Navigating Increased Scrutiny: What Acupuncturists Need to Know About VA Audit Findings and Legal Risks

By: Sinead Killeen

The regulatory environment for acupuncture providers is becoming increasingly complex as scrutiny and enforcement actions under the False Claims Act intensify. A 2021 audit by the Department of Veterans Affairs (VA) has revealed significant concerns about the handling of payments and authorizations for acupuncture services provided to veterans through non-VA providers. Understanding these findings and their implications is crucial for practitioners to effectively navigate these changes.

Expanding Coverage and Scrutiny

Acupuncture services for veterans have been a part of the VA’s offerings long before traditional Medicare even considered covering these treatments. The Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 (Choice Act) and the VA MISSION Act of 2018 were pivotal in expanding veterans’ access to acupuncture and accelerated referrals to non-VA providers. These acts allowed veterans to access funding to obtain acupuncture treatment from non-VA providers, given that the VA lacked sufficient in-house acupuncturists to meet demand.

During Fiscal Years (FYs) 2018 and 2019, the VA paid approximately $114 million to non-VA community acupuncture providers. However, a December 2021 audit by the VA’s Office of Inspector General (OIG) revealed significant issues with many of these payments. As a result, the number of VA acupuncture audits has increased dramatically. This article will examine the reasons cited for denying acupuncture claims and discuss strategies to reduce audit risks.

Problems Identified in VA Acupuncture Audits

The December 2021 VA OIG audit uncovered several issues with the acupuncture claims that had been paid in 2018 and 2019:

  • Lack of Authorization: Approximately 51,200 claims lacked the necessary pre-authorization from the VHA. The VA’s financial services system automatically paid for all claims within a year of authorization leading to overpayments for unauthorized services; including the number of visits in excess of the authorization, dates of service after the allowable dates on the authorization, etc.
  • Documentation Deficiencies: About 76% of the claims lacked proper documentation. The OIG found that many claims were not supported by medical documentation meeting VHA requirements, including illegible or incomplete records. The VA requires that claims conform to Medicare’s billing requirements.
  • Incorrect Billing for E/M Services: Some Evaluation and Management (E/M) services billed were not fully supported by medical records or illegible, leading to further issues with claims.
  • VHA Staff Failed to Follow Reauthorization Guidelines: The VHA failed to evaluate the efficacy of non-VA care prior to reauthorizing additional acupuncture services, thus improper payments were made with faulty authorization.

Lessons Learned from VA OIG’s Acupuncture Audits

  1. The acupuncturist is responsible for medical necessity and documentation.
  2. You must adhere to authorization limits – make sure that the services provided are administered by the provider listed on the authorization and limit the services to the amount of treatment and within the time period authorized by the VA.
  3. Correct Coding: Follow the AMA CPT Codebook for accurate coding of services.
  4. Maintain Legible Documentation: Ensure all documentation is clear and legible to avoid claim denials based on poor record-keeping.

Current Enforcement Trends

Followingthe VA OIG acupuncture audit report there have been a large number of resulting provider audits and investigations, in an attempt to recoup some of the funds that were paid in 2018 & 2019. The audits are being performed by the VA, third-party administrators and even the U.S. Department of Justice. You may receive a subpoena requesting claims information including progress notes or your entire case file on a group of VA patients as the initial indication of a pending investigation. Following transmission of these documents, you may be informed of several possible results. You may be subject to administrative recoupment which simply requires you to repay improperly paid funds. Common issues include unauthorized services or incomplete/illegible documentation. In more extreme instances the VA or DOJ may pursue you for civil damages pursuant to the False Claims Act. Providers may face significant penalties under the False Claims Act for knowingly submitting false claims. The DOJ often handles these cases, pursuing treble damages and substantial fines. If the investigation finds that your conduct may rise to the level of health care fraud you may be subject to criminal liability.

New Challenges: Veteran Interviews and Documentation Issues

Recent developments indicate that the VA is now interviewing veterans to challenge the validity of acupuncture claims. This new approach includes questioning whether treatments were actually received and undermining the claims made by acupuncturists. Notably, progress notes are increasingly being deemed insufficient evidence of treatment completion, particularly where legibility is an issue.

Recommendation: To counteract these challenges, we are advising acupuncture providers to incorporate an attestation form for patients to sign at each appointment. This attestation should confirm that the treatment was received and can serve as additional documentation to support the claim.

