Source: https://www.thehealthlawfirmblogs.com/category/the-health-law-firm-blog/in-the-know/health-care-industry/
Timestamp: 2019-04-21 00:14:32+00:00

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The health care industry includes health care providers (hospitals, nursing homes, pain management clinics, doctor’s offices, surgical centers, rehab facilities, etc.) and health care professionals (physicians, nurses, dentists, pharmacists, therapists, psychologists, psychiatrists, mental health counselors, medical students, medical interns, hospital administrators, etc.). These health care providers and health care professionals are often the subject of legal issues.
In the recent case of Mendelsohn v. State of Florida Department of Health, Mendelsohn’s license to practice medicine was suspended under an Emergency Suspension Order (ESO).
(b) A misdemeanor or felony under 18 U.S.C. s. 669, ss. 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s. 1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the Medicaid program.
Mendelsohn argued that his federal conspiracy conviction was not related to the Medicaid program, so the Florida Department of Health could not issue an ESO without establishing that his actions posed an immediate danger to public safety.
Florida law requires that an order directing the immediate suspension of a practitioner’s license contain “every element necessary to its validity . . . on the face of the order.” In general, an ESO will not be upheld unless the order on its face sets out the specific facts and reasons for finding an immediate danger to the public health, safety, or welfare, as well as the Florida Department of Health’s reasons for concluding that the procedure used is fair under the circumstances.
However, Section 456.074(1), Florida Statues, however, requires DOH issue an emergency order suspending a medical license in certain circumstances without regard to specific proof that a petitioner is acting in a way that poses an immediate danger to public safety.
Although Mendelsohn was convicted of a felony in violation of § 18 U.S.C. 371, he contended his conviction was not related to the Medicaid program, and thus, did not support the issuance of an ESO without further proof that he posed a threat to public safety.
Do not let the Florida Department of Health take away your license unless it is warranted. Contact a board certified health law attorney who is knowledgeable in handling these matters. For more information about Emergency Suspension Orders and other legal matters concerning healthcare providers visit www.TheHealthLawFirm.com.
With the increase in popularity of online review sites, defamatory attacks against doctors have also increased. On these sites, patients and competitors can post almost anything they want – good or bad – about a doctor or any health care professional. As more physicians become employees of hospital systems or large health care institutions, adverse surveys, reports or reviews may impact advancement, bonuses and basic income.
Internet ratings on review sites like Vitals.com and Yelp.com can range from jabs about the patient’s waiting time in the doctor’s office to ruthless attacks that can seriously impact a physician’s career, including economical impact. In many cases, the review, comment, or rating may be a purposely untrue statement by a disgruntled patient, competitor or former employee. When the comment is posted, search engines like Google, Yahoo, Bing, AOL, or MSN may bring up the false statement every time someone searches for that doctor’s name. This can cost doctors both their reputation and their business, especially if they start losing patients because of bad reviews.
Many doctors are now seeking legal strategies to combat alleged online libel and defamation in order to save their reputation and their practice. However, not all negative online comments or ratings meet the actual definition of “defamation.” Defamation generally is a factual statement that can be proven true or false. For example, if a patient writes that she had a procedure performed by a doctor, this is a statement of fact that can be confirmed or disproved. However, if someone writes about a doctor’s poor attitude during a visit, this statement is usually considered to be an opinion which cannot necessarily be proven true or false.
Your own records should be checked. Your notes about office visits or procedures, your appointment schedule or your own billing records may help you identify the patient who wrote the review or comment. If you think you may know who wrote a comment, try to contact the patient directly to discuss his or her concerns and request that the comment be removed. Sometimes you will find that you never treated this patient or that the patient has the wrong physician.
Before making any decisions about the contents of a comment, consult with an experienced attorney for guidance. An experienced attorney will be able to determine whether the internet posting is considered an opinion or defamation.
4. Send a letter to the website, host, owner and internet service provider.
Once the poster has been identified, doctors can contact the patient directly to ask that the post be removed. If the patient refuses, a doctor should request that his or her attorney send a letter warning the poster of potential legal action if the post is not removed from the website. If that doesn’t work, the physician should have his or her attorney send a letter demanding the comments be removed to the website, website host, owner and internet service provider.
For more information, please visit our website at www.TheHealthLawFirm.com.
Doctors and hospitals around the country seem to be butting heads. In the past month, an article in The New York Times and a segment on the television “magazine” show 60 Minutes shed light on some questionable practices being enforced by hospitals on physicians working for them.
I previously wrote a blog on this structural shift in the practice of medicine. Click here to read that blog.
