Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples
9th Circuit Says Former Federal Nurse Can Proceed With Medical Malpractice Suit Against VA Hospital
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On September 29, 2021, the U.S. Court of Appeals for the Ninth Circuit ruled that a former federal employee can sue the United States under the Federal Tort Claims Act (FTCA). The suit alleges medical negligence that occurred during psychiatric treatment for a non-workplace-related injury.
As a result, the three-judge panel of the appeals court said that U.S. Navy veteran and VA nurse S.H.s’ lawsuit against a Seattle VA hospital can proceed. (Please note: we are not providing the nurse’s name out of respect for her privacy.)
In 2019, the district court dismissed S.H.’s federal tort […]
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 […]
Medicare Final Rule Decreased Physician Payments But Expands Coverage to Counselors
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). However, the final rule increased payment rates for outpatient services and expanded telehealth services. The rule went into effect January 1, 2024.
Physician Fee Schedule Rate Reductions; Counselors Added.
The overall payment rates under the 2024 PFS were reduced by 1.25 percent for 2024. The conversion factor is $32.74, which is a […]
Esformes Reaches Plea Deal in Major Nursing Home Medicare Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
On February 1, 2024, the District Court for the Southern District of Florida announced that Florida nursing home mogul Phillip Esformes had reached a plea deal on pending conspiracy to commit healthcare fraud charges.
Esformes, who then owned more than 30 Miami-area nursing and assisted living facilities, was first charged in July 2016 with what the Department of Justice (DOJ) called a $1 billion, decades-long Medicare fraud and money-laundering scheme. Click here to read the DOJ’s press release. (https://www.justice.gov/opa/pr/three-individuals-charged-1-billion-medicare-fraud-and-money-laundering-scheme)
The Fraudulent Health […]
What You Need to Know Right Now If the DEA is Knocking on Your Door!
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Is the Drug Enforcement Administration (DEA) knocking at your door or, even worse, going through your files inside your office?
If so, this is what you need to know right now!
YES, you do have the right to call your attorney. Call your attorney right now. If you cannot, ask one of your employees or spouse to call your attorney. Get your attorney involved right now!
NO, do not sign a document to relinquish or voluntarily give up your DEA registration number. If you do so, this will probably be the biggest mistake you make in […]
Centene Agrees to Pay $19 Million to Washington State For Medicaid Fraud Allegations
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, it has been reported that Centene/Sunshine Health reportedly has over $31 billion in contracts with the state of Florida alone. Click here to learn more.
The agreement with Washington State resolves allegations that it overcharged its Medicaid program for pharmacy benefit management services, Washington Attorney General Bob Ferguson announced in a […]
Many Adverse NPDB Actions Are Reported That Should Not Be; Here Are Examples
Nurse Faces Suit for Wrongful Death of Jail Inmate Says 10th Circuit Court of Appeals
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 3, 2021, the U.S. 10th Circuit Court of Appeals reversed in part, a Utah court’s decision on a lawsuit for the death of a 21-year-old inmate, affirming that the jail’s doctor could claim qualified immunity, but not the nurse. After the inmate’s death, her estate sued for depriving her of her civil rights. The U.S. district court granted summary judgment in favor of the county. It ruled that qualified immunity applied to shield jail supervisors and staff. However, it denied qualified immunity to jail nurse Jana Clyde and to a […]