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Ayesha Mehdi Frontier Health Law, Principle As a health care attorney, Ayesha Mehdi brings dedicated focus to serve the needs of health care professionals and businesses in connection with corporate, transactional, and regulatory matters. She holds a bachelor’s from Walsh College in Michigan, as well as a juris doctorate and a master’s degree in health services administration from the University of Kansas. Ayesha Mehdi serves on the University of Kansas School of Law’s Board of Governors, and is also an active member of national organizations such as the American Health Lawyers Association. Originally from Lahore, Pakistan, Ayesha moved to the United States in 2003. Las Vegas has been home since 2010, and it’s been her privilege to give back by serving with the Children’s Attorneys Project. This November, she will run her first marathon in Athens, Greece! With the love and support of her family, she knows she can overcome any challenge—be it on the marathon course or in life. 

Ayesha Mehdi chosen for leadership program with national health care law association

Las Vegas health care attorney Ayesha Mehdi of Frontier Health Law has been selected for the Leadership Development Program of the American Health Lawyers Association’s (AHLA) Fraud and Abuse Practice Group, starting July 1. She will help provide a forum for other attorneys who represent health care providers, facilities and businesses. After coming to the U.S., Mehdi completed her undergraduate studies in Michigan, followed by law school and graduate school in Kansas. Mehdi and her physician husband spent five years in Kansas before moving to Las Vegas. She launched Frontier Health Law in 2016. The attorney, who grew up in Pakistan, says she always knew she wanted to be connected to the health care field. “I was raised to think of health care as a noble profession,” she says. “You don’t necessarily have to be a physician to make a difference in people’s lives.” Mehdi said it is a priority for her to be connected to leading health care attorneys. As a law student, she had been active with the AHLA, which she believes includes the nation’s top health care law firms and attorneys. When she started Frontier Health Law, she became more active and sought out mentors within the organization. One of her mentors suggested she apply for the leadership program, and she said she felt like it was a logical next step for her. “Being affiliated with AHLA at this level is an incredible honor for me,” Mehdi said. “Over the next year I will be furthering my own knowledge and working with incredible leaders in my profession.” She said she hopes her participation will inspire others, especially young girls — including her own daughter. “I come from a traditional background, and for us, family is the number one priority. As such, many women from my culture are encouraged to stay at home rather than pursue demanding careers. I believe that growth in my career sets an example for my daughter, as well as my son, that women can be good wives and good mothers without sacrificing their personal and professional growth.” Mehdi gives back to the community in other ways. Last year she served on the board for the Clark County Medical Society Alliance and she does pro bono work for the Legal Aid Center of Southern Nevada’s Children’s Attorneys Project, which advocates for children in the foster care system. She also serves on the University of Kansas School of Law’s board of governors and is a member of the American Bar Association’s health law section and the State Bar of Nevada’s insurance and health law section. ABOUT FRONTIER HEALTH LAW Ayesha Mehdi folded her passion for health care and her previous experience managing a cancer clinic into her present practice. Through Frontier Health Law, she focuses on representing physicians, dentists and other health care professionals in Nevada and throughout the United States in the areas of business and corporate law, board investigations and government audits, general counsel services as well as regulatory compliance, including federal Stark and fraud and abuse laws. For more information, call 702-852-2140 or visit frontierhealthlaw.com. MORE ABOUT THE AMERICAN HEALTH LAWYERS ASSOCIATION Founded in July 1997 with the merger of the National Health Lawyers Association and the American Academy of Healthcare Attorney, the nearly 14,000-member AHLA is the nation’s largest 501(c)(3) educational organization devoted to legal issues in the health industry. Its mission is to provide a collegial forum for interaction and information exchange to enable its members to serve their clients more effectively; to produce the highest quality nonpartisan educational programs, products and services concerning health law issues; and to serve as a public resource on selected health care legal issues.

Let’s Talk About Physician Employment Agreements.

