Rivas Goldstein, LLP Austin Health Care Lawyer | Texas Medical Licensing Attorney 2026-09-01T19:16:57Z https://www.rivasgoldstein.com/feed/atom/ WordPress On Behalf of Rivas Goldstein, LLP <![CDATA[DOJ emphasizes healthcare fraud in new enforcement plan]]> https://www.rivasgoldstein.com/?p=50977 2026-08-24T19:21:09Z 2026-09-01T19:16:57Z M. McDonald, Assistant Attorney General for the National Fraud Enforcement Division of the Department of Justice, recently announced a plan to prioritize rooting out fraud within the United States. The announcement points to five areas of focus: healthcare fraud, internal revenue, global trade and corporate misconduct as well as rebuilding public trust. 

A new era of fraud enforcement

The creation of the National Fraud Enforcement Division, announced by Attorney General Todd Blanche in April 2026, signals a shift in how the federal government approaches white-collar crime. This new division aims to consolidate resources and expertise to target fraud more aggressively. Healthcare fraud has emerged as one of five key enforcement targets.

Five areas under the microscope

The memorandum identifies specific areas of focus that will receive concentrated prosecutorial attention, including allegations of the following:
  1. Telemedicine fraud involving inappropriate prescribing or billing for services not rendered
  2. Medicare and Medicaid billing schemes that drain billions from federal healthcare programs
  3. Opioid diversion operations that fuel the ongoing addiction crisis
  4. Hospice fraud exploiting end-of-life care programs
  5. Deceptive marketing practices that mislead patients and payers
The agency states these areas represent some of the most costly and harmful fraud schemes affecting the American healthcare system. The DOJ's focus on telemedicine is particularly noteworthy given the explosive growth of virtual care during and after the pandemic.

What this means for healthcare organizations

Healthcare providers, technology companies and related entities must recognize that business as usual will no longer suffice. The heightened enforcement environment demands proactive compliance measures. Organizations should conduct comprehensive reviews of their billing practices to help better ensure accuracy and appropriate documentation. Marketing materials and patient communications also require scrutiny to check for any potentially misleading claims. Telemedicine programs deserve special attention, particularly regarding prescribing protocols and medical necessity determinations. Perhaps most importantly, as artificial intelligence and algorithmic decision-making become more prevalent in healthcare, organizations must work to ensure these technologies comply with applicable regulations and do not facilitate fraudulent billing or inappropriate care decisions.

The path forward

The DOJ's announcement serves as both warning and opportunity. While enforcement will intensify, organizations that invest in robust compliance programs can protect themselves from liability while improving patient care. The message from the National Fraud Enforcement Division is unmistakable: healthcare fraud will be prosecuted vigorously, and those caught in the crosshairs should take the matter seriously. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[Can a nurse have a relationship with a patient? What Texas nurses need to know]]> https://www.rivasgoldstein.com/?p=50976 2026-08-20T18:03:31Z 2026-08-25T18:02:36Z often go into nursing because they have a desire to help others. This path can lead to meeting lots of interesting people, and it is not uncommon for those interactions to lead to something more. This can leave a nurse wondering if it is possible to pursue a relationship with a patient or if romance could threaten their professional licensure. It is important to understand that such relationships can jeopardize your career and violate professional boundaries.

Understanding the Texas Board of Nursing's position

The Texas Board of Nursing (BON) takes boundary violations seriously. According to the Texas Nursing Practice Act and BON rules, engaging in romantic or sexual relationships with patients qualifies as professional misconduct. Those behind the rule point to the inherent power imbalance in the nurse-patient relationship, where patients are vulnerable and depend on nurses for care as a primary reason for the ban. Consequences for a violation are serious. If the Board determines a violation has occurred disciplinary action can range from a warning to loss of licensure.

When does a patient stop being a patient?

Many nurses wonder if there is a safe waiting period after the nurse-patient relationship ends. Unfortunately, Texas law does not specify an exact timeframe. The BON evaluates each case individually, considering the circumstances of the professional relationship and how it ended. Even after formal care has ended, the BON may still consider the relationship inappropriate if the patient remains vulnerable or if the nurse leveraged information or trust gained during the professional relationship.

