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Mandatory COVID-19 Vaccine and Incentives

by admin on June 17, 2021 No comments

Can an employer mandate a COVID-19 vaccination?  And if so, are there exceptions/exclusions that must be addressed?  Since the COVID-19 vaccines were first approved for emergency use, the debate has raged as to whether employers can or should require employees (as a condition of employment) to be vaccinated.  And, with large numbers on both sides of the debate, the answer, while clear from a legal standpoint (at least for the moment at the federal level) is not without controversy or consequences.

Requirements for Mandatory Vaccine Policies

Health care employers have long required flu vaccines of their employees, absent a medical reason or religious belief.  Accommodations have been made as required for those who cannot receive the vaccine.  And mandatory vaccines in the health care industry provide some protection for the health and safety of patients and the care providers. The same rationale and rules apply to the COVID-19 vaccine.

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4 Healthcare Laws That Are Protecting Patients’ Rights

by admin on June 14, 2021 No comments

Healthcare laws exist to ensure that patients have the best care possible. If they don’t get the treatments they expect, these patients can lean on legislative acts to get relief. And regulatory agencies can step in and close down those groups that don’t follow healthcare acts, so no future patients are harmed.

Multiple healthcare acts exist, but in this piece, we’ll focus on those devoted to protecting the rights of patients.

4 Healthcare Laws to Know

Healthcare acts protecting patient privacy are likely well-known to most consumers and professionals. These are the laws we talk about in common conversations about the care we get when we visit the doctor.

This list of healthcare laws isn’t comprehensive, but it can give you an idea of the landscape regarding patient rights.

These are four healthcare laws to know:

  • ACA: The Affordable Care Act is commonly associated with insurance. Under the legislation, consumers can tap into programs to help them pay for medical expenses. But the law also includes regulations regarding preexisting conditions and covered care.
  • EMTALA: The Emergency Medical Treatment and Labor Act allows patients to head to the emergency room to get care even if they can’t pay the bill that comes when treatment is complete.
  • GINA: The Genetic Information Nondiscrimination Act ensures that people won’t face discrimination based on the results of genetic testing. If patients participate in a test and some issue is revealed, they can fight back if their employers penalize them for the results.
  • HIPAA: The Health Insurance Portability and Accountability Act includes rules that protect patient privacy. Patients can limit who sees their information, and they can ask for compensation if a breach occurs.

Again, this list of healthcare laws isn’t meant to be comprehensive. Instead, think of it as a research starting point.

Moving Beyond Healthcare Laws

Medical professionals must comply with applicable healthcare acts and laws. But they’re also guided by their ethics, including some versions crafted by oversight agencies.

For example, the American Medical Association has a formal Code of Medical Ethics that all physicians commit to. These rules cover how doctors relate to their patients, how they communicate medical news, and more.

Also, some healthcare professionals are guided by rules that originate at the state level. A hospital, for example, might have state laws regarding patient care. They can’t take in more cases than staffing rules allow even if they want to help more people.

If you’re confused about the legal landscape in your area, let us help. We have a skilled team that can help you understand your local laws. Contact us to find out more.

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What Law Regulates the Healthcare Industry?

by admin on June 9, 2021 No comments

Healthcare officials often chuckle when they see questions like, “Who regulates health care?” If only one law or organization oversaw every aspect of healthcare in this country, life would be a lot simpler for medical professionals and the organizations in which they work.

In reality, many different organizations are involved with regulating healthcare. And they enforce rules and regulations that may appear at the federal, state, or local level.

Who Regulates Health Care at the Federal Level?

The largest and most complex healthcare laws originate at the federal level. They are enforced by a variety of different agencies.

These three main federal agencies oversee healthcare organizations:

  • The U.S. Department of Health and Human Services: The Health Insurance Portability and Accountability Act (HIPAA) passed in 1996 includes multiple rules regarding patient privacy and recordkeeping. The DHS is responsible for enforcing those laws.
  • The U.S. Inspector General: Seated within the DHS, the Office of the Inspector General creates compliance documents to help hospitals and doctors comply with a bevy of federal laws.
  • The United States Department of Labor: The Occupational Safety and Health Administration creates rules that ensure a safe workplace. Since so many people work in healthcare, the rules are critical.

