Conaway & Strickler, P.C. Criminal Law Attorney Atlanta GA | Conaway & Strickler P.C. | Georgia 2020-12-23T03:00:55Z https://www.conawayandstrickler.com/feed/atom/ WordPress On behalf of Conaway & Strickler, P.C. <![CDATA[What is the Medical License Verification Act?]]> https://www.conawayandstrickler.com/?p=49477 2020-12-14T19:45:28Z 2020-11-11T20:11:38Z The story, which included reporting about a Texas-based personal trainer, shows how easy it can be to bill health insurance providers for services despite lacking any legal basis for doing so. Unfortunately, as the ProPublica report points out, there are some problems with the current health care billing system. The Medical License Verification Act would change that.

Obtaining a National Provider Identifier number

Insurance providers typically only pay for care that licensed medical professionals provide. Therefore, before billing insurers for medical services or receiving payment, health care professionals must obtain a National Provider Identifier number from the Centers for Medicare and Medicaid Services.

Defrauding insurance providers

The CMS does not currently verify whether an individual requesting an NPI number has a valid medical license that is in good standing in the state where he or she practices. Consequently, non-physicians may obtain NPIs and improperly bill health insurance providers. This, of course, may constitute a violation of federal law.

Correcting the problem

Purportedly to close the verification loophole and protect insurers and patients from health care fraud, a group of senators introduced the Medical License Verification Act in February 2020. The legislation would simply require the CMS to verify an applicant’s medical credentials before issuing an NPI number. The Medical License Verification Act currently sits in the U.S. Senate Committee on Finance and has not become law. Still, if it passes, the bill is likely both to crack down on unlicensed medical providers and to reduce fraudulent billing, potentially saving taxpayers billions in health care costs.]]>
On behalf of Conaway & Strickler, P.C. <![CDATA[3 types of criminal charges that may threaten your nurse’s license]]> https://www.conawayandstrickler.com/?p=49439 2020-09-25T18:09:43Z 2020-09-22T19:05:58Z professional consequences as well. The state requires that licensed nurses report any convictions that involve a felony offense, controlled substances or irresponsible use of alcohol or drugs to the Georgia Board of Nursing. If charged with such a crime, the board may suspend or revoke your professional license.

1. Felony offenses

Any felony offense may automatically be cause for license revocation, even if you avoid an actual conviction by pleading “no contest” to a first-time charge. Other than drug-related violations, felony crimes in Georgia may include theft, forgery, arson, aggravated assault or unintentional vehicular homicide that involves a serious traffic offense.

2. Driving under the influence

In Georgia, DUI offenses are not usually charged as felonies. However, a DUI conviction may indicate to the Board of Nursing that you have a substance abuse problem that could impact your ability to perform your professional duties with reasonable skill and safety.

