How to Respond to Medical Board Complaints

complaints

When a complaint is filed with the Florida Medical Board, the Board responds by sending a letter to the physician in question.

This first step starts a time clock that ensures the complaint is handled expeditiously, so it is important for physicians to respond in a timely manner. However, it is recommended that they do not respond until they have the advice of a legal team that understands the ins and outs of the medical, dental, and pharmaceutical industries.

If you have been sent a letter indicating that a complaint has been filed against you with the Florida Medical Board, reach out to Florida Healthcare Law Firm today.

What Do I Do if I Receive a Complaint Through the Florida State Medical Board?

First things first, relax. Receiving a complaint does not automatically mean that heavy fines, a business shutdown, or suspension of your license is pending. It is important to take it seriously but not to allow panic to get the better of you.

Getting legal support should be your first move since it means you will have advice that is specific to your circumstances. You’ll also get assistance meeting all the deadlines. The timeline can be 20 to 45 days depending on the license you hold.

Tips for Responding to a Medical Board Complaint

  • Do not ignore it. There are time clocks that are triggered when a complaint is filed. It is important that you respond before that time clock runs out, or it could mean automatic fines, license suspicion, and/or legal proceedings.
  • Do not respond without legal advice. This may seem counterintuitive since the letter will likely request some action on your part, but it is important that you not make a move without the advice of an attorney.
  • Contact Florida Healthcare Law Firm. Florida Healthcare Law Firm is a boutique law firm that serves medical, dental, and pharmaceutical companies that work directly with patients.

What Are My Options When a Florida Medical Board Complaint Is Filed Against Me?

Your legal team will be able to direct you on which of the following options is best suited to the complaint you are facing. In general, you will usually have 21 days to choose from the following:

  • An informal hearing
  • A formal hearing
  • To waive your rights
  • A settlement agreement

In almost no case is it appropriate to waive your rights entirely. Otherwise, you can choose from the following:

  • Agree that there is truth to the allegations made against you in an informal hearing and ask for leniency.
  • Ask for a trial so you can submit evidence to challenge the allegations made against you in a formal hearing.
  • Accept or negotiate any settlement that may have been offered by the Florida Department of Health.

Florida Medical Board Complaint Response Support

If you have received a letter saying you need to respond to a complaint from the medical board, reach out to us at Florida Healthcare Law Firm for assistance right away.

OIG Revises Self-Disclosure Protocol

On November 8, 2021, The Department of Health & Human Services (HHS), Office of Inspector General (OIG) released a revised and renamed Provider Self-Disclosure Protocol (SDP), now known as the “Health Care Fraud Self Disclosure “protocol. The SDP was created in 1998, and the protocol can be used to voluntarily identify, disclose and resolve instances of potential fraud involving federal healthcare programs. As described on the OIG website, “Self-disclosures give persons the opportunity to avoid the costs and disruptions associated with a Government-directed investigation and civil or administrative litigation.”Continue reading

The Five Levels of The Medicare Appeal Process

medicare appeals pricess

medicare appeals pricessBy: Zach Simpson

There might be times when Medicare denies coverage for an item, service, or test that you or your company provided. In the event this occurs you have the right to formally disagree wit the decision and encourage Medicare to change it. Therefore, understanding the appeals process for Medicare claims is vital for all providers. The aim of this article is to give providers a better understanding of the five (5) levels of the Medicare Appeal process, and what must occur at each level.

The Medicare Fee-For-Service (FFS) has five levels in the claims appeal process:

Level 1 – Redetermination by a Medicare Administrative Contractor (MAC)

Level 2 – Reconsideration by a Qualified Independent Contractor (QIC)

Level 3 – Disposition by Office of Medicare Hearings and Appeals (OMHA)

Level 4 – Review by the Medicare Appeals Council (Council)

Level 5 – Judicial review in U.S. District CourtContinue reading

Permissible Payments For Referrals Under The Federal Anti Kickback Statute

anti kickback

anti kickbackBy: Karen Davila

The term “payment for referral” strikes fear in the hearts of health care providers throughout the country because of the significant prohibitions under the federal Anti-Kickback Statute (AKS).  And, Florida’s Patient Brokering Act (PBA) casts an even bigger shadow over arrangements involving payment in exchange for referrals.  There are other statutory restrictions as well, which may apply depending upon the services for which a referral is being made.  Those include but are not limited to statutes prohibiting physician fee-splitting and the federal Eliminating Kickbacks in Recovery Act (EKRA) (applicable to referrals to recovery homes, clinical treatment facilities, or laboratories in an effort to stave off growing opioid-related fraud), and the potential collateral damage of a false claim under the federal False Claims Act (FCA) if any of the above statutes are violated.