All of these groups offer guidance to help organizations comply with their rules and regulations. But compliance means paperwork. Hospitals and other care organizations must prove that they both understand and comply with the rules.

Who Else Is Involved in Regulating Health Care?

Healthcare providers are also required to abide by laws that originate from outside the federal system. The landscape varies from organization to organization.

A provider might have rules that originate in:

  • State agencies. Some states have rules regarding workers’ rights, patient access, and payment caps.
  • Federal payors, like Medicare. Some organizations must follow rules about payment options.
  • Private payors. Some companies like Blue Cross have rules about payments and access.
  • Nonprofit boards. Some hospitals and other care organizations are ruled by a board of directors. That group may also have compliance rules.

The landscape can be complex. An organization may face competing or conflicting rules regarding patient care and payments.

Navigate Health Care Industry Regulations

Healthcare providers need to focus on patient care, not paperwork. As one of the largest healthcare law firms in the nation, we can help. Let us assess your regulatory environment and help you come up with a comprehensive compliance plan. We can help you craft appropriate reports too, so you can prove you’re doing your job. Contact us to find out more.

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What Is Tort Law in Healthcare?

by admin on June 6, 2021 No comments

Tort laws in healthcare sound complicated. In reality, the underlying concepts are easy to understand.

A patient feels a doctor, medical facility, or other healthcare organization provided harmful services. That patient can use tort in healthcare to request compensation for the harms endured.

Tort Law in Healthcare Explained

If you don’t have a background in legal terms, understanding tort laws in healthcare takes a bit of time. But in general, know that a “tort” is a fancy way of saying “malpractice.”

Medical torts are triggered when a healthcare professional or organization causes patient injury. The aggrieved party files a suit and asks for compensation due to the damage.

These are a few of the issues that might trigger a tort in healthcare:

  • Diagnosis. A doctor misses a critical point and fails to issue a diagnosis, or the doctor interprets results improperly and misdiagnoses a patient.
  • Procedures. The doctor offers a treatment that isn’t needed, or the patient has a surgery performed on the wrong site.
  • Care. The patient is forced to leave the facility too quickly, or the patient doesn’t get proper instructions to help prevent complications.

This is a short, non-exhaustive list. In general, tort laws in healthcare are made to help patients fight back when something goes wrong with their care. Almost any complication you can think of could be part of tort law.

4 Legal Elements in Medical Torts

To win a case, the patient must show that the professional or organization was negligent when providing care, and that negligence caused an injury that deserves compensation.

Cases like this rest on four legal elements:

  1. Duty: The patient must prove the existence of a doctor-patient relationship. That connection requires the doctor to offer adequate care.
  2. Breach: The patient must prove that the doctor violated that relationship and the duty to provide care.
  3. Consequence: The patient must prove that the breach caused an injury.
  4. Damage: The patient must attach an appropriate monetary award to the breach.

In most cases, patients need competent legal representation. These aren’t issues they can win by acting as their own lawyers. And professionals need legal help too.

Assistance With Tort Law in Healthcare

If you’re facing a case like this, it’s critical to have an expert team on your side. You’ll need to gather information, talk coherently in court, and plead your case. Let us help you.

We focus exclusively on healthcare, and our team is ready to help. A consultation starts the process. Contact us to get started today.

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A Legislative “Vaccine” for Claims Against Florida Healthcare Providers

by admin on June 4, 2021 No comments

On March 29, 2021, Florida Governor Ron DeSantis signed the “Civil Liability for Damages Related to COVID-19 Act” into law. The Act was designed to shield businesses from COVID-19 liability claims, and includes a specific section dedicated to protecting healthcare providers. While the protections for healthcare providers are not as robust as those granted to other businesses, the immunity provided by the law (Florida Statutes s768.381) is significant.

