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Internal Medicine Specialists Should Be Aware of Impending Medicare Audits

Coming to a medical practice near you. . . It’s scary, it’s horrible, and it could cost you a lot of money!

It’s the dreaded Comprehensive Error Rate Testing (CERT) audit.

The Horror! The Horror!

First Coast Service Options, the Medicare contractor for Florida, announced a new prepayment audit program that will impact Internal Medicine Specialists. The prepayment program is focused on Initial and Subsequent Hospital Evaluation and Management Services, CPT Codes 99223 and 99233. The program is being launched due to the high CERT error rate associated with these codes.

The audits will start on October 21, 2014.

What is the CERT Program?

CMS created the CERT program to measure the paid claims error rate […]

By The Health Law Firm|2024-03-14T10:00:58-04:00June 1, 2018|CERT, Comprehensive Error Rate Testing, Internal Medicine, Medicaid, Medicaid audit, Medicaid Fraud Control Unit, Medicaid managed care, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

Chiropractors Not Allowed to Work for Clinics Owned by Non-Chiropractors in Florida, with Limited Exceptions

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

Apparently there are many chiropractic physicians and other medical business owners who are unaware of the prohibition provided in Florida law against a chiropractor providing services for a business owned by non-chiropractors. By non-chiropractor, this means anyone who does not have a current, active Florida chiropractic physician’s license.

The prohibition for chiropractors was passed into law in Florida originally in 2007. The law was amended in 2012. There had previously been similar prohibitions that applied to dentists and optometrists. To read the article I wrote on these issues, click here.

What’s the Purpose of This Law?

Found […]

By The Health Law Firm|2024-03-14T10:00:45-04:00June 1, 2018|Chiropractor, Health Care Industry, In the Know, Licensing issues, The Health Law Firm Blog|

Central Florida Pain Management Clinic Falls Victim to Civil Forfeiture

By Christopher E. Brown, J.D., The Health Law Firm

On June 14, 2013, Drug Enforcement Administration (DEA) agents, along with local police and sheriffs’ deputies raided a Longwood, Florida, pain management clinic. In addition to criminal charges, the physicians and employees associated with this clinic face another lesser known threat, the civil forfeiture of their money and property. During the raid agents took everything from the clinic that could help them build a criminal prosecution. This included paper records, computer equipment and prescription drugs. In addition to the Longwood pain management clinic, DEA agents also searched homes in Brevard County, Florida, where associates of the Longwood clinic allegedly live. To read more […]

By The Health Law Firm|2024-03-14T10:00:50-04:00June 1, 2018|Civil Forfeiture, In the Know, Pain Management, Pharmaceutical Drugs, The Health Law Firm Blog|

More Medicare Audits Now Than Ever Before

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

A Medicare audit, whether it is performed by a contractor of the Centers for Medicare & Medicaid Services (CMS), or by another organization, can be a daunting process. It is never “routine” and should never be taken lightly.

Because of the efforts to reduce expenditures on entitlement programs and the success that the government has had in recovering large sums of Medicare overpayments, we are seeing a tremendous increase in Medicare fraud initiatives, including but not limited to audits by Medicare Administrative Contractors (MACs), audits by Zone Program Integrity Contractors (ZPICs), Recovery […]

By The Health Law Firm|2024-03-14T10:00:59-04:00June 1, 2018|CMS, Medicare, Medicare Fraud, Recovery Audit Contractor, The Health Law Firm Blog, ZPIC|

Criminal Law: Warrantless Search of Cell Phones

Our guest author of this is article is Doug Plank, a legal research attorney with National Legal Research Group in Charlottesville, Virginia.

