State and federal laws heavily regulate the healthcare industry in the United States.
As a result, if you are involved in any level of providing healthcare services in our country, you must always remain aware that there are complex compliance issues you must adhere to.
Here is a look at some of the basic regulatory issues you might encounter and how a healthcare law specialist can assist you in addressing them.
Specific Issues and Risks Regarding Regulatory Compliance as a Healthcare Business Owner
Complying with general contract and business laws and rules when you are a healthcare business owner is not enough.
Medical offices deal with numerous other levels of compliance issues specific to their field. For instance, based on your business, you may find that you have to pay particular attention to rules regarding:
- Medicare billing for services;
- Facility licensing and certification;
- Hospital-physician contracting and alignment, and other non standard contract laws;
- Provider formation, operations, and acquisitions;
- Managed care compliance;
- Medical coding compliance plans and intricacies;
- Compliance with federal and state laws regulating HMOs and insurance companies; and
- E-health regulations.
The examples listed above are just the tip of the iceberg. The number of compliance plans your healthcare business must put in place are extraordinary and often changing. Violations, even unintended, can lead to serious consequences.
For instance, a compliance plan for a medical office, should be sure to address the Stark Law.
Under provisions of the Stark Law, a doctor may not refer a Medicare or Medicaid patient to an entity in which the provider or an immediate family member has a financial interest for the provision of designated health services. This is one of several important Federal fraud and abuse laws that apply to healthcare businesses.
Your office must have a medical compliance plan with checks and balances in place to ensure compliance with this law. Punishments for violating the Stark Law could include:
- Prosecution before the Department of Justice,
- Criminal penalties,
- Civil fines, and
- Loss of your medical and business licences.
These punishments can doom a healthcare business owner.
How a Lawyer Can Help Your Office With Medical Compliance
Healthcare attorneys are trained, experienced, and focused on helping healthcare business owners create compliance plans and address non compliance accusations.
Medical offices must be proactive in seeking legal assistance regarding formation of compliance plans and operating in alignment with those plans. It is also essential that your medical office have attorneys ready to defend you regarding non compliance claims.
Proactive Legal Support
If you are starting or already own a healthcare business, it is best to engage healthcare lawyers. Among other things, they can evaluate your business and provide services surrounding:
- Drafting and implementing a full compliance plan;
- Creating medical office contracts for transactions;
- Addressing medicare provider enrollment compliance;
- Preparing and negotiating full preferred provider agreements;
- Constructing physician compensation arrangements;
- Implementing mergers of medical groups;
- Purchasing equipment and lease agreements;
- Producing written policies, procedures, and standards of conduct documents; and
- Providing training and education on updated medical compliance.
You need a law firm with healthcare expertise to address, review, or create a comprehensive medical compliance plan for your healthcare business. Doing so will aid you in avoiding critical issues in the future.
Help During Regulatory Compliance Issues
Along with providing early and ongoing support, healthcare lawyers can assist with representation and legal advocacy if you face an audit or legal challenge. These may include addressing issues such as:
- Disputes over department closure and scope of exclusive contracts;
- Joint venture litigation;
- Voluntary disclosure of Stark violations and refunding overpayments;
- Failure to comply with Medicare coding and billing requirements;
- Inquiries regarding state licensing laws;
- Medicare and Medicaid suspension actions;
- Dissolution of corporations and partnerships;
- Accusations of HIPPA compliance failures;
- Dispute resolution involving a medical code compliance plan;
- Shareholder (“buy-sell”) partnership and operating agreement choices; and
- Handling of provider payment disputes.
The above list is not all inclusive. A lawyer who works with healthcare entities can provide timely and responsive legal representation for any issue you might face regarding audits, investigations, and alleged violations.
Whether you are part of a sole practice, medical group, hospital, managed care organization, or other healthcare related businesses, you need a medical compliance plan. Once that is in place, you should have ongoing assistance to ensure continued compliance with the ever changing regulations.
If you find yourself in need of representation, you want a firm with excellent reviews you can trust to handle your case. But do not wait until you reach that point. Seek out help now to address your medical office compliance plan needs.
Massingill: Providing the Massingill Difference
Massingill is an Austin, Texas-based law firm focusing on healthcare business law throughout the state.
Clients provide the firm with an ongoing top notch rating, and view us as exceptional legal professionals who are also personable and caring. Along with healthcare law, the firm addresses family estate planning and an array of general business and employment law areas.
When you need trusted, experienced legal counsel, look no further. Massingill offers a flat fee arrangement and quality representation.
Reach out to us today online or at 512-410-0343. We are available via video, phone, or in-person consultation.
Joshua Massingill
Joshua Massingill is an attorney practicing in Austin, Texas. He serves on the Texas State Bar’s Law Practice Management Committee, the Leander Educational Excellence Foundation (LEEF) Board of Directors, and the Success-Werx Board of Advisors. He mentors young entrepreneurs in Leander ISD’s INCubatorEDU program and is active in his church.
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