Asset Protection: Building Limits is a Strong Defense

Posted on by

By: Susan St. John

Should you consider asset protection planning as part of your estate planning? The short answer to this question is yes if you have significant assets, will inherit sizable assets, or work in a profession that is routinely sued pursuant to malpractice complaints. In particular, healthcare professionals should go the extra mile when it comes to asset protection in light of the McCall and Kalitan cases out of the Florida Supreme Court and Fourth District Court of Appeals, respectively, invalidating the limit on non-economic damages in medical malpractice cases. So how can asset protection be accomplished?

Protecting your assets and preserving wealth can be accomplished through a variety of planning techniques. These techniques are used to protect assets from being wasted or levied against. Asset protection planning is part of estate planning, which should be reviewed whenever an individual has a significant change in life circumstances, becomes aware he or she will inherit a sizable investment or asset, or enters a profession that is considered to carry considerable risk.

The intent of asset protection is to protect assets from waste or exposure to potential creditors, without concealment or tax evasion. Asset protection can preserve wealth for use later in life or to be passed on to descendants, that is, children or grandchildren, or perhaps other family members.

Asset protection can be maximized through various vehicles such as: Continue reading →

Protecting Your Practice’s Brand: Trademark Basics

Posted on by

By: Shobha Lizaso

Building a brand image is extremely important in today’s technology-driven economy.  Because of social media, online advertising, and the availability of online reviews, local healthcare providers need to engage at a higher degree than ever before to attract new patients, retain current patients, and establish themselves as experts in their respective fields.

Patients choose providers based on specializations, reputation, and quality of care, so the first step in branding is selecting and registering the trademarks for your practice.  Trademarks are the names, slogans, tag lines, and/or logos that identify and represent your practice, its services, and mission to the public, and are the foundation for the facility’s overall branding and marketing strategy. In addition to the trademarks associated with your main practice, you may also use trademarks to protect your stake in a specific area or a specific area of expertise. For example, the trademark and logos used for a hospital’s senior services might be different than one used for its cardiac care services.  If you do not protect your trademark, a competitor could use it or something similar, which could confuse your patients and potentially draw business away from your practice. Continue reading →

HMO Patient Emergency Care Reimbursement

Posted on by

By: Bradley M. Seldin, C0-counsel Guest Contributor

Prohibitions against balance billing Health Maintenance Organization (HMO) patients have been around for more than a decade, but many non-contracted providers to HMO patients still don’t fully understand their rights to payment when it comes to collecting monies from patients and HMO’s.

HMO’s often have predetermined rates they pay to non-contracted healthcare providers; sometimes they are artificially low, do not reflect what is written in the member’s contract, or do not abide by what is required by applicable law.  As a result, these providers may end up being underpaid if they don’t have a written contract with the payor and they do not understand the payment methodology being applied to them.  This is of particular significance to emergency care providers. ER doctors and hospitals must, by law, provide emergency care without regard to whether the patient has an ability to pay for the treatment received.

Following their provision of emergency care, medical providers often question the payment obligations under the patient’s Health Maintenance Organization contract. If the emergency medical provider has a direct written contract, the reimbursement is governed by that participating provider contract’s reimbursement terms.   Continue reading →

Florida Lawmakers On the Attack Re Marketing in the Substance Abuse Industry

Posted on by

B6306Color100By: Jacqueline Bain

On February 8, 2017, Florida Senator Jeff Clemens (Dem.) filed a bill entitled “Marketing Practices for Substance Abuse Services” (SB 0788). A sister bill was filed in Florida’s House of Representatives by Bill Hager (Rep.) on February 13, 2017 (HB 807).

In the most general sense, the bills propose the following:

  • creation of a marketing fraud statute specific to substance abuse treatment centers;
  • mandating that all recovery residences, even those owned by treatment centers, receive FARR certification prior to suggesting that patients reside there;
  • requiring lead generators, call centers and other web based marketing providers to make certain disclosures to consumers;
  • requiring lead generators, call centers and other web based marketing providers to be licensed by the State of Florida Bureau of Professional Regulations;
  • allowing the State Attorney’s office to prosecute patient brokering;
  • institutes and increases fines for convictions of patient brokering; and
  • expanding the definition criminal definition of “racketeering” to include patient brokering.

The bills also expand investigation and prosecution ability of the State and reduces substance abuse patient privacy in criminal investigations. If passed, the bill would grant law enforcement access to substance abuse patient records in criminal investigations. It also permits the State Department of Legal Affairs to investigate and prosecute patient brokering allegations.

