November 12th, 2018 by admin
August 10th, 2018 by admin
By: Jeff Cohen
Private money (e.g. private equity) is in full swing purchasing medical practices with large profit margins (e.g. dermatology). This is NOT the same thing as when physician practice management companies (PPMCs) bought practices the 90s. Back then, the stimulus for the seller was (a) uncertainty re practice profits in the future, and (b) the stock price. Selling practices got some or all of the purchase price in stock, with the hopes the purchasing company stock would far exceed the multiplier applied to practice “earnings” (the “multiple”). Buyers promised to stabilize and even enhance revenues with better management and better payer contracting. If the optimism of the acquiring company and selling doctors was on target, everyone won because the large stock price made money for both the buyer and seller. The private equity “play” today is a little different.
Today’s sellers are approaching the private equity opportunity the same way they did with PPMCs, except for the stock focus since most private equity purchases don’t involve selling doctors obtaining stock. Sellers hope their current practice earnings will equate to a large “purchase price.” And they hope the buyer have better front and back office management that will result in more stable and even enhanced earnings. And for this, the private equity buyer takes a “management fee,” which they typically promise (though not in writing) to offset with enhanced practice earnings. read more
October 5th, 2017 by admin
By: Jacqueline Bain
The transition from paper medical records to electronic medical records has brought with it many conveniences and some unintended consequences. One example of an unintended consequence is cloning in the medical record. Cloning is copying and pasting previously recorded information from a prior patient note into a new patient note.
Providing quality medical care is only one part of the job. Appropriately documenting that care in order to be paid for your efforts is another. And while medical professionals are trained at length to provide care, hardly any are aware of the potential pitfalls associated with improper documentation.
In late 2015, CMS advised that cloning “is a problem in health care institutions that is not broadly addressed.” CMS specified that cloning records may indicate fraud, waste and abuse in inquiries and audits and that each part of a “medical record must contain documentation showing the differences and the needs of the patient for each visit or encounter.” read more
May 16th, 2017 by admin
By: Jeff Cohen
Private money (e.g. private equity) is back chasing those selling medical practices and medical business acquisitions. This time around it is very different from similar activity in the 90s. Back then, the movement was public companies aggregating gross income dollars, which for a time drove stock prices. Today’s private money buyers are looking to maximize profitability through achieving efficiency and aggregating large groups for leverage and the development of new income streams. Though stock (in the form of warrants and options or stock itself) if often on the table, it doesn’t have to be. Buyers are doing all cash deals, albeit to some degree on an earnings basis. If you want the full price, you have to remain involved and do what you can to maintain revenues and perhaps even drive them up.
Physicians especially have to know what they’re dealing with and then have at least a basic understanding of the issues that will drive these deals. To begin with, “private equity” simply means private investors (typically a group that pools their capital) that buy a portion or all of a company. Their investments are usually much larger than venture capital firm deals. They are not publicly traded entities. What do they want? To invest money in mature businesses, grow a company’s profitability and then “flip” their ownership to another buyer, typically in three to five years form their launch date. In contrast, venture capital firms usually invest in start-ups, buy 100% of the company and require control. read more
November 8th, 2016 by admin
By: Valery Bond, RHIT
As healthcare professionals, we take pride and care in the detail in maintaining our employee files. Certain items must be separated from the others, files securely locked and out of reach from co-workers hands. Personnel’s personal information must be protected. We all know these things and probably already have a procedure in place for compliance.
Whether your facility has been deemed accredited (Joint Commission, for example) or just starting up, employee files must be maintained, reviewed, audited, and kept according to retention requirements. Knowing which laws apply aids in keeping your business compliant. For example, pursuant to ERISA laws, there is no specific time period to maintain records that reflect age, marital status and/or service records. The Social Security Acts states that employees’ social security numbers must be kept four years from the tax due date or payment of tax, whichever is later. So, there’s a lot of tracking going on. read more
June 14th, 2016 by admin
By: Shobha Lizaso
“Prevention is better than cure” is a maxim that has reigned in the healthcare industry for thousands of years; however, this phrase echoes through the halls of the legal profession as well.
Healthcare practices often neglect to appreciate the value of their confidential information as assets and the need to protect these assets. Although HIPAA and HITECH compliance aids in maintaining the confidentiality of patient records, it does not protect a provider’s trade secrets.
Trade secrets of a healthcare practice may include any of the following: patient lists, financial information, contract rates, contract terms client lists, collection rates, marketing tactics, pricing/discount information, and methods of doing business. If leaked, this information may be used by competitors to secure advantages over a healthcare practice. For example, patient lists could be used to solicit a practice’s patients or contract rates and terms can be used by a competitor to undercut the rates of a practice. read more
December 10th, 2015 by admin
By: Dave Davidson
There will likely come a time in your practice when you find yourself considering whether you should maintain a relationship with a patient. It may be that the patient is non-cooperative. Or the patient may refuse to pay his or her bill, or to follow a reasonable payment plan. Even more significantly, the patient may have engaged in behavior that is disruptive to your practice. For whatever reason, you are questioning the value of the relationship.