Protecting your license

The safest approach is to avoid romantic or sexual relationships with current or former patients entirely. If you find yourself attracted to someone under your care, the ethical course of action is to transfer that patient's care to another provider. Your nursing license represents years of education, training and dedication. Do not risk it for a relationship that could result in allegations of a boundary violation. When in doubt, always err on the side of professionalism and seek guidance from the Texas Board of Nursing. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[Reducing nurse burnout: The hidden role of operational efficiency]]> https://www.rivasgoldstein.com/?p=50972 2026-08-10T18:31:51Z 2026-08-20T18:31:09Z of nurses report significant stress and burnout. While short staffing and high patient ratios remain concerns, a national survey of more than 2,600 nurses reveals a less obvious culprit: operational friction. The daily frustrations of inefficient workflows, supply shortages and administrative burdens are quietly eroding the nursing workforce and costing healthcare organizations between $40,000 and $60,000 per nurse replacement.

Beyond staffing: Addressing operational barriers

Healthcare leaders often focus on hiring more staff, but the data tells a more nuanced story. Fifty-one percent of nurses feel undervalued by management, and only 60% state they would still choose this profession if given a chance to start over. These findings point to systemic issues that no amount of recruitment can solve alone. Instead, it is important leaders consider the following measures to address operational barriers:
  • Consolidate vendor relationships to simplify purchasing workflows
  • Implement centralized platforms with standardized product catalogs
  • Reduce time spent searching for supplies across multiple systems
These changes may seem minor, but they directly address the non-clinical tasks that nurses consistently cite as major sources of frustration. When administrative burden decreases, nurses can redirect their energy toward the work they were trained to do.

Creating environments that support recovery

Physical workspace improvements and reliable supply chains also play crucial roles in reducing burnout. Ergonomic workstations, well-equipped breakrooms and automated inventory tracking systems reduce both physical fatigue and cognitive load. Standardized signage and centralized communication platforms eliminate the confusion caused by fragmented information systems. These operational improvements deliver measurable benefits. Nurses experience fewer interruptions, encounter more predictable workflows and spend less time hunting for essential supplies.  The cumulative effect is a work environment that supports rather than undermines clinical performance. This better ensures nurses provide high quality of care and helps to mitigate the risk of allegations of a mistake that could jeopardize their professional license.

The business case for operational excellence

Healthcare leaders are uniquely positioned to address these challenges. By focusing on the daily experience of frontline clinicians and systematically removing operational friction, they can directly influence retention, satisfaction and patient outcomes. The research shows that reducing nurse burnout requires more than hiring initiatives. It demands a comprehensive approach that values operational excellence as a cornerstone of workforce resilience. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[Fraud at the pharmacy? 6 common allegations ]]> https://www.rivasgoldstein.com/?p=50962 2026-08-19T22:00:00Z 2026-08-19T20:00:46Z owners operate in a highly regulated environment where billing and documentation must align with federal and state rules. Even well run pharmacies can draw scrutiny from Medicare, Medicaid and private insurers when claims data, prescribing patterns or inventory records appear inconsistent. When investigators suspect intentional deception or reckless disregard for billing requirements, allegations may escalate into health care fraud cases with serious financial and professional consequences.

Common examples of health care fraud within pharmacies

Investigations often begin with audits, whistleblower complaints or data analytics that flag unusual utilization. Common examples include:
  1. Billing for prescriptions not actually dispensed, including refills processed without patient pickup  
  2. Upcoding or misrepresenting days’ supply, quantity or dispensing fees to increase reimbursement  
  3. Submitting claims for non covered drugs as covered alternatives or using incorrect National Drug Codes  
  4. Waiving copays routinely to induce business when prohibited by payer rules  
  5. Dispensing without a valid prescription or continuing therapy after a prescription has expired  
  6. Paying or receiving kickbacks tied to referrals, patient steering or prescriber arrangements
The government will look through evidence for issues with documentation, compliance or intent depending on the available evidence. Even seemingly small practices, such as copying prior directions or relying on verbal authorizations without proper records, can become a bigger issue when auditors compare claims to documentation.

