Is There Such A Thing As A "Bad" Fact In A Case?

Clients ask me all the time, is this a "bad" fact?

My response may sound a little "zen" rather than lawyer-like in that I tell them just to tell me ALL the facts and not worry for now if it's good or bad.  In a case, the only truly "bad" fact is one I do not know as I cannot prepare for it, anticipate it or explain it.

Often there are damaging facts that get worse if we do not own them and explain them or gain credibility with the judge and jury by bringing them out ourselves and owning them. I will be the one to tell the judge or jury this damaging fact. Every case has a mixed set of facts - or else we would not be in court or have a legal dispute.

When you meet with me or your lawyer, write out an attorney-client privileged chronology. Do your best to remember everything and tell your lawyer everything. Sometimes what you may think in your own judgmental head is a "bad" fact is something that helps explain what happens or that we can use to our advantage.

Posted by Tracy Green, Esq. 

How We Prepare For Your Administrative Hearing & 3 Basic Tips We Give Our Clients to Help Prepare for Hearings

Administrative and Board hearings are similar to trials, but some differences exist in procedure and practice. There is no jury and the administrative law judges (ALJ) must follow statutes, regulations, administrative procedure act (APA), constitutional requirements of due process and consider guidelines from the regulating agency. 

We encourage our clients to understand the administrative rules and procedures that will govern the conduct of the hearing since this is not simply making your "case" to the judge as if it were a jury that decides "guilty" or "not guilty." There are very different standards.

This is one of the reasons that individuals and businesses that represent themselves in pro per have a very difficult time and usually do not do well. Although the paperwork sent out by the agencies indicates that they can represent themselves it is almost universally a bad idea. At a minimum, if a client has financial restrictions and limitations, they should try to work out a payment plan with an attorney or at least pay for a consultation and find out what they need to do to prepare for their case at hearing or settlement.  

What else do you need to know if you are preparing for a State of California administrative hearing? Here are 3 things you need to know. There are many more levels but here are three basic things to know and consider:

First, you must know that if the ALJ reaches a decision that the board or bureau will not approve, that bureau or board does not have to adopt it. It is therefore important as an advocate to suggest a result and create a strong record that the board or bureau at issue will adopt. Otherwise, our client will have to start over again. 

Thus, if you have a recent felony conviction for fraud, the likelihood of going to a hearing and persuading an ALJ to dismiss the Accusation and impose no discipline would be difficult to achieve. But if it were achieved, it would be very unlikely that the board or bureau will adopt it unless the circumstances are so unusual and the record is well-established. Then you have to go through another hearing. In other words, trying a "Hail Mary" pass.

Second, we are creating a "record" with admissible evidence including administrative hearsay. We want a strong record for a couple of reasons: to have the ALJ adopt the findings we want and to have a record that will allow the board or bureau to adopt it. We push our clients to obtain evidence and expert testimony that they sometimes do not think is important but they do not understand that we want something other than their own testimony just in case the ALJ says our client is "not credible." Preparation is key. In most cases, witness testimony, without more, is not sufficient to prove your case. Exhibits, including documents and other forms of evidence such as expert witness reports, are often necessary.

This is where we seek to be creative when there are challenging facts or why we will seek to introduce a great deal of evidence in the record that can support our suggested level of discipline or findings of no discipline. This is also important for creating a record on appeal.  

Third, we help our clients know the ALJ. We gather information from other advocates about the particular practices of the hearing officer or administrative law judge if we have not previously appeared before him or her. We want to know the following:

How active a role does the ALJ or hearing officer play in taking testimony from witnesses? Some will ask questions or clean up weaknesses in the government's case. Some let you try your case.

How does the ALJ handle exhibits and administrative hearsay introduced by declaration? 

Does the ALJ or hearing officer apply any evidentiary rules? 

Is the hearing officer knowledgeable about the substantive law? 

What is the hearing officer’s attitude toward clients, witnesses, and advocates? 

Should you be prepared for anything unusual about the hearing officer’s conduct during hearings?

Make sure you practice good "Hearing Etiquette." Always arrive at the hearing on time or early. Be polite to the hearing officer and all of the parties. Comport yourself in a professional manner. No eye rolling, head shaking or displays of emotion when the judge or hearing officer is speaking or a witness is testifying. You want to show your professionalism and never compromise your credibility or that of your client by lowering your standards of professionalism or courtesy. And when we are acting professionally, understand that it will help you in the long run. Banging on the table or shouting is just for TV lawyers - an ALJ will stop listening. 

