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Medical and clinical researchers, whether in an academic community or in a practice setting, spend years on clinical trials and investigations in hopes of contributing to the field of medicine. However, many of these researchers instead find themselves defending their reputation after being accused of research misconduct or research fraud. One of the most notorious recent cases of research misconduct involved a South Korean stem cell researcher who claimed to have cloned human embryonic stem cel
In a recent blog post, we discussed the precedent set by Meyers v. Columbia/HCA Healthcare Corp. in determining court review standards for clinical privileges and peer review actions. Although Meyers is one of the major cases concerning peer review and termination of hospital privileges, there have been other recent clinical privileges cases that are important for physicians to be aware of when facing a peer review action.
When a physician, medical group or other healthcare provider receives a notice of an audit and site visit from Medicare, the Medicare Administrative Carrier (MAC) or the Zone Program Integrity Contractor (ZPIC), things happen fast with little opportunity to prepare. Hopefully this checklist will help you to prepare for the on-site visit that will shortly follow.
Pain management clinics in Orange County, Florida can expect to face more regulations in upcoming months. As of March 19, 2012, county lawmakers are planning to make major changes to the way pain management clinics operate in this Central Florida County, in order to minimize prescription drug abuse, according to the Orlando Sentinel. Some of the proposed regulations include: Pain management clinics will be required to provide Orange County with monthly business records documenting the number of
Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health
AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!
Despite the passage of Florida's Health Care Clinic Act over nine years ago, there are apparently still many health practices which are violating it. Unfortunately, the violation of the Health Care Clinic Act can have extremely serious repercussions, including conviction of a felony, loss of all fees collected, and disciplinary/licensure action against any physicians, nurses or other licensed health professionals working there.
The Florida Legislature unanimously passed HB 653 which relaxes some of the draconian exclusions enacted under SB 1986, which went into effect on July 1, 2009. SB 1986, which added provisions to Chapter 456, Florida Statutes, among others, prevented numerous healthcare providers from obtaining or renewing licenses based on prior criminal convictions, which could have occurred decades earlier.
Defamatory attacks against doctors have become increasingly prevalent as more and more review sites join the world wide web, allowing patients to post virtually anything they want - good or bad - about a physician or any professional. With more physicians becoming employees of hospital systems or large healthcare institutions, adverse surveys, reports or reviews can affect advancement, bonuses and basic income.
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Defamatory attacks against doctors have become increasingly prevalent as more and more review sites join the world wide web, allowing patients to post virtually anything they want - good or bad - about a physician or any professional. With more physicians becoming employees of hospital systems or large healthcare institutions, adverse surveys, reports or reviews can affect advancement, bonuses and basic income.
About a year ago, Florida pain clinics began to really feel the impact of becoming law enforcement's newest target. This was based in part on televison "magazine" shows and investigative reporters' shows and articles publicizing many abuses by patients who were "doctor shopping" and physicians who were allegedly "over-prescribing." Regulations increased, and lawmakers enacted severe penalties for doctors accused of over-prescribing, including prison sentences.
If you are a physician with hospital privileges, one of the most important cases for you to be aware of concerning "disruptive physician" actions is Meyers v. Columbia/HCA Healthcare Corp. , which was finally decided in 2003. In ruling on disruptive physician cases, courts almost always rely on Meyers , and it has been cited repeatedly in other disruptive physician cases to justify a hospital or medical staff's peer review actions disciplining the physician.
Previously, I have written articles and blogs on why a physician, dentist, pharmacist, nurse, psychologist, mental health counselor or other licensed health professional should never agree to voluntarily relinquish his or her license after any notice of a possible investigation being opened. This is treated the same as if the state licensing agency had revoked that license for cause.
For those Medicare providers who had their Medicare numbers terminated by the Medicare Administrative Contractor (MAC) (formerly called the "carrier" or "fiscal intermediary"), you can actually check the status of a corrective action plan (CAP) you submitted timely. If you go to the following: [link] you should be able to view the status. Note that the date that will be listed as being received will probably be days, if not weeks after you sent it.
Based on comprehensive survey data from diverse healthcare providers, the 2025 HIPAA Benchmark Report delivers actionable intelligence for modern compliance programs. This report examines how organizations are restructuring HIPAA Privacy Programs to address emerging regulatory requirements. Through analysis of staffing models, program operations, and breach management protocols, it provides a clear picture of current best practices.
One of the newest acronyms we have encountered in the Medicare Program's audit process is the Medicare Comprehensive Error Rate Testing program audit or CERT audit. It could be that we just haven't had clients who had problems with this in the past, as we have seen plenty of Zone Program Integrity Contractor (ZPIC) audits, Medicare Administrative Contractor (MAC) audits and actions, Medicaid Fraud Control Unit (MFCU) audits, etc.
Many nonphysician providers work in family practices, including nurses, medical assistants, clinical nurse specialists, nurse practitioners, psychologists, respiratory therapists, physician assistants, physical therapists, social workers and laboratory technicians, among others. These nonphysician healthcare providers not only assist with patients, they often see patients in the physician’s absence.
The American Board of Medical Specialities (ABMS) recently announced that it has adopted a new policy that will require doctors to attain board certification within three (3) to seven (7) years after finishing residency. Prior to the establishment of this new rule, the period between training and board certification was undefined, and physician's had an indefinite amount of time to become board certified.
On Friday, March 2, 2012, a judge ordered that the temporary restraining order entered on behalf of CVS Pharmacy against the Drug Enforcement Administration (DEA) will remain in effect until March 13. This temporary restraining order prohibits the DEA from banning two Sanford CVS pharmacies from filling prescriptions for controlled substances like oxycodone and hydrocodone.
Every health care provider that accepts federal payments must screen for excluded providers. Use this sample Exclusion Screening Checklist and Compliance Policy to evaluate and improve your organization’s compliance with the law. Payments from Medicare, Medicaid, and TriCare trigger screening requirements that may extend to employees, contractors, volunteers, board members, and network providers.
The Agency for Health Care Administration (AHCA), Office of Inspector General, Bureau of Medicaid Program Integrity, is the Florida agency responsible for routine audits of Medicaid health care providers to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited.
The Medicaid Fraud Control Unit is a division of the Florida Office of the Attorney General charged with investigating and prosecuting health care providers suspected of defrauding the state's Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific patient records.
Have you received a notice of termination of your Medicare provider number? Medicare has been revoking the Medicare provider numbers of many different Medicare providers including physicians, medical groups, home health agencies (HHAs), pharmacies, and durable medical equipment (DME) providers, based on returned mail sent to old addresses which have not been updated or based on inspection team site visits to old addresses.
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