Representing clients in matters of Florida and federal laws and regulations. Licensed to practice law in Florida, only.
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 MorePhoenix 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 MoreSection 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 [email protected] or via telephone at 305.329.1462.
Read MoreJanuary 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 MoreCMS has announced that it will postpone its Recovery Audit (RAC) Prepayment Review demonstration project that would have held up payments to hospitals until the Medicare RAC reviews the claim to ensure that the provider complied with all Medicare payment rules. The Medicare RAC Prepayment Review demonstration called for the RACs to conduct prepayment review of claims for 15 procedures that historically result in high rates of improper payments. Many doctors were unhappy with the proposed program, especially cardiologists, who would be most affected since 11 of the 15 procedures identified for Medicare RAC prepayment review affect cardiologists.
Read MoreFor the purposes of HIPAA, any person or business providing particular services to a covered entity involving “protected health information” (PHI) is known as a “business associate”; in fact anyone who would have occasion to encounter PHI in the course of their work for a HIPAA-covered entity—is a “business associate” and is not only under the same duty as the covered entity to comport itself by the dictates of HIPAA, but must also have a Business Associate Agreement (BAA). At Gaitan Morales, we regularly counsel health care entities and their subcontractors on such regulatory issues as HIPAA, the HITECH rule, the Red Flag rules and numerous other laws and regulations that govern the health care industry. To protect your medical practice or associated health care business from a regulatory mishap, call Rafael A. Gaitan, Esq. today at 305.329.1462, to schedule a free initial consultation and learn more about how the law firm of Gaitan Morales can help you.
Read MoreThrough an Oct. 1 letter to State Medicaid Directors, Peter Budetti, Deputy Administrator for the Center for Medicare and Medicaid Services (CMS), provided initial guidance on the implementation of the Recovery Audit Contractor (RAC) programs by State Medicaid agencies. Section 6411 of the Affordable Care Act, calls for the expansion of the RAC Program by
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