A law firm is a simple business entity formed by one or more lawyers, who look after the interest of their clients together. Lawyers in these firms can also allow other lawyers to work with them, who are called associates. In a law firm, all the partners not only share the profits and loss incurred, but also the risks associated with running the firm. It functions similar any other company, however in most companies lawyers cannot raise money through IPO’s, which is why conflicts of interest is often not there in this type of business.
Since its passage in 1989, the now ubiquitous federal law known as the Stark Law has driven the business behavior of health care providers of many kinds. Recent developments, however, make us wonder whether the end of Stark is near, and if so, whether that’s a good thing.
By way of background, the Stark law has two components: part one, a self referral prohibition, generally forbids physicians from referring to a provider of any “designated health service” (DHS) (e.g. MRI, PT, clinical lab) if the physician or his/her immediate family member has a financial relationship (including ownership interest) with the provider of the service. Part two mandates that certain compensation arrangements between healthcare providers meet certain requirements. Things like medical director agreements, management agreements, employment and independent contractor arrangements have been regulated by the law since its inception. Most notably, for purposes of this article, one provision (the “In Office Ancillary Services” exception or “IOAS”, also known as the “Group Practice Exception”) has allowed medical practices to provide all sorts of “ancillary services” to their own patients. That is the key aspect of the law that is lately coming under serious attack.
Regulatory Rumblings re IOAS
In October, 2012, a Government Accountability Office (GAO) report to the Senate Finance Committee was critical of the financial impact of physicians being able to provide diagnostic imaging services to their own patients. Even more recently, another GAO report was critical of the same dynamic with respect to anatomic pathology. On August 1st, the GAO issued yet another critical report, this time targeted at the practice of urologists referring patients to IRMT services that provide a financial benefit to the referring physicians. Congressman Pete Stark himself (voted out of office last year), on August 2nd, stated that the Stark Law had become overly complex and was full of loopholes that conflict with the original intent of the law, which prohibited anyone taking a bribe, commission or kickback in exchange for referring a patient.
But wait, there’s more! This month, Congresswoman Speier (CA) introduced a proposed law aimed at doing away with the IOAS altogether. HR 2914, the “Promoting Integrity in Medicare Act of 2013″ (PRIMA”) would prohibit self referral altogether for advanced imaging, anatomic pathology, radiation therapy and physical therapy. If it becomes law, HR 2914 will:
Substantially reduce the kinds of services that “group practices” may provide to their own patients
Create a $25,000 civil monetary penalty per violation
Create a $150K fine for wrongful referrals
Require DHHS to review compliance six month after becoming law
Applies the anti markup law to the technical or professional component or any (newly defined) “non ancillary service”
Creates a new category of impermissible referrals within group practices, “non-ancillary services” which are not usually provided and completed during a physician office visit and determined to be necessary. Those services include-
*The technical or professional component of (i) surgical pathology, (ii) cytopathology, (iii) hematology, (iv) blood banking, or (v) pathology consultation and clinical lab interpretation services
*Radiation therapy services and supplies
*Advanced diagnostic imaging studies (which include for instance MR and CT)
*Physical therapy services
The prohibitions, if they become law, would be effective 12 months after becoming law.
Support for the Law
Those who think the proposed law has no chance of passing and who continue to think the sacred nature of the IOAS aspect of Stark is unassailable, have to consider that the alleged cost-saving concepts in the proposed law has the support of the following organizations-
Medicare Payment Advisory Commission
American Academy of Dermatology
Alliance for Integrity in Medicine (coalition of medical societies)*
The American Society for Radiation Oncology
The American College of Radiology
The American Society for Clinical Pathology
The Wall Street Journal
The Washington Post
The Baltimore Sun
*AIM members include American Clinical Laboratory Association; American College of Radiology; American Physical Therapy Association; American Society for Clinical Pathology; American Society for Radiation Oncology; Association for Quality Imaging; College of American Pathologists and Radiology Business Management Association.
Interestingly, the Bill recites the CMS rationale for the IOAS: “to permit physicians to provide ancillary services in their offices to better inform diagnosis and treatment decisions at the time of the patient’s initial office visit.” The Bill strikes at the rationale by citing support for the assertion that a large majority of ancillary services provided by physician offices are not actually provided at the time of the patient’s initial office visit.
If passed, the Bill has the ability to strike a hole in the heart of many medical business models that are near and dear to physicians. For instance, a lot of the large medical group migration being observed is founded in good measure on the existence of the IOAS and the desire among physicians to provide more services and to expand their existing lines of business.
The Bill is another misguided and self- interested attempt at cost cutting. Bill supporters are clearly in a position to financially benefit from cutting medical practices out of ancillary services. The bigger issue, however, is the ever-increasing role of business in medicine.
