, so that they would qualify for the “Ultra High” reimbursement level Medicare pays.  U.S. Attorney Nancy Stallard Harr stated on Monday that the company’s actions “exploits our most vulnerable citizens.”

According to reports, Preston announced made a statement in connection with the settlement that denied that Life Care engaged in any illegal or improper conduct but was pleased to put the matter behind it.

Big Rewards for Whistle Blowers.

This cause helps show the big monetary rewards that employees and former employees of health care businesses can obtain by coming forward and reporting it when their employer is engaged in submitting false claims to the government.  If managers and supervisors condone or turn a blind eye toward its employees submitting false claims, then this is the same as knowingly committing such violations.  The business is profiting from the false claims.

What is usually missing when an employee or former employee tries to file a whistle blowers law suit is documentation of the companies submission of claims taht are actually false.  Therefore, before an employee or former employee files such a suit, he or she must have copies of the claims that were actually submitted (such as CMS forms 1500, superbills, explanation of benefits (EOBs), etc.) and other documentation.  Without such documentation that shows that false claims were actually submitted for payment, many FCA whistle blower suits are dismissed.

Also, any claims that are paid by state or federally funded healthcare programs can be the subject of such an action.  Most states have a state false claims act that is based on the federal law.  Usually this applies to the state Medicaid program,, but it can also apply to state provided employer health clinics that some cities, counties and agencies provide or to other state funded activities.  Federally funded health care programs that can result in FCA suits include not just Medicare, but also TRICARE, Veterans Administration (VA) funding, Public Health Service (PHS) funding, Indian Health Service (IHS) funding and other government health care programs.  When in doubt, call your friendly whistle blower attorney.

Contact Health Law Attorneys Experienced with Qui Tam, Whistleblower and False Claims Act Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

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

Sources:
Overly, Jeff. “Nursing Home Chain Inks Record $145M FCA Deal With DOJ.” Law360.(October 24, 2016).Web.

“Life Care Centers of America Inc. Agrees to Pay $145 Million to Resolve False Claims Act Allegations Relating to the Provision of Medically Unnecessary Rehabilitation Therapy Services.” Department of Justice. (October 24, 2016). Web.

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

KeyWords:  Whistle blower defense attorney, False Claims Act lawyer, qui tam legal counsel, reviews for the Health Law Firm, skilled nursing facility (SNF) attorney, Health Law Firm reviews, health law, health law firm, The Health Law Firm, False Claims Act whistle blower’s plaintiff attorney, False Claims Act relator’s lawyer, U.S. Department of Justice defense attorney, False Claims Act litigation attorney, False Claims Act defense attorney, consumer reports of Medicare or Medicaid fraud, whistle blower defense attorney, home health care defense attorney, nursing home lawyer, legal representation for home health agencies, attorney for home health agency, legal representation for False Claims Act of whistle blowers, attorneys for VA physicians, Tricare false claims act legal counsel, skilled nursing facility (SNF) defense lawyer, Tricare whistle blower case attorney, nurse reports false claims, defense attorneys on whistle blower, nursing law attorney, nurse attorney, lawyers for nurses

“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.

Illinois Hospital Chain Pays Record $5.5 Million HIPAA Settlement For Privacy Breaches

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

On August 4, 2016, one of Illinois’ largest hospital chains agreed to pay $5.5 million in settlement for lax data security and breaches of protected health information for millions of patients. This deal is a record payout under the Health Insurance Portability and Accountability Act (HIPAA), federal regulators said.

Advocate Health Care Network (Advocate), which operates 12 hospitals and hundreds of satellite locations in Illinois, agreed to the payout in connection with three separate data breaches that compromised the records of 4 million individuals at a medical group subsidiary. The affected private patient data included clinical information, health insurance information, credit card numbers and dates of birth, according to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS).

The Investigation.

Investigations of those privacy and data breaches turned up additional problems for the large hospital chain. The OCR found Advocate did not adequately assess risks to so-called electronic protected health information, or ePHI. The hospital system also failed to properly limit access to electronic systems and failed to obtain an agreement with a business associate to safeguard ePHI.

“We hope this settlement sends a strong message to covered entities that they must engage in a comprehensive risk analysis and risk management to ensure that individuals’ ePHI is secure,” OCR Director Jocelyn Samuels said.


The HIPAA Settlement.

This recent settlement brings HIPAA payouts to $20.4 million so far in 2016. That far outpaces the previous annual record of $7.9 million total for all of 2014. The stiffer penalties come as the OCR is launching a wave of audits to measure HIPAA compliance, potentially giving even more backing to enforcement.

In a statement, Advocate said that it has since strengthened its data encryption efforts in response to the “ever-evolving digital landscape” in hopes of preventing further problems.  “While there continues to be no indication that the information was misused, we deeply regret any inconvenience this incident has caused our patients,” Advocate said.

