South Florida Hospital Agrees To Pay $12 Million To Settle FCA Claims

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

On December 7, 2016, a Miami-area hospital will pay the federal government about $12 million to resolve allegations that it violated the False Claims Act (FCA) by submitting false claims to federal health care programs for medically unnecessary cardiac procedures, the U.S. Department of Justice (DOJ) said.

The Allegations.

The allegations against South Miami Hospital stem from procedures allegedly performed by Dr. John R. Dylewski while he worked for the hospital. “Performing medically unnecessary heart procedures is shocking to the conscience,” Shimon R. Richmond, the U.S. Health and Human Services’ (HHS) Office of Inspector General’s (OIG) special agent in charge, said in a statement. “Conducting cardiac catheterizations purely for profit, not patient care, seriously breaches the ‘do no harm’ commitment physicians pledge.”

Two Whistle Blowers Add to the Mix.

Two whistle blowers, Dr. James A. Burks and Dr. James D. Davenport, brought the suit to light and stand to receive about $2.75 million of the settlement. Dr. Burks is a vascular surgeon who started working at South Miami Hospital in 2003 and Dr. Davenport is a cardiologist who was active in various peer review committees at the hospital between 2010 and 2014.

Both whistle blowers claimed to have personal knowledge of Dr. Dylewski and the hospital performing a number of unnecessary cardiac procedures for the sole purpose of increasing the amount of reimbursements paid to the hospital and its doctors by Medicare the DOJ said. According to the two whistleblowers, the alleged wrongdoing was known throughout the hospitals’ corporate hierarchy, including top executives, department officers, medical division chiefs and members of peer review committees. Additionally, both whistleblowers claim to have witnessed “repeated and continuing instances” of the improper medical and billing practices.

Dr. Dylewski, who no longer works at the hospital, was not a party to the settlement. Click here to read the press release on the suit from the DOJ.

To learn more about FCA suit, click here to read one of my prior blogs on a similar case.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. 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 whistle blower 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:

Kennedy, John. “Florida Hospital To Pay $12M To Settle FCA Claims.” Law360. (December 7, 2016). Web.

Lincoff, Nina. “BREAKING: South Miami Hospital to pay $12M to settle false claims allegations.” South Florida Business Journal. (December 7, 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.

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

The American Nurses Association Breathes New Life Into The Nursing Code of Ethics For 2015

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 a daily basis, the average nurse uses knowledge, training and ethical standards to make vital decisions regarding patient health. Nurses are required to quickly process simple and complex emergency situations, which leaves little room for second guessing. So, to help guide those in the profession, the American Nurses Association (ANA) created a Code of Ethics.

This Code is the structure that provides foundational standards and offers guidance to practicing nurses for various situations. It also sets the standards against which nursing performance can be judged. For the first time since 2001, the ANA has revised the Nursing Code of Ethics. The revised Code was released to the public on January 1, 2015.

 

Why Now?

The revised version of the Nursing Code of Ethics is geared to help nurses in a more modern practice environment. It addresses some of the more current issues, including confidentiality issues raised by social media, treatment for end-of-life care and the integration of social justice into health care policy as a whole. These guidelines need to be updated as conditions and society changes, and health care advances and presents new problems.

 

What Changes Were Made?

Provisions 1-3: These contain newly established guidelines on advocating for the                                    patient, family and community, along with the need to exercise                                        kindness and respect in all professional relationships.

Provisions 4-6: Contains new guidelines on delivering and maintaining competent care                            that includes self-respect and self-care, accountability, and                                              responsibility to continue learning and growing personally and                                          professionally.

Provisions 7-9: Sets forth broader health issues in the community and on a national                                and international level, along with the advancement of professional                                  values, social policy and education.

 

The Nursing Code of Ethics is a reflection of the proud ethical heritage of nursing and serves as a guide and promise to society for all nurses now and into the future.

To view the complete revised Nursing Code of Ethics, click here.

ANA

Click here to find out more information on the American Nurses Association’s 2015 Year of Ethics

 

Comments?

