Jones Health Law Podcast

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When a physician provides a service, the reimbursement amount for that work is often measured through a metric referred to as work relative value units (wRVU). Although not every physician may be subject to wRVUs, such as physicians who have their own private practice, many physicians who work in large healthcare organizations may be required to meet a minimum amount of wRVUs.

The goal of the wRVU model is for physicians’ compensation to be directly correlated to the amount of work they perform, regardless of the patient’s insurance plan or the revenue generated during the services. Focusing on the amount of work performed has proven to be more effective than the previous method of tracking a physician’s productivity by the number of patients seen and number of services performed. Additionally, calculating reimbursement simply off the amount charged to the patient can be ineffective as well because the amount does not necessarily reflect the underlying value of the work provided. As such, the current wRVU model is the standard compensation model that many physicians and employers use in the healthcare industry.

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Record Keeping

Fla. Stat. §456.057(13) of the Florida statutes states that “records owners shall notify the appropriate board office when they are terminating practice, retiring, or relocating, and no longer available to patients, specifying who the new records owner is and where medical records can be found.”

As defined in the statute, a records owner means:

• Any health care practitioner who administers treatment, dispenses drugs, or generates a medical record after making a physical or mental examination of any person.
• A health care practitioner to whom records are transferred by a previous record’s owner.
• Any health care practitioner’s employer provided that the agreement designates the practitioner’s employer as the records owner.

Notification of Changes

In addition to notifying the appropriate board office when retiring, closing, or relocating their practice, a record’s owner must also place an advertisement in the local newspaper or notify the patients in writing of the change, pursuant to Fla. Stat. §456.057(12). The patients of the practitioner must have the opportunity to request a copy of their medical record. According to Fla. Stat. §456.057(14), when a new records owner has been appointed, the new owner is responsible for providing a copy of the complete medical record to a patient or a patient’s legal representative who has requested the record.

Outside of notifying the appropriate board office and patients, practitioners may need to notify the Centers for Medicare & Medicaid Services and the U.S. Drug Enforcement Agency to comply with the appropriate disposal of the drugs within the practice. If the practitioner holds a license from the Department of Health for their use of medical equipment, they must notify the department and keep a record of the transfer or disposal of the equipment. Other establishments that may need to be notified include the Florida Agency for Health Care Administration, the hospital where the practitioner worked if applicable, other vendors whom the practitioner may have received supplies or equipment from, and the practitioner’s medical malpractice insurance carrier.

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The United States Department of Treasury’s Financial Crimes Enforcement Network (FinCEN) is required through the Corporate Transparency Act to prevent and protect the community from fraud and illicit activities involving U.S. companies. In 2021, the Corporate Transparency Act was enacted and took effect on January 1, 2024.

Beneficial Owners of any U.S. reporting company are required to file a report. Beneficial Owner is defined by the Corporate Transparency Act as any individual who, “directly or indirectly, (1) exercises substantial control over the entity or (2) owns or controls not less than 25 percent equity in theentity.”

A complete list and compliance guide are available on the FinCEN Q&A website (https://www.fincen.gov/boi-faqs#B_2).

Beneficial Ownership Information Reports can be filed using the BOI E-Filing System at: https://boiefiling.fincen.gov/

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Per the Board of Nursing, if a specific act is questionable, a declaratory statement may be requested to provide clarity. The Board of Nursing defines a declaratory statement as a means for resolving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules, or orders over which the board, or department when there is no board. On September 26, 2022, Jessica James, a registered nurse (R.N.) from Pensacola, Florida requested a declaratory statement on clarification for the task delegation of Botox Cosmetic. The case referenced Florida Statute § 464.003, specifically quoting, “The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.” Jessica James’ request went on to identify some prerequisites in her case for Botox task delegation eligibility by stating that the physician would first examine the patient and write an order detailing the specific muscles to be injected as well as the units per injection site before delegating the task to a registered nurse.

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The Americans with Disabilities Act (ADA) is a comprehensive civil rights law in the United States that prohibits discrimination based on disability in everyday activities, including medical services. The ADA applies to healthcare providers and has implications for how they must treat individuals with disabilities to ensure equal access to medical services.

Title II of the ADA applies to public hospitals, clinics, and health care services operated by state and local governments. Title III of the ADA applies to privately-owned and operated hospitals, clinics, and health care providers. Under Title III of the ADA, businesses that provide services to the public are called public accommodations. Public accommodations are private entities such as a doctor's office, a dentist's office, a psychologist's office, a clinic, a hospital, a group practice, urgent care, a general physician, a physical rehabilitation facility, or other healthcare professionals.

All public accommodations must comply with basic nondiscrimination requirements prohibiting exclusion, segregation, and unequal treatment. Furthermore, the ADA requires healthcare providers to make reasonable accommodations to ensure that individuals with disabilities have equal access to medical care and health facilities.

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Health and Safety laws are regulated by various agency officials and theses are arguably the most crucial jobs in our community. Most people do not take the time to adequately research their healthcare providers prior to receiving healthcare services or medication. However, several agencies have been established to safeguard and regulate the health and safety of the healthcare services that consumers receive. These agencies can’t replace individual due diligence but they make every attempt to prevent patient harm and to eliminate fraudulent activity in the healthcare system.

