Representation of Health Care Providers

Department of Health Investigations
Hearings before the Division of Administrative Hearings (DOAH)
Florida Health Care Licensure Matters
Medicare or Medicaid Audits and Investigations
Peer Review
Medical Staff Credentialing
Professionals Resource Network (PRN) or Intervention Project for Nurses (IPN)
Third-party Insurance Billing Issues
DEA Registration Issues
False Claims and Qui Tam Litigation
Personal Counsel in Malpractice Case
HIPAA and Patient Confidentiality Violations
Physician Profiling
Adverse Medical Incident Reporting Issues
National Practitioner Data Bank Reports

Department of Health Investigations

Usually, a health care provider's license is their most important asset. Disciplinary action taken against one's license not only becomes public information, but can have a devastating impact on one's ability to practice. The attorneys at Dresnick, Rodriguez & Perry, P.A., have been defending physicians, dentists, chiropractors, nurses, pharmacists, and other health care providers in disciplinary cases brought against their licenses for many years. We never forget that every case we handle can affect our client's reputation or ability to practice in his or her chosen field. We are a boutique firm that includes a Risk Manager and former prosecutor for the Board of Medicine, and we often "brainstorm" difficult issues to ensure optimal results for our clients. Our lawyers frequently appear before Florida's professional licensing Boards. We also give lectures to hospital medical staffs, professional societies, and students or residents concerning disciplinary actions brought by the Board of Medicine, the Board of Nursing, and others. Our experience and knowledge of the operations of the Department of Health allows us to guide our clients through the regulatory process, as we strive to obtain the dismissal of Department of Health investigations.

Some of the typical Department of Health cases handled by Rodriguez & Perry, P.A., include the following allegations:

  • Malpractice or substandard care
  • Wrong side or wrong patient surgery
  • Inappropriate prescribing of controlled substances
  • Improper diversion of medication
  • Medicare/Medicaid fraud
  • Insurance fraud
  • Criminal convictions
  • Impairment
  • Sexual misconduct
  • Medical Staff actions
  • CME audit issues
  • Incomplete or inadequate records
  • Advertising violations
  • Physician Profiling violations

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Hearings before the Division of Administrative Hearings (DOAH)

In cases where an Administrative Complaint has been filed against a health care provider, the attorneys at Rodriguez & Perry, P.A. have the experience and knowledge necessary to properly defend their clients in front of Administrative Law Judges at the Division of Administrative Hearings. As these cases differ procedurally and substantively from cases in the civil arena, it is important to have counsel with the experience and expertise to defend these sensitive and often complex matters.

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Florida Health Care Licensure matters

We frequently assist applicants for licensure before the Board of Medicine and other health care boards who are required to appear before the Credentials Committee to explain negative information obtained during the application process, or to explain incorrect answers provided on an application. Proper preparation prior to these meetings can significantly affect whether a person ultimately becomes licensed. Retaining counsel at this juncture is particularly important because the denial of a license must often be reported on applications for licenses or medical staff privileges, and could prejudice an applicant's ability to become licensed in other states.

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Medicare or Medicaid Audits and Investigations

Providers are often audited for alleged Medicare or Medicaid overpayments. We have handled many such audits and investigations, sometimes coordinating with medical or coding experts. Audits may stem from deficient documentation, deficient coding, ambiguous Medicare or Medicaid manual guidelines, and other billing issues that expose the physician to tremendous overpayment obligations. It is our role to explain and justify the alleged overpayment to the greatest extent possible, or to represent our clients in hearings before Administrative Law Judges. Obtaining assistance early in the process is critical because Medicaid and Medicare frequently impose overpayments by extrapolating from alleged overpayments based on a relatively small sample. As such, it is frequently beneficial that counsel and experts thoroughly review all aspects of each patient file to attack and minimize any overpayment exposure.

As South Florida has become known as a hotbed of Medicare and Medicaid fraud, in some cases, rather than simply seeking return of an overpayment, providers are criminally investigated and charged with health care fraud, or their provider numbers are revoked. With our experience in criminal and administrative cases, we are able to handle these cases for our clients in any of these arenas. Understanding that a potential ramification of a fraud conviction or termination from Medicare of Medicaid can lead to non-renewal of a health care license, close coordination of criminal and administrative proceedings is central to our efforts to optimize results for our clients.

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Peer Review

We represent physicians in conjunction with peer review investigations and actions. This representation includes proceedings before peer review committees. Peer review proceedings can involve a number of different subject areas including allegations of deviations from the standard of care, qualifications for certain types of privileges, and alleged misrepresentations on medical staff applications. Adverse peer review actions may have significant ramifications which may include reporting to licensing authorities or the National Practitioner Database.

