The Health Law Firm Blog | The Health Law Firm Blog

So, the ZPIC Medicare Auditor Wants to Talk to You? What You Should Expect

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

You are a physician, nurse or other health care provider who bills Medicare. You have received that dreaded letter from the Zone Program Integrity Contractor (ZPIC) for Medicare advising you that it is auditing you for the Centers for Medicare and Medicaid Services (CMS). You know that the words “Program Integrity” by themselves mean that possible fraud is being investigated, at least that is the suspicion giving rise to this particular audit.

To read an earlier blog which I wrote […]

By The Health Law Firm|2024-03-14T10:00:15-04:00May 10, 2019|The Health Law Firm Blog|

Dental Clinic Owners Found Guilty of $1 Million Medicaid, Tax Scheme

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

On February 21, 2019, a federal jury found the owners of several dental clinics in Missouri guilty of a $1 million scheme to defraud the government. The owners of All About Smiles LLC, were convicted of submitting false claims to Medicaid for dentures and other services and payroll tax fraud, according to prosecutors.

Submitting False Claims.

Prosecutors alleged that the couple that owned the practice ran several schemes through the dental clinics from 2010 to 2015, including conspiring to defraud Medicaid. A main part of […]

By The Health Law Firm|2024-03-14T10:00:16-04:00April 18, 2019|Centers for Medicare and Medicaid Services, Dental Law Blog, Dentist Defense attorney, Health Care Fraud, Health care Law, Medicaid Fraud, Medicaid fraud|

OIG Exclusion: Do You Know if You’re on the List?

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

Have you ever faced a disciplinary action against your professional license? Have you ever been arrested or convicted of a criminal offense? If yes, then you may have also been terminated from the federal Medicare Program or your state Medicaid Program.

Many health care professionals don’t think about the repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their professional career. Whether you are a physician, nurse, dentist, psychologist or other health professional, if you allow yourself to be excluded from the Medicare Program, devastating economic […]

By The Health Law Firm|2024-03-14T10:00:19-04:00December 27, 2018|The Health Law Firm Blog|

Are You Worried About Health Care Compliance Consequences? Have They Gone Too Far?

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

From large hospital systems to solo practitioners, there is no escaping health care compliance in the industry. The concept of compliance can spark different thoughts in different people. For example, some believe it is an unnecessary government intrusion and others believe it’s a way to improve the quality and costs of health care.

No matter your thoughts on health care compliance and government oversight, regulation of the health care industry will never be eliminated. In fact, we expect it to increase as more quality-based requirements are implemented.

We believe compliance and regulations are necessary, but we have to wonder if sometimes these laws go too […]

By The Health Law Firm|2024-03-14T10:00:21-04:00October 27, 2018|The Health Law Firm Blog|

Health Care Professionals: Fight Back Against Bad Online Reviews

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

Defamatory attacks against health care professionals have become increasingly prevalent as more and more review sites join the world wide web. This allows patients to post virtually anything they want – good or bad – about a physician or any professional. With more physicians becoming employees of hospital systems or large healthcare institutions, adverse surveys, reports or reviews can affect advancement, bonuses and basic income.

Online Review Websites.

Internet ratings on review sites like Vitals.com and Yelp.com can range from snide comments about the patient’s waiting time in the physician’s office to vicious attacks that can have a […]

By The Health Law Firm|2024-03-14T10:00:21-04:00October 18, 2018|The Health Law Firm Blog, Uncategorized|

OIG Exclusion: What You Need to Know if You’re on the List

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

Have you ever had disciplinary action against your license as a health care professional? Have you ever been arrested or convicted of a criminal offense? Have you ever been convicted of fraud or patient neglect? If so, then you may have also been terminated or excluded from the federal Medicare Program or your state Medicaid Program.

Many health professionals don’t understand the significant repercussions that an exclusion action by the Office of the Inspector General (OIG) can have on their career and employment. Whether you are a physician, nurse, dentist, psychologist or other health professional, if you […]

By The Health Law Firm|2024-03-14T10:00:21-04:00October 10, 2018|In the Know, The Health Law Firm Blog|

Hey, Health Care Professionals…Why Can’t We Be Friends?!

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

Every year, our firm sponsors and attends various medical industry events. Needless to say, our law firm table is not the most popular hangout spot. If we had a penny for every time we have heard “Yikes, an attorney! I hope I never need you.” we could close our doors and all retire.

The feeling is akin to being the last kid picked for teams in gym class. So we ask ourselves: why are we attorneys shunned by health care professionals? Why won’t anyone make eye contact with us at meetings and events? Why is there a […]

By The Health Law Firm|2024-03-14T10:00:22-04:00September 11, 2018|The Health Law Firm Blog|

Ready or Not, It’s Irregular Behavior Season Once Again…

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

Every year, our firm receives calls from panicked medical students and residents about a recent letter they have received, alleging irregular behavior on standardized medical examinations.

This letter may come from the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE), or the Educational Commission for Foreign Medical Graduates (ECFMG). No matter the organization, if you receive a letter alleging irregular behavior, it will typically say the following:

A bulletin or policy related to the exam stating that Irregular Behavior is not permitted.

The facts alleging irregular behavior in this case.

You have an opportunity to […]

By The Health Law Firm|2024-03-14T10:00:23-04:00August 29, 2018|The Health Law Firm Blog, Uncategorized|

Helpful Tips to Speed Up the Medicare Prepayment Review Process

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

For Medicare providers, being notified of an impending audit is not welcome news. Being notified of a prepayment review is even worse. In a prepayment review, the health care provider must submit documentation to the Centers for Medicare & Medicaid Services (CMS) contractor before ever receiving payment. The health care provider will only receive payment (typically months later) if the contractor is satisfied with the provider’s documentation. This can be financially disastrous for the health care provider, who still must pay day-to-day expenses while waiting for a decision.

CMS Contractors.

If you have received notice of prepayment review, […]

By The Health Law Firm|2024-03-14T10:00:23-04:00August 29, 2018|The Health Law Firm Blog|

Health Care Professionals Need to be Compliant with Anti-Fraud Laws

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

The federal government has several tools available to help combat Medicare fraud. Among those are the Stark Act, Anti-Kickback laws and Civil Monetary Penalty Laws. Each of these typically focuses on a particular type of behavior that is prone to abuse by health care providers.

The Stark laws exist to combat the problems that can arise from physician self-referrals. Self-referrals are cases in which a physician orders a test or service and refers the patient to a provider in which the referring physician has a financial interest. This second provider will then bill Medicare for the service, […]

By The Health Law Firm|2024-03-14T10:00:23-04:00August 29, 2018|The Health Law Firm Blog, Uncategorized|