Laws and regulations governing the healthcare industry and the provision of healthcare services are diverse and complex. As healthcare attorneys, we understand the healthcare regulatory framework and help our clients navigate it successfully.
Healthcare Regulatory Law
The Stark and Anti-Kickback Laws
The federal self-referral law, known as the “Stark” law, originated in 1993 when Congress learned that incidents of physical therapy treatments and radiology procedures were higher when a patient’s physician had an ownership interest in the facility where the services were rendered. In short, the law prohibits Medicaid and Medicare payments to a physician if a health service is provided by a facility or entity with which the physician has some type of financial interest or financial relationship. Although the law applies only to ten designated health services, and there are exceptions, the Stark law and regulations need to be considered in every agreement entered into by a provider.
Similar to the Stark law, the federal anti-kickback law prohibits the exchange of anything of value to induce or reward the referral of Medicare and Medicaid business.
Certain transactions are viewed as prima facie evidence of a violation of the Stark and anti-kickback laws. Our knowledgeable attorneys can help you determine whether the Stark and anti-kickback laws affect your business arrangements. Violations of these laws can bring steep penalties. The advice and guidance of healthcare attorneys in this area is invaluable.
Billing & Reimbursement
Medicaid and Medicare billing and reimbursement are complex, and healthcare administrators must handle coding, coverage issues, coordination of benefits, enrollment, audits, appeals, and denials carefully to avoid penalties. The Jolley Law Group healthcare attorneys can skillfully advise you on payment and reimbursement issues, including Medicare Parts A & B transactions, and help ensure that your billing systems keep you in compliance with applicable law.
Licensing & Employment
Licensing and employment matters are another key area of concern for healthcare practitioners. Our attorneys are experienced in handling all aspects of licensing for physicians and healthcare facilities. If you need to dispute an action regarding your licensure or you wish to have a review of all your licensing documentation, we are here to assist you.
Whether you are a medical practice hiring a new doctor or a health professional accepting a new job, an employment agreement is often an important part of the process. An effective employment contract outlines each party’s responsibilities, the salary and benefits, and other requirements that are particular to working in the healthcare industry. For example, physician agreements also usually include covenants not to compete, which can impact your ability to practice after your employment ends. Employment agreements help to prevent employment-related conflicts in the future, but they require careful review by an experienced healthcare attorney. Jolley Law Group’s attorneys review, draft and negotiate employment contracts and can also help you resolve contract disputes.
You can also benefit from using a knowledgeable attorney to handle healthcare transactional matters – including practice purchase agreements, joint ventures, ACO formations, Medicare certification inspections and appeals, and internal and external regulatory audits.
Those who work in the healthcare industry are subject to an almost overwhelming array of laws and regulations, from both federal and state government. Healthcare is our business. Our attorneys continuously monitor trends affecting healthcare laws and regulations affecting the industry, and we are here to help healthcare businesses and practitioners succeed.
Health Information Technology Law
Jolley Law Group Advises Healthcare Providers and Businesses on Information Technology Law.
Information technology continues to grow in importance for businesses, healthcare providers and business associates. While the increased use of IT is expected to reduce healthcare costs and improve quality of patient care, these anticipated benefits bring additional compliance and liability issues with them.
This tension between anticipated cost savings from health information technology and increased compliance and privacy enforcement are present in both the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). HIPAA and HITECH first look to increase the use of electronic medical records for cost savings and efficiencies in healthcare delivery. HITECH offers providers financial incentives for widespread implementation of electronic medical records in the healthcare system. HITECH also strengthens the HIPAA privacy standards, applies the Security Rule directly to Business associates, and contains more stringent privacy compliance and notification measures.
Meaningful Use Incentive Payments
The Medicare and Medicaid Electronic Healthcare Record (EHR) Incentive Programs provide incentive payments to eligible providers that adopt, implement, upgrade or demonstrate meaningful use of certified electronic medical records in a timely manner. On September 4 2012, CMS published a final rule that specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to continue to receive annual incentive payments. All providers must achieve meaningful use under the Stage 1 criteria before moving to Stage 2. The meaningful use criteria are complicated and fluid. The attorneys at Jolley Law Group can help you determine the level of use needed and how to apply to participate in the incentive program.
Technology Service Contracts and Software License Agreements
Whether you are a business seeking to move operations to the cloud via a software as a service (SaaS) contract or a healthcare provider licensing electronic medical record software, you will face complex vendor agreements. Our lawyers know technology agreements and have the experience necessary to help negotiate and draft technology agreements and to advise you on software licensing , e-commerce, cloud computing, IT outsourcing, open source software, internet businesses and privacy compliance. Let our attorneys at Jolley Law Group utilize our knowledge of health information technology law and translate your complex business model into a straightforward legal agreement.
The Attorneys of Jolley Law Group Provide Skillful Advisement on HIPAA Privacy Laws and HIPAA Privacy Compliance.
The Health Insurance Portability and Accountability Act of 1996 and Health Information Technology for Economic and Clinical Health Act (HITECH) implement complex legal requirements for covered entities and their business associates that are designed to protect patient privacy and safeguard patients’ health information. Regulated entities were required to comply with the final HIPAA/HITECH Omnibus Rule by September 23, 2013 by revising their compliance plans and HIPAA privacy documents. Noncompliance with the HIPAA privacy laws has its consequences, including a wide range of both civil and criminal penalties, and fines per violation can be anywhere from $100 to $1,500,000 per violation per year.
Are you HIPAA compliant?
