Starting a Medical Practice

The decision to start a medical practice is an exciting time in the life of a health care professional. However, navigating the vast amount of regulations governing one’s practice can be daunting. Our team of health care attorneys are here to help you understand your legal responsibility and help limit your exposure to liability. Chapman Law Group is comprised of experienced health care transactional attorneys. With a wealth of knowledge in business formation and management, we are here to assist you in establishing your medical practice, clinic, or center.

Starting a medical practice requires a significant investment in time as well as money. While consultants can be helpful in a practices initial startup, certain elements should be reviewed by an experienced health care attorney. The failure of providers to retain an experienced health care attorney has led to the dramatic increase in criminal and civil charges related to fraud and abuse. Federal and state fraud and abuse laws impact the critical areas of a health care practice. From marketing strategies, employment/independent contractor contracts, and real estate leases, Chapman Law Group is here to navigate the mine field of liabilities a provider may face.

Given the personal and financial investment required in establishing a medical practice, it is of tantamount importance that your investment is protected. From ensuring that your practice is properly structured, and licensed, Chapman Law Group will safeguard your practice from violating both state and federal law. In addition, we can assist in negotiating third party payor contracts and reviewing marketing strategies to properly and legally increase patient volume. Our attorneys are here to handle the many startup hurdles and headaches; allowing you to focus on the exciting task of opening your doors and providing quality patient care.

Practice Startup Services:

AHCA Licensing. Our attorneys routinely deal with issues surrounding AHCA licensing and certification. Whether it is fully completing the proper form to inspection compliance, Chapman Law Group is here to ensure that your facility complies with AHCA requirements and to routinely update you on shifts in policy.

Ambulatory Surgery Centers. In Florida, Ambulatory Surgery Centers were originally only obtainable through a certificate of need. Now, they are licensed and regulated under AHCA and often JCO certified. Our attorneys have extensive experience in the ASC field. From initial development, licensing, certification, and accreditation, to the day the business opens, our attorneys will guide you through the two-hundred and thirty steps process of opening and running an ASC.

Ancillary Services. Physicians are often seeking to expand their revenue pool through offering other ancillary services to their patients. However, they must be wary that these services are not prohibited under STARK. Physicians looking to expand their existing business into durable medical equipment (“DME”), MRI, clinical laboratories, and pharmacies should contract our attorneys to ensure their proposed business model complies with State and Federal regulations.

Cardiac Cath Labs. Cardiologist who are tired of being servants to the hospital have the option of creating their own catheterization laboratory (“Cath Lab”). At this time a Cath Lab procedure is considered an office-based procedure that can be performed outside of a hospital or ASC setting. However, given the recent literature on “twilight anesthesia” this is likely to change in the near future. Therefore, it is important that when constructing a Cath Lab that it meet the same requirements for AHCA certification of an ASC. This will save the provider from an interruption of business if there is a change in policy. Our attorneys are experienced in the development, certification, and implementation of the items necessary to either create your own individual Cath Lab, or to join in under a group leasing arrangement. Either way, Chapman Law Group has the knowledge, resources, and experience available to make your business venture a success.

Certificate of Need. The MDHHS and AHCA Certificate of Need (“CON”) process can be a daunting and gargantuan task. The CON program regulates hospices, skilled nursing facilities (“SNF”), intermediate care facilities, and news hospitals. From the strict deadline requirements, numerous competition, and limited pool of available, our attorneys can guide you through the CON process. Even if the CON is awarded other applicants can still contest the validity of decision through an administrative hearing. Chapman Law Group consists of numerous attorneys that are well versed practicing before the Department of Health.

CMS Enrollment. We assist owners of start-up and existing facilities with CMS enrolling. Enrollees with prior disciplinary or criminal history may be required to report information regarding the incident. Failure to report such information can lead an indictment under the False Claims Act. As of August 1, 2016, the minimum penalty for False Claims Act violations has increased to ten-thousand seven-hundred and eighty-one dollars ($10,781.00) and the maximum penalty is now twenty-one thousand five-hundred and sixty-three dollars ($21,563.00) per claim.

