Healthcare Law

Running a successful medical practice is one of the more challenging small businesses out there. Not only are you faced with all of the hurdles of a traditional small business, but you have the added pressure of taking all the steps necessary to maintain your license, comply with the myriad federal, state, and local laws applicable to healthcare, and all of the requirements under the new healthcare reform laws. The Law Office of Mark Smith, PLLC can help you navigate safely through all of the legal obstacles so you can focus on what you do best – practice medicine.

Experience You Can Rely On

Since 2004, Mark has worked for a mid-sized healthcare provider as in-house and outside general counsel. He has developed a great deal of experience with many issues related to healthcare law, healthcare compliance, medical records and patient privacy issues, physician and staff credentialing, employment law, contracts, fraud and abuse, and more.

Small Business Advisor

If your practice is like most small businesses, a fundamental key to its success is your staff. From the receptionist, to your nursing staff, to your back office personnel, your business depends on effective, efficient, and motivated employees. Unfortunately, having employees also means risk – discrimination law suits, wage and hour claims, family and medical leave issues, hiring practices, and on and on.

Mark can advise you on best employment practices for your business. This may include a thorough review of your current job descriptions to ensure compliance with current Fair Labor Standards regulations. Or, you may need to develop a comprehensive employee handbook and policy manual which covers the most up-to-date statutes and regulations affecting small, healthcare employers.

Healthcare Compliance: Fraud & Abuse

The U.S. Departments of Justice and Health and Human Services announced in February 2013 it had set a record for the amount of recoveries related to healthcare fraud and abuse cases – $4.2 billion. In their joint report for FY2012, the Departments calculated the return on investment for their program was $7.90 to $1.00. So, the program recovered $7.90 for every $1 spent. With this level of ROI, the federal government will undoubtedly increase efforts to find, mitigate, and prosecute healthcare fraud.

These statistics should provide plenty of motivation for medical providers – especially those accepting reimbursement from federally funded sources (Medicare, Medicaid, Tricare) – to ensure they are compliant with all of the laws, regulations, and rules related to:

  • False Claims Act [31 U.S.C. § § 3729-3733]
  • Anti-Kickback Statute [42 U.S.C. § 1320a-7b(b)]
  • Physician Self-Referral Law [42 U.S.C. § 1395nn] (The Stark Law)
  • Exclusion Statute [42 U.S.C. § 1320a-7]

The Law Office or Mark Smith can conduct a thorough analysis of your current business practices to see if what risks, if any, your practice may have related to healthcare compliance.

Patient Privacy & Records

Another facet of compliance relates to patient privacy and protected health information. While it was not the primary intent of the law when it was passed, the Health Insurance Portability and Accountability Act (HIPAA) and the privacy rule has become synonymous with patient privacy. Since, HIPAA was passed in 1996, Congress has supplemented the privacy rule including the HITECH (2009). And, the Office of Civil Rights for the U.S. Department of Health and Human Services released its Omnibus rules related to enforcing HITECH and its provisions related to the security of electronic health records. Most of these rules are now in effect.

And, the federal government is not the only one with rules related to patient records. Texas has a very robust health care privacy law (the Texas Medical Records Privacy Act – Chapter 181 of the Texas Health and Safety Code) with some provisions even more restrictive than the federal standards.

With the changing landscape and potentially devastating fines, it is imperative for covered entities to have a good grasp on their risks associated with patient records. This includes not only the privacy aspect, but also the physical and electronic security of your files.