What This Means for Acupuncturists

  1. Increased Scrutiny: Providers with high billing amounts are under heightened scrutiny. The VA’s focus on these cases, combined with DOJ investigations, means that billing discrepancies or errors can lead to severe legal repercussions.
  2. Potential Penalties: The DOJ’s pursuit of treble damages for improper claims under the False Claims Act can lead to substantial financial penalties, significantly exceeding the original claim amounts.
  3. Proactive Measures: To mitigate risks, acupuncture providers should review and strengthen their compliance practices. This includes ensuring all treatments are pre-authorized, maintaining comprehensive and accurate documentation, and using additional patient attestations to confirm treatment receipt.
  4. Seek Professional Advice: Engaging with healthcare compliance specialists or legal advisors is crucial. These professionals can help navigate the complex regulatory landscape and ensure your practice remains compliant.

Conclusion

With the expanding coverage for acupuncture services and the rise in audits by federal, state, and private payors, acupuncturists must be vigilant. Reviewing and updating medical necessity, documentation practices, and billing procedures is crucial. By adhering to regulatory requirements and maintaining thorough records, providers can better manage audit risks and continue to offer valuable care to veterans with confidence.

Business Considerations for Starting a Medical Practice

Medical school equips physicians with the skills to care for patients but often leaves them unprepared for the business side of running a medical practice. Here are some crucial considerations for physicians before opening their own practice.

Business Expectations:  Most professionals (not just doctors) think if they’re amazingly good at what they do, patients will flock to them.  Not true at all, especially in this digital marketing age where our attention is the commodity.  Marketing and sales and administration is at least as important as excellent clinical skills.  If you’re not prepared to build a marketing business that provides medical services, you’re setting yourself up for an expensive lesson in business in the modern era.  

Florida Medical Licensing:

To practice medicine in Florida, you must be licensed by the state (the Board of Medicine). While it may seem straightforward, many doctors inquire about reciprocity, mistakenly believing they don’t need a Florida license if they’re licensed elsewhere. Timing and completeness are key here. Allow more time than you think you’ll need, especially around holidays. If your application is delayed, consult an attorney specializing in Board of Medicine matters to expedite the process. Omitting pertinent information can lead to delays or denials, so seek help from a Florida healthcare lawyer to ensure your application is complete and accurate. Flexibility in your start date can accommodate any unforeseen licensing delays.

Deciding Between Employee and Employer:

Most new physicians lack the experience, interest, or capital to start their own practice immediately. Therefore, many begin as employees in existing medical practices, hospitals, or universities. It’s crucial to get a Florida healthcare lawyer experienced in physician employment contracts rather than relying on lawyers from unrelated fields. Expert advice can save you money and headaches in the long run, especially now given the confusion about noncompetes and such.  Starting an employment relationship with an assumption that the noncompete you signed isn’t enforceable is a disaster.  Don’t use your neighbor or a friend doing you a favor because he’s a (real estate) lawyer.    

The Physician Entrepreneur:

For those with an entrepreneurial spirit, one option is to explore recruitment packages from local hospitals. These packages typically offer income guarantees and various forms of financial support, which are usually forgiven over several years.

Physicians wanting to start their own practice will need to form a legal entity. Common choices in Florida include professional corporations (P.A.s) and LLCs (or PLLCs). A single physician can easily form a legal entity, but multiple physicians will need an operating agreement or shareholders agreement. These documents cover decision-making processes, loan arrangements, overhead allocation, and protocols for events like the death or disability of a physician owner. While forming a corporation can be quick, preparing ownership-related documents can take months, depending on availability.  Even more perplexing is this:  while getting to Medicare is a snap, getting on commercial payer panels is a panicky endeavor.  “What do you mean you’re closed.?”  “Can payers do that?”  Yep, let’s talk!

Additional Considerations:

Contracting with managed care payers and building out office space can also be time-consuming. As a general rule, plan for everything to take twice as long and cost twice as much as initially anticipated.

Opening a medical practice involves significant planning and numerous legal and business considerations. Seeking expert advice early can streamline the process and help ensure long-term success.

Starting a medical practice requires meticulous planning and adherence to healthcare regulations. By addressing these business considerations and by creating a team, that can bring all the solutions to the table (not just legal stuff), healthcare providers can establish a successful and compliant practice that meets the needs of their patients while achieving financial stability.  It’s easy to get in business.  It’s not easy to stay in business.  And a lot of that depends on what you know and do up front!

