Cigna’s Global Compliance Officer Thomas F. O’Neil to Keynote Broad and Cassel’s Orlando Health Care Forum April 21

ORLANDO, Fla. (March 20, 2017) — Establishing and maintaining a culture of compliance is critical to the success of today’s health care organizations. That’s why attorneys from Broad and Cassel’s nationally recognized Health Law Practice Group alongside professionals from some of the nation’s leading health care companies will discuss board compliance oversight at the third annual Broad and Cassel Orlando Health Care Forum April 21.

Headlining the forum is Thomas F. O’Neil, III, global compliance officer at Cigna Corporation. In an armchair chat, O’Neil will sit down with Managing Partner Gabriel Imperato to discuss board responsibility for compliance oversight. O’Neil is a former federal prosecutor who has served as the general counsel of a major telecommunications company, the chair of the government affairs practice of a global law firm, and the executive vice chairman of a national managed care organization.

Following the keynote session, panel discussions will take place addressing board and executive leadership strategies and pitfalls and perspectives on health plan overpayments. Those panels will feature attorneys from Broad and Cassel as well as officers from Advize Health, Cancer Treatment Centers of America, d’Arcambal Ousley & Cuyler Burke, Florida Hospital Medical Group, Pershing Yoakley & Associates, PYA and Withum.

What:               Third Annual Broad and Cassel Orlando Health Forum

There is no cost to attend and registration includes lunch at noon and a reception following the presentations. To register, click here or contact Elizabeth Levine at elevine@broadandcassel.com or 407-839-4229.

When:              Noon-5 p.m.      Friday, April 21

Noon                Registration and lunch

1 p.m.               Presentations begin

4 p.m.               Reception for participants and speakers

Where:             Broad and Cassel, 390 N. Orange Ave., Suite 1400, Orlando, Fla.

Broad and Cassel has built one of the most experienced 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. Several of the firm’s health lawyers are certified by the Health Care Compliance Association in Health Care Compliance and are Certified Dispute Resolvers with the American Health Lawyers Association.

Information on the firm’s health law events and industry and attorney news can be found on Broad and Cassel’s Health Law Blog at http://www.healthlawfla.com/ or on Twitter at http://www.twitter.com/healthlawfla.

Posted in Health Forum, Uncategorized | Tagged , , , , , ,

Broad and Cassel Bolsters Health Care, Bankruptcy Groups with Focus on Insolvency, Adds Two Partners from GrayRobinson

We are pleased to announce Frank P. Terzo and Michael D. Lessne have joined the Fort Lauderdale office as partners, beefing up the firm’s health law and bankruptcy practice groups while creating a new health care insolvency service for the firm.

“With the addition of Frank and Michael comes the ability to offer new expertise in health care insolvency as clients navigate complex waters in today’s ever-changing environment and attempt to better address government and other third-party financial demands,” said Gabriel Imperato, managing partner of the firm’s Fort Lauderdale office. “This is an area of law that is seeing significant growth across the nation, so this transition comes at an especially critical time.”

Frank Terzo joins Broad and Cassel’s Health Law and Bankruptcy & Creditors’ Rights Practice Groups. He previously served as executive partner and chair of GrayRobinson’s bankruptcy practice group. While there, he was involved in a wide range of insolvency matters, including representation of corporate and consumer clients in complex workouts, bankruptcies, assignments for the benefit of creditors and receiverships. He also has substantial experience in both the prosecution and defense of all forms of complex bankruptcy litigation, including preference and fraudulent transfer proceedings and complex contested matters.

“What we are building here is a national health care insolvency practice, and we’re accomplishing that through a merging of minds, if you will,” said Terzo. “In my opinion, Broad and Cassel has one of the top health law practices in the country, and now we will build upon that success offering a specialized area previously unavailable to the firm’s clients. For clients, it’s about protecting themselves, a survival of the fittest of sorts. For the firm, it’s about offering clients a full spectrum of services to meet their needs in what has become a challenging and rapidly evolving health care system.”

Terzo’s previous experience as a chief executive officer coupled with his vast experience in the health care realm will build upon Broad and Cassel’s already strong breadth and depth of experience in health law, as he brings 18 years of experience in the health care industry, successfully starting, managing and operating various public companies prior to entering the legal field. Additionally, he has represented trustees and committees in hospital, nursing home, diagnostic center and HMO matters, and he has been appointed as a Patient Care Ombudsman.