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Medical Staff Credentialing

We represent physicians pertaining to medical staff credentialing issues. This representation may include the qualification of practitioners to be granted certain privileges, and the interpretation of medical staff bylaws and medical staff rules and policies as applied to specific situations.

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Professionals Resource Network (PRN) or Intervention Project for Nurses (IPN)

Our firm has represented many physicians, nurses, and other health care providers who have been accused of impairment as a result of drug or alcohol abuse, behavioral issues, or sexual misconduct or addiction. Many of these professionals had been referred to, or were under contract with the Professionals Resource Network (PRN) or the Intervention Project for Nurses (IPN). Although PRN and IPN often provide necessary guidance to impaired practitioners, any involvement with these entities can lead to significant licensure and practice issues. We are often called upon to counsel clients on issues related to impairment, PRN or IPN, and the potential benefits and ramifications of cooperating with these organizations. We also have extensive experience working with PRN to protect our clients against licensure or administrative actions during the recovery process. Cases involving allegations of drug or alcohol abuse or sexual misconduct can result in emergency suspension or restriction of one's license, or involve criminal and related issues. We have experience helping clients to coordinate criminal and administrative proceedings while they are on the road to recovery, often with the assistance of PRN or IPN. These cases are particularly gratifying because we are able to assist fine professionals through a difficult period, and help them to restore their professional and personal lives.

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Third-party Insurance Billing Issues

We represent health care providers when insurance companies refuse to pay justifiable bills or seek return of substantial payments alleging improper or insufficient documentation, alleging services were not rendered, that services billed were not medically justified, or were coded improperly. Health insurance carriers' fraud investigation units sometimes refer billing claims they believe were up-coded to the Department of Health to initiate a license disciplinary investigation, and we have defended many such cases. We work with coding and other professionals to justify our client's billing, to ensure that insurance companies comply with the prompt pay requirements, and to reduce any requested overpayment amounts.

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DEA Registration Issues

Practitioners cannot prescribe or dispense controlled substances without a DEA registration. We assist practitioners with issues involving the DEA, including the loss a DEA registration, DEA inspections, and applications for the issuance or renewal of a DEA registration.

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False Claims and Qui Tam Litigation

Both the Federal and Florida False Claims Act ("Qui Tam") provide substantial financial incentives for persons who, noting fraudulent wrongdoing related to health care fraud and other types of government contracts, comply with the necessary procedural steps to bring these activities to the government's notice. The attorneys at Dresnick, Rodriguez, & Perry are available to prosecute or defend whistleblower/Qui Tam cases.

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Personal Counsel in Malpractice Cases

Medical malpractice lawsuits can impact a physician's medical license and personal assets even when a physician has malpractice insurance, and the insurance company has assigned an attorney to the case. Personal counsel is sometimes advisable to monitor the litigation, and provide recommendations to the insurance company's assigned lawyer. We provide representation to make sure the medical malpractice insurance company is protecting the interests, and looking out for the medical license and personal assets of our clients.

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HIPAA and Patient Confidentiality Violations

HIPAA regulations can be confusing. Beginning with the enactment of the HIPAA Privacy Rules in 2002, we have created HIPAA compliance programs for large and small health care providers. We have also defended allegations of HIPAA and state privacy law violations brought by government regulators, or brought by patients. We have years of experience working with HIPAA and Florida patient confidentiality laws, and help our clients to avoid legal liability based upon patient privacy violations.

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Physician Profiling

Florida physicians and nurse practitioners are required to report various types of information to the Department of Health's practitioner profile unit. This information includes convictions for misdemeanors and felonies, certain medical malpractice settlements or judgments, and disciplinary actions. The information required to be reported also includes basic information such as changes of professional addresses and current hospital medical staff memberships. Physicians are sometimes audited to confirm that the information on their physician profiles is accurate and up-to-date. We routinely represent physicians that are uncertain as to whether certain events must be reported, or the appropriate wording of the reports to be submitted. We also represent physicians that are subject to investigations or prosecutions based upon allegations that they have not updated their physician profiles within the time periods required by applicable Florida law.

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Adverse Medical Incident Reporting Issues

We represent physicians involved in adverse medical incidents to assist them in determining whether reports are required to be submitted and complying with, and responding to adverse medical incident reports required by Florida law. We have advised hospitals regarding Code 15 reporting requirements for many years. Beginning in 2000, physicians are required to submit reports of certain types of adverse medical incidents occurring in their offices.

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National Practitioner Data Bank Reports

We advise physicians regarding National Practitioner Data Bank reporting issues. This representation includes determining whether certain incidents require the filing of a National Practitioner Data Bank report. We may challenge whether a report is required to be filed, or provide clarification pertaining to the allegations in the report to benefit our clients.

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