What to Do When The Government Comes Knocking

business meeting between healthcare professionals and goverment

business meeting between healthcare professionals and govermentBy: Karen Davila

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.Continue reading

Company Model Scrutiny For Physicians After Daitch Case

fhlf daitch case

fhlf daitch caseBy: Jeff Cohen

A 2018 Department of Justice civil settlement involving a Florida interventional pain physician was a cliff hanger when it surfaced, especially vis a vis the issue of the so-called Company Model, where anesthesiologists and referring physicians jointly owned an anesthesia provider.  The Daitch settlement involved interventional pain specialists who settled the case for $2.8 Million.  There, the government claimed that a mass of urine drug tests weren’t reasonable or medically necessary.  But the issue buried in the settlement call the issue of intertwined medical businesses and the Company Model into question.

The so-called Company Model involves the formation of a company that provides anesthesia services.  It’s jointly owned by anesthesiologists and referring physicians.  Theoretically, on a Monday, the anesthesiologists own the anesthesia practice and bill for all anesthesia services performed at a GI lab or ASC.  On a Tuesday, however, the new company (jointly owned by the same anesthesiologists and the referring physicians) steps in and starts billing for the anesthesia services, thus indirectly sharing a part of the profits with the physicians who are generating the anesthesia referrals.

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PPP Standing in the Way of Healthcare Mergers and Acquisitions

PPP Standing in the Way of Healthcare Mergers and Acquisitions

fhlfhealthcaretransactionsduringpandemicBy: Susan St. John

The trend that we are seeing affects both buyers and sellers in the health care sector with respect to entities that have received cash infusions from the Paycheck Protection Program (“PPP”) created pursuant to the CARES Act in response to COVID-19. Mergers and acquisitions can come to a significant slowdown, standstill or be terminated altogether if careful planning is not performed to account for the impact the PPP funds received by a healthcare target or seller will have on an anticipated merger or acquisition.  While tax and legal considerations have typically followed along with the merger or acquisition and these considerations are important aspects of any merger or acquisition, they have taken a forefront position when it comes to planning for a change of ownership when the healthcare target or seller has received PPP funds.

As we learned earlier, health care entities requested and received PPP funds to sustain them during the public health emergency caused by COVID-19, allowing them to avoid a virtual economic shut-down. These funds were a welcome relief to keep health care entities afloat financially, providing a way to cover certain expenses such as a) payroll costs, b) rent, c) interest on any covered mortgage obligation (which shall not include any prepayment of or payment of principal on a covered mortgage obligation), and d)  utilities. Using the PPP funds on these expenses allows for a recipient of the PPP funds to qualify for loan forgiveness under the PPP. That all seemed like welcome relief at the time.Continue reading

Patient Brokering & Money Laundering: Bieda Arrests Raise Serious Issues

patient brokering arrest treatment center toxicology lab ownership

patient brokering arrest treatment center toxicology lab ownershipThree family members involved in owning an addiction treatment center and/or a toxicology lab were charged in July with patient brokering and money laundering in an alleged scheme involving roughly $2 Million.  The allegations arise out of a complex corporate enterprise involving at least four companies and some common ownership between the treatment center and lab.  While it’s premature to assume that the defendants did anything illegal, there are some interesting things in this case:

Complexity Invites Suspicion.  Every business owner in the addiction treatment and toxicology lab space knows three things:  (1) it’s extremely regulated, (2) law enforcement has an especially sharpened focus on these industries, and (3) insurance companies are very suspect of any situation involving either industry, especially when there is any common ownership.  So why then would one construct an enterprise that even “looks” complex or tricky?  It intensifies suspicion in an already highly scrutinized business space.  This is clearly one of the points of focus in this case.  There’s an old saying woven into the mind of every experienced healthcare lawyer:  if something can’t be done directly, it can’t be done indirectly.  Time will tell if anything in this case was wrong or if there are any good reasons for the corporate structure, but the complexity of the corporate structure certainly invites suspicion. Continue reading

Prepping Your Dental Practice for Sale

dental practice sales transaction

dental practice sales transactionBy: Chase Howard

Thinking About Selling Your Practice? Preparation is key and the difference between a successful sale and seller’s regret.

