Texas Health Care Law Blog

DNA testing challenges doctors, laboratories and courts

Medical laboratories, doctors and other healthcare professionals have begun struggling with gnarly ethical questions brought on by DNA testing. With the technology now widely available and its meanings fast evolving, medical professionals may see the legal risks only when a lawsuit is filed.

Experts in law, public policy, medicine and genetics are scrambling to think about these questions before they’re raised in court, not to mention the clinical setting.

Explainer: No Corporate Practice of Medicine in Texas

The prohibition against the corporate practice of medicine doctrine isn’t necessarily a law or passage in the Texas Constitution, but rather a legal doctrine. That is, it’s a principle expressed as a set of rules or procedures that developed over multiple rulings.

This doctrine prohibits corporations from making or influencing medical decisions, and therefore from practicing medicine in any sense in Texas.

How to prepare for a ZPIC audit

Today, healthcare providers face more regulations than ever. One particular form of regulation that has become more common in the past decade are Zone Program Integrity Contractor (ZPIC) audits.

These audits were designed to enforce Medicare regulations and deter improper billing practices. They can lead to allegations of fraud which may bring a healthcare organization civil or criminal charges.

Managing difficult patients without risking your license

Whether due to a hostile attitude, refusal to follow medical advice, anger over a diagnosis or more, many doctors, nurses and other health care professionals have encountered difficult patients at some point. Dealing with these individuals can be complicated, especially when you fear that an unfounded or unreasonable complaint could jeopardize your medical license.

Managing difficult patients requires patience and a constant commitment to acting in the best interests of the patient. Because fighting to protect your license can take considerable time and resources from your Texas practice, attempt to gain control of the situation before it escalates. Here are a few tips to ease the tension:

The lengthy reinstatement process for nurse licensing

Licensed nurses rely on their accreditation for their living. If your license is revoked, Texas has a lengthy reinstatement process for you to undergo before you can work as a nurse again.

The reinstatement process includes these steps before you’re able to work as a nurse again:

What if you suspect fraudulent activity at your own practice?

Physicians rely on the trust of multiple people, including patients, employees and members of the public. Unfortunately, some unscrupulous doctors abuse this trust to commit acts of fraud. However, there is sometimes a gray area where a trustworthy physician inadvertently commits unlawful activity.

If you suspect that you or another staff member accidentally violated the law, it may be in your best interest to voluntarily self-disclose this to the Office of Inspector General. The OIG has a set of protocol to follow that physicians can follow to potentially avoid or mitigate civil or administrative penalties.

Actions that will threaten a medical career

A suspension or revocation of a medical license is one of the biggest threats to a doctor, nurse or other medical professional’s career. It may seem difficult to believe, but even after spending years striving toward their goal, many individuals in the medical field let their license be snatched away.

These are among the many behaviors that can lead to a suspension or even revocation of an individual’s license. If that happens, it is vital to speak with a legal professional immediately. An experienced attorney will know how to work within the medical field and make the strongest case possible to defend a doctor or nurse’s career.

How to prepare for a ZPIC audit

During the course of regular business, durable medical equipment (DME) providers may face audits from zone program integrity contractors (ZPICs) working under Medicare and Medicaid. These audits are meant to root out fraudulent activities. Being selected for an audit doesn’t mean your business is under suspicion, only that an impropriety has cropped up.

First, a little background. The 2003 Medicare Modernization Act created Medicare administrative contractors to oversee the plan’s administration. ZPICs were established to identify fraud, waste and abuse among Medicare Part A and Part B providers, DME prosthetics, orthotics and supplies providers, or home health and hospice providers.

Pharmacists can finally talk freely about drug prices

In the United States, where prescription drugs are not price-regulated by one, powerful agency, such as the federal government, smaller insurance companies must negotiate with these large drug makers. What the drug makers have found is, they have the upper hand. As many of us know, any drug in the U.S. costs significantly more than the same drug elsewhere.

Nothing makes the cost of prescription drugs more real than standing in front of the pharmacist when they give you the total. For that reason, it's common that pharmacists get the blame. Until recently, pharmacists were unable to even disclose cheaper alternatives to the drugs they prescribed. That has changed thanks to the bipartisan efforts of several senators. The Patients Right to Know Drug Prices Act allows pharmacists to share pricing information with customers on employer-sponsored and health care exchange plans, without penalty.

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