Category Archives: Medical Directorships

Avoiding Delays in License Renewals

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Florida Medical BoardIt’s almost renewal time once again for many health care practitioners.  If this is your renewal cycle, please note the following information provided by the Florida Board of Medicine, which can help you avoid some of the most common delays encountered with license renewals.

It is important to remember the upcoming renewal is the first to have mandatory continuing medical education reporting requirements.  If you have not done so, please activate your account with CE Broker and ensure that all required CME you have completed for this renewal has been uploaded.

Most of the medical practitioners renewing will be required to submit the following:

  • Completed renewal application
  • Required fees
  • Evidence that you have practiced medicine or have been on the active faculty of an accredited medical school for at least two years of the immediately preceding four years
  • Completion of Financial Responsibility form
  • Completion of Physician Workforce Survey
  • Verification of Physician Profile
  • Verification of your current status relating to prescribing controlled substances for the treatment of chronic non-malignant pain

Continue reading →

Tuomey Court Has A Lot to Say

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bcbs lawsuit

 

By: Jeff Cohen

The Tuomey decision, U.S. Court of Appeals case out of South Carolina, contains important lessons for physicians, especially as it relates to (1) compensation arrangements with hospitals, (2) proper compensation arising in connection with the provision of designated health services (“DHS”), and (3) the advice of counsel defense.

The concept of DHS arises largely in the context of the federal Stark Law, which in pertinent part (1) forbids physicians from owning and referring to providers of DHS (e.g. PT, rehab, diagnostic imaging, home health, DME, clinical laboratory, inpatient and outpatient hospital services), (2) describes how medical practices can provide DHS to their own patients, and (3) forbids even physicians within a practice from allocating DHS profits on the basis of who ordered or referred to them.

The Tuomey case involves a whistleblower action filed against a not for profit hospital system.  The original jury in that case decided that the system didn’t violate the False Claims Act, but the appellate court set aside the verdict using facts and testimony that had be excluded from the jury trial, Tuomey Healthcare System was found to have knowingly submitted over 21,000 false claims to Medicare and the government was awarded over $237 Million (most of it in the form of punitive damages).  The government (which often advances the plaintiff’s—“relator” case in whistleblower cases) filed a motion for a new trial, which the trial court granted and the appellate court affirmed.

The case involves the following: Continue reading →

The Next Passenger on the Health Train: Physician Assistants

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fl legBy: Jackie Bain

The scope of Physician Assistants’ practice is a dynamic and hotly debated area of law which shares many similarities with the nurse supervision issues we covered in a recent article (available here). House Bill 1275 would have also allowed for an expansion in the PA field and was included on the “Health Train” compilation of bills introduced during the Florida legislature’s recent session. As we know nothing on the Train passed before the session ended and though it may gain forward momentum next time, here’ how the laws stand today:  Continue reading →

The 8 Ways to Save Money or Make Money in 2014

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      2014Now that we’re on other side of the holidays and solidly planted in 2014, it’s a great time to chart a new course.  Here are 8 things you can do that will make you money or save you money:

  1. Hire someone.  If you are a solo practitioner, are responsible for generating the revenue and also for leading your business, you will learn one clear thing:  it’s impossible!  It’s simply impossible to do both.  In business, if you are not growing, you’re sinking.  There is no such thing as maintaining the status quo.  If you can’t see how you can afford to do it, then you need to meet with your financial advisors, since at least some part of the work of your new hire will come off your plate.  It may even make sense to ask a local hospital to assist you in bringing in a new doctor.    Continue reading →

Ordering and Referring Providers: CMS Just Won’t Take No for an Answer. Form 855-O.

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By: David Hirshfeld, Esq.

More and more of our seasoned clients are opting out of Medicare, and the younger ones are simply not enrolling.  The scale seems to have finally tipped so that the potential liability of being a Medicare provider outweighs the benefits.  So many providers are avoiding Medicare participation, that the Affordable Care Act and CMS have implemented the issuance of “Ordering and Referring Provider Numbers” through CMS Form 855-O.

As of May 1, 2013, physicians and other providers (collectively “Providers”) who bill Medicare must list the NPI of the ordering/referring Provider on their claim forms in order to be paid for the technical component of imaging services, the technical component of clinical laboratory services, durable medical equipment and/or home health services.  An issue arises when the referring/ordering Provider does not participate with Medicare, and does not have an active NPI.

The Affordable Care Act provides a solution by allowing Providers to enroll in Medicare for the sole purpose of ordering or referring covered services for their Medicare patients, even though the ordering/referring Provider cannot bill Medicare for the services (s)he provides.  This limited enrollment is accomplished through CMS Form 855-O.

Providers who have opted-out of Medicare by filing the required affidavit and entering into acceptable patient contracts do not have to submit Form 855-O as they have NPIs, even though they are not allowed to bill under them during their opt-out period.

