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Home Health Acquisitions On the Run

by admin on September 15, 2020 No comments

Home health acquisitions private equity transactionBy: Jeff Cohen

Home health agencies everywhere have become the favorite targeted acquisitions of “the financial world.”  Apparently, there is one seminar that every buyer attended convincing buyers or all kinds (buyers with money, buyers without money, buyers in the private equity space) that:

  1. HHAs are ripe for aggregation because the industry is disaggregated; and
  2. HHA owners lack business sophistication necessary to bring their businesses to the “next level.”

Unfortunately, some of the buyers lack any true industry experience and are looking at acquisition targets solely from a financial perspective.  They’re looking principally at business financials and nothing else.  And, worse yet, they’re not focused on the centrality of operational expertise.  All of which can come crushing down on the head of seller financed acquisitions.  In other words, if the buyer is paying the purchase price over time, the seller is effectively financing the transaction because the purchase proceeds are (in theory) coming from seller operational profits. This may make the transaction possible, but operations will ensure company profitability and growth, which is gonna drive seller interest.

So what?  A lot!  As current HHA owners know, the secret sauce is in not financial analytics.  It’s in the operations!  And the financial due diligence is just a part of the equation. What about regulatory due diligence? What about knowing where the bodies are buried (legally speaking)?  What are the payer relationships?  What are the marketing relationships?  What is really driving the business?  Who is the key reason why the HHA is successful?  It is typically one or two people.  And missing that or retiring them is a recipe for disaster for buyers and seller financed sellers.  As is missing illegal payments made to induce patient referrals, which can shut down even a completed transaction in a heartbeat.  None of this is part of the usual [financial] due diligence!

Lawyers might say “Yeah, but there will be plenty or reps and warranties to cover the transaction. And the indemnification sections will be tight.” So what?  The buyer doesn’t want a pig in a poke.  They want a reliable and growing income stream.  Details matter.  Especially the details both buyers and sellers are missing!

Further, if a buyer thinks they can buy an HHA on the cheap (1) without proper due diligence, (2) with lawyers waiting to get paid if the transaction closes and funds, and (3) with heavy seller financing, think again.  If you’re dealing with a buyer with pockets (or you have pockets) and will spend the right money on proper due diligence, the right (and experienced) marketing and management, have at it!  The HHA industry is ripe for aggregation.  But doing it in “the new way” isn’t new at all.  It’s just defective and a recipe for lots of heartache…and litigation.

Real buyers love due diligence. They love to measure twice (three times is even better!) and cut once.  They love either understanding the business they’re buying or buying the operational talent.  And they understand and embrace the notion of putting hard money to work.  They don’t try to buy something for nothing or find lawyers who don’t have enough work to do who are willing to work for free.  Real buyers are not trying to get something for nothing.  And they don’t allow a financial flow focus to blind them to the daily “wax on; wax off” aspects of the business.  Doing so would disappoint both sellers and buyer investors.

It’s great to see so much activity in the HHA space.  But the ones that win and stay will only be the ones that do it the old fashioned away—They’ll Earn It!

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The Most Savvy Business Law Lawyer in Florida Devotes 100% to Your Case

by admin on September 15, 2020 No comments

Business Law Lawyer in FloridaContact Florida Healthcare Law Firm to secure the most knowledgeable business law lawyer in Florida who will focus solely on the needs of your medical practice or facility.

It takes a myriad of skills to become a savvy business law lawyer in Florida, but at or near the top of the list of requisite traits is understanding. The team at Florida Healthcare Law Firm has this keen knowledge of the medical field and what matters most to the doctors and hospitals that depend on us for their legal protection. We are not simply dotting each ‘i’ and crossing each ‘t’ in every legal contract. We do much more. We become your partner and an active member of your team to ensure that while you are busy focusing on treating your patients, we are making sure that your newly hired colleague adheres to his or her obligations before moving away suddenly or the Medicare ZPIC audit issue to you is legitimate or the off-hours x-ray film readings you are doing are being compensated. Our attorneys are laser focused on how state rules and regulations can impact our everyday practice. We work solely with healthcare providers and continue to use creativity to ensure that your practice doesn’t just maintain status quo…it will grow.