We make good records with witnesses, exhibits and persuasive testimony. We let the facts speak for themselves and that also creates good records on appeal.

For your case, you can call or schedule a complimentary 15 minute consultation. Call 213-233-2260 or email tgreen@greenassoc.com.

Posted by Tracy Green, Esq. 

Tracy Green Speaking at Business Basics Webinar on "HIPAA for Naturopathic Doctors in a High Tech World"

I am speaking and presenting today for the California Naturopathic Doctors Association. You can register and participate live with questions and answer sessions or you can register and watch later.

This seminar is designed to outline the HIPAA rules for Naturopathic Doctors practicing in the real world. The real world includes office staff that need to be trained and understand these rules since you are responsible for their conduct. Naturopathic doctors also practice in a high tech world with email, cloud storage, flash drives, laptops, and smart phones all containing protected health information. Using actual experiences from the trenches, challenging compliance issues will be used as case examples for everyone to learn from. A list of agreements your practice requires along with sample draft agreements will also be provided.

Attend this presentation to confidently:

• Understand what information must be protected under the HIPAA privacy laws
• Understand the HIPAA patient rights
• Know when patient information can be disclosed (treatment, payment, subpoenas, etc.)
• Understand what agreements you need to establish with employees and business associates
• Understand your role as a healthcare provider in maintaining privacy of protected health information for: patient care, contacting patients,  marketing and social media
• Be aware of consequences for non-compliance
• Know what to do if there is a breach of patient protected health information

Posted by Tracy Green, Attorney at Law

78 Year Old Physician Assistant Sentenced to Three Years In Prison For Medicare Fraud - Older Physicians and PAs Are Often Solicited by Suspect Health Care Businesses That Engage in Billing Fraud and Abuse

A 78 year old Los Angeles physician’s assistant was sentenced on November 24, 2018 to three years in federal prison for defrauding Medicare by signing fraudulent prescriptions and other medical documents for durable medical equipment (DME) while working at two separate medical clinics in the Los Angeles area. This was after a guilty plea and not a trial.

Erasmus Kotey, 78, of Montebello, was sentenced by United States District Judge Margaret M. Morrow. In addition to the 36-month prison term, Judge Morrow ordered Kotey to pay approximately $3.5 million in restitution to the Medicare program. Kotey pleaded guilty in March to one count of health care fraud and one count of conspiracy to commit health care fraud in two separate cases. In a plea agreement filed earlier this year in United States District Court, Kotey admitted that he engaged in a scheme to commit health care fraud while working as a physician’s assistant at a clinic  located at 866 North Vermont Avenue in Los Angeles. (A co-conspirator in this scheme was Susanna Artsruni, a North Hollywood woman who owned a medical supply company and admitted that she got unnecessary prescriptions from physician assistants at three clinics was sentenced to over 6 years in prison for causing Medicare to pay $9.6 million for the $25 million in fraudulent claims submitted.) 

In addition to his role in the scheme at the clinic on North Vermont, Kotey admitted that he engaged in a conspiracy to commit health care fraud through his work as a physician’s assistant at another clinic at 943 South Atlantic Boulevard in Monterey Park.

At both clinics, Kotey admitted that he signed prescriptions and other medical documents for medically unnecessary power wheelchairs and other DME. Using these fraudulent prescriptions, DME supply companies submitted fraudulent claims to Medicare.

Kotey also admitted that he ordered medically unnecessary diagnostic testing at the North Vermont clinic. In the two cases combined, the government alleged that Kotey’s fraudulent prescriptions resulted in approximately $7 million in false and fraudulent claims to Medicare. Medicare paid approximately $3.5 million on those claims.

Attorney Commentary: Esasmus Kotey is 78 years old and our office often sees physicians and physician assistants who are older get caught up in Medicare or other fraud cases. There are a couple of reasons for this. One is that often the older physicians or providers are vulnerable in that they are having financial problems and are looking for a position and the only places that will hire senior citizens are health care businesses that are engaged in suspect activities or want to be able to take advantage of an older person's trusting nature. Sometimes these physicians retired and due to the economy or bad business investments need to work. 

In the past. these physicians were viewed as "victims" by the government but now they are being prosecuted alongside the individuals who created and profited from the fraud scheme. The older physicians and providers usually do not make much money from these schemes. If you or someone you know is an older provider be sure to perform due diligence on any clinic or health care business before working there especially when there is billing to government or insurance programs. 


Posted by Tracy Green, Esq. 

Green and Associates' Toy Drive for Children With Autism & Developmental Challenges

TOY DRIVE TIME! 