Step 1: Call Your Financial Planner

  • Be sure that you can afford to leave the business
  • Most buyers will require a comprehensive non-compete and you should be certain that you are financially prepared to retire, sell, or move before signing any restrictions.
  • You will also want to ensure that you are planning for the income you are about to receive. Are there vehicles in place or options that are best to ensure the purchase price is put to its best use for you.
  • Consider post sale options if not retirement – are you going to be employed by the buyer? Are you selling to an associate and will phase out? Are you just moving and will need to find new employment/open a practice?

Step 2: Visit Your Accountant

  • Your business is only worth as much as can be defined on paper.
  • If a potential buyer cannot make sense of your accounts and assets, you may leave significant value on the table.
  • Get your financial history in order by reviewing tax returns, profit statements, AR reports, and payroll history for prior 3-4 years.
  • Clean up creative bookkeeping – you will have to promise the buyer that your financial statements are true and accurate.
  • Have your accountant help value assets of your business – or use an appraiser if necessary.
  • Discuss company structure – there may be restructuring needs or you may need to transition to a different structure for tax purposes.

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Considering Compliance in Out of Network Physician Owned Specialty Hospitals

florida healthcare law firm physician owned hospital compliance info

florida healthcare law firm physician owned hospital compliance infoBy: Jacqueline Bain

Out of network physician owned specialty hospitals are unique in that there are less stringent legal requirements on the facility, but patient care obligations remain the same. This means that patient care must be prioritized over profits and all actions taken by the hospital and any physician investor must showcase that order of priority.

Given the amount of scrutiny placed in physician owned specialty hospitals in the past two decades, these facilities are well served to identify and implement a process to remedy compliance concerns. Even when a facility does not submit claims to any Federal health insurance provider and is out of network with all commercial insurance companies, it is still required to follow the laws of the state where it is located.

The best plan for surviving scrutiny in such situations is to have a plan. Proactively seek out applicable laws and regulations, and determine how your hospital will abide by them. Compliance can be tailored to fit your facility.

Overutilization and Self-Referrals

A physician who shares ownership in a hospital may have a financial incentive to refer patients for services if he or she receives a percentage of the revenue generated. Laws including the Federal Stark Law and Anti-Kickback Statute were promulgated to combat unnecessary referrals. A 2003 study by the Department of Health and Human Services concluded that physician-investor referrals to hospitals in which they have an investment interest are similar to those physicians without investment interests. Nevertheless, the fear of overutilization and unnecessary self referral remains at the forefront of the regulators’ minds at both the State and Federal level.Continue reading

Attorney Steven Boyne Joins Florida Healthcare Law Firm in Delray Beach, Florida

florida healthcare law firm managed care attorneyJune 1, 2020 – Florida Healthcare Law Firms adds experienced attorney Steven Boyne to the team to assist with human resource law, corporate and transactional law, as well as telemedicine, healthcare tech and cyber breaches.

Florida Healthcare Law Firm has announced that they have added Steven Boyne to the team. Steven brings over twenty plus years experience working with different types of healthcare entities from Air Ambulances to large healthcare insurance companies, and everything in between. Steven specializes in areas including specific healthcare business human resource issues, telemedicine and HIPAA, strategic disaster planning for healthcare providers, business interruption insurance, health insurance and air ambulances.