Other hallmarks of a savvy team of attorneys is their professional listings, testimonials and accolades. Florida Healthcare Law Firm has been recognized in prestigious journals and listings such as ‘Legal Elite,’ ‘Modern Healthcare,’ ‘Super Lawyers,’ ‘Best Lawyers’ (the world’s premier guide) and ‘AV Preeminent’ (the highest ranking in a peer-related professional listing). Countless testimonials from practitioners ranging from surgeons to radiologists and anesthesia groups praise our dedication to each client. With 24/7 service, compassion, humility, transparency, accountability, passion and remarkable value, we provide cost-effective legal guidance that exceeds your expectations. When it comes to business law, our firm speaks your medical language and understands your financial challenges. Every lawyer assigned to your case stays abreast of the ever-changing regulations driven by the State of Florida. From pay or issues to telemedicine, operations, acupuncture, pharmacy, dental, medical devices and technology, we stand beside you. Count on Florida Healthcare Law Firm’s savvy and longstanding expertise to partner with you every step of the way.

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In Florida Medical Attorney Advice Can Save Your Healthcare Practice Money

by admin on September 14, 2020 No comments

Florida Medical AttorneyFor healthcare professionals, who want the best legal from an experienced Florida medical attorney, contact Florida Healthcare Law Firm and save money as you navigate the legal complexities of operating a practice or facility.

The field of medicine is indeed a marriage of technology and humanity…science and art. But the reality for most practicing physicians is the day to day number crunching and looming complexities of navigating the legal and financial burdens of operating an office or hospital. A recent article in the AMA’s Journal of Ethics cited the burgeoning cost of healthcare, the confusion of understanding the cost, the puzzlement of interpreting the vocabulary of insurance firms and the need for physicians to “take ownership of their clinical decisions.” In Florida, healthcare practitioners or administrators who seriously want to get a handle on their earnings, costs and operations management expenses should employ the best medical attorney available,and Florida Healthcare Law Firm is the source for superb legal counseling and a team who cares about, and focuses on, healthcare providers exclusively.

Perhaps you are looking to negotiate a managed care contract, start a treatment center, obtain a license for DME, sell or buy a healthcare business, defend yourself against a ZPIC audit (typically initiated by the Centers for Medicare and Medicaid), hire or terminate a physician in your practice or implement new and complex policies and procedures. Perhaps you simply need guidance in creating a legally binding employee handbook for your healthcare staff. In each of these cases in Florida and throughout the nation, our unparalleled team of legal experts can help you. Every medical attorney we employ is solely focused and trained in the area of healthcare law. With 150 years’ combined experience, we know our ‘stuff.’ Imagine the unnecessary costs you could incur without trained legal counsel as you make these difficult decisions. Imagine the time wasted that could be better spent with your patients. We offer free consultations, flat-fee pricing and a money-back guarantee because we know that our record of success, accountability and transparency will boost your business. Contact Florida Healthcare Law Firm today to save your practice time and money.

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Interpreting Telehealth Law in Florida Has Never Been Easier

by admin on September 13, 2020 No comments

Telehealth Law FloridaFor medical practices and professionals who need guidance interpreting telehealth law in Florida, contact Florida Healthcare Law Firm, where legal advice for healthcare professionals is our sole focus.

As in most corners of the country, the practice of telehealth is in full swing, especially during this unprecedented year of Covid-19 ramifications. Most physicians completely support and embrace the notion of virtual office visits and have been utilizing these innovative methods even more so since the pandemic’s onset this past spring. The challenge for most physicians, dentists, ancillary facilities and hospitals, however, lies not in the ability of their professionals to fulfill virtual appointment requirements, but in insurance companies’ willingness to pay for it, according to many legal scholars. This is why most healthcare professionals agree that healthcare law experts have never been so important throughout the nation, and Florida is no exception. That’s where Florida Healthcare Law Firm comes into play. With a team that collectively brings 150 years’ experience to the field of medical legal services, our staff can help busy doctors and hospital administrators interpret the complexities of virtual regulations and negotiate within legal parameters so their rights are upheld. The worry of insurance companies outwitting healthcare providers need not be an issue, so healthcare workers can get back to their business of focusing on what’s most important: their patients.

