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Pill Mill Busts Around the State Print E-mail
Written by Various Sources   
Saturday, 15 October 2011 14:32
Last Updated on Saturday, 15 October 2011 14:47
New Law Now Enforceable Print E-mail
Written by Jeffrey Herschler   
Thursday, 13 October 2011 09:36


As of Oct 1, physicians from outside Florida are required to get a state certificate before providing expert witness testimony in medical malpractice litigation.  They then could face sanctions if it is determined that they gave "deceptive or fraudulent testimony."  The new law also offers safe harbor from lawsuits for doctors who donate health services to high school and college sports teams.  

Presented by MF Healthcare Solutions

Last Updated on Thursday, 13 October 2011 09:56
Healthcare Leaders Discuss Medicaid Reform Print E-mail
Written by Jeffrey Herschler   
Thursday, 13 October 2011 09:31

The Greater Miami Chamber of Commerce recently hosted a Panel Discussion entitled :

The Epicenter:  How Medicaid Reform Will Shake Up Healthcare in Florida

Serving on the panel :
-Melanie Brown-Woofter, AHCA, Acting Assistant Deputy Secretary for Medicaid Operations
-Jorge D. Luna, DO, Continucare (Broward County), Chief Medical Officer
-Jorge Rico, MBF Healthcare Partners, L.P., Co-Founding Partner
-Joseph Rogers, Broward Health, COO 

Ms. Brown-Woofter opened the discussion with a review of the current state of affairs, a few references to the past and some sobering statistics.  She reminded us that the state has a $20B budget with 56% federal and 44% state via the matching program.  (see Studies: Medicaid).  She went on to describe an explosion in utilization of Medicaid services due to a bad economy.  "This is what is driving the interest in managed care," she stated.

Dr. Luna stated that "This is Medicaid managed care 2.0" since it's already been attempted in the past.  He was optimistic about the potential to be "ahead of the curve" in Florida.   He went to suggest that the Medicaid managed care model works better in densely populated areas as a more robust network can be created.
Mr. Rico was also upbeat.  He predicted that managed care would create disciplines that are financially sustainable.  He pointed out that there are 3 million Medicaid recipients currently.  That number is expected to swell to 4 million by 2014.

Providing proof that panel discussions should always include a fourth, Mr. Rogers weighed in with a few zingers.  For example, he stated "Medicaid recipients know how to work the system."  He suggested that a program created as temporary assistance to those in an episodic crisis has evolved into a permanent health plan for many citizens.  He was decidedly skeptical about the merits of Medicaid managed care stating "You are dealing with a population not receptive to managed care".  He went on to impersonate a typical Medicaid patient:  "I call the ambulance.  They take me to the hospital.  That's my health plan."

At the end there was a Q & A.  One advocate expressed concern with the potential bad behavior of contracted third parties.  Ms. Brown-Woofter assured her that "intense monitoring of managed care" is part of the plan going forward. 

Last Updated on Thursday, 20 October 2011 07:24
Alt Weeklies: Pill Mill Enablers? Print E-mail
Written by Tara Pihn   
Friday, 30 September 2011 00:00

I Read the News Today Oh, Boy!

Earlier this month I read Bernd Wollschlaeger's post:   Pill Mills Under Pressure.  It's an upbeat article highlighting recent achievements in shuttering pill mills and "choking off" the supply of prescription drugs being sold illegally in Florida.   So feeling cheery, I decided to break for lunch.  I grabbed a copy of the Broward/Palm Beach New Times as my meal companion.   I enjoy the feature articles exposing local government corruption, the events calendar and the restaurant reviews.   And I must admit I sort of like the Savage Love column.

So there I was eating a sandwich and a bag of chip and I couldn't help noticing that there are a lot of ads for pain management clinics.  For example in the September 8 edition of Broward/Palm Beach New Times, there are 36 ads for clinics and physician offices offering pain management services.  Sadly and perhaps ironically, there are also several ads offering to treat opiate addiction.  I also see ads for very inexpensive MRI's, less than $200 (more on this later). The other alternative weeklies in the area, Miami New Times and City Link, also run these ads.  And these ads look very sleazy.  Click HERE to watch a video.  One clinic offers pain management services with "NO LIMIT".  Another beckons new patients with this message:  "Has Your Doctor Closed?".  Others will "Meet any Competitors Offer" or deliver "Full Service Pain Management".

These papers have wide circulation in the 25-45, single, urban lifestyle demographic. According to my sources these ads cost $200-$850 per week. Trying to keep an open mind, I thought, perhaps, these operators are legitimate and providing some benefit to the community. But would a legitimate operator get value from this type of marketing expenditure?   To this type of audience?  And if they are not legitimate, could they operate openly by running ads in the alternative weeklies?   

