Category Archives: Health Care

Reimbursement for Coronavirus paid leave

For the first time in our nation’s history there is a federal general paid leave act. While, the Family Medical Leave Act (“FMLA”) provides unpaid leave, it is only with the enactment of The Families First Coronavirus Response Act (“Act” or “FFCRA”)), signed March 18, 2020, that there is a requirement if an employee misses work, for certain Coronavirus related issues, he or she will be paid something under certain circumstances. Or at least that applies to some people, the
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Social Media in the Healthcare World

Social Media is invaluable for all businesses but in the health care business it comes with many challenges.  The primary reason is that patient confidentiality rules, generally called HIPAA, can prevent or seriously limit a response to a complaint or review.  Also, patient solicitation rules prohibit certain types of patient outreach for some providers. What can be infuriating for a health care provider to learn is that even though a former patient wants to criticize it on social media, by
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Coronavirus Legal Advise: get your estate in order – NOW

  The largest state in the country is shutting the doors of all nonessential businesses starting sundae night. As this unprecedented measure is taken in New York to safeguard its residents, it is projected that other states will follow. Now is the time to get your affairs and estate plan in order. If you are over 60-you need an estate plan. This virus has the ability to create havoc in individuals over the age of 60- a segment of our
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Off-Label Prescribing For COVID-19; Is It Fraud?

In several press conferences the President of the United States has been promoting the use of a malaria drug, Chloroquine, for treatment related to COVID-19.  Because Chloroquine is not approved for COVID-19, the prescribing and dispensing of that medication for COVID-19 is what is described as off-label.  It is the position of CMS however, that the promotion of the use of pharmaceuticals for unapproved symptoms or conditions, in unapproved patient groups, or in unapproved dosages, off-label use, is subject to
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Can States Regulate the Behavior of PBMS? The Supreme Court Will Decide.

Pharmacy Benefit Managers (PBMs) control pharmacy networks for a number of insurers and there are not that many PBMs, so a PBM contract is the sole gateway to a number of insurers for pharmacy service claims.  However, the PBM role is not merely processing claims; they hold a great amount of power over pharmacies because PBMs set payment criteria and policies.  The PBM makes its revenue largely on the difference between the price the PBM pays to the pharmacy and
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The New Medicare Fraud – MRA Scores and Medicare Surplus Payments

Physicians who treat geriatric patients are aware of the new direction Medicare patient treatment models are headed.  To provide care and services to these patients increasingly require direct contracts with a Medicare Advantage carrier or a contract with a Management Services Organization.  Physicians practicing under those plans receive a flat rate per month per patient, which may be based on a capitation payment. Under most of those plans  proper coding can also generate a bonus (risk-adjusted surplus payments), which are
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HIPAA Business Associates (Including You) Have Exposure Too

Every individual and business in the health care industry must understand their obligations under the Health Insurance Portability and Accountability Act of 1996 ("HIPM"), the Heath Information Technology for Economic and Clinical Health Act of 2009 ("HITECH"), and their implementing regulations. Surprisingly, many physicians do not seem co realize the changes HITECH made to H!PM include holding a Business Associate ("BA") to most of the requirements that are imposed on a Covered Entity ("CE"); that is, a health plan, healthcare
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What You Can Do if You Have a Surprise Medical Bill

NBC 6 Responds has heard from consumers frustrated over medical bill disputes. In some cases, they have owed thousands of dollars more than expected. Experts say there are steps to take if you find yourself with a surprise bill you can’t pay. Original Story Courtsey of NBC Miami Channel 6 News

Its Back! Binding Arbitration Requirements Between SNFs/Nursing Facilities and Residents

  The Centers for Medicare and Medicaid Services (“CMS”) recently published a Final Rule modifying this agency’s arbitration requirements for SNFs and nursing facilities (collectively, “Facilities”) that participate in the Medicare or Medicaid program. 84 C.F.R. 34,718 (July 18, 2019). Previously, on October 4, 2016, CMS published a Final Rule addressing the use of arbitration to resolve disputes between Facilities and their residents, or their family members or other guardians (collectively, “Residents”). 42 C.F.R. 483.70(n) (“483.70(n)”) The October 4 Final
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SB 732 (the “Act”) and The Many Questions it Brings

As you may be aware, during its 2019 session the Florida Legislature passed a substantial revision to the State’s regulations concerning certain in-office surgical procedures. The new revision, SB 732 (the “Act”), amends 456.074, F.S. and adds 458.328 and 459.0139, F.S. (for allopathic and osteopathic physicians, respectively). Under the Act, certain liposuction procedures, Level II, and Level III office surgeries performed in a physician’s office that has registered with the Department of Health (an “Office”), unless the facility is in
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Florida Legislature Considers Bill To Require All Non-Provider Owned Practices To Become Licensed.

Under the Florida Health Care Clinic Act, most health care clinics not owned by a licensed physician or practitioner must apply for a license with the Agency For Health Care Administration (AHCA). The licensing process can be quite onerous and requires background checks of owners and certain employees, financial requirements, and inspections. Because the law was a result of investigations into personal injury clinics, a quirk in the language of the law made it possible for health care clinics that
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The Importance of Timely Retaining Personal Counsel

Doctor, when is the best time to treat an infection?  As soon as possible, right?  Timely care usually means that the least amount of harm has occurred, options are available, and a better prognosis.  If significant time passes before an infection is treated, sometimes it’s “better late than never,” but sometimes it’s “too little too late.”   The same is true for retaining personal counsel. Personal counsel is most effective if utilized as soon as possible. If significant time passes
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Personal Counsel protects doctors not insurance companies. Every doctor being sued for medical malpractice should have a personal counsel

When a doctor with malpractice insurance gets sued, the first thing he or she should do is forward the lawsuit to their carrier. The first thing a carrier will do is determine if it owes coverage to the doctor.   Sometimes the insurance company determines the claim is not covered by the policy.  Sometimes the insurance company will cover the claim but reserve their right to withdraw from defending the doctor. In either event, personal counsel can advocate for the doctor’s
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Health Law Primer: Prohibition Against Kickbacks

It is a crime for any person to pay or receive anything of value if even one purpose of that payment is to induce the referral of a patient for a health care good or service. This prohibition exists in Federal law and, in various permutations, often exists in states’ laws as well. On the Federal level, this restriction does not apply if and to the extent that the arrangement fits within one of approximately twenty-five fact patterns that appear
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