Florida Department of Health

The Florida Department of Health (DOH) was the first accredited public health system in the United States. Their mission is to protect and improve on the health of all people in Florida by regulating healthcare practitioners and facilities. They offer programs and services for the Florida community, but they are also responsible for the licensing and regulation of various healthcare practitioners and facilities. Various healthcare professions must be licensed and are regulated via the Florida Department of Health such as: medical doctors, acupuncturist, optometrists, and many more. Certain facilities such as piercing salons and pharmacies are also regulated by the Department of Health. Complaints can be filed against any of the practitioners or facilities, which will then be investigated by an officer for violations. The complaint is referred over to the Probably Cause Panel, which will determine whether to file an Administrative Complaint against the healthcare provider based on the weight of the evidence that is provided by the complainant and the provider who under investigation. It is not uncommon for the DOH to place an emergency restriction on a provider’s license if they pose an imminent danger to patient safety. If a violation is found, the Department of Health will determine appropriate disciplinary action to enforce the regulations, which includes, probation, suspension, or even revocation of a healthcare provider’s license.

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Once a real estate purchase reaches the closing process, there are many standard and procedural documents that must be signed and notarized. All closings require many pages of paperwork filings and signatures from all parties in a transaction. Traditionally, parties would need to sign documents and appear at a physical location at a predetermined time to have signatures verified and notarized. Many states have now adopted laws that allow for virtual signature verifications.Remote Online Notarizations(also known as RON) are the backbone of remote closings. Without Remote Online Notarizations (RON), it would not be possible to conduct a remote closing. Florida became the twenty-first state to adopt remote online notarizations. On January of 1, 2020, Governor Ron DeSantis signed House Bill 409 into law allowing for Florida to accept closings using the remote online notarization system. This came at a convenient time for Florida’s real estate market with the looming pandemic soon to be underway. This new process streamlined the closing of transactions within the State of Florida.

Some states do not accept remote online notarizations but provide other options for online notarizations. Remote-Ink Signed Notarizations, (known as RIN), are notarizations with wet-ink signatures. Parties are able to use a video conference technology such as zoom to appear before a notary and sign documents virtually. The documents are then sent to the title company for processing.In-Person E-Notarization(also known as IPEN) are notarizations where closing documents are signed electronically but not remotely. This method merely eliminates the paper involved in signing. While this method is not technically ‘remote’ it cuts waste on paper and allows an electronic signature as an alternative to a ‘wet ink signature’.

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In May 2023, Florida House Bill 264 passed, and it went into effect on July 1, 2023. The bill has two main parts: the first prohibits offshore health record storage, and the second requires additional ownership disclosures.

he first part of the bill is an update of the Florida Electronic Health Records Exchange Act. This amendment prohibits healthcare providers using certified health record technologies from storing electronic health records outside the continental United States, its territories, or Canada. This prohibition extends to patient data stored through third-party cloud services and subcontracted computing facilities, which must maintain the data in the continental United States, its territories, or Canada.

Once the ban takes effect, it will no longer be possible to use vendors that do not store patient data in the continental United States, its territories, or Canada. All healthcare providers covered by the Florida Electronic Health Records Exchange Act must comply with the law by July 1, 2023. The prohibition applies to all qualified electronic health records stored using any technology that allows information to be electronically retrieved, accessed, or transmitted.

The purpose of the prohibition is to prioritize patient privacy by ensuring that personal health data remains within jurisdictions where privacy and security measures can be enforced. Offshore storage has raised concerns due to potential security breaches and varying data protection standards across countries. By mandating storage within the continental United States, its territories, or Canada, Florida aims to mitigate the risks associated with data breaches, unauthorized access, and potential exploitation of patient information. While these new regulations offer essential benefits such as increased privacy protection and informed decision-making for patients, there are also potential challenges to consider. These include increased costs for healthcare providers, technological limitations, implementation and compliance challenges, and the potential disruption of existing partnerships.

In many states, homeowners have the option of using what’s called a Homestead Exemption to reduce the amount of property tax owed on their home per year. The exemption is a property tax break that lowers the taxable value of a home. Property taxes are assessed by the local taxing authority and are calculated based on the assessed value of the property and location. The Homestead Exemption also serves as a provision to protect against bankruptcy and creditors in the event of a homeowner’s passing. The exemption provides surviving spouses with continued lower tax and asset rates. The allowable Homestead Exemption differs based on which State the primary residence is in and does not lower or affect the assessed value of a home. In some states, a homeowner needs to meet certain requirements (age requirements, be a disabled person or a veteran, etc) to qualify for a Homestead Exemption. In Florida, the exemption is available to all homeowners on their primary residence. The Homestead Exemption can reduce the taxable property value by as much as $50,000 a year.

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After the unfortunate death of a young, aspiring nursing student in South Florida (Ms.Stephanie Balais) Florida Representatives filed House Bill 725. It is cited as the “Stephanie Balais Act”. In the products liability case of Stephanie Balais it is noted that her untimely passing was due to a Selenium treatment she received in 2018. It is unclear whether the fault lie with the manufacturer and the batch of products; the individual administering the product; or the lack of established procedures in the event of an emergency.  Liability was never determined in this case, and the case was settled out of court. However, this case prompted the introduction of House Bill 725.

The Act defines Intravenous Hydration Therapy as “a procedure in which high concentrations of vitamins and minerals are administered directly into the person's bloodstream, allowing rapid absorption of higher doses of the vitamins and minerals than if received through food or supplements”. The purpose of the Act is to ensure the safety of patients considering IV Hydration treatments. Due to the rise in popularity and frequency of these treatments, it has become necessary to create safety guidelines to eliminate or at the very least minimize risks for the healthcare and wellness community. This is why any written emergency plan must at a minimum include: (1) the name and address of the hospital closest to the location where the IV Hydration Treatment is being performed; (2) reasons why an emergency transfer may be obligatory; and (3) the medical services that must be utilized in the event of a medical emergency. Additionally, if a health care provider, upon review of the completed self-screening risk assessment questionnaire determines that a patient can’t safely receive an IV Hydration Treatment the provider must decline administering the treatment to that individual.

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