According to the resolution agreement, the three privacy and data breaches occurred in 2013. One breach involved the theft of four laptop computers from an office building. A second involved unauthorized access onto a business associate’s computer network and a third stemmed from the theft of an unencrypted laptop computer from an Advocate employee’s unlocked vehicle. The majority of the 4 million individuals were affected by the first data breach.

Under the resolution agreement, Advocate committed to a number of security improvements, including a risk analysis of ePHI, a plan for managing security risks and an expanded program of HIPAA compliance training.

Click here to read the resolution agreement in full.

To read more on the importance of HIPAA and how to avoid violations, click here to read one of my prior blogs.


No Private Cause of Action (Right to Sue ) under HIPAA.

It is important to remember that neither the federal law itself, HIPAA (the abbreviation for the Health Insurance Portability and Accountability Act), nor the federal regulations which implement it, give an individual the right to sue for its violation.  Complaints on violations cane be filed with the Office of Civil Rights (OCR) which investigates such cases and issues fines, penalties, and takes other actions.  If an individual sues for a breach of his/her medical confidentiality, it is usually under the state’s law for the state in which it occurs.

If the facility is a federal facility (such as Veterans Administration (VA), Public Health Service (PHS), military hospitals and clinics, Indian Health Service (IHS)), then the federal Privacy Act of 1974 also provides the right to sue.  The Privacy Act contains provisions that set a minimum statutory damages as well as awards attorney’s fees and costs.  Recent cases in several states have allowed HIPAA to be used as a statute which establishes an affirmative duty the violation of which can then be pursued under state negligence law.


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 healthcare providers and institutions in investigating and defending alleged HIPAA complaints and violations and in preparing Corrective Action Plans (CAPs).  They also represent patients and plaintiffs in the case of major data breaches and individual breaches of medical privacy which result in damages or losses to the patient.

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:

Overley, Jeff. “Ill. Hospital Chain Inks Record $5.5M HIPAA Deal.” Law360. (August 4, 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), legal defense for HIPAA violations, HIPAA defense attorney, HIPAA plaintiff’s attorney, breach of medical privacy attorney, patient data breach legal counsel, Electronic Protected Health Information (ePHI) attorney, suit for HIPAA violation, federal Privacy Act violation attorney, HIPAA compliance counsel, OCR HIPAA investigation defense attorney, HIPAA audit attorney, legal counsel for HIPAA compliance, health law 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.

CMS Asks Federal Officials to Enforce Penalties on Nursing Home Employees Using Social Media to Violate the Privacy of Nursing Home Residents

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

On August 8, 2016, federal health regulators announced plans to crack down on nursing home employees who take “demeaning” photographs and videos of residents and post them on social media. Patient advocates want the federal agency to more explicitly outline the penalties for the growing number of nursing home employees who are abusing patients in this extremely public way.

“Patient Abuse” Using Social Media Platforms.

The move follows a series of reports that have documented alleged abuses in nursing homes and assisted living facilities (ALFs) arising from use of social media platforms such as Snapchat, Facebook and Instagram. These reports of abuse include photos and videos of residents who were naked, covered in feces or even deceased. They also include other images of abuse.

The Centers for Medicare and Medicaid Services (CMS), which oversees nursing homes, said in a memo to state health departments issued on August 5, 2016, that all nursing homes should be checked to make sure they have policies prohibiting their staff from taking demeaning photographs of residents. The memo also calls on state officials to quickly investigate such complaints and report offending workers to state licensing agencies for investigation and possible discipline. State health departments (such as the Agency for Health Care Administration or “AHCA” in Florida)help enforce nursing home rules for the federal government. To read the memo in full, click here.

The new document also guides nursing homes on protocols that should be followed if one of their employees abuses a patient in this way. Those steps include staffing changes, increased supervision and follow-up counseling for the residents. The facility must implement corrective actions to prevent recurrence.

The CMS states that nursing home employees must report cases of abuse to “at least one law enforcement agency,” and that anyone who fails to report incidents is subject to “various penalties, including civil monetary penalties.”

Patient Advocates Think The Document Doesn’t Go Far Enough.

Several industry stakeholders say that CMS’s document only supports what many facilities are already enforcing in their nursing home facilities. In 2015 it was reported in that since 2012 there have been 35 documented cases in which nursing home staffers have used social media to share photos or videos of residents. Some showed residents who were partly or completely naked.

The Department of Health and Human Services (HHS) did not penalize any facilities for violations regarding federal privacy laws, though many were fired and banned from ever working at nursing homes. Some states charged the offenders with elder abuse, voyeurism and invasion of privacy.

While the efforts from CMS are helping to thwart social media abuse in nursing homes, it’s not an issue that is conquered overnight. To read more on the issue of patient abuse in nursing homes, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Representing Nurses and Nurse Aides.