How do we make this happen so easily? In short, it’s our sole focus. As we say, our team “doesn’t dabble in healthcare [legal service]; it’s the only thing we do.” As an active part of our client’s team, we work with healthcare practitioners every step of the way to increase understanding, educate and partner to achieve your goals and, ultimately, your success. We have found that medical providers often face challenges in interpreting the ever-changing legal state and federal regulations that govern telemedicine. Confusion can arise in the areas of practice standards, medical records, scope of practice, registration, venue, reimbursement of fees, exemptions and review of fees. But this field of the law is our area of expertise. We can counsel you in services ranging from diagnosis to consultation, treatment and patient care management. We also are up to date on regulations regarding medical data, health education and public health. Trust our skilled and experienced team to know what’s happening in Florida, the most critical changes implemented by the state’s advisory council and the expanding capabilities of telemedicine as they evolve. We are available for your support 24/7. Contact Florida Healthcare Law Firm today for your first free consultation and find out how we can ease your legal burdens.

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Dentist Employment Contracts

by admin on September 9, 2020 No comments

https://www.floridahealthcarelawfirm.com/our-team/chase-howard-attorney-florida-medical-lawyer/By: Chase Howard

A dentist’s first employer agreement is just as important as their last one. While all contracts include basic terms regarding compensation and restrictions, many simply do not contemplate important terms that have impacts on Dentist’s daily lives. Understanding, and negotiating, your contracts is the most valuable investment you can make prior to entering into a contract.

To understand what’s in your employment contract, simply read it over a few times. To understand not only how those terms affect you, but also what isn’t in your contract, hire an experienced health care lawyer.

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What’s All This Talk About 340B Discount Drug Programs?

by admin on September 8, 2020 No comments

340B Discount Drug ProgramBy: Jackie Bain

There has been so much in the news lately about 340B Discount Drug Programs and the fraud that accompanies them.

The 340B Discount Drug Program allows manufacturers participating in Medicaid to agree to provide outpatient drugs to certain designated clinics and hospitals at significantly reduced prices. The typical discount ranges from 30% to 50% off the drug’s list price. In turn those clinics/hospitals are able to reach more high-risk, high-need patients and provide more comprehensive services. Each designated clinic/hospital involved in the program is called a “covered entity.”

Covered entities may provide drugs purchased through the 340B Discount Drug Program to all eligible patients of that covered entity, regardless of a patient’s payer status. In order to be a “patient” of a specific covered entity, an individual (1) must have an established relationship with the covered entity such that the covered entity maintains records of the individual’s care; and (2) must receive care from a professional employed by or contracted with the covered entity such that responsibility for the care remains with the covered entity. Under the guidelines, an individual is not considered a patient of the covered entity if the individual only is dispensed a drug for the patient to take at home.

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OIG’s Audit found Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process

by admin on September 1, 2020 No comments

oig auditBy: Karina P. Gonzalez

When an overpayment is identified in Medicare Part A or B claims, providers can contest the overpayment amount by using the Medicare administrative appeals process.  Because of the large difference between overpayment amount in a sample from an extrapolated amount, the OIG states that it is critical for the review process during an appeal to be fair and consistent. In the first and second levels of Medicare appeals (redetermination and reconsideration) extrapolated overpayments are reviewed by MAC (Medicare Administrative Contractors) and by QICs (Qualified Independent Contractors).

The OIG audit was to make sure that the MACs and the QICs reviewed the appealed extrapolated overpayments consistently and in compliance with CMS requirements.

What OIG found was that CMS did not always provide sufficient guidance and oversight to ensure that these reviews were performed in a consistent manner.  The most significant inconsistency identified was the use of a type of simulation testing that was performed only by a subset of contractors.  The test was associated with at least $42 million in extrapolated overpayments that were overturned in fiscal years 2017 and 2018.

