Healthcare Law Today: Compliance, Regulations, and Patient RightsIn today’s complex healthcare landscape, understanding healthcare law is more critical than ever. Healthcare law encompasses a wide range of issues, including compliance with regulations, patient rights, and the prevention of fraud and abuse. Navigating these intricacies requires a deep understanding of the intersection of compliance, regulations, and patient rights. In this blog post, we will explore the key components of healthcare law and the importance of ensuring compliance in the healthcare system. Attorneys at SBEMP (Slovak, Baron, Empey, Murphy & Pinkney) law firm provides professional legal advice and services to clients in Palm Springs, Palm Desert, Rancho Mirage, Inland Empire, Orange County, Coachella Valley, and surrounding communities.

Understanding Healthcare Compliance: More Than Just Following Rules

Healthcare compliance extends beyond the mere act of adhering to a set of prescribed regulations. It embodies a comprehensive commitment to ethical practices and the highest standards of care within the healthcare sector. At its core, compliance is a proactive endeavor designed to safeguard patient welfare, ensure the privacy and security of health information, and uphold the integrity of medical billing and service provision. Effective compliance frameworks within healthcare organizations are multi-faceted, integrating stringent policy enforcement, continuous staff education, and a culture of accountability and transparency.

Central to a robust compliance program is the development and implementation of clear, accessible policies and procedures that guide the conduct of healthcare providers and staff. These guidelines serve as a roadmap for navigating the complexities of healthcare delivery, emphasizing the importance of ethical decision-making in every patient interaction. Regular training sessions are vital, equipping personnel with the knowledge and tools necessary to identify and prevent potential violations of healthcare laws, including those related to fraud, abuse, and privacy breaches.

Moreover, an open environment where employees feel empowered to report discrepancies without fear of retaliation is essential for maintaining a culture of compliance. Such an atmosphere encourages vigilance and collective responsibility among all members of the healthcare team, contributing significantly to the early detection and correction of compliance issues.

Healthcare organizations must also invest in systems that facilitate continuous monitoring and auditing of compliance-related activities. This ongoing scrutiny helps to identify areas of improvement, ensuring that compliance measures evolve in tandem with changing regulations and standards of care. Through a commitment to comprehensive compliance, healthcare entities not only protect their patients and staff but also fortify their reputation and ensure their long-term success in a highly regulated industry.

Navigating the Maze of Healthcare Regulations

The landscape of healthcare regulations presents a dynamic and often daunting challenge for healthcare providers and organizations. With laws governing everything from the privacy and security of patient information to the intricate details of billing practices and adherence to quality of care standards, it’s no wonder that keeping abreast of current regulations feels like navigating a labyrinth. The stakes are high, as non-compliance can lead to substantial penalties, including financial fines and legal repercussions, which underscore the importance of robust systems to monitor and adapt to regulatory changes.

Healthcare entities must engage in a continuous learning process, staying informed about legislative and regulatory updates that impact their operations. This requires a dedicated effort to interpret complex regulations and translate them into actionable policies and procedures. Collaboration with legal experts specializing in healthcare law can provide invaluable insights and guidance in this ongoing endeavor.

Implementing effective training programs is critical, ensuring that all members of the healthcare team understand their roles in compliance and are equipped to uphold the regulations governing their practices. This education is not a one-time event but a continuous process that evolves with the regulatory landscape.

Technology also plays a pivotal role in navigating the regulatory maze. Leveraging advanced software solutions can help healthcare organizations efficiently manage and monitor compliance activities, from tracking changes in regulations to auditing internal processes for potential vulnerabilities. These technological tools support a proactive approach to compliance, enabling healthcare providers to remain one step ahead in a constantly changing environment.

Moreover, engaging in open dialogue with regulatory bodies can foster a deeper understanding of the intent behind regulations and encourage a culture of compliance. Through active participation in industry forums and advisory committees, healthcare organizations can gain insights into emerging regulatory trends and contribute to the development of fair and effective healthcare policies.

Patient Rights and Advocacy in the Healthcare System

In the realm of healthcare law, the protection and advocacy of patient rights stand as cornerstones, ensuring individuals are treated with respect and dignity while receiving medical care. This encompasses a broad spectrum of entitlements, including the right to be fully informed about one’s health status and treatment options, the right to privacy regarding health information, and the right to give or withhold consent for treatments. Such rights are vital for fostering an environment of trust between patients and healthcare providers, encouraging an open dialogue that contributes to more effective and personalized care.

