Lee Little speaks to local artists at Arts Business Workshop sponsored by the Greater Augusta Arts Council regarding incorporating and setting up arts businesses.
Interstate Medical Licensure Compact: Will Georgia physicians soon be able to share their expertise with more patients?
Georgia physicians seeking licensure in other states hope to benefit soon from a more streamlined process. In fact, a bill was recently introduced in the Georgia House of Representatives to allow Georgia to join the growing number of states participating in the Interstate Medical Licensure Compact. (House Bill 637). Such a bill, if passed by both houses of the legislature and signed into law by the Governor, would greatly simplify the process for Georgia physicians to obtain licenses in other member states, allowing a wider population of patients access to their services and expertise. This type of bill would not change the existing methods of obtaining a license in Georgia but would provide an additional route. Although the bill was not voted on, the effort indicates this type of change may be on the horizon.
July 11, 2017, Lee Little is a speaker/panelist, American Health Lawyers Association Considerations for Academic Medical Centers in Developing Clinically Integrated Networks and ACO’s
Lee Little is a speaker/panelist, American Health Lawyers Association Considerations for Academic Medical Centers in Developing Clinically Integrated Networks and ACO’s.
U.S. Opioid Crisis and the Effects on Pain Management Clinics
The United States only holds about 5% of the world’s population yet is consuming 99% of the word’s hydrocodone, 80% of the world’s oxycodone, and 65% of the world’s hydromorphone; all powerful narcotics. Those statistics show themselves in the most disheartening of ways with an opioid epidemic that has 1.3 million Americans needing hospital care for opioid related issues and over 30,000 dying from opioid overdoses in one year alone, with the number climbing every year. The nation’s opioid crisis also costs the U.S. over $70 billion a year when accounting for healthcare costs, productivity loss, addiction treatment and the costs of criminal justice actions and resources. The nation’s epidemic has garnered a federal response in the form of CDC guidelines that are discouraging primary care physicians from prescribing opioids as a first line of defense (or only line of defense) for patients with chronic pain and instead encouraging the use of non-opioid and even non-drug treatments for pain. A DEA response shortly thereafter indicated production quotas would be enforced for Schedule II pain medications, reducing the production of some medications by a quarter or even a third.
AMA Announces Physician Ownership of Medical Practices Drops Below 50%
Traditionally a hallmark of success for many physicians, physician ownership of medical practices continues to decline, for now, according to a recent study by the American Medical Association (AMA). The AMA recently issued the results of a survey, entitled Policy Research Perspectives, Updated Data on Physician Practice Arrangements: Physician Ownership Drops Below 50%.
Physician and Medical Practice Attorneys
The survey evaluated, among other things, whether physicians fall into one of four categories as to a physician’s “main” practice: (1) whether the physician is an owner, employee, or independent contractor of the medical practice; (2) the type of medical practice; (3) ownership structure of the practice; and (4) how many physicians are in the practice. The information and data reviewed spanned the period from 2012 to 2016. The survey results confirm a continued trend favoring employment and larger practices. 2016 was the first year with survey results demonstrating that less than half of practicing doctors (about 47%) own their own practice. Surveying over 30,000 physicians, the survey excluded physicians who work less than 20 hours/week providing patient care or are Federal employees.
June 5, 2017, Kevin Little speaks to American Osteopathic Association physicians on, Physician as W2 or 1099? Why Proper Legal Classification of a Physician as “Employee” or “Independent Contractor” is Essential
Kevin Little speaks to American Osteopathic Association physicians on, Physician as W2 or 1099? Why Proper Legal Classification of a Physician as “Employee” or “Independent Contractor” is Essential.
FQHC Suffers Monetary Consequences for HIPAA Violations
A Denver area Federally Qualified Health Center (FQHC) must pay $400,000 in fines and implement a corrective action plan for HIPAA violations that resulted from a hacker’s breach into the health center’s employee emails. The breach led to theft of electronic protected health information (ePHI) of 3,200 individuals. Although the HIPAA violations were a result of a malicious breach, Metro Community Provider network (MCPN) was found at fault by OCR officials after OCR’s investigation showed MCPN did not conduct a risk analysis of its ePHI environment and waited another two months after discovery of the breach to conduct a risk analysis. MCPN had no system of risk management in place to determine what vulnerabilities the center was susceptible to.
