Category Archives: Medical Staff Matters

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 →

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 →

$800,000 HIPAA Settlement for Leaving Patient Records on Physician’s Front Porch

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HIPAAThe Department of Health and Human Services announced this morning that it has entered into a settlement agreement with Parkview Health System, Inc., an Indiana medical group caught up in HIPAA violation case.  Parkview was assisting a retiring physician to transition her patients to new providers.  Parkview was also considering purchasing some of the physician’s patient records.  When Parkview attempted to return between 5,000 and 8,000 patient records to the physician, she was not home to accept their return.  Parkview employees left cardboard boxes containing between 5,000 and 8,000 patient medical records outside of the physician’s home, and within twenty feet of a public road.  In settlement and release of HHS’ claims against Parkview for such a HIPAA violation, Parkview agreed to pay the Department of Health and Human Services $800,000 and enter into a Corrective Action Plan.  The entire Resolution Agreement between Parkview and HHS is available here.

HIPAA Stings Dermatology Practice

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HIPAAThe US Department of Health and Human Services, Office of Civil Rights is the chief enforcer of HIPAA.  The Office’s recent enforcement of HIPAA with respect to a Massachusetts derm practice is illustrative of how the government views HIPAA and how vulnerable medical practices are.  Continue reading →

Medical Staff Doctors: Your Bylaws Are Your Bond

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bylaws   Over time, medical staffs have become overwhelmed with the business of healthcare and have fallen asleep on a very critical issue:  Medical Staff Bylaws.  Physicians who think all bylaws are the same, that they are essentially meaningless and that medical staff members are powerless are simply wrong.     

Medical staff bylaws are a contact between medical staff members and the hospital.  That is settled law in Florida.  Moreover, medical staff members need to know that they have certain rights under those bylaws and also rights afforded them by law, such as the right to a fair hearing if their privileges are reduced or stripped.  Medical staff members need to keep the following sort of understandings in mind when reviewing medical staff bylaws: Continue reading →

Board of Medicine: New Rule Regarding Adequacy of Medical Records for Compounded Medication

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gavelThe Florida Board of Medicine reviewed Rule 64B8-9.003, Florida Administrative Code which provides standards for the adequacy of medical records.  The underlined portions below are the new standards required for medical records as it relates to compounded medications.  These standards are effective September 9, 2013. Continue reading →

The Cost of Inaccurate Medical Records

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0607-for-the-record-1690On July 8, 2013 the United States Attorney’s Office for the Southern District of Florida issued a Press Release with the headline “Supervisor of $63 Million Health Care Fraud Scheme Sentenced in Florida To 10 Years in Prison”. The Defendant, a 51 year old employee of the Healthcare Provider was the director of medical records. The employee was a certified medical records technician and was found to have overseen the alteration, fabrication and forgery of documents that were used to support claims submitted to Medicare and Medicaid. In addition, the employee was found to have directed therapists to fabricate documents and forged signatures on documents. The defective medical records were used to support claims to Medicare and Medicaid in excess of 63 million dollars. 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 →

Gift Giving and the Anti Kickback Law

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Even though the holiday season is long gone Healthcare Providers need to pay attention to the value of gifts they give or receive to avoid violating the Anti Kickback Laws. Providers may not accept any one gift with a value of more than approximately $30.00 or gifts worth more than $350.00 annually. The Government is concerned that gifts may cause billing for unnecessary services or may affect the referral of patients. Providers as well as their employees must not solicit gifts either. When a gift is given or received it must not be based upon either the volume or value of any referrals. Gifts that are given frequently after referrals or after any specific successful referral are red flags for violations of the law. In fact the Sunshine Act now requires pharmaceutical companies and durable medical equipment companies to report gifts to providers with a value over $25.00. Continue reading →