Fresh off celebrating its 35th anniversary, Fitzpatrick Lentz & Bubba is starting the new year by continuing its focus on the future. FLB announced the following leadership changes for 2024:
● Executive Committee member Colin J. Keefe will assume the role of Deputy Managing Shareholder alongside Managing Shareholder Erich Schock. Colin will focus on the firm’s financial initiatives. Colin is a member of the firm’s Mergers & Acquisitions (M&A) group and handles a significant number of these transactions for FLB’s clients. He is handing over the chair of that group as he assumes this new role.
● Stepping into the role of Chair of the M&A Group is Shareholder Kenneth R. Charette. A long-time member of the M&A team, Ken routinely assists entrepreneurs, start-ups, privately held businesses and capital partners with a variety of complex business and investment transactions, including notably in the Food & Beverage sector, a practice group he also chairs.
● Peter E. Iorio is now Chair of the Estate Planning & Administration team. His practice focuses on estate planning, administration of estates and trusts, taxation, beneficiary representation and business succession planning. With the recent acquisition of Fries Law Office, that group has increased in size, and Pete is looking forward to continuing to grow this practice area.
“As we look to the next 35 years of FLB, it’s a positive to see the next generation of leaders carrying our longstanding legacy forward,” says Managing Partner Erich J. Schock. “Just as the Firm’s founders and my generation at FLB have been a part of the growth of the Firm and the Lehigh Valley’s success, we all are confident that FLB has the talent to continue delivering exceptional representation to our clients for decades to come.”
Congratulations to Colin, Ken and Pete as they take on these new roles!
Other Fraud and Abuse Regulations for the Healthcare Industry
In addition to Stark Law, medical providers are governed by other legal statutes to help prevent fraud and abuse. Common ones include:
- Anti-Kickback Statute (AKS) – beyond medical referrals, the AKS prohibits the knowing and willful payment of “remuneration” to induce or reward the generation of business for any item or service payable by any federal healthcare programs, not just Medicare/Medicaid. AKS governs relationships like those with pharmaceutical companies, medical supply and device manufacturers, and other healthcare services, with remuneration broadly covering compensation, including anything of value, such as exorbitant hotel stays and meals, entertainment, and excessive compensation for medical consulting. SAFE HARBOR REGULATIONS identify nearly 20 allowable relationships and exclusions. Additionally, PENNSYLVANIA’S AKS WAS AMENDED IN 2023 to allow for a more integrated approach to healthcare delivery for Medical Assistance program providers.
- False Claims Act – with both civil and criminal penalties, the False Claims Act outlaws the knowing, ignorant, and reckless submission of Medicare or Medicaid payment claims that are false or fraudulent – the intent is not relevant. Doing so may result in fines of up to three times the programs’ loss plus $11,000 per claim filed, with each instance of an item or a service billed to Medicare or Medicaid counting as a claim, i.e., fines can be very costly. Whistleblowers, be they current or ex-business partners, medical facility staff, patients, or even competitors, may file a civil lawsuit on behalf of the United States, entitling them to a percentage of any recoveries. Criminal penalties for False Claims Act violations include imprisonment and criminal fines.
- Health Care Quality Improvement Act – healthcare providers must hold physicians to quality care standards and provide professional peer review processes and standards to help eliminate incompetent physician care, restrict deficient or poorly performing physicians from moving practices (especially between states) without disclosure or discovery of past issues through documenting adverse actions in a national practitioner database, and to provide hospitals and physicians immunity in lawsuits, with protections for both the facilities and physicians who participate in the review process in good faith.
- Patient Protection and Affordable Care Act (PPACA)/HIPAA – individuals’ health information is of the utmost importance, and medical providers must be sure to protect medical records, payment information and treatment records while making pertinent information accessible when necessary for further treatment, public health purposes, or to appropriate entities. Patients must be provided privacy rights to understand and control how their health information is used. Civil and criminal penalties apply for violations for knowingly disclosing or obtaining protected data.
The healthcare industry faces an ever-changing regulatory climate that impacts the licensure and operations of medical facilities and care providers. Failure to comply with regulations can result in heavy fines, loss of licensure, loss of ability to participate in federal health programs, and even imprisonment.
In an effort to remain compliant with Stark Law and other fraud and abuse statutes noted above, healthcare organizations should consider:
- Proper governance – under the guidance of a chief compliance officer (CCO), experienced clinical professionals, and an interdisciplinary committee, medical providers can make compliance part of their culture and ensure it’s part of all integral operations, with a regular review and audit process.
- Policies and procedures – employee handbooks and code of conduct can reinforce the importance of compliance and cast a shared vision.
- Training – robust onboarding and ongoing educational programs can help ensure staff, especially those in high-risk areas, have a deep understanding of federal statutes and legal updates.
- Performance programs – measure and communicate compliance efforts and key metrics to help staff understand opportunities for improvement; consider creating performance incentives.
Legal guidance for Stark Law compliance
Physicians commit to doing no harm, and medical providers must also commit to compliance with their referrals, billing, coding, and more. Medical providers are positioning themselves for compliance success by following the abovementioned measures. However, medical professionals are human, and mistakes happen. Additionally, with the increasing number of healthcare mergers and acquisitions, facilities need to pay due diligence to uncover and resolve any possible Stark Law or other regulatory violations with a possible acquisition and ensure compliance going forward.
If your medical facility suspects compliance issues or is facing a possible claim, FLB’s Healthcare attorneys are well-versed in Stark Law and Anti-Kickback Statute, HIPAA, medical staff and physician relationships, patient safety, accreditation standards, Medicare and Medicaid, ready to counsel our clients on a wide range of matters to improve patient safety and satisfaction and meet regulatory requirement, while avoiding costly litigation. Contact us today to discuss your unique challenge