As Georgia schools and other businesses respond to open and operate safely in the face of the COVID-19 Pandemic, many are posting warning signs consistent with a new law in the state passed to protect them from liability.https://www.healthcarelaw-blog.com/files/2020/09/ewscripps.brightspotcdn.com_-300x169.jpg

Georgia-based Business and Healthcare Law Firm

This summer, Georgia joined many other states in passing a law to protect businesses including healthcare facilities and workers from liability from lawsuits brought by individuals or their survivors related to infections from or exposure to COVID-19 in visiting the premises of or obtaining healthcare services or personal protective equipment from those facilities, entities or individuals.  Senate Bill 359, signed by the Governor on August 5, 2020 provides that no healthcare facility or provider, entity or individual shall be liable for damages in an action involving a “COVID-19 liability claim” unless the claimant proves the actions of the healthcare facility, entity or individual resulted from gross negligence, willful and wanton misconduct, reckless or intentional infliction of harm.

On March 27, 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2 trillion relief act to provide financial support for individuals, businesses and CARES-ACT-close-scaled-e1585882477755-300x195government organizations that experienced revenue losses from COVID-19. The purpose of the Act is to offer financial relief and to establish telehealth benefits for patients needing non-COVID-19 services. Section A of the Act authorizes programs for relief and contains information about mandatory spending provisions, while section B contains provisions regarding discretionary and emergency appropriations. Over the next few weeks, this blog will discuss recent changes to the CARES Act, and the impact that those modifications are having on hospitals and physician practices. This post provides a brief overview of the CARES Act, as well as the attestation process that providers must follow upon receiving funds.

The Provider Relief Fund

The federal government partnered with United Health Group to disburse funds to providers from the Center for Medicare & Medicaid Services (CMS), through the Provider Relief Fund (the “Fund”). This $175 billion fund provides monetary relief for hospitals and healthcare providers on the front lines of the coronavirus response in the form of grants. The grants may be used for necessary expenditures due to the COVID-19 public health emergency and other expenses related to the Coronavirus that were not already part of an approved state or government budget.

About 20% of United States tax dollars are spent on heathcare.  Naturally, reducing improper payments has been a priority of CMS. Thus, all medical practice managers and healthcare providers should be aware of CMS’s process of contracting with Uniform Program Integrity Contractors (UPIC’s), private entities hired by CMS Health-Audit-300x200to audit providers suspected of fraud. UPIC contracts combine Zone Program Integrity Contractors (ZPIC’s) and Medicaid Integrity Contractors (MIC’s) to coordinate Medicare and Medicaid auditing. UPIC’s focus primarily on Medicare claims, and seek to distinguish between provider billing errors or fraud.

UPIC Audit Lawyers

Our business and healthcare law firm follows legal trends in the healthcare industry.  UPIC’s are private sector organizations that review Medicare claims in order to assist the government in recovering overpayments to healthcare providers.  UPIC audits are often generated through data analysis or by review of consumer complaints and most often target specific healthcare providers. UPIC’s conduct screening, medical reviews, and investigations, while also implementing remedies and collaborating with state and local governments to ensure compliance with payment guidelines. UPIC’s are organized regionally, with Georgia and South Carolina falling in District 4 and managed by Safeguard Services.  In recent years, home health agencies, DME companies, therapy clinics, and laboratories have been targets for fraud investigations through extensive audits.

Telemedicine has new and profound importance due to the COVID-19 crisis.  “Virtual” healthcare preserves patient protective equipment that would otherwiimage_4-e1587393250939se be used and allows physicians to manage chronic illnesses remotely, without the in-person interaction that exposes provider and patient to the risk of spread. This increased reliance on telemedicine has prompted state and federal legislative bodies to pass new rules and guidelines to promote access to telehealth services by reducing costs, increasing availability, and promoting relationships between healthcare providers and their patients.   Our Georgia-based business and healthcare law firm follows regulatory developments that impact healthcare providers.  As of the date of this post, seven states (Arizona, Florida, Kansas, Maine, New Jersey, Oregon, and Utah) have waived restrictions on telehealth. More relaxation of telehealth rules may be expected.

 New Regulations: an Overview

Virtual medicine is expected to aid in slowing the spread of coronavirus by limiting contact between individuals.  New telemedicine regulations encourage video and audio conversations between providers and their patients.  Telemedicine platforms can serve a variety of functions, some assist with managing patient triage, while others provide alerts to providers and patients in regard to medication management.  Other platforms allow for effective monitoring of chronic illnesses for patients, even with the strict social distancing guidelines that are currently in place. Thus, as part of an effort to allow healthcare providers to better support each other and their patients, the federal government has reduced the regulatory hoops that have previously limited access to Telehealth services. The CMS Fact Sheet discusses in depth the changes that have been made to provide virtual services.

As patients, naturally we intend to go to the doctor to get well.  But there is a catch 22.  What if the trip to the doctor or the emergency room to be made well might cause us to get sick, or more sick? Or what if we make the doctor sick, impairing his ability to care for other patients?  Such risks have always existed to a degree, but nothing like today, during the Coronavirus pandemic.

