Tag: HIPAA

Regulatory Compliance for Medical Practices

Health care is a highly regulated industry. It is crucial that all medical practices are in full compliance with applicable federal and state regulations. Any violation could lead to significant problems—potentially even financial sanctions.

Lynnette Ariathurai is an experienced business lawyer for medical practitioners. Attorney Ariathurai helps all types of medical practice with regulatory issues. To set up a confidential consultation with an experienced business attorney, please contact our Fremont law office today.

An Overview of Federal and State Regulations for Medical Practices in California

 Moscone-Knox Professional Corporation Act

California has specific rules and regulations in place regarding the formation and ownership of medical practices. Medical practices must be structured as professional corporations (PCs) under the Moscone-Knox Professional Corporation Act. If you have any specific questions about forming or structuring a medical practice in California, an experienced business attorney for doctors, nurses, and medical personnel can help.

Anti-Kickback Laws

There are federal and state laws in place prohibiting “kickbacks” for medical referrals. The federal Anti-Kickback Statute (AKS) and the California Anti-Kickback Statute largely prohibit the offer of anything of value in exchange for a referral for a patient who participates in a federal or state health program.

Stark Law

Also known as the physician self-referral law, the Stark Law is a federal statute that bars physicians from referring patients that receive service paid by Medicare, Medicaid, or another federal health program to an entity with which the physician or their family member has a financial relationship. There are some limited exceptions to the law.

Regulations against Billing Fraud

Both California and the federal government have strict rules and regulations in place for billing fraud. Notably, the Office of Inspector General (OIG) can bring civil charges for health billing fraud even if the conduct is deemed to be accidental. Medical practices need to understand billing regulations, including the California state prohibition on “surprise medical bills.”

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) requires medical practices to strictly protect the confidentiality of sensitive patient information. It is imperative that all medical practices operating in California have a well-developed system in place for protecting the privacy of patient records.

Sharing Office Space

It is not uncommon for medical practices—especially smaller medical practices—to share office space. Such an arrangement can be advantageous for all parties involved. Though, in doing so, medical practices must ensure that their conduct is consistent with their lease. A violation of the lease for improper share could lead to problems. Medical practices also need to ensure that patient records are protected as required by HIPAA. In 2019, the Centers for Medicare and Medicaid Services (CMS) released draft guidelines on medical practice share space arrangement. A key principle is that each medical practice should keep its business clearly separate and that proper disclosures should be made to patients.

Get Help from a California Business Lawyer for Medical Practices

Lynnette Ariathurai is a Bay Area business law attorney committed to providing forward-looking legal advice and cost-effective solutions for medical practices in Fremont CA, near Newark, or Hayward, East Bay, Milpitas, Union City, San Leandro, Gilroy, San Jose, or Santa Clara. If you have any questions about regulatory compliance for medical practices, please contact our Fremont office for a strictly confidential consultation. 

health billing regulations, health care regulations, HIPAA, medical practice regulations, structuring a medical practice

Three Things You Must Know When Starting a Home Health Agency

business lawyer

Home health agencies have revolutionized elder care options, permitting many older adults to live in their own homes longer than before. These agencies are responsible for placing health care professionals – registered nurses, nursing assistants, physical therapists, or home care aides – in the patient’s home to provide primary care, medical treatment, and assist with day-to-day living activities so that the patient may remain in his or her home.

If you are interested in starting your own health care agency, you will need to master the following three topics to successfully grow your business and meet market demands:

  1. Regulations that apply to home health agencies
  2. The importance of providing employee training, and
  3. The labor laws that apply to the home health care industry.

Know the Regulations That Apply to Home Health Agencies

The federal government and the state of California heavily regulate the home health agency field. There are different laws that apply when hiring a home health care worker directly than when hiring a health care worker through an agency. Additionally, you must have a license to operate a home health agency before you start operating your business.

Copying information from another home health agency to create your compliance documents may not be sufficient. The information may not apply in California, may be outdated, or may never have been correct. It is important to consult with a business lawyer who is knowledgeable about the legal needs of a home health agency and can help you comply with all legal requirements, including record keeping, on-going legal requirements, and compliance with HIPAA.

One of the costliest problems is that if the home health agency collects Medicare, their rules regarding what protocol must be followed and required documentation must be kept in compliance.  Medicare performs audits routinely and then charges back the agency many thousands of dollars if records are not in compliance.

Develop and Train Your Team of Employees

It is important for your employees to be fully trained to perform their tasks and to understand what documents need completing and maintaining when providing care for an individual in his or her home. You must provide training that demonstrates how to properly complete these documents and why their inclusion in the patient’s care plan is necessary. Other topics that you should cover in training include HIPAA compliance and labor law compliance.

Know Applicable Labor Laws

Owners of home health agencies must know the labor laws that apply to their workforce. Your payroll department must understand when to pay overtime, the rest and meal break laws, the difference between independent contractors and employees, and what labor records to keep.

If you are an entrepreneur planning to start a home health agency or already running one in the East Bay Area including the communities of Fremont, Hayward, Union City, Milpitas, or Newark, California, seek legal advice and counsel of a business lawyer today.

Business Startup, HIPAA, home health agency, labor laws

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