On October 6, 2020, the Unites States Attorney’s Office of the Western District of Louisiana announced that George M “Trey” Fluitt III of Monroe, Louisiana was indicted. The federal grand jury indicted the lab owner for paying bribes and kickbacks in violation of the Anti-Kickback Statute, resulting in improper Medicare billing of approximately $117 million. Fluitt was the owner and operator of Specialty Drug Testing, LLC and is alleged to have solicited paid kickbacks and bribes in return for patient DNA specimens and physicians’ orders for cancer genetic and pharmacogenetic testing. Medicare allegedly paid Specialty Drug Testing, LLC $28,726,299 as a result of the fraudulent claims. If convicted, the defendant faces up to five years in prison for each count of conspiracy to defraud a healthcare program. Fluitt also faces 10 years in prison for illegal kickbacks, a $250,00 fine, forfeiture and restitution.
COVID-19 has affected all aspects of everyday life and healthcare rules and regulations are no exception. All areas of healthcare have been impacted, including the patient’s financial responsibility for healthcare services in the form of co-insurance, copays and deductibles. The waiver of a patient’s financial responsibility for healthcare services is regulated by federal and state law. The waiver of co-pays, co-insurance and deductibles has been deemed a violation of the federal Anti-Kickback statue. A provider who routinely waives the patient’s financial obligation may be violating the participating provider agreement with commercial carriers, state law and federal law with respect to Medicare beneficiaries. Waiving patient fees is seen as an inducement to the patient to prefer one provider over another for financial reasons. However, The Centers for Medicare and Medicaid Services (CMS) and commercial carriers have been authorized by the federal government to waive patient financial responsibility during the pandemic in order to encourage the public to get treated for COVID-19 and non-COVID medical conditions without fear of a hefty bill.
Florida Healthcare Law Firm in Delray Beach, FL has exceeded their 2020 growth plans with the fourth hire this year, seasoned attorney Dean Viskovich, aka “The Lab Guy”. Dean will play an essential role representing healthcare businesses and providers with respect to regulatory compliance matters and is uniquely experienced on issues pertaining to laboratory compliance, as well as laboratory operations. Dean has over 25 years’ experience in the health law space and is licensed in both Florida and New York.
Florida Healthcare Law Firm has announced that they have added Dean Viskovich, “The Lab Guy,” to the team. Dean brings a wealth of healthcare business expertise working on the inside in settings such as laboratories and health insurance companies. Dean has served as a trial attorney on behalf of insurance companies and healthcare providers. He specializes in laboratory compliance and offers education and training programs geared at OIG compliance. Dean’s extensive experience in laboratory compliance and operations includes Stark, Anti-Kickback, Fraudulent Claims Act, Safe Harbor and State regulatory provisions. Additional areas of expertise include billing, reimbursement, charge-master review, CPT, ICD-10, HCPC coding and audits.
What options do doctors have in determining if a patient has the flu or COVID-19?
The days of assuming a sniffle and low fever during the Fall are just signs of the common flu are long gone. The challenge doctors now face is determining whether a cough, temperature and sore throat is the flu or COVID-19. If the symptoms are essentially the same for both illnesses, what’s a doctor to do? In the old days before Fall of 2019, a doctor would order a lab test to see if the patient tested positive for the flu. Today, a doctor who is faced (in person or virtually) with a patient with fever, chills, cough, runny nose, headaches and fatigue now must know if it is the seasonal flu or COVID-19. Ordering a COVID-19 test may seem like the obvious choice, but a more efficient alternative exists. Instead of a standalone COVID-19 test, ordering a comprehensive respiratory pathogen panel is a better decision.
As the country reopens in light of COVID-19 many patients are beginning to feel safe to return to practices for services. In an effort to generate additional business to make up for lost revenue many practices have turned to internet-based marketing programs, such as Groupon to help attract new patients. Such sites provide a platform for discounted services, in exchange for a fee to refer patients to those businesses. While every state and business is different, chiropractors need to be aware of the implications of working with such sites while accepting federal health care insurance reimbursements, and the marketing requirements that still must be adhered to that often go overlooked.
When a discount is offered, Groupon customers (in this case, chiropractic patients) pay fees directly to Groupon. The chiropractor is then paid a percentage of the fees collected. Such marketing might affect Federal laws, for patients covered by federal insurance programs. The federal anti-kickback statute (AKS) prohibits any person from knowingly and willfully offering or paying cash to any person to induce the person to refer a patient for services for which payment may be made under a federal healthcare program. While some safe harbors exist, none specifically fit in a case like this.
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:
HHAs are ripe for aggregation because the industry is disaggregated; and
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!
Contact 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.
For 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.
For 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.
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.
Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.