20 Tips to Help You Survive Facing Peer Review for Your Hospital Clinical Privileges-Part 2 of 2

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

In Part 1 of this blog I began a list of tips that should serve you well if you are notified by your hospital or medical staff that you are the subject of an internal or external peer review action. Click here to read Part 1.

20 Tips For Successful Outcome in Peer Review (Continued):

10.    If you are given the opportunity to meet with the reviewers or provide information to them, do so.  If you haven’t been offered this, ask for it in writing.

11.    Make sure any written response is provided in a typewritten letter formal not via e-mail, text or YouTube posting or handwritten note.

12.    In your written statement or response, if you use any abbreviations, spell them out completely the first time you use them and place the abbreviation after, in parentheses.  Remember, future reviews of your statement may not be physicians (e.g., a judge) or may not be in your medical specialty.

13.    It is never too early to engage experienced health car legal counsel to assist you in such matter.  But if you do, make sure you do hire an actual health law attorney who has experience with medical staff peer review actions.  This is no place for a plaintiff’s personal injury attorney, a criminal defense attorney or your tax, or business lawyer.

14.    If you find out that your matter is being sent out to an external peer review organization you should retain an experienced health law attorney immediately and obtain your own medical expert review.

15.    If the care being examined involved another physician as well as you, or if the care was of a patient referred by another physician, see if that physician supports the care you provided and will provide you a letter or statement saying that.

16.    If the allegation being reviewed involves facts that you know are not true, see if you can obtain evidence of this.  For example, I had a case where nursing staff filed a complaint against my client a male OB/GYN claiming that the mother of a minor female patient had demanded that her daughter only be examined by a female doctor.  We are able to obtain an affidavit from the mother swearing that she had never stated that.  The peer review matter was dismissed and closed.

17.    If it appears that you are being targeted for repeated peer review complaints or investigations, it is time to get out of that place.  Read the handwriting on the wall.  However , see #1 above.  Do not resign with any type of peer review pending.

18.    Remember that peer review proceedings are supposed to be confidential.  Therefore work through your legal counsel in obtaining outside reviews.  Do not discuss the matter with those outside the medical staff.

19.    Although the peer review process is confidential, it is not supposed to be “secretive.”  The person who is the subject of peer review should have access to the complaint and medical records involved.  This should not be a Star Chamber proceeding.  Make a polite written request for copies of such materials or to be allowed to review them and make notes.

20.    In many cases, you may find that you did make a mistake, violate a policy or procedure, skip a step in an algorithm, fall below the standard of care, or otherwise screw up.  Except in cases of the most egregious situations, your best course o action may be to admit this, explain how this happened, and outline steps you are taking to make sure it does not happen again.  This is especially true when it is your first “offense” and you have many years of otherwise excellent performance.  The medical staff usually wants to make sure that when a mistake occurs, the health provider has the ability to recognize it and learn from it.

Follow These Tips for The Best Results in a Peer Review Matter.

If you follow these tips, you have the best chance of coming out of the peer review without problems.  However, in a really serious case, where many records are being reviewed and the allegations appear to be very serious, then it is most important to retain an experienced health care attorney at the earliest opportunity and take that attorney’s advice.  You will be in for the fight of your professional life.

Click here to read Part 1 of this Blog
.

For more information, read one of my prior blogs on peer review, avoiding the disruptive physician label and clinical privileges.


Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Reviews.

If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.

At the Health Law Firm we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.  We also represent physicians and health care providers in complex litigation in both state and federal courts.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians,  health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

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Little Known Facts About State and DOH Investigations That Could Save Your Professional License

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The notice that you are under investigation may seem nonthreatening. It may come in the mail, be delivered personally by an investigator or you may receive a telephone call from the investigator. This is a very serious matter for you.

Our attorneys include those who are board certified in health law by The Florida Bar, those who are nurses, and those who are themselves licensed health professionals.  Our attorneys represent health care professionals and providers at formal administrative hearings at the Division of Administrative Hearings (DOAH), in defense of administrative complaints and in informal hearings before the Department of Health (DOH).
The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license:

1. You do not have to make any statement at all to an investigator.  The Fifth Amendment applies to administrative investigations that can affect your license in Florida.  We recommend you never speak to an investigator or make any statement.  Let your attorney do this for you.

2. You do not have to sign an affidavit that your health records are complete.  In fact, we strongly recommend against doing this.  Consult an experienced health lawyer in who has experience in litigating your type of case before signing anything.

