Lifshutz & Lifshutz, P.C.

Fee Splitting: a Dangerous Game

Every physician and health care provider has heard of the term "fee splitting". Unfortunately, few really look beyond the most simplistic application of the prohibition, a mistake that could have serious consequences for their career as fee splitting is a violation of professional misconduct regulations.

An allegation of fee splitting is more likely to arise in a dispute with a third party such as an insurance company, independent contractor, or an employee than it is by direct investigation by the Department of Health or Department of Education. This exposes a provider to a greater risk since an adversarial party is the one bringing it to attention of the Office of Professional Medical Conduct (OPMC) or Office of Professional Discipline (OPD in the case of a non physician health care provider).

Any arrangement where one party's compensation or contract fees are based on a percentage of a provider’s revenue is likely to fall under fee splitting prohibitions. There are limited exemptions, one of the most common being partners/shareholders/owners of a professional organization or professional employee’s incentive bonus (providing they are the same license).

Non professionals do not have a license to lose and are not affected by an allegation for professional misconduct based on fee splitting. As laypeople the OPMC and OPD have no authority over them, so physicians and other health care providers must be extra cautious when dealing with them.

Published 1/27/12

Navigating the EUO (Examination Under Oath) Minefield

It should come as no surprise to any provider that no fault insurers use any means they can to withhold or delay payment of no fault claims. One of the most widely misused tactics is the EUO which permits an oral examination of the provider or the provider’s representative, to verify the claim.

No fault insurance companies often misuse the EUO as a means to go on a "fishing expedition" to uncover reasons to withhold any outstanding payments to the provider. Often documents are requested that are outside the scope of the EUO. Since the State Farm Mutual Auto Insurance Co. v Malella 2005, 4 NYS 313 decision, insurance companies have had greater leeway, however they still misuse and often intentionally misinterpret the decision.

The more recent case of Dynamic Medical Imaging v State Farm Mutual Auto Insurance Co. 2010, 29 Misc 3d 278 restricts no fault insurers with its ruling stating that the EUO is not intended to have the same scope as traditional discovery at trial. Insurance companies tend to ignore these decisions and similar case decisions in hopes that a provider will go along with their fishing expedition and over-reaching document request.

Over-reaching types of documents which are generally asked for by no fault insurance companies typically are:

Personal and/or corporate tax returns
Lists of employees
Lists of independent contractors
Lists of employees of independent contractors with whom the provider deals
Provider landlord information and data
Corporate agreements
Billing agreements
Corporate by-laws
Bank account records and account information

Many providers feel that even if the insurance company is not entitled to it, if they turn over the information, claims will get paid more quickly. In most instances however, the provider is still forced to pursue outstanding claims in arbitration or court before the insurance company will pay.

Additionally, the provider needs to be aware and wary of insurers who will immediately pay claims then turn around and files a civil RICO (Racketeer Influence Corrupt Organization Act) action against the provider which carries a penalty of triple (3x) damages in addition to other penalties.

A private company’s no fault insurance bottom line is profit, not "fairness". As such the EUO should be viewed as a proceeding in which the provider is "playing defence" due to the large exposure they could face. While one tactic would be to skip the EUO if an insurance company feels that a provider is not going to contest future claims, then it will simply deny future claims as well. For this reason it is very important to handle an EUO properly to prevent future problems with the insurance companies and claims.

Even if a provider is not engaging in any improper conduct, if the insurance company can create a plausible argument that says they are, the provider can still face potential exposure and have to pay legal fees to defend. The provider will most likely settle such a lawsuit.

Do you know anyone who would also find this blog relevant? Please feel free to forward it to them.

Published 1/12/12

Urgent Care Centers Help Build Your Practice

Urgent Care Centers have been increasing in popularity because they provide an opportunity for a patient to receive immediate, extra-hour medical attention that may not require hospitalization or hospital treatment but still is of an urgent/emergency nature.

This opportunity is good for physicians in that it does not require a large facility and only enough staff to provide extra-hour coverage. With an Urgent Care facility, however, there are additional regulations that a physician needs to be aware of related to being able to cover the facility for these extended hours.

The Urgent Care facility provides an excellent opportunity for physicians just out of residency as it enables a young physician to build up a reputation in the community and in their area of practice.

If the physician wishes to remain in urgent care treatment, there is also an opportunity to open up new locations and operate urgent facilities in groups with other physicians. The group might cater to different specialties in addition to having a relationship with a hospital for care that requires admission. This can also be of benefit to a young physician’s future career in that it fosters positive relationships with such institutions.

