When Medical Healthcare Meets the Law
“Health is wealth” is a phrase often heard by many, and nowhere is that more true than in a healthcare business. Maintaining optimum business health in the face of an ever changing healthcare legal landscape is a treacherous endeavour providers must retain highly experienced counsel for. When things go wrong, there can be dire consequences. We had the opportunity to speak to the Founder and President of one of South Florida’s leading healthcare law firms, about the healthcare regulatory climate and oft overlooked regulations that providers need to know.
Can you talk LM through the types of legal matters that healthcare services and medical professionals have to deal with on a regular basis?
Sure thing. They tend to be issues and problems with administrative employees, hiring a physician or midlevel provider, making an employed physician a partner and checking into the legality of a proposed business arrangement.
What kinds of disputes can arise for medical professionals, such as negligence cases for example?
Typical disputes often include problems with vendors (IT, electronic health record [EHR], etc.), problems with landlords, problems with employees (noncompetes, etc.) and patient complaints/difficulties.
What can medical professionals do in order to reduce their chances of being involved in such disputes? Are there common regulations often looked over by professionals?
First, selecting experienced counsel. Second, engaging that counsel BEFORE signing any contract. Effective regulatory awareness is nearly impossible for the non-lawyer, because the application of applicable healthcare laws and regulations is nearly always unclear, and those laws and regulations change regularly. Additionally, understanding the laws is not enough. One has to know how they’re being applied by insurers and regulators, which changes over time. Sometimes, following the law isn’t enough. Experienced counsel will ask (1) is this legal, and also (2) does this work? Compliance is nearly always a moving target; the best physicians can often hope for a quick assessment of how risky a proposal is in light of the law at the time and also the environment at the time.
Can you detail some of the healthcare professionals you are often engaged in more than others, in regards to legal matters, and why?
Usually, bigger ticket items and services draw more scrutiny, as do practices that also provide ancillary services to their patients (e.g. PT, clinical lab, diagnostic imaging).
Are there any further legal considerations to make in relation to children healthcare services? What are the commonly the consequences of missing these considerations?
A more modern frustration for physicians is caring for kids in a divorced family who face a non-urgent problem. Physicians will often ask for some proof of which parent has the legal capacity to consent to care.
Do you believe US medical legislation is due reform, and in what area do you think reform would help the healthcare service, or impact its engagements?
Yes. Focus has to be paid more on prevention, outcome and patient compliance. Physicians are routinely expected to perform miracles, but patient compliance is sometimes elusive. And since the state of diseases can be driven by patient choice, effective outcomes have to take into consideration patient “buy-ins” and incentives. Also, with so much cost allocated to emergency situations, more attention has to be brought to effective prevention. Finally, our culture has to consider the role of profit in health insurance. Government based healthcare is regarded as being less expensive and more efficient that many commercially backed insurers. At least with respect to effective preventative healthcare, what’s the most effective care payment platform? I don’t think that’s clear at the moment.
Do you find personal ethics often clashing with legal regulations? How do you overcome this and thus advise your clients in respects to this?
I don’t’ find ethics to be a barrier. I do find the following, however, affects client sensitivity to legal issue spotting: how entrepreneurial minded the physician is, and years in practice.
How do you believe your years of experience qualify you as a Thought Leader in healthcare services?
Because I’ve limited my practice to healthcare law over the past 30 plus years and because I’m fascinated by the industry and the practice of law; I observe not only the changing statutory landscape, but also how the views of regulators and insurers impact it. I see cycles, where others see isolated events. I routinely analyse legal and risk factors across specialty/provider areas. The years and engagement with clients has created a sensitivity to not only know the laws, but also understand them and then be able to assess risk in light of the laws, what I’ve seen work (and not work) and the current state of regulatory and law enforcement views. All of this enables me to function in an often inherently grey area of the law and also have a solid opinion that clients find valuable!
Is there anything else you would like to add?
Yes – there is a seeming unending stream of lawyers who practice outside the area of their core competence. It’s very frustrating and a real problem. The best lawyers I know, recognise what they know and what they don’t know. That seems to be a rare distinction. At the end of the day, the best lawyers answer one question repeatedly: What’s the best way I can help this client?