In what some commentators have described as the most important criminal law decision of its 2013-2014 Term, the U.S. Supreme Court ruled unanimously in Riley v. California, 134 S. Ct. 2473 (2014), that before police may search the contents of a cell phone seized after an arrest, they must first obtain a search warrant. In reaching this determination, which is a departure from the Court’s general rule that a person’s belongings may be searched without a warrant incident to an arrest of that person, […]

By The Health Law Firm|2024-03-14T10:00:58-04:00June 1, 2018|Criminal Law, Supreme Court Rulings, The Health Law Firm Blog|

DEA Has Online List of Cases Against Doctors

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

The Drug Enforcement Administration (DEA) has a public list of physicians with DEA registrations that have been arrested and prosecuted. On the DEA’s website, there is a list of all investigations of physician registrants in which the DEA was involved that resulted in the arrest and prosecution of the registrant which was updated and released on April 3, 2012.

The list includes:
• The name of the physician;
• The physician’s city/state;
• Date of arrest/conviction;
• Judicial status;
• Conviction;
• Status of the physician’s DEA registration; and
• Remarks regarding the physician’s case.

Click here to view a copy of the most recent list (last updated on April 3, 2012).

We cannot […]

By The Health Law Firm|2024-03-14T10:00:30-04:00June 1, 2018|DEA, The Health Law Firm Blog|

Cardinal Health’s Settlement With the DEA Results in Shipment Suspension

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

Cardinal Health and the Drug Enforcement Administration (DEA) have reached a settlement which will suspend Cardinal Health’s ability to ship controlled substances from its Florida distribution facility for two years. The company will now supply controlled substances from its distribution center in Jackson, Mississippi.

Cardinal Health’s Settlement Does Not Prevent the DEA from Pursuing Civil Penalties.

The settlement was announced on May 15, 2012. It includes an Administrative Memorandum of Agreement (MOA), the terms of which will apply to all of Cardinal Health’s registered distribution facilities. The MOA will not prevent Cardinal Health from possible civil penalties related to the DEA’s case against the pharmaceutical distributor.

The […]

By The Health Law Firm|2024-03-14T10:00:30-04:00June 1, 2018|DEA, The Health Law Firm Blog|

DEA’s Medical Marijuana Research Ban Appealed by Professor

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

A University of Massachusetts-Amherst professor is appealing a final order issued by the Drug Enforcement Administration (DEA) that has stopped him from growing marijuana for medical research purposes.

Appeals Court Hears Oral Arguments in Medical Marijuana Research Case.

The U.S. Court of Appeals for the First Circuit heard oral arguments in the case on May 11, 2012. During the hearing the DEA attempted to get the case thrown out by claiming that the court has no jurisdiction over the issue. The court’s ruling should come in about three months.

To hear the oral arguments presented in this case, click here.

DEA’s Final Order […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|DEA, The Health Law Firm Blog|

Doctors and Nurse Practitioner Arrested in Prescription Drug Abuse Raid

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

A crackdown on prescription drug abuse by New York law enforcement has resulted in the arrests of 98 people. Two doctors and a nurse practitioner were among those charged.

A series of raids were carried out by Brooklyn federal prosecutors, the Drug Enforcement Administration (DEA), district attorney’s offices, and local law enforcement agencies. The raids began June 5, 2012 and resulted in the arrests.

To view the DEA’s press release concerning the raid, click here.

Both Doctors Accused of Overprescribing.

One of the doctors is accused of conspiring […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|DEA, The Health Law Firm Blog|

Medical Marijuana Legalized in Connecticut: Will More Problems Develop for Doctors, Pharmacists?

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

The use of marijuana for medical reasons has been legalized in Connecticut. The state’s governor signed into law HB 5389 on May 31, 2012, which allows licensed physicians to certify a patient’s use of marijuana for medical purposes. Connecticut is the 17th state to legalize marijuana for medical use.

To view Connecticut HB 5389, click here.

Medical Marijuana Legislation in Connecticut Imposes Restrictions on Patients.

The new law outlines restrictions to prevent abuse of the substance. Patients and caregivers in Connecticut must register with the Connecticut Department of Consumer Protection. In addition, a doctor must certify there is a medical need […]

By The Health Law Firm|2024-03-14T10:00:31-04:00June 1, 2018|DEA, In the News, The Health Law Firm Blog|