Learn how to rock concierge medicine laws by answering some key concierge medicine legal questions.
Why? Do the math. X number of patients times Y fees means more money with fewer patients and less hassles.
Key Concierge Medicine Legal Issues
However, concierge medical practices face some key legal hurdles, including the following:
- Is concierge medicine considered “the business of insurance” by your state, requiring licensure as an insurance company, or other legal restrictions that force you to abide by specific legal rules?
- Does your concierge medicine practice package and discount medical and other healthcare services, thus exposing you to potential claims of state-law fee-splitting or anti-kickback violations?
- Does the access or retainer fee for the concierge medical practice includes services that are routinely covered by insurance — such as physical exams, routine medical office visits, and routine diagnostic tests?
- Are there “free” or “discounted” services in violation of Medicare and Medicaid anti-kickback laws?
- Does the arrangement comply with participation agreements with your private healthcare insurance companies who insure your patients?
- Are you complying with state and professional rules prohibiting patient abandonment, when you terminate regular private practice patients to try to put them on a concierge medical plan?
- Are you advertising your concierge medical practice, in ways that comply with state advertising rules, and do not overpromise results or effectiveness?
- Are you breaking corporate practice of medicine issues when bundling in spa, massage therapy, or other non-medical services?
- Are you honoring HIPAA or even if not billing insurance, state privacy and security legal obligations (such as making adequate provision ahead of time for breach notification)?
To really rock concierge medicine laws, you have to understand the whole suit of legal rules that could apply to your practice.
Sure, many lawyers can find precedents and draft you a variety of contracts – including a concierge medical practice agreement. But not every concierge medicine attorney understands the value of structuring a practice with an eye toward legal compliance.
Key Concierge Medicine Legal Checklist Items
Here are some items your concierge medicine lawyer should have on your concierge medicine legal checklist:
- Are you participating, non-par, or opted out of Medicare?
- What are the names of the private insurance panels for which you are participating, in-network providers? Do you have the participation agreements and other related documents handy for review by concierge medicine legal counsel?
- What medical or healthcare services would you like to have reviewed (what services would you like to see if you can offer in your concierge practice)?
- Do you have existing practice forms that will now require legal review (e.g., consents; new patient information form;medication record)?
- What policies, procedures, forms and training do you currently have in place for HIPAA compliance?
Concierge Medicine 2.0
Many physicians now think of setting up a private-pay practice, say for functional medicine, anti-aging medicine, or integrative medicine, as more of a wellness consult.
In other words, they want to take the concierge medical idea, yet not limit the “concierge” practice to high-fee, VIP care. The medical focus will be on a prevention, wellness, and maintenance plan, with more attention per visit and without the constraints of Medicare or private insurance.
Our law firm counsels medical providers to structure these kinds of plans and practices.
Structuring wellness models requires understanding concierge medicine law as well as integrative medicine concerns, plus other legal spaces, such as telemedicine law, FDA rules governing mobile medical apps, how to handle physician sales of dietary supplements, intricacies of Medicare opt-out, and other legal arenas–even laws applicable to wearable health tech.
Today’s healthcare consumer is equipped with the ability to instantaneously tap into global medical databases, query their doctor, comparison shop, track quantifiable self data, and handle their care online or via their mobile devices (telehealth, m-health, use of mobile medical apps, and so on). The “extra” services in the concierge medical model might just include telemedicine consultations, or, additional physician involvement in the patient’s own health tracking, which technology now facilitates.
I call it Concierge Medicine 2.0 here, but it’s really the amalgamation of many different forms of delivery of healthcare services, coming together through new healthcare technologies and the ability of medical providers to deliver care anytime, anywhere, through a variety of portals.
This is why our healthcare and FDA lawyers stay abreast of developments on both the health law side for health and wellness services, and the FDA and FTC side for health and wellness products. Today, healthcare is not in silos, and it is critical to understand multiple, overlapping legal domains to best counsel clients.
Contact our legal team for legal counsel relevant to your healthcare clinic, practice or venture.