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Can Florida Dental Board Execute Disciplinary Actions?

by admin on January 24, 2022 No comments

Gross negligence, incompetence, unprofessional conduct, and repeated incidences of any or all of these may give the Florida Board of Dentistry cause to levy disciplinary action against a dentist, dental hygienist, or dental provider in the state of Florida.

Fraud, licensure issues, and other problems may also be the source of a disciplinary action brought by the Florida Board of Dentistry.

What Does the Florida State Dental Board Do?

The Florida Board of Dentistry helps dentists, dental hygienists, and dental labs to secure licensing in the state of Florida as well as supply them with the information they need to remain in compliance year after year.

For dental professionals, there is an online resource available to assist with the process, making it easy to stay current with regulatory changes, renew licensing, and keep up with other dental information as needed.

Dental board of Florida license verification is an especially important duty, providing all dental professionals across the state with easy access to the tools they need to make sure they are always up-to-date.

Dental Board of Florida Complaints and Disciplinary Actions

Florida dental board disciplinary actions may be the result of an investigation into a complaint made by a patient or other entity claiming negligence, fraud, or civil rights violation.

When complaints are filed with the Dental Board of Florida, an investigation usually follows. If the board finds that the complaints are valid, a citation or other disciplinary action may ensue.

However, the filing of a complaint or an investigation by the Florida Board of Dentistry does not guarantee that disciplinary action will result.

Whether the complaint is filed against you as a dental professional or against your clinic or agency, you may have recourse to respond and rectify the situation without disciplinary action. If that is available to you, you should take it.

Recourse Against Florida Board of Dentistry Disciplinary Action

Depending on the nature of the complaint, there will almost always be a path to respond within a certain timeframe. Your response could clarify the situation enough that the investigation is closed right there. In some cases, however, more clarification may be requested or the investigation may be elevated.

Knowing how and when to respond to disciplinary action and complaints can be the key to simplifying the process, saving you time and money.

Get Help With the Florida Board of Dentistry

If you believe that you have been the victim of a fraudulent complaint or if you are unsure how to protect yourself or your dental business going forward, contact Florida Healthcare Law Firm today to set up a consultation.

We can assist you with navigating the legal paperwork, manage meditation and court appearances, and help you to upgrade your processes in the workplace so you can get back to doing what you do best.

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What Is AHCA in Florida?

by admin on January 20, 2022 No comments

The Agency for Health Care Administration (AHCA) in Florida was created by Chapter 20 of the Florida Statutes and serves as the primary health policy and planning institution for all of Florida.

Florida’s Medicaid program is worth $25.2 billion. The more than 4 million Floridians served by that program and the licensure of the almost 50,000 health care facilities in Florida all fall under the jurisdiction of the AHCA in Florida.

What Does the AHCA Do in Florida?

Essentially, the AHCA regulates and coordinates the Medicaid system and the healthcare providers that offer medical services through that program to Floridians, so there is sharing of healthcare data and resources across the state through the Florida Center for Health Information and Policy Analysis.

As much as the AHCA is a regulatory agency in Florida, they have ongoing goals to get more Floridians the health insurance they need, identify and eliminate fraudulent providers that are raising costs for everyone, and cut back on regulations that aren’t valuable or productive.

What Are Florida AHCA Regulations?

It may be easier to list what Florida AHCA does NOT regulate rather than all it does, but here are just a few of the primary things that ACHA regulates:

  • Fraud and abuse of billing and services
  • Licensure of healthcare professionals, healthcare clinics and other facilities, including hospitals and long-term care programs
  • Quality of care and civil rights complaints in all healthcare facilities
  • Compilations of healthcare data
  • Background screenings for those who work as administrators or employees in nursing homes
  • Health plan enrollment, rates, contracts, and related information

What Do I Need to Be in Compliance With ACHA in Florida?

Every healthcare provider and facility will have a different list of regulations, licensure, and other compliance tools to address with the ACHA. Contact us at the Florida Healthcare Law Firm to set up an appointment. We can help you discover what you and your business need to remain compliant.

