Rivas Goldstein, LLPAustin Health Care Lawyer | Texas Medical Licensing Attorney2024-03-12T15:13:08Zhttps://www.rivasgoldstein.com/feed/atom/WordPressOn Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506472024-02-26T20:51:07Z2024-03-05T20:50:00ZUnderstanding Stark Law
The Stark Law, also known as the physician self-referral law, prohibits physicians from referring patients to entities with which they have a financial relationship for certain designated health services paid for by Medicare or Medicaid, unless an exception applies.
Over time, the Stark Law has adapted to the changing landscape of healthcare, with amendments and new regulations addressing emerging trends and technologies. These include the following developments:
Introduction of exceptions for value-based arrangements
Clarifications to accommodate integrated care and alternative payment models
The evolution of the Stark Law reflects a broader trend in healthcare regulation, aiming to balance the prevention of unethical practices with the facilitation of innovative care models. As healthcare continues to advance, regulations like the Stark Law will likely continue to evolve.
The application of Stark Law
The Stark Law is a strict liability statute, meaning that a violation does not require intent. The Centers for Medicare and Medicaid Services (CMS) takes violations seriously, settling over 100 self-disclosures for more than $9 million in 2022 alone.
The future
The Stark Law continues to evolve, most recently with the updated exception that allows improved mental health services.
Physicians should stay informed about these changes to ensure compliance and to leverage opportunities for improved patient care. It is wise to consult with a healthcare attorney or compliance expert for more detailed information on how these regulations can impact your practice.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506462024-02-22T20:44:34Z2024-02-27T20:42:58ZHow do I fulfill the fingerprinting requirement?
All physicians renewing their medical license must generally comply, regardless of how long they've been practicing. The TMB encourages physicians submit fingerprints well in advance of their license expiration date to avoid processing delays.
To fulfill this new requirement, physicians must follow a specific process. The TMB has outlined clear steps to ensure compliance:
Schedule an appointment: Physicians must schedule a fingerprinting session with an approved vendor.
Complete the process: Attend the session and have your fingerprints electronically submitted to the TMB and the FBI.
The TMB's fingerprinting process is straightforward but requires attention to detail and timely action to ensure uninterrupted licensure.
When is the deadline?
Physicians are wise to approach this new requirement proactively, scheduling their fingerprinting appointment early to better ensure compliance and a smooth license renewal experience. The TMB expects all physicians to complete this requirement prior to renewing their medical license. Although compliance is not required immediately, physicians can choose to move forward with the process before their renewal date. This can be advantageous as the fingerprinting process can take weeks to complete.
For physicians preparing to renew their medical licenses, understanding and actioning these new requirements are essential. A failure to do so can hinder the ability to renew your medical license, potentially having a negative impact on your ability to practice in the state.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506452024-02-16T20:53:32Z2024-02-20T20:52:46Zin certain circumstances.
How do these circumstances apply to your practice? The following guidance can help.
Texting patient data to colleagues
When texting patient data for referrals or medical advice, HIPAA compliance is non-negotiable. These tips can better ensure you are on the right side of compliance:
Use secure, encrypted messaging platforms that meet HIPAA standards
Verify that the recipient is authorized to receive protected health information (PHI)
By implementing these precautions, medical professionals can minimize the risk that collaboration will be viewed as a violation of HIPAA regulations.
Texting pharmacies and patients
The communication of prescription information to pharmacists and updates directly to patients also demands adherence to HIPAA's strict privacy rules. It is important to obtain explicit patient consent for text communications and limit the amount of PHI disclosed to the minimum necessary.
Texting patient data within the healthcare community can be compliant with HIPAA, provided that appropriate security measures are in place. It is the responsibility of healthcare providers to utilize secure texting solutions and to establish clear, HIPAA-compliant protocols for digital communication. A failure to comply with HIPAA guidelines when texting patient data can have significant legal consequences for healthcare professionals and trigger a board investigation that could threaten the integrity of your medical or professional license.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506442024-02-09T17:01:58Z2024-02-13T17:01:10ZStep 1: Review the contract.
