At Weaver Johnston & Nelson, we take pride in assisting physicians, hospitals and other medical providers with the daily operational and regulatory requirements that these providers have to comply with. We know the healthcare industry is an ever-changing and expanding area that requires medical providers to be constantly up-to-date on the latest changes and reforms that occur. That is why we make sure to give our clients the timeliest, most current advice we can. With a diverse background of experience between our attorneys, our firm has the expertise to effectively serve our clients.
We routinely assist our clients in matters ranging from the transactional to the litigious. We believe that, because the healthcare industry is so quick to evolve, it is essential to provide personalized, exceptional service to Texas medical providers.
Weaver Johnston & Nelson, PLLC has extensive experience advising health care providers on various issues, including matters implicating the following:
- The Federal Anti-Kickback Statute
- The Physician Self-Referral Law/Stark Law
- The Texas Illegal Remuneration Statute (a/k/a the Texas Anti-Kickback Statute)
- The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)
- The False Claims Act
- The Emergency Medical Treatment and Active labor Act (“EMTALA”)
- The Patient Protection and Affordable Care Act
We have particular experience in the following areas of health care:
- Hospital Operations and Regulatory Compliance
- Physician-Owned Hospitals
- Free Standing Emergency Departments
- Pharmacy Law
- Medicare Enrollment, Changes of Ownership, Changes of Information
- Hospital/Physician Alignment Strategies
- Bundled Payments and Narrow Networks
- Clinically Integrated Networks
- Joint Ventures and Business Affiliations
- Private Offerings
- Mergers and Acquisitions
- Hospital Administration
- Management of Physician Groups and Independent Physician Associations
- Accountable Care Organizations
- Corporate Practice of Medicine Compliance
- Hospital Operations (general acute care, psychiatric and rehabilitation)
- Licensing, Certification and Accreditation
- Reimbursement and Payor Audits
- Corporate Compliance Programs
- Compliance with Fraud and Abuse Laws, and Physician Self-Referral Laws
- Population Health
- Post-Acute Providers (nursing facilities, assisting living, home health, hospices)
- Durable Medical Equipment Providers
- Management Service Organizations (MSOs)
- Dental Offices and Dental Support Organizations (DSOs)
- Clinical Trials Companies
- Digital Health Providers (telehealth)
- Franchise Retail Healthcare Providers
Areas of Focus
HIPAA: One of our largest focuses at the firm is HIPAA compliance. With technology advancing at an astounding rate, it is easy for medical providers to fall vulnerable to breaches of patient information. We make it a priority to ensure that providers are well equipped to protect patient health information and properly prepare for any situation that may occur. To bolster this goal, we provide thorough HIPAA training to our clients that covers everything from what counts as PHI to how breaches are enforced and investigated. It is critical for medical providers to have stringent compliance programs in place so they can serve their patients effectively and keep their most private information safe.
The Federal Anti-Kickback Statute: The Federal Anti-Kickback Statute is one of the most important statutes in the healthcare industry. It prohibits the exchange of remuneration, or anything of value, in return for referring an individual or providing items or services for which payment may be made under a Federal health care program-mainly Medicare. The penalties are very stiff for medical providers who violate this statute; violators can be fined up to $25,000.00 and excluded from the Medicare and Medicaid programs, as well as face up to five years in prison if on criminal charges. Medical providers have to tread very carefully when conducting business around this statute, and we make sure to advise our clients on the best ways to comply with the statute.
The Physician Self-Referral Act: The Physician Self-Referral Act, part of the Stark Laws, prohibits physicians from making referrals of “designated health services” to an entity with which the physician has a financial relationship. This is another statute in which medical providers must comply. Much like the Anti-Kickback Statute, there are stiff penalties for violating this act. Violators may be fined up to $100,000.00 for each arrangement or scheme. If a person knows about an arrangement that violates the Physician Self-Referral Act and does not report it, they can be subject to a penalty of $10,000.00 for each day a report is required to have been made. We work hard to ensure our clients’ business arrangements are not in violation and have particular experience in ensuring compliance with this act.
The Texas Illegal Remuneration Act: Similar to the Federal Anti-Kickback Statute, the Texas Illegal Remuneration Act prohibits a person from paying or agreeing to accept remuneration for referring patients. Penalties for violators include a civil penalty of up to $10,000.00 for each day and act of violation, and they could face disciplinary action from the agency that issued their license or certification. In addition, since we are a Texas law firm, all of our team members have an extensive knowledge of this act and take pride in competently advising medical providers on issues that arise from this act.
The False Claims Act: Any person who knowingly presents a false or fraudulent claim to the U.S. government for payment is liable for penalties up to $10,000, plus three times the amount of damages sustained by the government because of that claim. Because of the heavy penalties involved, it is imperative that medical providers understand what constitutes a violation of this act and what the ramifications of such a violation are. We have a great wealth of knowledge and background on this act and work tirelessly to assist our clients in education and matters implicating this act.
Medicare Enrollment: We have extensive experience in assisting our clients with updating and changing their information in regards to their Medicare enrollment. Whether we use physical forms or the PECOS system, we always ensure that we have the information updated in an accurate and timely manner.
EMTALA: EMTALA, or the Emergency Medical Treatment and Labor Act, is crucial for hospitals to adhere to in their daily operations. Hospitals must provide appropriate evaluation and stabilization for individuals admitted to the emergency room before they are transferred to another facility. If hospitals or providers violate EMTALA, it could lead to fines up to $50,000 for each violation. The government takes both EMTALA and any violations of it very seriously, and hospitals have an obligation to comply with this act if they wish to avoid those fines.
Patient Protection and Affordable Care Act: The Patient Protection and Affordable Care Act has gone through a turbulent year thus far. Like the healthcare field itself, it has been subject to revision, constant change and even outright deletion. We make sure to keep our clients updated on the latest changes to this important act and make sure that the team is fully aware and keeping tabs on any new developments that come along.
Regulatory Compliance and Operations: We have a broad range of experience in helping our clients become and stay compliant in the wake of the numerous regulations and statutes that govern the healthcare industry. We know how difficult it is to keep track of all of these regulations, so it is always a priority to keep our clients aware of their compliance and any outstanding issues.
Mergers and Acquisitions: In addition to our health compliance experience, we also have corporate experience in mergers and acquisitions.
Hospital Administration and Operations: Hospitals make up a significant portion of our clientele, and so we have a deep understanding and knowledge of hospital administration and operations.
Licensing, Certification and Accreditation: We have advised providers on licensing and other issues on a variety of occasions.
Litigation: We have particular litigation experience in reimbursement matters, bad faith cases, health-care related collection cases, and disputes with payors.
Audit Responses: We understand that audits can be intimidating for our clients, so we ensure our responses to audits are timely, professional and thorough.
Corporate Compliance Programs: The penalties for being noncompliant in the healthcare industry are severe, so we work to create robust compliance programs that allow organizations to comply with the strict industry regulations and to train their employees to effectively recognize and deal with any compliance issues that arise.
Reimbursement and Payor Audits: We are well versed in reimbursement and payor audits and have extensive experience in assisting clients in responding to these types of audits.
Pharmacy Law: In working with pharmacies, we have developed an extensive working knowledge in the laws that govern pharmacy operations. It is critical that pharmacies have experienced counsel on hand to ensure they stay within the boundaries of those rules, and we are proud to assist our clients with all aspects of pharmacy law.
Accountable Care Organizations (ACOs): Accountable Care Organizations, or ACOs, are groups of health care providers, including doctors, hospitals, and health plans that join together to provide coordinated, quality care to patient populations.