Physician Practices

Alabama State Telemedicine Rules

June 27, 2022 | Little Health Law

csm_FlatDesign-Telework_c532b56131-e1645230859515 Our healthcare and business law firm previously published a blog post on the federal telemedicine rules. Both Federal and State rules govern the provision of telemedicine. Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules, insurance code, and, when applicable, Medicaid rules. This post focuses specifically on the telemedicine rules applicable to the practice of telemedicine in Alabama. This post does not discuss telemedicine prescribing rules. If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Alabama Rules Prior to July 11, 2022

Telemedicine authority in Alabama is new. In fact, the law discussed herein (Act No. 2022-302) does not go into effect until July 11, 2022. Prior to the enactment of Act No. 2022-302, there was little to no authority regulating telemedicine versus traditional in-person medical practice, and physicians were held to the same standard of care, regardless of treatment modality, regarding such matters as the establishment of a physician-patient relationship and the prescribing of controlled substances and other medications. Prior to the enactment of Act No. 2022-302, physicians treating Alabama citizens via telemedicine had to have the medical license and controlled license of an Alabama physician and were held to the same standards as in-person treatment. See, e.g., Ala. Admin § 540-X-9-.11. Regarding prescribing controlled substances, telemedicine physicians were required to adhere to all federal and state statutes, and federal regulations currently require a previous in-person examination before prescribing controlled substances via telemedicine, except in a declared health emergency. Id.

Concierge Medicine Practices: Medicare Compliance Risks

May 23, 2022 | Little Health Law

iStock_000033418316_Medium-e1626470315777 Increasingly, our healthcare and business law firm’s clients are interested in opening concierge medicine practices. Little Health Law’s last blog post provided an overview of what concierge medicine is with references to compliance risks. This post outlines those very serious compliance risks for practices that treat Medicare patients and are not opted out of Medicare. If you have questions regarding this blog post or starting a concierge practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Understanding the compliance risks associated with concierge medicine practices requires understanding a fairly easy and, perhaps, obvious concept: Providers cannot bill patients for services paid for by their insurance; a practice referred to as “double billing.” Applying that concept is easier said than done. Consider the complexity in this: a concierge medicine practice requires a $200/month fee that includes “longer appointments,” which is a clear benefit to patients. Assuming the appointment itself is covered by insurance, is the fact that it’s longer something that insurance does not cover? Maybe, but maybe not. There are ample examples of how complex this question is and, as it relates to Medicare, CMS and the Office of Inspector General (“OIG”) offer minimal guidance.

Concierge Medicine Practices FAQ

May 19, 2022 | Little Health Law

new-practice-startup-01-1-300x225 Both concierge medicine and direct primary care practices have become popular alternatives to the traditional insurance medical practice model. In a previous post, we discussed direct primary care (“DPC”) practices, which are typically different from concierge medicine practices because DPC practices generally cut insurance companies out from the provider-patient relationship. This post focuses just on concierge medicine practices, which generally offer members non-medical benefits while the patients, or their insurance companies, remain responsible for the cost of all office visits, medical services, medications, treatments, etc. If you have questions regarding this blog post or starting a concierge practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Although many states have specific rules on direct primary care practices, it is less common that there are state rules governing strictly concierge medicine practices, which are also referred to as retainer-based or boutique medical practices. A forthcoming blog post will discuss compliance risks to consider with concierge medicine practices. This post answers a few preliminary questions about concierge medicine.

Before You Voluntarily Surrender Your State Medical License Part II: Consider That Your ABIM Board Eligibility or Board Certification May Be At Risk

April 8, 2022 | Little Health Law

Medical-License-e1644515318522 For various reasons, licensed medical providers may choose to voluntarily surrender their state medical license. Earlier this year, our healthcare and business law firm blogged about the repercussions of voluntarily surrendering a state medical license on the physician’s Medicare enrollment. Our firm recently had success in challenging a Medicare MAC’s decision to revoke a client’s Medicare enrollment based on a voluntary surrender of a medical license, resulting in the rescission of the revocation decision. Another usually unexpected repercussion may also be ineligibility for Board examination or loss of Board Certification status. Losing board certification or being found ineligible for board certification is a serious matter with potentially far-reaching adverse consequences. This post outlines the American Board of Internal Medicine’s (“ABIM”) eligibility rules and steps to challenge such a decision. If you have questions regarding this blog post or wish to discuss an adverse decision by the ABIM or strategize ways to overcome an adverse decision, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw .com.

Federal Telemedicine Rules

March 21, 2022 | Little Health Law

4-e1647895403919 Many of our healthcare and business law firm’s clients have an interest in offering a practice that offers more flexibility to patients when it comes to in-person versus virtual visits. Deciding to offer telemedicine visits to your patients not only requires acquiring a video product that satisfies HIPAA and other privacy requirements but requires compliance with numerous laws at the state and federal level. This post analyzes potentially relevant federal laws and rules that currently apply during the Public Health Emergency (“PHE”). A subsequent post will provide an overview of state law considerations. If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

State laws provide the majority of laws and regulations governing telemedicine visits. There are, however, two potentially relevant federal rules that a medical practice should consider before offering telemedicine: Medicare rules and the Ryan Haight Act. Continue reading ›

3 Compliance Questions to Ask Before Opening a Medical Spa as a Non-Physician

March 15, 2022 | Little Health Law

nurses-and-docs-300x240 We have seen a continued growth in the popularity of medical spas despite the hurdles presented by the COVID-19 pandemic. See Unpacking the Success Factors of the Medical Spa Industry During the Pandemic, Forbes (May 21, 2021). Medical spas present unique compliance challenges from determining whether certain aesthetic services are considered the practice of medicine in the state to whether non-physicians can own the practice. This blog post outlines 3 compliance questions every potential non-physician medical spa owner should ask. If you have questions regarding this blog post or need counsel navigating the complex rules and regulations for opening or operating a medical spa, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

The procedures I plan to offer are aesthetic, so do I really need a physician involved?