The attorneys at Jolley Law Group are well-versed in HIPAA compliance. We will work with your business to establish or update your policies and procedures, to ensure that consumer privacy is maintained and safeguard personal identifying information (PHI). When you hire our knowledgeable team, we will immediately review your systems and perform a risk analysis.
We can also train your staff on information security and how to avoid a data breach. The rules and regulations pertaining to the delivery of healthcare services are many and complicated. Inadequate knowledge can lead to unnecessary violations of applicable laws and regulations.
In addition, we will help you create privacy compliance manuals and required security risk analysis to ensure that you are both compliant with the HIPAA Privacy and Security Rules and prepared should a HIPAA audit occur. We also assist you in negotiation of business associate agreements.
It is our sole and ongoing goal to keep your business HIPAA compliant at all times. Privacy practices, privacy compliance, data security and audit defense are what we do best. Leave it to our highly skilled legal team to address your HIPAA compliance concerns.
Are you being audited?
With the increased use in technology, consumer information is at risk more than ever before. Statistics on health data breaches show that they are on the rise, affecting hundreds of thousands of consumers each month. The federal government has reacted with implementation of an HIPAA audit program that will become permanent in 2015. Auditing has increased, and it is simply a matter of time before your business faces a CMS or HIPAA audit, if you have not already.
At Jolley Law Group, we represent covered entities and business associates when an HIPAA audit is taking place. We work diligently and thoroughly to address every aspect of your infraction. When a breach occurs, our attorneys will assist you with necessary notification protocols; we are highly knowledgeable about HIPAA privacy laws and experienced at data breach notification and reporting.
Reimbursement Audits & RAC Audits
You’ve Found a Dedicated RAC Audit Lawyer Who Will Help You Handle Every Step of an RAC Audit.
Healthcare providers and home medical equipment suppliers (HMEs) have no choice but to work with Medicare and Medicaid for their business. But what CMS and your state Medicaid agency gives, it can take away. Audits can come at any time, resulting in denied or disputed claims. Unfortunately for the healthcare and HME industry, the volume and scope of these audits has greatly increased…And they are not going away anytime soon, if ever. You need to be prepared to deal with these audits should you find yourself facing CMS, RAC, or Medicaid audit.
Medicare Recovery Auditors work for the CMS (Centers for Medicare & Medicaid Services) as part of the CMS effort to prevent overpayment to providers. The goal is to eliminate abuse of the reimbursement system and ensure that fair/correct amounts are being submitted. And they are utilizing technology to do so. Once you submit an electronic claim for payment, the auditing process is in place—you are at that moment being reviewed or ‘audited’ for those services, which you are asserting – by submitting the claim – that you rendered in accordance with CMS guidelines.
This is an automated claim review but there is also a complex review involving extensive records and often an onsite audit. Recovery Audit Contractors (RACs) have the authority to implement efforts to reclaim incorrect payments (overpayments) on behalf of CMS. Similarly, state Medicaid agencies have in-house auditors and contractors who audit providers in an attempt to find and collect for overpayments.
If you have received a demand letter issued by a RAC, CMS, or Medicaid and would like assistance addressing and refuting the determination of fraud/overpayment, our law firm can help. We are highly skilled and experienced at Audits and Overpayment Appeals. We work with clients who have received a Medicare / Medicaid RAC audit letter, and it is your right to fight for the hard earned reimbursements that you received.
Remember, you have just 15 days to submit your rebuttal request once you receive a demand letter.
Kelly M. Jolley is a seasoned audit defense attorney who knows how to successfully address overpayment issues and adeptly handle your Medicare/Medicaid Appeals case. She offers a decade of experience in healthcare regulatory law, and will explain all of your options. If an appeal is denied, we can file a request for reconsideration. Medicaid Reimbursement Audits are necessarily stressful, but they are not hopeless.
Contact RAC audit lawyer Kelly M. Jolley at Jolley Law Group. We can put your mind at ease.
Labor, Licensing & Regulation
Jolley Law Group is prepared to represent you in either administrative hearings or court proceedings to defend you against any claims that affect your business or profession. These cases fall into a few distinct areas of our legal practice.
Professional and Occupational Licensing
Over forty professions in South Carolina are regulated by the Department of Labor, Licensing and Regulation (LLR) for purposes of licensing, practice standards, and complaints. As a holder of a professional license, you can be subject to disciplinary action if a complaint is filed against you and an LLR investigation ensues. You should have an attorney represent you at this stage to prevent any further harm to your professional reputation or ability to retain your license. Jolley Law Group maintains a focus on licenses for healthcare practitioners, including the standards for obtaining a license and how to respond to complaints. These areas of professional licensing include:
- Medical Examiners
- Chiropractic Examiners
- Massage Therapy
- Occupational Therapy
- Physical Therapy
If you are seeking a license or facing a licensure complaint, the attorneys at Jolley Law Group are prepared to assist you.
Employers are required to compensate their employees in accordance with federal minimum wage standards. Issues often arise around payment of overtime, commissions, and hours, as well as employee leave. If your employee has filed a wage and hour claim with the LLR, we can represent you in evaluating the claim and responding appropriately. Although some unpaid wage claims are valid, there may be facts that were not part of the original employee complaint that can mitigate the claim. These claims should be taken seriously, because an employee also has the option to pursue a court case and can be awarded up to three times the original unpaid wages plus litigation costs under current state laws.
Please contact our labor, licensing and regulation attorneys so that we can guide you through compliance with the full range of state and federal labor and licensing laws that affect your profession or business.