Jamie Gelfman Named to Health Law Executive Council, Selected for Leadership Broward

Fort Lauderdale, Fla (July 9, 2018)- Broad and Cassel LLP, which will combine with Nelson Mullins on Aug. 1, today announced Fort Lauderdale Associate Jamie Gelfman has been voted on to the Florida Bar Health Law Section Executive Council.

Gelfman currently serves as the editor-in-chief of Health Law Updates for The Florida Bar. In her new role with the Executive Council, she will join approximately 20 other leaders in the field in governing the 1,100-member section as it seeks to help improve and develop the field of health Law.

Additionally, Gelfman has been selected as a participant in Leadership Broward Class XXXVII. Leadership Broward offers programs that help emerging and recognized leaders expand their skills and enhance their knowledge of local and state issues, as well as leverage their individual passion to make positive changes in the community.

Certified in Health Care Compliance (CHC) by the Health Care Compliance Association (HCCA), Gelfman practices in the arenas of administrative and regulatory law serving as a member of the Health Law Practice Group. Gelman’s regulatory practice includes advising health care providers on compliance and fraud and abuse matters under federal and state laws, including Medicaid and Medicare regulations, anti-kickback, physician self-referral laws and HIPAA.

Broad and Cassel has built one of the most experiences and diversified Health Law Groups in the Southeastern United States. The firm has more lawyers certified in Health Law by the Florida Bar Board of Legal Specialization & Education than any other firm. Many of the firm’s health lawyers are certified by the Health Care Compliance Association in Heath Care Compliance and are Certified Dispute Resolvers with the American Health Lawyers Association.

Posted in Honors and Awards, Jamie Gelfman, Uncategorized | Tagged , , ,

Frank Rainer Hosts Online Seminar on Direct Primary Care

Senior Counsel Frank Rainer recently hosted an online seminar for more than 100 health care professionals to discuss the impact of the Florida Legislature’s recent adoption of The Direct Primary Care Bill.

With the recent changes, providers will be able to charge patients a flat fee per month for a bundle of services, with simple contracts and minimum to no regulations.

The seminar explored the recent changes and its applications in practice. Specifically, the hour-long online event addressed:

  • What change in the law caused this unique business opportunity
  • Statistics and information about how this payment model has been working in Texas, Michigan, Washington and 10 other states
  • The tax benefits of coupling your plan with a Health Savings Account

A PDF of the presentation slides can be accessed here.

Rainer is a member of Broad and Cassel LLP’s Health Law Practice Group and has more than 33 years of experience in both transactional and litigation matters with a primary focus in the health care, general business and real estate industries.

Posted in Frank Rainer, Practice News, Uncategorized | Tagged , , ,

Department of Justice Raises Penalties for False Claim and Anti-Kickback Violations

By: Timothy S. Wombles

On January 29, 2018, the United States Department of Justice (“DOJ”) increased the per-claim range of civil monetary penalties under the federal False Claims Act (31 U.S.C. § 3729 et seq.) (“FCA”) in accordance with a statutory requirement issued under the Bipartisan Budget Act of 2015, Public Law 114–74. Simultaneously, the DOJ increased the per-claim civil monetary penalties for federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b et seq.) (“AKS”) violations.

Section 701 of the Bipartisan Budget Act of 2015, entitled the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, revised federal requirements for civil monetary penalties by federal agencies. Section 701 of the Balanced Budget Act of 2015 required federal agencies to adjust civil monetary penalties each year on January 15 to account for inflation during the preceding year. The new formula for calculating inflation adjustments to civil monetary penalties drastically increased civil monetary penalties during the first adjustment period in 2016. Prior to this first adjustment in 2016, the civil monetary penalties for AKS and FCA violations remained unchanged since 1996, when they were revised pursuant to the Debt Collection Improvement Act of 1996. In 1996, the per-claim civil monetary penalty for FCA violations was increased to $5,500 to $11,000 per claim and for AKS violations to $11,000 per claim. 64 Fed. Reg. 47099, 47,104 (Aug. 30, 1999).

