BMN Blog

It is back to school time. Although it is still hot outside, many schools have opened, we have taken first day of school pictures, and football practice is underway. As we enter this new season, it’s a good time for physicians to review some practice fundamentals. To that end, I offer ten reminders about regulatory compliance fundamentals that can help to avoid legal liability and an unwanted invitation to Montgomery.

Why do physicians leave their employment with a practice group? 

There’s no single reason for such a separation. A physician's leaving might be planned well in advance, or might be an unplanned, precipitous event. 

The journey toward mental health parity began in 1961, when President Kennedy directed the Civil Service Commission (now known as the Office of Personnel Management) to implement mental health parity. The Strengthening Behavioral Health Parity Act (“SBHPA”), which was signed into law on December 27, 2020 as part of the Consolidated Appropriations Act of 2021, represents a major milestone in that journey by adding ERISA plans to the plans that are covered by the Mental Health Parity Act of 1996 and by working to achieve parity in physical and mental health care management processes.

Each year, the landscape for physician practices has experienced seismic shifts in the areas of reimbursement, regulatory requirements, technology, and competition. Meeting the challenges of such a shifting landscape is a formidable task for even the most sophisticated of physician practices. Doing so requires a keen eye on what’s ahead and careful planning. So, let’s look at a couple of trends that should be considered in the planning process for 2020.

While it’s easy to shop around for the best price on a car or the cheapest gallon of milk, it can be nearly impossible to predict what your medical bill will be following a procedure or hospital visit, regardless of your health insurance coverage.

The United States Environmental Protection Agency (“EPA”) regulates pharmaceutical hazardous waste. Under the EPA, unused and disposed of pharmaceuticals are evaluated, managed and disposed of as potential “hazardous waste” under the Resource Conservation and Recovery Act (RCRA) Regulations. The RCRA establishes procedures and standards for hazardous and solid waste material management and disposal. Under the RCRA, solid waste includes “solids, liquids and gases and must be discarded to be considered waste.”[i]

Regulation Background

The False Claims Act (“FCA” or “Act”) is a federal anti-fraud statute that protects against persons and companies defrauding the government. The Act has been dubbed the government’s “primary litigation tool for recovering losses resulting from fraud.”[1] The FCA imposes civil liability on any one who “knowingly presents…a false or fraudulent claim for payment or approval” to the federal government.[2] It is used extensively to protect against fraud in healthcare.[3]

Studies have shown that almost 9 out of 10 adults have difficulty using the health information they receive.[1]  This difficulty reflects a gap in patients’ capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions. In other words, the studies reflect a gap in health literacy. 

It is especially important for smaller practices to be mindful of Electronic Protected Health Information (ePHI) security regulations – a breach of ePHI can lead to costly notification requirements and potential monetary penalties under the HITECH Act.[1]  Managing physicians of small independent practices hold many responsibilities, including the duty to comply with the Security Rule within HIPAA regulations.  This article provides a brief overview of federal ePHI compliance safeguards required in a practice.  While not meant to be a comprehensive discussion of all requirements, it highlights legal considerations and safeguards a practice must implement to comply with HIPAA ePHI regulations.  The federal Security Rule under HIPAA requires a health care provider (typically known as a Covered Entity[2]) to have the minimum ePHI safeguards, listed below.

On Friday, January 19, 2018, the Department of Health and Human Services (HHS) issued a proposed rule that will complicate the issues healthcare providers face in providing treatment to LGBTQ patients.