Mental Health Law Blog | The Health Law Firm Blog

Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals – Part 2

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

Over the past year I have observed an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.

I have recently seen a number of audits initiated against psychologists and mental health professionals who treat assisted living facility (ALF) and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because this area of medical practice has been identified as one fraught with fraud and abuse. Sometimes these are only “probe” audits, initial audits requesting one (1) to five […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Medicaid audit, Medicare Audit, Medicare Fraud, Mental Health Counselor, Mental Health Counselor Law, Psychology|

CMS Issues Conditions of Participation for Community Mental Health Centers

By Lance O. Leider, J.D., The Health Law Firm

On October 28, 2013, the Centers for Medicare and Medicaid Services (CMS) announced a Final Rule establishing conditions of participation (CoPs) for Medicare-certified community mental health centers (CMHCs). The Final Rule is CMS 3202-F. These conditions are the health and safety regulations Medicare providers must meet in order to participate in the Medicare program and receive reimbursements. The stated purpose of the CoPs is to improve client care, establish requirements for staff and provider operations, and encourage clients to participate in their own treatment. According to CMS, many CMHCs are currently not required to meet any health and safety standards.

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By The Health Law Firm|2024-03-14T10:01:09-04:00May 15, 2018|CMS, Mental Health Centers|

Two Owners of Florida Counseling Center Arrested for Allegedly Defrauding Medicaid Out of $80,000

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

The two owners of a Minneola, Florida, ministry that helps provide counseling therapy and case management for children and families, each face up to 15 years in prison for allegedly defrauding Medicaid. According to the Florida Attorney General (AG), the pair was arrested on December 11, 2013. The owners were arrested after an investigation by the AG’s Medicaid Fraud Control Unit (MFCU) revealed that they allegedly bilked the Medicaid program out of $80,000.

Click here to read the press release from the AG.

Pair Charged With Participating in an Organized Scheme to […]

By The Health Law Firm|2024-03-14T10:01:09-04:00May 15, 2018|Medicaid audit, Mental Health Centers, Mental Health Counselor|

Two South Florida Doctors Convicted of Fraudulently Billing American Therapeutic Corporation (ATC)

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

A federal jury convicted two South Florida doctors, one Miami-area therapist, and two other individuals for their participation in a Medicare fraud scheme. The scheme allegedly involved more than $205 million in fraudulent billings by American Therapeutic Corporation (ATC), a corporation which provided mental health care services. The jury reached a decision on June 1, 2012.

To see the Department of Justice press release, click here.

The two doctors and the therapist were each found guilty of one count of conspiracy to commit health care fraud. The other two individuals were each found guilty of one count […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Mental Health Counselor, Mental Health Counselor Law|

Director of Center for Developmentally Challenged Adults Accused of Medicaid Fraud

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

The director of a center for developmentally challenged adults in Okaloosa County, Florida, was arrested on August 16, 2012, for allegedly fraudulently billing Medicaid for more than $270,000 for services under the Medicaid Developmentally Disabled Waiver Program, according to the Attorney General’s (AG) office.

To read the entire press release from the AG’s office, click here.

Director Allegedly Submitted False Claims for Non-Billable Services and Falsified Hours.

According to the press release, in 2009, the Medicaid Fraud Control Unit (MFCU) began investigating the center after it […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Medicare Fraud, Mental Health Counselor, Mental Health Counselor Law|

Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law

A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the Florida Office of the Attorney General (AG). On March 27, 2013, the facility owner was arrested. She faces charges of racketeering, Medicaid fraud and identity theft. According to the AG, local, state and federal law enforcement officers were all involved in the investigation.

Click here to read the press release from the AG.

Mental Health Counselor Reportedly Billed […]

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Medicaid audit, Mental Health Counselor, Mental Health Counselor Law|

Department of Health and Human Services Announces Mental Health Parity Final Rule

By Lance O. Leider, J.D., The Health Law Firm

On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system has openly discriminated against Americans with behavioral health problems.”

The purpose of the regulations is to close the gaps in coverage that permit insurance carriers to treat mental and substance-abuse related treatment different from traditional medical and surgical benefits.

Among the key provisions of the regulations are the elimination of separate mental health deductibles, co-insurance, etc.; elimination of limits on […]

By The Health Law Firm|2024-03-14T10:01:51-04:00May 15, 2018|Mental Health Counselor, Mental Health Counselor Law, Psychology|

Your Professional Therapist License Is a Valuable Asset; Insure It!

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

Time and time again, I am contacted by mental health counselors, social workers, and other therapists who have worked hard for years, have paid tens of thousands of dollars for tuition, fees, books, and board, and made sacrifices in order to obtain a professional degree and a professional license. Yet they have not purchased professional insurance to protect their licenses.

Your professional license is arguably your most valuable asset. Yet, I am continuously surprised to learn the number of health professionals who come to our firm in serious trouble because a complaint has been […]

By The Health Law Firm|2024-03-14T10:01:51-04:00May 15, 2018|Mental Health Counselor, Mental Health Counselor Law|

How to Prepare for an Informal Hearing Before the Florida Board of Clinical Social Work, Marriage & Family Therapy & Mental Health Counseling

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

If you are scheduled to appear for an informal hearing before the Florida Board of Clinical Social Work, Marriage & Family Therapy & Mental Health Counseling, there are a number of facts that you will want to know in order to be properly prepared. This article will cover many of them.

Limited Circumstances for Informal Administrative Hearing

First, you should understand that you will only be at an informal hearing in which you appear before the Board of Clinical Social Work, Marriage & Family Therapy […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Mental Health Counselor Law|

Fake Occupational Therapist Worked at Numerous Hospitals Around the State

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

A Kissimmee, Florida, man is accused of posing as an occupational therapist (OT) and working at various health care facilities in Central Florida, according to the Department of Justice (DOJ). On October 16, 2012, the DOJ announced that the phony OT was charged with three counts of mail fraud, five counts of wire fraud, and one count of aggravated identity theft.

Click here to see the press release from the DOJ.

Phony OT Worked at […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Occupational Therapist|