FAQs about Health Care Representation

Look to our health care law firm for guidance

Is your hospital in compliance with HIPAA and the Affordable Care Act in Hawaii? Has a whistleblower filed a complaint against your medical practice for Medicaid fraud? How should you respond? What should you do? We can help you find the answers to these complicated questions at Torkildson, Katz, Moore, Hetherington & Harris, Attorneys at Law. Our experienced Hawaii health care attorneys work with hospitals, physicians, surgeons and other health care providers to solve such problems. Schedule an appointment with one of our skilled attorneys.

Our law firm offers a broad spectrum of legal services to clients doing business in Hawaii. This includes cases involving compliance with state and federal health care laws, certificates of need, credentialing for medical staff and the formation of health care facilities. The following questions focus on topics our law firm regularly deals with in Hawaii with health care providers.

What is the False Claims Act?

Created in 1863, the False Claims Act targets government fraud. Specifically, the False Claims Act grants private citizens the right to report fraudulent spending of government funds. In exchange, whistleblowers who report such fraud receive a percentage of the money recovered by the government.

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What does the False Claims Act have to do with health care law?

Allegations of fraud often involve government-funded health care programs like Medicare (federal program for people over 65 years old or younger people with disabilities) and Medicaid (federal-state program for people with limited income).

Many False Claims Act lawsuits or allegations of wrongdoing involve fraudulent spending of Medicare or Medicaid funds. Our law firm defends health care providers facing False Claims Act accusations and works with clients to make sure they are in compliance with state and federal laws.

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What is qui tam law?

Qui tam law dates back to the 1300s, when England's King Edward II financially rewarded people who reported fraudulent government spending. Today, qui tam law in the United States is primarily covered by the False Claims Act. However, other laws can also apply in certain circumstances. In particular, government workers who report allegations of government fraud are protected by the Whistleblower Protection Act. In addition to the federal False Claims Act, Hawaii has its own False Claims Act that targets mishandling of state government funds.

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What does qui tam law have to do with health care law?

Accusations of fraudulent spending by private companies or government agencies often involve health care-related matters. In particular, an employee or sometimes a patient or someone else who suspects wrongdoing might file a qui tam lawsuit against a private health care provider that receives state or federal funding. Our False Claims Act and qui tam defense lawyers frequently represent physicians, hospitals, nursing homes and other health care companies accused of such serious allegations.

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What is a certificate of need?

In Hawaii, hospitals and other health care providers must obtain a certificate of need (CON) if they want to expand their business, open another facility or purchase another health care provider. Our law firm represents companies applying for a CON in Hawaii, a process that can take 90 days or more to complete.

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What is HIPAA?

Enacted in 1996, the Health Insurance Portability and Accountability Act (HIPAA) provides health care coverage for people if they lose their job or change jobs. HIPAA was also designed to eliminate health care fraud and create standard electronic billing methods.   Compliance with the HIPAA regulations governing the privacy and security of patients' health care records is a critical issue, not only for health care providers and insurers, but also for employers who participate in administration of their employee group health plan.  Our attorneys are ready to assist with:

  • Preparation of privacy, security and breach notification policies and procedures
  • Assessment of privacy and security breaches and development of appropriate response plans-including breach notification
  • Employee training programs
  • Preparation of Business Associate Agreements that will protect you from the consequences of privacy or security breaches by contractors with whom you share protected health information

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What are common Affordable Care Act Compliance issues?

The Patient Protection and Affordable Care Act contains provisions intended to provide health care to every legal resident in the United States. As a result, this law prohibits health insurance companies from denying coverage to people with pre-existing medical conditions. The law was also created in an effort to provide health care to people, regardless of their income. Businesses must comply with all of the regulations contained in this law with regard to providing health care to their employees. Otherwise, they could be fined or possibly face criminal charges for failure to comply with the Affordable Care Act.

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What are common physician recruitment issues?

Any job search must be conducted in accordance with applicable state and federal employment laws. This is especially true when it comes to hospitals and other health care providers recruiting physicians. Our law firm has years of experience working with companies actively recruiting physicians. As a result, we're familiar with how to legally advertise for the position, conduct the interview process, facilitate contract negotiations and manage other aspects associated with recruiting and hiring qualified, experienced physicians.

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What are common hospital medical staff credentialing issues?

Hospitals, health care facilities and individual medical staff (surgeons, doctors, anesthesiologists, nurses, etc.) must be properly licensed to legally provide health care services in Hawaii. Specific boards and review panels often must verify that a particular facility or individual has the qualifications to provide such services to the public. If an individual or health care company does not have the proper license, such individuals or businesses could be held legally liable for their actions if a patient suffers health issues. Insurance providers will also often refuse to reimburse unlicensed doctors or hospitals. That is why credentialing is such an important issue in Hawaii.

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What role does risk assessment and mitigation play in health care?

Many health care compliance issues arise because health care providers do not take the time to properly assess the risks of certain procedures or protocols and fail to create a system for addressing such issues. The more work health care providers do to prevent problems from occurring (including fraud, waste and medical errors), the less likely such situations will arise in the future. Our attorneys have extensive experience working with companies on risk assessment and mitigation in the health care field in Hawaii.

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What are common health care fraud and abuse issues?

Overbilling, billing for services not performed and falsifying medical records in an effort to conceal fraud are just some examples of health care fraud and abuse. Sometimes, health care facilities had no knowledge such illegal activity was occurring at their facility. Other times, health care providers knew and attempted to conceal such information. In either case, a health care provider could be held responsible if the company did not have the proper compliance procedures or policies in place to prevent such activity from occurring.

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What are common legal issues involving formation of health care facilities?

Health care companies typically need approval from local, state and federal boards and agencies to open a hospital, medical practice, nursing home or other health care facility in Hawaii. Legal issues involving real estate transactions, tax planning and labor and employment law also often come into play when forming a new health care company, expanding an existing business or purchasing a new one. All of these issues and many more fall under an area of the law known as formation of facilities. Contact our law firm for more information on how we can help your health care company grow and expand in Hawaii.

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