Rivas Goldstein, LLPNew York Health Care Law Attorney | Medical Licensing, Medicare Fraud2024-03-12T15:24:08Zhttps://www.rivasgoldsteinnyc.com/feed/atom/WordPressOn Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499632024-03-01T19:50:23Z2024-03-07T19:49:34ZWhat are noncompete agreements?
In essence, noncompete agreements are legal contracts that restrict a doctor's ability to practice within a certain geographic area or within a specific time frame after leaving an employer. These covenants aim to protect medical practices from competition by former employees who might otherwise use proprietary knowledge or patient relationships to gain an advantage.
Challenges to these provisions within the medical world are becoming more common. It is wise for those who are looking to use these restrictive covenants as well as those who are trying to figure out how the agreement impacts their ability to practice medicine have a basic understanding of how these legal restraints work. If challenged, the courts generally review two elements to determine if a noncompete is valid:
Scope of the geographical restriction
Duration of the noncompete period
The nuances of enforceability of noncompete agreements varies by state. Some states uphold these agreements with certain limitations, while others may deem them entirely unenforceable. Physicians must understand the specific legal landscape in their state of practice. Challenges arise when these covenants are deemed overly broad or unnecessarily punitive, potentially hindering a doctor's right to work.
How do these agreements affect the medical profession?
Noncompete agreements not only limit the mobility of individual doctors but can have a broader impact on the medical field as a whole. On one hand, they protect investments made by healthcare facilities in training and developing their staff. On the other hand, they can limit patient access to preferred physicians and reduce competition, which may lead to higher healthcare costs.
The use of noncompete agreements in medicine continues to be a contentious topic. As the healthcare landscape evolves, so too may the legal interpretations of these contracts. Physicians and healthcare providers must stay informed about changes in legislation and court rulings that could affect the enforceability of noncompete agreements.
Noncompete agreements wield considerable influence over doctors' careers and the broader medical industry. While they serve to protect healthcare entities, they also pose challenges to the mobility and autonomy of individual physicians. Whether a physician trying to determine the impact of a noncompete or a healthcare leader looking to craft an agreement to meet their practice’s needs, legal advice can review your goals and discuss the potential impact of the agreement.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499622024-02-28T15:44:35Z2024-03-06T15:43:52ZWhat are the rules?
Physicians must follow federal and local regulations or can face fierce consequences, including the potential for criminal conviction. Physicians can reduce this risk by being aware of the following legalities:
Physicians must be aware of how the Anti-Kickback Statute and Stark Law guide their practice.
Always remember that ordering tests or services that are not medically necessary can result in allegations of wrongdoing.
Receiving kickbacks for referrals can lead to severe penalties.
The last one is often complicated by the fact that we continually push for collaborative care to benefit patients. It is important for physicians to carefully review their practices and billing agreements to better ensure they are able to work together with other professionals and avoid allegations of a violation.
What happened in the Baldonado case?
The government recently released the indictment for Dr. Baldonado and alleged involvement in a scheme costing the government over $20.7 million in fraudulent Medicare claims. The prosecution claims the physician received kickbacks in exchange for ordering unnecessary lab tests.
If convicted, he could face significant prison time.
Physicians can learn from his error. Important lessons from the case include:
Only order tests that are medically necessary.
Ensure all referrals are based on patient need, not financial incentives.
Maintain thorough documentation of all tests and services provided.
The legal implications of non-compliance in healthcare are serious and far-reaching. Physicians must stay informed and vigilant, not only to protect their practices but also to uphold the trust placed in them by their patients and the community.
It is also important to note that those who face similar allegations of wrongdoing have options. An attorney can review your case and discuss strategies to better ensure you reach the most favorable resolution possible.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499612024-02-23T18:41:06Z2024-02-28T18:40:17Zthe move would ease the process for facilities to hire international workers including allowing sponsored work vias instead of permanent labor certifications.
How is the hiring process different for those trained at foreign institutions?