Physicians & Nurses in for a Long Ride on the Health Train

Nearly half of US states have expanded the scope of nursing practice, with several more evaluating the appropriateness of such measures. The debate between physicians and nurses regarding nursing autonomy remains a contentious issue that is likely to resurface in legislative discussions. In the meantime, the Board of Medicine and the Board of Nursing will continue to enforce existing requirements quietly. Under current Florida laws, advanced registered nurse practitioners (ARNPs) are authorized to perform medical diagnoses, treatments, and prescriptions, but these acts generally require the supervision of a physician. This supervisory relationship must be detailed in a protocol that specifies the medical acts to be performed and the conditions for their performance.

Contents of an ARNP Protocol:

With few exceptions, every ARNP must file an original protocol with the Florida Board of Nursing within 30 days of:

  1. Entering into a supervisory relationship with a physician,
  2. Renewing a State of Florida medical license, or
  3. Any changes to the information contained in an existing protocol

The protocol should include:

  • The date of the protocol or amendment,
  • The nature of the ARNP’s practice and duties,
  • The location of the ARNP’s practice,
  • The names, signatures, license numbers, and DEA numbers of the supervising physician(s),
  • The duties of each supervising physician, and
  • All medications that each supervising physician has agreed the ARNP may prescribe.

If multiple physicians supervise the ARNP, only one protocol needs to be filed, but it must include signatures, license numbers, and DEA numbers of all supervisors. A sample ARNP protocol is available on the Board of Nursing’s website at floridasnursing.gov/forms/arnp-protocol-sample.pdf.

Physician Obligations:

Every physician supervising an ARNP must file a notice of supervision with the Board of Medicine within 30 days of entering or terminating the relationship. If the physician supervises an ARNP in an office different from their primary practice location, they must post:

  1. The times when the physician is physically present in each office, and
  2. Office hours when the physician is not present.

Primary care physicians may not supervise more than four primary care offices other than their primary location, while specialists are limited to two additional offices. Additional regulations apply if the ARNP provides dermatologic or skin care services.

Evolution:

Florida law has greatly expanded the scope of APRN services to include those which don’t require physician supervision.  That expansion is expected to continue and is something to watch virtually every legislative session.

By: Jeff Cohen

Founder, Florida Healthcare Law Firm

Physician-Owned Hospitals Gaining Momentum in Florida

Florida is still flirting with becoming the next hotspot for physician-owned specialty hospitals, much like Texas experienced. While Texas had its share of successes and failures with such hospitals, if executed correctly, these facilities could offer a better fit for many patients, particularly those with specific co-morbidity issues. And they should be far more attractive to payers with lower price points.  Ideally, they would serve as an effective bridge between surgery centers and traditional acute care hospitals. The specialized nature of these hospitals suggests a more efficient staffing model and targeted overhead costs, as opposed to the broad, generalized overhead typical of acute care hospitals. So, what challenges will physicians encounter when organizing and launching these new facilities?

Corporate Structure: Physicians will need assistance in creating the appropriate corporate structure and documenting relationships to balance clinical and business control effectively.

Legal Considerations: Understanding the Stark Law and state self-referral laws, such as the Florida Patient Self-Referral Act of 1992, is crucial. Physicians must navigate what they can legally order and refer, as well as handle state licensure requirements. As certificate of need laws become more relaxed in Florida, these facilities are likely to proliferate.  The issue of the need for an emergency department has to be approached affectively.  And the conflict of such hospitals with Medicare regs is another point of complexity.  

Business Operations: Distinguishing between the cash-based nature of their medical practices and the earnings-based model required for the hospital is essential. This includes maintaining adequate cash reserves and understanding that these hospitals cannot be run like typical medical practices. Success will depend on a solid foundation in operations and financial management.

Payer Relations: Many of these facilities operate out-of-network, meaning they do not have contracts with managed care payers. They bill and collect based on what’s “usual, customary, and reasonable.” Setting up the business to anticipate payer challenges is critical, especially given past costly disputes. A core issue often involves payers questioning the medical necessity of procedures, alleging that actions were driven by investor physician interests rather than patient care.  This is an exciting and promising time for physician-owned hospitals in Florida. However, physicians and their advisors must proceed cautiously, thoroughly planning each step to ensure success.

