Jose Vela Jr

Healthcare Trial Lawyer | Former AUSA
Clark Hill PLC
Vela Healthcare Law Intelligence
DOJ, CMS & OIG enforcement
For providers, executives & private equity

[Jose Vela Jr @JoseVelaLaw]

SIX YEARS IN FEDERAL PRISON FOR THE CEO OF A DIGITAL HEALTH COMPANY.

Federal prosecutors looked beyond physicians. They prosecuted a CEO who orchestrated a business model that controlled clinical operations, displaced independent medical judgment, and profited at the expense of patients.

37 million Schedule II stimulant pills.
$90 million in revenue.
CEO: 6 years.
Clinical President: 2 years.

The company pays the fine. The C-suite does the time.

https://t.co/vjWzT6fjNT

#Healthcare #Telehealth #HealthcareFraud #DigitalHealth #DOJ

[Jose Vela Jr @JoseVelaLaw]

THERE IS NO NATIONAL PATIENT'S BILL OF RIGHTS.

Most Americans think there is. There isn't.

Several states, including New York, have adopted their own Patient's Bill of Rights, while federal regulations, accreditation standards, and hospital policies recognize many of the same patient rights.

If you were writing a National Patient's Bill of Rights, what would it include?

My Top 10:

1. Respect
2. Information
3. Informed Consent
4. Participation in Care
5. Privacy
6. Access to Medical Records
7. A Second Opinion
8. Make Your Own Healthcare Decisions
9. Continuity of Care
10. Be Heard

Which Right is most important? What Right would you add?

New York Hospital Patient's Bill of Rights:
https://t.co/60ruDqOIEx

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Vela Healthcare Law Insights

#HealthcareLaw #PatientRights #Physicians #Hospitals #HealthLaw

[Jose Vela Jr @JoseVelaLaw]

YOUR DOCTOR'S NAME IS ON THE DOOR. WHO'S REALLY IN CHARGE OF YOUR CARE?

California sued Carbon Health and Aspen Dental, alleging that non-physicians exercised excessive control over healthcare practices.

The US DOJ, OIG, and state attorneys general are increasingly scrutinizing private equity and MSOs in healthcare.

This is only the beginning.

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Vela Healthcare Law Insights

https://t.co/SHx3kyAdUS

#PrivateEquity #Healthcare

[Jose Vela Jr @JoseVelaLaw]

HAPPY FOURTH OF JULY! 🇺🇸

The Declaration of Independence explained why America sought independence: government derives its power from the consent of the governed.

The Constitution explained how that government would work: popular sovereignty, limited government, separation of powers, checks and balances, federalism, republicanism, and individual rights.

The Declaration announced the ideals. The Constitution built the structure. The Bill of Rights reinforced the limits.

#IndependenceDay #Constitution #AmericanHistory

https://t.co/Jmd02oTbTa
https://t.co/2DT3RZWfy5
https://t.co/TzRVpzLMYF
https://t.co/FYvfG6VjoJ

[Jose Vela Jr @JoseVelaLaw]

OIG ALERT: PROVIDERS CANNOT PAY FOR PREFERENTIAL ACCESS TO PATIENTS

A home health agency paid subscription fees to access a digital platform used by hospitals during discharge planning.

Providers that paid could receive and respond to referral requests immediately. Providers that did not pay were forced to rely on slower methods.

OIG concluded the arrangement could violate the Anti-Kickback Statute because providers were paying for access to referral opportunities involving Medicare patients.

The lesson extends far beyond home health. Healthcare providers should carefully evaluate whether they are paying for legitimate services or paying for preferential access to patients.

#Healthcare #AKS #Medicare #Compliance #Fraud #Medical #Health #Doctor #Hospital #Patient

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Vela Healthcare Law Insights

https://t.co/MlGLDQaGQS

[Jose Vela Jr @JoseVelaLaw]

MEDICARE NOW PAYS FOR GLP-1 WEIGHT-LOSS DRUGS.

Beginning July 1, 2026, eligible Medicare patients may obtain certain GLP-1 weight-loss drugs through CMS's new Medicare GLP-1 Bridge Program.

Providers, pharmacies, and patients should understand the eligibility requirements, prior authorization rules, coverage limitations, and compliance obligations before participating.

Stay informed.
Vela Healthcare Law Insights

https://t.co/EB4klln6Ch

#medicare #CMS #HHS #glp1 #Ozempic #Wegovy #Obesity #weightloss #physician #doctor #pharmacy #telehealth #telemedicine #Drug #Medication #Medicine #medical

[Jose Vela Jr @JoseVelaLaw]

MEDICAL SPA OWNER SENTENCED TO 45 YEARS IN PRISON.

According to prosecutors, a medical spa owner performed liposuction, Brazilian butt lifts (BBLs), breast augmentations, and tummy tucks beyond the scope of his license and training. Multiple patients reportedly suffered serious injuries.