    The demand for physicians continues to grow faster than supply. Take charge and negotiate your employment agreements with competent representation. Top five issues to consider: 1. Unreasonable non-competes. 2. Cop out on tail coverage. 3. Vague termination language/no notice and cure provisions. 4. Unrealistic productivity bonuses. 5. One-way Indemnification clauses.    

How much should a covered entity charge for requested copies of protected health information (PHI) aka medical records?

    Copying fees must be “reasonable,” and in accordance with the Health Insurance Portability and Accountability Act (HIPAA). As such, certain costs cannot be included, for example: reviewing the request, searching for and retrieving the requested information, and preparing a summary that was never requested.The Office for Civil Rights (OCR) at the Department of Health & Human Services (DHHS) allows for a maximum flat fee of $6.50 for electronic copies. Regardless, the OCR has recently recommended in its FAQs that “covered entities should provide individuals who request access to their information with copies of their PHI free of charge.” HIPAA does not override state laws that provide patients with greater rights than those afforded to them in federal law (45 CFR 160.202 & 160.203). Nevada allows copying charges of $0.60 per page, and “reasonable” fees for X-rays and other media (NRS 629.061). A state-by-state guide of medical record copying fees is available at: bit.ly/24X8Ltd .    

Closing shop? See below for a brief summary of issues to consider when devising your exit plan.

    🔷 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. ✌️    

State Laws Impacting Healthcare Transactions.

    State regulations are, at times, more stringent than federal regulations and/or guidelines. Below are a number of important state law issues and concerns to consider within a healthcare business context: 📌 First, the transaction must be evaluated pursuant to the state’s “mini” anti-kickback and stark statutes (yes, it’s true, they exist – see, e.g., Nevada Revised Statues (NRS) 439B.420 and NRS 439B.425, available at bit.ly/2a6Iwwp ). 📌 Second, if applicable, corporate practice of medicine restrictions (i.e. restrictions, subject to exceptions, on the employment of physicians by corporations), may impact the structure and governance of hospital-affiliated practice entities. 📌 Third, after identifying any and all notice requirements, licenses, permits, and certifications (such as facility licenses or CLIA certificates), a timeline of such state filings and notifications is always helpful. 📌 Fourth, Certificate of Need (CON) requirements (to prevent unnecessary saturation of facilities and services within the state), may also affect the transaction’s structure. See, e.g., NRS 439A. 📌 Finally, healthcare business transactions face ever-changing regulatory demands, topped with an array of complex legal issues. As such, one must always be on the look out for unique regulatory requirements specific to the transaction. Everything yields to diligence. The depth and variety of Frontier Health Law’s healthcare-related expertise sets the firm apart. Contact today at 702-852-2140, to get your transaction evaluated under both federal and Nevada law. ✌️    

Let’s Talk About International Medical Graduates.

    The 2016 physician workforce report by the Association of American Medical Colleges (AAMC), available at bit.ly/29oTUFM , predicts a significant shortage of physicians in the United States (of up to 94,700 by 2025). To alleviate this pressing issue, the AAMC recommends a “multi-prong approach,” which includes making better use of technology, innovations in health care delivery, and increasing the number of medical school graduates by easing admissions into medical schools domestically, as well as by recruiting graduates from abroad. The top five countries of citizenship for such graduates a.k.a. the International Medical Graduates (IMGs) are: India, United States, Pakistan, Philippines, and China. A number of compliance issues come into play when hiring an IMG. For example, IMGs are prohibited from bearing expenses associated with legal fees and costs associated with securing their visa status. This is because such expenses are deemed the employer’s business expense within the meaning of 20 C.F.R.§655.731(c)(9)(iii)(C). Also see, Kutty v. U.S. Department of Labor, 764 F.3d 540 (6th Cir. 2014). There are also prohibitions regarding non-compete provisions imposed on an IMG physician employee. Given that ignorance of the law excuses not (ignorantia juris non excusa), it is advisable to contact legal counsel early in the hiring process.    