There are situations that require the attention of a doctor, but do not necessarily require the services of a full-fledged emergency room. In these situation, the local Urgent Care Center provides much needed assistance, attracting new patients for anything from stitches to flu shots. These Centers are a good way to help the community and to relieve the pressure and wait time in an emergency room.

Published 12/17/11

Outpatient Mental Health Clinics:
Back in Business

Image of mental health rememberance ribon

The Office of Mental Health (OMH) recently revised the application process to streamline the procedure for obtaining an outpatient mental health clinic operating certificate (New York Mental Hygiene - Article 31) making it possible to obtain approvals again in areas of need. The approval process has always been there, but the OMH simply stopped processing applications for a while.

The strengths of the Article 31s are:

Outpatient mental health clinics can be owned by someone other than a doctor (non professional), however similar to an Article 28 Diagnostic and Treatment center, there are regulations regarding the staff needed to run the clinic.

Corporate billing is accomplished under one group as opposed to each individual provider.

Mental health care provides expansion for other areas of practice if desired by the owner/operator. This is because other health care fields such as drug detox and pain management clinics need mental health clinics in order to grow. This is because after a certain number of visits, they cannot prescribe controlled substances without sending the clients to a mental health office/facility. Mental Health Care clinics also work with other existing programs and hospitals.

In a poor economy, more and more attention is given to mental health care because of the hopelessness and desperation many people are experiencing.

The overhead for a mental health clinic is low as there is no need for specialized diagnostic or durable medical equipment. Treatment rooms are used for talking and discussion.

The pre-approval application process consists of a visit to a field office to pitch the clinic project idea and go over the preliminary proposal. The pre-approval gives an early indication of whether the project will be accepted by the Office of Mental Health. If the pre-approval board give the project a “thumbs up”, the applicant can go ahead and file their full application electronically. For an Article 28 D&T center, the applicant must go through the full application process and then wait to find out if it will be accepted or not.

Published 11/12/11

Article 28 Diagnostic and Treatment Centers

An Article 28 facility is approved by the New York State Department of Health through the Certificate of Need process. The same application process and law (Article 28 of the New York State Public Health Law) also applies to Surgical Centers and Nursing Homes as well as general hospitals. There are similar and specific requirements as far as what the Department of Health is looking for from each facility. Understanding the process and these requirements is important in order to obtain a Certificate of Need to own and operate a Diagnostic and Treatment Center.

An Article 28 Diagnostic and Treatment Center can be the proper tool for you to operate your practice. Much about them is misunderstood leading to many misconceptions about what they are and are not.

The following are the four most important factors to consider when determining if a Diagnostic and Treatment Center is right for you:

1. Can you provide the same service in another manner?

New York state law prohibits the practice of medicine (or any other profession) without a license. In most cases this also extends to owning any form of medical or health care clinic that provides health care services or treats patients.

The Article 28 authorized Diagnostic and Treatment Center is an exception that allows a non-licensed doctor or non-professional to own and operate a medical clinic and/or partner with non-professionals, professionals or any mix of the two. For a physician however, the value of the services provided must make sense given the reimbursement rates for a private practice as opposed to an Article 28 facility.

2. I'm a physician. Will an article 28 Diagnostic and Treatment Center help my practice?

The answer is maybe. It depends on your current practice, the types of patient that you have and the demographic area of those patients, specialty and specific goals for future avenues of practice. An Article 28 Diagnostic and Treatment Center can help a physician (and other owners) gain advantages in:

negotiating HMO contracts
increasing the available services you can provide to your current payment base
forming relationships with other providers in other locations through affiliations or extension clinics
expanding your practice into a larger demographic area
assisting with compliance related activities and collections

3. How do I apply?

The application process is a long and detailed one that can take approximately 18 months depending on the applicants background, the overall proposed facility and the site location. Some areas are better than others and certain locations may from time to time be extremely difficult to get based on the current level of need for facilities and access to health care by patients. However, the right program can speed along an application and improve your chance of approval. This is why it is crucial to find proper representation and experts to assist in the application process.

4. What are the downsides?

For most people, the biggest downside is the lengthy application process. It requires a significant amount of work during the application process, putting most projects on hold during that time. Although a project specifically designed to treat a need in a specific population (a need the DOH sees as particularly urgent) can speed the application process along. Also there are increased reporting and accounting requirements to the Department of Health in the application process and the continued operation of the Diagnostic and Treatment Center.