“Positioning your healthcare business to be proactive is one of the most important things you can do. Who would have imagined we’d see a global pandemic in our lifetime? Being prepared for ‘interruptions’ help keep your business afloat when disaster strikes, especially when it comes to finances. Steven’s experience in large health insurance companies brings a wealth of knowledge and expertise that will help individual practitioners be just as prepared as the big guys. And, as technology grows in the healthcare industry, Steven is on board to help with his tech expertise,” Florida Healthcare Law Firm COO Autumn Piccolo says. Founder and President, Jeff Cohen, goes on to say that, “We advise many clients on telemedicine and telehealth laws. Steven’s passion for tech is a great addition for current and future clients. His unique firsthand knowledge on cyberbreaches, tech software and security systems is hyper-specific, which will benefit healthcare business owners.Continue reading

Webinar | How can you transform your business to be prepared for future situations like COVID-19?

prepare your business to be fully remote online during a crisis like covid-19

prepare your business to be fully remote online during a crisis like covid-19Join Florida Healthcare Law Firm Attorney Chase Howard on our free webinar titled “How can you transform your business to be prepared for future situations like COVID-19?”

Faced with the reality of remote operation, we’ll talk about how your business prepare to thrive in a similar scenario in the future.

  • What to do with remote staff when it comes to contracts, operations and patient privacy.
  • How do Federal regulations impact telework.
  • Could expanded telehealth laws ease the transition to remote care in a future crisis.

Presenter: Chase Howard, Esq. is an Attorney at the Florida Healthcare Law Firm and has focused his legal practice on health law, medical malpractice defense, business law, and contracts. He deploys crucial skills gained through hands-on business experience in the medical tech world to service clientele such as medical spas, medical practices, medical technology businesses, healthcare business entities, physicians, chiropractors, and dentists. Chase’s experience working in University of Miami Health System’s Risk Management Department provided him with a strong understanding of legal compliance in the healthcare world as well as experience in liability assessment, prevention and defense. With his multi-specialty background, Chase’s practice focuses on all aspects of transactional Health Law, MedSpa Start-up and consulting, general business law, and MedTech.

Webinar to prepare for future situations like covid-19

A Telehealth Break for Medicare Patients and Providers

new medicare laws for telehealth related to corona virus

new medicare laws for telehealth related to corona virusBy: David J. Davidson

Up until now, Medicare has been fairly structured in how telehealth services are reimbursed. Medicare would pay for telehealth services only if certain, very narrow criteria were met. These rules covered the patient, the patient’s location, the provider, the types of services rendered, the telehealth equipment used and the way the services are coded. Those rules can now be relaxed under recent federal legislation.

On March 6, 2020, President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 into law. That law relaxes the current Medicare criteria, in order to expand the use of telehealth as a resource against COVID-19. Pursuant to this law, the Secretary of HHS has the authority to waive the “site” requirements for telehealth services provided to Medicare beneficiaries who are located in an identified “Emergency Area” during an “Emergency Period.” Since the whole country is currently is experiencing a public health emergency, as declared by both the President and the Secretary of HHS, the Emergency Period and Emergency Area requirements are met on a nation-wide basis.

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Webinar | Boosting Business: Advising Physicians on Third Party Relationships

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boosting business, advising physicians on third party relationshipsThe Florida Healthcare Law Firm is hosting a free webinar for physicians on appropriate third party relationships. With shrinking reimbursement rates, physicians are increasingly turning to alternative methods and innovative physician relationships to increase revenue. However, not every opportunity is compliant with Federal and State kickback laws, which are designed to prevent overutilization of services.

This course aims to help attendees recognize and advise physicians about relationships designed to compensate for more than just patient care, including, but not limited to:

1. White Coat Marketing;

2. Contractual Joint Ventures;

3. Relationships with Pharmaceutical and DME Companies.

It will use recent trends in the market to reinforce its objectives. This free webinar is for physicians and healthcare providers full of valuable information.All you have to do is register here, put it on your calendar and then click on the link emailed to you on March 25th!

Physician relationships of any kind should be approached carefully by a highly qualified healthcare attorney. Nearly every aspect of healthcare is governed by a complex array of regulations and remaining compliant when drafting a contractual relationship of any kind is no easy task.