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.
The placement of laboratory personnel in the physician’s office has been a routine arrangement in healthcare. The arrangement has been permitted under federal law, with limitations, however various states have prohibited this arrangement. Florida has restricted this relationship by statute.
Federal regulations have been construed to allow the placement of a phlebotomist or specimen collector in the physician’s office and asserts that the placement does not necessarily serve as an inducement prohibited by the anti-kickback statute. The OIG has previously stated when permitted by state law, the statute is implicated when the phlebotomist performs additional tasks that are normally the responsibility of the physician’s office staff. The tasks can include taking vital signs or other nurse functions, testing for the physician’s office laboratory, or performing clerical services. Where the phlebotomist performs clerical or medical functions not directly related to the collection or processing of laboratory specimens, a strong inference arises in that he or she is providing a benefit in return for the physician’s referrals to the laboratory. (See OIG Special Fraud Alert, December 19, 1994). read more
There has been a lot of confusion lately as to whether Paramedics can administer IVs at doctors’ offices, clinics or MedSpas. While these professionals are trained to administer IVs during emergency transport, they are not allowed to administer IVs in most other situations.
The statutes and rules pertaining to paramedics and scope of practice fall under Chapter 401, Medical Telecommunications and Transportation, Florida Statutes, and Chapter 64J-1, Emergency Medical Services, Florida Administrative Code.
Based on definitions and the text of the statutes and rules, although a paramedic is trained to administer IVs, they can only do so during the course of emergency services and transportation and at public health care programs. Further, a paramedic’s services must be rendered under a medical director’s supervision, as the term medical director is defined under Section 401.23, Florida Statues. Under this statute, a medical director “is a physician employed or contracted by a “licensee” and who provides medical supervision, including appropriate quality assurance but not including administrative and managerial functions, for daily operations and training pursuant to this part.” Section 401.23(15). Pursuant to statutes, a “licensee” means any basic life support service, advanced life support service, or air ambulance service licensed pursuant to this part.” Section 401.023(13). read more
Medical necessity is foundational to payment by government payers (Medicare, Medicaid, Tricare, FEHBP) for health care services. If services are not medically necessary, any claims filed constitute false claims. In a recent DOJ False Claims Act (FCA) case, a civil settlement of a whistleblower action was reached in resolution of allegations that over a more than six-year period, a rehabilitation therapy contractor violated the FCA by causing the submission by 12 skilled nursing facilities (SNFs) of false claims for “medically unnecessary, unreasonable, and/or unskilled rehabilitation therapy services.” Under the Settlement Agreement, the rehabilitation therapy provider agreed to pay $8.4 million to resolve the matter.
BACKGROUND ON SNF REIMBURSEMENT
In order to understand the case, it is important to understand (at least at a basic level) SNF reimbursement. This case arises during the time period 2010-2016 when SNFs were paid by Medicare under the Resource Utilization Groups (RUGs). By way of background, RUGs are a prospective payment model which includes a system of grouping a SNF’s residents according to their clinical and functional statuses which information derives from the minimum data set (MDS) assessment for the resident. Soon after adoption, many SNFs and rehabilitation therapy providers adjusted their model of care delivery to increase the level of reimbursement. The methodology created an incentive to deliver more therapy than skilled nursing services since those RUGs were reimbursed at a higher rate. read more
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: read more
Does your office treat Medicare or Medicaid beneficiaries? If so, this article is vital to you and your staff. The first question that I want all of you to ask yourself is if your practice treats Medicare or Medicaid beneficiaries do you know what an ABN is, and why they are vital for your practice? The acronym ABN stands for Advance Beneficiary Notice of Non-coverage. ABNs safeguard your practice’s right to collect on non-covered services (other than statutorily excluded services) from patients who have Medicare or Medicaid. Multiple organizations I have worked with throughout my career had never been informed about ABNs or had never been properly educated on how utilize them. This article is intended to provide you and your practice with the most recent information regarding the renewed ABN form that became mandatory for use on January 1, 2021.
As of January 1, 2021, a new Fee-for-Service Advanced Beneficiary Notification of Non-coverage became effective until it expires on June 30, 2023. In the event that your practice has been utilizing the same ABN forms for years then listen up. read more
If you are a physician, hospital administrator or other licensed healthcare providers working in the Sunshine State, then you are likely familiar with the routine, but still serious, Florida medicare audit. Many times, this can result in an overpayment of claims, which can be costly. You need to be armed with the tools and counsel that can avoid claim denials or overpayments…you need the team at Florida Healthcare Law Firm. From RACs to CERTs and Probes, we know the rules and regulations and make it our business to be on top of trends and changing requirements. Experience shows that if you are in the unfortunate predicament of being evaluated, it is much better to have an attorney present to ensure a successful outcome. What’s more, most experts agree that it is wisest to retain an attorney before the problem arises. You may be able to avoid the situation entirely. At the very least, we will ensure that you and your practice survive the process in one piece.