Donate new unwrapped toys for low income children with autism & developmental challenges serviced by one of our favorite nonprofit and multidisciplinary clinic Professional Child Development Associates for speech, OT (occupational therapy), music therapy, social skills, feeding therapy, and psychological counseling. 

You can drop off at our office in downtown Los Angeles or just have it shipped to our office. If you drive to our office, let us know and we will come and meet you in the parking garage to make it easy for you.

If you read our blog and get some benefit and want to show your gratitude -- this is a way to do it. Or if you have gotten free consultations from our office, here's a great way to show your gratitude with a donation of a new unwrapped toy. 

Developmental toys preferred with no batteries. Great toys can be found for under $10. Toys or gifts needed for all ages 1-18.  

From now till Dec 21. Thanks and happy holidays!

Call us at 213-233-2260 and we will arrange for pick up or drop off.

Posted by Tracy Green, Attorney and Advocate for children with special needs.

Frequently Asked Compliance Questions About DEA Registration

Compliance with federal and state laws by health care providers (physicians, physician assistants, and advanced nurse practitioners) is critical. One of the frequently asked questions we receive is whether DEA registrants have to complete a separate registration when they practice at different locations. There is no simple answer to this question but the answer depends on whether the various locations are in the same state and whether there is any direct dispensing of controlled substances at the various locations.

What is the DEA law? It's always best to start with the statute or regulation as that is your road map.  Title 21 C.F.R. § 1301.12(a) states, “A separate registration is required for each principal place of business or professional practice at one general physical location where controlled substances are manufactured, distributed, imported, exported, or dispensed by a person.” 

Question: But I am not "dispensing," I am prescribing so do I need a DEA registration at the other locations?

Answer: Yes since under DEA law  the term "dispense" includes prescribing.Title 21 U.S.C. § 802(10) defines the word “dispense” as including the prescribing of a controlled substance.

Question: I have three offices in California where I am prescribing controlled substances, do I need a separate DEA registration for each office?

Answer: If you are only prescribing and are not maintaining supplies of controlled substances, administering, or directly dispensing controlled substances in these other locations in the same state, then you do not need to register the other offices.  21 C.F.R. § 1301.12(b)(3).

If your other practices are dispesing or administering controlled substances (even Schedule III or IV), that office needs a separate DEA registration. For example, if you have a weight loss clinic that dispenses phentermine in three different locations in the state then you need DEA registrations at each office.  Another example is that if your office injects human growth hormone (Schedule III) at different locations, then you need DEA registrations at each location. Even if you have the phentermine or HGH shipped to only one office and then have it transported to the other offices, you need DEA registration at each office.

Question: If I work locum tenens in other states do I need a separate DEA registration in that state?

Answer: Yes. You will need to obtain a separate DEA registration in each state where they plan to administer, dispense, or prescribe controlled substances.

Question: If am working solely in a hospital/clinic setting, can I may use the hospital’s DEA registration instead of registering independently with DEA if the hospital agrees?

Answer: Yes this is allowed under 21 C.F.R. § 1301.22(c).

Importance of Compliance. Make sure you are complying with all DEA registration requirements. Failure to follow them can result in discipline by the DEA and state licensing boards. One of the most common failures is for those practices that are dispensing controlled substances such as weight loss clinics who dispense phentermine. 

Compliance is not difficult but it does require setting up systems where all providers and staff must follow the rules. Failure to comply with these rules could result in criminal violations. Thus, following DEA rules helps protect everyone. We would rather focus on compliance rather than representing businesses and individuals when there have been violations but often our clients did not know the rules until there was an audit or visit by the DEA, government agency or licensing boards. Take the time and make sure you and your office is in compliance. One good thing is to review your compliance at the beginning of the year so that it is reviewed on a regular basis.

Posted by Tracy Green, Esq.

Green and Associates, Attorneys at Law

Happy Thanksgiving - We Are Grateful For Our Clients

Happy Thanksgiving to one and all. I am thankful for my law practice, my clients (many of whom have become friends) and my family. I am also thankful for the many clients who have entrusted me with their cases and their lives. I am honored to be able to represent each and every one of you. I hope all of you can spend time with or at least speak with those you love over this Thanksgiving weekend. It's my favorite holiday because it's all about gratitude, friends and family. 