Civil monetary penalties assessed after January 29, 2018 for AKS violations occurring after November 2, 2015 are now are $22,363 per claim, up from $21,916 per claim. 83 Fed. Reg. 3944, 3945 (Jan. 29, 2018).

Civil monetary penalties assessed after January 29, 2018 for FCA violations occurring after November 2, 2015, now range between $11,181 to $22,363 per claim, up from $10,957 to $21,916 per claim. Id. In addition to the civil monetary penalties, defendants still are subject to damages calculated at treble the amount paid by a governmental program for FCA violations.

Posted in Timothy Wombles, Uncategorized | Tagged , , , ,

Mike Bittman, co-chair of Broad and Cassel’s Healthcare Practice Group, weighs in on the Amazon, JPMorgan, Berkshire healthcare partnership for Becker’s Hospital Review

The following article, written by Laura Dyrda, was published by Becker’s Hospital CFO Report.

When Amazon, JPMorgan Chase & Co. and Berkshire Hathaway launched their partnership in the healthcare space, they left more questions than answers about their new venture. The announcement shared few details on how the companies would partner, but ultimately shared the goal of providing high-quality, lower-cost healthcare to employees and their families.

All three companies are disruptors in their industries, but have little experience in healthcare. Here, 35 executives from across the healthcare industry share their reaction to the announcement and predictions for the future.

Note: Responses have been edited for length and clarity.

Question: What does this partnership mean for the healthcare industry?

Chuck Stokes. President and CEO of Memorial Hermann (Houston): “Today’s announcement is precisely why health systems across the country, including Memorial Hermann, have been innovating from within. Our industry has a lot to learn from these three powerhouse institutions that have transformed their consumer experiences. Through their expertise, I firmly believe that our industry will accelerate the journey to become more affordable and convenient for everyone. Here in Houston, we understand the healthcare needs of our community better than anyone else and have launched several groundbreaking solutions to make healthcare more affordable and accessible to our neighbors.”

Damian Becker. Manager of Public Relations at South Nassau Communities Hospital (Oceanside, N.Y.): “Their venture into the healthcare industry means one thing to me: disruption, with a singular focus on growth from the get-go. Accounting for the core strengths, roster of services and market share dominance of each organization and how they will innovate collaboratively, it is imperative as a healthcare organization to conceptualize and anticipate what they will bring to market as not just a national entity, but also a global entity that will either compete directly with or complement the services that your organization provides and/or specializes in. For example, health and medical care services delivered to the patients/customers wherever they are and whenever they need it, whether at the home or on the road or at work, through digital, delivery, informational and direct care services, at a lower cost and simplified payment model.”

John Driscoll. CEO of CareCentrix (Hartford, Conn.): “Anyone with a high-cost, high-margin healthcare business should be scared. But healthcare is complicated, and I believe the most effective path for this dream team of disruptors is to share their goal — to provide better care at a lower cost to patients — with industry incumbents. Bending the cost curve and improving outcomes is going to require a team effort.”

Michael Bittman. Partner at Broad and Cassel (Orlando, Fla.): “All industries are being disrupted to some extent by the new digital economy. It appears as if this will be one of the best-funded efforts to disrupt the traditional employer-sponsored health plan model. That said, it’s important to remember you can’t deliver healthcare without hospitals and physicians. The new model may involve groups of employers contracting directly with healthcare providers to decrease cost and enhance quality.

“What Amazon, JPMorgan and Berkshire Hathaway have presented could be a new national model. With their combined resources, technology and foresight, they could reduce reliance on insurers and avoid some of the related costs. It could show a new way for employers to provide good, affordable coverage, and increase wages with the savings.”

Please click here to continue reading “What the Amazon, JPMorgan, Berkshire partnership means for healthcare: 35 executives respond” from Becker’s Hospital CFO Report.