Published 11/12/11

The OASAS

New York’s Answer to Providing Clinical Help to Recovering Addicts

Since the economic downturn in 2008 there has been a rise in substance abuse in general, and as a result, the Office of Alcohol and Substance Abuse (OASAS) has recently begun a large push to help and treat individuals suffering from addiction. OASAS has streamlined the process and regulations for opening outpatient drug and alcohol detox centers.

The OASAS is a specially approved facility by the Office of Alcohol and Substance Abuse. You don’t need to be a physician or other professional to own an OASAS so long as you have the proper credentials; however they do require you to have certified alcohol and substance abuse counselors as well as other related professional staff. These professionals may include psychologists, nurse practitioners, detox counselors and nurse’s aides. They could also include other medical staff positions needed to operate the facility.

There are different levels of treatment and patients for an OASAS come from a variety of sources enabling operators to branch out their services. These sources range from:

Programs with the court system for non-violent drug addicted offenders to reduce or eliminate their sentence is they complete a drug rehabilitation program overseen by the court.
The prison systems where many people coming out of prison are substance abusers and need to remain clean in order to comply with the terms of their parole and to get their life back together.
Various shelter projects have a high amount of recovering addicts in need of such a program.
Churches and other religious organizations might have counselors and programs that assist individuals on a counseling basis but need a greater amount of care for those individuals.

Treatment of individuals who have a chemical dependency is usually done in a group session. The groups number around 15, and assist in the acceleration of the recovery process.

Reimbursement is generally either through Medicare, Medicaid, private insurance, or private pay.

Published 9/26/11

What Are You Going to Do When the Medicaid Auditor Comes Knocking?

Medicaid has significantly greater authority than a private HMO or non-government operated third party provider. It is important to remember that an audit by Medicaid and possibly a Medicaid HMO, might not only be looking for money to be returned but also to revoke your provider status and exclude you from the program. They may even press for further actions if real instances of criminal violations are uncovered in the audit.

It is important to know your rights and how to handle any Medicaid audit and investigation since auditors often abuse their authority or use tactics that can cause you to respond in a way that you normally would not.

Steps one can take to protect against and minimize the impact of such intrusions or investigations, vary depending on the practice, specialty and individual conduct of the auditors.

It is possible to control the timing of the audit if the provider can demonstrate to Medicaid that the audit significantly interferes with the quality of patient care. It is important to remember, however, that this must be more than a minor inconvenience.
Often auditors lose or mix up parts of records so it is important to oversee their review and copying process.
Additionally it is important to take note of what records and charts were reviewed so that you can perform a self audit with the aid of an expert to look for any deficiencies in your records prior to the completion of any review by Medicaid.
An active compliance plan with proper compliance records of self auditing and protocols can help minimize the intensity of any random audit.
Presenting the auditors with information of an attorney can also deflect any questions being asked directly of the provider but this must be done in a way that will not appear non-compliant.

Important points to remember in any Medicaid audit:

In most instances you must permit entry.
Keep records of exactly what is taken and monitor the activities of the auditors.
Make notes of the questions the auditors ask and arrange to provide answers at a later time. Try to avoid answering questions on the spot.
Disclose any compliance plan or self auditing activities
Use passive tactics to avoid appearing non cooperative.

The Medicaid audit, which it can be inconvenient, does not have to bring your practice to a screeching halt.

Published 9/20/11

ARE YOU IN VIOLATION OF THE NEW CHANGES TO THE STARK REFERRAL LAW?

The Stark Regulations, which prohibit a physician from making a referral to an entity or practice in which he has a financial or beneficial interest in, were recently changed on March 26, 2004. With these new changes to the Stark Law it is expected that government investigation and enforcement related to these issues will increase significantly. It is important to review your practice and referral patterns to determine whether or not you are in violation of the new Stark Regulations. Stark is especially dangerous in the respect that it imposes strict liability on physicians (no intent required); so if a physician makes a referral that is covered by the Stark Regulations and the referral does not fit into one of the safe harbors under the new Stark Regulations, you are in violation and subject to significant penalties imposed by the law.

HIPAA DEADLINE FOR SMALL BUSINESS REMINDER

The final extension for the deadline for small businesses to implement certain HIPAA protections for protected health information of their staff, is near. Small businesses that do not qualify for the narrow exceptions must be HIPAA compliant by April 14, 2004, or face civil or criminal penalties.