Advocating for these rights is not merely about legal compliance but also about championing ethical care practices that recognize patients as partners in their health journey. It involves educating patients about their rights and responsibilities, providing them with the tools and knowledge to make informed decisions about their care. This effort extends to ensuring equitable access to care for all individuals, irrespective of their background, and promoting policies that protect vulnerable populations from discrimination and harm.

Healthcare professionals play a pivotal role in this advocacy, acting as intermediaries who navigate the complexities of healthcare laws to safeguard the interests and well-being of their patients. By integrating patient rights into the culture of healthcare organizations, these entities can improve patient satisfaction, enhance the quality of care, and minimize legal and ethical conflicts. Engaging patients in discussions about their care, respecting their choices, and maintaining confidentiality are fundamental practices that reinforce the importance of patient rights within the healthcare framework.

Moreover, the rise of patient advocacy groups and health law advocacy initiatives reflects a growing recognition of the importance of patient rights. These groups work tirelessly to influence healthcare policies, improve patient care standards, and ensure that healthcare systems remain accountable to the individuals they serve. Through collective efforts, the healthcare community continues to evolve, guided by a steadfast commitment to upholding the rights and dignity of every patient.

The Role of Technology in Healthcare Law Compliance

In the modern healthcare landscape, the integration of technology is indispensable for achieving and maintaining compliance with healthcare laws. Sophisticated technological tools such as advanced analytics, artificial intelligence, and blockchain are reshaping how healthcare organizations approach compliance challenges. These innovations enable the automation of complex compliance processes, from tracking regulatory changes to ensuring the accurate documentation of patient interactions and treatment histories.

Utilizing electronic health record (EHR) systems enhances the efficiency and accuracy of patient data management, a critical component in meeting privacy and security regulations. These systems facilitate the secure exchange of patient information among authorized providers, ensuring that patient confidentiality is preserved while enabling better-coordinated care. Moreover, telehealth platforms, which have seen exponential growth, require rigorous adherence to privacy standards to protect sensitive health information transmitted over digital channels.

Blockchain technology offers a promising solution to several compliance hurdles, including the secure and transparent management of health records, thus minimizing the risk of data breaches. Meanwhile, artificial intelligence algorithms can be deployed to monitor and analyze vast amounts of data for potential compliance issues, streamlining the detection of irregularities that could indicate breaches of healthcare regulations or instances of fraud and abuse.

Investments in cybersecurity infrastructure are critical to safeguard against threats and vulnerabilities, ensuring that healthcare organizations remain compliant with evolving regulations concerning data protection. By embracing these technological advancements, healthcare providers can not only navigate the complexities of healthcare law compliance more effectively but also pave the way for a more secure, efficient, and patient-centered healthcare system.

Addressing the Challenges of Healthcare Fraud and Abuse

Healthcare fraud and abuse not only erode the financial stability of the healthcare system but also compromise patient care and trust. These illicit activities range from the submission of false claims to the exaggeration of patient diagnoses to inflate reimbursement rates. To combat these issues effectively, healthcare organizations must establish robust compliance programs that incorporate comprehensive risk assessments, regular monitoring, and a zero-tolerance policy towards fraudulent activities.

Internal audits play a crucial role in identifying vulnerabilities within the system that may be exploited for fraud. By conducting these audits regularly, organizations can detect irregularities early and implement corrective actions swiftly. Additionally, educating staff on the nuances of healthcare fraud and the importance of adherence to ethical billing and documentation practices is paramount. This education helps create a vigilant workforce capable of recognizing and reporting suspicious activities.

Healthcare providers can also leverage technology to enhance their fraud detection capabilities. Implementing sophisticated data analytics tools can help identify patterns that may indicate fraudulent behavior, such as anomalies in billing codes or inconsistencies in patient records. Moreover, fostering an organizational culture that encourages open communication and reporting of unethical conduct without fear of retaliation is essential. Such a culture ensures that employees feel supported in their efforts to maintain integrity within the healthcare system.

By addressing healthcare fraud and abuse proactively, organizations can safeguard their resources, uphold their reputational standing, and, most importantly, protect their patients from potential harm. This comprehensive approach is critical in maintaining a healthcare environment that is both ethical and compliant with the law.