California Pain Clinic & Physician Settle Federal Qui Tam Case For Allegedly Upcoding Medicare, Medi-Cal and Tricare – Case Filed by Former Biller Took 6 Years to Resolve

On November 19, 2014, a federal qui tam lawsuit was settled in Los Angeles by the U.S. Attorney’s Office civil division and physician Dr. Narinder S. Grewal and his pain clinic, the Santa Clarita Surgery Center for Advanced Pain Management.  Dr. Grewal agreed that he and the clinic would pay $1,087,176.09 to the United States for Medicare and Tricare billing and $112,823.91 to the State of California for Medi-Cal billing.

This is not a criminal case only civil. As a qui tam attorney, one common driving force that parties often settle these cases, however, is to make sure that the U.S. Attorney’s Office does not use the discovery process to build a criminal health care fraud case.

The background is as follows. On April 16, 2008, a person (Chandana Basu) who did  billing and collection for Dr. Grewal and his clinic (who in qui tam cases gets called a “whistleblower”) had lawyers file a qui tam lawsuit against the doctor and his clinic.  On November 10, 2009, an amended complaint was filed. Ultimately, the key issue was whether or not the United States and/or the State of California would intervene in the case.

Basu’s lawsuit alleged that Grewal and his clinic obtained improper reimbursements from government-run health insurance programs, including Medicare, Medi-Cal and Tricare, a federal health insurance program for military and related military personnel. The lawsuit alleged that Grewal and his clinic submitted fraudulent claims by “upcoding” medical services, which means that he allegedly submitted bills that were not justified by the services that were actually provided.

Negotiations ensued between the U.S. Attorney’s Office, the plaintiff biller’s attorneys and the doctor’s attorneys. A settlement was reached. On November 19, 2014, the U.S. Attorney’s Office filed a notice that it and the State of California would intervene in some allegations in the first amended qui tam complaint and would decline to intervene in other. As part of the settlement, the case was dismissed with prejudice against the doctor and the clinic. The settlement agreement is confidential but the payment amounts have been released. 

The False Claims Acts permit a private person to sue on behalf of the United States and California, and to share in the proceeds of the suit. As a result of the settlement announced today, Basu will receive a total of $204,000. The settlement was announced after United States District Judge Andrew J. Guilford unsealed the lawsuit. The parties asked the court to dismiss the suit.

Attorney Commentary: Billing errors and upcoding can be serious issues. It is critical for practices with a significant amount of governmental billing have a compliance plan in place in order to avoid qui tam cases, audits for recovery and health care fraud allegations. This is risk management and former employees will be the first to file qui tam cases or call in an anonymous complaint to Medi-Cal, Medicare or Tricare.

Posted by Tracy Green, Esq.

Green and Associates

Phone: 213-233-2260

San Diego Doctor Who Took Photos of Patients On Cell Phone Agrees to Interim Suspension Order Pending Accusation or Criminal Filing

A San Diego physician agreed to an interim suspension order by the California Medical Board as reported by the San Diego Tribune in its article that was effective October 31, 2014. The physician admitted that he took photos and videos of female patients using the camera on his smart phone. The patients were unclothed in some of the photos. In addition, the patients alleged inappropriate touching or photographing. This interim suspension order will require the Medical Board to file an Accusation within 30 days but it appears there is also a criminal investigation as well.

Any physician who takes photos of patients whether clothed or not should be careful to obtain proper consent forms, use a camera for office use only where the photos will be HIPAA compliant and that there is a medical reason for the photos or videos.

Posted by Tracy Green, Esq.

Before You Submit Your License Application Or Report Your Conviction -- You May Be Eligible To Have Certain Felony Violations Designated As Misdemeanors Under Penal Code 1170.18 (Prop. 47)

If you have been convicted of certain felonies and are eligible under the recently passed Proposition 47 which enacted Penal Code Section 1170.18, you may be eligible to have the felony designated as a misdemeanor and/or resentenced as a misdemeanor.  

Here are some frequently asked questions our office is receiving:

Who Should Seek Relief Under Penal Code Section 1170.18 (Prop. 47)?
My recommendation is that anyone who is eligible should seek relief. Felony convictions can result in negative collateral consequences for future student loans, SBA loans, job opportunities, background checks for jobs, clearance for coaching kids' sports or volunteering, admission to colleges, and licensing by governmental agencies, among other things. Reducing to a misdemeanor will at least make some of these exclusions "discretionary" instead of mandatory.  

When Should I Seek Relief Under Penal Code Section 1170.18 (Prop. 47)?
I recommend doing it now. The statute provides that relief should be sought within 3 years of the enactment of the statute or later for good cause. You do not know what you could be doing in 3 years or how this can effect your future. Do not put it off and do it now.  

