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Paying Hospital-Employed Physicians for Services Performed by Others
/in Reimbursement & CollectionsBy Kim Stanger
The Ethics in Patient Referrals Act (“Stark”) prevents hospitals from paying employed or contracted physicians in the same way that physicians are or were paid by independent physician groups. Specifically, physician groups may generally pay physicians a share of the profits from services performed by others, but hospitals may not pay physicians in a way that varies with the volume or value of referrals for certain services payable by Medicare or Medicaid, which usually precludes paying physicians a share of profits or a percentage of fees for services referred or ordered by the physician but performed by others.
Stark Requirements. Per Stark, if a physician (or a member of the physician’s family) has a financial relationship with an entity, the physician may not refer patients to that entity for certain designated health services1 payable by Medicare or Medicaid unless the financial arrangement is structured to fit within a regulatory safe harbor. (42 USC § 1395dd; 42 CFR § 411.353). Under Stark’s “group practice” safe harbors, physician groups that qualify as a “group practice” may pay physician group members based on services the physician personally performs, services billed “incident to” the physician’s personally performed services, or, subject to certain limits, a portion of the overall profits of the group, including profits from services derived from services performed by others. (See 42 CFR §§ 411.353 and 411.355(a)-(b)). These “group practice” safe harbors are not available to physicians who are employed by the hospital. Read more
Utah Care-Review Privilege
/in Liability & Risk Managementby Cory Talbot
Utah adopted a care-review privilege “to improve medical care by allowing health-care personnel to reduce morbidity or mortality and to provide information to evaluate and improve hospital and health care.”1 In January, the Utah Court of Appeals gave some helpful guidance about the application of this privilege in Vered v. Tooele Hospital Corporation.2
The Care-Review Privilege Generally
Before discussing the Vered case, we will go over a number of general background issues regarding the scope and application of the care-review privilege. Read more
Want to Hire an Employee Subject to a Noncompete Agreement?
/in Contracts & Transactions, Employmentby Nicole Snyder
Republished with permission from Idaho Medical Group Management Association (MGMA). Original article appeared in Idaho MGMA’s May 2018 e-newsletter.
As the healthcare industry grows, and at a time when unemployment is low, it can be very frustrating to find potential employee candidates who are bound by noncompete agreements with current or former employers.
Medical practices shouldn’t be too quick to throw in the towel before rejecting candidates on the basis of having a noncompete agreement. Here are some pointers to help with the hiring process in these situations: Read more
IMGMA Q/A: Service Animals
/in ADAby Rob Low
Republished with permission from Idaho Medical Group Management Association (MGMA). Original article appeared in Idaho MGMA’s April 2018 e-newsletter.
Question: What are “Service Animals”, and to what extent (i) must they be allowed on health care facility premises, and (ii) can they be refused or removed from premises?
Answer: Under the Americans with Disabilities Act (ADA), “Service Animals” are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. This means the dog must be trained to take a specific action when needed to assist the person with a disability (e.g., a dog which is trained to guide a blind person, alert a deaf person, pull a wheelchair, alert a person with diabetes that his or her blood sugar is too high or too low). The ADA also recognizes that, in some instances, a person with a disability may use a miniature horse that has been trained to do work or perform tasks for people with disabilities as a service animal. Under the ADA, service animals must be harnessed, leashed, or tethered, unless these devices interfere with the service animal’s work or the individual’s disability prevents using these devices. However, the ADA does not require service animals to wear a vest, ID tag, or specific harness. Read more
Minimizing Liability For Business Associate Misconduct
/in HIPAABy Kim Stanger
Republished with permission from AHLA’s Physicians and Hospitals Law Institute. Original article appeared Feb. 5, 2018.
Healthcare providers, health plans and healthcare clearinghouses (“covered entities”) and business associates are subject to significant penalties for violations of the HIPAA Privacy, Security and Breach Notification Rules. To make matters worse, covered entities may be liable for their business associates’ misconduct, and business associates may be liable for their subcontractors’ violations. Covered entities and business associates must take appropriate steps to minimize exposure for their business associates’ or subcontractors’ violations. Read more