Little Health Law Blog

3 Key Provisions of the Management Services Agreement (MSA) for CPOM-Conscious MSO Arrangements

January 17, 2024 | Little Health Law

nurses-and-docs-e1681928313827 Our healthcare and business law firm often represents medical practices, including primary care practices, specialty practices, and med spas, in the initial set up phase of their practice. Whether a Management Services Organization (“MSO”) is necessary or advisable for your practice usually requires a detailed review of your business structure and state laws. If an MSO is advisable for your practice based on the Corporate Practice of Medicine (“CPOM”) doctrine in your state, this post provides 3 key provisions that should be within your Management Services Agreement (“MSA”). If you have medical practice set up or MSO questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

As discussed in previous blog posts, including 2 Facts About Management Services Organizations (MSOs) and Med Spas, Management Services Organizations can be useful in CPOM states to provide all non-medical functions of the business while contracting with the Physician Entity to provide all medical functions. The MSA that outlines this agreement is typically a lengthy and involved document, but here are three key provisions that should be contained within the agreement: Continue reading ›

2 Facts About Management Services Organizations (MSOs) and Med Spas

January 5, 2024 | Little Health Law

HealthcareImage_062618-700x525-1-e1682709849274 Our healthcare and business law firm often represents medical practices, including primary care practices, specialty practices, med spas, and IV hydration clinics, in the initial set up phase of the business. Related to questions about the Corporate Practice of Medicine (“CPOM”), a common question we are asked is: “Do I need an MSO”? This is not always an easy question to answer. There are many reasons why an MSO may be a useful tool for your practice. For instance, it may reduce the risk of violating your state’s CPOM doctrine, it may increase regulatory compliance, or it may assist you in exit planning. This post specifically focuses on how MSOs may be useful in the context of the CPOM doctrine. If you have medical practice set up or CPOM/MSO questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Two facts about MSOs and Med Spas:

Fact 1: Most med spas and IV hydration clinics offer services defined as the practice of medicine and, thus if there’s a CPOM doctrine in your state, it’s likely triggered.

If you own a med spa or IV hydration clinic, I can almost guarantee you are offering services that are considered the practice of medicine. Continue reading ›

3 Initial Questions to Determine if the Corporate Practice of Medicine (CPOM) Doctrine is Relevant to Your Medical Practice

December 29, 2023 | Little Health Law

nurses-and-docs-e1681928313827 Our healthcare and business law firm often represents medical practices, including primary care practices, specialty practices, and med spas, in the initial set up phase of their practice. A main question we are asked is: What’s the Corporate Practice of Medicine (CPOMs) Doctrine and does it mean I have to have an MSO? This is not always an easy question to answer. The CPOM doctrine essentially encapsulates the following sentiment: We don’t want non-physicians, including corporations, practicing medicine so non-physicians cannot own medical practices. There is quite a bit of nuance to add to that explanation, but that’s the main idea behind the doctrine. This post provides 3 initial questions to consider relating to the CPOM doctrine. If you have medical practice set up or CPOM questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Question 1: Am I practicing medicine?

This is not always an easy question to answer, even though common sense would say it should be. Each state’s idea of what constitutes the practice of medicine is drastically different. Continue reading ›

4 Considerations for Medical Practices When an Employee is Unable to Perform Due to an Injury or Illness

December 14, 2023 | Little Health Law

1651676570_Transworld-May-Blog-Header950x460-e1686600049528 Our healthcare and business law firm often represents medical practices, including primary care practices, specialty practices, and med spas, in employment matters. At some point, each medical practice deals with the situation where an employee becomes unable to perform due to an injury or prolonged illness. For instance, an esthetician breaks her hand and can no longer perform essential services of her position. Or a staff member has a serious illness that requires them to stay home for three weeks. Our medical practice clients are always sympathetic and want to take care of their employees, but they also have to balance that interest against the interest of running a business. That leads them to ask us: What should I do? This post provides four considerations for a medical practice if an employee is unable to perform due to an injury or illness. If you have employment questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

If the injury happened on the job, does your workers compensation policy provide a benefit?