The IOAS is one tool in the toolbox of attorneys and consultants who assist physicians in growing the business foundation and continuity of care offered by physician owned medical practices. The Bill would not work to reduce the volume of ancillary services. It would merely shift the provision of those services away from [less expensive] physician owned medical practices and into the hands of corporate (including hospital) owned medical practices which charge more for the same services.
The Bill is simply a physician robbing measure, since the IOAS is not a limiting factor for those non-physician owned practices. It is also a way for businesses that compete with physician practices to grab at the ever shrinking healthcare dollar. Moreover, though the Bill would give practices 12 months to restructure and divest, there will be strong foundations for litigating what amounts to a “taking” of the many millions of dollars invested by physicians in their ancillary business structure which extends to costly equipment and facilities, all of which is ironically billed far below the cost of what will now be charged entirely by corporate owned practices.
Physician organizations like the AMA and FMA need to scratch behind the rhetoric and step up to the plate to call things as they really are. Legislators need to be more aware of the difference between positioning and real policy-making, which is especially tough when policy makers are not even affected by the healthcare decisions they make.
Practices focused on the Bill will have to be cautious re planned ancillary expenditures, planned hiring and expansion. Moreover, practices that fuel the expense of departing shareholders with ancillary revenues will have to reexamine their corporate plans in the even the Bill’s traction continues. In short, the Bill is a game changer. It is also a call to arms. Who will answer?
Personal injury lawyers are people who specialize in getting clients compensation for harm that has come to them. These lawyers work with the intent to show that one person or organization has wronged another by being neglectful or irresponsible. Anyone who has been injured either physically or mentally has a right to seek counsel with this type of attorney. However, because there are so many lawyers in competition, a prospective client must follow a certain protocol before choosing one for his or her protection. A winning attorney or law firm will have certain qualities. The following are some elements to look for when attempting to select the best attorney for personal injury:
Facts About the Firm
Every respectable personal injury law firm should have a website. A majority of people search for goods and services online. To consider a law firm, a prospective client should be able to visit the website for certain information. He or she should be able to read a brief paragraph about the history of the firm and the people who work for it. A prospective client should also be able to find contact information very quickly. He or she should have access to a telephone number, e-mail address, or branch location to visit. Such information shows the legitimacy of the firm.
A respectable law firm provides certain accommodations for prospective clients. One accommodation that many firms offer is a free consultation. A free consultation allows the lawyer and prospective client to form a relationship. The lawyer gets to learn more about the case while the prospective client gets to form an opinion about the attorney. A free consultation is a kind gesture that shows a person that the law firm is not all about making money. It shows compassion for people who may not have the funds to pay for the first meeting.
A personal injury attorney with a high level of integrity will have positive reviews from former clients. Whenever a person receives stellar representation from an attorney, he or she will note such in a review or comment. Customers love to inform other customers of a firm that has provided superior service. Anyone searching for a good personal injury lawyer should try to locate these comments on the firm’s website.
One of the most important attributes a top-notch attorney will have is attentiveness. A prospective client can measure the attorney’s attentiveness during the very first contact. An attentive attorney will make contact with a prospective client very quickly. He or she will show a high interest in that person’s case and his or her situation. Additionally, he or she will remember important facts and information.
Anyone who needs help with a personal injury situation should compare several firms before choosing. Selecting the best attorney is an important step in the process. A good firm can make a difference in the outcome of a case. Therefore, the prospective client should take his or her time to make sure he or she chooses a certified firm with a great reputation.
Personal injury lawyers help you obtain justice and compensation after you have been injured by another person. These lawyers typically work in a field of law that is known as “tort law.” The basic premise of tort law is that victims should be able to sue the other person who is at fault for causing an injury to them.
Personal injury lawyers are involved in your case from the moment that you meet with them. When you meet with personal injury lawyers, you will first discuss what happened in your case during the initial consultation meeting. The initial consultation meeting gives you a chance to fully explain everything that happened in your case. It is important for you to take as much paperwork as you have to this meeting. The lawyer will be able to review your paperwork and decide whether he or she wants to add your case to his or her current caseload. You should also bring any photographs, videos or other evidence of the accident that occurred and caused your injuries.
You should not worry if your videos or photos are on a camcorder, smartphone or computer. If you want, you can even bring your laptop to the meeting. While attorneys are formal individuals, they also want to see the direct proof of the negligence that occurred in your case. They have handled many different types of evidence throughout their careers and will be expecting to see the evidence for your case. Presenting the evidence to your lawyer may also convince him or her to accept your case.
It is also important for you to explain any prior health issues that you had before the accident. A lawyer will have to take this into consideration when he or she presents your case to the jury. The jury may mistake your prior health issue for the cause of your injuries at the time of the accident. The job of a lawyer is to show that your prior health condition was not the cause of the accident or played no role in inflaming a heart attack or other sudden medical condition. One of the personal injury lawyer’s main tasks will be to anticipate the issues that the opposing counsel can raise at your trial in order to have your case dismissed. A case dismissal means that you are awarded no damages and that you do not have another change to file a lawsuit against the person who caused your injuries.