3. Violating controlled substance laws

The Board also takes drug-related charges very seriously, including illicit use or distribution of prescription medications. A conviction for violating any state or federal laws concerning controlled substances may jeopardize your license. Even a misdemeanor charge for possessing a small amount of marijuana could lead to disciplinary action, and a felony conviction may result in mandatory license suspension or revocation. When facing a criminal charge that could threaten your professional license, an attorney may be able to help by either reducing the charge or minimizing the impact of disciplinary actions taken by the Board of Nursing.]]>
by lzebrowitz <![CDATA[PPP Loan Fraud Explained]]> https://www.conawayandstrickler.com/?p=49437 2020-09-04T19:08:48Z 2020-09-04T19:08:48Z https://www.nbcnews.com/business/economy/congressional-investigation-finds-over-1-billion-ppp-fraud-n1239001).  The Paycheck Protection Program (“PPP”) was authorized as part of the Coronavirus Aid, Relief, and Economic Security Act to provide forgivable loans to eligible small businesses. Under the PPP, small businesses can apply for loans that must be used for payroll expenses, interest on mortgage, rent, and/or utilities only. The amount of a PPP loan that a business could receive is generally 2.5 times (or 250%) the business’s average monthly payroll cost.  The United States Small Business Administration oversees the PPP, but individual PPP loans are issued by private, approved lenders and banks, which are federally insured financial institutions. How does the government identify potential fraud?  They review the following, among other things:
  1. The PPP Borrower Application Form - An applicant must provide information related to their loan application, including the amount of the business’s average monthly payroll, the number of employees, and the purpose of the loan, with options for payroll, lease/mortgage interest, utilities, etc. The lender will use this information to calculate the amount of the loan that a business is eligible to receive. The Application Form also requires certain representations and certifications, including certifications as to the accuracy of the information included in the application itself and in any supporting documents and a certification that the funds will be used to retain workers and maintain payroll or to make mortgage interest payments, lease payments, and utility payments. So, anything on this form, anything, that is incorrect can be an issue.
  2. IRS Form 941 - These are Employer’s Quarterly Federal Tax Returns.  Generally, in an application for PPP, one needs to upload Form 941s to supplement the application.  These forms are used to report payroll for each quarter and must be provided for 2019 and 2020, at least. Any figures on the uploaded forms that don’t match IRS records will raise a flag.
  3. Bank statements - A PPP application requires the business to upload recent bank statements.  Here, one can get in trouble if the statements uploaded don’t match bank records. Also, the government can confirm previous payroll by reviewing these statements, and can use them to confirm business revenue and expenses.
  4. W2s - If these are uploaded as part of the application, they must match IRS records.
  5. Articles of Incorporation - The government will have records from the Secretary of State as to when a business was officially incorporated.  Any officers currently listed on the Secretary of State may have criminal liability should a PPP loan application be defective.
To understand what charges can result from issues with a PPP Loan application, please click here:  https://www.conawayandstrickler.com/blog/2020/06/could-you-face-prosecution-for-paycheck-protection-program-ppp-loan-fraud/ Additional documentation can be required for a PPP loan to be processed successfully.  If your business has had its PPP loan proceeds frozen for any reason, it is wise to contact us immediately. We can work with the banks and investigators to ensure a positive resolution.]]>
by lzebrowitz <![CDATA[Operation Double Helix and Operation Brace Yourself are two recent examples of the United States Department of Justice efforts to punish health care fraud  ]]> https://www.conawayandstrickler.com/?p=49434 2020-08-28T19:15:05Z 2020-08-28T19:15:05Z
  • False Claims Act (FCA).  The statute prohibits a person from knowingly presenting (or causing to be presented) a false or fraudulent claim for payment to the federal government. It also prohibits knowingly making a false statement material to a false or fraudulent claim. The FCA covers wrongful conduct like "upcoding" and "unbundling," as well as submitting claims for procedures that were not undertaken at all.
    1. Stark Law. The Stark Law prohibits a physician from referring a Medicare patient for certain designated health services to any entity in which the referring physician has a financial relationship.
    CRIMINAL
    1. Anti-Kickback Statute (AKS). The AKS is a criminal statute that prohibits offering or providing anything of value to induce the referral of Medicare or Medicaid business. Please see https://www.justice.gov/opa/pr/federal-indictments-and-law-enforcement-actions-one-largest-health-care-fraud-schemesThis was the beginning of a massive amount of criminal charges nationwide.
    2. Criminal health care fraud statute. Under this statute (18 U.S.C. § 1347), a person can be held liable for a scheme to intentionally (1) defraud any healthcare benefit program or (2) use false statements to obtain funds held by a federal healthcare program. The penalties are steep: up to 10 years in prison and a fine up to $500,000 or twice the amount of the fraud.
    The DOJ will continue to investigate these type of cases aggressively. That is why you need to call an experienced lawyer as soon as there appears to be an indication of an investigation.]]>
    On behalf of Conaway & Strickler, P.C. <![CDATA[Doctors facing drug charges]]> https://www.conawayandstrickler.com/?p=49392 2020-08-19T16:54:12Z 2020-08-21T16:50:48Z high-profile opioid sting resulted in the federal prosecutors charging dozens of medical professionals with drug crimes. Most charges centered on prescribing opioids unnecessarily. Lately, an increasing number of health professionals are seeking treatment for using the substances themselves. If you are a doctor or nurse charged with a drug offense of any kind, you may have questions.

    Should I talk to police?

    In general, no. Police are eager to collect information, whether it be about your or a colleague. They sometimes become overbearing or use intimidation tactics to achieve their goals. Remember that you have the right to decline their requests. You do not have to answer their questions nor let them search your premises without a warrant.

    What if police arrest me?

    An arrest can be humiliating and frightening, but do not make decisions out of fear. Stand up for your rights by refusing to speak without a lawyer present. Educate yourself by asking questions. Police should inform you of the charges against you. If officers collected evidence illegally or violated your right to due process, you should have a strong defense.

