New York Healthcare attorneys of Joseph Potashnik and Associates PC represent Urgent Care providers and practices in all types of regulatory and legal matters.

With the monumental changes in our healthcare system, urgent care services are taking a new role and urgent care providers face numerous challenges, both legal and regulatory. Some of the common issues New York urgent care providers face include:

• The prohibited corporate practice of medicine
• Fee Splitting
• Stark Law and state and federal anti-kickback statutes
• Audits by RAC, MAC, ZPIC, OMIG, or private insurance companies
• Compliance with numerous state and federal statutes and regulations such as HIPAA, Stark, EMTALA, etc.
• Compliance with Medicaid and Medicare regulations
• Government investigations of fraud and abuse
• Business management issues such as practice setup, corporate formation, physician contracts, mergers, and internal compliance, practice purchases and sales.
• Accreditation and credentialing

Our attorneys assist New York urgent care providers with all of these issues.

URGENT CARE REGULATIONS IN NEW YORK

Under New York regulations, Urgent Care should be differentiated from emergency care. The term “urgent care” is reserved for medical providers who treat acute episodic conditions and minor traumas. Emergency services are for the treatment of major traumas, life threatening or disabling conditions.

Urgent care centers may treat unscheduled walk‐in visits and may provide the following services:

• X‐Ray and EKG
• Phlebotomy and Lab Services
• Administration of oral, sublingual, subcutaneous, intramuscular, intravenous, and respiratory medication and IV fluids
• Stich certain laceration wounds

Furthermore, in New York, urgent care centers are required to use the actual term “Urgent Care” in their business name and on their signs as well as on their websites and other materials. At the same time, urgent care centers are not allowed to use the word “emergency”. Emergency care services require special licensure by the government.

NEW YORK URGENT CARE PROVIDER APPROVAL AND ACCREDITATION

In New York, healthcare providers who wish to provide urgent care services must apply for it and be approved by the Department of Health. All existing healthcare providers fitting under NY Public Health Law Article 28 such as hospitals and nursing homes who wish to provide Urgent Care services usually undergo a limited review by the DOH. A private physician practice affiliated with an Article 28 provider is allowed to provide Urgent Care services but only when they become certified or accredited by an organization approved by the DOH or if they become an Article 28 provider.

Non-Article 28 providers who want to provide Urgent Care services need to certified and/or accredited by accrediting organizations approved by the DOH.

Our attorneys can assist New York providers with the DOH approval and accreditation matters.

URGENT CARE CENTERS AND OVERPAYMENT/MEDICAID/MEDICARE/COMMERCIAL PAYOR AUDITS

With the growing number of urgent care centers in the state and the increased volume of treatments, urgent care has come under increase scrutiny by Medicaid, Medicare, and private payor auditors. Insurance audits usually result in overpayment demands and may even lead to various sanctions including exclusion from Medicaid and Medicare, recoupment actions, and more.

New York Office of Medicaid Inspector General has increased the number of Medicaid audits of billing documents submitted for payment by urgent care providers.

The following billing issues are amongst the most focused on by essentially all auditors:

• Billing for services not authorized by Operating Certificate
• Billing for services denied for lack of medical necessity
• Incorrectly identifying provider on the claim
• Using wrong diagnosis codes
• Failing to provide a satisfactory explanation of services
• Orders not signed by qualified practitioners

Maintaining proper billing practices and avoiding unintentional errors (as well as legally questionable activities) are parts of implementing and following an effective compliance plan. Our attorneys assist urgent care practices with creating such compliance plans and protecting them at all stages of Medicaid, Medicare, and commercial payors audits and appeals.