CALIFORNIA HEALTHCARE LAW

The title of this post says it all: read
this article to see what I mean.

The
United States is not the only country that faces a shortage of medical care and
a lack of resources to pay for it.  According the The Economist,
most countries face aging populations.

At the same time, there are
chronic shortages of doctors.

The solution that seems to be currently in
vogue in both the United States and the rest of the world is to make the
physician less relevant to the healthcare.

The future of healthcare
utilizes more technology to make sure that patients stay healthy, including
remote monitors which notify centers if a patient’s blood sugar or blood
pressure are not normal. Technology will also help healthcare administrators to
judge success and quality, making adjustments to those practices that are too
expensive.  Healthcare intends to utilize more para-professionals in
healthcare, including nurses in place of doctors.  The doctors role will
be reduced to the most intensely medical activities, particularly surgery, which is interesting.

Submitted by Matthew L. Kinley

The Department of Health and Human Services and Internal
Revenue Service have issued a recent regulation defining what “full-time” is
for employers wondering if they are required under the Affordable Care Act to
provide insurance.  In just one more indication how complicated the
regulations are under the Act as this takes 18-pages to describe.
Interestingly, “full-time” is an average of 30-hours a week (not the widely
accepted 40-hours per week).

This is a key rule because companies with more than 50
full-time employees must provide health insurance under the law. Defining the
term to include 30-hour per week employees will include several more small
businesses that will need to comply with this Act.

Submitted by Matthew L. Kinley

The US Centers for Medicare and Medicaid Services (CMS) has advertised and encouraged physicians across the country to take advantage of incentive payments in order to upgrade their offices for meaningful use of electronic health records (EHR) technology.

Government and private payers are seeking to have such EHR technology more standardized and many healthcare experts expect that EHR systems will be required to participate in government and private payer systems.   Reports from physicians about the incentive program have not been complimentary, with many physicians complaining that funding has been slow in coming.

Now, may providers who took advantage of the incentive payments are being audited.  Many have received letters from a CMS contractor asking that they submit extra documentation within 2 weeks to support their claims that they met federal meaningful-use criteria. CMS will recoup bonuses from those who turn out not to have deserved the payments.  While the regulations have always provided that such audits were possible, the audits are still surprising many physicians. See this CMS link for audit regulation information.

The audit letter from Figliozzi & Company asks for 4 types of information that back up what providers reported to CMS to obtain their bonuses.

• A copy of a document from the US Department of Health and Human Services that certifies the provider’s EHR technology as eligible for the incentive program.
• Documentation of reported emergency department admissions, a key number in calculating whether the provider met certain meaningful-use requirements.
• Supporting documentation for a provider’s claims to have satisfied mandatory meaningful-use objectives and measures, such as electronic prescribing.
• Supporting documentation for a provider’s claims to have satisfied voluntary meaningful-use objectives and measures.

Submitted by Matthew L. Kinley

By Kelly Greene

Twenty-nine states have “filial support” laws on the books that could be used to go after patient’s families for unpaid long-term-care bills.

We described one case in Pennsylvania, the main state where health-care providers have started using such a law, in last weekend’s Family Value column, “Are You on the Hook for Mom’s Nursing-Home Bill?”

This has become a hot topic for financial planners and others advising Americans, young and old, on healthcare costs for aging parents.

Many estate planners are selling all kinds of asset protection strategies (i.e. forming business entities, creating irrevocable trusts and off-shore trusts, re-titling property in joint-tenancies, etc.).

But since these filial responsibility laws were rarely enforced in the past, attorneys do not really know how well these strategies will hold up in court, in terms of protecting children's assets from their parents' creditors. As a result, attorneys aren't giving too much information, at least not on their web pages/blogs, about exactly what kinds of asset protection strategies they use and/or that work.

They merely alert their readers to the re-emergence of filial responsibility law enforcement, and then invite people to consult them about asset protection strategies, medi-cal planning, and long-term insurance possibilities.

Be careful if you are delving into estate planning and asset protection for this reason as it is truly uncharted territory as to what works and what does not.

Submitted by Jennifer N. Sawday

California Medical Association General Counsel and Vice President Francisco J. Silva, Esq., and Matthew L. Kinley, Esq. of Tredway, Lumsdaine & Doyle, LLP, spoke to the Orange County Medical Association on June 7, 2012, about the impact of medical foundations and accountable care organizations. 

The wide ranging topics included the legal basis for medical foundations and accountable care organizations, the benefits and burdens of physician employment by such entities, and the contracts and agreements that typically are utilized for such arrangements.

Matt reported that, "Physicians and medical providers who are considering working for an integrated health care model should carefully consider their options before signing on the dotted line.  A lawyer with healthcare experience should be retained to help the medical professional through the legal maze presented by such a step." 

Some the specific areas that a physician should be concerned with:

Does the culture of the new entity fulfill the needs of the physician group? 

How do valuations play a part in the transaction? 

What due diligence will take place? 

What potential contracts may need to be signed? 

What to look for in an employment contract, an asset purchase agreement, or a professional services agreement? 

How are physician salaries determined? 

The two hour seminar was attended by approximately 50 physicians.

In January and February of 2012, attorneys Matt Kinley and Mark Doyle teamed up with healthcare accountants Steve Williams and Jay Wikum to make several presentations to providers on medical office management in 2012. This discussion included the practical and legal issues of the size of medical practices, the the pros and cons of merging, and the regulatory issues involved in merging. This is the powerpoint of that presentation.