As you can see, it is essential for you to be upfront and direct about the facts of your case. You should always err on the side of disclosure with your attorney. Too many clients wait until a trial to tell a lawyer at the last minute that they had a bad heart condition or were suffering from a lack of medication at the time of the accident. You can ensure that your case is handled in a successful way if you are fully honest with your lawyer from the first meeting.
It now seems as if Tiger Woods and his Swedish wife, 29 year old Elin Nordegren, are getting divorced. Nothing unusual per se, as over one million Americans get divorced every year. What is unusual though is the way the divorce settlement is looking to shape up. Bookmakers are now putting their money that the final settlement will result in Elin Nordegren being awarded as much as $500 million, half of Tiger Woods estimated wealth. Any way you choose to look at it, this is a staggering amount and one that begs the question: Are divorce laws unfair to men?
Is the idea that women deserve half their husband’s wealth after divorce an antiquated idea in our modern society?
Several experts on family law think so. The argument is that divorce laws are a left over from a time, when women were supposed to stay at home after marriage to care for the family and children. But in a time were women are not only encouraged to seek equal opportunity in pay and employment, but actually outnumber men in many high paying fields and education, does it still make sense that society calls for women to take half the husband’s wealth? Divorce laws imply that the role of the man is to be a provider, while the woman to be the housewife. This seems to contradict everything else the equal opportunities movement has fought for.
Several divorce and family law experts are now speaking out on this. They feel that alimony pay should only be paid in the cases where the woman is unable to work due to old age or small children that require care. In all circumstances the alimony payments should be stopped when the woman remarries or takes up employment that outpay alimony.
Only assets acquired after the marriage should be divided and even then, according to some, should not all assets be divided 50-50. The claim that women should be compensated for their lack of career or opportunity to further education is false, experts say. The fact of the matter is that housework needs to be done whether single or in a relationship. Many couples live together unmarried and have similar arrangements in the home, yet no one would dream of implying that this stops the woman from working or studying.
It becomes all the more clear in cases where the husband earns a significant income and employs domestic help. In these cases, paying a woman for not doing much else than simply living, is actually punishing the man for leaving. It also aids in discrimination from employers who worry they will lose female employees as soon as they get married.
This unfortunately leaves a sour taste for many men, who feel like divorce settlements are simply nothing more than revenge from a woman scorned, sanctioned by the courts.
Unfortunately, as witnessed with the outrageous sums mentioned in the Tiger Woods case, there is not much to suggest that divorce laws are about to change.
The best advice to give men in a divorce situation is therefore to learn everything they can about how the process works before consulting a lawyer. Staying civil trough the divorce process can be difficult, particularly when emotions are running high but it’s the best way for men to aid their case.
This article is intended for those who have little to no knowledge of solicitors and their role within society. Many people feel reluctant to approach solicitors, hoping to settle legal matters out of court themselves. However consulting a solicitor is best advised in order to help the client benefit from the legal matter.
Traditionally speaking, solicitors are lawyers who deal with any legal matter apart from conducting proceedings in court, with only a few exceptions. In Britain, the legal profession is generally split between solicitors and barristers, with a lawyer usually holding just one title. The distinction between solicitors and barristers however is most often retained.
Before the unification of the Supreme Court in 1873, solicitors would practice in courts of equity, whilst attorneys would do so in the common law courts, with only some exceptions. However after 1873 the title of ‘attorney’ disappeared in the UK, being replaced by ‘solicitor’ in all courts.
Solicitors in England and Wales are generally represented by the Law Society of England and Wales, and therefore pay their fees to them. The Solicitors Regulation Authority and Legal Complaints Service act separately and independently of the Law Society, but together make up the complete system of professional regulation for solicitors. This is the same for all solicitors around the country, including solicitors Dorset.
Training and qualifications are regulated by The Solicitors Regulation Authority, and as such prospective solicitors must first possess a qualifying law degree, or otherwise undertake a conversion course. Many solicitors in Bournemouth that I have spoken to received their degree at the renowned universities such as Durham, London and Oxford or Cambridge.
After their initial degree prospective solicitors must then enrol in the Law Society as a student member and take a one-year course called the Legal Practice. This is usually followed by two years in an apprenticeship or training contract, before being fully qualified to handle clients. My local law firms in Bournemouth make sure all their employees have undertook this programme before they start in order ensure the best quality service for their clients.
Recent developments in the field, particularly in England and Wales, have shown that the strict separation between the duties of solicitors and barristers has slightly broken down. As a result, solicitors often appear not only in the lower courts but also increasingly in higher courts. Some law firms, including law firms in Bournemouth have followed this up by employing their own barristers and solicitor advocates to do some court work.
This breakdown is expected to deepen in the next few years.