The effects of this trend are examined in these two news stories. Doctors and former employees from a number of hospitals around the country were interviewed and all seem to be dealing with the same issues. The biggest concerns addressed were: pressure to order unnecessary tests, admitting patients to fill hospital quotas and drive hospital profits, and the feeling of being controlled by hospital executives and administrators instead of practicing effective medicine.
Doctors Allegedly Pressured to Fill Emergency Room Beds to Increase Profits.
On December 2, 2012, 60 Minutes aired an investigative segment on one of the largest for-profit hospital chains in the country. Former employees and physicians alleged this hospital system thrived by buying urban-area hospitals and turning them into profit centers by filing empty beds from emergency rooms. A former emergency medicine doctor stated that the hospital in which he worked required an admission rate of twenty percent (20%) for patients seen in the ER and fifty percent (50%) for patients who were 65 years old and older (most of whom are Medicare patients) seen in the ER.
A former hospital system employee interviewed by 60 Minutes claimed he was in charge of auditing the hospital chain in question. He stated that he was convinced that doctors were under an extraordinary amount of pressure to fill hospital beds. He stated that he personally audited hospitals in Texas, Florida and Oklahoma, and concluded there were hundreds of thousands of dollars submitted to Medicare and Medicaid for hospital stays that did not meet standards for reimbursement, including medical necessity.
Doctors interviewed for The New York Times article had similar stories. They stated in interviews that hospital administrators created quotas for how many patients should be admitted, because more admissions allegedly meant more money. Doctors who met or exceeded quotas were rewarded with increased compensation, while doctors who did not felt in danger of losing their jobs.
Consequences of Ordering Unnecessary Tests.
The New York Times article looked at a number of lawsuits filed by former employees who allege the hospitals they worked for compensated doctors for ordering more tests than necessary.
The Department of Justice (DOJ) recently settled with a hospital group in Joplin, Missouri. According to the DOJ press release, the hospital system had to pay more than $9.3 million for rewarding doctors partly based on how many tests they ordered. This is in direct violation of the Stark Law and the False Claims Act.
I recently wrote an article for Medical Economics on the legal ramifications of ordering unnecessary tests. To read that article, click here.
If you want to know more on the Stark Law, click here.
Doctors Feel Controlled By Hospital Executives.
Doctors also stated they felt controlled by hospital executives. This was due, in part, to a corporate wide computer software system that was customized to automatically order an extensive battery of tests, some unnecessary, as soon as a patient walked into the hospital. It’s also stated that the software would prompt a physician to reconsider when he or she decided to send an emergency room patient home.
Most doctors interviewed were upset that the program also generated reports that evaluated each doctor’s performance and productivity.
To watch the segment from 60 Minutes, click here.
Hospitals Say They are Embracing the New Model of Health Care.
The hospital system in question by 60 Minutes maintains that these allegations are not correct. The executive vice president said that as a whole admission rates haven’t changed in four years and are near or below industry averages. The hospital systems believe that by consolidating they are embracing the new model of health care and state patient care comes first.
Do you think there are constant battles between doctors and hospitals? As a health professional, have you experienced the pressure to admit patients, order unnecessary tests or refer a patient inside your network? Please leave any thoughtful comments below.
As the Centers for Medicare and Medicaid Services (CMS) prepares to designate the next class of accountable care organizations (ACOs), the agency sought the advice and input of the Medicare Payment Advisory Commission (MedPAC) on how to proceed. MedPAC is an independent Congressional Agency established to advise the U.S. Congress on issues affecting Medicare.
Click here to read our previous blog on the background and purpose of ACOs.
MedPAC Suggests All Medicare Shared Savings Program ACOs Join the Two-Sided Risk Model.
In response to the request from the CMS, MedPAC reiterated its previous position that it would like to see all Medicare ACOs take on greater financial risk. As it presently stands, some Medicare-contracted ACOs do not share in the risks associated with the ACOs patients’ healthcare costs exceeding certain target ranges. Even though those ACOs do not bear any financial risk if the goals are not met, they nevertheless stand to benefit if they are.
MedPAC found that the one-sided risk model being used by most Medicare Shared Savings Program (MSSP) ACOs to be insufficient to reach the goals of the MSSP.
Specifically, MedPAC wants to see all MSSP ACOs in the two-sided risk model. That model requires the ACO to reimburse Medicare for some of the costs which exceeded the target ranges. This pressure is important to note because only 13 of the 32 Pioneer ACOs generated enough savings to Medicare to qualify for MSSP savings payments.
Understand an ACO Agreement Before You Sign.
As we see more and more physicians being approached to join or form ACOs, it is crucial to understand exactly what type of arrangement you are getting into.
Many ACO contracts we see are simply for participation as a provider in the organization. However, some of the contracts we see require that the physician make a financial investment in the ACO or otherwise require that the physician pay a “pro rata” share of any penalty assessed by CMS.
