Thank you @scottnelsonlive for featuring us on #Medsider today! Hear the interview here: #ACO http://medsider.com/interviews/accountable-care-orgnizations-interview-jeffrey-cohen-florida-healthcare-law-firm/
AMN Healthcare on PRNewswire.
“Fifty-eight percent of 882 administrators and physicians responding to the survey indicated their facilities are either in the process of forming ACOs or are considering doing so, while 42% said their facilities will not form ACOs in the foreseeable future.
Of those who are moving toward ACOs, 42% said physician alignment is the most serious obstacle to their efforts, followed by lack of capital (38%), lack of integrated IT systems (31%), and lack of evidence-based treatment protocol data (25%). ”
Read more: PRNewswire
Event: Washington, DC: 6/27- 6/28: Kathleen Sebelius Keynote Speaker at ACO Summit
Second National Accountable Care Organization (ACO) Summit, June 27-28, 2011, Omni Shoreham Hotel, Washington, DC
Sessions include:
Transforming Medicare with Accountable Care
Core Competencies of Successful ACOs
Models for ACO Implementation
Creating High-Value Health Care:The Big Picture
Read more/register: ACOSummit.com
Most readers know that the federal Stark Law deals primarily with matters involving physician
self referral. The state equivalent, the Florida Patient Self Referral Act of 1992, has provisions that are even tougher than the Stark law. For instance, the Stark law allows some physicians to refer to renal dialysis centers in which they have an ownership interest, but the Florida law does not. Fresenius, a provider of renal dialysis services, filed suit seeking a declaration that the federal law (and not the state law) should control on the issue. Since there are several key areas where state law is more stringent than federal law (e.g. supervision requirements and ownership of entities that don’t provide “designated health services”), many eyes were on the court. Instead of giving Fresenius a pass and saying “Florida can’t make it tougher than what the federal law says,” the court stated that the federal laws do not preempt (supplant) the state ones.
Since the Stark Law does not preempt the state law and since the state law does not violate the U.S. Constitution, business people and professionals will have to make sure that both layers of compliance (state and federal) and solidly in place.
A recent decision out of the 11th Circuit Court of Appeals will help Florida’s tort reform efforts. As part of broad tort reform measures, the Florida Legislature implemented a $1 Million cap on noneconomic damages (e.g. pain and suffering damages). Florida has had a hard road in implementing tort reform measures, which often fall under Florida Supreme Court analysis; and many insiders wondered if the 11th Circuit Court in Atlanta would strike Florida’s cap. Nope!
The case involved the death of a woman following childbirth. The District Court determined her death was caused by the negligence of her medical team, the members of which were U.S. military employees. The plaintiffs were awarded $2 Million in noneconomic damages, but the court reduced it to comply with the $1 Million noneconomic damage cap. On appeal to the 11th Circuit, the plaintiffs argued that the cap violated the state’s equal protection clause; but the court rejected the argument.
Since, however, the court did not address other aspects of the plaintiff’s state constitutional challenge (right of access clause, right to jury trial clause and separation of powers clause), the matter was sent to the Florida Supreme Court for final resolution. The state Supreme Court may take up the case; and if it does, it’ll be important to watch.
It is estimated that health care fraud is a $60 billion a year business fueled by illegal conduct such submitting false claims and paying kickbacks to physicians and suppliers. Until recently, if large health care organizations were the targets of fraud investigations, these companies, as their penance, typically wrote a big check to the government and continued business as usual. Things have changed.
While indicting and convicting health care executives is not a new practice, officials at the Department of Health and Human Services (“DHHS”) and the Department of Justice (“DOJ”) are said to be frustrated with the frequent occurrence of repeat violations and they are ramping up their strategy. Lately there have been aggressive new initiatives rolling out to combat rampant health care fraud and the government is increasingly bringing criminal charges against executives even if they were not complicit in the fraud scheme, but could have stopped it if they had known.
What’s more striking is that in addition to civil monetary penalties and criminal indictments, the government is taking great efforts to exclude convicted executives from being involved in companies that do business with federal health programs. A recent bill introduced to Congress under the name of the “Strengthening Medicare Anti-Fraud Measures Act of 2011 (the “Act”), increases DHHS’ existing powers and allows them to seek to exclude owners, officers and mangers of companies that are convicted of health care fraud from federal healthcare programs even if they left the company prior to any conviction of the entity.
In addition to the expansion of the permissive exclusion afforded by the Act to DHHS, regulators and law enforcement officials are going to be increasingly utilizing current permissive exclusion remedies. DHHS’ bold move appears to be based on the rationale that the permissive authority of Secretary of DHHS or the Office of the Inspector General of DHHS to exclude individuals is a much easier process than criminal proceedings.
The impact of this aggressive new government strategy will likely have even further reaching consequences for convicted healthcare business owners and executives. For instance, an exclusion from being part of a business that works with federal health care programs would be a career ending blow for most executives. It should also be emphasized that smaller organizations are not in any way immune from enforcement activity. In fact, with newly increased enforcement budgets, authorities have the means and the time to target organizations of all sizes.
Law makers and regulators are hopeful that by ramping up the enforcement of existing laws and expanding the scope of DHHS’ power, it will act as a powerful deterrent against overt acts and will compel corporate executives to take proactive steps in preventing fraudulent activities and affirmatively addressing fraudulent practices when discovered. It is vitally important now more than ever, to have an active compliance program in place. A strong compliance program can not only detect and prevent fraudulent or negligent activities but also will typically be considered as a mitigating factor if an organization is culpable of fraudulent activity. The Florida Healthcare Law Firm works with health care organizations of all sizes to assist in the audit, development and implementation of effective compliance programs.
Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship. Though
they approach healthcare issues differently, there are many instances where they share care or even work together. Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects. Properly constructing the arrangements is critical, especially since government regulators and payers tend to view such arrangements with skepticism, alleging that the true reason for the combination is for chiropractors to avoid coverage restrictions.
The core legal issues the parties need to be aware of include:Continue reading