Most recently, Terzo was involved in a large, complex Chapter 11 health care matter in opposition to the Centers for Medicare and Medicaid Services and the Florida Agency for Healthcare Administration that was pending in the U.S. Bankruptcy Court in the Middle District of Florida, Tampa Division. As special health care insolvency counsel for the provider, Terzo has assisted in taking the bankruptcy court’s decision through two levels of appeal up to the 11th Circuit Court of Appeal. The case has received national notoriety as the debtor pursues a petition for Writ of Certiorari to the United States Supreme Court.

Terzo is admitted to practice in Florida; the U.S. District Courts for the Middle, Northern and Southern Districts of Florida; the U.S. District Court for the Western District of Tennessee; and the U.S. Court of Appeals for the 11th Circuit. Additionally, he remains active in various professional and community organizations, including serving on the board of directors for the Boys & Girls Clubs of Broward County; as a past adjunct professor at Nova Southeastern University Shepard Broad College of Law and Florida International University College of Law; on the American Bankruptcy Institute’s Committee on Health Care Insolvency; and as a past director for the Bankruptcy Bar Association of the Southern District of Florida, among others.

He holds a bachelor’s degree from the University of Cincinnati and received his juris doctor from Nova Southeastern University Shepard Broad College of Law.

Michael D. Lessne also joins Broad and Cassel as partner in the Bankruptcy and Creditors’ Rights, Health Law, and Commercial Litigation Practice Groups. A licensed CPA in Florida, Lessne provides counsel to businesses and individuals in a broad array of restructuring and insolvency matters, including to debtors, lenders and other creditors, and fiduciaries in complex business and consumer bankruptcy matters, state court assignments, and out-of-court workouts, as well as in state and federal court proceedings involving complex litigation. Lessne has represented bankruptcy trustees in a variety of matters, including in health care provider cases and in cases involving fraud and Ponzi schemes, Prior to joining the firm, he was a shareholder with GrayRobinson in Fort Lauderdale.

“What’s attractive to me is the ability to offer what is a growing need for clients while expanding an already established and nationally recognized health law practice,” said Lessne. “The reputation of the firm and its attorneys really speaks for itself.”

Lessne is admitted to practice in Florida; the U.S. District Courts for the Middle, Northern and Southern Districts of Florida; the U.S. Court of Appeals for the 11th Circuit; and the U.S. Supreme Court. He holds bachelor’s and master’s degrees in accounting from the University of Florida and received his juris doctor from the University of Miami School of Law.

A rising star both professionally and civically, Lessne serves as the Broward director for the Bankruptcy Bar Association for the Southern District of Florida; as an advisory board member for Keiser University’s Legal Studies program; on the board of directors for Deliver the Dream, a nonprofit organization helping families experiencing a serious illness or crisis; as a member of the steering committee for the Ghost Light Society at the Broward Center for the Performing Arts (and he was just named co-chair of its annual soiree); as a steering committee member for the Historic Stranahan House Museum’s annual Holiday Hangover (new-year kickoff); and as a committee member for the Turquoise Takeover Task Force for the American Lung Association in Broward County. Lessne is a graduate and past curriculum chair of Leadership Fort Lauderdale and is in the current Leadership Broward class.

The addition of Terzo and Lessne rounds out a string of announcements tied to Broad and Cassel’s growth in South Florida and the state in recent weeks. The firm recently announced the lateral hiring of Partner Gary M. Freedman in the Bankruptcy and Creditors’ Rights and Commercial Litigation practice groups. In Orlando, James Lovegren joined as of counsel in the Real Estate Practice Group.

Posted in Practice News | Tagged , ,

2017 Legislative Session Preview

By: McKenzie A. Livingston

The first two months of 2017 have seen quite a bit of activity in health law in Florida.

In February, the Eleventh U.S. Circuit Court of Appeals struck down a Florida law, known as the Gun Gag Law, which barred doctors from discussing guns with patients. Under the Gun Gag Law, which was blocked from taking effect shortly after it was passed, doctors could face fines of up to $10,000 and the possibility of losing their medical license for discussing gun ownership with patients. The Court found that the Gun Gag Law violates doctors’ First Amendment rights.  Governor Scott’s office is reviewing the Court’s decision and deciding whether to appeal to the U.S. Supreme Court.

With Florida’s legislative session commencing March 7th, a flurry of bills related to healthcare have been filed, debated and circulated in the State Capitol.