Potential penalties and collateral consequences

Pharmacy owners are wise to understand potential penalties. The most common is often civil repayment demands and additional damages under the False Claims Act but criminal charges for health care fraud, wire fraud or related offenses can also apply and may carry the risk of imprisonment. Exclusion from Medicare and Medicaid is also possible, which can effectively end a pharmacy’s ability to operate. The pharmacist may also face state board discipline, including license suspension, probation or revocation.   The practical impact is often broader than the headline penalty. Even before a case resolves, payers may suspend payments, terminate network participation or impose prepayment review that strains cash flow. Pharmacy owners can reduce risk by auditing claims regularly and documenting medical necessity and prescription validity with care. When you receive an audit notice, subpoena or contact from an investigator, early legal guidance can help preserve records, manage communications and evaluate exposure. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[What Not to do at a Texas Board of Nursing Informal Settlement Conference]]> https://www.rivasgoldstein.com/?p=50971 2026-08-19T19:24:04Z 2026-08-07T17:59:01Z a Texas Board of Nursing Informal Settlement Conference (ISC) can be one of the most stressful experiences in your professional career. While preparing what you should do is important, understanding what to avoid is equally critical. A wrong move during your hearing could jeopardize your nursing license and your livelihood.

Never appear unprepared or unrepresented

Walking into a board hearing without proper preparation is perhaps the biggest mistake you can make. The Texas Board of Nursing takes these proceedings seriously, and you should too. Consider retaining an attorney with experience in nursing license defense. These professionals understand the nuances of board hearings and can help you navigate the complex process. Arriving without legal counsel puts you at a significant disadvantage against the board's legal team.

Avoid these mistakes during your ISC

Your behavior and presentation during the Informal Settlement Conference can significantly impact the outcome. The following will not help your case and can put you at a disadvantage. Do your best to avoid these strategic missteps:
  • Argue. Do not argue with board members or become defensive. Maintaining composure shows professionalism and respect for the process, even when questions feel accusatory or unfair.
  • Lie. Do not provide inconsistent statements or lie. Board members review your case file and will likely notice discrepancies between your testimony and documented evidence.
  • Interrupt. Do not interrupt or speak out of turn. Wait for your opportunity to respond and follow proper hearing protocols at all times.
  • Fail to take the matter seriously. Do not dismiss the seriousness of allegations. Remember, it is possible for the Board to revoke your nursing license. Minimizing concerns or making excuses demonstrates a lack of accountability and professional insight. 
These behaviors can damage your credibility and suggest you are not taking responsibility for your actions.

Do not neglect your appearance and attitude

First impressions matter in formal proceedings. Dress professionally as you would for an important job interview. Business attire demonstrates respect for the board and the gravity of the situation. Additionally, your attitude throughout the hearing should reflect humility and professionalism. Appearing arrogant, dismissive or indifferent will work against you.

The bottom line: Preparation matters

A Texas Board of Nursing ISC is not the time for improvisation or casual attitudes. Avoiding these common missteps can mean the difference between keeping your license with conditions and losing it entirely. Take the process seriously, seek qualified legal representation and approach your hearing with professionalism. Your nursing career depends on the decisions you make before and during this important proceeding. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[Hospice owners take note: Common issues that trigger allegations of fraud]]> https://www.rivasgoldstein.com/?p=50969 2026-07-28T17:02:39Z 2026-08-04T16:58:16Z Medicare fraud in hospice care has become an increasing focus for government investigators. Understanding common violations can help those who own or invest in these health care organizations avoid costly legal battles.

The growing scrutiny of hospice billing practices

The Office of Inspector General and Department of Justice have intensified their oversight of hospice providers in recent years. With Medicare spending on hospice care exceeding $26 billion, regulators are closely examining billing practices to identify potential fraud and abuse. Hospice owners must recognize that even unintentional errors can trigger investigations and result in severe penalties.

Common fraud allegations against hospice providers

Several types of fraud cases appear repeatedly in hospice settings. Being aware of these patterns can help you implement stronger compliance measures:

Eligibility-related violations:

  • Enrolling ineligible patients 
  • Keeping patients on hospice care long after they have stabilized or improved
  • Falsifying physician certifications to justify continued enrollment
  • Pressuring physicians to certify patients who clearly do not qualify for end-of-life care
These eligibility violations represent the most common type of hospice fraud allegation. In a recent example, the government is moving forward with health care fraud charges connected to over $3 million in false claims due to enrolling allegedly ineligible patients. Prosecutors argue that companies like the one currently facing allegations knowingly enrolled patients to generate revenue rather than to provide genuine palliative care.

Billing and service violations:

  • Billing for higher levels of care than actually provided to patients
  • Submitting claims for services that were never rendered
  • Billing for visits that did not occur or were significantly shorter than documented
  • Charging for medications or medical equipment never delivered to patients
These billing violations often emerge during audits when documented services cannot be verified through medical records or patient interviews.

