Category Archives: Rafael A. Gaitan

07 Feb

Responding to Record Requests on a Timely Basis.

Health care providers are increasingly seeing request for records from all types of payors including but not limited Medicaid, Medicare and commercial insurance providers. The basis for receiving a requests for records could be as a result on any number of reasons, including compliance, aberrant billing practices or as a result of a ZPIC audit

Read More
07 Feb

Florida Behavior Analysis Services – Overpayments

The Florida Agency for Health Care Administration (Agency), Medicaid Program Integrity (MPI) has and is undergoing review of several Behavior Analysis Services providers regarding their Medicaid reimbursement claims for services rendered. MPI is reviewing said claims in order to insure compliance with the program’s Florida Medicaid Behavior Analysis Services Coverage Policy dated October 2017, including

Read More
01 Aug

One More Week to Go: FDA’s New Tobacco Rules Go Into Effect on August 8, 2016

Retailers, manufactures and retailer/manufacturers of tobacco products should take note that compliance with the U.S. Food and Drug Administration (FDA) new tobacco rules is rapidly approaching.  Certain provisions of the final rule become effective Monday, August 8, 2016.   On May 10, 2016, the FDA issued its final rule expanding the FDA’s definition of “tobacco

Read More
07 May

Success of CMS ACO Pilot could bring big changes to Medicare payment structure

The Center for Medicaid and Medicare Services’ (CMS) Pioneer Accountable Care Organization (ACO) program successfully saved Medicare nearly $400 million in spending over two years, clearing the way for CMS begin expanding the program nationwide. A CMS study released May 4, 2015 on the JAMA website, revealed that expenditures for Medicare beneficiaries receiving care through

Read More
17 Sep

AHCA Increases Efforts to Collect Medicaid Overpayments

On September 16, 2014, Florida’s Agency for Health Care Administration (AHCA) issued a notice to Medicaid providers informing that “in the upcoming weeks the Agency will increase its efforts to ensure that providers are repaying overpayments”, while also reminding Medicaid providers of “their obligation to promptly refund moneys due to [AHCA], including any moneys received

Read More
04 Mar

Hospital enters $85 million settlement for alleged Stark Law violations

Halifax Hospital agreed Monday, March 3, 2014, to settle a whistleblower case for alleged Stark Law violations with the U.S. Justice Department in the amount of $85 million — an amount so large it is more than twice the previous recors for hospital systems accused of Medicare fraud.  The Daytona Beach, Florida  hospital is accused of

Read More
23 Aug

Gaitan Law Group Successfully Reduces a $736,305.93 Overpayment to $6,826.00

  CMS sought recovery of an alleged overpayment in excess of $730,000 from a diagnostic laboratory, upon the conclusion and recommendation of Safeguard Services (SGS) to deny all claims submitted for 3,006 Medicare beneficiaries.  Mr. Gaitan and Mr. Suarez, of our health care practice group, appealed the overpayment claim through the reconsideration (second level appeal),

Read More
17 Apr

HHS reaches $100,000 settlement with Phoenix Cardiac Surgery for Lack of HIPAA Safeguards

Phoenix Cardiac Surgery, P.C., of Phoenix and Prescott, Arizona, has agreed to pay the U.S. Department of Health and Human Services (HHS) a $100,000 settlement and take corrective action to implement policies and procedures to safeguard the protected health information of its patients. The settlement with the physician practice follows an extensive investigation by the HHS Office for Civil Rights (OCR) for potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. For assistance developing a HIPAA compliance program or responding to a HIPAA breach, contact Rafael A. Gaitan, Esq. Mr. Gaitan has over 15 years experience in the health care industry and regularly counsels physician practices on regulatory matters including HIPAA and the HITECH rules.

Read More
17 Apr

Community Pharmacy Re-permitting Required Before July 1, 2012

Section 465.018, Florida Statutes was amended in 2011, by HB 7095 to require every community pharmacy that dispenses Schedule II and Schedule III controlled substances to be re-permitted by July 1, 2012. All owners, officers, and prescription department managers of the community pharmacy will need to submit fingerprints to the Department of Health as part of the permitting process; and the community pharmacy must implement written policies and procedures for preventing controlled substance dispensing based upon fraudulent representations or invalid practitioner-patient relationships. To avoid disruptions to a business, community pharmacies are advised to begin the permitting process immediately. For assistance and guidance with applying for a community pharmacy permit, developing policies and procedures for preventing controlled substance dispensing fraud and abuse, or to appeal a permit denial or revocation, contact Rafael A. Gaitan, Esq. Mr. Gaitan has over 15 years experience in the health care industry, regularly representing pharmacies and pharmacist before regulatory bodies like the Florida Department of Health, and the Board of Medicine. Mr. Gaitan can be reached via e-mail at rgaitan@gaitanmorales.com or via telephone at 305.329.1462.

Read More
17 Jan

House subcommittee passes bill authorizing the Surgeon General to restrict the license of doctors who over-prescribe narcotics

January 17, 2012.  Today, the House Health & Human Services Quality Subcommittee passed a bill aimed at giving the Surgeon General more power to stop doctors who over-prescribe narcotics, but only after a rewrite removing the word “suspension” — a compromise worked out between the Florida Medical Association and  Department of Health. Under the rewritten version of

Read More