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Healthcare Fraud Scheme Indictment Starts the New Year

by admin on January 14, 2022 No comments

The U.S. Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims.  Some of the facts alleged include—

  • Bribed 911 operators and hospital employees for confidential information of insured drivers
  • Unnecessary and painful medical procedures
  • A non-physician owning medical clinics
  • Paying hundreds of thousand of dollars to “runners” who used the money to bribe people

Healthcare businesses that largely serve people injured in motor vehicle accidents remain a top tier focus for law enforcement and special investigative units (SIUs) of insurers.  But so do many other providers in the healthcare sector, such as pharmacies, durable medical equipment (DME) providers, addiction treatment providers and labs.  Payer and governmental presumption is often that financial motives are driving clinical behavior, NOT documented medical necessity.  Hence the need for active compliance plans and policies and procedures that don’t sit on a shelf, but rather are woven into daily business and clinical operations.  Nothing less than the right contracts, the right compliance plan and the right business culture will establish and maintain a sustainable healthcare business!

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What Is the Anti-Kickback Statute?

by admin on January 10, 2022 No comments

Gifts from another healthcare business or professional may seem harmless enough. They may actually be nothing more than a gesture that says, “Thank you for your time,” or “Thank you for recommending me.”

But the federal government may not agree that these gifts are harmless if you are in the healthcare industry and the gift is a thank you for a referral for a patient who paid for care or services with Medicare or Medicaid.

Anti-fraud laws come with stiff penalties. Getting to know them can help you to protect yourself and your business from inadvertently triggering investigations, fines, and/or prison time.

What Is the Anti-Kickback Statute?

The Anti-Kickback Statute, or AKS, is a criminal statute designed to stop medical professionals from encouraging Medicaid or Medicare patients to enroll in medical treatment or take drugs that may not be medically necessary in return for a “kickback” or remuneration of any kind, be it in cash, supplies, or services.

In some industries, receiving an affiliate fee or otherwise getting paid for referrals is standard practice and perfectly above board, but when it comes to the federal health care program, any payment for referrals is a criminal act.

Is the Anti-Kickback Statute Impacting Your Business?

If you, your business, or a colleague within your clinic is being investigated for potentially violating the Anti-Kickback Statute, contact Florida Healthcare Law Firm.

We can assist you in navigating the investigation process and help with any legal issues that arise as a result, including meetings with mediators and court dates. We can also help you adjust your best practices for handling referrals for your Medicare and Medicaid patients, so there is no future risk to your business or your career due to the Anti-Kickback Statute.

Call Florida Healthcare Law Firm now to set up your consultation.

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What Are 3 Major Things Addressed in the HIPAA Law?

by admin on January 4, 2022 No comments

HIPAA law protects patients and their personal health information to keep doctor-patient confidentiality safe. It also serves to ensure that healthcare clinics and businesses do not share sensitive information without a patient’s consent.

What Is HIPAA Law?

HIPAA law is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996, a federal law that required the construction of nationally standardized regulations in regard to the handling and protection of sensitive patient health data.

In response, the U.S. Department of Health and Human Services (HHS) created the HIPAA Privacy Rule and the HIPAA Security Rule, which protects some of the private information identified in the HIPAA Privacy Rule.

What Are 3 Major Things Addressed in the HIPAA Law?

Though HIPAA regulations are complex and detailed, these are the three main areas that are addressed:

  • Administrative standards: This portion of the requirements identifies people who will oversee HIPAA standards, create backups and implement emergency plans, address breaches when they occur, and handle the annual assessment of data care.
  • Physical security: This aspect of HIPAA is directed at the computers and security for offices and databases that contain the sensitive information that requires protection.
  • Technical security: HIPAA also requires encryption of sensitive data in order to protect healthcare networks from hackers. It also requires that employees at healthcare businesses update passwords and make them as unique as possible frequently.