To compete, or not to compete. That is the question.

    Non-compete provisions in employment contracts serve to restrict or limit an employee from competing with the employer after termination of employment. Nevada generally enforces such provisions, provided, however, they are reasonable in scope and duration (see, NRS 613.200(4)). Violations grant the employer the right to seek money damages and/or a preliminary injunction against the terminated employee. A balancing of competing interests approach is applied by Nevada courts to determine the reasonableness of such covenants. Factors include public policy, employer’s protectable interest, undue hardship on the employee, time period and geographic scope. By way of example, a physician’s employment contract with a medical group based in Elko, Nevada, may state that if the physician terminates her employment, she is prohibited from providing similar professional services within a seven mile radius, for a period of one year upon termination. However, such a provision may be deemed unreasonable and detrimental to public interest, since Elko is deemed a “Health Professional Shortage Area” (for more shortage areas across the U.S. see: 1.usa.gov/28LCYpu ). Contact Frontier Health Law today at 702-852-2140, to ensure that your legal rights are protected.    

Did you know that the limited liability company (LLC) and the limited liability partnership (LLP) are relatively new business structures in the U.S.?

    Wyoming passed the first LLC statute in 1977; Texas enacted the first LLP statute in 1991. LLPs generally consist of professionals, such as attorneys and physicians, as partners. To the contrary, LLCs are more versatile with greater management options, as well as protection. If you want to start a LLC in Nevada, the first step is to determine whether your chosen business name is available. Conduct a quick entity name search at the following link: http://bit.ly/2aAoUAh .Hope this helps. ✌️  

Stark Law, anyone?

        “It’s been complicated by people looking for the loopholes—scumbag-type physicians who are trying to get kickbacks and referral fees, aided by very smart attorneys who dream up these things.” – Rep. Pete Stark… on Stark Law. ✨⚖️💉💰✨ Ah! The infamous Physician Self Referral Law a.k.a. Stark Law (42 U.S.C. §1395nn; 42 C.F.R.§411.350 et seq.) – a source of much anxiety for physicians. Below, you’ll find a brief overview of Stark Law, followed by a quick and dirty guide (courtesy of Quarles & Brady, LLP for the Health Care Compliance Association) on identifying a Stark Law violation. In a nutshell, Stark Law prohibits all physicians (not just scumbags) from referring certain designated health services (DHS) payable by Medicare to an entity with which the physician or an immediate family member has a financial relationship…unless, an exception applies. And this is the part where SMART lawyers come in. Folks, beware! Stark Law is a strict liability statute, which means ignorance of the law, good intentions, or bad counsel, does not exempt you from penalties. Furthermore, Stark Law may not impose criminal penalties, but its civil penalties, such as monetary penalties of up to $100,000 for “circumvention schemes,” are soul-crushing, enough. To identify an arrangement that violates Stark Law, ask yourself the following four questions: 1. Is there a financial relationship between a referring physician (or the physician’s immediate family member) and the DHS entity? 2. Did the physician make a referral for the DHS? A referral by a physician for a DHS that is performed by the physician, is not a “referral.” 3. Is the referral made for the specific categories identified as DHS? 4. Lastly, is the DHS payable by Medicare? Note, that the Department of Justice and many courts, hold the position that Stark Law is applicable to Medicaid for the purpose of False Claim Act allegations. An answer of “yes,” to any of these questions implies that Stark Law is violated, unless an exception applies. The exceptions are complicated, and begs the necessity of an attorney knowledgeable in Stark Law to review the arrangement, and help physicians identify the correct category of an applicable exception, if any. In closing, since its enactment in 1989, the framework of Stark Law has lead to a voluminous body of interpretations and commentary that does not, necessarily, give physicians the liberty of indulging in business ventures or referring relationships without help from competent counsel. Like it or not, docs cannot do without them darn healthcare lawyers, if they want to legitimately grow their medical practice.