Protecting your hospice organization

Prevention begins with robust compliance programs. Ensure your clinical team understands Medicare eligibility criteria and documents all patient interactions thoroughly. Regular internal audits can identify billing errors before they become legal problems. Training staff on proper documentation and billing procedures can help to create a culture of compliance throughout your organization. Hospice fraud allegations can devastate your business and result in millions of dollars in penalties, exclusion from Medicare programs and even criminal prosecution. By understanding common fraud patterns and implementing strong compliance measures, you can provide quality end-of-life care while protecting your organization from legal exposure. When allegations do arise, it is wise to promptly consult experienced health care fraud to begin tailoring a defense strategy to the particulars of your case. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[Return on humanity is becoming a boardroom metric]]> https://www.rivasgoldstein.com/?p=50966 2026-08-04T20:57:46Z 2026-07-28T19:09:38Z care leaders have long relied on return on investment to guide staffing models, service lines and technology purchases. Increasingly, however, executives and governing boards are recognizing the impact of a failure to remember another important factor: the return on humanity. In practical terms, this means measuring whether operational decisions protect the people who deliver care and whether the patient experience reflects dignity, access and trust.

Clinician burnout remains a business and legal issue

Physicians, nurses and allied professionals are struggling with burnout like never before. High patient volumes, administrative burden, staffing shortages and general frustration have created conditions where even resilient teams are fraying. Burnout is not only a human tragedy. It is also a driver of turnover costs, patient safety events and workplace conflict that can escalate into claims, investigations or reputational harm. Organizations that invest in measures to help reach a more realistic work life balance for these professionals often see improved retention, fewer disruptions in continuity of care and stronger patient satisfaction scores.

Patient-centered access can pay dividends

Return on humanity also shows up on the patient side of the equation. Patients remember whether a system made it easy to get help, understand next steps and feel heard. Small operational choices can either build loyalty or push patients to competitors, urgent care centers or online alternatives. Investments in this return on humanity can strengthen relationships with patients. 

Humanity is a durable competitive advantage

Those looking to invest or are already active players in the health care industry are wise to recognize that a return on humanity is not a soft concept. It is a disciplined approach to protecting the workforce and serving patients in ways that sustain trust. Health care organizations that prioritize clinician well-being and patient access are often the ones that achieve stronger performance, lower risk and more durable profitability. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[The high cost of inaccurate coding: How CMS is recouping Medicare Advantage overpayments]]> https://www.rivasgoldstein.com/?p=50964 2026-08-04T18:03:49Z 2026-07-21T15:22:52Z Advantage plans remain under scrutiny as the Centers for Medicare and Medicaid Services (CMS) continues an aggressive strategy to identify and recoup overpayments tied to risk adjustment practices. Current CMS Administrator Dr. Mehmet Oz has doubled down on his push to expedite audits in an effort to increase recoveries. These audits are often triggered by allegations that the organization submitted the diagnoses without adequate clinical support, inflating patients’ illness severity and increasing plan payments.

What is the agency’s plan?

CMS is expanding and refining its audit approach, particularly through Risk Adjustment Data Validation (RADV) audits. These audits test whether diagnoses used to calculate risk scores are supported by medical record documentation and meet applicable coding rules. When CMS determines that a diagnosis is not properly supported, it may treat the related payment as an overpayment and seek repayment, sometimes across a broader population through extrapolation. These RADV audits have received pushback, most recently when the Northern District of Texas tossed out the agency’s RADV final rule. In its decision, a federal judge removed the agency’s ability to extrapolate a sample audit to the entire organization. Regardless, CMS’s strategy continues to reflect a broader policy objective: to vigorously review documentation and root out bad coding practices that prioritize revenue over clinical accuracy.  Those within this field can use the following measures to help to better ensure they have what they need to withstand the scrutiny of an audit:
  1. Records. Medical record support for each submitted diagnosis, including clear provider documentation and appropriate signatures
  2. Correct coding. Coding accuracy and adherence to risk adjustment rules, including specificity and proper linkage to assessment and treatment
  3. Oversight. Oversight of vendors and downstream entities, such as risk adjustment consultants and chart review providers
With these measures in place, your business should have the information it needs to defend claims if it faces agency scrutiny.

What should my health care business do if we get an overpayment notice?