The CMS Vaccine Mandate: Are Boosters Required?

February 2, 2022 | Little Health Law

a540959b140223b6f8a472cfe17667c1672de165-3389x2260-1-scaled-e1643836004971 Our previous blog post provided an overview of the Centers for Medicare and Medicaid Services’ (“CMS”) Vaccine Mandate and addressed two basic questions of the mandate: What providers are covered and what’s the timeline to comply? Many of our healthcare and business law firm’s clients have additional questions about the requirement of CMS’ vaccine mandate (a.k.a. the “federal healthcare worker vaccine mandate”). One such question is: Does the mandate require individuals to receive a booster shot to comply with the mandate? This blog post outlines CMS’s current stance on the booster requirement. As always, the analysis herein is current as of the date this blog is posted and subject to change as agencies and courts release new decisions.

If you have questions regarding this blog post or the applicability of state and federal regulations to you or your medical practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

SHORT ANSWER: The CMS Vaccine Mandate does not require individuals to receive booster shots or additional doses in addition to the primary vaccination series, but that may change. Continue reading ›

The CMS Vaccine Mandate: What Providers are Covered and What’s the Timeline to Comply?

January 25, 2022 | Little Health Law

021721125026-e1643150049878 Many of our healthcare and business law firm’s clients have questions about whether CMS’ vaccine mandate (a.k.a. the “federal healthcare worker vaccine mandate”) applies to their workforce. The vaccine mandate landscape is evolving. For instance, the OSHA vaccine mandate applicable to 100+ employee-businesses was overruled by the Supreme Court. The analysis herein is current as of the date this blog is posted and subject to change as agencies and courts release new decisions.

If you have questions regarding this blog post or the applicability of state and federal regulations to you or your medical practice, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

The CMS Vaccine Mandate

CMS’ vaccine mandate requires all staff at Medicare and Medicaid-certified provider facilities, except for those with approved medical or religious exemptions, to be vaccinated. The mandate is still being tested in court however, the Supreme Court has preliminarily agreed with the federal government that the mandate is valid and has ruled that the mandate is in effect now, pending further litigation. As such, the CMS vaccine mandate is now active.

The Anti-Kickback Statute’s Rules on Per-Use or Per-Click Rental Equipment Leases

January 21, 2022 | Little Health Law

223220955_d39c2ebad0_b-e1642805878743 Many of our healthcare and business law firm’s clients are in the business of renting expensive medical equipment for use by medical practices. Generally, these arrangements raise compliance questions under the Physician Self-Referral Act, referred to as Stark Law, and the Anti-Kickback Statute (“AKS”). Should a regulator find an arrangement violates either law, the consequences are severe. The perhaps unfortunate truth is that rarely can a sincere and analytical attorney tell you with confidence that an arrangement does or does not violate either law. The analysis usually places an arrangement on a scale of low to high risk of noncompliance. To assist in understanding whether an arrangement complies with Stark Law and AKS, the rules provide specific exceptions and safe harbors, respectively. Both Stark Law’s exceptions and AKS’s safe harbors outline ways in which an equipment rental agreement may satisfy the protections. One question that frequently arises with our clients is whether they can structure an equipment rental agreement to have a per-use (often called a “per-click”) payment term, wherein there is no set monthly amount but, rather, the lessee pays the lessor a predetermined amount for each time the equipment is used.

In this blog post, we outline the basic rules for equipment rental agreements under AKS and whether per-click payment terms satisfy AKS’s Equipment Rental safe harbor. Continue reading ›

Stark Law’s Rules on Per-Use or Per-Click Rental Equipment Leases

January 14, 2022 | Little Health Law

iStock_000033418316_Medium-e1626470315777 Many of our healthcare and business law firm’s clients are in the business of renting expensive medical equipment for use by medical practices. Generally, these arrangements raise compliance questions under the Physician Self-Referral Act, referred to as Stark Law, and the Anti-Kickback Statute (“AKS”). Should a regulator find an arrangement violates either law, the consequences are severe. The perhaps unfortunate truth is that rarely can a sincere and analytical attorney tell you with confidence that an arrangement does or does not violate either law. The analysis usually places an arrangement on a scale of low to high risk of noncompliance. To assist in understanding whether an arrangement complies with Stark Law and AKS, the rules provide specific exceptions and safe harbors, respectively. Both Stark Law’s exceptions AKS’s safe harbors outline ways in which an equipment rental agreement may satisfy the protections. One question that frequently arises with our clients is whether they can structure an equipment rental agreement to have a per-use (often called a “per-click”) payment term, wherein there is no set monthly amount but, rather, the lessee pays the lessor a predetermined amount for each time the equipment is used.

In this blog post, we outline the basis rules for equipment rental agreements under Stark Law and whether per-click payment terms may satisfy Stark Law’s Rental of Equipment exception. Our next post will analyze the same question under AKS. If you have questions regarding this blog post or wish to evaluate the risks in your equipment lease arrangement, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.