Georgia-based Telemedicine Lawyers

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The extraordinary, unprecedented COVID-19 pandemic and staggering fallout has cast new and very bright light on telemedicine and its potential efficacies in providing safe health care.  Above all, telehealth benefits include ability to provide healthcare without no risk of COVID spread, a serious health risk for both patient and healthcare practitioner to avoid that will necessarily attend both commuting and in-person interaction.  Telemedicine offers another way to “go to” the doctor and for the doctor to render care, free of the risk of virus spread.  Apart from all other advantages and conveniences of telemedicine, the paramount importance of health and safety (of both healthcare practitioner and patient) have never been underscored so forcefully.

AOA WebinarOn April 6, 2020, Lee Hamil Little co-presented with Brian Tuttle, Navigating HIPPAA and Telemedicine during COVID19.

The United States Office for Civil Rights (OCR) has issued new COVID-19 guidance on various aspects of its jurisdiction under both HIPAA and the federal civil rights laws.  Many of these changes were directly relating to telemedicine and relaxing some of the HIPAA Security and Privacy regulations.  However, this DOES NOT mean we can just use any technology we want to, there are still guidelines.  This in-depth 60-minute webinar discussed the do’s and don’ts relating to telemedicine during this national emergency caused by COVID19.

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Business interruption insurance is especially important for small businesses and companies that rely on physical locations to carry out day-to-day activities associated with their organizations.  Our business and healthcare law firm represents medical practices and other businesses with regard to insurance coverage disputes.  Filing a business interruption claim can be the best way to recover income loss and damages that occur as a result of a reduction or cessation of business operations. As the COVID-19 pandemic, continues to create disruption and financial uncertainty for business owners, insurance companies’ reluctance to cover interruption claims has initiated state responses to protect businesses from losses stemming from closures, seizure of ordinary business operations, and supply chain interruption.

Georgia-based Insurance Coverage and Business Litigation Attorneys

A March 6 article in the Wall Street Journal reported that U.S. insurance companies already have rejected claims submitted for coverage of business interruption related to the Coronavirus.

dzqzy3qjSfnax53La6eDlRo2g7UAsYjdm_L0J6lb7vPPAK3pA4rMqaOcyx8OdzUcX8UIBYdQ3211KJxM1BFbD6Fw74BjciPgCtbHbWWeplYZH3t1OI8S-v8b1qbgKGUaGavSJ15sT-3JA0kq_Kr1qG0caH5RCAs0-d-e1-ft-1We salute all of our clients and friends who are healthcare providers on the front lines of COVID-19 pandemic for their commitment and steady hand during these perilous days of uncertainty. All of us are better and safer because of you.  Above all, we wish good health and safety for all healthcare providers. We appreciate the trust and confidence that our clients place in us. As we all work through this difficult time together, we reiterate our commitment to helping all healthcare providers.

The Coronavirus pandemic has created a fluid situation that may trigger unpredictable legal issues and risks for all medical practices, hospitals, other healthcare delivery businesses, and healthcare professionals, including:

  • Business interruption insurance coverage disputes where a medical practice’s lost revenue potentially triggers coverage.

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In a landmark federal False Claims Act case closely watched for many years by hospice administrators, other healthcare providers and legal experts, last week the Department of Justice (DOJ) entered a joint dismissal in settlement of the case against AseraCare Inc., a national hospice provider company.  The settlement marks an effective win for the defendants, in that the government agreed to accept repayment of $1 million, reduced from its initial demand of more than $200 million. https://www.businesswire.com/news/home/20200227005767/en/

Georgia-based Healthcare Reimbursement and Compliance Attorneys

Allegations in the case were brought initially between 2008 – 2010 by several former employees of AseraCare and the Department of Justice, alleging that AseraCare had submitted false claims to Medicare for patients who were arguably not terminally ill, and thus ineligible for hospice benefits, placing pressure on employees to enroll more patients using questionable recruitment practices – including targeting near-death patients so that length of stay numbers were kept low.

1221952_to_sign_a_contract_3As a business and healthcare litigation firm focused exclusively on advising and representing health care providers, we work virtually every day with contracts that involve non-compete agreements and other forms of restrictive covenants.  Almost all physician employment, for example, will involve a physician employment agreement that contains a restrictive covenant.  Typically, a restrictive covenant will apply to prohibit certain competitive activities both during the employment and for some agreed period following employment, often one to three years.  The details of such agreements can vary dramatically and, contrary to the impressions of many medical practice owners and employed physicians, there are not “standard” provisions for duration, geographic scope, etc.  Further, Georgia and South Carolina case law and relevant statutory provisions are subject to interpretation, about which reasonable minds can often differ.

As a healthcare law firm, we are exposed to agreements on the transactional end, when the parties get married (i.e., when they sign the contract), and when they divorce (i.e., when the employment ends).  If a non-compete issue is raised at the end of the relationship, the implications for employer and employee can be severe and, in unfortunate cases, devolve into litigation.  For a highly compensated physician, whose ability to ply his/her trade following many years of education and training is suddenly impaired by the signed contract, whether to proceed with certain employment opportunities (that might violate a non-compete agreement) can make for a highly stressful decision-making process.  Some factors that physicians may consider follow.

Should you determine if the non-compete agreement is enforceable?

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