Employment Agreements. Chapman Law Group routinely assists health care practitioners in the drafting and negotiation of employment agreements. From drafting/negotiating a non-compete agreement to the structuring of appropriate bonus or incentive payments, Chapman Law Group can assist employers and employees in achieving the most favorable agreement for their party’s needs.

Facility Lease. Unlike normal commercial leases, a leasing arrangement for a health care provider is subject to Federal regulation and STARK compliance. Our transactional healthcare attorneys routinely assist our clients in obtaining a STARK compliant lease arrangement. It is important that the term of the lease be made for more than one (1) year and that the written lease agreement is set out at fair market value.

Formation and Corporate Structure. Our attorneys draft entity formation documents including articles of incorporation, obtaining an EIN, operating agreements, employee/independent contractor agreements, and employee handbooks. Great care is taken in assisting owners to selection the correct corporate structure based upon their current situation and future goals. Selecting the correct corporate structure is important in limiting an individual’s personal liability and tax exposure.

HIPAA & HITECH. Our attorneys can help owners develop and maintain appropriate administrative technical and physical safeguards to protect a patient’s electronic protected health information (“ePHI”). The failure to maintain the appropriate safeguards can lead to a breach of a provider’s data security, leading to potential HIPAA and HITECH violations; the latter of which imposes a penalty up to $1.5 million.

Independent Contractor Agreements. While a typical business can routinely work with a variety of different independent contractors through a mere 1099 filing, federal law regulates the independent contractor relationship in the healthcare field. Any independent contractor relationship and agreement must be highly scrutinized to ensure proper compliance. The failure to do so may cause a provider to face state and federal charges for patient brokering and anti-kickback violations. Any payment relationship that takes into account patient volume or percentage of payment, even if reduced to writing, can be volatile of these laws.

Licensing & Registration. Our attorneys help owners obtain all proper state and federal licenses. Whether it be through complex licensing requirements of the DEA, FDA, or CLIA to the simple EIN and NPI numbers, Chapman Law Group can guide a provider through all steps through the licensing and accreditation process.

Marketing Agreements. Physician marketing arrangements are designed to increase patient volume without violating state or federal law. Whether as an employee or as an independent contractor, any marketing program must face strict scrutiny in order to limit a practices liability. While some practices try to limit liability by not billing Medicare, Medicaid, or Tricare, Florida law imposes a violation for any remuneration paid for any patient referral as a kickback unless the arrangement falls under the safe-harbor provisions of 42 CFR 1001.952. Chapman Law Group routinely examines marketing relationships and structures to ensure proper compliance with federal and state law.

Pharmacies. The attorneys of Chapman Law Group has an existing group of clientele of national and community pharmacies. Whether it is the initial formation of a community pharmacy, to the acquisition of a multi-state compounding practice, our attorneys represents clients in all aspects of the pharmacy business. Chapman Law Group can help you obtain the proper licenses through the Board of Pharmacy and DEA. The most important aspect of any pharmacy transaction is the proper notice that must be given to the appropriate agency to ensure the parties to the transaction are not brought up on criminal charges.

Skilled Nursing Facilities. In 2014 AHCA lifted the moratorium on Skilled Nursing Facility (“SNF”) beds in the State of Florida. Since that time the number of available SNF beds is published during four batching cycles every year based upon geographic need. Our attorneys are experienced in this process and have assisted in the awarding of a CON for a sixty-four bed facility.

Time Share Arrangements. A physician practice can often be located in multiple areas. In this situation a group of physicians may choose to maximize their profits and minimalize their expenses by entering into a time-share arrangement for space and equipment. In the fall of 2015 STARK published their proposed updates to include time share arrangements in the lease and equipment rentals. The pertinent parts of the time-share arrangement is that the lease must be in writing for at least one (1) year, with the time share arrangement clearly carved out, and the lease must be at a commercially reasonable rate. This means that the lease itself must be at fair market value and not take into account the percentage of revenue raised, earned, billed, collected, or attributable to the services covered by the agreement or a per-unit of service fees that are not time based.

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