a. Oncologist was charged for consistent over-billing. Two insurance companies filed a complaint for the over-billing.
b. Hearing was held before a hearings examiner to determine whether the physician violated the MPA by over charging.
c. There is a conflict between the right to contract for fees with your patients and the responsibility of the state to sanction for over-billing.
d. Court held there was no evidence that he flagrantly overcharged. Although he did over-bill, he did not do so flagrantly. But the Board did not define “flagrant.”
e. Court looked at the standard of review, and that agencies’ decisions are usually upheld and the burden is on the other party to prove abuse. Decisions of an administrative agency are presumed to be supported by substantial evidence, and the burden is on the contestant to prove otherwise.
f. But the board nor the statute define “flagrant” and the Board has to prove both that the physician overcharged and that his overcharging was persistent or flagrant in order to conclude that the physician had violated the statute.
We have located some similar legal questions and legal question categories. Check out these challenging questions that askquestions about Health Care Law Cases and are similar to Give me a case brief on the case of Texas State Board of Medical Examiners v. Birenbaum.. Also, we have included a list of some of our more popular legal question categories. These categories are based on what everyone is asking and answering.