HEALTH CARE LAW: Specialists Needed More Than Ever To Navigate ‘Minefield’
California Medicine recently reported on the numerous developments in California's health care arena are keeping health care attorneys on the jump. "Never before has so much regulation clashed with so many dynamic market forces, with so much money on the line. Vast new bodies of federal regulation covering physician referrals, tax-exempt entities and Medicare Part C have created an ever-greater need for legal counsel," the magazine reports. "Because the health industry is so heavily regulated, business decisions always have heavy legal implications," said Marilou King of the American Health Lawyers Association. "A physician group today can't even determine its internal compensation system without an attorney," said Laurence Kessenick of the health care firm Hanson, Bridgett, Marcus, Vlahos & Rudy, LLP. According to CM, Medicare compliance has created the greatest need for health care lawyers, but another "hot-button issue" concerns physician compensation, "particularly in the case of hospitals purchasing and managing practices." In addition, another "complex and active new area of California health law involves structuring public managed care entities," according to George Root of Foley & Lardner, which counsels organizations such as CalOPTIMA. "It has all the issues an HMO would have, like credentialling and quality, but it also has this overlay of public entity laws," Root said. An increase in the number of mergers in the health care market -- especially between nonprofit and for-profits -- also provides attorneys with yet another set of complex issues to sort out. Another "quagmire keeping California health law specialists busy these days is the issue of patient 'ownership,'" CM reports. "There's a lot of 'patient stealing' litigation going on where an [independent physician association] claims a physician took patients that did not belong to him to another IPA," said Michael Dowell of Miller & Holguin. And in what could portend even more fodder for health care melees, the state Supreme Court is now hearing the case of Potvin. "If upheld, the case would make managed care organizations in California ... unable to terminate physicians from provider panels without a due process hearing," CM reports. As one lawyer put it, "[U]ntil Potvin is decided, a hospital needs to think twice about terminating someone without giving them the reasons why and some sort of fair procedure." CM concludes that "in today's constantly changing regulatory and legal environment, the success of health care providers' contracting relationships as well as their ability to comply with a Medicare audit will be closely linked to the quality of their legal counsel" (Havighurst, 12/98 issue).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.