Why Compliance Plans Make Sense

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Clipboard with Checklist and Red PenHas your practice implemented a compliance program or considered improving an existing one?  Is it really necessary?  Prior to the Patient Protection and Affordable Care Act (ACA), the necessity for physician practices to develop compliance plans was merely voluntary.  However, the ACA will now require physician practices to have a fraud and abuse compliance plan in place as a condition of continuing to participate in Medicare or Medicaid programs.  Because the government first published guidelines in the year 2000 for the voluntary use of compliance plans in physician practices and has subsequently enacted a mandate in the ACA for compliance plans, many physician practices are proactively implementing them.  While this compliance plan mandate may be viewed by physicians as yet another administrative burden and expense to the practice, it can have many benefits as well.  Implementing an effective compliance program can have the result of not only reducing liability risks, but can also allow a practice to reap monetary benefits.  In fact, it could be more costly for the practice not to have one! Continue reading →

Split-Fee Soup: A Recipe for Disaster

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Cauldron-psd74325By: David Hirshfeld

When people ask me what I do, I used to say “I’m a transactional health care attorney.  I represent health care practitioners in their business deals.  I don’t do malpractice.”  That response does little to wipe the blank stare off my questioner’s face, and even I have to stifle the urge to yawn.  My new and improved response is that “I spend a lot of time advising health care practitioners how they can share fees with people who refer them patients.”  Now I get invited to all sorts of cocktail parties !!!

Practitioners split fees with one another for a variety of reasons; and they very often do not realize that a particular arrangement involves a split-fee arrangement, or that split-fee arrangements are often illegal in Florida.  The purpose of this article is to provide practitioners with a general overview of the concepts underlying the prohibition against split-fee arrangements in Florida, in the context of three common business arrangements. Continue reading →

Billing for Associates Fraught with Risk

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ACO-Payment-300x225You’ve hired a new doctor to join your practice, but it will take several months to get the new doctor on your insurance plans and to add him or her to your group practice.  What do you do?  Can you bill for the new doctor’s services under your own provider name or number?  Can you hold the billing and submit it at a later date?

Billing for the new doctor’s services under the name or provider number of a physician who did not actually perform the service is fraud.  It’s as simple as that.  And it’s a serious offense, punishable as a criminal offence, regardless of the payer involved.  In other words, it’s not true to say “Well, it’s ok to do with HMOs, but not Medicare.”  It’s fraud for every payer.  And, with federal payers, it’s a federal crime!  So what do you do?

Physicians are very limited with respect to Medicare and Medicaid patients.  The new doctor must be added to the practice’s provider number, especially if the practice provides “designated health services” such as PT, rehab, clinical lab and diagnostic imaging.  Most practices time the hiring of the new doctor with adding him or her to the provider number and also ensuring that the new doctor is contracted with various payers, all of which can take several months.

There may be a little more flexibility with respect to PPOs and HMOs, though this is tricky.  These payers are usually adamant about credentialing the new doctor and about having him or her sign a participating provider agreement before providing services to their insureds.  In some very limited circumstances, a payer may expedite the process and may even suggest a billing arrangement that would otherwise constitute insurance fraud, but physicians still need to be careful with these arrangement.  When a payer suggests such an arrangement, it is absolutely essential that the proposal and agreement be in writing and review to ensure regulatory compliance.  Otherwise, the practice and the doctors involved may be subject to fraud based claims—e.g. violations of the state insurance laws and even the federal False Claims Act.

 

M.D./Chiropractor Organizations Face Licensure

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Beginning January 1, 2013, healthcare organizations owned by both chiropractors and M.D.s (or D.O.s) will have to obtain a Florida Health Care Clinic License (HCCL) in order to take care of patients whose care is compensated by PIP.  These sort of “integrated practices” are clearly on the upswing, especially after the tough new PIP Clinic regulations were passed this year, which makes providing care to patients injured in motor vehicle accidents tricky. Continue reading →

Doctors: Beware Signing ACO Documents

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There continues to be terrific interest in accountable care organizations (ACOs), which are of course a financially risk-based model of providing healthcare to patients who choose to enroll in the Medicare Shared Risk Program.  ACO organizations are often led by hospitals and hospital systems, though occasionally by physician organizations.  One of the key common threads among these provider led ACOs is the fear of being left out of “the game,” the fear of losing out financially.  This fear, however, can lead physicians to run headlong into danger if and when they sign ACO documents.

 

One of the key ways ACOs get formed involves a stack of contracts being created, then shoved under physicians’ noses.  Doctors afraid to lose out tend to just sign.  The organizations are really to blame here, when the documents fail to contain material terms to deal with things like:  credentialing criteria, disciplinary procedures, financial provisions, how the financial up side or down side can affect physician compensation.  The documents are simply slid under their noses and, in fear of being left out, they get signed!  Or, as my buddy Rodger says “Ready, shoot, aim.”

 

Regardless of a doctor’s view of ACOs, no document ought to be signed unless all the questions raised by them are addressed, very clearly and in writing.  Be at the table with ACO organizers and do your best to design a good system, but don’t be naïve to think that the unaddressed portions will magically get filled in somehow in a way that benefits you or that even makes sense.  At the very least, wait until the document is complete, then consider if you want to sign it.