Physician-owned hospitals are gaining momentum in Florida, presenting unique opportunities and challenges for healthcare providers. Clients who work with the Florida Healthcare Law Firm benefit from our deep industry experience and dedicated legal support. Our team doesn’t merely dabble in healthcare law; we specialize in comprehensive representation of healthcare providers and almost every type of healthcare business. We are aligned with your success to protect your interests and ensure a smooth and successful operation.

By: Jeff Cohen

Founder, Florida Healthcare Law Firm

Selling A Healthcare Business

Selling a healthcare business is uniquely complex and demands a specialized team of advisors who understand the intricacies involved.

Selecting the Right Team

The first priority is assembling the right team long before the planned transaction (ideally at least 12 months). The two crucial members are a healthcare lawyer and a healthcare accountant. They must have spent the majority of the last decade representing healthcare professionals and businesses, and should possess extensive experience with the specific type of healthcare business you are buying or selling. Without this expertise, they may be unaware of critical issues such as the moratorium on new home health licenses in Florida, preparatory work required to optimize financials for the sale, or the lengthy process to obtain a healthcare clinic license (HCCL) for non-physician owners.  The right team will do three essential things:  (1) facilitate a transaction instead of learning about it on your dime, (2) expedite it by having “been there” many times, and (3) close is so you get what you came for.   Frankly many don’t close because surprises in the transaction created deal fatigue that cause the buyer to run off.  The right team finds and clears those issues before the risk of scaring a buyer off becomes a factor.    

Structuring the Sale or Purchase

With your team in place, the next step is structuring the healthcare business sale or purchase. This often involves deciding between selling assets or ownership interests. Sellers prefer selling ownership interests (e.g., stock) due to favorable tax treatment, while buyers might favor purchasing assets to mitigate risks. However, buyers may also consider acquiring the entity for continuity, particularly if the business earns income through contractual relationships such as insurance contracts. Even so, most contracts aren’t assignable and parties will reopen contract negotiations when they find out you need their approval to close a deal.  These high-level considerations typically go into a Letter of Intent (LOI).

Due Diligence

If you’re purchasing a healthcare business, a thorough due diligence period is essential. During this time, accountants review financials, and a professional coding consultant examines coding and billing practices to avoid liabilities from payer clawbacks and penalties. It’s also critical to engage a healthcare regulatory compliance expert to review regulatory issues comprehensively. This is something best done even before LOI, since the more surprises a buyer experiences, the less likely the deal is to close.  Investing time and money in detailed due diligence is crucial for any serious buyer.

Contract Preparation

Once the decision to proceed is made, the process accelerates with contract preparation. Buyers generally prefer their attorneys to draft contracts, especially when purchasing ownership interests or stock, to avoid inheriting significant liabilities. Governmental payers, like Medicare, hold the buyer accountable for any existing liabilities, regardless of the buyer’s awareness.  Only the most sophisticated parties know this and adjust he deal and the deal agreements accordingly.  

Expert Document Preparation

Drafting documents for buying a healthcare business is distinct from other corporate transactions. While corporate lawyers may be adept at asset or stock purchase agreements, their experience is futile without an understanding of the specific issues pertinent to healthcare transactions and businesses. For healthcare lawyers experienced in forming the right deal team, these transactions are straightforward. Surprises are best left out of healthcare business purchases or sales.  If the attorney doesn’t know how the business and money in a client flows, what it’s tied to and the risks of issues like clawbacks and audits and contracts that are terminable without cause with little notice, move along!

Clients who work with the Florida Healthcare Law Firm benefit from our deep industry experience and dedicated legal support. Our team doesn’t merely dabble in healthcare law; we specialize in comprehensive representation of healthcare providers and almost every type of healthcare business. We are aligned with your success and committed to navigating the complexities of healthcare transactions to protect your interests and ensure a smooth and successful sale.

By: Jeff Cohen

Founder, Florida Healthcare Law Firm

Tips for Chiropractors Integrating Their Practices

Inspired by numerous medical integration consultants and coaching organizations, chiropractors have increasingly pursued the integration of medical services into their practices over the past few years. Driven by the dual goals of providing comprehensive healthcare solutions and tapping into the broader healthcare spending of their patients, chiropractors are wise to approach this integration cautiously. Too often, chiropractors, excited and perhaps pressured at integration seminars, sign agreements only to later regret it due to several issues: (1) their lawyers disapprove of the advice they received, (2) they underestimated the complexities and risks involved in expanding their practice, (3) they think integration lone will fix fundamental business issues in their practice (e.g., lack of effective marketing and sales), and (4) the integration ultimately fails due to business needs of their practice that are actually intensified by adding the “weight” of an additional service line. What are some of the most significant areas of disappointment for those whose integrations did not go smoothly?