3. If you receive a DOH subpoena for records, you do not necessarily have to provide them.  You may file an objection to producing them based on an invasion of the privacy of the patient, lack of relevance to the investigation, super-confidential medical information (including HIV/AIDS testing or information, drug or alcohol counseling or testing information, or mental health information) or other proper grounds.  In one case, our client received a subpoena for copies of her professional school records and when we checked the case number for the case in which it was issued, the case did not exist.

4. The Surgeon General (formerly known as the Secretary of the Department of Health) does not have the authority to enforce a subpoena or to issue a final order to you compelling you to respond to the subpoena.  Only a court of law with jurisdiction has the legal authority to compel you to produce records in response to a DOH subpoena.

5. If you have filed an objection to an administrative procedure, you cannot be legally charged with violating an order from the head of the agency to produce those records.  The Surgeon General (formerly known as the Secretary of the Department of Health) does not have the legal authority to enforce such subpoenas.

6. If you are facing an emergency suspension order (ESO) for certain types of misconduct (e.g., drug abuse, alcohol abuse, sexual misconduct, mental impairment) you may be able to submit a voluntary request/agreement to refrain from practice in the state of Florida.  This may avoid having an ESO issued, which is a public record and is published through the media.  If you have a license in another state, you may still practice in that state.

7. A voluntary relinquishment of your professional license after an investigation has begun is treated the same as a revocation of your license.  This may result in a report being made to the National Practitioner Data Bank (NPDB) or the Healthcare Integrity Procurement Data Bank (HIPDB) just the same as a revocation of your license would be (even for LPN, R.N., or ARNP).  This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment.

8. You do not have to report a pending DOH investigation against you to anyone.  A DOH investigation is and remains completely confidential until at least ten (10) days after there is a finding of probable cause.

9. Until there is a suspension or other final action taken against you, there is no indication on your license or in your licensure file that you are being investigated.
If you receive notice that the Department of Health (DOH) has opened an investigation against you, contact The Health Law Firm immediately, before you talk to an investigator.

To learn more about how The Health Law Firm can assist you if you find yourself in this situation, click here.

To learn more on how to protect your medical license, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals Today.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Department of Health (DOH) investigations, legal representation for DOH complaints, licensure defense attorney, DOH defense attorney, health law defense attorney, legal representation for health care professionals, legal representation for disciplinary actions against your license, legal representation for license revocation, licensure defense attorney, administrative complaint attorney, legal representation for administrative complaints, Board of Medicine representation, legal counsel for Board representation, The Health Law Firm, health law defense attorney, Florida health law attorney, reviews of The Health Law Firm, The Health Law Firm attorneys review

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2018 The Health Law Firm. All rights reserved.

Little Known Facts About State and DOH Investigations That Could Save Your Professional License

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The notice that you are under investigation may seem nonthreatening. It may come in the mail, be delivered personally by an investigator or you may receive a telephone call from the investigator. This is a very serious matter for you.

Our attorneys include those who are board certified in health law by The Florida Bar, those who are nurses, and those who are themselves licensed health professionals.  Our attorneys represent health care professionals and providers at formal administrative hearings at the Division of Administrative Hearings (DOAH), in defense of administrative complaints and in informal hearings before the Department of Health (DOH).
The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license:

1. You do not have to make any statement at all to an investigator.  The Fifth Amendment applies to administrative investigations that can affect your license in Florida.  We recommend you never speak to an investigator or make any statement.  Let your attorney do this for you.

2. You do not have to sign an affidavit that your health records are complete.  In fact, we strongly recommend against doing this.  Consult an experienced health lawyer in who has experience in litigating your type of case before signing anything.

3. If you receive a DOH subpoena for records, you do not necessarily have to provide them.  You may file an objection to producing them based on an invasion of the privacy of the patient, lack of relevance to the investigation, super-confidential medical information (including HIV/AIDS testing or information, drug or alcohol counseling or testing information, or mental health information) or other proper grounds.  In one case, our client received a subpoena for copies of her professional school records and when we checked the case number for the case in which it was issued, the case did not exist.

4. The Surgeon General (formerly known as the Secretary of the Department of Health) does not have the authority to enforce a subpoena or to issue a final order to you compelling you to respond to the subpoena.  Only a court of law with jurisdiction has the legal authority to compel you to produce records in response to a DOH subpoena.

5. If you have filed an objection to an administrative procedure, you cannot be legally charged with violating an order from the head of the agency to produce those records.  The Surgeon General (formerly known as the Secretary of the Department of Health) does not have the legal authority to enforce such subpoenas.

6. If you are facing an emergency suspension order (ESO) for certain types of misconduct (e.g., drug abuse, alcohol abuse, sexual misconduct, mental impairment) you may be able to submit a voluntary request/agreement to refrain from practice in the state of Florida.  This may avoid having an ESO issued, which is a public record and is published through the media.  If you have a license in another state, you may still practice in that state.