State government and local law enforcement examined the owner's licensure, training, competency, supervision, delegation of clinical responsibilities, and authority to perform the procedures at issue. Prosecutors alleged that he seriously injured patients by performing procedures without a medical license.

When a patient is injured or dies, law enforcement and prosecutors often examine not only what happened to the patient, but who was authorized to provide the care and whether the required supervision and oversight actually existed.

Medical spa owners, physicians, medical directors, and advanced practice providers should ensure that only properly trained, licensed, and supervised healthcare professionals examine or treat patients.

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Vela Healthcare Law Insights

https://t.co/TlMXnNCbLi

#MedicalSpa #HealthcareLaw #PatientSafety #PhysicianSupervision

[Jose Vela Jr @JoseVelaLaw]

See: https://t.co/U9WjAdZk3N

[Jose Vela Jr @JoseVelaLaw]

🚨 455 defendants.

🚨 90 licensed healthcare professionals.

🚨 $6.5 billion in alleged fraud.

The 2026 National Health Care Fraud Takedown targeted wound care providers, telemedicine companies, hospice providers, behavioral health companies, and others.

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Vela Healthcare Law Insights

#Healthcare #HealthcareFraud #DOJ

[Jose Vela Jr @JoseVelaLaw]

WOUND CARE OWNER AND NURSE PRACTITIONER INDICTED FOR PREYING ON TERMINALLY ILL HOSPICE PATIENTS.

Federal prosecutors allege she billed Medicare and TRICARE more than $900 million, received approximately $300 million in payments, and submitted more than $1 million in claims per patient.

The indictment also alleges kickbacks, altered medical records, and inflated invoice prices.

#Healthcare #Medicare #Hospice #HealthcareFraud

[Jose Vela Jr @JoseVelaLaw]

National Clinical Lab Business and Its Owners Pay $30 Million to Settle US DOJ Kickback Claims

Physicians have opportunities every day to increase revenue, expand services, improve patient access, reduce overhead, and participate in new healthcare ventures. These opportunities come from laboratories, management companies, technology vendors, investors, consultants, and healthcare entrepreneurs, who promise to provide expertise, infrastructure, staffing, equipment, or operational support.

These business arrangements begin as an effort to expand services, improve efficiency, or create a new revenue stream, but can lead to a government investigation, payment suspension, recoupment, civil monetary penalties, False Claims Act lawsuit, criminal prosecution, exclusion, license revocation, and reporting to the National Practitioner Data Bank (NPDB).

Healthcare professionals and their organizations should carefully review their relationships and arrangements to protect their business, licenses, and reputation.

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Vela Healthcare Law Insights

https://t.co/TqtYaJgb7j

[Jose Vela Jr @JoseVelaLaw]

One in four working Americans is underinsured.

Five million more Americans could lose comprehensive health insurance coverage.

Alternative plans may cost less upfront, but cost much more when a serious illness or injury strikes.

Having health insurance and having comprehensive health insurance are not the same thing.

The next healthcare crisis may not be the uninsured. It may be the underinsured.

CMS Fact Sheet: https://t.co/Jxhkef7Dti

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Vela Healthcare Law Insights

#Healthcare #HealthInsurance #ACA #HealthcarePolicy

[Jose Vela Jr @JoseVelaLaw]

Denied. Then approved.

HHS OIG found that Medicare Advantage plans denied more than 56,000 post-acute care requests. Yet many of those denials were later overturned on appeal—including 95% of appealed denials for skilled nursing facility admissions.

When denials become approvals, patients, providers, OIG, and DOJ all start asking the same question:

Why was the request denied in the first place?

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Vela Healthcare Law Insights

https://t.co/ieiBP5IwIs

#Medicare #MedicareAdvantage #PriorAuthorization #Healthcare

[Jose Vela Jr @JoseVelaLaw]

MORE THAN 6,000 MEDICARE NUMBERS SOLD ON THE BLACK MARKET.

According to a federal indictment, patient names, dates of birth, and Medicare identifiers were allegedly purchased, resold, and used to fuel a $5M+ Medicare fraud scheme.

Healthcare fraud does not always begin with a false claim. Sometimes it begins with a photograph of a computer screen.

https://t.co/q4cvyqzUS6

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Vela Healthcare Law Insights.

#HealthcareFraud #Medicare #DOJ #HHSOIG

[Jose Vela Jr @JoseVelaLaw]

Thank you to Ron Shinkman and Health Payer Specialist for including my perspective.

Article:
https://t.co/zUSWbtVNiU
#AI #Healthcare #Insurance #Compliance

[Jose Vela Jr @JoseVelaLaw]

Artificial intelligence is rapidly becoming part of everyday operations in the healthcare and insurance industries.

The challenge is no longer whether AI can improve efficiency. The challenge is whether organizations can demonstrate that AI-enabled systems are accurate, properly supervised, validated, transparent, and compliant with legal and regulatory requirements.

I recently spoke with Health Payer Specialist about these issues and the growing importance of AI governance, oversight, and accountability.