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.
Whether you’ve been in practice for years or you’re just graduating, buying an existing dental practice can be a great way to quickly enter into an already established patient base without the pains of starting up from scratch. While it may seem like a daunting task, the right team can make the purchase transaction flow as smoothly as possible. Here’s a list of important things to consider when negotiating the purchase.
Healthcare fraud continues to be a significant priority for the U.S. Department of Justice. On February 24, 2021, the DOJ’s Criminal Division Fraud Section published its annual “Fraud Section Year in Review 2020.” While the Fraud Section has three separate enforcement units, the Health Care Fraud (HCF) Unit is responsible for all enforcement activities in the health care industry. The Unit’s focus is to protect against fraud and abuse in federal health care programs and recoup illicit gains.
During 2020, the HCF Unit operated 15 strike forces in 24 federal judicial districts throughout the U.S. The efforts of these strike forces led to charges against 167 individuals alleging $3.77 billion in fraudulent charges for health care paid for by federal and state programs. This should cause any health care provider to stand up and take notice. And enforcement in the health care industry is not likely to go away soon with so many schemes ripe for the government’s picking and generating recoupment on behalf of the federal health care programs.
Here are couple of the latest schemes that have landed pharmacies, pharmacists and other health care professionals squarely in the crosshairs of federal enforcement:
The Office of Inspector General (OIG) and other Federal agencies charged with responsibility for enforcement of Federal law have emphasized the importance of voluntarily developed and implemented compliance plans. The government, especially the OIG, has a zero- tolerance policy towards fraud and abuse and uses its extensive statutory authority to reduce fraud in Medicare and other federally funded health care programs. The OIG believes that through a partnership with the private sector, significant reductions in fraud and abuse can be accomplished. Compliance plans offer a vehicle to achieve that goal. The OIG has provided a model compliance plan for clinical laboratories to assist laboratory providers in crafting and refining their own compliance plans.
The OIG suggests that the comprehensive compliance program should include the following elements:
There have been a rise in cases recently, in which practices that operate under a Health Care Clinic License have been brought under scrutiny by insurance companies trying to recoup funds through any means possible. In an effort to claw back funds insurance companies are beginning to claim that medical directors are failing to meet their statutory obligations under Florida Law which in turn can have serious monetary repercussions. Due to the clinics allegedly failing to meet their statutory obligations the insurance companies are filing suit to recoup any payments made while violating the Health Care Clinic Act obligations, and to stall any future payments due until such cases are heard.
By law, a medical director must be a health care practitioner that holds an active and unencumbered Florida license as a medical physician, osteopathic physician, chiropractic physician, or podiatric physician. The type of services provided at a clinic may dictate who would be able to serve as a clinic’s medical director, because a medical director must be authorized under the law to supervise all services provided at the clinic.
With the passage of autonomous practice ability for nurse practitioners in Florida this year, many are wondering how this will affect the healthcare industry in Florida. In a traditional sense, rural and underserved areas should have the opportunity for growth in healthcare providers. The autonomous practice law removes restrictions on certain nurse practitioners, granting them the ability to practice in primary care practice settings without worrying about supervision restrictions. Outside of that, the application of the new law can expand healthcare business offerings and abilities. read more
You do everything right. You’re careful to dot your i’s and cross your t’s. Compliance is hard-wired because you’re in an industry that’s highly regulated and you’ve built into your operations a series of compliance checks and balances. However, even with strong controls in place, compliance efforts sometimes fall short– and whether you’re a physician group, a pharmacy, a durable medical equipment company, a home health agency, or any other health care provider, someday you might find yourself face-to-face with law enforcement officials or regulatory enforcement authorities. What do you do? How do you assure the most successful outcome with minimal business disruption?
Compliance is the foundation to mitigating the risks inherent in any health care operation. Compliance can reduce the likelihood that regulators or law enforcement suddenly appear on your doorstep. But preparation for emergencies and uncertainties is the key to reducing the risk that non-compliance leads to lengthy business interruption. Although you may be saying “if”, you really should be thinking and acting more like “when”. It costs everything to be ill-prepared and it costs very little to be well-prepared. The following preparation can prevent much of the uncertainty that arises in these cases.
POLICIES AND PROCEDURES
First and foremost, make sure you have well-developed policies and procedures for what to do in such instances. You should review these policies and procedures with your employees regularly, focusing on the importance of compliance. Out of fear and uncertainty, employees can do things that create unnecessary challenges. Educating them as to what their rights and responsibilities are will mitigate those risks. Make sure your policies and procedures include the designation of who is in charge (“person in charge”) when the government does show up. read more
If you are a doctor who needs needs expert assistance with debt collection, contact Florida Healthcare Law Firm and partner with healthcare recovery attorneys who can easily resolve pay or issues.