The language of the contract guides these decisions. It is important to thoroughly reviewing the existing contract for a termination clause. This section will likely outline the necessary steps for ending the agreement, including notice periods, any required grounds for termination, and responsibilities post-termination.
Step 2: Consider the options for termination.
There are many ways to achieve this goal, whether a physician group or healthcare facility wants to end the agreement. These include:
Negotiations. It can help to attempt to negotiation new terms or a transition out of the agreement.
Lawsuit. Litigation may be necessary if the other party will not agree to the proposal.
Patience. In some cases, it is best to wait the contract out. Most contracts in these types of relationships have expirations. If possible, consider waiting until the expiration date.
In the last option, a failure to renew the contract can mean that the arrangement simply ends. This was the method used recently when a healthcare facility in Billings, Montana decided to add its own anesthesiology department. Instead of terminating the agreement with a private practice that offered these services, the hospital system waited for the contract to expire and is building its own department to meet these needs.
Step 3: Take steps to ease the transition.
Once a plan is in place there are additional steps that can help ease the transition. For example, it can prove helpful to plan the termination to coincide with the end of a billing or service cycle to minimize disruptions for both parties. Consider the impact on patients and ensure a transition plan is in place to maintain continuity of care. You may also need to inform patients and staff of any upcoming changes.
Additional considerations before moving forward with a termination can include:
Financial obligations. Identify and address all outstanding financial obligations. This can include final payments, refunds, or settlements.
Internal audits. It may be wise to conduct an audit to verify that all services billed and paid for have been delivered according to the contract. Resolving any discrepancies now can prevent legal issues later on.
Documentation. Keep detailed records of all correspondence and decisions made during the termination process. Documentation can protect your interests if disputes arise after the contract has ended.
Terminating a healthcare contract can be a complex process, but with careful planning, clear communication, and a focus on compliance, it can be managed effectively. Remember to always prioritize the welfare of patients throughout the transition and seek expert advice when needed. These tips can help to better ensure private practice owners and healthcare facility administrators navigate the end of a contract with confidence and integrity.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506412024-01-19T20:02:27Z2024-02-08T20:01:41Z
Continued education. Ongoing education not only enriches your skill set but is often a legal requirement for maintaining your license. Keep abreast of advancements in your field and fulfill any mandatory training or educational credits.
Uphold ethical boundaries. It is important to uphold high standards of professional conduct. This includes honesty in communication, integrity in billing practices, and respect in patient interactions.
Know the regulations. Respect for patient privacy is a cornerstone of healthcare. Familiarize yourself with laws like HIPAA and ensure that you and your staff are fully compliant with all confidentiality requirements.
Keep good records. Meticulous documentation can be your best defense in a legal dispute. Ensure that all patient interactions, treatments, and outcomes are accurately recorded in a timely manner.
It is also important to avoid common mistakes. One example is a failure to be truthful when filling out an application for employment. A failure to disclose the truth on an employment application within a medical facility can result in serious repercussions. In a recent example, employers terminated employment of a woman who falsely posed as a professional sonographer. In addition to losing her job she also faces criminal charges for fraud.
Although these regulations help to preserve the integrity of the medical profession and keep patients safe from the unscrupulous, like the woman in the case noted above, false allegations of wrongdoing are not uncommon. Those who believe they are the victims of such false accusations are wise to seek legal counsel to help preserve their interests.
Protecting your professional healthcare license is an ongoing process that requires vigilance and proactivity. By staying informed, maintaining professional competence, upholding ethical standards, documenting diligently, communicating effectively, and handling complaints professionally, you can safeguard your license — and your career — for years to come.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506402024-01-19T17:06:38Z2024-02-07T17:05:22Z#1. Role of AI
Artificial Intelligence is a branch of computer science that enables machines to mimic human intelligence. Machine Learning, a subset of AI, allows computers to learn from data and improve over time. In healthcare, medical professionals like nurses can use these technologies for various applications, from administrative tasks to patient monitoring. Machine learning algorithms can help in creating personalized care plans by analyzing patient history and current health data. Nurses can then use these insights to tailor their approach to individual patient needs.
