Boston Lawyers for pharmacies and dispensaries
The current healthcare system consists of many laws and regulations meant to ensure dispensaries and pharmacies offer quality care to patients. As a result, pharmacies and dispensaries find it difficult to fulfill all the legal requirements they regularly encounter. It is during such times that practitioners need to have legal representation. In some cases, the acquisition or sale of pharmacies may be put to question, in other cases, charges of abuse and fraud may arise. When these kinds of situations come up, it is necessary to be represented by Boston lawyers specializing in dispensaries and pharmacies.
A lawyer is essential for structuring pharmacies and dispensaries to comply with the Stark Law and Anti Kickback Statutes aimed at addressing health care abuse and fraud. The Stark Law governs how physicians refer Medicaid and Medicare services to entities and the financial relationship between the physician and these entities. Legal counsel is also instrumental in determining the exceptions of the Stark Law and their applications within a particular organization.
The anti-kickback statute prevents healthcare practitioners from receiving or providing any form of remuneration to provide a referral of Medicaid, Medicare, or other healthcare services. The anti-kickback statute is a criminal law that is interpreted broadly with violations resulting in severe penalties and jail term. Boston legal services can provide advice to pharmacists on the boundaries of AKS laws, exceptions, and rules for complying with these statutes.
Audits and Investigations
Many pharmacists and doctors go through investigations and audits with respect to licensure questions, Medicaid, and Medicare. Boston legal counsel is instrumental during such occasions. Some of the areas that attorneys can counsel pharmacists and dispensaries on include:
- Pharmacy claim reviews
- Third party audit and issues
- Licensure and certification
- Employee issues
- Medical necessity
- Referral relationships
Whatever audit or investigation that a physician or pharmacist is facing, it is recommended that one retains legal counsel. Furthermore, during questioning the presence of a lawyer is important to avoid incrimination and a violation of the accused party’s rights.
HIPPA and PRIVACY LAWS
Physicians are required to maintain patient confidentiality, however, complying with HIPAA’s Privacy, Breach and Security Notification rules and other regulations regarding protecting the patient’s privacy is often a difficult undertaking. Legal counsel can be important in interpretation of HIPPA Privacy rules and helping pharmacies with compliance issues. Consulting a lawyer is also important when it comes to making amendments to HIPAA Privacy rules and the Breach Notification Rule. Attorneys can also help with documenting risk management and risk assessment processes.
In addition, HIPAA can be expanded to conform to business associates. Health care lawyers usually represent entities and venders who support health care businesses in understanding HIPAA regulations and assist them with drafting business agreements. For pharmacies or dispensaries facing investigation by the Department of Health and Human Services’ Office of Civil Rights, the presence of an attorney can be crucial in fighting severe penalties and license revocation.
Other Compliance Laws
Health care providers are required to abide by many other compliance laws whose violation results in huge fines and jail time. Lawyers are indispensable when reviewing a pharmacy’s regulatory compliance or when helping entities implement compliance programs. These safeguards are important especially owing to the unpredictable investigations conducted by government or other third party authorities.
Another area that pharmacies and dispensaries can use the help of a lawyer is when appealing to Medicaid, Medicare, and audits. The involvement of a lawyer during appeals comes in handy when drafting templates, coordinating expert witnesses, overseeing a pharmacist’s internal audit, and appearing at hearings.
The process of dealing with audit contractors and correcting errors made during audits and appeals requires the presence of a legal expert. Attorneys also play an important role in representing practitioners in Medicare’s Settlement Conference Facilitation initiatives. SCF is a fast and efficient way of resolving Medicare claims appeals.