The protections apply to virtually all Florida healthcare providers, regardless of whether they are individuals, agencies, or facilities; and cover all “COVID-19 related claims.” The types of claims covered are those arising from:

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Medical Spa Industry Is Booming But is Regulation Keeping Up?

by admin on June 3, 2021 No comments

medical spa lawMedical Spas nationwide, but specifically in Florida, have been opening up at a staggering pace. For many reasons, including new services, technological advances, and lax regulations, the opportunities for medical spa businesses are endless.

In 2010, there were about 1,600 medspas operating in the United States generating about $1.1 billion in revenue (about $700,000 per medspa on average). By 2018, these numbers increased to over 5,000 medspas generating about $7 billion-$8 billion in revenue (about $1.4 million per medspa on average). The number is expected to grow to over 10,000 medspas by 2023 with about $18 billion-$20.7 billion in revenue.

While medical spa owners have taken advantage of these opportunities, state authorities have yet to keep up. The medical spa industry is largely unregulated, whether that be due to the nature of the services provided, or the explosive growth in this alternative type of medical clinic. On top of that, there’s been a expansion in scope of practice and supervision requirements for certain providers, including nurse practitioners.

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What Is the New Healthcare Law?

by admin on June 2, 2021 No comments

Skim through social media posts and blogs, and you might believe that there’s a new healthcare law in the books. Otherwise, why would so many people ask questions like, “When does the new healthcare law take effect?” and “What is the new healthcare reform law?”

It’s critical for healthcare professionals to know how reform laws work and when they take effect. But it’s also very easy to get overwhelmed and confused by the ever-changing landscape.

Let’s break things down.

What Is the Affordable Care Act?

The health care reform law enacted in March 2010 is the Affordable Care Act (ACA). It’s also commonly known as Obamacare and the new healthcare law.

The ACA is far from new. Chances are, you’ve heard of it or billed patients using this form of insurance within the last decade. Key benefits of the legislation include:

  • Subsidies. People with lower incomes get help with premiums.
  • Penalties. Those who don’t get health insurance are dinged for that decision.
  • Expansions. Some states lowered Medicaid eligibility rules.
  • Marketplaces. People can sign up for health insurance through programs run at the state or federal level.

The bill contains many more provisions, including some involving preexisting conditions and others involving covered services. There’s a lot to unpack, and sometimes, consumers get lost in the details.

What Is the New Healthcare Law?

When people ask questions like, “When does the new healthcare law take effect?,” they’re reading news articles about changes.

The short answer: There is no new healthcare law.

The longer answer: The older legislation is changing. For example:

  • Expansions were enacted. The Biden administration allowed for special enrollments due to the pandemic. And some states reviewed their plans to increase Medicaid enrollments.
  • Premiums decreased. Cost-sharing programs announced by the Biden administration reduced costs, allowing some people to buy plans for about $10 per month.
  • Legislation could change things. A lawsuit filed in late 2020 asks the Supreme Court to consider whether the Affordable Care Act is unconstitutional.

In an environment like this, it pays to watch the news carefully and monitor how coverage and eligibility may change.

But it’s also wise to take the long view. Tiny shifts and ongoing legislative battles are unlikely to change your day-to-day work as a healthcare administrator. Don’t panic about the headlines.

Make Sense of the Affordable Care Act

As a boutique, full-service law firm focused exclusively on healthcare, we know the ins and outs of the ACA from the perspective of consumers, providers, and payers. We’d love to help you understand what the law means and how you should react to it. Contact us to find out more.

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Routine Waiver of Patient Financial Responsibility – A Wolf in Sheep’s Clothing

by admin on May 19, 2021 No comments

By: Michael Silverman

While not a ‘classic’ kickback – such as the scenario of a practitioner receiving remuneration in exchange for a prescription or referral of healthcare business – the routine waiver of patient financial responsibly by a healthcare provider ALSO constitutes healthcare fraud, even for commercially insured patients!