Legislators have proposed eliminating (HB 7), or at a minimum creating exemptions to (SB 676), the Certificate of Need (CON) regulatory process for hospitals, nursing homes, and hospice facilities.  The CON process requires hospitals, nursing homes and hospice facilities to obtain approval from the Agency for Health Care Administration (AHCA) before building new facilities or expanding.  AHCA determines whether there is a need in the community for the healthcare facility before permitting new facilities to be built or existing facilities to expand.  Proponents claim that eliminating, or allowing exemptions from, the CON process will increase competition, drive down the cost of health care and create jobs.  Opponents claim it will result in a glut of beds, create staffing shortages and negatively impact the quality of care provided to patients.

There is also discussion (HB 154) of revising Florida law governing ambulatory surgical centers, which currently bars overnight stays, to permit patients to remain at the centers for up to 24 hours.  The bill also introduces a new entity called a recovery care center, where patients could stay up to 72 hours after surgery.

Lawmakers are also discussing proposals (HB 161 and SB 240) to permit the use of direct primary care agreements between doctors and patients.  Direct primary care agreements typically involve patients or their employers making monthly payments to physicians or other health providers to cover routine primary-care services.  The bills would carve out such agreements from the purview of state insurance laws.

State legislators in both the Senate (SB 900) and House (PCB HHS 17-01) have also submitted proposals which would provide state workers with four levels of insurance options, wherein state workers could choose less coverage in their health insurance benefits and pocket some of the savings.  Proponents of the bill claim it provides state workers a variety of health insurance options.  Opponents voiced concern that individuals may be enticed to select less coverage in order to obtain the savings payments.

Two bills have been introduced to structure the implementation of Amendment 2, approved by last November, which legalizes medical marijuana for individuals with specific debilitating diseases or comparable debilitating conditions as determined by a licensed state physician.  Under existing law, medical marijuana businesses must function at every aspect of the process from growing to processing to dispensing. In order to open a dispensary, one must own a nursery.  One bill (SB 406) is built upon this pre-existing framework of licensing vertically integrated businesses, though it does permit a very gradual increase in the number of medical marijuana treatment centers permitted in the State.  The other bill (SB 614) seeks to completely revamp the way legalized medical marijuana is regulated.  It eliminates the cap on the number of medical marijuana treatment centers that are permitted to exist in the State.  It also does away with the vertically structured licensing by permitting companies to be licensed in four distinct areas – growing, processing, transporting or dispensing.  At least one additional bill is expected to be introduced by Florida’s House of Representatives.

 

 

Posted in McKenzie Livingston, Regulatory | Tagged , , , , , , , , , , , , , ,

Medical Cannabis – Myth, medicine, or malpractice?

By: Paul R. DeMuro, PhD and Dr. Jose Valdes, PharmD, BCPP

Medical cannabis or cannabinoids (or medical marijuana as some like to call it) is now a reality in Florida.  Although it can only be recommended for certain maladies and obtained in certain ways, those logistics do not necessarily affect some of the safety and key legal considerations of which those in the healthcare industry should be aware.

There are gaps in knowledge about cannabis, its efficacy , long term side effects, dosing, and optimal administration routes in part, because of the paucity of research in these areas.  Cannabis is still an FDA Schedule I drug, and thus not legal from a federal perspective which places unnecessary strain on researchers trying to determine the therapeutic value of cannabis.  Additionally, some clinicians may be wary of prescribing it because of potential federal ramifications.  Thus, a patient’s ability to locate a clinician who will recommend cannabis might be difficult even though there are nearly 400 clinicians who have completed the required continuing education course to be able to recommend its use.  As clinicians must weigh the therapeutic effects against the potential adverse health effects, generally they do not have the same type of guidance as with other prescription drugs.  How can clinicians be assured that the quantity, quality and type of cannabinoid products are consistently what they say they are?

