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How To Use This Section Of Our Website

In this section of our website, we have answered hundreds and hundreds of questions our clients have asked us over the years. Instead of looking all over the Internet for an answer to a question you have about health care law or license defense in New York, spend 10 seconds and see if we have answered it here. Here’s how to find your answer….

One, just to the right, you will see a SEARCH BOX. Just type your question in the box and press your enter key. Every answer on this site that is related to your question will fill your screen.

Or two, just below and to the right, are the Categories we’ve answered questions on. Just go the specific topic you have a question on and click the topic. Every question related to that topic will appear on your screen.

And remember, if you need assistance with health care law or license defense, call us at 212-577-6677.

The Stark Law is a prohibition intended to curb Medicare and Medicaid physician “self-referrals,” as when a doctor refers a patient to a provider where the doctor or a family member have a financial interest.

Medicare’s Anti-Markup Rule focuses on a similar, but slightly different area.

In recent years, Medicare has noted a big increase in medical practices that have expanded to include a range of diagnostic testing.

This led to concerns that many of the arrangements between ordering physicians and the labs who process the tests were being overused and resulting in abuse of the Medicare trust fund.

In 2009, Medicare unveiled a new Anti-Markup Rule that applies to certain diagnostic tests.

Medical practices can continue to bill Medicare for diagnostic tests that are performed within the practice.

But if the test is either performed by or supervised by personnel who do not “share a practice” with the doctor who ordered the test, Medicare considers the test to be a “purchased test” that is billed at a lower rate.

Like the Stark Law, the Anti-Markup Rule is intended to clarify the relationships between practitioners and remove incentives for practitioners to order tests that may be medically arguable, but lucrative from a billing standpoint.

If your practice is expanding to include diagnostic testing and you’re concerned about compliance with Medicare’s Anti-Markup Rule, the health care attorneys at Joseph Potashnik & Associates can evaluate your expansion plans to ensure compliance.

Call us at (212) 577-6677 today to schedule a consultation.

Medical and dental practices are usually organized as professional associations, which limit your liability for another practitioner’s misdeeds.

So while an investigation of another practitioner may not directly put you in jeopardy of legal liability for a business partner’s alleged insurance fraud, it’s very likely that investigators will want to interview you as part of their investigation.

It is absolutely vital that you not talk to investigators – either law enforcement or from insurance companies – without consulting with an experienced health care law attorney first.

Investigators are looking for evidence of misconduct, and questions that may seem innocuous to you may in fact end up casting doubt on your own ethics, or even implicating you in a criminal conspiracy.

It can also be a difficult personal situation when a colleague, peer, business partner, or friend is implicated in wrongdoing.

You may have a desire to try to shield your associate or downplay suspicions you may have had. It’s important to understand how your answers may be used by investigators.

Your career and your practice’s reputation may well be on the line when it comes to these situations.

Protect yourself and your business.

Call our experienced NYC health care defense attorneys at (212) 577-6677.

Any time you are being investigated by any agency, you need to talk to an experienced attorney before you talk to investigators.

This is especially true with Medicare fraud investigations in New York City, which are often handled by the Medicare Fraud Strike Force, a joint FBI-HHS venture.

Your patients may not only be approached by Medicare investigators – they may be questioned by the FBI.

This happened recently in the case of Dr. Sayed Imran Ahmed, who is alleged to have billed Medicare for some $85 million for surgical procedures that authorities claim he never performed.

While patient testimony played a role in his indictment, the investigation expanded to include the doctor’s entire professional network, including hospitals where he had privileges.

You can see why an investigation – even if you’re entirely cleared, and even if no charges are ever filed – can be so dangerous.

Your patients, your peers, your employees, and everyone who holds you in a position of trust may be asked hard questions about your ethics and the details of your practice. It’s poison for your career.

If you believe you are under investigation as part of a Medicare fraud inquiry, don’t waste time.

Call our experienced Medicare fraud defense attorneys at (212) 577-6677 to schedule a consultation right away.