Lifshutz & Lifshutz P. C. will provide Physicians, Dentists, Chiropractors, Podiatrists, and other health care providers with a free consultation to evaluate their exposure, if any, under the new Federal Stark Law which was recently signed into law as of March 2004.



		Fee Splitting: a Dangerous Game Every physician and health care provider has heard of the term "fee splitting". Unfortunately, few really look beyond the most simplistic application of the prohibition, a mistake that could have serious consequences for their career as fee splitting is a violation of professional misconduct regulations. An allegation of fee splitting is more likely to arise in a dispute with a third party such as an insurance company, independent contractor, or an employee than it is by direct investigation by the Department of Health or Department of Education. This exposes a provider to a greater risk since an adversarial party is the one bringing it to attention of the Office of Professional Medical Conduct (OPMC) or Office of Professional Discipline (OPD in the case of a non physician health care provider). Any arrangement where one party's compensation or contract fees are based on a percentage of a provider’s revenue is likely to fall under fee splitting prohibitions. There are limited exemptions, one of the most common being partners/shareholders/owners of a professional organization or professional employee’s incentive bonus (providing they are the same license). Non professionals do not have a license to lose and are not affected by an allegation for professional misconduct based on fee splitting. As laypeople the OPMC and OPD have no authority over them, so physicians and other health care providers must be extra cautious when dealing with them. Published 1/27/12 Navigating the EUO (Examination Under Oath) Minefield It should come as no surprise to any provider that no fault insurers use any means they can to withhold or delay payment of no fault claims. One of the most widely misused tactics is the EUO which permits an oral examination of the provider or the provider’s representative, to verify the claim. No fault insurance companies often misuse the EUO as a means to go on a "fishing expedition" to uncover reasons to withhold any outstanding payments to the provider. Often documents are requested that are outside the scope of the EUO. Since the State Farm Mutual Auto Insurance Co. v Malella 2005, 4 NYS 313 decision, insurance companies have had greater leeway, however they still misuse and often intentionally misinterpret the decision. The more recent case of Dynamic Medical Imaging v State Farm Mutual Auto Insurance Co. 2010, 29 Misc 3d 278 restricts no fault insurers with its ruling stating that the EUO is not intended to have the same scope as traditional discovery at trial. Insurance companies tend to ignore these decisions and similar case decisions in hopes that a provider will go along with their fishing expedition and over-reaching document request. Over-reaching types of documents which are generally asked for by no fault insurance companies typically are: Personal and/or corporate tax returns Lists of employees Lists of independent contractors Lists of employees of independent contractors with whom the provider deals Provider landlord information and data Corporate agreements Billing agreements Corporate by-laws Bank account records and account information Many providers feel that even if the insurance company is not entitled to it, if they turn over the information, claims will get paid more quickly. In most instances however, the provider is still forced to pursue outstanding claims in arbitration or court before the insurance company will pay. Additionally, the provider needs to be aware and wary of insurers who will immediately pay claims then turn around and files a civil RICO (Racketeer Influence Corrupt Organization Act) action against the provider which carries a penalty of triple (3x) damages in addition to other penalties. A private company’s no fault insurance bottom line is profit, not "fairness". As such the EUO should be viewed as a proceeding in which the provider is "playing defence" due to the large exposure they could face. While one tactic would be to skip the EUO if an insurance company feels that a provider is not going to contest future claims, then it will simply deny future claims as well. For this reason it is very important to handle an EUO properly to prevent future problems with the insurance companies and claims. Even if a provider is not engaging in any improper conduct, if the insurance company can create a plausible argument that says they are, the provider can still face potential exposure and have to pay legal fees to defend. The provider will most likely settle such a lawsuit. Do you know anyone who would also find this blog relevant? Please feel free to forward it to them. Published 1/12/12 Urgent Care Centers Help Build Your Practice Urgent Care Centers have been increasing in popularity because they provide an opportunity for a patient to receive immediate, extra-hour medical attention that may not require hospitalization or hospital treatment but still is of an urgent/emergency nature. This opportunity is good for physicians in that it does not require a large facility and only enough staff to provide extra-hour coverage. With an Urgent Care facility, however, there are additional regulations that a physician needs to be aware of related to being able to cover the facility for these extended hours. The Urgent Care facility provides an excellent opportunity for physicians just out of residency as it enables a young physician to build up a reputation in the community and in their area of practice. If the physician wishes to remain in urgent care treatment, there is also an opportunity to open up new locations and operate urgent facilities in groups with other physicians. The group might cater to different specialties in addition to having a relationship with a hospital for care that requires admission. This can also be of benefit to a young physician’s future