What is “healthcare law” or “health law”? Those terms generally refer to the field of law governing the provision of health care as a business or profession. Little Health Law is a highly specialized boutique firm focused exclusively on representing and assisting healthcare providers and healthcare businesses. While “healthcare law” is broad in scope, our practice is geared narrowly toward helping medical practices, licensed healthcare providers and closely held healthcare businesses in matters involving regulatory compliance, transactions, employment and disputes. Many large firms have a section, department or a few lawyers dubbed with “healthcare law.” But we are different in this way. Health law is all we do. Our mission as a business devoted exclusively to health law is to have a big impact on health care by allowing top providers to focus on what they do best – delivering exceptional healthcare.
Georgia-Based Health Law Firm
Our AV-rated firm maintains two offices, one in Atlanta, Georgia and the other in Augusta, Georgia. We have a multi-jurisdictional practice and serve the needs of providers and healthcare businesses throughout the United States. We represent medical practices, physicians and closely held healthcare businesses. We pride ourselves in white-glove VIP treatment for all of our customers.
As health law counsel, we are accustomed to analyzing and assessing esoteric regulatory issues that present unique business and professional risks to providers and healthcare business owners. For example, we are often asked about the so-called “corporate practice of medicine doctrine,” a concept typically embodied in state statutes and regulatory provisions with the intention of limiting business or compensation arrangements that may result in improper influence on a physician’s clinical judgment or overutilization of health care.
Corporate Practice of Medicine
“Corporate practice of medicine” and “fee-splitting” restrictions typically involve complex legal issues that can vary widely between States. Such rules may prohibit corporations and other entities from practicing medicine or employing physicians or other licensed healthcare professionals (including chiropractors), prohibit non-professionals or entities from having an ownership interest in a chiropractic or medical practice, or otherwise prohibit a non-professional or entity from controlling the professional activities of a licensed physician or chiropractor or from receiving profits from the provision of such professional services. The corporate practice of medicine doctrine and fee-splitting restrictions are based on concerns that: “(1) allowing corporations to practice medicine or employ physicians will result in the commercialization of the practice of medicine; (2) a corporation’s obligation to its shareholders may not align with a physician’s obligations to his or her patients; and (3) employment of a physician by a corporation may interfere with the physician’s independent medical judgement.” See American Medical Association’s “Corporate Investors” Issue Brief, available at: https://www.ama-assn.org/system/files/2019-12/issue-brief-corporate-investors.pdf; see also American Medical Association’s “Corporate Practice of Medicine” Issue Brief, available at: https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/premium/arc/corporate-practice-of-medicine-issue-brief_1.pdf. These concerns stem from the underlying concern that, because “the unlicensed person or entity is not bound to the same ethical code as the physician, the unconstrained nonprofessional could introduce improper economic incentives that could undermine the quality and safety of a patient’s care, through, for example, overbilling or overutilization of care.”
So, for example, in Georgia only persons that are licensed by the Georgia Composite Medical Board to “practice medicine” (i.e., M.D./D.O. physicians) may: (i) “suggest, recommend, or prescribe any form of treatment for the palliation, relief, or cure of any physical or mental ailment of any person” or otherwise hold themselves out to the public as being engaged “in the diagnosis or treatment of disease or injuries of human beings;” or (ii) maintain “an office for the reception, examination, or treatment of diseased or injured human beings.” O.C.G.A. § 43-34-22. Similarly, only persons that are licensed by the Georgia Board of Chiropractic Examiners as a “doctor of chiropractic” may render chiropractic services or chiropractic adjustments in Georgia. O.C.G.A. §§ 43-9-18 & 43-9-19; see also O.C.G.A. § 43-9-1(2)
A Unique Firm Problem Solving in a Unique Field of Law
“Health law” thus describes a unique and often esoteric and developing legal field due to the changing regulatory needs of the healthcare industry. As health lawyers focused on representing medical practices, physicians and healthcare businesses, our health law practice typically involves healthcare transactions, regulatory compliance, medical licensing and credentialing, physician employment, compliance audits and civil investigations, and healthcare business disputes.
So, what we do is unique. We may in the same month show a physician how to set up a concierge medical practice tailored to his specified model; advise a surgery center on Certificate of Need issues; design a healthcare MSO for a non-physician management company owner; dispute the enforceability of a physician non-compete agreement; close the sale of a dental practice by a retiring dentist; dispute for a physician group a third party payor’s notice of recoupment; or research and advise a client regarding the potential application of Stark Law to a proposed business arrangement. In each instance, we are committed to a singular goal: problem solving for healthcare providers so that they can focus on what they do best. In this way, we hope to have a Big Impact on healthcare delivery.
Compliance
Virtually all aspects of the provision of healthcare warrant cautious and careful attention to the subject of compliance. “Compliance” is a word we hear a lot in our health law practice. But what does it mean?
In a general sense, “compliance” as a subject is the broad way to refer to myriad state and federal laws and regulations that govern providers in delivering healthcare. Not only is the universe of compliance rules and laws quite broad, but it is also changing. All the time. In a sense, it may be impossible for any provider to be perfectly “compliant” all the time with all rules. However, because the stakes can be high for compliance missteps, a real and bona fide effort to follow the rules is in the best interests of every healthcare provider and licensed professional. In some cases, such as fraud and abuse compliance rules, the adverse consequences of violations can be draconian financially or, worse, even involve criminal responsibility.
Every healthcare business, from small medical practice to large hospital system, stands to need and would substantially benefit from a compliance program. A compliance program is a plan to follow the essential rules applicable to one’s healthcare business. A good compliance program may, for example, enable the business to better ascertain billing and coding errors, failures to properly document, or unlawful referrals. A real compliance program not only will decrease the likelihood of a compliance infraction, but it will also aid in demonstrating a good faith intention to do the right thing. That can matter where a practice is investigated. So, while a good compliance plan will not make a practice or other healthcare business bullet proof, it will significantly mitigate business and professional risks that attend being a healthcare provider.
Generally speaking, a good compliance program will do the following: 1) establish clear standard; 2) be supervised by a Compliance Officer; 3) not delegate discretionary authority to individuals who have a propensity to engage in illegal activities; 4) provide for employee training about relevant compliance subjects; 5) provide for audits or other monitoring of the business systems; 6) establish enforcement mechanisms to deal with violations of established standards; and 7) provide for corrective action or other proper responses to violations.
An effective compliance program will have written standards that all employees in the business or practice can follow. For example, a compliance program should include a Code of Conduct that articulates standards for such things as ethical behavior, billing, coding and documentation. A good compliance plan should include written policies and procedures written in simple, plain English to serve as a compliance road map for all healthcare professionals and staff.
A compliance program’s handling of corrective action is crucial. Clearly stated, well defined corrective action steps are essential and may include, for example: 1) informing a person who has made a mistake of the violation and how to avoid another one; 2) providing remedial education regarding the rules; 3) a follow up interview to check on progress; 4) refunding improper payments; 5) discipline; 6) steps for voluntary disclosure of billing infractions to the government; and 7) the suspension of billing services of an offending professional.
Call Us Today
Connect with us. We are glad to consult with you about your medical practice, professional circumstances or business events to let you see if our business is a fit for yours. Many of our legal engagements are done on a flat-rate basis and are always set up with an intention to ensure you have predictability about legal expense and ready access to your counsel. To schedule a confidential consultation, email us at info@littlehealthlaw.com. Or call us at our Atlanta office (404.685.1662) or our Augusta office 706.722.7886.