7. A voluntary relinquishment of your professional license after an investigation has begun is treated the same as a revocation of your license.  This may result in a report being made to the National Practitioner Data Bank (NPDB) or the Healthcare Integrity Procurement Data Bank (HIPDB) just the same as a revocation of your license would be (even for LPN, R.N., or ARNP).  This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment.

8. You do not have to report a pending DOH investigation against you to anyone.  A DOH investigation is and remains completely confidential until at least ten (10) days after there is a finding of probable cause.

9. Until there is a suspension or other final action taken against you, there is no indication on your license or in your licensure file that you are being investigated.
If you receive notice that the Department of Health (DOH) has opened an investigation against you, contact The Health Law Firm immediately, before you talk to an investigator.

To learn more about how The Health Law Firm can assist you if you find yourself in this situation, click here.

To learn more on how to protect your medical license, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals Today.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for Department of Health (DOH) investigations, legal representation for DOH complaints, licensure defense attorney, DOH defense attorney, health law defense attorney, legal representation for health care professionals, legal representation for disciplinary actions against your license, legal representation for license revocation, licensure defense attorney, administrative complaint attorney, legal representation for administrative complaints, Board of Medicine representation, legal counsel for Board representation, The Health Law Firm, health law defense attorney, Florida health law attorney, reviews of The Health Law Firm, The Health Law Firm attorneys review

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2018 The Health Law Firm. All rights reserved.

20 Tips to Help You Survive Facing Peer Review for Your Hospital Clinical Privileges-Part 1 of 2

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

If you are a physician, nurse practitioner, psychologist, clinical pharmacist, oral surgeon, ophthalmologist, or other licensed health professional with clinical privileges in a hospital, chances are that one day you will be subject to a peer review action or investigation.  It may be a simple one-time matter based on a patient complaint or adverse outcome, or it may be a lengthy process involving a large number or your cases and records.

A peer review action action may be initiated because of a patient complaint.  It may be commenced because of complaints filed by hospital staff.  It may be begun because of an unexpected adverse outcome.  It may be begun because a patient files s medical malpractice lawsuit.  It may result from a statistical review by the Utilization Review office or from the Quality Improvement office.

This is part 1 of a 2 part blog series. Click here to read part 2.

A Notice of A Peer Review Must Be Treated Seriously.

Regardless of the source, or how petty or meritless it may seem, the health professional who is the subject of the peer review must treat it seriously.  The actions you take may resolve the matter at a preliminary stage or it may cause an escalation to a hearing, adverse action, and a National Practitioner Data Bank (NPDB) Report, with career-ending results.


Tips to Survive Peer Review.

Following are tips that the individual who is the subject of a peer review action that may help you to resolve it at the lowest level feasible under the circumstances.

The following tips assume that you have been notified of an initial peer review matter ant the facts or subject being investigated.

1.    Do not resign or allow your clinical privileges to expire while the matter is pending. If you do so, this will be treated in a similar manner to having your privileges revoked in a clinical privileges matter and it will be reported out as such to the NPDB and other reporting organizations.

2.    Provide a response or explanation if given the opportunity.  But make sure you have reviewed the records, researched the medical issues as appropriate, and provide a well-organized, thought-out, objective and professional response.

3.    Remember that this review is only about you and your actions.  It is not about anyone else and this is not the place to make accusations about others.  Discuss what you did (or did not do);  do not point the finger at others and argue that they have done the same thing or worse.

4.    Remain objective.  Do not lose your temper and respond in a defensive, inflammatory matter.  Assume that everyone is just trying to do their jobs.

5.    In any written response, address the facts.  Do not address what you think the motives of other individuals are.

6.    Make sure your response is objective.  Try to avoid subjective statements.  Speak in terms of provable facts and what the record or other documents show.  If you have documents (e.g., office records, algorithms, standards, guidelines) that those conducting the peer review do not have, attach them to your response.

7.    Make sure your response is professional.  Follow the rules for professional correspondence, that I wrote about in a prior blog about this.  [Note:  Add link.]

8.    If you don’t have all of the records on the matter, ask for them.  Also, obtain and review any applicable hospital or department policies and procedures.  Review the medical staff Rules and Regulations, as well.

9.    Support and explain what you did logically and with reference to medical journal articles and medical treatises.  Attach legible copies of any relevant medical literature (or relevant portions of it).  Be sure to completely identify any medical literature you attach by including title page, publication info, date, volume, pages, etc.

I will continue these tips in Part 2 of this blog.

For more information, read one of my prior blogs on peer review, avoiding the disruptive physician label and clinical privileges.