career in that it fosters positive relationships with such institutions. There are situations that require the attention of a doctor, but do not necessarily require the services of a full-fledged emergency room. In these situation, the local Urgent Care Center provides much needed assistance, attracting new patients for anything from stitches to flu shots. These Centers are a good way to help the community and to relieve the pressure and wait time in an emergency room. Published 12/17/11 Outpatient Mental Health Clinics: Back in Business The Office of Mental Health (OMH) recently revised the application process to streamline the procedure for obtaining an outpatient mental health clinic operating certificate (New York Mental Hygiene - Article 31) making it possible to obtain approvals again in areas of need. The approval process has always been there, but the OMH simply stopped processing applications for a while. The strengths of the Article 31s are: Outpatient mental health clinics can be owned by someone other than a doctor (non professional), however similar to an Article 28 Diagnostic and Treatment center, there are regulations regarding the staff needed to run the clinic. Corporate billing is accomplished under one group as opposed to each individual provider. Mental health care provides expansion for other areas of practice if desired by the owner/operator. This is because other health care fields such as drug detox and pain management clinics need mental health clinics in order to grow. This is because after a certain number of visits, they cannot prescribe controlled substances without sending the clients to a mental health office/facility. Mental Health Care clinics also work with other existing programs and hospitals. In a poor economy, more and more attention is given to mental health care because of the hopelessness and desperation many people are experiencing. The overhead for a mental health clinic is low as there is no need for specialized diagnostic or durable medical equipment. Treatment rooms are used for talking and discussion. The pre-approval application process consists of a visit to a field office to pitch the clinic project idea and go over the preliminary proposal. The pre-approval gives an early indication of whether the project will be accepted by the Office of Mental Health. If the pre-approval board give the project a “thumbs up”, the applicant can go ahead and file their full application electronically. For an Article 28 D&T center, the applicant must go through the full application process and then wait to find out if it will be accepted or not. Published 11/12/11 Article 28 Diagnostic and Treatment Centers An Article 28 facility is approved by the New York State Department of Health through the Certificate of Need process. The same application process and law (Article 28 of the New York State Public Health Law) also applies to Surgical Centers and Nursing Homes as well as general hospitals. There are similar and specific requirements as far as what the Department of Health is looking for from each facility. Understanding the process and these requirements is important in order to obtain a Certificate of Need to own and operate a Diagnostic and Treatment Center. An Article 28 Diagnostic and Treatment Center can be the proper tool for you to operate your practice. Much about them is misunderstood leading to many misconceptions about what they are and are not. The following are the four most important factors to consider when determining if a Diagnostic and Treatment Center is right for you: 1. Can you provide the same service in another manner? New York state law prohibits the practice of medicine (or any other profession) without a license. In most cases this also extends to owning any form of medical or health care clinic that provides health care services or treats patients. The Article 28 authorized Diagnostic and Treatment Center is an exception that allows a non-licensed doctor or non-professional to own and operate a medical clinic and/or partner with non-professionals, professionals or any mix of the two. For a physician however, the value of the services provided must make sense given the reimbursement rates for a private practice as opposed to an Article 28 facility. 2. I'm a physician. Will an article 28 Diagnostic and Treatment Center help my practice? The answer is maybe. It depends on your current practice, the types of patient that you have and the demographic area of those patients, specialty and specific goals for future avenues of practice. An Article 28 Diagnostic and Treatment Center can help a physician (and other owners) gain advantages in: negotiating HMO contracts increasing the available services you can provide to your current payment base forming relationships with other providers in other locations through affiliations or extension clinics expanding your practice into a larger demographic area assisting with compliance related activities and collections 3. How do I apply? The application process is a long and detailed one that can take approximately 18 months depending on the applicants background, the overall proposed facility and the site location. Some areas are better than others and certain locations may from time to time be extremely difficult to get based on the current level of need for facilities and access to health care by patients. However, the right program can speed along an application and improve your chance of approval. This is why it is crucial to find proper representation and experts to assist in the application process. 