In those situations, the law does allow a physician to terminate a patient from his or her practice. However, careful analysis must be done in these situations, and there are several steps that should be followed. The risk of a claim of abandonment or of professional negligence makes it important to protect yourself, your practice, and the licenses of the providers within your group. You may already have a process spelled out in your policies and procedures, and if you do, that process should be followed. However, make sure your policy at least covers the points below. read more
September 8th, 2015 by admin
By: Jeff Cohen
Stepping into 2016, physicians and medical practices must continue to be vigilant about the changing landscape in healthcare. Those who adapt quickly and smartly will thrive, while those who don’t will lose. What can they do?
Stability for medical practices requires two things: clear analytics and fixes. Smart medical practices will examine threats outside the practice and within it. As far as external threats go, the key area to focus on is competition. Do you know what competitors are doing and how they’re different than you?
Internal threats are general revealed in the form of (a) employees that need better training and communication, (b) employees that just need to go, and (c) creating a succession plan for the practice. If the practice is top heavy with older physicians, what plan is in place to ensure that “new blood” is brought in? What recruitment strategies are in place? Can the practice go it alone or does it need a recruitment arrangement with a hospital that can demonstrate a community need? How will the older physicians phase out? Is there a plan in the corporate documents to make sure phase out is slow and planned? What do departing physicians get? What about billing and collection? When was the last time that was analyzed? And finally, coding analysis. Is money being left on the table? Far too many practices actually undercode visits and services out of fear of payer audit. Apart from constituting a False Claims Act violation (though regulators are not fast to indict providers who are underpaid), the differential can mean the difference between a good year and a bad one.
Finally, in light of the fact that regulatory and recoupment activity has never been higher, practices would do well to ensure compliance via a self-audit and compliance plan. This is a different animal than a coding audit. This one looks at all contractual relationships to ensure compliance and augments coding compliance. read more
July 29th, 2015 by admin
It’s almost renewal time once again for many health care practitioners. If this is your renewal cycle, please note the following information provided by the Florida Board of Medicine, which can help you avoid some of the most common delays encountered with license renewals.
It is important to remember the upcoming renewal is the first to have mandatory continuing medical education reporting requirements. If you have not done so, please activate your account with CE Broker and ensure that all required CME you have completed for this renewal has been uploaded.
Most of the medical practitioners renewing will be required to submit the following:
- Completed renewal application
- Required fees
- Evidence that you have practiced medicine or have been on the active faculty of an accredited medical school for at least two years of the immediately preceding four years
- Completion of Financial Responsibility form
- Completion of Physician Workforce Survey
- Verification of Physician Profile
- Verification of your current status relating to prescribing controlled substances for the treatment of chronic non-malignant pain
April 1st, 2015 by admin
By: Jeff Cohen
The Tuomey decision, U.S. Court of Appeals case out of South Carolina, contains important lessons for physicians, especially as it relates to (1) compensation arrangements with hospitals, (2) proper compensation arising in connection with the provision of designated health services (“DHS”), and (3) the advice of counsel defense.
The concept of DHS arises largely in the context of the federal Stark Law, which in pertinent part (1) forbids physicians from owning and referring to providers of DHS (e.g. PT, rehab, diagnostic imaging, home health, DME, clinical laboratory, inpatient and outpatient hospital services), (2) describes how medical practices can provide DHS to their own patients, and (3) forbids even physicians within a practice from allocating DHS profits on the basis of who ordered or referred to them.
The Tuomey case involves a whistleblower action filed against a not for profit hospital system. The original jury in that case decided that the system didn’t violate the False Claims Act, but the appellate court set aside the verdict using facts and testimony that had be excluded from the jury trial, Tuomey Healthcare System was found to have knowingly submitted over 21,000 false claims to Medicare and the government was awarded over $237 Million (most of it in the form of punitive damages). The government (which often advances the plaintiff’s—“relator” case in whistleblower cases) filed a motion for a new trial, which the trial court granted and the appellate court affirmed.
The case involves the following: read more
March 25, 2015 Advisory Opinion No. 15-04 addresses a proposed arrangement involving a clinical/anatomic lab’s desire to position itself as the single lab recommended by practices.
The proposal arises in the context of the OIG Advisory Opinion process, which allows the OIG to opine on its view of how the federal anti-kickback statute might view a proposed arrangement. Though Advisory Opinions are not “law,” they do provide good insight into prosecutorial intent.
The clinical/anatomic lab (“Lab”) wanted to have agreements with physician practices to provide all their lab services. To deal with the fact that some commercial insurers have exclusive arrangements with labs, the Lab proposed that if a practice patient’s insurer required the patient to use another lab, the Lab would waive all fees for the affected practice patients and would not bill the patient, the medical practice or the patient. The Lab would provide its services to these “exclusive patients” for free, while billing all other patients (and/or their insurers, including governmental payers) its fee scheduled or contracted rates. The proposed arrangement would allegedly simplify things for the practices and keep lab results uniform. A practice patient would be required to use the Lab. The Lab’s services would simply be offered by the practices to their patients. The Lab stated that the provision of free services to certain practice patients would not provide any financial benefit to the practices, although the lab would provide the practice a limited-use interface. Samples would not be drawn in physician offices. read more