For pharmacists trained at foreign institutions, the hiring process involves additional layers of verification and assessment. These can include:
Verification of the foreign degree's equivalency to U.S. standards through the Foreign Pharmacy Graduate Examination Committee (FPGEC) Certification
Passing the Test of English as a Foreign Language (TOEFL) if applicable
Completion of the NAPLEX and Multistate Pharmacy Jurisprudence Examination (MPJE), or other state-required exams
Employers must recognize the legal implications when hiring pharmacists with different training backgrounds. Compliance with federal and state regulations is non-negotiable, ensuring that all pharmacists, regardless of their training origin, meet the same practice standards. As such, foreign trained pharmacists are wise to review these requirements before they begin the application process.
What else should foreign pharmacists know about the hiring process?
State requirements can also apply. In New York, the foreign educated pharmacists must receive an intern permit prior and complete 2,080 hours of internship.
Whether trained domestically or at a foreign institution, the licensing process is complex. It is important to move forward carefully and make sure to complete all requirements to better ensure a smooth transition into your chosen profession.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499602024-02-09T21:48:10Z2024-02-14T21:47:22Zrecent example, healthcare facilities removed two physicians after they made social media posts about the Israel-Hamas war. One was officially fired, the other reinstated to his position shortly after removal. Healthcare professionals can learn two important lessons from these vastly different responses to similar actions:
Reaction matters. More than 100,000 individuals signed a petition in support of the physician who was reinstated. This outpouring of community support may have played a role in his reinstatement.
Expertise matters. When your license is on the line, it is important to gather a team to help fight back against this type of unfair treatment. An attorney specialized in this niche form of healthcare law can help to defend your license so you can focus on your patients.
It is also important to keep in mind that professional bodies often update their guidelines regarding social media use. Keep updated of any new policies from the New York State Medical Board and other relevant organizations that may impact your practice. It can also help to increase your awareness of the appropriate use of social media by attending workshops or seminars on digital professionalism.
By following these best practices, doctors can leverage social media to enhance their professional standing while upholding their ethical obligations. As the cases highlight above, it is important to remember that online actions can have real-world consequences. If you chose to engage with social media, do so mindfully and professionally.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499572024-01-19T20:28:55Z2024-02-09T20:25:35ZA case that combines fishing and healthcare
The case involves two fishing boats that have filed a lawsuit because they believe it is unfair to pay for federal inspections that check for compliance with fishing safety regulations.
A brief bit of history before answering the question
In order to rule on this case, the Supreme Court of the United States (SCOTUS) is likely to overrule long-standing framework that allows courts to defer to expert agency interpretations of the law. This case involves a federal statute, a federal agency, and the fisherman.
This framework used to decide cases that involve federal agencies essentially states that if a statute is clear, the court applies the statute. If the statute is not clear, the court refers to the expert agency’s interpretation. As long as that interpretation is reasonable, it stands. This is important because the laws Congress enacts often leave room for interpretation.
This framework is known as the Chevron deference because it was established in a decades old case, Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc., where SCOTUS explained that when Congress uses broad language to craft a law it “implicitly delegates” authority to the agency to interpret and apply the law.
Some legal experts have stated that the increasingly conservative make-up of SCOTUS has led to a more anti-regulatory approach when ruling on cases. As such, they argue that it seems likely the current SCOTUS will overrule Chevron.
A look at the impact of a fishing case on healthcare
At first glance, a case about the fishing industry does not seem to have much to do with the healthcare industry. However, overturning Chevron could impact the practice of medicine. For example, the American Cancer Society has voiced concern that overruling Chevron will reduce the stability of public funded health insurance policies, like Medicare and Medicaid. The group filed a brief with SCOTUS, outlining their concerns, using three cases that challenged Medicare statutes as examples.
It is important for medical professionals to keep current on this issue. We will provide updates as they become available.
Attorney John Rivas is responsible for this communication.