Unfortunately, such a serious violation does not readily come to mind for many of those operating in the healthcare space, but its relatively straightforward once you think about it. In essence, a financial incentive is being provided to the patient to utilize the services of a certain healthcare provider by virtue of that individual not being subjected to out-of-pocket expense they normally would be subjected to if they were to utilize another similarly situated provider.

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COVID Home Health Care Trend Here to Stay

by admin on May 17, 2021 No comments

With governments locking down communities to combat the COVID-19 pandemic, health care providers and practitioners scrambled to find ways to deliver care to patients at their homes or residences. CMS relaxed restrictions on providing health care via telehealth, allowing for all Medicare patients to receive care via two-way, audio and video communications, and even via telephone calls notwithstanding that patients may not reside in rural zip codes. Hospitals pivoted to providing services to patients in their homes, again using telehealth modalities or by deploying practitioners to a patient’s home. Skilled nursing facilities also adopted strategies of keeping patients in their homes, deploying needed skilled caregivers to the patient. And while home health services may have hit a lull in the first couple months of the pandemic, services provided by home health agencies soon started to soar. Home health agencies started to become busier than ever, with many providers reporting overall growth due to demand to receive services at home instead of hospitals, skilled nursing facilities or nursing homes.

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Fraud & Abuse Healthcare Law

by admin on May 12, 2021 No comments

Healthcare fraud law should be easy to understand. If you don’t set out to lie, cheat, or steal to make money, you should be safe, right?

Unfortunately, the laws can be incredibly complex. Add in partnerships and sophisticated work-sharing agreements, and untangling the mess of responsibility could be even more difficult.

We’ll explain a few examples of healthcare law and fraud to make the problem easier to understand. But know that it’s always wise to contact a lawyer when you think you’re engaged in activity that could be considered fraudulent.

Inadvertent Healthcare Fraud Cases

Sometimes, the decisions you make as a healthcare professional break the laws, even if you never intended to do so.

Consider the Stark Law. Under that statute, you’re not allowed to refer a Medicare patient to any entity with which you have a financial relationship. In theory, you could break that law by:

  • Referring patients for tests and accepting a portion of the fees billed for those tests.
  • Giving your doctors an incentive for some kinds of tests.
  • Improperly paying your physicians
  • Making an arrangement with a medical center and promising to refer patients for some kinds of tests.

Inadvertent fraud is real, and these cases are complex. It’s wise to work with a lawyer, especially if healthcare arrangements are involved.

What About the Healthcare Fraud Law False Claims Act?

You can’t submit Medicare or Medicaid claims you know are fraudulent. Doing so is a violation of the False Claims Act, and fines are steep.

Typically, healthcare professionals know that they’re breaking this particular fraud law. They doctor the paperwork and hope to make money before anyone notices. But sloppy bookkeeping could also play a role. If you’re not absolutely sure that you’re submitting everything properly, wait and think before you take action.

Healthcare Fraud Law: Criminal Statutes

Sometimes, your mistakes aren’t inadvertent or paperwork related. If you intend to break the law and you know your conduct is wrong, you could be liable for criminal charges.

Two main criminal statutes apply to medical professionals, and they involve:

  • Kickbacks. If you get something in return for Medicare or Medicaid business, you’re involved in an illegal scheme.
  • Fraud. If you intend to falsify records or documents for your financial gain, you could face legal challenges.

Criminal charges could end your career. And they could also put you in jail for long periods of time.

What Should You Do When You Suspect Fraud?

If you’ve been reading this list with a growing suspicion that you’re engaged in something unethical, take action.

The government recommends:

  • Stopping. Don’t submit anything else that’s fraudulent.
  • Assessing. Determine how much you’ve made on the scheme.
  • Untangling. If you’re part of a scheme to defraud, get out of those relationships.
  • Disclosing. Own up to the mistakes you’ve made before you’re caught.

You should also work with legal counsel at this point. At Florida Healthcare Law Firm, we can help you assess the damage and find a proper path forward. Contact us for a confidential conversation.

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