Workers’ compensation requirements differ state to state. Continue reading ›

South Carolina Advisory Opinion on Retail IV Therapy Businesses: A Breakdown of the Opinion and Summary of Critical Information

November 20, 2023 | Little Health Law

health-medical-e1680627379406 Our healthcare and business law firm works with healthcare providers and businesses like IV hydration therapy practices. The IV hydration therapy industry has grown drastically over the past few years. Some states and medical boards have developed laws and rules governing IV Hydration Therapy practices. On August 15, 2023, the South Carolina Board of Medical Examiners, Pharmacy, and Nursing published a joint opinion on Retail IV Therapy Businesses. The language used and sanctions referenced reveal that the South Carolina Boards are critically reviewing IV therapy businesses. At one place in the 10-page opinion, the Pharmacy Board compared the “patient-drive menu” in many IV therapy practices “to a fast-food restaurant.” Reading between the lines of the advisory opinion, it is likely each board will begin cracking down on IV therapy practices. A full version of the Advisory Opinion is available here. We recommend you read the entire opinion if you have or are starting an IV therapy business in South Carolina. This blog post starts our review of the Advisory Opinion and outlines whether IV therapy is the practice of medicine. Forthcoming blog posts will dive deeper into different aspects of the opinion. If you have a question about South Carolina’s rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

What lead to this opinion?

After reviewing the opinion, it is clear that each South Carolina board believed this opinion necessary for four main reasons: Continue reading ›

HITECH Act and Self Pay

November 9, 2023 | Little Health Law

HealthcareImage_062618-700x525-1-e1682709849274 Our healthcare and business law firm works with healthcare businesses to assist in compliance matters, including the Health Insurance Portability and Accountability Act (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act was designed to strengthen HIPAA in many ways. A question our healthcare business-owning clients often have is whether patients with insurance can choose to pay cash instead of billing to insurance. This post focuses on what the HITECH Act states on this subject. If you have a question about the HITECH Act or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Summary of Self-Pay Rule

Congress passed the HITECH Act in 2009. It provides in part that health care providers must honor a patient’s request—even an insured patient’s request—to pay out-of-pocket for services, and thus not have their Protected Health Information (“PHI”) shared with third parties like billers or insurers—if the patient requests it. The patient, however, must pay in full 42 U.S.C. 17935(a). Continue reading ›

Alabama’s IV Therapy Declaratory Ruling Answers 3 Important Questions

November 3, 2023 | Little Health Law

IV-Therapy-1-e1699043729176 Our healthcare and business law firm works with healthcare providers and businesses to IV hydration therapy practices. The IV hydration therapy industry has grown drastically over the past few years. Some states and medical boards have developed laws and rules governing IV Hydration Therapy practices. In 2022, the Alabama Board of Medical Examiners (“Medical Board”) conducted an investigation into ten businesses advertising retail IV hydration therapy services. The investigation revealed that many IV therapy businesses allowed unqualified people to treat patients. Although IV therapy is relatively safe, there are still risks, such as harm to the patient’s kidney. Because there were no rules or regulations directly governing IV therapy businesses, the Medical Board issued a declaratory ruling. This blog post summarizes the Medical Board’s answers to three key questions relating to retail IV Therapy practices in Alabama. If you have a question about the Alabama Medical Board’s rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Is IV Hydration Therapy the Practice of Medicine?

Yes, “the diagnosis of the patient’s condition and the recommendation of IV therapy constitutes the practice of medicine.” It is a Class C felony for a person to practice medicine or osteopathy without a medical license.

Who can evaluate, diagnose, treat, and prescribe IV Therapy?