Current ACO participation and recruiting is something akin to the gold rush of the nineteenth century. Everyone is rushing to stake a claim in fear of being left out. Be careful about what kind of an agreement you sign and be sure that you understand the long-term consequences of tying your practice to an as-yet unproven model. To read our previous blog on the first year pioneer ACO results, click here.
If you are approached to join an ACO, or are considering signing a participation agreement/contract with one, make sure to read the contract carefully and consult with an experienced healthcare attorney.
What do you think of MedPAC’s position on ACOs? Have you considered joining an ACO? Why or why not? Please leave any thoughtful comments below.
Despite mailing out hundreds of thousands of postcards and letters to physicians, nurses, dentists, pharmacists, and psychologists throughout Florida, we continue to receive calls from new clients and from potential clients, after they have already spoken to and made critical harmful admissions against their own interests to investigators. In Florida, you do not have any duty to cooperate with any investigator who is investigating you. This extends to Department of Health (DOH) investigators (who are sometimes titled “Medical Quality Assurance Investigators” or “Medical Malpractice Investigators“), Drug Enforcement Administration (DEA) special agents, police officers, sheriff’s deputies, or criminal investigators of any type.
For more information about investigations and other legal matters, visit www.TheHealthLawFirm.com.
Although Meyers v. Columbia/HCA Healthcare Corp.is one of the major cases concerning termination of clinical privileges and peer review hearings, there have been other recent clinical privileges cases that are important for physicians to know when confronted with a peer review action. This is especially true if the physician is being accused of disruptive behavior.
One such case is Isaiah v. WHMS Braddock Hospital Corp., decided in 2008. In this case, Dr. Isaiah’s medical staff privileges were revoked after hospital staff members reportedly expressed concerns about the surgeon’s surgical skills and allegedly compulsive behavior. Dr. Isaiah argued that his behavior did not impact his skills. The court concluded that the hospital’s revocation of Dr. Isaiah’s medical staff privileges was immune from liability under the federal Health Care Quality Improvement Act (HCQIA) because the hospital acted in an attempt to protect quality health care, which relates not only to a physician’s abilities, but also to the doctor’s behavior.
In 2009, Abu-Hatab v. Blount Memorial Hospital was decided, again in favor of the hospital. In this case, Dr. Abu-Hatab sued Blount Memorial Hospital after his medical staff membership and clinical privileges had been terminated due to his allegedly disruptive behavior. Dr. Abu-Hatab argued that allegations of his poor conduct were not true. However, the court decided that it didn’t matter whether the complaints were undisputedly true. Under the Health Care Quality Improvement Act, as long as a hospital and its medical staff act “reasonably” in considering complaints, the professional review actions are protected. According to the court, the hospital’s many meetings concerning Dr. Abu-Hatab’s behavior were enough to show that it acted reasonably.
Another case reported originally in 2009, Leal v. Secretary, U.S. Department of Health and Human Services, involved a urologist, Dr. Leal, who held clinical privileges at Cape Canaveral Hospital in Florida. According to the reported court decison, after being told he would have to wait to use an operating room, Dr. Leal exhibited behavior that led the hospital to suspend his clinical privileges for sixty (60) days. The reported decisions state that Dr. Leal broke a telephone receiver and copy machine, threw jellybeans into a trash can in a medical suite, shoved a metal cart and spoke sternly to a nurse. The hospital filed a report of its action taken against Dr. Leal with the National Practitioner Data Bank (NPDB), which was established under the Health Care Quality Improvement Act (HCQIA) to collect information on the professional conduct and competence of health care practitioners. Dr. Leal felt that he should not have been reported to the NPDB and challenged the action. However, the trial court found that the decision to report Dr. Leal to the NPDB was supported by the HCQIA, which requires a report to the NPDB for a professional review action that adversely affects the clinical privileges of a physician for a period longer than thirty (30) days. This decision was also upheld by the appellate court (the Eleventh Circuit Court of Appeals) in 2010.
One of the more recent clinical privileges cases is Badri v. Huron Hospital, decided in 2010. According to case reports, in this case Dr. Badri was involved in a car accident. Allegedly, the other driver involved choked Dr. Badri. Dr. Badri then began experiencing neck pain for which he self-medicated with steroids. He was then accused of disruptive behavior after several alleged incidents of poor conduct towards hospital employees and patients. When deciding Dr. Badri’s case, the court relied on Meyers, which provides authority for immunity for hospitals and medical staffs in professional review actions that cite a physician’s disruptive behavior as undermining quality health care.
These are just a few of many cases concerning clinical privileges and peer review actions where the hospital involved is found to be acting in accordance with the Health Care Quality Improvement Act and therefore not liable.
