Archive for March, 2014

Health care providers embrace the challenge to do better

March 29, 2014 Leave a comment

Iowa is a leader in providing high-quality, low-cost health care.

— This is what is supposed to happen under Obamacare.

Let’s all admit one thing — the serious talk of improving quality of healthcare, increasing access to care, and reducing the cost of care began in earnest as a result of Obamacare.

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Obamacare Faces Major Struggles

March 29, 2014 Leave a comment

Public support for President Barack Obama’s health care law is languishing at its lowest level since passage of the landmark legislation four years ago, according to a new poll.

At some point the liars win and progress stops.  Has there ever been a bigger campaign of deceit and misinformation than what the ACA has had to endure?

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Tampa pill mill pharmacist tells court his attorneys didn’t get it right

March 29, 2014 Leave a comment

TAMPA — Disgraced pharmacist Christopher Switlyk shows no love for the attorneys who defended him over his key role in a Tampa pill mill ring.

When you break the law and can’t get off after turning others into addicts, I suppose it’s a good time to blame the lawyers.

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Categories: Fraud and Abuse, Pharmacy

The Next Big Health App Needs to Do More Than Just Track Our Numbers | Gadget Lab |

March 22, 2014 Leave a comment

This week we got a deep look at the rumored new health and fitness tracking application for Apple’s next iPhone, called Healthbook. Supposedly, Healthbook will not only track things like how much exercise and sleep you’re getting, but also your blood pressure, your blood sugar levels, and much more. All that collection will be great, but without a way to not just collate them, but make them meaningful, it runs the risk of becoming data clutter.

Parochial restrictions on telemedicine will become irrelevant when smartphone apps effectively aggregate healthcare data to help individuals become and stay healthier. It is only a matter of time when face to face interaction between healthcare providers and their patients become the exception rather than the rule.  Physicians will be able to devote their time to sicker patients while still monitoring their healthier patients to keep them healthy.

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Doctors on Twitter: 2006 – 2014 Worldwide growth mapped #hcsm

March 22, 2014 Leave a comment

[Video maps growth in doctors, nurses and healthcare professionals using Twitter since its launch in 2006 to 2014.]

While Facebook lends itself better as a professional social media portal, it would be interesting to know the growth in patients’ following their physicians on Twitter (and other social media).  If we can get past the hurdles of HIPAA restrictions and other legal silliness, social media could become the mechanism through which patients and their physicians effectively interact and improve their healthcare.

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Steps 3, 4, 5, 6, and 7 in Doing a Healthcare Deal (Correctly)

March 12, 2014 Leave a comment

Steps 2

Step 3 – Identify the governmental agencies that have authority over the deal

  • Are there any notices or approvals required?
  • What are the licensing requirements?
  • Will a change in control occur?
  • Is a new provider application/number needed?
  • Is a CON needed?  An inspection?
  • What effects will the deal have on any accreditation needed by the parties?
  • What is the timing of agency requirements vs. closing the deal?

Step 4 – Identify the third party payors that will be involved

  • Are the services to be performed as a result of the deal reimbursed by Medicare?
  • Medicaid?
  • Other federal or state programs?
  • Commercial payors?
  • What credentialing/provider applications are needed?
  • Do any payors have special requirements that must be satisfied before closing the deal?

Step 5 – Identify the due diligence requirements

Remember that a healthcare deal starts like any other deal, and the parties must do their basic due diligence about each other

  • Entity organization and ownership
  • Legal authority
  • Financial statements, assets and liabilities, liens
  • Contracts and commitments, leases
  • Employees and benefit plans
  • Taxes
  • Insurance
  • Litigation

Step 6 – Identify the healthcare due diligence requirements

What other items items of due diligence are required by the applicable healthcare laws and regulations?
  • Licenses and requirements applying to transaction
  • Equipment and inventories
  • Cost reports, inspections, regulatory correspondence
  • Quality of care, malpractice claims/insurance
  • Patients records, EHR compatibility, billing software
  • Managed care/provider agreements, liability, assignability
  • Subcontractors/suppliers
  • Stae law requirements
  • Fair market value
  • Commercial reasonablenessFair market value and Commercial Reasonableness — These are the critical underpinnings of every healthcare deal.  What is being given, what is being received, and is it commercially reasonable?Get an opinion from a qualified healthcare valuation expert to support the FMV.