Those who find their organizations subject to an audit are wise to check the correspondence and note any listed deadlines. Gather and preserve records, including the notice, underlying claims data and relevant medical records before addressing the allegations. The CMS is likely to continue its crackdown on abuse of the Medicare Advantage program. As such, those who operate in this area should continue to implement the measures noted above to protect their business in the event of an audit.  Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[The ripple effect: How a Texas board complaint can threaten your DEA registration]]> https://www.rivasgoldstein.com/?p=50960 2026-07-06T15:53:07Z 2026-07-14T15:51:57Z Texas Medical Board (TMB) complaint can feel like a state level problem with a state level solution. In reality, it often has federal consequences. Physicians, advanced practice providers and pharmacists sometimes learn too late that a TMB investigation can become the first domino in a chain that ends with a Drug Enforcement Administration (DEA) “Notice of Intent” to revoke or suspend a registration. Understanding how that ripple effect works is essential to protecting your license, your ability to prescribe and your future in your chosen profession.

Why a TMB investigation rarely stays in Texas

The DEA does not need to independently prove every underlying allegation to take action. Federal law allows the agency to evaluate whether a registrant’s continued registration is consistent with the public interest. When a state board opens an investigation, issues an order or imposes restrictions, the DEA may view that as a signal to scrutinize controlled substance privileges. It is important that those who rely on these privileges understand that state licensure and federal registration are often linked. If your state authority is questioned, limited or revoked, your DEA status can become vulnerable.

How a “Notice of Intent” can develop

A Notice of Intent is the DEA’s formal step toward revocation, suspension or denial of a registration. It typically outlines the legal basis for action and provides an opportunity to respond, often through an administrative hearing process. The timeline can move faster than many clinicians expect, especially when there is a public board order or an emergency restriction.  It is important to note that although correspondence from the DEA is serious, not all correspondence is legitimate. Scammers have presented themselves as officials and made threats to professionals, demanding payment to mitigate the risk of formal investigations. The agency has clarified that it does not contact professionals in this manner and will not demand payment over the phone. Treat any such correspondence with care as it is likely an attempt at fraud. Legitimate communications often come through mailings. Legal counsel can review any correspondence and help determine the best course of action.  In addition to carefully reviewing all correspondences it is important that professionals remember that a TMB complaint is not only a licensing issue. It can trigger federal scrutiny that threatens your DEA registration and your ability to practice. An early, coordinated approach that treats the state investigation as the beginning of a broader risk, not the end of one can help to better ensure a more favorable outcome. Attorney John Rivas is responsible for this communication.]]> On Behalf of Rivas Goldstein, LLP <![CDATA[Opportunity or liability? Checking compliance before expanding your business]]> https://www.rivasgoldstein.com/?p=50950 2026-07-27T19:41:58Z 2026-06-16T18:55:24Z and other licensed clinicians are frequently approached with business opportunities like partnerships or ownership interests in ambulatory surgery centers or diagnostic labs. Some are perfectly lawful and can not only lead to financial benefits but also benefit your patients. Others can jeopardize your license, trigger audits or create civil and even criminal exposure. The key question is often not whether the idea sounds innovative, but whether the arrangement respects professional licensing rules, billing requirements and fraud and abuse restrictions.

When an opportunity is usually compliant

A business opportunity is more likely to be compliant when it preserves independent clinical judgment, aligns with your scope of practice and uses truthful documentation and billing. Rules that guide these relationships often focus on the physician’s duty to practice medicine with appropriate standards, proper delegation and adequate supervision. Federal rules layer in requirements affecting referrals, prescribing and billing for federal healthcare program beneficiaries. Even when these elements are present, the opportunity may still require careful guardrails, but the risk profile is typically manageable.

When an opportunity is not compliant or high risk

Red flags that should grab your attention include any interference with medical judgment or an arrangement that resembles payment for referrals. Federally, the Anti Kickback Statute can apply when remuneration is tied to referrals or federally reimbursable business. The Stark Law can restrict physician referrals for certain designated health services where there is a financial relationship, unless an exception applies. The False Claims Act can create major exposure if claims are not supported by medical necessity or accurate documentation. In Texas, additional risk often arises from the corporate practice of medicine doctrine, fee splitting restrictions and improper delegation to nonphysicians.  If one or more of these factors are present, the opportunity may be unlawful as structured even if the underlying service is legitimate.

Practical next steps

Those who are considering a proposal are wise to ask for the full proposed deal terms in writing, including who owns what, who bills, patient referrals and clinician payment. Then have counsel review federal fraud and abuse implications and Texas specific licensing, delegation and corporate practice constraints for compliance concerns. Attorney John Rivas is responsible for this communication.]]>