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adminOIG’s Audit found Medicare Contractors Were Not Consistent in How They Reviewed Extrapolated Overpayments in the Provider Appeals Process

Patient Brokering & Money Laundering: Bieda Arrests Raise Serious Issues

by admin on September 1, 2020 No comments

patient brokering arrest treatment center toxicology lab ownershipThree family members involved in owning an addiction treatment center and/or a toxicology lab were charged in July with patient brokering and money laundering in an alleged scheme involving roughly $2 Million.  The allegations arise out of a complex corporate enterprise involving at least four companies and some common ownership between the treatment center and lab.  While it’s premature to assume that the defendants did anything illegal, there are some interesting things in this case:

Complexity Invites Suspicion.  Every business owner in the addiction treatment and toxicology lab space knows three things:  (1) it’s extremely regulated, (2) law enforcement has an especially sharpened focus on these industries, and (3) insurance companies are very suspect of any situation involving either industry, especially when there is any common ownership.  So why then would one construct an enterprise that even “looks” complex or tricky?  It intensifies suspicion in an already highly scrutinized business space.  This is clearly one of the points of focus in this case.  There’s an old saying woven into the mind of every experienced healthcare lawyer:  if something can’t be done directly, it can’t be done indirectly.  Time will tell if anything in this case was wrong or if there are any good reasons for the corporate structure, but the complexity of the corporate structure certainly invites suspicion.

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Pharmacists Authority To Give Vaccinations Expanded By HHS

by admin on August 26, 2020 No comments

pharmacists giving childhood vaccinesBy: Zach Simpson

On August 19, an amendment to the Public Readiness and Emergency Preparedness Act was announced by HHS which allows pharmacists in every state to now administer childhood vaccinations to children ages 3 and older, subject to several requirements,

  • The vaccine must be approved or licensed by the Food and Drug Administration (FDA).
  • The vaccination must be ordered and administered according to the CDC’s Advisory Committee on Immunization Practices (ACIP) immunization schedules.
  • The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.
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How Healthcare Recovery Attorneys Are the Key to Debt Collection

by admin on August 25, 2020 No comments

Healthcare Recovery AttorneysTo ease financial burden and ensure proper claim processing, contact FHLF and learn how our expert healthcare recovery attorneys will guide your medical facility’s collection efforts and maximize reimbursement.

For medical practices and facilities—whether big or small—collecting accounts receivable are an ongoing worry. Bad debt, secondary insurance processing, billing and claim filing can make or break cash flow for your business. Maybe you are feeling that insurance companies are tremendously underpaying you. Or perhaps you know that you are compliant with billing regulations and coding, but your payor has not adhered to your contract. Healthcare recovery can be an exhausting process. With our seasoned team of attorneys who specialize in medical law, we understand the nuances of payor issues and can help you quickly and efficiently, while treating your patients fairly, as well. We are advocates and advisors who make your case our #1 priority. With comprehensive solutions-driven planning, our team is ready to serve you immediately, drawing on 150 years’ collective experience in the medical law arena.

Under the umbrella of healthcare compliance and regulatory services, we can assist your practice with both in-network and out-of-network scenarios. For the past 25 years, fraud and abuse have been rife in private and public sectors. Many practices therefore employ auditing companies for quarterly or annual assessments. But individual payer interaction is just as, or even more important than, a periodic progress report. Ultimately this keeps a blueprint, or paper trail, of denials and payments. We offer convenient flat free screenings for these exact purposes. Likewise, out-of-network insurers sometimes accuse providers of waiving copays or deductibles so they can wiggle their way out of paying a provider or so they can regain what the amount they originally paid. We can advise you on your legal rights to ensure efficient payment and avoid payer recoupment. And if you’re still not sure you want to hire us, rest assured we have a 15-minute complimentary consultation. Give us the opportunity to show you why our team has been awarded elite and superior ratings among our competition. Contact FHLF today.

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