Posted in Mike Bittman

Florida Federal Judge Vacates $347 million False Claims Act Judgment against Nursing Home Operator

By: Timothy S. Wombles

On January 11, 2018, a federal judge in Tampa, Florida vacated a $347 million False Claims Act judgment against a skilled nursing facility operator and its related entities.

In United States ex. rel. Ruckh v. CMC II LLC et al., relator Angela Ruckh convinced a jury that CMC II LLC and its affiliated entities (collectively, the “Defendants”) committed certain paperwork violations, such as the failure to maintain comprehensive care plans, amounting to a material and knowing misrepresentation in the claims submitted to the government. After the jury found the Defendants liable for approximately $115 million in false claims, U.S. District Judge Steven D. Merryday trebled the damages to $347,864,285 pursuant to the False Claims Act. The Defendants moved to stay execution on the judgment, requested a new trial, and requested the court vacate the verdict.

Just under a year later, on January 11, 2018, Judge Merryday, relying on the U.S. Supreme Court’s decision in Universal Health Services v. Escobar, granted the Defendants’ renewed motion for judgment as a matter of law and conditionally granted their motion for a new trial, vacating the $347,864,285 judgment against the Defendants.

Judge Merryday recognized that “the False Claims Act requires the relator to prove both that the non-compliance was material to the government’s payment decision and that the defendant [knew] at the moment the defendant sought payment that the non-compliance was material to the government’s payment decision.” Further, Judge Merryday stated that “[a]t an irreducible and necessary minimum, the ‘essentially punitive’ False Claims Act requires proof that a vendor committed some non-compliance that resulted in a material deviation in the value received and requires proof that the deviation would materially and adversely affect the buyer’s willingness to pay.”

Judge Merryday acknowledged that Ms. Ruckh’s burden was to show that the government did not know about the recordkeeping violations and would have refused to pay the defendants’ claims if it was aware of the violations. Judge Merryday found that the government continued to pay the Defendants’ claims, despite its knowledge of their recordkeeping deficiencies. Judge Merryday relied on Escobar for the proposition that a government’s reimbursement of a facility’s claims after fraud allegations emerge is “very strong evidence” that the allegations were not material to the government. Since the record failed to include evidence that the recordkeeping deficiencies were material to the government, Judge Merryday found that the judgment could not stand and vacated the judgment.

Posted in Timothy Wombles, Uncategorized | Tagged , , ,

Do Not Forget to Review These Items in the New Year

By: Stephen H. Siegel

With the holidays behind us, the world should become a more orderly place. In fact, that frequently is not the case. In addition to remembering to use 2018 as the correct year for checks, etc., every new year seems to be the point in time to start new diets, new exercise plans, and other well-intentioned resolutions. The start of the year is also an excellent time for medical practices and other healthcare businesses to either review or make plans to review a number of important matters. Here are a few of the issues that merit review, either early in the year or at a later pre-determined time.

Licensure and Certification
Even if the time for renewing professional or business licenses, permits, or certifications is not early in the year, now is the time to add these items to your calendar to be done at a later date. DO NOT rely on receiving and timely acting once the notice for renewal is received from the Board of Medicine, Secretary of State, or another licensing or accrediting organization, like the Medicare program. If those licenses and permits are not timely renewed, the business will be harmed with little opportunity or relief, especially inexpensive relief.

Business Organization
Typically, a healthcare business is organized as a professional corporation, limited liability company, or partnership in order to take advantage of certain federal tax benefits available to these entities. In any case, it is prudent to review the businesses’ articles of incorporation/organization, operating agreement/bylaws, etc., at least annually in order to ensure that they accurately reflect both what the owners want and what the business is doing.

Please visit South Florida Hospital News and Healthcare Report to continue reading. 

Posted in Care Delivery, Stephen Siegel | Tagged , , , , , , , , , ,

Former Federal Prosecutor Benton Curtis Named Partner at Broad and Cassel

MIAMI (Jan. 2, 2018) — Statewide law firm Broad and Cassel LLP today announced Benton Curtis has been named a partner in the firm’s Miami office, effective Jan. 1.