The Health Law Firm’s attorneys routinely represent nurses and nurse aides in Agency for Health Care Administration (AHCA) complaints, investigations and hearings. They represented skilled nursing facilities (SNFs), assisted living facilities (ALFs), adult homes, group homes, nurse registries, home health agencies (HHAs) and other types of health facilities. They also represent individual nurses and other licensed health professionals in investigations and defense of their licenses before state boards. We represent nurses across the U.S., and throughout Florida. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Huseman, Jessica. “Federal Officials Seek To Stop Social Media Abuse Of Nursing Home Residents.” NPR. (August 8, 2016). Web.

Dickson, Virgil. “CMS puts the onus on states to stop invasive videos and photos of nursing home residents.” Modern Healthcare. (August 8, 2016). Web.

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

KeyWords: Nursing home patient abuse investigation, defense attorney, nursing home defense, assisted living facility legal counsel, regulatory attorneys, administrative complaint and hearing defense, nursing disciplinary actions, nursing home abuse investigations, patient privacy abuse attorney, HIPAA attorney, invasion of patient privacy attorney, Department of Health investigation defense, Agency for Health Care Administration (AHCA) hearing defense attorney, Board of Nursing complaint defense, The Health Law Firm reviews, legal representation for nursing home facilities, legal representation for assisted living facilities (ALFs), reviews for The Health Law Firm attorneys, Agency for Health Care Administration (AHCA) survey and investigation defense, Healthcare Provider Service Organization (HPSO) defense attorney, Nursing Service Organization (NSO) 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.

OIG Alert Warns of Improper Conduct Involving Home Health Agencies and Physicians

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

On June 22, 2016, the United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a fraud alert regarding improper arrangements and conduct involving home health agencies (HHAs) and physicians. The alert comes as a result of recent investigations and studies, where it has been found that home health fraud in Medicare continues to warrant scrutiny and attention from the OIG, its law enforcement partners, and the Centers for Medicare & Medicaid Services (CMS).

According to the alert, in the past year, home health agencies, individual physicians, and home-visiting physician companies have faced criminal conviction and civil settlements for defrauding Medicare because they have:

1) made or accepted payments for patient referrals;
2) falsely certified patients as homebound; or
3) billed for medically unnecessary services or for services that were
not rendered.

Payments in Return for Referrals of Beneficiaries.

Home health agencies were alleged to have violated the Federal anti-kickback statute (AKS) by directly or indirectly paying physicians in return for referrals of Medicare beneficiaries to home health agencies.

In turn, physicians were alleged to have violated the AKS because they directly or indirectly, either solicited or received payments from home health agencies in exchange for referring Medicare beneficiaries to those home health agencies.

These payments, between home health agencies and physicians, were sometimes disguised as compensation agreements for services provided. For example, a Medical Director agreement, which purportedly based compensation of a physician for services rendered as Medical Director of a home health agency, would act as a front of validity. According to the OIG, these agreements were actually mere guises for illegal payments for referrals of Medicare beneficiaries.

A Valid Compensation Agreement.

A valid compensation agreement for services, between home health agencies and physicians, must comprise of arrangements and payments that are commercially reasonable and at fair market value.

According to the OIG, payments that are made or received to induce referrals, raise the following concerns:

1) corruption of medical judgement;
2) patient steering;
3) overutilization;
4) unfair competition; and
5) increased costs to Federal health care programs.

Other Federal Law Violations.

According to the alert, the government also alleged that home health agencies, individual physicians, and home-visiting physician companies violated other federal laws such as the health care fraud statute and the statute that prohibits false statements relating to health care matters.

Conclusion.

Entities or individuals that are engaged in fraudulent activities involving federal health care programs, such as Medicare and Medicaid, are potentially subject to criminal, civil, and administrative sanctions.

Home health agencies and physicians should rely on experienced legal counsel for guidance in proper compensation agreements to ensure compliance with federal laws.

Comments?

What do you think of the OIG’s alert? Leave your comments below.

Contact an Experienced Health Care Attorney.

The attorneys of The Health Law Firm represent health care providers 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.

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

Source:

“Alert: Improper Arrangements and Conduct Involving Home Health Agencies and Physicians.” U.S. Department of Health and Human Services: Office of Inspector General, 2016.

