🔷 Notification to Patients:
Physicians have an ethical obligation to support continuity of care for their patients. Practitioners licensed by the Nevada State Board of Medical Examiners and the Nevada State Board of Osteopathic Medicine (collectively, the “Board(s)”), are subject to the provisions of the Nevada Revised Statutes (NRS) 630 and 633, respectively. Pursuant to both statutes, terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient, is grounds for initiating disciplinary action. (NRS 630.304; NRS 633.511). Although NRS 630 and its respective regulations fail to define “adequate notice,” NAC 633.070 interprets it as written notice that is delivered to the patient’s last known address, at least 30 days prior to terminating care (absent exigent circumstances).
🔷 Notification to the Board and Other Third Parties:
If a practitioner changes her address within Nevada, she must provide the Board with a written notice of her new mailing address. Such notice must be delivered to the Board 30 days prior to commencing her new practice. (NRS 630.254; NAC 633.260). If a practitioner closes shop and moves to another state, the Board of Medical Examiners requires a written notice within 14 days of such closure, while the Board of Osteopathic Medicine requires a written notice within 30 days. Practitioners are further obligated to keep their respective Boards informed of the location of their patients’ medical records for a period of 5 years (or longer, if the patients are less than 23 years of age and/or as required by federal law). (NRS 629.051). Finally, relevant third parties, such as the state and federal drug enforcement agencies, hospitals, and payors, also require updated contact information pursuant to the law, bylaws, and/or other agreements.
🔷 Patient Access to Medical Records:
The Health Insurance Portability and Accountability Act (HIPAA), Nevada law, and the American Medical Association’s (AMA) Code of Medical Ethics, all require proper retention, use and release of medical records. Practitioners also face harsh penalties for electronic medical data breaches under the American Recovery and Reinvestment Act of 2009 (ARRA)/HITECH Act. Hence, it would be prudent for practitioners to ensure a written contract between themselves and the custodian of their patients’ medical records, delineating each party’s rights and responsibilities pursuant to the law.
🔷 Dissolution/Sale of Practice:
Dissolution or sale of a medical practice comes with its own set of business, tax, and compliance implications. For example, practitioners may be required to submit certain documentation to the Secretary of State, or the Internal Review Service (IRS) (see IRS’ checklist at: 1.usa.gov/28ZJzxs ). Further, the sale of a medical practice must pass federal and state regulatory muster under the anti-kickback and physician self-referral laws. Finally, to avoid being on the receiving end of lawsuits and injunctions, practitioners must also be cognizant of their rights and obligations upon termination of their business agreements. Issues to consider are non-compete clauses, rights to accounts receivables, equipment leases, and tail coverage.
🔷 Competent Guidance:
Health care is highly regulated on both federal and state levels, and closing shop requires several years of planning. Such long term planning helps ensure that the practitioners maximize and protect their assets, while easing the transition for their patients and staff. Hiring counsel well-versed in health law is never a bad idea (really). Furthermore, guidance from a proficient accountant is also warranted. ✌️