If you are visited by a Florida medicare auditor, we suggest you take the situation seriously. The extrapolation factor is a case in point. For example, even if only 40 claims are assessed with a 25% denial rate, this could be evidence enough for full denial of all claims from that period. Such drastic measures could be enough to shut down an entire practice. Don’t put yourself, your reputation and your livelihood in jeopardy. Contact us within 30 days of receipt of your demand letter. With 150 years’ collective experience, we can get the process started with a full diagnostic of your practice. We will guide you through and keep your business viable until a satisfactory result is achieved. And even if these pinpointed services aren’t used daily or weekly or even monthly, our full spectrum of resources, including free webinars and frequent healthcare legal blogs, are available to you 24/7. Protect yourself and contact Florida Healthcare Law Firm today to plan for and understand better the ramifications of claim assessment.
Outside of board-certified medical doctors, other licensed providers can benefit enormously from healthcare malpractice insurance in Florida. These licensed providers include physician assistants, osteopathic physicians, osteopathic physician assistants, advanced registered nurse practitioners, naturopaths, physical therapists, chiropractors, dentists, massage practitioners, acupuncturists and occupational therapists.
Even medical assistants can obtain coverage to protect themselves against being named individually in a lawsuit. At Florida Healthcare Law Firm, we can help all of these specialists realize the full power of this type of professional liability coverage and understand its benefits and parameters. Together, our team of attorneys offers 150 years’ experience delving into medical-related cases. This area is not simply part of what we do; it is everything we do. In the unfortunate event of a medical professional or hospital (or both) being named in a case of mistreatment of a patient, our seasoned legal staff will investigate the claim, provide legal representation and partner with you every step of the way until we reach a successful conclusions.
With a complimentary consultation, a money-back guarantee and flat-fee pricing, we approach each of our clients’ cases with a breadth and depth of knowledge in the field that makes us confident we will reach a winning situation for you. In the state, there are situations in which medical practitioners can forego liability coverage. But at what risk? Healthcare malpractice insurance in fl can be tricky. Our team helps you decode the rules of this coverage, determine if you need coverage and to what extent. As the medical field becomes more complicated, experts show that the need for coverage is increasing, especially to protect from financial devastation and human error and to supplement insufficient coverage from a professional’s employer. Let the capable team of Florida Healthcare Law Firm handle your decision to cover yourself and, if necessary, represent you should a claim arise. Contact us today for your free personal meeting.
Most physicians and health care providers know that coverage for liability claims as a result of treating patients is essential…a no-brainer. In fact, the AMA reports that by the age of 55, more than 65% of physicians have been the target of at least one lawsuit. Factor into this equation the time, cost and heartache, and most professionals agree the coverage is well worth it. Yet, the demands of a physician’s schedule can make it difficult to navigate the nuances of medical malpractice insurance for doctors in Florida and throughout the nation.
That’s why Florida Healthcare Law Firm is here to help. We are a comprehensive firm of attorneys who specialize in only one thing: researching, counseling and representing healthcare providers and hospitals. We don’t dabble in healthcare; we know the field inside and out. Collectively, our 150 years’ experience has proven itself time and time again with success stories from professionals who represent a myriad of healthcare specialties. From solo practices to $90 million facilities, our clients come to us with diverse challenges, and we deliver spectacular results with transparency, innovation and expertise that is unparalleled in the industry.
First off, it is important to note that there are no loopholes that allow physicians to work without medical malpractice insurance in Florida. Physicians must carry up to $100,000 in coverage and up to $250,000 in order to have hospital privileges. To the untrained legal eye, the intricacies of these document can be tricky, so our staff is ready to interpret and prepare you before any incident occurs. We advise you on ways to avoid legal suits, including 1) knowing how to document actions, 2) knowing what you can and cannot say when you are speaking with patients, peers and indemnity companies and 3) knowing how to keep working during the law suit. We offer complimentary consultations, webinars and ongoing 24/7 support once you begin working with us. In addition, our services, include telemedicine, payor issues, dental and pharmacy law, regulatory compliance, business transactions, hiring and firing issues. Let us exceed your expectations and protect your reputation. Contact Florida Healthcare Law Firm today.
In March, the Florida Legislature passed multiple bills that would allow advanced practice registered nurses (APRN) to practice independently of physicians in the delivery of primary care practice. The law, however, went into full effect on July 1. Still, the law did not automatically grant autonomous practice to all nurse practitioners. Rather, an application process is still needed, as well as final regulations governing the new law.
In June, the Florida Board of Nursing voted to move forward with the drafting of rules and the application process to be designated as an independent practice Nurse Practitioner. This process usually takes three months to complete before it is open for practitioners to apply. The Board also voted to define “primary care practice” to include “health promotion, disease prevention, health maintenance, counseling, patient education, and diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings.”
Until final rules are decided, a nurse practitioner will at least need to meet the following requirements: read more
Access to telehealth for Medicare beneficiaries was further increased by the Trump Administration April 30, 2020. These new changes allows all health care professionals eligible to bill Medicare for services to provide services via telehealth communications and to bill the Medicare program for such services. Additionally, certain services may now be provided using audio technology only.
For a list of services eligible for reimbursement by the Medicare Program, including services requiring audio technology only, download here. There are approximately 180 different codes reimbursable by Medicare if provided via telehealth communications.