]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499582024-02-01T19:39:46Z2024-02-06T19:36:49ZWhy did pharmacists participate in Pharmageddon?
To bring attention to the issue. Years and years of perceived inaction and a snowball effect of rising expectations while serving as a pharmacist led many to hit a breaking point. As more and more pharmacists face burnout, Pharmageddon served as a way to better ensure public awareness and push for change.
Why is burnout a problem within this industry?
Burnout manifests as emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Recognizing these signs early is the first step in addressing the potential for burnout before it becomes a problem. Emotional exhaustion can manifest when feeling drained and fatigued, depersonalization can result in developing a cynical attitude towards patients or colleagues, and a reduced sense of accomplishment can result in pharmacists feeling like their work is no longer making a difference.
When combined, these natural responses to burnout can result in harm to patients. In addition to patient harm, burnout can result in mistakes that an put your professional license at risk such as a HIPAA violation if not alert and carefully navigating discussions with patients.
How can I reduce the risk of burnout?
In addition to a healthy diet, exercise, good sleep habits and other steps to take care of essential selfcare, a positive work culture can also reduce burnout. This can serve to encourage open communication and support among colleagues. Some examples to help achieve this goal can include:
Team building: Engage in activities that build camaraderie.
Peer support: Establish a system where pharmacists can talk about their challenges.
Recognition: Celebrate successes, no matter how small.
Continued learning and professional development can also be beneficial as it can renew your sense of purpose and keep you engaged. You can achieve this by attending workshops and seminars to help stay current with the latest in pharmacy practice.
Burnout is a serious issue for pharmacists, but it's not inevitable. By recognizing the signs, prioritizing self-care, fostering a supportive workplace, setting boundaries, and staying engaged, you can maintain your well-being and continue to thrive in your career. Remember, taking action to prevent burnout is not only beneficial for you but also for the patients who rely on your expertise and care.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499562024-01-17T16:07:23Z2024-01-29T16:04:46ZCommon Allegations
The scope of infractions includes:
Unlawful financial incentives: Illegal kickbacks remain a critical area of government scrutiny.
Unnecessary medical procedures: Authorities are cracking down on the authorization of tests lacking medical justification.
Services not provided: The feds also review claims to see if the patients received the services.
Inflated billing: Upcoding, or charging for more expensive services than those actually delivered, also remains a prevalent issue.
Physicians and healthcare business owners have paid out millions of dollars through settlements to resolve these matters. A notable instance involved a clinical laboratory owner who settled with the government for an excess of $10 million. This case underscores the government's resolve to address suspect financial interactions between laboratories and referring physicians. It serves as a cautionary tale, emphasizing the necessity for medical practices to meticulously examine agreements for potential indicators of illicit activity.
Preventive Measures
Use of regular internal audits is recommended as a proactive measure to identify and address vulnerabilities before they escalate into legal allegations.
Broader Implications
It is essential to understand that the highlighted cases represent just a fraction of healthcare billing fraud, a segment of the broader spectrum of healthcare fraud. Practices such as double billing and unbundling services to submit multiple claims are also under federal surveillance.
The ongoing legal actions in 2024 reflect continued federal scrutiny within the healthcare system, signaling that compliance and vigilance are more crucial than ever for healthcare professionals.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499552024-01-11T19:48:16Z2024-01-25T19:45:22ZCase studies provide examples of violations
But what exactly does a violation look like? Recent examples include a health system executive sentenced to two years probation and mandatory repayment of $140,000 in restitution after pleading guilty to impermissibly disclosing protected health information. The exec shared patient data with a collection vendor as part to the process to develop software to aid other healthcare companies.
Another potential violation involves the use of tools like a chatbot to help organize notes or aid in drafting correspondence. The information the physician inputs into the software may not be safe as many chatbots gather data to help aid in learning. Although use of the chatbot is especially helpful to reduce administrative burdens like correspondence to insurance companies, physicians must use these tools wisely to avoid allegations of a violation of applicable federal and state regulations.