Have any legal questions? Contact the Attorneys at SBEMP Law Firm:

For more information or to request a consultation please contact the law offices of SBEMP (Slovak, Baron, Empey, Murphy & Pinkney) by clicking here. 

SBEMP LLP is a full service law firm with attorney offices in Palm Springs (Palm Desert, Inland Empire, Rancho Mirage, Indian Wells), CA; Indian Wells, CA; Costa Mesa (Orange County), CA; San Diego, CA; New Jersey, NJ; and New York, NY.

DISCLAIMER: This blog post does not constitute legal advice, and no attorney-client relationship is formed by reading it. This blog post may be considered ATTORNEY ADVERTISING in some states. Prior results do not guarantee a similar outcome. Additional facts or future developments may affect subjects contained within this blog post. Before acting or relying upon any information within this newsletter, seek the advice of an attorney.

Medical Malpractice Lawyer

Medical malpractice occurs when a medical professional or a doctor whose standards fall below the appropriate standard of care results in hurting a patient. Actions ranging from improper diagnosis of cancer to making improper incisions during surgery leading to unexpected permanent disability can result in a malpractice lawsuit.

These are a few common types of medical malpractice claims:

Attorneys at SBEMP (Slovak, Baron, Empey, Murphy & Pinkney) law firm provides professional legal advice and services to clients in Palm Springs, Palm Desert, Rancho Mirage, Inland Empire, Orange County, Coachella Valley, Costa Mesa, San Diego, New Jersey, New York, and surrounding communities.

Establishing Liability in a Medical Malpractice Case

Plaintiffs suing for medical malpractice will need to prove the following:

Doctor’s specialty and the illness at issue will determine the precise standard of care that should have been followed by the doctor. Plaintiffs can find proving actual and proximate causation in medical malpractice lawsuits challenging since a patient would only visit the doctor when they are already injured or sick.

A patient would need to prove that there is a high degree of likelihood that the doctor’s failure to meet proper standards of care is what caused the harm.

Challenges Faced in a Medical Malpractice Lawsuit

Doctor or plaintiff may present the findings of the panel to the court during the proceedings of a medical malpractice lawsuit. The court’s decision about permitting a medical malpractice to proceed can be affected by the findings of a pre-suit panel. This is possible even when the findings of the pre-suit panel are not a substitute for a lawsuit.

Statute of Limitations: The statute of limitations in some states can complicate matters. This is because the period can either start from the date the doctor begins acting negligently or when the patient should have reasonable discovered the injuries. In addition, patients are required to give the doctor due notice before filing the claim in certain states.

Expert Testimony: The outcome of majority of medical malpractice lawsuit hangs on expert testimony. Every state has different rules regarding the qualifications required for someone to be deemed an expert in the field in regards to medical malpractice. Generally, experts are people with considerable experience in the specialty field under discussion.

Caps on Damages: There can be state caps on the amount of medical malpractice damages that a plaintiff can demand even if they prove their case. Majority of states have enacted tort reform laws as a form of medical malpractice cap. This cap is usually for noneconomic damages rather than economic ones.

This means the plaintiff can recover their lost income and medical bills but cannot recover more than a certain amount in terms of loss of consortium, loss of enjoyment, or pain and suffering. However, there is an umbrella cap on some states in regards to overall medical malpractice damages.

Lawyers at the SBEMP law firm serve clients from Palm Springs, Palm Desert, Rancho Mirage, Inland Empire, Orange County, Coachella Valley, Costa Mesa, San Diego, New Jersey, New York, and nearby locations for a range of legal practice areas.

Have any legal questions? Contact the Attorneys at SBEMP Law Firm: 

For more information or to request a consultation please contact the law offices of SBEMP (Slovak, Baron, Empey, Murphy & Pinkney) by clicking here. 

SBEMP LLP is a full service law firm with attorney offices in Palm Springs (Palm Desert, Inland Empire, Rancho Mirage, Indian Wells), CA; Indian Wells, CA; Costa Mesa (Orange County), CA; San Diego, CA; New Jersey, NJ; and New York, NY.