How Can Penal Code Section 1170.18 (Prop. 47) Affect A Licensing Board's Determination on Discipline?
If a felony is reduced to a misdemeanor, then the disciplinary guidelines will be more favorable to a misdemeanor conviction. With Section 1170.18, this gives individuals convicted of certain felonies the opportunity to reduce it to a misdemeanor.  In addition, this can be used to help show rehabilitation and mitigating evidence.  

Some felonies known as "wobblers" can be reduced to a misdemeanor under Penal Code Section 17(b) but that reduction is discretionary with the court. This new statute gives individuals convicted of felonies another avenue.

Who Is Eligible?
Anyone who has been convicted of the following  California state crimes (not federal) and meets the eligibility criteria:

Health and Safety Code Section 11350 [Possession of a controlled substance] 
Health and Safety Code Section 11357(a) [Possession of a concen. cannibis] 
Health and Safety Code Section 11377(a) [Possession of methamphetamine] 
Penal Code Section 459 [Second Degree Burglary] or Section 459.5
Penal Code Section 473 [Forgery]
Penal Code Section 476a [Bad Checks/Fraud]
Penal Code Section 496 [Receiving Stolen Property] 
Penal Code Sections 484/666 [Felony of Petty Theft With a Prior/Shoplifting]

For theft charges to be reduced, the amount at issue must have been less than $950.

Also the court will not change your charges from felonies to misdemeanors if you have certain strike priors, or if you are required to register pursuant to Penal Code Section 290(c). 
  
What Will Be The Effect of Having The Petition Granted? 
A re-designation means that the conviction is now deemed a misdemeanor for all purposes, except that re-designation does not permit the defendant to own, possess, or have in their custody or control, any firearm or prevent their conviction under Chapter 2 (commencing with Penal Code Section 29800 felon with a gun) of Division 9 of Title 4 of Part 6.  

What Does The Court Consider And Will Be The Effect of Having The Petition Granted? 
If the person is eligible under Section 1170.18(f), the court shall grant the petition.  Section (f) eligibility is where the felony conviction, whether by trial or plea, would have been a misdemeanor under this act had Section 1170.18 been in effect at the time of the offense. No hearing is necessary to grant or deny an application filed under subsection (f) but a hearing can be requested.

For other offenses, where there are no disqualifies present under Penal Code Section 1170.18(b)(1)-(3) and (i), a re-designation will be granted unless the court, in its discretion, determines that resentencing the petitioner would pose an unreasonable risk of danger to public safety. In exercising its discretion, the court may consider all of the following:

(1) The petitioner's criminal conviction history, including the type of crimes committed, the extent of injury to victims, the length of prior prison commitments, and the remoteness of the crimes.

(2) The petitioner's disciplinary record and record of rehabilitation while incarcerated.

(3) Any other evidence the court, within its discretion, determines to be relevant in deciding whether a new sentence would result in an unreasonable risk of danger to public safety.

"Unreasonable risk of danger to public safety" means an unreasonable risk that the defendant will commit a new violent felony within the meaning of Penal Code Section 667(e)(2)(C)(iv).

How Long Does This Process Take?  
The petition process may take between 15 to 60 days, depending on the details of the case and the amount of time it takes to prepare the petition.

Our office is handling these matters and contacting clients to make sure they take advantage of this new law.  If you want your case evaluated, feel free to call or email our office for a complimentary 15 minutes consultation.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Email: tgreen@greenassoc.com
Call:    213-233-2260

FAQ About Rescheduling All Hydrocodone Combination Products from Federal Schedule III to Federal Schedule II

We have received questions from physicians and pharmacies about the new DEA rules for hydrocodone combination products (HCPs).  Effective October 6, 2014, the DEA rescheduled HCPs from federal Schedule III to federal Schedule II.  This change impacts how hydrocodone combination products are prescribed and dispensed in California. Federal requirements for prescribing and dispensing Schedule II controlled substances will apply to all hydrocodone combination products. This means, among other thing, a very limited ability to orally prescribe HCPs (see below) and ability to authorize refills.

This “up scheduling” is a major change for California. According to CURES, over 1 billion dosage units of HCPs were dispensed last fiscal year in California. HCPs are the most frequently prescribed opioid in the United States: nearly 137 million prescriptions for HCPs were dispensed in 2013.

Here are frequently asked questions and answers: 

Question 1: Does this mean California law has also reclassified ALL hydrocodone combination products as Schedule II controlled substances?