So, is there any scenario where a payment may be made by a health care provider in exchange for referrals?  The answer is yes- there is a safe harbor under the AKS (42 U.S. C. §1320a-7b(b)) specifically for such arrangements.  This safe harbor is not commonly used and likely means revision to existing arrangements to come into compliance with its specific requirements.  But it may be worth considering if the referral (and payment for that referral) is not otherwise prohibited as noted above.Continue reading

Is Your Office Utilizing An Outdated Advanced Beneficiary Notice of Non-Coverage Form?

medicare abn

medicare abnBy: Zach Simpson

Does your office treat Medicare or Medicaid beneficiaries? If so, this article is vital to you and your staff. The first question that I want all of you to ask yourself is if your practice treats Medicare or Medicaid beneficiaries do you know what an ABN is, and why they are vital for your practice? The acronym ABN stands for Advance Beneficiary Notice of Non-coverage. ABNs safeguard your practice’s right to collect on non-covered services (other than statutorily excluded services) from patients who have Medicare or Medicaid. Multiple organizations I have worked with throughout my career had never been informed about ABNs or had never been properly educated on how utilize them. This article is intended to provide you and your practice with the most recent information regarding the renewed ABN form that became mandatory for use on January 1, 2021.

As of January 1, 2021, a new Fee-for-Service Advanced Beneficiary Notification of Non-coverage became effective until it expires on June 30, 2023. In the event that your practice has been utilizing the same ABN forms for years then listen up.Continue reading

A Quick Refresher On Medicare’s Requirements For Self-Reporting & Returning Overpayments

bribe

By: Zach Simpson

With the current healthcare environment many providers looked to alternative methods of treating patients and achieving outcomes this past year due to the pandemic. To meet the needs of their patients, and their financial obligations many providers implemented services that were not customary to their practice, or their billing departments. As is the case for any office that begins to provide something new there is always the potential for error in any aspect of the practice involved with the patient or claim. Therefore, I believe it is a great time to refresh providers on the procedures for reporting and returning Medicare overpayments as they are discovered moving forward.

As many of you are aware in 2016 the Centers for Medicare and Medicaid Services (CMS) published a final rue pursuant to Section 1128J(d) of the Social Security Act (the Act), as amended by the Affordable Care Act, that requires Medicare Parts A and B health care providers to report and return overpayments 60 days after the date an overpayment is identified, or the due date of any corresponding cost report, if applicable, whichever is later. If credible information indicates that an overpayment exists, the rule requires that a reasonably diligent inquiry must be performed.

Continue reading

5 Easy Steps To Implement An ABN Into Your Practice’s Standard Procedures

adding abn to your medical practice

adding abn to your medical practiceBy: Zach Simpson

Due to the increasing number of forms being required these days it is all too common for practices to get lost in the vast terminology, rules, and coding requirements that have to be followed as well. An area that practices have one of the most difficult times with is operationalizing the issuance of an ABN properly. I am frequently asked to consult for practices that ask who does which part, when, and with whom in regards to ABNs? In other instances, many practices I have worked with simply make the mistake that they can solve the complexities of trying to understand the nuances of how to properly utilize ABNs by deciding to issue ABNs to every Medicare patient for every service which is not a viable option either. The solution that many offices try that I just described is called issuing blanket ABNs, which in turn may cause Medicare to invalidate all issued ABNs from the practice, including those that may been appropriate which is why it is very important that blanket ABNs are never issued.