I needed feedback from some experts. So I asked my pal, Jeff Herschler, Publisher of FHIweekly and, if he could survey his audience.   The survey response was remarkable. Some evaluated the situation from a completely economic view point by calculating a hypothetical ROI.  "Assume a $70 gross rev per visit with 40% margin. Do the math for the cognitive component excluding the technical component and other mark ups..." one Healthcare Consultant wrote. Others were pragmatic, suggesting clinics could meet the letter if not the spirit of the law.  "There is so much scrutiny on these clinics now I have to assume they are doing everything possible to make money and avoid the authorities" a Healthcare IT Executive stated.  But most of the respondents felt the clinics were at best barely legal with serious moral and ethical issues:

"Some of the same clinics are advertising pain management and addiction treatment.  So the suppliers are meeting the demand and in that process creating demand for a new service."   Advertising Executive

"The ease of getting these drugs eventually brought in real druggies who gamed the system in order to get pills to consume or sell. Come here and see a few different pain clinics and a drug dealer can get lots of oxy codone to sell."   IDTF Owner

"The readers of New Times who pay attention to (respond to) pain clinic ads are generally interested in pain meds and other controlled substances for non-medical (abuse, profit) purposes."   M.D. Broward
"I have called and will call those doctors drug dealers in white coats. They should not be confused with legitimate pain management specialists who apply multiple treatment modalities to treat pain. We must undertake  all efforts to stop those pain mills."  M.D. Miami Dade

"Any real pain physician would not advertise in those papers."   Practice Management Consultant, Miami Dade

"I remember....,  the truly scary scene where a motley crew of tattooed low lifes and dazed & pierced  hipsters were about to riot because the Doc's office was locked up with a note saying the good doctor was on vacation (probably in the Caymans depositing some cash)."     Healthcare Professional, South FL 

Submit a READER RESPONSE for possible publication.

In sum not a single respondent believes legitimate Pain Management Clinics would or should advertise in an alternative weekly.  Oh, and what about those $199 MRI's?  According to a healthcare professional familiar with the economics of imaging in Florida, "It is hard to imagine earning a profit on an MRI at $200 after subtracting the cost of capital, rent, materials, the tech and the read." Legitimate IDTF operators have long believed these rock bottom priced MRIs are shoddy or even counterfeit studies. To get a scrip the patient needs a study in his chart.  But that film might not be his or her body part.  Thus the pill mills have apparently spawned a cottage industry of questionable MRI providers. 
This survey is hardly scientific.   However it does include a broad cross-section of the healthcare community in S. Florida:  men and women with the education, experience and geographic proximity to evaluate what's going on. Please follow this LINK to view the complete Reader Response. 

It seems reasonable to suggest that New Times, part of Village Voice Media, and City Link (Tribune Company) need to rethink who they are doing business with.  One could make the "Freedom of Speech" and "Victimless Crime" argument with regard to the Adult ads.  It's hard to defend the Pain Clinic ads.
In addition, it is apparent to me that if you are a law enforcement official charged with Pill Mill crackdown, finding suspects must be like shooting fish in a barrel.
Please Read this Report:

Prescription Drug Abuse in Miami-Dade, Broward, and Palm Beach Counties            (Thanks to the BCMA for providing)  
Please contact your Florida State Representative. 
The above link will take you to a web page that (after typing in your home address) will lead you to another web page where you can draft e mails to your State Representative.
Please write a Letter to the Editor:
Last Updated on Thursday, 13 October 2011 09:36
The New Rules of Evidence: Litigating in the Cyber Age Print E-mail
Written by Michael J. Sacopulos, JD   
Saturday, 17 September 2011 15:17

In most law schools around our country, second year students take “Evidence”.  This is a technical class which teaches one rule and its exceptions after the next.  What information is privileged and not, the hearsay rule and its dozen exceptions, relevant versus irrelevant testimony, and waivers all make up a body of law whose origins date back centuries to English common law.  Rising above the trees to look at the forest, the general idea is to determine what information is fair and reliable to present to a jury.  The thought goes that some information is simply too prejudicial or unreliable to be presented to a jury.  At their core, the rules of evidence control information heard by jurors.  Well, it seems that there are some new rules... 

In the past several years one example after the next has emerged of jurors using social media and internet searches to “supplement” the information they are being provided at trial.  Last year a New York trial court judge received word that a juror had conducted some independent research during the trial by performing “google” searches on the parties.  Upon questioning, the juror admitted that he had “googled” the parties and gave the excuse that he was “curious.”   Apparently he wasn’t the only curious juror.  The trial court judge went on to question the remaining jurors.  Eight of his fellow jurors also admitted to conducting independent internet searches.  That is nine (9) out of the twelve (12) jurors.  The judge was forced to declare a mistrial.  This is not an isolated incident.  In another case, when a juror heard contested testimony relating to the drug Paxil, the juror conducted internet research.  The juror then shared the results of the Paxil research with fellow jurors.  In yet another case, a juror was uncertain whether a defendant was guilty or not.  What did she do? She conducted a poll on her Facebook page.  This also resulted in a mistrial.

