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Breaking News - Founding Dean Barbara Atkinson was honored with the 2019 Women of Distinction Award in the Medical/Healthcare Services Category. The National Association of Women Business Owners Awards Luncheon was held May 7th at the Conference Center of Las Vegas.
Making the Rounds with Founding Dean Dr. Barbara Atkinson
 Issue 193 - May 7th, 2019
Dear Friends and Colleagues,

At the recent annual gala benefiting the Adelson Educational Campus, an academically invigorating preschool through Grade 12 independent school based on Jewish values and identity, my special assistant, JoAnn Prevetti, struck up a conversation with Crane Pomerantz. He's a Las Vegas attorney who has specialized in healthcare law, both as an Assistant U.S. Attorney and in private practice. The more Joann talked with Mr. Pomerantz, the more she realized that his experience could benefit our students. So she invited him to campus. The other day he graciously came to talk with several residents who are largely concentrating on their internal medicine specialty, young men and women about to embark on their careers. What he had to say accomplished what he set out to do -- helped sensitize them to some of the real world legal, ethical and business issues they could one day face. From today’s newsletter, I trust you’ll get a better sense that not everything a doctor needs to know can be found in medical textbooks.
Barbara signature, first name only

Attorney Crane Pomerantz, seen here with Dr. Budda Dawn and some internal medicine resident physicians, has worked as a federal prosecutor and in private practice, handling many noteworthy cases.
As attorney Crane Pomerantz spoke to UNLV School of Medicine internal medicine residents -- physicians who have finished medical school and who are now receiving training in their chosen specialty -- he emphasized that young doctors just starting their careers can unwittingly end up in legal trouble.

“You are...about to embark on a career that is highly regulated -- as highly regulated as any industry I can think of,” he said at a powerpoint presentation delivered during a weekly “Academic Half Day” held every Tuesday afternoon for residents. “The problem you face at this point in your career is that you don’t know what you don’t know. My goal today is to give you a brief overview of some of the things you need to be aware of as you start practicing.”  

Pomerantz definitely knows his way around healthcare law. He was the criminal healthcare fraud coordinator in the U.S. Attorney’s Office for the District of Nevada, where he worked for almost 14 years. Prior to his tenure as a federal prosecutor, Pomerantz worked in a pair of large Washington, D.C. law firms, where his practice focused on healthcare fraud and abuse litigation and counseling. He began his career at a Boston law firm, where his work focused on healthcare fraud defense.

Four years ago, Pomerantz was doing something far different than talking to medical residents. He stood in a Las Vegas courtroom as an Assistant U.S. Attorney and spoke of a physician, Dr. Dipak Desai, who intentionally defrauded the government by inflating the length of medical procedures and overbilling Medicare, Medicaid and private insurance companies for anesthesia.

Pomerantz called Desai, a gastroenterologist, a “despicable human being” who was driven in medical practice by “wanton, crass greed.”

Desai would receive 71 months in prison for his role in the multimillion dollar healthcare fraud scheme -- a federal conviction that was to be served concurrently with a life sentence that Desai received earlier in state court for his role in a 2007 hepatitis outbreak at clinics where colonoscopies were performed. Health officials, who said unsafe injection practices involving the reuse of syringes for anesthesia led to the outbreak, had to notify 63,000 former Desai clinic patients to get tested for potentially fatal blood-borne diseases, including hepatitis and HIV. Two former Desai clinic patients died, and as many as 114 cases of hepatitis were linked to Desai clinics. Desai died in Nevada State Prison in 2017.

In the days following his presentation at the UNLV School of Medicine, Pomerantz couldn’t have been more clear about his respect for physicians, saying that the overwhelming majority of physicians work tirelessly to give patients the best care possible. “Part of me is a frustrated physician,” says Pomerantz, who now does legal work for physicians on behalf of the Sklar Williams law firm. “Doctors work unbelievably hard to help others.”

