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Can I become a Federally Qualified Health Center?

Federally Qualified Health Centers (“FQHC”) are community-based healthcare providers that receive money for providing primary care services to under-served populations or areas. FQHCs were enacted under Section 1861(aa) of the Social Security Act and was amended by Section 4161 of the Omnibus Budget Reconciliation Act of 1990. FQHCs are required to adhere to certain criteria, including, but not limited to, providing comprehensive healthcare services (either on-site or by arrangement with another provider) on a sliding fee scale based on ability to pay and operating under a governing board that includes patients. These comprehensive services may include: (1) preventive health services; (2)...

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Reinstatement After A Healthcare Entity or Individual is Placed on the OIG and Florida’s Exclusion List

What is the Exclusion List? The Office of Inspector General’s (“OIG”) list of Excluded Individuals and Entities (“LEIE”) provides information to the healthcare industry, patients and the public regarding individuals and entities currently excluded from participation on in Medicare, Medicaid and all other Federal healthcare programs. OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. On May 8, 2013, the OIG released a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, which states that no federal healthcare program payment may be made for items or services furnished by...

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The Truth About the Corporate Practice of Medicine, Optometry, and Dentistry in Florida

Many states place restrictions on how medical doctors, optometrists, and dentists may organize themselves and conduct business within the state. Some states place significant restrictions on these healthcare providers while others are more lenient. Several states have enacted laws that prohibit certain healthcare providers from being employed by or controlled by any corporation or business, which is not entirely owned by other physicians. This is referred to as the prohibition of the “corporate practice of medicine.” Florida is unique in many ways, including its approach to regulating how these healthcare providers can organize themselves. Florida does not place the same...

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Do I need a Business Associate Agreement?

Your healthcare entity may need to enter into a signed Business Associate Agreement with certain vendors and contractors that you have contracted with depending on the type of services that will be provided to your healthcare entity. Failure to produce a signed Business Associate Agreement could lead to fines and/or penalties by the Office for Civil Rights (“OCR”) in connection with potential HIPAA violations.   What is a Business Associate? A business associate is one that creates, receives, maintains or transmits protected health information (“PHI”). Companies that only store encrypted PHI are also considered Business Associates. Subcontractors may also have to sign a...

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Healthcare Provider Marketing and Management Arrangements

Healthcare providers interested in entering into marketing or management arrangements with companies must structure these arrangements in such a way that they don’t violate any federal or Florida healthcare laws. Providers should avoid entering into any marketing and management arrangements, which gives the impression that they offered, paid, or solicited cash, or any other type of remuneration in exchange for referring patients to that provider. Failure to do so may result in an Anti-Kickback violation if the arrangement does not fit squarely within an Ant-Kickback Statute Safe Harbor. Safe harbors that might be available to a healthcare provider, depending on the terms...

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Medicare Audit by Zone Program Integrity Contractor

If you’re reading this article it’s probably because you or your medical office has received a letter from a Zone Program Integrity Contractor (“ZPIC”) for The Centers for Medicare & Medicaid Services (“CMS”) alleging that you may have improperly billed Medicare for the provision Medicare Services to your patients.   What is a ZPIC? There are seven ZPIC zones. It is possible for providers to hear from more than one ZPIC since the seven ZPICs focus on different aspects of the Medicare program. ZPIC Zone 7 includes Florida, Puerto Rico, and the U.S. Virgin Islands in its geographic scope. The Zone 7 –...

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Healthcare is the Next Cryptocurrency Frontier

What is Cryptocurrency? Cryptocurrency is a virtual currency designed to work as a medium of exchange. It uses cryptography to secure and verify transactions as well as to control the creation of new units of a particular cryptocurrency. Essentially, cryptocurrencies are limited entries in a database that no one can change unless specific conditions are fulfilled. Bitcoin is the most popular cryptocurrency on the market but there are well over 1000 other “altcoins” in existence. The value of each cryptocurrency is largely speculative similar to stocks on an index. It has no intrinsic value or legal tender status and is only...

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Does Blockchain Belong in Healthcare?

Healthcare providers have been slow to implement blockchain into their practice. Providers are hesitant due to: (1) unfamiliarity with this technology and how it works; (2) some don’t see its practical application to healthcare; (3) others are employing the wait and see approach to determine if it is financially rewarding; and (4) some are put off by the lack of regulation, which could expose their patient records to cybertheft.   What is Blockchain? In 2009, blockchain stormed on the scene as the foundation for swapping digital currency. Blockchain is a permanent record of online transactions or exchanges that are logged publicly and in...

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Florida Pharmacists Must Use E-FORCSE To Combat Opioid Abuse

By: Saamia Shaikh, Esq., OMS-III In 2011, Florida legislator’s enacted the Prescription Drug Monitoring Program, also known as, the Electronic-Florida Online Reporting of Controlled Substances Evaluation (“E-FORCSE”). The program has legally expanded the role of dispensing pharmacists by requiring them to report the distribution of controlled substances.   E-FORCSE requires dispensers of controlled substances to report, within seven days, information regarding the prescriber and the patient for any prescription filled for controlled substances. Specifically, a patient’s demographic information, DOB, gender, as well as the prescriber’s demographic information, DEA number, NPI number, and license number must be reported. Additionally, dispensing information such as the...

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Negotiating Malpractice Insurance in Physician Employment Contracts

Medical Malpractice Insurance is an essential part of any physician’s practice. According to the American College of Physicians, “Medical Malpractice” insurance is a specialized type of professional liability insurance that covers physician liability arising from disputed services that result in a patient’s injury or death. Injuries may present themselves immediately or at some time in the future. Malpractice insurance requirements will vary depending upon several factors including, but, not limited to how long you have been practicing, the size of your practice, specialty, prior claims filed against you, etc. Many providers receive their malpractice insurance  through their hospital employer while...

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