DISCLAIMER: This blog post does not constitute legal advice, and no attorney-client relationship is formed by reading it. This blog post may be considered ATTORNEY ADVERTISING in some states. Prior results do not guarantee a similar outcome. Additional facts or future developments may affect subjects contained within this blog post. Before acting or relying upon any information within this newsletter, seek the advice of an attorney.

In recent years the federal government has shown increased aggression and creativity in its prosecution of fraudulent referral activities within the healthcare profession. This creativity is front and center in the recent case of USA v. Beauchamp et al. (“Forest Park”).

There, prosecutors alleged that 21 individuals used fraudulent marketing agreements to pay kickbacks or bribes to physicians for referring surgical patients to Forest Park Medical Center in Dallas, Texas. Although the federal government typically uses the Stark Law and Anti-Kickback Statute to combat healthcare fraud, some of the fraud involved in this case would traditionally fall outside of the jurisdiction for those laws. Therefore, in order for the government to extend its reach, it employed an anti-racketeering law, the Travel Act, to “federalize” the underlying state law bribery violations. In what follows, we briefly detail this case and discuss its implications for providers.

What happened in the Forest Park case?

In Forest Park, the government detailed a conspiracy whereby Forest Park Medical Center, a physician-owned surgical hospital, sought to increase reimbursement by refusing to join insurance plan networks, paid bribes and kickbacks to physicians and other providers in exchange for referrals and for performing medical procedures at the hospital, and laundered these bribes through sham business ventures (marketing and management agreements). As additional inducement to high reimbursing out-of-network patients, the hospital also waived copays and paid for their travel and lodging.

The effect of this fraud on the private insurance plans was that plans paid many times the normal rate for what these same procedures would have cost at in-network facilities. This generated a huge amount of profit for the hospital which then shared those illegal gains with referring providers. According to the prosecutors, between 2009 and 2013, these providers were paid approximately $40 million in “marketing money”. In one particularly egregious example, a single spinal surgeon received $7 million for his referrals.

Ultimately, 10 of the initial the 21 defendants pled guilty before trial. Of the remaining 11 defendants, 7 were found guilty of violating the federal Anti-Kickback Statute (“AKS”) (which prohibits anyone from offering, paying, soliciting or receiving anything of value in exchange for referrals of items or services reimbursable under a federal healthcare program) and sentenced to federal prison terms ranging from 10 to 65 years.

However, what makes this case unique is that 2 of the 11 defendants were also found guilty under the Travel Act for paying or receiving kickbacks for referrals of privately insured patients.

What is the Travel Act and how did the Federal Government apply it to the Forest Park Case?

The Travel Act is a federal law originally used to fight organized crime involving gambling, narcotics, and bribery of corrupt politicians. Under the Travel Act it is illegal to use a facility in interstate commerce (e.g. email, wires between states, or the federal banking system) with the intent to distribute the proceeds of “unlawful activity”. “Unlawful activity” includes bribery, as defined by state law.

In Forest Park the prosecutors predicated their Travel Act claims on underlying violations of the Texas commercial bribery statute by alleging that the directors used email instructions and a Federal Reserve Bank’s computer network to transmit bribery payments to a shell company, which in turn sent the money to referring physicians. Although the crime, the bribery of physicians to refer patients to the hospital, was purely a state law violation, because “interstate commerce” was used to carry out the crime the prosecutors can “federalize” that state law violation under the Travel Act.  This allows the government to pursue commercial insurance kickbacks under federal criminal law.

Conclusion –How Does this affect my hospital and/or practice?

The Forest Park case should serve as a reminder to hospitals, physicians, and other healthcare professionals that there is risk of criminal and civil exposure whenever healthcare professionals receive compensation for patient referrals. Since most federal healthcare fraud prosecutions have involved Medicare, Medicaid or other federal healthcare programs, many medical providers overlook the risk that federal enforcement agencies will also scrutinize arrangements with purely private payers.

As such, healthcare organizations should review any compensation arrangements that have been specifically designed to carve out federal program business to confirm that they are not prohibited under other state laws which might form the basis for exposure under the Travel Act. Compliance procedures and training materials should also be re-evaluated and updated with information on how to spot problematic arrangements under the Travel Act.

For more information or for legal guidance concerning these matters, please contact the Healthcare Department at sbemp.com. Our attorneys have years of experience in this field and will ensure that your practice remains an ethical and compliant environment both for workers and patients.