During his presentation, Pomerantz said it is important for doctors just getting into practice to find a good healthcare lawyer, a competent certified public accountant, a solid office manager and a mentor that he/she can count on for good advice. The lawyer, he said, must be a specialist in healthcare law because there “are so many arcane areas.”
“What if, unbeknownst to you, your patient is selling his Percocets. What safeguards do you have in place to make sure your prescribing practices are gold standard?” - Crane Pomerantz
For example, he said that most young physicians know that if they give or receive, offer or solicit something of value in exchange for patient referrals, they’ve committed a crime. But then he showed how a physician could get into trouble by not understanding the Anti-Kickback Act (AKA): “What if you have a large Medicaid census in your practice, and out of sympathy for their financial situation, you consistently waive their copayments? Or, simply in an effort to make sure that they keep their regular appointments, you give them Uber or Lyft coupons to come to the practice? Even though your motivations may be good, those practices arguably violate the AKA.”

Another violation, he said, of the AKA could come if the physician is, say, an orthopedist and  decides to invest in a small durable medical equipment business to which he/she already refers. Unless that contractual agreement was structured properly, Pomerantz said it is “likely a violation of the AKA.”

Pomerantz also talked about the Ethics in Patients Referral Act, which is also known as the Stark Law because it was introduced by California U.S. Rep. Pete Stark. Essentially, it means the government can sue a physician of a Medicare or Medicaid patient for referring to any entity in which the physician has a financial interest. No, Pomerantz said, you can’t put the ownership of a lab in which a physician has a financial interest in the name of a spouse or business partner. “The Stark law prohibits the referral if you or an immediate family member have a financial interest in the entity to which the referral is made,” Pomerantz noted.

Prescribing medications, particularly during the current opioid crisis, can also be a potential legal minefield for physicians if they’re not careful, Pomerantz said before giving an example:

“You prescribe a 30-day supply of Percocet (acetaminophen/hydrocodone blend). And 20 days in, your patient, a long standing patient of the practice, comes in and says, 'I accidentally dropped my pills down the sink' or 'I left my prescription at the hotel on vacation’ or 'My dog ate some pills.' As a new physician, I’m guessing you’re going to be very trusting. Your concern is going to be to want to ameliorate your patient’s pain, and you’re going to be inclined to write a new script. But what if the patient is taking the pills inconsistent with your prescription (4 a day instead of 2) and you’ve unwittingly contributed to your patient’s addiction? What if, unbeknownst to you, your patient is selling his Percocets. What safeguards do you have in place to make sure your prescribing practices are gold standard?”

Dr. Bhavana Bhaya, a senior resident in the internal medicine program, said she learned a lot from the presentation made by Pomerantz. “It is very important for medical personnel to understand the laws within which we have to practice medicine,” she said. “Many of today’s physicians are ill-equipped to handle the legal, regulatory and business realities of modern medicine."  

Even Dr. Budda Dawn, the UNLV School of Medicine Department of Internal Medicine Chairman who has practiced medicine for decades, found Pomerantz’s remarks helpful.

“In this day and age, all doctors need a good lawyer,” he said.

What appear to be simple things -- manners and respect for others -- Pomerantz said, can keep physicians out of legal trouble:

“Who makes complaints to the Board of Medicine? Patients who feel like they haven’t been treated with respect...Know who causes doctors to lose their privileges at hospitals and with insurers? Other doctors and nurses who think you’re being greedy or rude or disrespectful...Know who files civil litigation and makes law enforcement referrals? Disgruntled business partners.”

Pomerantz told the residents that he knows that they’re going to have a million demands and a busy schedule and challenging cases. That said, he told them to remember to mind their manners if they don’t want to end up in trouble.

In his presentation, he said he’s been involved in “many hospital privilege hearings where my client is at risk of losing their privileges simply because they were rude to a charge nurse or had a personality conflict with another physician...So if you take nothing else out of this today, quote me on this: Play nice in the sandbox.”
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