Tips to avoid a violation
It is a good idea for private practices and healthcare facilities to address this potential issue and make sure they have a compliance program in place. Inform physicians and other healthcare professionals of the expectations and how they can use these tools while remaining in compliance with various regulations such as HIPAA.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499542024-01-10T22:13:58Z2024-01-23T22:13:14ZFor sellers: Preparing for a successful exit
Understanding the value of your home health agency is paramount. Engage a professional with experience in healthcare valuations to consider factors such as cash flow, market trends, and regulatory compliance. Next, take time to get affairs in order. Ensure that your agency’s documentation, including licenses, contracts, and employee records, is complete, current, and in compliance with all regulations. This due diligence will be attractive to potential buyers.
It is also important to stay up-to-date with state and federal regulations, including Medicare and Medicaid compliance, to avoid any legal issues that could derail the sale.
Once these steps are taken, it can help to work with a broker or advisor who has a proven track record in the healthcare sector. They can help you find qualified buyers and market your agency effectively.
For buyers: Conducting due diligence
Although national demand is high, one of the first steps for a potential buyer is to understand the local demand for home health services, competition, and reimbursement rates. This will inform your decision on whether to buy an existing agency or start a new one.
For those who choose to purchase an existing facility, it is important to investigate a prospective agency's financial performance, legal compliance, and operational efficiency. Review all contracts, employment agreements, and patient care records. Ensure that the agency is in compliance with all healthcare regulations, including state licensure and Medicare certification. Non-compliance can result in penalties and jeopardize future reimbursement.
Once these boxes are checked, it is helpful to develop a transition plan to retain key staff and maintain continuity of care for patients. This will help preserve the value of the agency post-acquisition.
For both parties: Closing the deal
Both parties should negotiate terms that reflect the agency's value and future potential. This includes purchase price, payment terms, and contingencies. It is generally wise to have legal counsel review transaction documents that may include the purchase agreement, non-compete clauses, and any representations and warranties.
After closing, sellers should ensure a smooth handoff of the business. Buyers should focus on integrating operations and maintaining quality care.
Buying or selling a home health agency involves navigating a complex web of legal, financial, and regulatory challenges. The steps discussed above provide a starting point. Those interested in moving forward are wise to engage experienced professionals to help achieve their objectives and ensure the continued delivery of quality home health care services.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLPhttps://www.rivasgoldsteinnyc.com/?p=499512024-01-09T19:46:28Z2024-01-18T19:45:24ZExperts predict that these start-ups will “find their footing” in 2024 and the market for digital health will continue to grow.
These same experts predict 2024 will likely see a surge in merger and acquisition deals, including a mix of start-ups joining forces and larger corporations purchasing promising start-ups to expand their reach within this field.
Those looking to take advantage of the growth in this sector of healthcare are wise to tread carefully. Regulatory compliance is important and an evolving concern within this area of healthcare. The concerns are complex and can include:
Patient confidentiality. The ability to make use of digital tools to improve patient care and diagnostics are well known. However, it is important to make sure to use these tools wisely to ensure patient confidentiality and avoid allegations of a Health Insurance Portability and Accountability Act (HIPAA) violation.
Proper approval. The United States Food and Drug Administration (FDA) will likely play a role in the approval of use of some technology. The process is complex and generally applies if the tech qualifies as a device. Certain types of AI and machine learning software may qualify.
Payment structure. The government is particular when it comes to paying out claims. A failure to follow the rules can result in allegations of a violation. Physicians and healthcare leaders are wise to review the Anti-Kickback and Stark Laws to make sure their relationships with providers do not constitute a violation and lead to allegations of illegal kickbacks.
This is an evolving area of the law. As such, healthcare providers are wise to stay agile and review their practices on a regular basis to ensure they follow applicable regulations.
Attorney John Rivas is responsible for this communication.]]>