What are your thoughts on the updates made to the code of ethics? Do you think it will help nurses identify components of real-world problems and analyze the situation effectively? Please leave any thoughtful comments below.
Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, Department of Justice (DOJ) 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.
Sources:

Howard, Cynthia. “2015: The Year of Nursing Ethics.” Nurse Together. (February 5, 2015). From: http://www.nursetogether.com/2015-the-year-of-nursing-ethics

Northeast Ohio Media Group Marketing Staff. “Year of Ethics Offers Nurses Guidance and Support Regarding Moral Decisions.” Cleveland.com. (April 15, 2015). From: http://blog.cleveland.com/university_hospitals_health_system_inc/2015/04/year_of_ethics_offers_nurses_g.html

American Nurses Association. “Code of Ethics for Nurses With Interpretive Statements.” (May 1, 2015). From: http://www.nursingworld.org/Mobile/Code-of-Ethics

 

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1999-2015 The Health Law Firm. All rights reserved.

Nurses Service Organization (NSO) Attorneys, Lawyers and Defense Council in Florida

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

Often we learn after the fact that a health professional such as nurses, advance registered nurse practitioners (ARNPs), certified registered nurse practitioners (CRNPs) and nurse midwives (NMs) has received Nurses Service Organization (NSO) insurance, has had a legal problem, and has not been able to locate an attorney or law firm that accepts this type of insurance. We have offices in Florida and Colorado, but we have attorneys licensed in Florida, Colorado, Louisiana, the District of Columbia, Virginia and other states.

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

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

The Health Law Firm Will Work with Your Insurance Company.

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

Contact Health Law Attorneys Experienced in the Representation of Nurses.

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

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

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

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

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

The Collateral Effects of Discipline on Your Nursing License

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

A. A case involving an arrest or a conviction involving alcohol abuse (DUI/public Intoxication) or drugs (possession, diversion, theft, trafficking) will probably result in an emergency suspension order (ESO) until the entire licensure case is complete.

B. Client may be required to be evaluated and probably enrolled in the Impaired Nurses Program (IPN) (for nurses only) or the Professionals Resource Network (PRN) (for all other licensed health professionals), which is usually at least a five year contract.

C. Action to revoke, suspend or take other action against the clinical privileges and medical staff membership of those licensed health professionals who may have such in a hospital, ambulatory surgical center, skilled nursing facility, or staff model HMO or clinic. This will usually be advance registered nurse practitioners (ARNPs) and certified registered nurse anesthetists.

D. Mandatory report to the National Practitioner Data Base (NPDB) (Note: Healthcare Integrity and Protection Data Bank or HIPDB recently folded into NPDB) which remains there for 50 years.

E. Must be reported to and included in the Department of Health (DOH) profile that is available to the public online (for those having one), and remains for at least 10 years.

F. Any other states or jurisdictions in which the client has a license will also initiate action against him or her in that jurisdiction. (Note: I have had two clients who had licenses in seven other states).

G. The Office of Inspector General (OIG) of Department of Health and Human Services (HHS) will take action to exclude the provider from the Medicare Program. If this occurs (and most of these offenses require mandatory exclusion) the provider will be placed on the List of Excluded Individuals and Entities (LEIE) maintained by the HHS OIG.

H. If the above occurs, the provider is also automatically “debarred” or prohibited from participating in any capacity in any federal contracting and is placed on the U.S. General Services Administration’s (GSA’s) debarment list.

I. The U.S. Drug Enforcement Administration (DEA) will act to revoke the professional’s DEA registration if he or she has one.

J. The certified health professional’s certify organization will act to revoke his or her certification.

K. Third party payors (health insurance companies, HMOs, etc.) will terminate the professional’s contract or panel membership with that organization.

L. Any profile maintained by a national organization or federation (e.g., American Medical Association physician profile or Federation of State Boards of Physical Therapy profile) will include the conviction.

M. Regardless of any of the above, any facility licensed by AHCA (hospitals, skilled nursing facilities (SNFs), public health clinics, public health clinics, group homes for the developmentally disabled, etc.) that are required to perform background screenings on their employees will result in AHCA notifying the facility and the professional that he or she is disqualified from employment.
Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health Investigations, before the Board of Nursing, in appearances before the Board of Nursing in licensing matters, and in administrative hearings.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.