How Can Dentists Avoid Medicaid Fraud Inquiries?

With the state of New York clamping down on Medicaid fraud, practitioners feel more pressure than ever to avoid even the appearance of impropriety. But what does the state consider to be improper when it comes to operating a dental practice?

State Medicaid auditors have compiled extensive data on how “average” practices operate – how many procedures are typically performed on each patient and what types of procedures, as well as how many patients the average dentist sees in a day, a month, and a year. If your practice is consistently performing more procedures, unusual procedures, or seeing an excessive number of patients, you’re likely to end up with Medicaid investigators asking to look at your records.

Keeping thorough and detailed records in your practice isn’t enough. Errors happen, and if you’ve billed over a long period of time, odds are that incorrect billings have occurred here and there. They won’t be viewed innocently by investigators.

Your first step is to speak to an attorney. Not only are you potentially liable to pay back huge sums of money if an investigation turns up irregularities, but you may also be permanently excluded as a Medicaid provider and your license to practice dentistry in the state may even be in jeopardy.

You’ve worked hard to build a practice and a business. Make sure you protect it with experienced help from attorneys who know New York’s health care system.

Call (212) 577-6677 to schedule an immediate consultation with a NYC attorney who knows the provider’s side of Medicaid fraud issues.

It depends on the reason why your pharmacy was denied enrollment. Under the Affordable Care Act, state Medicaid agencies are required to terminate or deny enrollment to providers based on a long list of potential reasons, from not providing paperwork in a timely manner to submitting false information on an application.

It is possible to re-apply to the program, but it’s vital that you understand why your pharmacy was denied enrollment and take corrective measures.

In some instances, this can mean significant changes to your business, like buying out a partner who has been excluded in other states.

If you’ve been denied enrollment as a Medicaid provider in New York, you’ll benefit from talking through the issues and your options with an attorney experienced in Medicaid issues.

Call us at (212) 577-6677 to schedule an immediate consultation with an experienced health care and Medicaid attorney.

New York’s Office of the Medicaid Inspector General monitors the statewide Medicaid system and investigates potential fraudulent activities.

In this era of “big data,” the Medicaid Inspector General has more tools than ever at its disposal.

One of the simplest methods OMIG uses to look for fraud is simply to send an undercover investigator into a pharmacy to have a prescription filled, then watch to see that the billing is properly handled.

If there are problems, the pharmacy may be excluded from Medicaid and the pharmacists may find themselves under investigation.

More technically advanced methods are in play as well. New York is one of the few states to have engaged in a significant Medicaid fraud crackdown.

From the creation of the OMIG in 2006, to advanced software that monitors Medicaid billing patterns to watch for unusual and suspicious activity, the state has gotten extremely serious about fraud detection and recovery.

OMIG also invites the public to report potential Medicaid fraud through its website, so any customer or even an employee who suspects Medicaid fraud can trigger an investigation.

It’s not a satisfying answer, but the truth is that normal operations of your business can trigger a Medicaid fraud investigation.

To protect yourself, keep excellent records, and if you’re notified of an investigation, talk to a lawyer first.

Call (212) 577-6677 and schedule an immediate consultation with an experienced attorney well versed in Medicaid fraud issues.

If you’ve started to feel like pharmacists are under more scrutiny than ever before in New York, you’re probably right.

Just this week, a small prescription drug fraud ring was exposed – but not before it cost Medicaid and Medicare almost $10 million.

The two owners, plus the supervising pharmacist, of 184th Street Pharmacy in the Bronx were arrested as part of a lucrative prescription drug fraud scheme.

Investigators say that the pharmacy would fill prescriptions for HIV anti-retroviral drugs, then buy them back from financially vulnerable patients – sometimes for hundreds of dollars – while billing Medicaid and Medicaid managed health care organizations for the drugs as though they had been dispensed.

The pharmacy also paid Medicaid recipients cash for referring new patients to the scheme.

The three alleged conspirators have been charged with felony Grand Larceny, Scheming to Defraud the Government, and Money Laundering.