Except in a few states, the dispensing of cannabis does not have to involve a pharmacist in the process. Thus, the same assurances of pharmacist oversight which might be available for other prescription drugs might not be assured. Complicating the lack of pharmacist intervention is the fact that there does not appear to be a consensus for safe and appropriate doses for various illnesses in clinical studies, or conclusive evidence that cannabinoids are even effective for some conditions. Furthermore, the lack of pharmacist involvement in the dispensing of cannabis places the responsibility of reviewing the patient’s medication profile and medical history for potential complications, interactions, and adverse effects solely on the clinician. This removes an important second check that pharmacists are equipped to provide, and gives the clinician less assurance of safe and appropriate utilization of cannabis by their patients

Many practitioners will be concerned about the potential professional liability consequences.  The traditional standards of the duty of care and breach of that duty should apply, but how will they be applied?   A physician patient relationship undoubtedly will be created, but how will the standard of care be determined, and the breach of that duty determined?  The latter can be a particularly thorny issue where cannabis use might cause addiction and/or respiratory problems, if inhaled. Additionally authorizing clinicians to recommend cannabis will not absolve them from rendering competent and informed medical care. Clinicians must remember that they may be recommending a non-FDA approved product that a large majority of their professional colleagues or medical associations do not fully support which may expose them to malpractice. This is especially so for clinicians who recommend its use for unproven, discredited, or unsubstantiated purposes.

For some specific symptoms, such as spasticity (seen in multiple sclerosis and amyotrophic lateral sclerosis), increased intraocular pressure (seen in glaucoma), pain and appetite stimulation (in cancer and HIV/AIDS respectively), cannabis is generally considered to be helpful. Could cannabis help wean someone off of opioids? Could it be ordered in place of opioids?  Can it improve the quality of care and be more cost-effective than alternative treatments, resulting in the potential for greater use in the context of Accountable Care Organizations (ACOs) and other models which are value-based purchasing in nature? All are possible, and require further research to conclude on these points. However for other specific indications such as epilepsy, post-traumatic stress disorder, Crohn’s disease, and Parkinson’s disease the jury is still out.

Many challenges and barriers are likely to be encountered as medical cannabis moves forward in Florida.  Will the research be truly evidence based medicine, given the challenges research faces because of cannabis being a Schedule I drug?  Will such research be supported and will it be standardized in some form?  Will the cannabis used in medical research be the same that is available to be ordered for patients? While we may be only at the tip of the iceberg in discovering what and how cannabis may be useful for and in what forms, there is still much to be learned. Until then, keeping abreast of the legal and medical data as it is published, is paramount.

 

Posted in Malpractice, Paul DeMuro | Tagged , , , , , , , , ,

Save the Date!

Broad and Cassel’s Third Annual Orlando Health Care Forum is scheduled for Friday, April 21. Please join us to explore “Compliance from the Top: Board Responsibility for Compliance Oversight.” Stay tuned for more details.

Click here to register.

Posted in Uncategorized

Legalize Marijuana: Don’t Count Your Chickens Before They Hatch

By Stephen H. Siegel

In the aftermath of the elections, last November, proponents of legalizing marijuana scored a number of victories. For them, the goal of legalizing marijuana nationwide seems closer than ever. However, the elections have released counter-forces that may seriously upset their vision of the future of marijuana in the United States.

Background
In August 2013, the Department of Justice issued guidance to states indicating that this agency intended to devote fewer resources to investigating and prosecuting individuals who distribute and consume marijuana in a manner that is consistent with state law. Later, the so-called “Hinchey-Rohrabacher Medical Marijuana Amendment” to the Consolidated Appropriations Act of 2016, prohibited the expenditure of federal funds to prosecute individuals whose marijuana-related activities are permitted under the relevant state law (an analogous amendment is included in the proposed 2017 Consolidated Appropriations Act). There also have been signs that the federal government is considering reclassifying marijuana from a Schedule 1 to a Schedule 2 drug.

To continue reading on South Florida Hospital News, please click here.

Posted in Reform, Stephen Siegel | Tagged , , , , , , ,

Fraud and Abuse Enforcement; Go Back to the Fundamentals

By Stephen H. Siegel

The great basketball player Michael Jordon observed:

The minute you get away from fundamentals-whether it is proper technique, work ethic or mental preparation- the bottom can fall out of your game, your schoolwork, your job, or whatever you are doing.

In federal fiscal year 2016, the Department of Justice recovered $4.7 billion as the result of judgments and settlements under the Civil False Claims Act (“FCA”, the so-called “Whistleblower” statute). Over half of this amount, $2.5 billion, was collected from defendants involved in the healthcare industry. Paying attention to “fundamental” issues, such as coverage requirements, accurately billing for items and services rendered, and avoiding referral arrangements that implicate the Federal Kickback Prohibition or Self-Referral Restriction are fundamental aspects of doing business in this industry. However, as the issues, examples and lessons forgotten/ignored discussed below illustrate, there seems to be a significant gap between what should be and what certain healthcare providers and professionals actually are doing.