A former federal prosecutor for 10 years, Curtis focuses his practice on white collar criminal and civil matters and complex civil litigation, government investigations and compliance counseling, with an emphasis in the health care industry. He is a member of the firm’s Health Law and White Collar Defense and Compliance practice groups.

“Since joining the firm just over two years ago, Ben has proven himself as a rising star in the profession and firm,” said Gabriel Imperato, a managing partner and co-chair of the firm’s White Collar Defense and Compliance department. “He has become an integral part of the firm’s white collar practice, and we look forward to his continued success in this new role.”

To continue reading, please click here.

 

Posted in Benton Curtis | Tagged ,

December 2017 NLRB Changes Direction

Please click here to learn more about the December 2017 NLRB Memorandum and recent changes.

Posted in Regulatory | Tagged , , ,

Uncertainty is Creating Fear, and Private Equity Claims to be the Savior

The following article, written by Heather S. Miller, was published by the Palm Beach County Medical Society.

The Affordable Care Act (ACA) and passage of the Medicare Access and CHIP Reauthorization Act (MACRA) and its primary vehicle, the Merit-Based Incentive System (MIPS), have been transformative influences in the health care sector. Despite attempts to repeal and replace the ACA, the sentiment underlying MACRA – the transition from volume to value-based payments – is here to stay. Many small practices seem reluctant to take MACRA seriously, despite the fact that it puts yet another significant percentage of a provider’s Medicare reimbursements at risk. Large practices, understanding the uncertainties of complex payment reforms requiring advanced technology and business savviness to remain competitive, are responding by merging with other groups, joining hospital systems, or selling their practices to private equity investors. This niche is well-suited for private equity firms, as they feed on uncertainty.

Please click here to continue reading on Page 20 of the Palm Beach County Medical Society’s “On Call” Newsletter.

Posted in Heather Miller | Tagged , , , , ,

Taking Florida into the Future with Telemedicine

The following article, written by Kristina G. Maranges, was published by the Florida Bar Health Law Section Winter 2017 Newsletter.

On October 31, 2017, the Telehealth Advisory Council issued its recommendations to Florida Governor, Rick Scott, and the Florida Legislature on how to increase the use and accessibility of services provided via telehealth. The report comes on the heels of a state and national shortage of healthcare practitioners to serve our country’s growing and aging population. Echoing HHS’s designation of telehealth as a means or method  of delivering healthcare, not a type of healthcare service, and noting Florida regulations include multiple definitions of “telemedicine” but no definition of “telehealth” and these terms are commonly used interchangeably, the Council recommended a definition of “telehealth” to replace all existing definitions. “Telehealth is defined as the mode of providing health care and public health services through synchronous and asynchronous information and communication technology by a Florida licensed health care practitioner, within the scope of his or her practice, who is located at a site other than the site where a recipient (patient or licensed health care practitioner) is located.”

Recognizing the lack of adequate insurance coverage and reimbursement for healthcare services as barriers to the delivery and growth of telehealth services, the Council next recommended the Florida legislature require both coverage and reimbursement parity, excluding Medicare plans. Specifically, insurance policies must provide coverage for health care services delivered via telehealth if coverage is available for the same service provided in-person without the imposition of any additional conditions for coverage of services by the insurer,, and payment rates must be the equivalent to rates for comparable in-person services. Regarding Medicaid, the Council recommended the Agency (1) modify its telehealth fee-for-service rule to include coverage of store-and-forward (transmission of recorded health history like X-rays and photos through a secure electronic communications system to a practitioner who uses the information to evaluate the case or render a service outside of a real-time or live interaction) and remote patient monitoring (personal health and medical data collection from an individual in one location via electronic communications technologies, which is transmitted to a provider in a different location for use in care and related support) modalities; and (2) develop a model that would allow Medicaid Managed Care plans to utilize telehealth in order to meet network adequacy.

Posted in Kristina Maranges, Technology | Tagged , , , , ,