What Does HIPAA Law Mean for Employers and Healthcare Businesses?

Healthcare businesses are most frequently found to be violating HIPAA laws when there is a data breach followed by an investigation, an investigation into complaints by employees or patients, or a HIPAA compliance audit is conducted.

If your business is facing a compliance audit or investigation due to HIPAA, reach out to Florida Healthcare Law Firm today. We can help you navigate the problem, update your processes, and get compliant.

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Statute of Limitations for Medical Malpractice In Florida

by admin on December 20, 2021 No comments

Medical malpractice is devastating for both patient and the medical professional. There are some statutes in place in Florida that limit how long it is legally an option for a patient to pursue a medical malpractice case.

Timing is important in these situations, as is proof of negligence or error on the part of the medical professional.

Here’s what you need to know.

What Is the Malpractice Statute of Limitations in Florida?

The statute of limitations for a medical malpractice suit is two years from the date that the harm caused by malpractice was discovered or could reasonably be discovered, according to Florida Statute 95.11 (4)(b).

However, there are a few exceptions to this rule. Oftentimes, an injury caused by medical malpractice may not immediately come to light.

If the case involves an adult and was immediately obvious, there is a two-year statute of limitations.

In the event that the patient is an adult, and the injury was not immediately obvious, and also involved fraud or an attempt to conceal the problem by medical staff, the statute is extended two years from the time it is identified but no more than seven years from the incident that caused the harm.

If it is an adult as the patient, the injury was not immediately discoverable, and there was no attempt to conceal the issue by medical professionals, the statute is four years from discovery.

If the patient is a minor, every case is different. There are no hard guidelines in terms of statutes of limitations in Florida.

What Defines Medical Malpractice in Florida?

Not every case in which the outcome is negative will have legal basis for a malpractice suit. If the doctor followed industry standards and made no mistakes when performing a medical service and the outcome is negative, there is no case for malpractice.

Additionally, if a mistake is made during a medical procedure but there is no clear and lasting damage to the patient’s health and well-being as a result, there is no case for malpractice.

In order to be classified as medical malpractice in the state of Florida, there must be a clear professional patient-doctor relationship between the two people, the doctor must fail to do their duty through negligence or error, and there must be demonstrable harm or injury to the patient that is serious in nature.

I Need Assistance With a Medical Malpractice Suit

Florida Healthcare Law Firm is the only boutique law firm in Florida dedicated to helping medical professionals handle any and all legal issues, including the nuances of a medical malpractice suit.

Contact us today to set up a consultation and get the help you need.

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What Is the Florida Board of Nursing?

by admin on December 17, 2021 No comments

The Florida Board of Nursing plays a number of roles in the state of Florida, but all of them have one goal in common: to protect patients from receiving substandard medical care.

For nurses, this can be a positive support system, but it can also mean a lot of unexpected hurdles, paperwork, and stress.

At Florida Healthcare Law Firm, we can help you navigate the system, address issues that may threaten your employment status, and allow you to spend more time focusing on doing your job rather than managing licensure updates or disciplinary requirements.

Here’s what you need to know.

What Does the Florida Board of Nursing Do?

The Florida Board of Nursing does a few things when it comes to ensuring that working nurses are fully qualified to do their jobs. They:

  • Manage the details of licensing and require all Florida nurses to update and maintain their licenses as needed.
  • Monitor nurses who are currently employed in Florida and address any issues that may arise with employers or patients.
  • Discipline nurses as needed if there are measures needed to address wrong action on the job.
  • Educate nurses on what is expected of them on the job and in terms of managing their documentation, ongoing education, and licensure.
  • Rehabilitate nurses who need help getting back to work after disciplinary action.

What Do I Do If I Need a Florida Board of Nursing Re-Examination Application?

If the board of nursing in Florida has determined that you have fallen below the minimum competency level, you may need to apply again for proper licensure, so you can legally be employed as a nurse in the state of Florida.