Answer 1: This is a technical question where federal law governs. Technically, there has been no equivalent change to California law, or to the controlled substance schedules in California. But for many intents and purposes, the practical effect will be the same: that all prescribers and practitioners in California will be required to treat HCPs as Schedule II controlled substances.

Question 2: Are prescriptions written for HCPs before October 6, 2014 that are presented to the pharmacy for dispensing on or after October 6, 2014 to be dispensed as a Schedule II or Schedule III controlled substance? 

Answer 2: If the prescription is first presented on or after October 6, it must follow federal Schedule II requirements. For example, this means no HCP prescription issued on or after this date may authorize any refills. It also means that as of October 6 oral, telephone or fax-transmitted prescriptions for HCPs are no longer possible. 

Question 3:  Can the remaining refills for HCP prescriptions written and filled before October 6 as a Schedule III, be dispensed after October 6?   

Answer 4:  Yes. The DEA has stated that it will allow refills on HCPs written and initially filled before October 6 (under Schedule III requirements and limitations), to be dispensed up to six months from October 6, 2014 (until April 8, 2015). This extends the Schedule III treatment of prescriptions for HCPs written and initially dispensed prior to October 6, 2014 to the maximum allowable period for Schedule III refills. Of course, the original date on the prescription cannot exceed 180 days, or the maximum allowable period for Schedule III refills. 

If there are any questions for prescribing physicians or dispensing pharmacists, err on the safe side and seek consultation so that you comply with the federal laws and regulations. Patients may be frustrated by the change in the law but do not let them pressure you into prescribing or dispensing unless you are fully compliant. 

Posted by Tracy Green, Esq.

Green and Associates, Attorneys at Law 

DEA and Medical Boards Target Weight Loss Clinics and Phentermine

We have seen more investigations of physicians or advanced practitioners (physician assistants and nurse practitioners) prescribing phentermine to patients.  Phentermine is a Schedule IV drug and we have seen increased scrutiny of weight loss clinics and investigations into the physicians, nurse practitioners, physician assistants and nurses who work at them.

The investigations include the following topics:

1.   The business structure of the weight loss clinics and whether management companies or non-physicians are involved in the business.

2.   Whether the physician established a bona-fide doctor-patient relationship before prescribing phentermine to patients.

3.   Whether the physician obtained a thorough history or complete a thorough physical examination prior to initiating treatment utilizing a Schedule IV controlled substance.

4.   Whether the physician continued prescribing phentermine to a patient who had failed to lose weight after taking the controlled substances over a period of thirty days.

5.   Whether the physician had initiated treatment utilizing a Schedule IV controlled substance without having performed a review of the patient's prior medical and weight-loss program records to determine that the patient had made a substantial good-faith effort to lose weight in a treatment program utilizing a regimen of weight reduction based on caloric restriction, nutritional counseling, behavior modification and exercise, without the utilization of controlled substances, and that said treatment had been ineffective.

6.   Whether physician had dispensed drugs having addiction-forming or addiction-sustaining liability otherwise than in the course of legitimate professional practice.

7.   Whether the physician had violated 21 C.F.R. Section 1306.04(a) which requires that a controlled-substance prescription "be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice."

8.   Whether the phentermine is being properly stored and dispensed under state and federal rules. Are the DEA logs maintained properly? Is the receptionist or a medical assistant improperly handing the phentermine to the patients? Is the phentermine properly labeled with instructions?

9.   Are referral fees given to patients for referring friends in violation of state anti-kickback and referral fee rules?

10.    Is the phentermine being given at a discount if private or government insurance is billed for other services?

We handled one case outside of California where law enforcement sent in a  confidential informant to gather information on the physician’s weight loss practice. The government informant was female, short and weighed over 210 pounds at the time of her initial visit to the practice and it was obvious that law enforcement chose her to participate in the investigation because she was not only obese, but had a number of other medical conditions as well.

In that case, the physician was investigated for prescribing phentermine (controlled substances) to the undercover without performing an adequate physical examination, properly documenting her medical history, recording adiposity measurements such as BMI or waist circumference, conducting any laboratory testing, or verifying that the undercover had made good faith efforts to lose weight without the aid of controlled substances. We helped obtain the dismissal of criminal charges but the DEA and Medical Board still pursued the physician.  

If you have medical weight loss as part of your practice, now is the time to get compliant with state and federal rules and regulations -- before there is an an investigation.  Have us or another experienced firm conduct an audit and make sure you comply before the Medical Board or DEA pays your office a visit or requests records from your office.  If there is an investigation, get counsel right away so you do not respond to records requests or interview requests without representation. 