AI and ML are rapidly evolving fields. Nurses can benefit by staying updated on use of new technologies like these and healthcare facilities will likely provide training programs to ensure that their staff can competently use AI tools if they have not yet done so.
#2. Ethical considerations
The World Health Organization (WHO) recently released guidelines for use of AI in healthcare for everything from administrative tasks and diagnostics to nurse education and drug development.
The WHO is not the only organization providing such guidance. President Biden recently issued an order tasking the United States Department of Health and Human Services (HHS) with digging into AI practices within healthcare that could pose harm to patients. Although gathering information on potential hazards, the federal government also recognizes the benefits that AI cab bring to the field and is offering grants to help fund research efforts.
#3. Accountability
At the end of the day, the proverbial buck stops with you. It is wise to know what about the tools you are using. If using AI to aid in communications or for other purposes make sure to review the product before signing off. Remember, your license could be at risk.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506382024-01-18T19:07:46Z2024-02-01T19:07:04Ztranslating to more than $75 billion in alleged overpayments. Medical providers are wise to take proactive steps to minimize the risk of triggering overpayment investigations and ensure they maintain a positive standing with Medicare.
Step #1: Maintain accurate and comprehensive records
Accurate documentation is the cornerstone of Medicare compliance. Providers must ensure they support all services billed to Medicare with clear, detailed, and timely records. Documentation should include the rationale for the service, the specific services provided, and the medical necessity for each service. It is also critical to keep up-to-date with the latest documentation requirements as they evolve.
You can help achieve this goal through:
Educating. Educate all staff on the expectations and importance of thorough and accurate documentation.
Training. Take time to implement regular training sessions on proper documentation practices.
Auditing. Conduct internal audits to ensure compliance with documentation standards.
When taken together, these three actions can help to better ensure proper record keeping.
Step #2: Watch for updates
Medicare billing and coding regulations are constantly evolving. It is imperative for providers to stay current with the latest updates to avoid billing errors that could lead to overpayment claims. It can help to regularly attend seminars, workshops, and continuing education courses focused on Medicare billing to better ensure you are up to date on current practices.
Additional steps to help keep current include subscribing to Medicare newsletters and updates from reputable sources.
Step #3: Implement a compliance program
The use of a comprehensive compliance program is helpful in the event you need to build a defense against overpayment investigations. Such a program should include policies and procedures tailored to prevent, detect, and correct billing and coding errors. It should also foster an environment that encourages employees to reach out to leadership with potential issues without fear of retribution.
You can help achieve this goal by establishing a compliance officer or committee responsible for overseeing the program. Develop clear internal policies and procedures for all aspects of Medicare billing and regularly review and update your compliance program to reflect regulatory changes.
Preventing Medicare overpayment investigations requires diligence, education, and a proactive approach to compliance. By focusing on accurate documentation, staying informed about billing and coding updates, and implementing a robust compliance program, medical providers can significantly reduce the risk of overpayment claims. While these practices demand time and resources, the investment is minor compared to the potential consequences of non-compliance. It is always more cost-effective to prevent an issue than to resolve one after it arises.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506372024-01-17T19:51:28Z2024-01-31T19:50:18ZCase study: Recent M&A deals provide important lesson
Recently announced deals that provide important guidance include that of neighboring Huntsville Hospital Health System’s plan to acquire Alabama based DeKalb Regional Medical Center during the first quarter of 2024. The parties expect the deal to help the facilities more efficiently provide additional resources to rural locations.
Many of the recently announced mergers aim to serve more rural populations but they do not always move forward as intended. In some cases, a deal falls apart. Sometimes the reach is too great, and a proposed deal does not effectively manage the increased labor costs that come with meeting the needs of the patients. In these situations, the parties may call off the deal. This was highlighted in a recent example from our neighbors up north in Wisconsin and Minnesota. After more than a year of negotiations, the organizations chose to call of the deal citing the target facility’s dire financial situation as a primary reason.
The example serves as an important reminder of the need for thorough due diligence when navigating these deals to mitigate the risk of any surprises and better ensure the proposal meets your organization’s needs.