Addressing Underlying Business Problems

Using integration to solve an existing business problem can be problematic. For instance, if you’re pursuing medical integration because your chiropractic patient volume has decreased, you should first understand why your core business is suffering. Evaluate your marketing efforts – are they effective? Do you have a dedicated sales team comfortable discussing your services and fees with potential clients? Since medical integration patients typically come from your core chiropractic business, a decline in chiropractic patients will undermine the success of any new medical services you offer.  Fewer chiropractic patients will likely mean fewer integration patients.  

Navigating Legal Complexities

Many chiropractors are drawn to the promise of medical integration but often overlook the legal intricacies involved. Are you aware of the self-referral issues related to creating a second Tax Identification Number (TIN) for the medical entity? Do you understand the state and federal requirements for physician supervision? It is illegal for a newly formed entity to refer patients to itself for certain specific services. Chiropractors often find themselves following a “one-size-fits-all” model touted as standard practice with consultants and “their lawyers” who just flow the deal instead of making sure their clients understand the laws, risks and options.  It’s common for practitioners to reconsider medical integration when informed about state and federal self-referral restrictions.  Additionally, not all states require a complex “management model”; some, like Florida and approximately 12 other states, permit simpler direct services models.  Chiropractic leaders must do two important things here:  (1) accept that one size fits none, and (2) measure twice; cut once!

Clients who work with the Florida Healthcare Law Firm benefit from deep industry (both business and legal!) experience and dedicated legal support. Our team doesn’t merely dabble in healthcare law; we specialize in comprehensive representation of healthcare providers and almost every type of healthcare business. Whether you’re a new physician starting a practice or a chiropractor looking to integrate your practice, our attorneys are aligned with your success and committed to navigating the complexities of healthcare regulations to protect your interests.

By: Jeff Cohen

Founder, Florida Healthcare Law Firm

Understand the Impact of HB197

Licensed Massage Therapists (LMT) who hold a Medical Establishment license and serve as their own Designated Establishment Manager must be apprised of the employment and patient recordkeeping requirements outlined in Florida House Bill 197 which became effective on July 1, 2024. Florida House Bill 197 broadens the definition of “Designated Establishment Manager”, “Employee” and “sexual activity”. The broadened language has a critical impact on offices which rent office space to massage therapists who are required to have a Medical Establishment license. A “Designated Establishment Manager” is now defined as a licensed massage therapist or health care practitioner who is responsible for the operation of a massage establishment.  Additionally, the broadened definition of an “employee” includes independent contractors or lessees working within the massage establishment whose duties involve any aspect or capacity of the massage establishment including, but not limited to, preparing meals and cleaning regardless of whether such person is compensated for the performance of such duties. The broadened language is accompanied by ambiguity as it is not entirely clear what is considered to “involve any aspect or capacity of the massage establishment”, or “any aspect or capacity of the massage establishment including, but not limited to, preparing meals and cleaning regardless of whether such person is compensated for the performance of such duties” which leaves medical establishment owners in a state of unease for potential noncompliance despite good faith efforts to adhere to the broadened language. Further, the interpretation of the meaning is then left to the judiciary to employ rules of statutory construction to resolve these ambiguities.

Although certain definitions have been broadened, the patient and employee recordkeeping requirements which employers are responsible for are quite detailed. Employment records must include the employee’s start date, full legal name, date of birth, address, phone number, position, and a copy of their ID. These details must be recorded before the employee can provide any service or treatment. Similarly, patient records must include the date, time, type of service, the employee’s full legal name, and the client’s/patient’s full legal name, address, and phone number. These records must be maintained for at least one year after the service. If an LMT’s duties serve a non-LMT practice, they are considered an employee, requiring the non-LMT practice to comply with these recordkeeping mandates. 