Posted by Tracy Green, Esq.

Green and Associates, Attorneys at Law

213-233-2260

Email: tgreen@greenassoc.com

Louisiana Psychiatrist Sentenced to Serve More Than 7 Years in Prison for Role in Medicare Fraud Case Involving Partial Hospitalization Psychiatric Services

A Louisiana psychiatrist, Dr. Zahid Imran, was sentenced in federal court in Baton Rouge, Louisiana, on August 25, 2014 to serve 86 months in prison for his role in a Medicare fraud case involving partial hospitalization psychiatric services. 

The sentencing followed his guilty plea. He was further ordered to pay $43.5 million in restitution and to forfeit all proceeds from the fraudulent scheme. Chief U.S. District Court Judge Brian A. Jackson of the Middle District of Louisiana imposed the sentence and ordered Dr. Imran to self-surrender by September 29.

According to documents filed in the case, Zahid Imran, M.D., 56, of Baton Rouge, served as the medical director of Shifa Community Mental Health Center of Baton Rouge, and co-owned Serenity Center of Baton Rouge and Shifa Community Mental Health Center of Texas.   As part of the alleged fraud, Dr. Imran admitted mentally ill patients to the facilities, some of whom were inappropriate for partial hospitalization, and then re-certified the patients’ appropriateness for the program in an effort to continue to bill Medicare for services. 

To support the fraudulent Medicare billing, it was alleged that Dr. Imran and others allegedly falsified patient treatment records to reflect services on dates when no such services were provided. Dr. Imran pleaded guilty on May 13, 2014, to conspiracy to commit health care fraud. There were allegations that the patients were brought in by buses from Memphis and other areas which is indicative of illegal marketing.

This was a wide-ranging prosecution that began with an investigation in 2011 into the three community mental health centers. This investigation has resulted in 17 convictions of individuals employed by the facilities, including therapists, marketers, administrators, owners and the medical director.  The companies billed Medicare for partial hospitalization program services for the mentally ill that were allegedly unnecessary or never provided over a period of approximately seven years. The companies, collectively, submitted more than $258 million in claims to Medicare during this period. Medicare paid approximately $43.5 million on those claims.

Attorney Commentary: The days where facilities could avoid fraud charges by seeing patients are over. Prosecutors are no longer afraid to tackle medical necessity. This is especially true in psychiatric cases where the people served are mentally ill, poor and not receptive to treatment. Add marketing and patients who travel for services and there are significant red flags for audits and investigations.

Posted by Tracy Green, Esq.
Email: tgreen@greenassoc.com
Phone: 213-233-2260
Green and Associates, Attorneys at Law

Co-Owner of Florida Home Health Company Sentenced to Serve 70 Months in Federal Prison and Ordered to Pay $6.2 million in Restitution for Participation in a Health Care Fraud Scheme Where Services Were Medically Unnecessary, Services Were Not Provided, Kickbacks Were Paid, And Patient Documentation Falsified

The criminal cases against home health owners continue to increase. On August 26, 2014, a co-owner of Professional Medical Home Health LLC, Annarella Garcia, 44, of Florida was sentenced to serve 70 months in prison and ordered to pay $6.2 million in restitution for her participation in a health care fraud scheme involving the now defunct home health care company. U.S. District Judge Federico A. Moreno of the Southern District of Florida imposed the sentence.

According to court documents, Ms. Garcia was a co-owner of Professional Medical Home Health, a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries.  On June 25, 2014, Ms. Garcia pleaded guilty to conspiracy to commit health care fraud.  Ms. Garcia admitted in her plea that between December 2008 and February 2014, she and others were engaged in a scheme to bill the Medicare Program for expensive physical therapy and home health care services that were not medically necessary or were not provided.   During that time, Professional Medical Home Health was paid approximately $6.25 million by Medicare for the fraudulent claims.

Specifically, Ms. Garcia admitted that she and her co-conspirators paid kickbacks and bribes to patient recruiters in return for their providing patients to Professional Medical Home Health for home health and therapy services that were not medically necessary or were not provided.   In furtherance of the scheme, Ms. Garcia admitted that she and her co-conspirators falsified patient documentation to make it appear that beneficiaries qualified for and received home health care services, when, in fact, many of the beneficiaries did not actually qualify for such services and did not receive such services.