Step 7 – Document the Deal

  • Documentation is a critical step in protecting the parties, achieving the goals of the deal, and meeting compliance requirements.  Stark Exceptions and Anti-Kickback Safe Harbors impose specific requirements on deal documentation.
  • Should the parties enter into a nonbinding letter of intent/memorandum of understanding?
  • Pros – helps the parties determine whether there has been a meeting of the minds prior to devoting substantial time and expense and helps manage expectations and reduce surprises.
  • Cons – can consume an inordinate amount of time prior to due diligence being completed and lock the parties into unrealistic positions.

Paper StackNext time — How to screw up the deal that everyone wants.

Justice Department Hits Physician Owned Distributorships (PODS)

March 12, 2014 2 comments

Florida Healthcare Law Firm Blog

money doctor For the first time, the Department of Justice (DOJ) has fired a shot at a physician owned distributorship (POD).  In the case, the DOJ suit claims that the ownership interest of a neurosurgeon in a spinal surgery device distributorship has caused him to perform unnecessary surgeries.

PODs have been the source of considerable controversy for years.  A couple years ago, they caught the attention of Congress.  The Office of Inspector General of the Department of Health and Human Services (“OIG”) has even issued a Fraud Alert making clear their dislike of PODs and sending a clear shot across the bow of those who are in that industry.  In 2006, the Office of the Inspector General of HHS and CMS expressed major concerns about PODs, and cited concerns about “improper inducements.”  At that time, the OIG stopped short of prohibiting them, but called for heightened scrutiny.  CMS itself has stated…

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Phoning It In – Florida’s Brand New Telemedicine Law

March 12, 2014 Leave a comment

Florida Healthcare Law Firm Blog

?????????? By: Jackie Bain

Until recently, the State of Florida has successfully avoided regulating telemedicine to account for advancements in technology. In 2003, the State issued standards for telemedicine prescribing practice for medical doctors and doctors of osteopathy, but has not formally revisited its position in light of increasingly common telemedicine practice in several states – until now.

Florida’s forestalling has officially come to an end.  The State recently enacted new physician standards for telemedicine practice, and the State legislature is presently considering further regulation.  These new standards do not impinge upon the prior standards for telemedicine prescribing practice, but are issued in conjunction to it. 

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Steps 1 and 2 (of 7) in Doing a Healthcare Deal (Correctly)

March 11, 2014 Leave a comment

Step 1 – Describe and Understand the Deal

  • Why?
  • What is it that is hoped to be accomplished?
  • Why is that a good outcome?
  • Does it make sense? I.e., is it commercially reasonable?
  • Is the deal more than just about referrals and money?
  • What happens if a regulator “follows the money”?
  • How will the deal affect others – patients, employees, physicians, competitors, the community, etc.?
  • What are the tax effects?
  • Engage legal, accounting, valuation, and other professional consultants early in the process to review the proposed deal.


Step 2 – Identify the Parties to the Deal

  • Who is involved (medical professionals, background)?
  • Why are they involved?
  • What do they bring to the deal?
  • When did they get involved?
  • Who got them involved?
  • What does each party hope to achieve?
  • Are the goals reasonable?
  • Are the goals legal and ethical?

Dos and Donts of Deal Making in Healthcare

March 9, 2014 Leave a comment

Last week, I presented at a webinar sponsored by the American Association of Orthopaedic Executives.  The topic dealt was “2014 Healthcare Compliance.”  You can access the entire PowerPoint presentation at SlideShare.

I spoke about the dos and don’ts of healthcare deal making. The focus was on deals with physicians, but the concepts are applicable to deals involving all types of healthcare providers.  Below I summarize my Rules of Thumb for healthcare deals:

Rules of Thumb for Healthcare Deals

  • RULE #1:  Just because a proposed deal makes sense and would be appropriate in a business other than healthcare, doesn’t mean it’s legal. (Corollary —  Just because everyone is doing it, doesn’t mean it’s legal.)
  • RULE #2:  Determining the legality of a healthcare deal can be complicated, time consuming, expensive, and inconclusive.
  • RULE #3:  The risks of doing an illegal healthcare deal far outweigh the benefits.
  • RULE #4:  Get professional help early in the deal.

In subsequent posts, I will discuss steps in the deal and ways to screw up the deal.

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