Tips for success: The following can increase the odds of a beneficial M&A deal
It helps to research market trends, understand regulatory changes, and identify the economic forces at play. Assess your financial stability, organizational structure, and strategic goals to make sure your organization is prepared for the deal. A robust foundation is important to better ensure a successful M&A. Additional considerations to better ensure a smooth transition include attention to the following:
Cultural Compatibility: Equally important is the cultural fit between the entities involved. M&A success often hinges on the seamless integration of staff, values, and practices.
Industry Consolidation Trends: Observe industry consolidation trends. A wave of M&As may signal a ripe market for strategic partnerships or indicate market saturation, guiding your timing.
Long-Term Vision: Your M&A decision should align with a long-term strategic vision. Consider how the deal will position your organization for future growth and address evolving healthcare needs.
The decision to enter a merger or acquisition in the healthcare marketplace should never be taken lightly. It requires meticulous planning, a deep understanding of the market, and a clear alignment with your organization's strategic objectives. By considering these factors and timing your move strategically, you can maximize the potential for a successful and transformative M&A deal.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506362024-01-11T17:26:19Z2024-01-24T17:25:35Zavailable here. Although helpful to incorporate proactive measures to reduce the risk of allegations of a violation, it is also important to know some basic strategies to consider if ever faced with such an accusation.
What if I find the violation?
If you suspect a violation has occurred, act promptly. In some situations, it is helpful to conduct an internal investigation to assess the scope of the issue. If this investigation results in concerning information, self-reporting to the authorities can mitigate potential penalties. Seeking legal counsel with expertise in healthcare law is crucial when navigating these situations.
What if I receive notification of an investigation into allegations of fraud?
Notification generally arrives in the form of a letter from an official, such as the United States Attorney’s Office. This letter will likely provide general information and inform the recipient of their rights. At this point, it is often wise to seek legal counsel.
In either situation, defenses are available and can include mistake or insufficient evidence. In some cases, a safe harbor may apply which basically means that what may otherwise appear to be a violation falls within an exception. Even those who initially face a conviction can win on appeal or, as was highlighted in a recent case, a motion to acquit. In that example, upon review the judge agreed with the defense team’s argument and overturned a jury’s verdict against an emergency department physician.
Healthcare fraud is a serious offense with grave consequences. Had the physician noted above not found success with the motion to acquit he was facing sentencing for up to ten years imprisonment for the alleged violation. Although the allegations can come with criminal charges, it is generally wise to seek legal counsel with experience in healthcare law, not just criminal defense. This distinction can help to better ensure you find legal counsel experienced to handle the unique aspects of these types of charges while also remaining aware of the potential impact on your medical license.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldstein.com/?p=506342024-01-10T19:56:34Z2024-01-19T19:53:13Zmultiple nurses for various allegations of wrongdoing including instances of criminal charges for violent acts and animal cruelty as well as failure to properly document prescriptions taken and provide care without proper supervision.
These are just a few examples of the cases the Board reviewed and found warranted some of the most extreme measures available: revocation. Those who wish to avoid a similar fate can take proactive steps to protect their license. Prevention is the best defense against disciplinary actions such as these.
Nurses can protect their licenses by following these best practices:
#1: Keep up to date with changes to regulations and standards of care
It is important to continuously update your knowledge on nursing laws, ethics, and Board regulations. You can better ensure you are up to date on such matters by regularly attending workshops, seminars, and continuing education courses.
#2: Maintain professionalism
It is also helpful to uphold the highest standards of patient care and professional conduct both within the workplace and within your personal life. Document patient interactions thoroughly and accurately. Refrain from posting about patient interactions on social media.
#3: Build a support team
Everyone needs support. Whether in the form of friends, family members, co-workers, or mentors, find a mix of individuals who help you navigate the complicated issues that come with this demanding profession. This can range from a safe place to vent frustrations to someone with experience to provide guidance on how to manage shifts or scheduling frustrations.
If you are subject to disciplinary action, consider obtaining legal counsel who specializes in nurse licensing defense. They can guide you through the process and help protect your rights.
Attorney John Rivas is responsible for this communication.]]>