By: David Roth, Esq.
Slovak, Baron, Empey, Murphy & Pinkney LLP

Leasing space in a physician’s office to a lessee who, themselves, provides health-related services risks violation of the Federal Anti-Kickback Statute (“AKS”). Violation of the AKS is a felony and can result in imprisonment for up to five years. In order to avoid the serious consequences of violating the AKS, physicians need to make sure that they know the Anti-Kickback leasing arrangement formula. The relevant law and this crucial formula are detailed below.

 

What is the AKS?

The AKS is a criminal statute that prohibits the exchange (and even the offer to exchange), of anything of value, in an effort to induce the referral of federal health care program business. 42 U.S.C. § 1320a-7b. Violation of the AKS is a felony and may result in a fine of up to $25,000 and imprisonment for up to five (5) years. A conviction also results in mandatory exclusion from participation in federal health care programs.

 

How Does the AKS Apply to Physician Leasing Arrangements?

In February 2000, the Office of the Inspector General (“OIG”) of the Department of Health, the governmental agency in charge of finding fraud and abuse in federal healthcare programs, published a Special Fraud Alert on physician leasing arrangements. There, the OIG explained that their main concern is that rental payments to physician-landlords may be disguised kickbacks to induce referrals.

 

For instance, rental of space in excess of a lessee’s needs creates a presumption that rental payments are a pretext for payment for physician referrals. Rental amounts which pay for time when the rented space is not being used, such as renting for the whole month when the sub-lessee only uses the space every other week, also create a presumption of fraud.

 

The Safe Harbor & Anti-Kickback Leasing Formula Can Protect You.

In order to protect themselves, physician-landlords need to ensure that their leasing arrangements fall within a “safe harbor.” Safe harbors describe payment and business practices that, although they potentially implicate the AKS, are immune from prosecution thereunder.

 

The following criteria must be met in order to satisfy the leasing arrangement safe harbor:

 

Consistent with these criteria, the OIG has specified the following leasing arrangement formula for proration of the annual rent:

Annual rent of primary lease

No. of work days/year
x
Sq. ft. exclusively occupied by Lessee

Total office sq. ft
x
Lessee hours

Landlord hours
x
No. of days leased per year =

Lessee’s annual rent for exclusive space

The charge for any common space must be similarly apportioned among the physician-landlord and Lessees that use the common space.

 

Conclusion

The above has been a brief discussion of physician leasing arrangements and their potential consequences under the Federal AKS. There are other important federal and state laws, such as the Stark Law, which were not discussed in this article.

 

However, the complexity of compliance with the AKS alone and the potential serious legal complications of being found in violation of the statute, present significant issues for physician-landlords. For this reason, physicians, who are currently renting space to health-care related providers or other physicians, are strongly encouraged to review their leasing arrangements with their legal counsel.

 

If you would like to have your leasing arrangement reviewed, please contact one of our experienced attorneys for a consultation.

 

About the author: David R. Roth is an Associate of the firm and works in the corporate transaction and healthcare practice. Mr. Roth graduated from UC Hastings College of the Law with a Concentration in Health Law and has particular experience in advising health care clients with respect to contract issues, business transactions, practice formation, regulatory compliance, mergers and acquisitions, and healthcare fraud. You can reach Mr. Roth at (760) 322-2275 or via email: roth@sbemp.com.

SBEMP LLP is a full service law firm with attorney offices in Palm Springs (Palm Desert, Inland Empire, Rancho Mirage), CA; Costa Mesa (Orange County), CA; San Diego, CA; Princeston, NJ; and New York, NY.

 

DISCLAIMER: This blog post does not constitute legal advice, and no attorney-client relationship is formed by reading it. This blog post may be considered ATTORNEY ADVERTISING in some states. Prior results do not guarantee a similar outcome. Additional facts or future developments may affect subjects contained within this blog post. Before acting or relying upon any information within this newsletter, seek the advice of an attorney.

 

Many small hospitals struggle to find physicians, as there is a shortage nationally, especially among smaller and more rural hospitals. Recruiting new physicians is not easy, and part of the issue is regulation and scrutiny of the process by the government. Our Palm Springs medical general counsel law firm has been trying to negotiate these complicated rules in order to facilitate recruitment. Another aspect is reimbursement of medical expenses from the government, which puts a strain on doctors and makes them harder to recruit.

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