The full text of each bill is available here and here. Continue reading →

Payor Strategies to Reduce the Harm of Opiods

Posted on by

By: Karina Gonzalez

CMS recently published a white paper entitled “Healthcare Payer Strategies to Reduce the Harms of Opioids.” The white paper was prepared by the Healthcare Fraud Prevention Partnership (“HFPP”), which is a voluntary public-private partnership between the federal government, state agencies, law enforcement, private health insurers, employer organizations and fraud units to reduce fraud, waste and abuse.  The white paper gives information and provides insight on the way payors view addiction treatment.

HFPP identified five actions that should be considered for implementation by all payors as quickly as possible.

  • Train providers on Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain;
  • Promote access to and usage of Medication Assisted Treatment (MAT);
  • Promote the availability of Naloxone;
  • Encourage use of cross-payor data to identify fraudulent, wasteful or abusive practices associated with opioids in order to target corrective actions; and
  • Identify and disseminate effective practices across the healthcare sector.

Continue reading →

Healthcare Trend Alert for Out of Network Providers

Posted on by

300x300_alertWe are seeing an increasing number of challenges to payors cost saving measures of retroactively changing the payment methodologies on unpaid claims for out-of-network providers involved with audit activity. For instance, if payors audited a 2015 claim and didn’t resolve the claim until 2017, the payor will pay 2017 rates instead of 2015 rates. More recently, payors have based their out-of-network rates on the benchmark set by Medicare, but have not explained the reduced reimbursements. The lack of payor transparency as reimbursements slide is frustrating to out-of-network providers who have little notice or opportunity to react.

ASC Update for 2017

Posted on by

For years, Ambulatory Surgery Centers (ASCs) have dabbled with the notion of overnight stay for late scheduled procedures or those that require extended recovery beyond the usual 23 hours period.   The day of clarity may finally be upon us!  HB 0145 and SB0222 in the Florida Legislature are both aimed at the notion of creating the concept of recovery care centers at which post surgical recovery of 24 hours (in the Senate Bill) or 72 hours (in the House Bill) can occur.  If the bills pass both houses, it means ASC care can move to possibly more complex cases and at least later scheduled cases.  Regardless, it certainly means greater ASC case volume and could be a boon to the industry.

Conflicts of Interest Issues Can Poison Your NonProfit

Posted on by
Charity jar

Charity jar

By: Shobha Lizaso

You have a cause that you are passionate about. You have the drive and motivation to put your time and effort behind that cause. You have the dedication to use all of the aforementioned to create a 501(c)3 nonprofit organization.  However, once you create the organization, you must also be diligent in protecting your organization’s tax-exempt status.

Like most people who start a non-profit organization, your focus and energy is probably directed towards serving the community rather than performing internal compliance checkups. However, you cannot serve your target community well if your nonprofit is not run in a manner that is compliant with the law.

What happens when the IRS revokes your organization’s nonprofit status? Here are some examples: Continue reading →

How to Make an Out of Network Appeal Count

Posted on by

out of network appealBy: Karina Gonzalez

As many know, out-of-network providers have much different appeal rights with commercial plans than in-network providers.  It is important to understand each health plan’s appeal procedure as well as time requirements for an appeal may vary.  However, the appeal process is still one of the most important tools providers have to get paid in the current environment of reduced reimbursements, caps on the number and frequency of services, bundled payments based on specific codes, delayed payments, daily errors in claims processing leading to denied claims, claw backs, and the list goes on.   Continue reading →

OIG Opines that Charities Allowed to Help with Patients’ Insurance Obligations

Posted on by

financial hardshipBy: Jacqueline Bain

In the healthcare business, giving a patient a break on a health insurance copay is often viewed as suspicious. The reasoning for the suspicion is that the financial incentive may give one provider a competitive advantage over another, or persuade a patient to seek services that might not be medically necessary.  Moreover, any person who interferes with a patient’s obligations under his/her health insurance contract may be viewed as tortuously interfering with that contract. However, in an advisory opinion issued on December 28, 2016, the OIG opined that, in certain instances, a non-profit, tax-exempt, charitable organization could provide financial assistance with an individual’s co-payment, health insurance premiums and insurance deductibles when a patient exhibits a financial need.

The party requesting the advisory opinion was a non-profit, tax-exempt, charitable organization that did not provide any healthcare services and served one specified disease. The non-profit, tax-exempt, charitable organization is governed by an independent board of directors with no direct or indirect link to any donor. Donors to the non-profit, tax-exempt, charitable organization may be referral sources or persons in a position to financially gain from increased usage of their services, but may not earmark funds and or have any control over where their donation is directed. Continue reading →