Debt collection for doctors, medical practices and hospitals has never been easy. Payor issues have always been a battle, and the statistics bear that out. How big a deal is bad medical debt? A leading financial services company found that in 2009, about 44% of consumers had racked up some type of medical debt. By 2020, that number increased to 61%, particularly in the wake of Covid-19. Consumers are in the red for medical procedures and doctor visits, but with more and more patients delaying elective surgeries—the bread and butter of hospital revenue—hospital executives are counting on collecting on bills to insulate their finances. Going after that money is going to get tougher; analysts predict U.S. consumers will likely owe about $115 billion in medical expenses by the end of 2020. What about securing government funded assistance, aka Medicaid? This is an important issue for physicians. How can doctors make good on what’s owed them? Hiring a sharp, experienced team player from Florida Healthcare Law Firm, the best healthcare recovery attorney team in the industry, is a wise solution. We collectively boast 150 years’ experience solely in medical-related legal issues so we’re not only on your side, we know your business.
In addition to securing third-party funds or negotiating debt from uncooperative patients, a healthcare practice attorney is your partner as you manage your practice or facility. Our skilled team works side by side with you on a variety of issues that may be taking up unnecessary time from your busy schedule. We specialize in medical legalities so we know the current regulations, trends and issues you are facing. Statewide and nationally, we are at the forefront of payor issues, compliance, hiring and firing, business operations and transactions, telemedicine, technology, durable medical equipment and much more. We are a unique boutique firm that delves into each issue with a depth and breadth of knowledge that our competitors don’t have.
So when you’re looking for a Florida health law attorney who has handled everything from orchestrating bond-financed $90 million medical facilities to ensuring financial raises and providing advice on daily operations for maximum efficiency in a tiny practice, you can count on our seasoned team to represent you. We offer flat-fee pricing and a money-back guarantee. That’s how sure we are that we can help you reach your goals. Contact Florida Healthcare Law Firm for a free consultation today.
For the most up-to-date knowledge of state and federal regulations, consult with Florida Healthcare Law Firm and discover how our seasoned medical attorney team will be your practice’s best source of business information.
As seasoned legal counselors, we know that ‘lawyer up’ can have negative connotations. But if you want to get serious about the countless and ever-changing regulations that are spinning around your practice—especially this year—then the only way to stay up to date on trends, policies, regulations and compliance is to hire the best possible medical attorney you can find: the experienced experts at Florida Healthcare Law Firm. From regulatory compliance to business operations, transactions, telemedicine, laboratory compliance, pay or issues and even dentistry and pharmacy, we can help educate you and guide you as you make important business decisions. We don’t work with a handful of physicians or hospitals; we work solely with doctors and facilities like yours. We are specialists in our field, and we guarantee that the business end of your job will become a whole lot easier with us as your partner.
In addition to working side by side with each of our clients, we also offer ongoing education events. These include our recent webinar on business lessons learned in 2020 that can guide you in the future, and our upcoming January webinar on what your office needs to know as you prepare for Covid vaccination in the new year. Pharmacists may be interested in our February webinar about protecting your business from risky prescriptions. The menu of classes is always relevant—led by our Florida medical attorney team who are experts in the field, with 150 years’ collective experience behind them. We also post regular blogs on specific topics, including trademarks in the state, malpractice issues, estate tax planning, self-referral statutes and telemedicine contracts.
As the leading health care law attorney Florida has to offer, we pride ourselves in the core values that set us apart from the competition. First our advice is speedy and cost-effective; we don’t drag our feet and we don’t overprice. In fact, we guarantee results before we are paid. We communicate openly and honestly with clients—no misunderstandings, nothing concealed. We’re not afraid to take educated chances, seeking innovative ways to serve you. Finally, we hold ourselves accountable and stand behind every decision we make. If the outcome isn’t what you expected, we make it right. Why not partner with a stellar legal team that will be your biggest champion and your best source of business education. Contact Florida Healthcare Law Firm today.
On January 1, 2021, every hospital in the United States (with very few exceptions) will be required to post clear, accessible pricing information online about the items and services they provide. These “standard charges” must be provided in two ways: first, as a comprehensive list of all items and services offered by the hospital in a machine readable format; and second, as a display of “shoppable services” in a consumer friendly format. According to CMS, the stated goal of the new rule is to empower patients “with the necessary information to make informed health care decisions.”
With the first requirement, the list must include gross charges, discounted cash prices, payor-specific negotiated charges, and de-identified minimum and maximum negotiated charges. The items and services covered are basically anything for which the hospital has established a standard charge, regardless of location or whether the item or service is provided on an inpatient or outpatient basis. These include, but are not limited to, supplies, surgical implants, procedures, room and board, and professional charges.
A recent Department of Justice $500,000 settlement with a cardiology practice underscores the need for ensuring tighter compliance by medical practices. There, the practice billed Medicare for cardiology procedures for which interpretive reports were also required. Medicare paid for the procedures, but upon audit, CMS could not find the requisite interpretive reports. The False Claims Act case settled for $500,000, but it’s likely that (1) the reimbursement by Medicare was far less, and (b) the legal fees behind the settlement weren’t too far behind the settlement amount! Had the practice self-audited each year, would they have found the discrepancy?
Medical practices have felt the weight of price compression and regulatory load more than probably any segment in the healthcare sector. They are doing far more for far less. And regulations expand faster than viruses! Hence, many have a strategy of regulatory compliance that can best be characterized as a combination of facial compliance (“We bought the manual and put it on the shelf”) and hope (“They’re not really serious about this, are they?”). Unless you’re part of a practice of more than 20 doctors, it’s likely that you can do more to ensure regulatory compliance.