Alabama’s New Laser Rules: Overview of Changes

October 27, 2023 | Little Health Law

laser-hair-removal-service-e1698438994608 Our healthcare and business law firm works with healthcare providers and businesses to open cosmetic medical and wellness spas. The medical spa entity has grown drastically over the past few years. Some states and medical boards have developed laws and rules governing medical and wellness spas. As medical and wellness spas continue to grow, we can anticipate more laws and rules governing medical and wellness spas. On July 19, 2023, the Alabama Board of Medical Examiners (“Medical Board”) published changes to the rules governing the “Use of Lasers and Other Modalities,” which can be found in Chapter 540-X-11 of the Rules of the Medical Board. The rule is broken down into many different categories. This post provides an overview of the rule changes that are potentially applicable to medical spa practitioners. If you have a question about the Alabama Medical Board’s rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Rule 540-X-11 “Guidelines for the Use of Lasers and Other Modalities Affecting Living Tissue” has been a rule in Alabama since 2007. However, on March 16, 2023, the Medical Board passed changes and additions to the Rule, which became effective on July 17, 2023. The deadline for compliance with the provisions is July 17, 2024.

Although the Medical Board made many changes, an important change to the rules is that these rules apply to many cosmetic lasers including cryotherapy, infrared lasers, radiofrequency micro-needling, Class III lasers that work on heat-based targeting of skin and collagen. The Medical Board made many changes to Rule 540-X-11. The Medical Board made many notable changes to the rule that may apply to med spa practitioners, including as follows:

Alabama’s New Laser Rules: Non-Laser Skin Rejuvenation

October 10, 2023 | Little Health Law

woman_receiving_skin_resurfacing_treatment_657671370-e1696966883317 Our healthcare and business law firm works with healthcare providers and businesses to open cosmetic medical and wellness spas. The medical spa entity has grown drastically over the past few years. Some states and medical boards have developed laws and rules governing medical and wellness spas. As medical and wellness spas continue to grow, we can anticipate more laws and rules governing medical and wellness spas. On July 19, 2023, the Alabama Board of Medical Examiners (“Medical Board”) published changes to the rules governing the “Use of Lasers and Other Modalities,” which can be found in Chapter 540-X-11 of the Rules of the Medical Board. The rule is broken down into many different categories. A previous post provided an overview of the rule changes that are potentially applicable to medical spa practitioners. This post focuses on important rules that apply to Non-Laser Skin Rejuvenation procedures. If you have a question about the Alabama Medical Board’s rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

As mentioned in the previous blog post, the use of Lasers/Pulsed Light Devices (“LLBDs”) for cosmetic purposes is considered “the practice of medicine” in Alabama. Level 1 and Level 2 Delegates can perform certain LLBDs only if allowed by the rules, which go fully into effect on July 17, 2024. This post focuses on the new rules governing Non-Laser Skin Rejuvenation. Continue reading ›

Getting an NPDB Report Voided

September 29, 2023 | Little Health Law

health-medical-e1680627379406 Our healthcare and business law firm consistently works with physicians who are dealing with complications resulting from adverse reporting to the National Practitioner Data Bank (“NPDB”). A previous blog post outlines the process for disputing an NPDB report. Although difficult, our law firm has had success in appeals to HHS resulting in void reports. This post provides more information about the process of disputing a report directly with HHS and what occurs with a successful resolution. If you have a question about the NPDB or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@littlehealthlaw.com. You may also learn more about our law firm by visiting www.littlehealthlaw.com.

Initiating the Dispute with HHS

As mentioned in our previous blog post, Two Steps to Dispute an NPDB Report, after attempting to resolve a dispute with the reporting entity, a provider can elevate the dispute by submitting a dispute to the Secretary of the U.S. Department of Health and Human Resources (“HHS”). HHS’s jurisdiction to review reports is strictly limited, such that it can only review: (a) “if the report was submitted in accordance with reporting requirements”; (b) “if the reporting organization is eligible to report the information”; and (c) “if the report accurately depicts the action taken by the reporting organization and basis for the action in the organization’s written record.” It is important to frame the request in a way that allows HHS to agree and exercise its jurisdiction. For example, in a recent matter our firm worked on, our client resigned from employment while the entity was conducting an investigation into matters relating to our client. Continue reading ›