Attorney Commentary:  This is a lengthy sentence for a plea. The determining factor may have been that in the Indictment there was a money laundering count due to cashing checks for cash that gave exposure up to 20 years' in prison while the health care fraud charge carries a maximum of 10 years. The plea was to the conspiracy to commit health care fraud which saved exposure on the money laundering count.  There were also false statement charges that could carry additional consecutive time. This case moved quite quickly from indictment to plea to sentence, just over 3 months.  

Posted by Tracy Green, Esq.
Office: 213-233-2260
Email: tgreen@greenassoc.com
Green and Associates, Attorneys at Law

Investigations Continue Post-Arrest As Shown By Physician Arrested For Second Time While Charges Pending. Lesson: What Not To Do While On Bail

One of the terms and conditions of bail is "to obey all laws." Committing an offense while on bail is a separate offense and can result in loss of bail. We have had cases where a client committed a new offense while out on bail and it can complicate greatly the defense of a case.

Last week, Yahya Hedvat, a Los Angeles doctor awaiting trial for allegedly prescribing and selling narcotics without a legitimate reason, was arrested for selling hydrocodone to undercover agents. He was arraigned in Los Angeles County Superior Court and pleaded not guilty on August 19, 2014 to the charge in the second case of sale of a controlled substance. His bail was set at $1 million bail. It is also likely that a motion was filed to revoke or increase bail in his first case.

According to City News, Dr. Hedvat was scheduled to go on trial this month on a 10-count indictment accusing him of unlawfully prescribing the drugs hydrocodone, clonazepam and suboxone. Dr. Hedvat was free on his own recognizance while awaiting trial and had surrendered his federal license to prescribe controlled substances, according to the District Attorney's Office. 

On August 8, an undercover investigator with the California Medical Board went to Dr. Hedvat's clinic and allegedly negotiated the purchase of narcotics, including Norco and Ativan. Undercover agents allegedly bought the drugs in the clinic's parking lot from Dr. Hedvat's office assistant, Nikravan Hormuz, 70, who was also charged.

Mr. Hormuz pleaded not guilty to the sale of a controlled substance count and posted bail early Saturday. Dr. Hedvat's bail was more complicated and he was not able to post bail at the first appearance.  

Attorney Commentary: It is quite likely that the investigation was continued in order to obtain more evidence on the first case or to create another case -- which is what has occurred here.  Without a DEA registration, the charge is more serious and enhances the punishment that the doctor faces in his case.

Penal Code Section 23 Order Pending Criminal Case
The new case greatly impacted the criminal case in another way in that it prompted the Medical Board to seek an interim suspension order against him under the authority of Penal Code Section 23.  On August 22, 2014, the Judge in issued a PC23 Order that restricted Dr. Hedvat from practicing pending the criminal case.  Under the Order, as a condition of bail or own recognizance (O.R.) release during the pendency of this criminal action until its final conclusion and sentence, Dr. Hedvat shall:

1.    Forthwith cease and desist from practicing as a physician and surgeon;

2.    Be restricted from prescribing, ordering, administering, furnishing, or dispensing any drugs;

3.    Surrender to the clerk of the Court, any prescription forms in his possession;

4.    Be prohibited from obtaining, ordering, or using any additional prescription forms; and inform his patients that he is not currently permitted to prescribe any drugs due to a pending matter. 

The Penal Code Section 23 orders can range from restrictions on practicing to outright prohibition on practicing while the criminal case is pending. This was a complete prohibition and will cause the physician additional economic and professional consequences while the criminal cases are resolved.  

When we have a client charged, it is critical to ensure that they (and their office staff) are not engaged in any acts that could be used to revoke bail or create new charges. While it may be difficult for clients to accept the fact that they will need to give up certain activities that may be legal (prescribing any controlled substances for example where there is a valid DEA registration), even that may be preferable to having to defend one's clinical judgment.  In this case, it was allegedly more serious without the DEA registration and with an office person who was allegedly engaged in activities that could never be legal.  

The lesson: if you are under investigation or charged, be paranoid.  Be careful. Do not assume that an investigation is "over" and that law enforcement or the Medical Board does not continue to send in invetigators.

We have seen cases where the Medical Board has sent undercover investigators to a clinic on the date the physician or other medical staff are scheduled to be in court to see what happens at the clinic without the physician.  In other words: take these investigations seriously.  

Moreover, you can use the time to create good facts and that your office has been cleaned up, is compliant with all laws and regulations. This can help in the defense of the case as well as in any further administrative proceedings. 

Posted by Tracy Green, Esq.

Green and Associates, Attorneys at Law

Phone: 213-233-2260

Email: tgreen@greenassoc.com