One thing in common with practices that issue ABNs in a proper manner is that they all have a process in place for identifying potential denied services prior to delivering them. To many practices this may sound easy, but to ensure that your practice is as effective as possible it will take some claims data analysis to ensure that your practice is capturing all potential opportunities for ABN issuance. The aim of this article will be to provide practices with 5 steps that will make ABN issuance easier.Continue reading

Health Care Fraud Enforcement Got You Worried?

healthcare fraud in 2020

healthcare fraud in 2020By: Karen Davila

Healthcare fraud continues to be a significant priority for the U.S. Department of Justice.  On February 24, 2021, the DOJ’s Criminal Division Fraud Section published its annual “Fraud Section Year in Review 2020.”  While the Fraud Section has three separate enforcement units, the Health Care Fraud (HCF) Unit is responsible for all enforcement activities in the health care industry.  The Unit’s focus is to protect against fraud and abuse in federal health care programs and recoup illicit gains.

During 2020, the HCF Unit operated 15 strike forces in 24 federal judicial districts throughout the U.S.  The efforts of these strike forces led to charges against 167 individuals alleging $3.77 billion in fraudulent charges for health care paid for by federal and state programs.  This should cause any health care provider to stand up and take notice.  And enforcement in the health care industry is not likely to go away soon with so many schemes ripe for the government’s picking and generating recoupment on behalf of the federal health care programs.

Here are couple of the latest schemes that have landed pharmacies, pharmacists and other health care professionals squarely in the crosshairs of federal enforcement:

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A DME Fraud of Epic Proportions

dme telemedicine fraud

dme telemedicine fraudBy: Michael Silverman

Almost two years after “Operation Brace Yourself” regarding purported telemedicine and orthotic bracing fraud made national headlines, on February 4, 2021 the Department of Justice Announced that a major player in that fraud – Florida businesswoman Kelly Wolfe – recently pled guilty to criminal health care and tax fraud charges.

Operation Brace Yourself was a 2019 crackdown on the illegal use of telemarketing and telemedicine to generate fraudulent claims for DME orders, whose reach spanned continents and ultimate implications defrauded taxpayers out of billions of dollars.

According to the Department of Justice Press Release and Settlement Agreement, Mr. Wolfe was seemingly a significant mastermind in establishing hundreds of DME companies that went on to defraud US taxpayers and Medicare beneficiaries.

Here are some highlights of the recently signed Settlement Agreement between the United States DOJ, Kelly Wolfe and her company Regency, Inc.Continue reading

What Does a Medical Attorney Do?

Healthcare Practice Attorney

Healthcare Practice AttorneyA medical attorney can defend you in court. Learn how these professionals can also help you to examine and amend your business so you avoid lawsuits altogether.

Watch a movie about a medical attorney, and you’re destined to see plenty of courtroom scenes. While it’s true that defending a client in court is a big part of a medical attorney’s job, attorneys do much more for their clients. And often, their work keeps clients out of the courtroom altogether.

3 Ways a Healthcare Practice Attorney Can Help

Medical attorneys working in a private practice like ours tackle all sorts of disparate tasks. They’re all rooted in the law, of course. But the connection may not be clear at first glance.

A healthcare practice attorney with our firm might help you to:

  • Avoid risk. Every employee within a healthcare organization deals with matters of life and death. Tiny mistakes can lead to big lawsuits. We help to ensure our clients are complying with local, state, and federal laws. We can even assist with training programs to educate staff about their responsibilities.
  • Handle paperwork. You can’t put up a sign and start helping clients. You must hold the proper accreditation. Your facilities and staff must be certified. And you need the right licenses too. Our medical attorneys can handle these tasks for you.
  • Draw up contracts. Hiring employees means negotiating benefits, drawing up non-compete clauses, ensuring that ethical clauses are met, and more. These are extremely time-consuming tasks, but they are critical. A healthcare practice attorney can help.

Our staff can handle many other tasks that we’re not including here. We pride ourselves on creating the right mix of help for each client.

How to Choose the Right Law Firm

Plenty of companies hope to entice you to sign with them. Learning how to separate a good medical attorney from an inexperienced one isn’t easy.

Experts say a good lawyer will do these things at the start of a contract:

  1. Explain your options.
  2. Discuss the strategy.
  3. Offer a timeline.
  4. Answer questions.

We would argue that a medical attorney should do more. The right firm will demonstrate expertise, offer references, and provide proof of value. We’re ready to do all of those things for you.

Contact us to learn why we’re considered the primary healthcare law firm in Florida.