Articles Posted in Physician Practices

QuackbustersandtheShockTroopsofMedicalMcCarthyism-e1664472813118This is the second post in a series related to the Pretrial Diversion Program in Georgia.  The first post provided an overview of the Pretrial Diversion Programs in Georgia and the potential impact on a successful participant’s criminal record.  This post focuses on how successful completion may impact a participant’s responses to questions relating to the offense on employment, licensing, and credentialing applications.  If you have questions regarding this blog post or need counsel relating to your professional responsibilities after an arrest or conviction, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

For clients who have been arrested and charged with an offense, the concern is how to answer offense-related questions on questionnaires while participating in and after completing a pretrial diversion program. Continue reading ›

ny-medicare-fraud-img-e1664218102664Our healthcare and business law firm works with many providers and other professionals who have been arrested and charged with misdemeanors.  Our clients will, of course, hire criminal defense counsel to handle the criminal proceedings but professionals generally hire our firm navigate the professional consequences of an arrest.  Many of our clients are first time offenders who are presented with the option of participating in a pretrial diversion program.  Whether to participate in such a program should be discussed with criminal defense counsel.  This is the first blog post of two on this subject, and it focuses on providing an overview of the Pretrial Diversion Programs in Georgia and the potential impact on a successful participant’s criminal record.  The second post will focus on how successful completion may impact a participant’s professional responsibilities thereafter responding to questions relating to the offense on employment, licensing, and credentialing applications.  If you have questions regarding this blog post or need counsel relating to your professional responsibilities after an arrest or conviction, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Eligible Offenders

Pretrial diversion programs are authorized under O.C.G.A. § 15-18-80.  Thereunder, “the prosecuting attorneys for each judicial circuit . . . shall be authorized to create and administer a Pretrial Intervention and Diversion Program.”  Each county may have different guidelines on who is eligible for a Pretrial Diversion Program and different requirements for successful completion. Continue reading ›

contract-signature-e1663868054811Our healthcare and business law firm works with many providers at all stages of employment, including physicians taking their first jobs after training, becoming partners at practices, and selling their practices and retiring.  One consistently stressful time for all providers is resigning from a practice.  Through our experience, we have learned many tips to assist providers in exiting employment as smoothly as possible. If you have questions regarding this blog post or need counsel navigating an employment exit, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Our first step with clients is always to start the exit process by reviewing their employment contracts.  Assuming the agreement is enforceable and binding, your employment agreement governs how you and your employer behave.  Most clients want to leave professionally and effectively and so do not want to breach the contract on their way out.  The following are terms we generally start with in reviewing employment contracts: Continue reading ›

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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 Tennessee’s telemedicine prescribing rules.  Our firm previously posted an overview of Tennessee’s general telemedicine 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@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Tennessee Rules on Prescribing Based on a Telemedicine Visit

A. General Telemedicine Prescribing Rules

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iStock_000033418316_Medium-e1626470315777Many of our healthcare and business law firm’s clients periodically face audits by insurance companies or governmental organizations, usually through a contractor.  Audits can be unnerving times for a practice to go through.  This blog post outlines 3 tips for handling an insurance audit.  The Centers for Medicaid and Medicare recently published that the flexibilities allowed during COVID-19 will soon end and practices should ensure compliant safety and billing practices.  As a result of this change after two and half years, practices may see increased audits.  If you have questions regarding this blog post or need counsel navigating an audit, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

  1. Take it Seriously at the Initial Record Request (and Not Just When They Ask for Repayment).

Many practices call us after the auditor requests repayment.  Almost always, the process starts before then with the auditor initiating an investigation by requesting additional records and information.  After the repayment is requested, however, there is an uphill battle to argue on behalf of your practice that no or less repayment is warranted.  The best chance that your practice has of both reducing any requested overpayment and persuading the auditor not to expand its investigation to more patients or a larger time period is during the response to the initial request for records and documentation.

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csm_FlatDesign-Telework_c532b56131-e1645230859515Our 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@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.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.

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iStock_000033418316_Medium-e1626470315777Increasingly, our healthcare and business law firm’s clients are interested in opening concierge medicine practices.  Hamil Little’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@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.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.

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new-practice-startup-01-1-300x225Both 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@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.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.

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Medical-License-e1644515318522For 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@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

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4-e1647895403919Many 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@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.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 ›

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