If you thought prescription drug fraud was primarily a problem with patients trying to get their hands on narcotic painkillers or recreational prescription drugs, think again.

These days, pharmacy owners and staff have to stay aware that their records are always open to scrutiny, and the consequences for sloppy record keeping can be catastrophic for your business and your career.

Pharmacists who are concerned about their exposure to liability for any reason should promptly contact our experienced team of New York health care defense attorneys at (212) 577-6677 to schedule an immediate consultation.

Yes, your employees carry a phone and camera on their bodies that connects them effortlessly and constantly to social media services like Instagram, Twitter, Facebook, and – unfortunately for you – whatever the social media tool of the day is, which you may never even have heard of.

So how can you police your staff’s social media presence? Realistically, you can’t, but you can and should implement a strong, written Social Media Policy that makes clear both to health professionals in your practice and your staff how easily HIPAA violations can occur with a simple smart phone.

Some basic policies you should consider:

  • Your staff should never discuss patients, even anonymously, on social media platforms and blogs, whether they are on the clock or on their own time.
  • Patient records, log sheets, and other documentation with identifying information should never be photographed using a smart phone or tablet.
  • Encourage appropriate social media use. Blogs that deal with health or dental issues in general provide valuable information and perspective to the public and can even be a marketing tool for your practice.
  • Let your employees know that violations of patient privacy on social media will result in termination from your practice, and may have far reaching implications for their future ability to work in health care.

A written social media policy is your first step in protecting your practice from HIPAA violations.

If you’d like to talk to an experienced health care attorney about best practices when it comes to social media and patient privacy in small practices, call our New York health care attorneys at (212) 577-6677 to schedule a consultation on-site or in our offices.

You are only in jeopardy if you were directly asked about a juvenile arrest record and withheld that information.

For instance, if an employer, licensing board, or the DEA asks the question on a form, you are obligated to answer truthfully.

If you omit information that was specifically asked for and the entity asking the question finds out, the deception may well be a bigger problem for you than the existence of a juvenile record, which was likely sealed when you turned 18 anyway.

If your employer or the OPMC has reason to believe you have lied, then potentially your whole career is open to suspicion and investigation.

It’s a bad place to be, in any case. For the most part, juvenile arrests won’t impact your ability to hold a professional license in New York.

If you have concerns about a past arrest or conviction that may come to light, you should request a copy of your criminal history from the New York State Division of Criminal Justice Services so you can know exactly what might be found.

While New York generally doesn’t allow expungement of criminal records, even for juvenile records, licensed practitioners shouldn’t have to live with the fear of a youthful indiscretion crashing their careers.

If you are concerned about a juvenile arrest coming back to haunt you, call our team of professional license defense attorneys at (212) 577-6677 to schedule a confidential consultation.

It is possible to overcome substance abuse and keep your medical, dental, or other professional license in New York, but it has a lot to do with how you take responsibility for the situation.

If you believe you have a substance abuse problem today, you need to reach out to a skilled substance abuse counselor – today.

If you take steps to confront the issue in a forthright way, it’s possible that OPMC may not take any action at all.

Facing your problems doesn’t just protect your license or reduce your risk of discipline, job loss, and more. Health care personnel have high stress jobs and access to a literal pharmacy they can avail themselves of, as well as the resources to develop other common vices like alcoholism.

None of these behaviors make you a safe provider of medical care. Addiction threatens your license, your career, but most of all, it threatens your patients.

If you don’t act, your colleagues will eventually realize that you have a problem. You’ll be drug tested, suspended, and a report will be filed.

The best thing you can do, for yourself and your license, is to get help, on your own. Doing so may let you fly under OPMC’s radar while you get clean, and working through your problems can help you avoid scrutiny at work.

Suspensions have to be disclosed at various points for the rest of your career, from applications for liability insurance to joining a new HMO network. Avoid one if you can.

If you’ve been suspended, are under investigation from OPMC, or just want to understand the legal implications of getting healthy from addiction as a licensed professional, call our experienced professional license defense attorneys at (212) 577-6677.