Healthcare compliance is a complicated process involving strict standards from state and federal levels of government. Any violation of these standards, or laws may result in severe consequences. Violations often lead to lawsuits, loss of licenses, or huge fines. Thus, it’s important to understand state and federal compliance regulations and laws.
Healthcare organizations and professionals must adhere to healthcare regulations to ensure patient safety. For example, all hospital instruments must be sterilized before surgery. Without that regulation many people would die of infection. The federal government establishes “Standards of Practice” which dictate how surgical instruments must be sterilized. The Standards are extensive and must be followed to protect the patient. Of course, this is only one small example of regulations hospitals must follow.
This page provides examples of key healthcare laws and regulations throughout the State of Florida. It’s important to note, this information provides general knowledge; however, this general knowledge is not a substitute for professional legal advice. If you have legal questions/concerns related to healthcare law in Florida you should consult with an experienced Florida healthcare attorney.
Anti-Kickback Statute Compliance
Florida’s Anti-Kickback laws affect physicians, dentists, pharmacies, pharmacists, nursing homes and hospitals. Simply put, people and organizations involved in the healthcare industry may not pay someone to find new clients, or accept monies for referring patients. This does not mean that a doctor may not send a patient to a specialist for treatment. However, no medical professional, or organization may receive a monetary reward for referring a patient.
Numerous statutes exist under Florida law regarding Anti-Kickback laws. Each statute is very specific and requires an attorney’s interpretation. Non-compliance of Florida’s Anti-Kickback laws may be a felony. If convicted, a person faces imprisonment, fines, or loss of license. It’s important to note that Anti-Kickback Law is also a federal law and involves criminal charges. So, a person may receive criminal and civil penalties if convicted of Anti-Kickback non-compliance.
Stark Law involves fraud and abuse related to Medicare, Medicaid, and any federally funded related program. Under this statute the federal government forbids physicians from referring patients to any facility or medical professional they have a financial relationship with that receives federal funds. Violators will be held civilly (not criminally) responsible for breaking this law. Even if a doctor unknowingly makes a referral they may be charged. In other words, intent is not necessary for a conviction. So, it’s important to seek legal advice if you are charged with violating this statute.
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996. Since that time a patient’s medical information has been protected. In other words, you must give written approval for your doctor to bill your insurance company and to share your medical information with anyone.
There are some exceptions to HIPAA. For example, if a patient comes to an emergency room with a communicable disease that could threaten the population, proper authorities must be notified. Likewise, a victim of suspected child abuse requires law enforcement notification. So, there are times when HIPAA does not apply.
Health care professionals must be careful to follow strict confidentiality practices regarding patients. This includes social media posts and discussing patients inside/outside the work environment. Office workers must also protect patients’ privacy. The minimum criminal penalty for willful violation of HIPAA Rules is $50,000. The maximum criminal penalty is $250,000. An individual may also serve jail time for disclosing private information. Of course, civil fines may be less; so, it’s important to seek legal advice if you are charged with a HIPAA violation.
Department of Health (DOH) Compliance And Investigations
The medical profession has numerous federal and state rules and regulations. All organizations and professionals must be in compliance with federal and state laws. At the federal level the Office of Inspector General (OIG) provides resources to assist medical professionals in navigating federal healthcare compliance regulations. The federal government mandates that any organization that receives Medicare dollars must have a compliance program in place. In other words, medical facilities require an effective compliance department to ensure federal laws are being followed.
In addition to federal compliance laws, Florida has numerous state compliance laws and healthcare regulations. In Florida, the Compliance Management Unit (CMU) oversees 22 boards and 6 councils. These groups supervise six different types of medical facilities and forty different healthcare professions. Professional licensing is handled by the Department of Health’s Division of Medical Quality Assurance. Due to the complexities of compliance law and the extensive bureaucracy at the federal and state level, legal issues may occur if a person, or institution is found to be noncompliant in health related matters.
Compliance regulations are extremely important in a hospital setting. Hospitals are visited by an independent accreditation team on a regular basis. This team is called the “Joint Commission.” The purpose of the Joint Commission is to ensure the hospital is following state, federal, and independent standards. Another possible compliance issue arises if staff does not meet state licensing requirements. Safety standards must be maintained in every medical facility. Any institution not following safety regulations is noncompliant. Finally, failure to monitor Stark Law, fraud, and Kick-backs could present future problems for any medical organization or medical professional. So, if you or your organization is concerned about understanding compliance regulations contact an attorney that understands these laws.
Healthcare organizations must also follow the same laws non-healthcare companies do. For example, the Occupational Safety and Health Administration (OSHA) and the Equal Employment Opportunity Commission (EEOC) are two groups that establish safety and hiring practices hospitals and medical professionals must follow. So, it’s important to understand all applicable business laws and consult an attorney if you feel your organization has broken any safety and/or hiring rules.
Healthcare Compliance Attorney
Attorneys are not only necessary for trials and litigation. In fact, healthcare has its own specialized legal practice area. Di Pietro Partners is a premier healthcare law firm in Fort Lauderdale, Florida. The legal team at Di Pietro Partners is dedicated to helping physicians, medical providers, and businesses involved in the healthcare industry. This includes assisting with healthcare compliance, selling/purchasing medical practices, setting up new practices, establishing legal contracts, medical licensing, and more.