Please click here to continue reading this article.

Posted in Fraud/Abuse, Stephen Siegel | Tagged , , , , , , , , ,

Broad and Cassel Honored as a 2017 Top Law Firm: Guide honors 18 firm attorneys

Statewide law firm Broad and Cassel today announced South Florida Legal Guide has named the firm a 2017 Top Law Firm. Sixteen firm attorneys were also recognized as 2017 Top Lawyers and two as 2017 Top Up and Comers. Peers nominated the attorneys, including all four South Florida managing partners, for inclusion on the list.

To view the list, please click here.

 

Posted in Honors and Awards, Practice News | Tagged , , , , , ,

Providers Attesting to Their Compliance With Meaningful Use Need to Ensure That They Truly Protected Their Electronic Health Information

By Gabriel Imperato and Paul R. DeMuro

Providers are starting to get notices from the government that they have not met the Meaningful Use requirement with respect to protecting electronic health information. They have attested that they have and thus, stated that they have conducted and reviewed a security risk analysis implementing security updates as need to meet this Meaningful Use Core Measure, but have they? Having attested to doing so, if they do not meet the requirement, the government has taken the position that such providers have improperly sought and received government monies, which results in false claims liability.

Eligible Professionals (EP) must conduct or review a security analysis of their certified EHR technology (CEHRT), including addressing encryption/security of data, and implement updates as necessary at least once prior to the end of the EHR reporting period. A new review has to occur for each reporting period. If EPs have attested to this conductand review, and have not properly done so, they may be subject to recoupment of payments for Meaningful Use and a reimbursement adjustment, depending upon their particular situation.

To continue reading, please visit South Florida Hospital News and Healthcare Report

Posted in Compliance, Gabriel Imperato, Paul DeMuro | Tagged , , , , , , , , ,

Stephen H. Siegel Quoted in Miami Today Article

Please see the article below from the Miami Today published on December 1, 2016 and written by Susan Danseyar.

People of all ages should think about long-term care, says Greater Miami Chamber of Commerce Health Care Chair Stephen Siegel, whether for their grandparents, parents, employees or even themselves.

“This topic is not unlike wills,” he said Tuesday in reference to “The Long Term Care Dilemma: Which Way to Go?” which the chamber will present from 9 a.m. to 11 a.m. Dec. 8 at the University of Miami. “No one wants to write their own, but we all have to do it.”

The same principle applies to long-term care, Mr. Siegel told Miami Today. “If you haven’t been forced to do so already, start thinking about what it will be like for your family or even you,” he said. “This presentation and panel discussion is about issues all of us – if we’re lucky- are eventually going to face.”

The chamber’s health committee strives to provide information and assistance not only to people in South Florida healthcare industry but even more to the area’s wider business community, Mr. Siegel said. “We try very hard to anticipate the business community’s needs and how it must interact with the health-care industry.”

Last year, he said, the committee presented a program on the “sandwich generation” that cares for children at the same time it takes care of aging parents. Those people need assistance as do their employers, he said.

The keynote presentation Dec. 8 will address the prevalence of caregiving and its impact on the family, given by Dolores M. Perdomo, assistant professor at the University of Miami’s Miller School of Medicine in the department of psychiatry and behavioral sciences on aging. Her address will be followed by a panel on a range of options for long term care and the differences as well as appropriate uses and of skilled nursing, home health, assisted-living facilities and non-medical social services.

Panelists include Edilia Alzugaray, medical director of Florida PACE Centers Inc. at Miami Jewish Health System; Rona S. Bartelstone, a social worker and consultant for Our Aging LLC; Laly Joseph, a vet who made a career change to nursing, a consultant with Plaza Health, and assistant professor at the UM School of Nursing & Health Studies, and Dr. Perdomo. The panel will be moderated by Christopher Dudley, who is the principal and CEO of Advancement Associates.

Mr. Siegel said years ago, when he first worked in the healthcare industry as an attorney, the only option for long-term care was nursing homes. From the mid- to late- 1980s, however, the concept of long-term care has evolved in response to both changes in technology and individual’s desire for greater independence, staying in their homes and the least institutionalized environment possible.

He encourages this presentation for employers so they’ll know how to help their employees with this very confusing topic that one often needs help navigating.

The help businesses can provide to their employees, Mr. Siegel said, can range from something as simple as offering flexible work schedules to offering long-term health care insurance benefits.

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