4. What are the downsides? For most people, the biggest downside is the lengthy application process. It requires a significant amount of work during the application process, putting most projects on hold during that time. Although a project specifically designed to treat a need in a specific population (a need the DOH sees as particularly urgent) can speed the application process along. Also there are increased reporting and accounting requirements to the Department of Health in the application process and the continued operation of the Diagnostic and Treatment Center. Published 11/12/11 The OASAS New York’s Answer to Providing Clinical Help to Recovering Addicts Since the economic downturn in 2008 there has been a rise in substance abuse in general, and as a result, the Office of Alcohol and Substance Abuse (OASAS) has recently begun a large push to help and treat individuals suffering from addiction. OASAS has streamlined the process and regulations for opening outpatient drug and alcohol detox centers. The OASAS is a specially approved facility by the Office of Alcohol and Substance Abuse. You don’t need to be a physician or other professional to own an OASAS so long as you have the proper credentials; however they do require you to have certified alcohol and substance abuse counselors as well as other related professional staff. These professionals may include psychologists, nurse practitioners, detox counselors and nurse’s aides. They could also include other medical staff positions needed to operate the facility. There are different levels of treatment and patients for an OASAS come from a variety of sources enabling operators to branch out their services. These sources range from: Programs with the court system for non-violent drug addicted offenders to reduce or eliminate their sentence is they complete a drug rehabilitation program overseen by the court. The prison systems where many people coming out of prison are substance abusers and need to remain clean in order to comply with the terms of their parole and to get their life back together. Various shelter projects have a high amount of recovering addicts in need of such a program. Churches and other religious organizations might have counselors and programs that assist individuals on a counseling basis but need a greater amount of care for those individuals. Treatment of individuals who have a chemical dependency is usually done in a group session. The groups number around 15, and assist in the acceleration of the recovery process. Reimbursement is generally either through Medicare, Medicaid, private insurance, or private pay. Published 9/26/11 What Are You Going to Do When the Medicaid Auditor Comes Knocking? Medicaid has significantly greater authority than a private HMO or non-government operated third party provider. It is important to remember that an audit by Medicaid and possibly a Medicaid HMO, might not only be looking for money to be returned but also to revoke your provider status and exclude you from the program. They may even press for further actions if real instances of criminal violations are uncovered in the audit. It is important to know your rights and how to handle any Medicaid audit and investigation since auditors often abuse their authority or use tactics that can cause you to respond in a way that you normally would not. Steps one can take to protect against and minimize the impact of such intrusions or investigations, vary depending on the practice, specialty and individual conduct of the auditors. It is possible to control the timing of the audit if the provider can demonstrate to Medicaid that the audit significantly interferes with the quality of patient care. It is important to remember, however, that this must be more than a minor inconvenience. Often auditors lose or mix up parts of records so it is important to oversee their review and copying process. Additionally it is important to take note of what records and charts were reviewed so that you can perform a self audit with the aid of an expert to look for any deficiencies in your records prior to the completion of any review by Medicaid. An active compliance plan with proper compliance records of self auditing and protocols can help minimize the intensity of any random audit. Presenting the auditors with information of an attorney can also deflect any questions being asked directly of the provider but this must be done in a way that will not appear non-compliant. Important points to remember in any Medicaid audit: In most instances you must permit entry. Keep records of exactly what is taken and monitor the activities of the auditors. Make notes of the questions the auditors ask and arrange to provide answers at a later time. Try to avoid answering questions on the spot. Disclose any compliance plan or self auditing activities Use passive tactics to avoid appearing non cooperative. The Medicaid audit, which it can be inconvenient, does not have to bring your practice to a screeching halt. Published 9/20/11 ARE YOU IN VIOLATION OF THE NEW CHANGES TO THE STARK REFERRAL LAW? The Stark Regulations, which prohibit a physician from making a referral to an entity or practice in which he has a financial or beneficial interest in, were recently changed on March 26, 2004. With these new changes to the Stark Law it is expected that government investigation and enforcement related to these issues will increase significantly. It is important to review your practice and referral patterns to determine whether or not you are in violation of the new Stark Regulations. Stark is especially dangerous in the respect that it imposes strict liability on physicians (no intent required); so if a physician makes a referral that is covered by the Stark Regulations and the referral does not fit into one of the safe harbors under the new Stark Regulations, you are in violation and subject to significant penalties imposed by the law. HIPAA DEADLINE FOR SMALL BUSINESS REMINDER The final extension for the deadline for small businesses to implement certain HIPAA protections for protected health information of their staff, is near. Small businesses that do not qualify for the narrow exceptions must be HIPAA compliant by April 14, 2004, or face civil or criminal penalties. Lifshutz & Lifshutz P. C. will provide Physicians, Dentists, Chiropractors, Podiatrists, and other health care providers with a free consultation to evaluate their exposure, if any, under the new Federal Stark Law which was recently signed into law as of March 2004.


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