About the Authors: Michelle L. Bedoya, J.D., is an attorney with The Health Law Firm and a long-time consultant to home health agencies. 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 Avenue, Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Home health agency (HHA) lawyer, Florida health fraud defense attorney, health law defense lawyer, health professional attorney, nursing board defense attorney, home health agency defense lawyer, Medicare fraud defense attorney, Office of the Inspector General (OIG) investigation defense lawyer, OIG exclusion attorney, Medicaid fraud defense attorney, Medicare Fraud Strike Force attorney, home health agency (HHA) defense attorney, Zone Program Integrity Contractor (ZPIC) audit defense attorney lawyer, review of The Health Law Firm attorneys, The Health Law Firm, The Health Law Firm reviews, Nursing Service Organization (NSO) insurance defense attorney lawyer, Healthcare Providers Service Organization (HPSO) insurance defense attorney lawyer, Recovery Audit Contractor (RAC) audit defense attorney lawyer, Florida health attorney, Medicare fraud defense lawyer, Health care fraud statute, Medical Director agreements

“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.

Big Surprise! California Doctors And Hospitals Can’t Agree Over Role Of Nurse-Midwives

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 August 8, 2016, a California bill was announced that would allow certified nurse-midwives (CNMs) to practice in hospitals independently. It is apparently upsetting many of teh state’s physicians. The California Hospital Association and the California Medical Association (which represents doctors), agree that nurse-midwives have the training and qualifications to practice without physician supervision. But they differ greatly over whether hospitals should be able to employ midwives directly — a dispute the certified nurse-midwives fear could derail the proposed law.

The Supervision of Nurse-Midwives.

The proposed bill would override an existing law that requires certified nurse-midwives to practice only under the supervision of licenced medical doctors. California is one of only six states that requires full supervision. Several other states mandate other looser forms of supervision or monitoring by physicians, such as through collaboration agreements or preceptor agreements, especially for such issues as prescribing medications.

The American College of Nurse-Midwives has been attempting to chisel away for decades at state laws that require physician supervision, and it has finally passed the tipping point nationally, said Jesse Bushman, director of federal government affairs for the organization. Nurse-midwives aren’t seeking permission to go off and do whatever they want without consulting anyone, Bushman said. “They’re just asking to be able to do what they are trained to do.”

Additionally, in the states where nurse-midwives can practice independently, there is much more access to care, he said, citing a recent report published by the George Washington University’s Jacobs Institute of Women’s Health.
To read the report in full, click here.

Corporate Practice of Medicine.

Now, the debate between the doctors and the hospitals centers on the state’s prohibition of what’s known as the “corporate practice of medicine.” The state of California does not allow corporations, including hospitals, to hire physicians directly, though there are several exceptions. The intent of the ban is to avoid undue corporate influence on doctors’ medical judgment and patient care. Under the current law, hospitals can hire nurse-midwives, though many don’t. However, there is no such bar on hiring nurses directly

According to Dr. Jaun Thomas, a lobbyist with the medical association, patients should have the same consumer protections whether they see a nurse-midwife or a doctor. “It should be a level playing field,” he said. “We believe very strongly that the corporate practice of medicine bar language provides an important layer of patient protection.”

Assemblywoman Burke’s office is continuing to talk to representatives of both the physicians and the hospitals to try and find a solution to the issue.

“For both of them, it is an issue they don’t want to compromise on,” Burke said. “The bill became a pawn in the fight between the hospitals and the physicians. It still is.”

To learn more, click here to read one of my prior blogs.

Turf Battle or Antitrust Violation, or Both?

This appears to me to be just another one of those turf battles that we have seen in the practice of medicine through recent history. Whether its podiatrists trying to get their foot in the door and orthopedic surgeons trying to shut them out, or dermatologists being criticized by plastic surgeons for doing to many “cosmetic procedures,” or chiropractors being ostracized by medical doctors, or allopathic doctors discriminating against osteopathic physicians, this seems to be just another turf battle. After all, midwives have been delivering babies before there were hospitals and before Hippocrates was born (probably delivered by a midwife).

I would think the recent flurry of antitrust lawsuits against healthcare systems and against professional licensure boards over attempted monopolization would give most doctors cause to think twice before supporting such efforts to shut out nurse-midwives. This seems like a good time for the nurse midwives to be thinking about this type of litigation.

After all, sometimes you just have to wake up and smell the coffee and give up on hoping for a return to the ways of the Twentieth Century. I know it’s been hard for me!
Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

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

Source:

Gorman, Anna. “California Doctors And Hospitals Tussle Over Role Of Nurse-Midwives.” Kaiser Health News. (August 8, 2016). Web.

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

KeyWords: Roles of nurse-midwives practicing in hospitals, supervision of nurse-midwives, nurse -midwife attorney, midwife legal defense counsel, corporate practice of medicine attorney, turf battles in medicine, attorney for nurses, nursing law attorney, board of nursing defense lawyer, nurse-midwife training and qualifications, supervision of licensed medical doctors, legal representation for nurse-midwives, nurse-midwives defense attorney, review of The Health Law Firm attorneys, The Health Law Firm, The Health Law Firm reviews, Nursing Service Organization (NSO) insurance defense attorney, hospital clinical privileges attorney, hospital credentials hearing lawyer, ancillary medical staff clinical privileges defense attorney

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