Health care is governed by binding rules that apply to governments, doctors, hospitals, patients, and civil society. These rules are healthcare ethics and stem from the Hippocratic oath to “not harm.”
Medical practitioners face ethical concerns daily. Two examples are striking a balance between quality care and costs and fighting for patient access.
False Claims Act
False Claims Act investigations and litigation—from the disruptive to the existential—pose significant legal, financial, and reputational risks for healthcare providers. Our team marshals the expertise of attorneys with vast and varied FCA experience to help clients defend against allegations, avoid government intervention or defeat claims outright.
A healthcare provider’s activities may be subject to the FCA if they knowingly present or cause to be presented a false claim for payment to the United States or a government contractor, including Medicare and Medicaid. This comprehensive statute has been the basis for several high-profile qui tam actions against healthcare providers.
For example, the 2022 year saw one of the highest volumes of FCA settlements and judgments in history involving healthcare fraud allegations. One of the most common examples of FCA claims is when healthcare providers submit false information to the federal government, including offering fraudulent billing codes or creating false documents supporting a claim. To violate the FCA, the false statement must be submitted knowingly. The Supreme Court’s decision in Allison Engine clarifies that a defendant must intend to mislead to be liable. Still, reckless disregard or deliberate ignorance of the truth can also trigger liability.
Physicians who commit the most severe healthcare fraud offenses face criminal penalties, fines, and exclusion from Federal healthcare programs. Other violations of the FCA, like the Anti-Kickback Statute (AKS), may lead to civil monetary penalties of up to $11,000 for each false claim submitted.
Data Protection
Healthcare organizations, whether hospitals or private medical practices have a lot of sensitive information that needs to be kept secure. This is not only important for a company’s financial health but also crucial to patient safety. If patients believe that a healthcare organization is not keeping their data safe, they will be less likely to trust it in the future and may even avoid using the facility for their medical needs.
To protect their patients, medical facilities must ensure that they comply with all the strict laws and regulations around healthcare data privacy. Failure to comply can result in fines that can significantly impact the organization’s bottom line and cause a loss of customer trust.
Healthcare attorney has extensive experience helping our life sciences and healthcare clients navigate these complex issues. The dedicated team of lawyers can provide strategic and business counsel on various healthcare matters.
Attorneys have handled multiple cases involving mergers and acquisitions of hospitals and healthcare companies; structuring accountable care organizations, physician-hospital alignment arrangements, and joint ventures between medical practices, hospital systems, and ambulatory surgical centers; revenue enhancement and compensation structures; certificates of need; and compliance programs. They have also helped many clients with a mission-critical NDIS audit and various investigations of potential False Claims Act, Anti-Kickback, Stark Law, or other fraud and abuse violations.
Telemedicine
In a world of rapidly changing technologies, healthcare practitioners are working to keep up. This includes telemedicine, which allows doctors to provide services when distance, time, or health risks make in-person visits difficult.
Medical practitioners use telemedicine to conduct diagnoses, consult with specialists not located in the same place as patients, and help manage medication or treatment regimens. The telemedicine industry is booming, with many states and private insurers now offering coverage for telemedicine visits.
The committee focused its efforts on assessing telemedicine applications in the United States but recognized that there were also several important initiatives taking place in other countries. Evaluations of telemedicine applications can be informed by a wide range of existing evaluation research concepts and methods, including those developed in different fields such as education and welfare policy.
The legal team has extensive experience representing clients in all aspects of the telemedicine industry. They have counseled medical practices, ambulatory surgical centers, and other providers on structure and governance matters; physician referral rules; certificates of need; HIPAA and privacy issues; and compliance programs. They have also advised on mergers, acquisitions, software agreements, and joint ventures. Additionally, they have helped clients develop strategic business opportunities by incorporating behavioral healthcare into physical health. They have also advised on various regulatory, insurance, and reimbursement issues.
Malpractice
Physicians, hospitals, and other healthcare providers face various industry-specific legal challenges. They are also subject to the broader corporate, tax, employment, and regulatory issues that affect all businesses in the United States. Malpractice is a term that describes the failure of a healthcare worker to provide the level of care expected of someone in their profession. To be liable for malpractice, the person must have a duty to the patient and breach that duty by failing to exercise reasonable professional care under the circumstances. The failure must cause injury or death, and the injured party must suffer damages. In some cases, medical malpractice claims are brought against hospital and clinic employers under the theory of vicarious liability for the on-duty actions of their employees.
Some doctors are concerned that malpractice lawsuits and pretrial settlements contribute to the significant expenditure of national wealth on U.S. healthcare, partly because of defensive medicine practices by physicians to avoid litigation. Several reform proposals have been advanced to reduce costs, expedite the resolution of negligence claims, and prevent opportunistic and frivolous malpractice claims.
Attorneys counsel hospitals, physician groups, insurance companies, and other healthcare providers on the various industry-specific legal issues they face. We advise them on broader business, financial, and regulatory matters that impact the industry overall.