    What will happen to my practice?

    California lawmakers have recently drafted several measures aimed at stemming the tide of opioid abuse in the state. Laws and sentencing trends are changing rapidly. Abusing or over-prescribing opioids is a serious offense, and conviction carries stiff penalties including fines and imprisonment. Your best strategy involves defending yourself rigorously. Your goals include staying out of prison, maintaining your license and being able to return to your medical practice. If you are battling addiction, you may be able to seek treatment. Completing a recovery program can help you restore your career and your reputation.]]>
    by lzebrowitz <![CDATA[Sanctions against the ICC: Product of Isolationism or Defense of Sovereignty?]]> https://www.conawayandstrickler.com/?p=49399 2020-08-06T20:32:35Z 2020-08-06T20:32:35Z https://www.americanbar.org/events-cle/mtg/web/402850456/]]> by lzebrowitz <![CDATA[Mass Electronic Surveillance Suspected In Protests]]> https://www.conawayandstrickler.com/?p=49395 2020-08-04T20:40:15Z 2020-08-04T20:40:15Z https://theintercept.com/2020/07/31/protests-surveillance-stingrays-dirtboxes-phone-tracking/]]> On behalf of Conaway & Strickler, P.C. <![CDATA[Protect your Georgia nursing license after substance use arrest]]> https://www.conawayandstrickler.com/?p=49358 2020-07-30T17:07:22Z 2020-07-29T21:11:49Z self-reporting a problem with drugs or alcohol can help protect your ability to practice as a nurse. Learn how a DUI or drug diversion arrest could impact your Georgia nursing license.

    Understanding mandatory reporting requirements

    Other nurses and nurse employers must report certain actions by other nurses to the state board of nursing. This includes instances in which another nurse cannot practice with safety and skill because of drug or alcohol use. A nurse can also self-report to the Georgia Board of Nursing if he or she:
    • Diverted drugs from the health care facility and/or patients
    • Recently entered or completed treatment for substance use disorder
    • Received a positive test for recent drug or alcohol use
    • Uses and/or has a dependency on alcohol or drugs

    Seeking treatment for substance use as a nurse

    After self-reporting or learning that another individual reported you to the nursing board, entering treatment can help you retain your Georgia nursing license. You must follow these steps:
    • Attend inpatient or outpatient substance use treatment by an authorized provider.
    • Follow all recommendations of the treatment provider, including limitations on your professional practice.
    • Give your treatment provider consent to release your treatment plan, records, assessments and discharge plan with the date to the nursing board.
    Once you finish the recommended course of substance use treatment, your doctor must provide the Georgia Board of Nursing with a discharge summary. This document must detail the type of treatment you received, your diagnosis, prescribed medications, results of drug screenings, ongoing treatment recommendations and a statement indicating whether you can safety and skillfully practice nursing. Generally, the board will follow the recommendations of your treatment provider as long as you maintain a substance-free lifestyle. This includes information about whether the state should limit your nursing practice in any way for patient safety and quality care.]]>
    by lzebrowitz <![CDATA[Could you face prosecution for Paycheck Protection Program (“PPP”) Loan Fraud?]]> https://www.conawayandstrickler.com/?p=49361 2020-07-27T20:24:04Z 2020-06-12T13:11:55Z https://www.conawayandstrickler.com/criminal-defense-practice/) or at 470-357-6280 to discuss your case.]]> by lzebrowitz <![CDATA[After a Data Breach, What to Do?]]> https://www.conawayandstrickler.com/?p=49353 2020-05-14T19:49:29Z 2020-05-14T19:47:43Z After the Hack: A Data Breach Post Game Show[/caption] As chair of the Cyber Crime committee at iTechlaw, Meg Strickler gives her insight on data breaches from various perspectives on an iTechlaw webinar this week.  She and the other panelists discuss:
    1. The criminal charge of BEC (Business email compromise) fraud
    2. Representing a victim of BEC
    3. Theft of trade secrets
    4. Representing a victim of theft of trade secrets by a disgruntled employee or insider
    5. Protecting small companies from potential hacks/ data breaches
    6. Contacting law enforcement after a hack/breach
    7. Commencing civil litigation in an attempt at restitution
    8. Aggravated identity theft
    9. Protection of PII
    10. Cyber insurance
    Please watch here: https://lnkd.in/gjHgVWt]]>