If you are a physician or any hospital staff member accused of disruptive behavior, misconduct, “rudeness,” disrespectful conduct or language, abusive acts, anger, hostility, profanity or other similar acts. beware. This is a serious matter. It could result in adverse peer review action that could be career-ending.
If you are concerned that your medical staff privileges may be suspended or revoked, or if you are currently facing a peer review action, make sure you consult an experienced health care attorney who is familiar with matters regarding clinical privileges.
For more information about clinical privileges, peer review, or fair hearings, please visit our website at wwww.TheHealthLawFirm.com.
It’s been a long time since most of us have seen a report card, but hospitals all over the nation received their safety grades on November 28, 2012. Leapfrog, a national group that advocates for safer health care, determined the grades. According to the Orlando Sentinel, Florida hospitals ranked well. Overall, 39 percent (39%) of the 156 hospitals graded received A’s, earning the Sunshine State a tenth place ranking in the nation.
To see the number of hospitals receiving each grade for patient safety by state, click here.
Grades Were Calculated by Safety Measures in Hospitals.
According to the Kaiser Health News article, Leapfrog calculated the grades based on 26 different measures of safety. The company used publicly-available data, including the number of blood line infections, falls in the hospital, bedsores and the consistency that hospitals follow recommended methods of care.
Physicians Believe Rating System is Pointless.
This grading system has physicians reportedly complaining. In the Kaiser Health News article doctors interviewed said that the grades are redundant and offer no benefit to hospitals since Medicare calculates and publishes most hospital-related issues.
Click here to read the Kaiser Health News article.
Leapfrog defends the ratings, saying the report cards provide a more transparent health care system for patients.
How to Fight Poor Online Reviews.
The Leapfrog grading system is just one of the many ways the performance of physicians, hospitals, nurses, dentists and all health providers is put on the chopping block. Other internet review websites like Vitals.com and Yelp.com allow patients to post virtually anything they want – good or bad. If you’ve personally received an unfavorable review that was possibly planted by a disgruntled patient, competitor or former employee you need to fight it. When the comment is posted, search engines like Google, Yahoo, Bing, AOL, or MSN may bring up the false statement every time someone searches for that health provider’s name. To learn legal strategies for health providers to fight bad online reviews, click here.
As a health professional, do you think this grading system is redundant? Do you believe there is any merit to the grades hospitals received? Do you think patients benefit from the published grades? Please leave any thoughtful comments below.
The American Medical Association (AMA) and several other physician organizations announced support of a court appeal by physicians at Avera Marshall Regional Medical Center in Minnesota. The medical staff at Avera alleged the hospital’s governing board amended the medical staff’s bylaws and took away the medical staff’s right to self-govern. On February 6, 2013, the AMA, the Minnesota Medical Association, the American Academy of Family Physicians, the American Osteopathic Association and the Minnesota Academy of Family Physicians filed a friend-of-the-court brief on behalf of the hospital’s medical staff.
Click here to read the press release from the AMA announcing its support of the medical staff at Avera.
Background on the Case at Avera Marshall Regional Medical Center.
In January 2012, the Avera medical staff filed a lawsuit alleging the new bylaws created by the hospital’s governing board left the physicians without “nearly all rights and responsibilities” and gave Avera’s governing board controlling power in processes that required medical staff direction. On September 26, 2012, a Minnesota District Court judge issued a final order on a lawsuit refusing to recognize the medical staff’s lawsuit and refusing to recognize the bylaws as a contract.
To read more on the final order by the judge in the Minnesota District Court, click here.
AMA and Other Physician Organizations in Favor of Self-Governance by a Medical Staff.
The brief supports reestablishing the independence of the hospital’s medical staff to ensure their right and responsibility to uphold the quality of patient care, without interference by the hospital’s governing board. The AMA president said the judge’s ruling gave unchecked power to Avera’s governing board over the medical staff. The brief urges the state’s court of appeals to revise this ruling and allow the medical staff to present its case for self-governance. The AMA believes giving the medical staff the right to self-govern will restore balance between patient care and corporate interests at the hospital.
Click here to read the friend-of-the-court brief file by the AMA.
My Input on a Self-Governing Medical Staff.
By law the medical staff in a hospital is supposed to be self-governing. The AMA, along with other medical associations, created a minimum standard to govern hospitals and to lay out what health care professionals need to do to improve the quality of care in the hospitals. Self-governing includes allowing the medical staff to discipline its own members when necessary, conduct peer reviews, and take action when they see hospital issues.
To watch a video explaining medical staff self-governance in more detail, click here.
What are your thoughts on medical staff self-governance? Please leave any thoughtful comments below.
Don’t wait until it’s too late. If you are concerned of any possible violations and would like a consultation, contact a qualified health attorney familiar with medical billing and audits today. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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