Georgia Healthcare and HIPAA Compliance Lawyers
The HIPAA Privacy Rule was enacted to protect patient health information and secure for patients more control over the use of their private information. Under Federal law, healthcare businesses have a strict obligation to protect the information of patients. While there is no private cause of action for violations of HIPAA, complaints can be filed with the Office of Civil Rights (OCR) of the Department of Health and Human Services (HHS), states’ Departments of Health, federal third-party Payors (Medicare, TRICARE, VA, etc), state licensing boards, and, in some cases, state law may provide a cause of action for individuals under specific state privacy laws. Such complaints can lead to investigations, fines and other negative consequences for a healthcare professional or practice.
Convictions Will Stand for Mental Health Employees in $200 million Medicare Fraud Case
The Eleventh Circuit Court of Appeals denied an appeal and upheld the convictions of a physician assistant and a patient recruiter in Florida for their actions in allegedly defrauding the Medicare program of $200 million in false claims. Both the physician assistant, Roger Bergman, and the patient recruiter, Rodolfo Santaya, worked for American Therapeutic Corporation based out of Miami. ATC provides psychiatric care for patients with mental illness.
Medicare Fraud
Bergman was alleged to have submitted false claims to the Medicare program by falsifying patient documents to make it appear that the patients were eligible for the programs offered at ATC, but in fact they were not. In addition, Bergman submitted false patient documentation that stated Medicare-eligible care was given to patients when no such services were ever provided. Claims for payment from the Medicare program for false or ineligible services were billed by ATC and paid out to the company. Santaya’s alleged role in the fraud scheme was to go to low-income neighborhoods, apartment complexes, and retirement homes to recruit disabled or elderly patients to ATC, receiving up to a $45 kickback for each patient obtained. The patients brought in by Santaya would be ineligible for the outpatient psychiatric care provided by ATC or did not even have medical needs necessitating psychiatric care at all. Santaya was alleged to have focused only on Medicare beneficiaries in his recruitment efforts and instructed the patients to lie about their symptoms in order to administer billable services to them. The subject convictions and sentences affirmed by the Eleventh Circuit are 15 years for Bergman and 12 years for Santaya.
NO TO OPIODS: GRANTING PATIENTS CONTROL OVER THE USE OF PAIN MEDS IN THEIR CARE
Prescribing opioids for pain can be a routine part of medical treatment, however, opioids are a national dilemma and though patients may need them for pain management, they are also highly addictive. Some patients being administered these prescriptions are recovering from opioid addictions and face a high-risk of relapse. And, because some more unscrupulous health care providers use “pill mills” to make money, there is a strong push in many states to protect patients. This push has brought about a new idea – patient directives that notify providers NOT to prescribe or administer opioids to them.
Medical Practices Beware Risks that Attend Improper Classification of Contracted Physicians
Many medical practices and health care services businesses confront circumstances in their business model that justify unique and flexible arrangements with physicians to meet healthcare delivery needs (e.g. call coverage). Unique situations for health care delivery models lead to creative employment situations that may prompt evaluation of whether treatment of physicians as independent contractors (versus employees) makes business and financial sense. Too often, this issue is evaluated short shrift, however, leaving the owners of a medical practice unknowingly exposed to serious financial risks that could have been avoided.
Georgia and South Carolina Medical Practice and Physician Employment Attorneys
As with many legal considerations, factual details matter. Therefore, each situation should be examined independently giving due regard to specific facts, rather than relying upon general legal notions one has heard. Each medical practice employer’s situation is inherently different to some degree. Given the fact driven analysis required, what one practice does may not be reliable for another practice. Therefore, medical practice owners and decision makers should not defer too much to what is heard about what others do; others may be wrong. With regard to the question of whether a contracted physician can be properly treated as 1099 versus W2, it is best for a medical practice to consult with its law firm and permit the law firm to fully evaluate the details.