Don’t Wait Until It’s Too Late, Contact a Health Law Attorney Experienced in the Process of Peer Reviews.

If you are the subject of a peer review proceeding, immediately retain experienced, knowledgeable health care counsel to represent you. The attorneys of The Health Law Firm have experience in most, if not all, types of “fair hearings” involving health care issues and health care providers.

At the Health Law Firm we provide legal services for physicians and other health care providers. This includes nurse practitioners, nurses, dentists, psychologists, psychiatrists, mental health counselors, medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. We represent facilities, individuals, groups and institutions in contracts, sales, mergers and acquisitions.  We also represent physicians and health care providers in complex litigation in both state and federal courts.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida area.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Keywords: Legal representation for peer review, peer review defense attorney, medical staff peer review confidentiality, medical staff fair hearing legal representation, medical staff fair hearing attorney, clinical privileges hearing defense attorney, clinical privileges hearing legal representation, clinical privileges hearing attorney, legal counsel on peer review process, legal representation for physician defamation, health law defense attorney, economic credentialing, sham peer review attorney, health law peer review attorney, legal representation for peer review investigations, health care litigation legal counsel, complex health care litigation attorney, legal representation for health care employment issues, disruptive physician representation, legal representation for disruptive physicians,  health care employment defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

Federal Judge Refuses to Dismiss Florida Compounding Pharmacy’s FCA Suit

10 Indest-2008-7By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 4, 2017, a Florida federal judge refused to dismiss the federal government’s False Claims Act (FCA) suit against a compounding pharmacy. RS Compounding LLC and its owner, Renier Gobea, are accused of overbilling Tricare for prescriptions. The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner.

Judge Finds Claims Are Sufficiently Stated.

According to U.S. District Judge Virginia M. Hernandez Covington, the government adequately pled its claims that RS and Gobea had knowingly charged Tricare prices well in excess of what it charged cash payors for substantially the same drugs. “The United States’ amended complaint in partial intervention sufficiently states claims for unjust enrichment and violation of the FCA,” the judge said.

The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

Additionally, Judge Covington rejected the owner’s argument that claims against him personally should be dropped from the case pointing to his “extensive involvement” in RS’s operations and his profit-taking from the company.

The Relator’s FCA Suit.

The relator McKenzie Stepe, a former RS sales representative, originally filed her complaint in December 2013. She accused RS and Gobea of charging Tricare, Medicare and Medicaid excessively high rates for certain compounded drugs. Those drugs, all mixtures containing the anesthetic ketamine, were charged to the government at prices of between $400 and $3,000 per bottle when the equivalent rate for an uninsured cash payer was between $15 and $45 a bottle.

The relator’s complaint was dismissed in November 2017, based on what Judge Covington said was a lack of firsthand knowledge to support her claims, but with leave to file an amended complaint by December 7, 2017.

To read the court’s order in full, click here.

To learn about a similar case involving a Florida compounding pharmacy, click here to read one of my prior blogs.

 

Contact Health Law Attorneys Experienced in Representing Pharmacies and Pharmacists.

The Health Law Firm represents pharmacists and pharmacies in DEA, DOH and FDA investigations, qui tam and whistleblower cases, regulatory matters, licensing issues, litigation, administrative hearings, inspections and audits. The firm’s attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Wilson, Daniel. “Fla. Compounding Pharmacy Can’t Escape Tricare FCA Suit.” Law360. (December 4, 2017). Web.

Raymond, Nate. “Florida compounding pharmacy must face U.S. fraud suit – judge.” Reuters. (December 4, 2017). Web.

KeyWords: False Claims Act defense attorney, FCA legal counsel, TRICARE false claims legal defense attorney, TRICARE physician representation, legal representation violating False Claims Act, pharmaceutical fraud lawyer, compounding pharmacy attorney, fraudulent practices of pharmaceutical companies, whistle blower lawyer, FCA violations, fraud detection, financial interest in physician referrals, TRICARE fraud attorney, health attorney, defense attorney, The Health Law Firm, health law firm, fraud investigations, consumer reports of health care fraud, conflict of interest in physician referrals, compound medication prescriptions, compounding pharmacy lawyer, prescription reimbursement, legal defense of military physicians, legal defense of TRICARE providers, attorney reviews of The Health Law Firm, Veterans Administration (VA) physician defense attorney, The Health Law Firm attorney reviews, legal representation for pharmacies, legal representation for pharmacists, health law defense attorney, legal representation for health care professionals

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

Florida Senate Health Committee Approves Change In Optometrist Certification

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 5, 2017, the Florida Senate Health Policy Committee approved a bill that would allow the Florida Board of Optometry to offer practical and written “certification” examinations to applicants. The bill would assist optometrists who were licensed before July 1993 and, therefore, were not required to be “certified.”