In light of the broad and ambiguous language provided in the bill, non-LMT’s can protect themselves by taking precautionary measures by maintaining independence through a sublease and clear delineation of duties with the LMT who shares the office space. As such, a clear separation of respective duties might lower the regulatory risk that the non-LMT is not considered an “employee”, and the recordkeeping requirements therefore do not apply to the non-LMT subletter. It is at a minimum critical for LMT’s to maintain separate business operations and ensure clear sublease agreements and disclaimers to delineate independence from sublessees so as to not incur liability for a sublessee who is not an employee. This separation lowers the regulatory risk that the non-LMT premises owner or subletter would be considered by regulatory authorities subject to the employment and patient recordkeeping requirements. Non-LMT owners and leasers must understand when these requirements apply and maintain proper documentation to demonstrate the LMT’s independence.  

If you have any questions pertaining to how this bill may impact your specific Medical Establishment, it is important to consult with an experienced healthcare attorney to understand how to best proceed to maintain compliance.

Article By: Rachel E. Broughton | Attorney, Florida Healthcare Law Firm

Resurgence of Medical Practice Acquisitions by Private Equity

Private equity is once again showing a strong interest in acquiring medical practices and healthcare businesses. This wave of acquisitions differs significantly from the activity seen in the 1990s, where public companies focused on aggregating gross income to boost stock prices. Today, private equity investors aim to maximize profitability by achieving efficiencies, consolidating large groups for leverage, and developing new income streams. While stock options, warrants, or shares may be part of the deal, many transactions are all-cash, often based on earnings. To secure the full price, sellers typically must remain involved in the business to maintain or even increase revenues.  

Physicians, in particular, need to understand the nature of these deals and the factors that influence them. “Private equity” refers to private investors, usually a group pooling their capital, who purchase a portion or all of a company. These investments are notably larger than those from venture capital firms and do not involve publicly traded entities. The goal of private equity is to invest in mature businesses, enhance their profitability, and eventually sell their ownership stake to another buyer within three to five years. In contrast, venture capital firms often invest in start-ups, acquire complete ownership, and seek control over the company.

Key Issues for Sellers:

  1. Buyer Experience: Sellers should evaluate the buyer’s experience in their specific industry. Since buyers promise to grow the seller’s profitability, it’s crucial to confirm that they have a successful track record in similar businesses. Sellers should also seek detailed plans on how the buyer intends to achieve growth.
  2. Impact on the Seller: It’s important for sellers to understand how the acquisition will affect their income, their operations and their business operations.  Will there be significant cultural changes? Will there be major shifts at the executive level? What kind of control will the buyer exert? What effective voice will the seller have in the issues that direct impact them?  Speaking with other businesses that have been acquired by the same buyer can offer valuable insights into what to expect post-acquisition.  If the past is any predictor of the future, the happiest sellers in these transaction are the ones who have an eye on retirement within he next 3-5 years.  
  3. Buyer Plans: The timing of additional investment rounds is critical, especially if the transaction involves stock options or warrants. If the buyer is in the early stages of their investment cycle, it could take several years before any stock has real value, as the initial phase often involves significant debt accrual.  And that says nothing at all about dilution or the subordinated nature of the interest.  Unless the sellers pick the right buyer, the sellers with stock or warrants will likely just paper a bedroom closet with them!

Understanding these factors can help physicians and other healthcare business owners navigate the complexities of selling to private equity and ensure they make informed decisions that align with their goals. 

By: Jeff Cohen

Founder, Florida Healthcare Law Firm

How to Elevate an IV Hydration Practice with Aesthetic Services

IV hydration therapy providers are increasingly expanding their menu of services to include aesthetic services such as Botox, injectables and other aesthetic and/or dermatologic skincare services. The growing trend of embracing aesthetic treatments not only enhances the comprehensive care offerings available under one roof but is also useful in attracting a broader clientele and unlocking new revenue streams for an IV hydration therapy business. Today’s wellness landscape is more competitive than ever and staying ahead means differentiating through not only customer service, clinical quality but also with in-demand service offerings. Adding aesthetics can keep a practice competitive and attracts new patients who seek convenience and comprehensive care.