If you are having difficulties in maintaining licensure and you need help working with the Florida Board of Nursing, we can help.

At the Florida Healthcare Law Firm, we can assist you in determining what documentation and actions are necessary on your part as you work to gain or regain nursing licensure in the state of Florida. We can also assist you in appealing any denials you face.

Contact us today to set up your first consultation.

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DME Industry 2021 Year End Review & Looking Into 2022

by admin on December 10, 2021 No comments

Many DME providers have had tremendous hurdles to overcome this year, from the implementation of a new round of Medicare’s Competitive Bidding Program through continued impacts of COVID-19. Mergers and acquisitions are through the roof as a result, as are continued compliance concerns that plague the industry.

Let’s dive into some of the major DME related matters & issues that have come across my desk this year, and what to be on the lookout for in the next.

Competitive Bidding Impacts

After much uncertainty about what DME products would actually be included upon its implementation, Round 2021 of Medicare’s Competitive Bidding Program (“CBP”) kicked off at the beginning of this year.

With off-the-shelf knee and lumbar braces (HCPCS Code OR03) included in Round 2021 of the CBP – and thus ability to supply such devices to beneficiaries in competitive bid areas restricted to bid-winners – non bid-winning DME providers have been scrambling to find new revenue streams to fill the void. Unfortunately, many are doing so in a non-compliant manner.

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No Surprise Billing Requirements to be Implemented Jan 1, 2022

by admin on December 9, 2021 No comments

On January 1, 2022, a new federal law, “Requirements Related to Surprise Billing, Part I” (“The Rule”),  goes into effect for health care providers and facilities and for providers of air ambulance services.  The Rule will restrict excessive out-of-pocket costs to consumers which resulting from surprise billing and balance billing.

Group health plans and health insurers contract with a network of provider and health care facilities, these providers are considered as in-network providers.  They agree to accept a specific payment for their services.  Providers and facilities that are not contracted with a health plan or insurer are known as out-of-network providers (OON). They usually charge higher amounts than in-network providers.  When OON providers do not receive full payment for their charge from the insurance payor, they charged the patient for the difference between the charge and the amount paid, a practice known as balance billing.

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Telemedicine Pharmacy Fraud Trial Ends in Convictions

by admin on December 7, 2021 No comments

Telemedicine pharmacy arrangements continue to be of significant interest to fraud enforcement.  A 2018 case in which four individuals and seven companies were indicted ended in a month-long jury trial of one of the individuals, a Florida pharmacy owner.  The federal jury trial in the billion-dollar telehealth pharmacy fraud scheme resulted in conviction on 22 counts of mail fraud, conspiracy to commit health care fraud and introduction of misbranded drugs into interstate commerce.  Sentencing in the case is set for May of 2022.  Other co-conspirators entered plea agreements along the way, pleading guilty to various charges including felony conspiracy to commit health care fraud, felony misbranding, conspiracy to commit wire fraud, and fraudulent telemarketing of dietary supplements, skin creams and testosterone.  Many of these are still awaiting sentencing, also expected to be scheduled sometime in 2022.

THE SCHEME

The scheme involved several individuals, compounding pharmacies and telemarketers engaged in a conspiracy to commit health care fraud, mail fraud and introducing misbranded drugs into interstate commerce.  Peter Bolos, along with two other co-conspirators, owned and operated Synergy Pharmacy in Palm Harbor, Florida.  Working with HealthRight, a telemarketer, the co-conspirators generated prescriptions for drugs such as pain creams, scar creams, and vitamins.  Using the HealthRight telemarketing platform, they would call consumers and deceive them into providing their personal insurance information and accept the drugs. HealthRight then communicated the prescription requests to physicians who authorized the prescriptions without ever interacting with the patients, and paid those physicians for issuance of the prescriptions. Through this scheme, the co-conspirators were able to solicitate insurance coverage information from consumers across the county for prescription pain creams, fraudulently obtain prescriptions, mark up the prices of the drugs and bill private insurance carriers.

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