Certified vs. Licensed.

In Florida, the law allows certified optometrists to prescribe pharmaceuticals for the treatment of glaucoma. However, licensed optometrists who aren’t certified cannot prescribe those drugs. They are required to make the public aware by posting in their offices a sign that states, “I am a Licensed Practitioner, not a Certified Optometrist, and I am not able to prescribe ocular pharmaceutical agents.”

Applicants are required to submit proof to the Department of Health (DOH) that she or he meets certain requirements and pass an exam within a specified time frame if they wish to be certified.

The Senate Health Policy Committee unanimously approved the bill (SB 520). To read more on SB 520, click here.
To stay on top of news and regulations for optometrists, check our Vision Law Blog regularly.

 

Contact Health Law Attorneys Experienced in Representing Optometrists.

The attorneys of The Health Law Firm provide legal representation to optometrists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, contract matters, business law matters, business litigation and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Miller, Daylina. “Panel Approves Change In Optometrist Certification.” Health News Florida. (December 6, 2017). Web.

“Panel Approves Change In Optometrist Certification.” WLRN TV. (December 6, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Legal representation for optometrists, optometrist defense attorney, ophthalmologist defense attorney, legal representation for eye doctors, medical license defense attorney, optometry license defense attorney, legal representation for optometry licensure issues, Board of Optometry investigation defense attorney, legal counsel for Board of Optometry investigations and hearings, Board of Medicine investigation defense attorney, legal counsel for Board of Medicine investigations and hearings, Department of Health investigation defense attorney, legal counsel for Department of Health investigations and hearings health care professional defense attorney, legal representation for medical professionals, Florida health law attorney, informal administrative hearing defense attorney, informal administrative hearing defense lawyer, informal administrative hearing defense legal counsel, complaint against professional license defense attorney, complaint against professional license defense lawyer, legal representation for Optometrists in Florida, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews, health law defense attorney, legal representation for health care professionals, complex health litigation defense attorney, complex health care litigation legal counsel

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

Kmart Agrees to Pay $32.3 million to Settle Whistle Blower’s False Claims Act Suit

PS 3 Indest-2009-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 22, 2017, Kmart Corporation agreed to pay $32.3 million to settle a whistle blower lawsuit alleging its pharmacies caused federal health programs to overpay for prescription drugs by not telling the government about discounted prices. The department store chain withheld certain information from Medicare Part D, Medicaid and Tricare, the Department of Justice (DOJ) said.

The Whistle Blower False Claims Act (FCA) Suit.

The new agreement resolves allegations arising from a 2008 lawsuit brought under the qui tam, or whistle blower, provisions of the False Claims Act (FCA). This provision permits private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.

The 2008 lawsuit, which was filed by a former Kmart pharmacist, alleged that Kmart pharmacies offered discounted generic drug prices to cash paying customers through various club programs. The pharmacies then knowingly failed to disclose those prices when reporting to federal health programs. According to the suit, in one case, Kmart had sold a 30-day supply of a generic version of a prescription drug for $5 to customers of its discount program, but then filed for reimbursement from the government for $152 for that same drug for its Medicare customers.
To read more on the 2008 suit, click here.

The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. The former pharmacist will receive a whistle blower award of $9.3 million. The case was heard in the U.S. District Court in the Southern District of Illinois.

To read the DOJ’s press release on this case in full, click here.

To read about a similar case of a pharmacy inflating prices to government health care programs, click here to read one of my prior blogs.

Who Knew Medicare Part D Claims Could Yield Such Big Whistle Blower Settlements?

Who knew Medicare part D claims could yield such big whistle blower settlements? I know I didn’t. I didn’t even think about such claims until I read this case. This could mean some serious compliance issues for big chain stores that have pharmacies (note that I said “could”). Walmart, Publix, Albertsons, Costco, Sam’s Club, Winn Dixie, Engel’s, and every other chain that owns and operates pharmacies, may be in jeopardy.

Contact an Experienced Health Law Attorney to Assist in Whistleblower/Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid, TRICARE/CHAMPUS or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim (the whistle blower). We have also defended health professionals and institutions in litigation of whistle blower complaints filed against them.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at
www.TheHealthLawFirm.com.

Sources:

McCausland, Phil. “Kmart to pay $32.3M to settle health care-related whistleblower case.” NBC News. (December 22, 2017). Web.

The Associated Press. “Kmart to pay $32.3 million to settle prescription drugs case.” ABC News. (December 22, 2017). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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