First Five Steps:

  1. Ensuring that a practice has appropriately licensed and trained Clinicians who are allowed via their scope to perform the aesthetic services it plans to offer is key. Though regulations vary from state to state it is typically a licensed APRN or PA;
  2. Structuring the appropriate supervisory relationship ensures that each APRN/PA is appropriately supervised by a licensed and qualified physician, and that the supervisory relationship is properly documented in accordance with the state’s laws and regulations – which most typically consists of offsite supervision with a written agreement and protocols between them;
  3. Applying for a Health Care Clinic Establishment Permit (HCCE) permit (not to be confused with a health care clinic license from AHCA) enables a provider to order aesthetic treatment supplies from vendors; The purpose of the HCCE permit is to allow the business to purchase prescription drugs in the name of the business for use by the practitioners of the business instead of having each practitioner within the business purchase the prescription drugs under his/her individual license for use on his/her individual patients.
  4. Patient Intake Documents – It’s crucial you incorporate service specific informed consents covering each aesthetic service you will offer; Each informed consent should disclose detailed information regarding the healthcare treatment or procedure, including its potential risks and benefits and alternative treatment options. These documents should be written in clear, understandable language that the patient can comprehend, should be signed voluntarily by the patient and should be documented into each patient’s medical record prior to treatment.
  5. Checking with your insurance carrier prior to offering an enhanced line of services will not only ensure your insurance coverage is up to date, but also that it covers the scope of the aesthetic services you will offer, whether as an “endorsement” or “rider”. An endorsement is a modification or addition to an existing insurance policy that changes the terms or scope of coverage, for example to include additional procedures, specialties, or types of claims that are not typically covered under the base policy. Similarly, a rider is a provision added to an insurance policy to provide additional coverage for specific risks or situations. In the context of medical malpractice insurance, a rider might be used to extend coverage for certain procedures, locations, or activities that are not covered by the standard policy. Both endorsements and riders allow policyholders to customize their insurance coverage to better suit their needs and mitigate risks specific to their practice or circumstances.

Please contact us at Florida Healthcare Law Firm to discuss in more detail the growth of your IV hydration business today and how your business can stay ahead of the curve and address each of these compliance measures proactively. 

What to Consider When Adding Aesthetic Services to a Medical Practice in Florida

In today’s competitive healthcare landscape, staying ahead by expanding to include wellness and elective offerings is growing increasingly popular.  Adding aesthetics to a medical practice platform keeps the practice relevant to patients, and competitive in the marketplace and may even attract new patients who seek convenience and comprehensive care.

Five Key Concepts to Consider:

  1. Scope of Practice. Owners will want to ensure that the medical practice has the appropriately licensed and trained Clinicians to perform the aesthetic services the practice will offer. In Florida, this consists of ensuring that each midlevel provider (APRN, PA) has a supervising physician and that the documentation in place between each of those clinicians adequately complies with Florida’s scope of practice requirements as indicated by the various professional boards;
  2. Physician Collaboration. Each Clinician must be appropriately supervised by a licensed and qualified physician, and the supervisory relationship must be properly documented in accordance with Florida’s laws and regulations. Depending upon the nature of the practice, and the comprehensive menu of services being offered, there might be additional qualifications of the collaborating physician, such as requisite board certification(s);
  3. Biomedical Waste Program. Medical practices need to be appropriately registered as a Biomedical Waste Provider with the Florida Department of Health. This entails submitting an application to the state, and scheduling an inspection where the state will ensure you have contracted with one of its approved biomedical waste transporter servicers, and that you have development a completed operating plan;
  4. Patient Intake Documents. Service specific informed consents covering each aesthetic service offering must be incorporated before any patient is ever touched. Each informed consent should disclose detailed information regarding the healthcare treatment or procedure, including its potential risks and benefits and alternative treatment options. These documents should be written in clear, understandable language that the patient can comprehend, should be signed voluntarily by the patient and should be documented into each patient’s medical record prior to treatment; and
  5. Insurance. Check in on the medical malpractice insurance coverage to ensure it is up to date, and that it covers the scope of the aesthetic services aesthetic services you will offer, whether as an “endorsement” or “rider”. An endorsement is a modification or addition to an existing insurance policy that changes the terms or scope of coverage, for example to include additional procedures, specialties, or types of claims that are not typically covered under the base policy. Similarly, a rider is a provision added to an insurance policy to provide additional coverage for specific risks or situations. In the context of medical malpractice insurance, a rider might be used to extend coverage for certain procedures, locations, or activities that are not covered by the standard policy. Both endorsements and riders allow policyholders to customize their insurance coverage to better suit their needs and mitigate risks specific to their practice or circumstances.

Embracing aesthetic treatments can not only enhance a medical practice by incorporating medical and aesthetic treatments under one roof, but it can also attract a broader clientele and open new revenue streams for the business. It may be time to embrace change!