Medications and Other Substances that Mimic Prohibited Drugs on Urinalysis Drug Tests (Part 1 of a Blog Series)
Medicare Revocation and the Collateral Damage It Can Cause Health Care Providers
Lasting Consequences of Medicare Revocation.
Florida Attorney Says AHCA Must Put Medicaid Final Orders Online
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Florida’s Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against AHCA, trying to force AHCA into compliance with state public records laws.
Attorney Nancy Wright says the AHCA orders fall under a state law that requires all proceedings determined by a state agency to be placed into a centralized electronic database accessible to the public. This would allow citizens and healthcare providers more accessible access to those decisions and […]
Former Dental Office Manager Sentenced to One Year in Prison for Defrauding Medicaid Out of More Than $813,000
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On October 1, 2021, a former dental office manager was sentenced to 12 months in prison for her role in a Medicaid fraud scheme. The office manager for Universal Smiles, a D.C.-based dental practice was sentenced for her guilt in bilking Medicaid, according to the U.S. attorney’s office for D.C.
The office manager was indicted in January 2019, along with the dentist who ran the practice. The office manager pleaded guilty in May 2021 in the U.S. District Court for the District of Columbia and admitted she received over $813,000 through false billings.
The Fraudulent Billing […]
Don’t Get Labeled as a “Problem Resident” for Disputes With Your Medical Education Program: Prepare to Identify and Address Problems
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
A resident physician has a tough life while working to become specialized in a medical specialty, especially in the more complex ones. Try to make it less complicated instead of more complicated.
Residents are In Two Different Positions: An Academic Position and an Employee Position.
Residents actually serve in two different positions. One position is as a learner in an academic situation, similar to a student, pursuing post-graduate training and education in an accredited graduate medical education (GME) program. The second position is as a full-time employee, paid to take care of patients in hospitals and […]
Court Assesses $170 Million in Fines Against Two Texas Ophthalmologists For False Claims
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On November 18, 2021, the Justice Department announced that two Texas ophthalmologists and their eye clinic must pay millions of dollars in penalties for fraudulently billing Medicare. The penalties were assessed in connection with their evaluation and treatment of glaucoma.
U.S. District Judge Lynn Hughes assessed $170 million in penalties against the ophthalmologists and their eye clinic in Houston, Outreach Diagnostic Clinic.
A Former Employee Blew the Whistle.
According to the U.S. Department of Justice (DOJ), the action resulted from a False Claims Act (FCA) or “qui tam” suit. The whistleblower was […]
Humana Agrees To Pay $11.2 Million to End Nurses’ Overtime Suit
By George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law
On September 27, 2021, Humana agreed to pay $11.2 million to end claims that the health insurance company denied a group of nurses overtime pay by misclassifying them as exempt employees. A Wisconsin federal judge approved the deal with Humana, and a group of more than 200 nurses reached, securing a $36,000 average payment for each nurse involved in the suit.
A Violation of the Fair Labor Standards Act (FLSA).
This dispute stems from a class-action lawsuit filed in 2017 alleging that Humana misclassified its clinical nurse advisers as exempt employees and denied them overtime compensation, violating […]
From the archives: CMS Using Medicare Termination to Squash Doctors Involved in Overprescribing Opioids
Previously published on February 11, 2022
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Recently it has come to our attention that there may be a nationwide effort by the Centers for Medicare and Medicaid Services (CMS) Medicare Administrative Contractors (MACs) to squelch physicians who prescribe opioids and other narcotic medications. We have seen letters sent out by CMS MACs to physicians notifying them that their Medicare program billing privileges have been terminated because CMS has identified them as a provider who is overprescribing.
Nationwide Effort to Run “Pill Mills” Out of Business.
We are well aware of efforts by the various law enforcement authorities at the […]
From the archives: CMS Using Medicare Termination to Squash Doctors Involved in Overprescribing Opioids
Previously published on February 11, 2022
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Recently it has come to our attention that there may be a nationwide effort by the Centers for Medicare and Medicaid Services (CMS) Medicare Administrative Contractors (MACs) to squelch physicians who prescribe opioids and other narcotic medications. We have seen letters sent out by CMS MACs to physicians notifying them that their Medicare program billing privileges have been terminated because CMS has identified them as a provider who is overprescribing.
Nationwide Effort to Run “Pill Mills” Out of Business.
We are well aware of efforts by the various law enforcement authorities at the […]