The problem of juror misconduct by use of the internet has become so common that courts now issue jury instructions on the topic.  Federal courts now have standard jury instructions stating that jurors are not to do independent internet research on the parties, witnesses or facts of the case.  Many believe that such instructions are futile.  In August 2011 a Fort Worth, Texas juror plead guilty to contempt of court after it was discovered that he attempted to “friend” the defendant on Facebook during the trial.  The juror’s attorney summed up the situation by saying: “It is a reflection of the times.  Most everyone has smartphones now.  They can hop on at almost any time.  And there’s a lot of downtime in jury duty, so what most people do is hop on their phone."

The social media revolution has inflamed other aspects of the trial process.  Attorneys now devote effort to reviewing the other party’s social media use.  In Bass v. Miss Porter’s School, the plaintiff had been suspended for cheating on an exam.  The school requested all Facebook pages and Twitter documents that related to not only the exam, but the plaintiff’s alleged teasing and taunting of others.  Here the court found:

Facebook usage depicts a snapshot of the user’s relationships and state of mind at the time of the content’s posting.  Therefore, relevance of the content of Plaintiff’s Facebook usage as to both liability and damages in this case is more than in the eye of the beholder than subject to strict legal demarcations… (No. 3:08 cv1807, 2009 WL 3724968, D. Conn. Oct. 27, 2009, Id at *1). 

With that ruling, the plaintiff was forced to turn over 750 pages of her Facebook account. 

In a 2010 case from Pennsylvania, a court when ruling to compel social media usage disclosure found: 

Facebook, MySpace, and their ilk are social network computer sites people utilize to connect with friends and meet new people.  That is, in fact, their purpose, and they do not bill themselves as anything else.  Thus while it is conceivable that a person could use them as forums to divulge and seek advice on personal and private matters, it would be unrealistic to expect that such disclosures would be considered confidential (No. 113-2010 CD, 2010 WL 4403285 at *2). 

Here the court ordered the plaintiff to produce his Facebook and MySpace user names and passwords and to preserve existing information and posts on these accounts.

These court rulings and others like them serve as a warning.  Information that you post for friends or colleagues may well end up as a piece of evidence in a trial.  A simple rant posting following an unpleasant appointment or difficult staff encounter reported in a Tweet could end up as a line of questioning in your deposition or trial.  Social media sites have become a new frontier for lawyers to explore in litigation so be careful what you post. 

The above discussion can be worrisome.  Here are some tips on how to protect yourself:

Own your name as a domain name: Log onto websites like or and buy the domain name of your private and practice names. Domain names typically cost around $7.99 a year. It is a small price to pay if a patient or competitor of yours decides they want to own your cyber identity. It may also be wise to buy pejorative derivatives of your name; for example:

Electronically Monitor Your Online Reputation: This is as simple as going to Google Alerts and type in your name. Other firms, such as Medical Justice, offer a much more specialized search service.  These services send you a note “as-it-happens” every time your name or your practice name is mentioned on the web. This allows you to react to any positive or negative comments in a timely manner.

Have your employees sign a social media policy: Defining what your employees can and cannot do both in the workplace and at home, needs to be spelled out. If you fire an employee for something they’ve said online, that needs to be spelled out in your own company’s policy or you could be subject to a wrongful termination suit.  These policies have become standard for larger institutions and help properly set expectations as to how staff and employees will use the internet.

Separate your personal social media activities from your professional activities: Healthcare providers should maintain both personal and private social media accounts. If you are worried about having to log in and out of multiple accounts a day you can use programs like or to manage your accounts. Having separate accounts keeps your personal and private lives separate. Friending patients may cross professional boundaries. There are also issues with HIPAA and the HITECH Act when communicating with your patients online so be careful. A common professional way for physicians to stay in touch with patients is to start a fan page. Search Fan Page on Facebook and they will provide you with step-by-step instructions to start one.

Attempt to encourage patients to review your practice online via rating sites: Physicians like yourself probably have hundreds if not thousands of patients but the truth is only a couple of them have taken time to review you online. The simple fact is the majority of your patients like you, but the few who don’t let their voices be heard by reviewing you on multiple rating sites. Those reviews could cast you in a negative light to potential patients. To brighten the scope of your image, find ways to encourage your patients to rate you online.  More accurate reviews will help marginalize negative outliers.  

All of this indicates that an individual’s online reputation may have a major impact upon litigation that the individual is engaged in.  In a very real sense, a defendant’s online reputation can become a major witness in his or her trial.  While many physicians view the importance of their online reputation in terms of practice development and patient volume, they should be concerned for a whole other reason.  Anyone engaged in litigation would be wise to begin taking action to address his or her online reputation.

Mike Sacopulos, JD, is general counsel for Medical Justice.  Run by physicians for physicians, Medical Justice is a membership-based organization that offers services and proprietary methods to protect physicians' most valuable assets – their practice and reputation. The company offers proactive services to deter frivolous medical malpractice lawsuits prevent Internet defamation and provide strategies for successful counterclaim prosecution. Medical Justice works as a supplement to conventional professional liability insurance.  For more information visit, email
Last Updated on Saturday, 17 September 2011 15:42
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