Last Updated on: 13th October 2023, 12:30 am

Lawyers for Physical Therapists: A Helpful Guide

Physical therapists and physical therapist assistants work in a complex legal environment that requires compliance with various healthcare laws, rules, and regulations. As issues arise in clinical practice, employment, or running a private practice, physical therapists may benefit from securing legal counsel who can provide tailored advice and guidance. This article aims to provide a helpful overview of common legal issues facing physical therapists and how working with a lawyer can help.

Why Physical Therapists Need Lawyers

There are several reasons physical therapists may need to consult with a lawyer:

• Navigating healthcare laws and regulations – Healthcare is one of the most heavily regulated industries. There are complex federal and state laws governing areas like privacy, documentation, reimbursement, telehealth, and more. Lawyers can help PTs understand and comply with these laws.
• Managing liability risks – As healthcare providers, PTs face liability risks related to issues like professional negligence, informed consent, and standard of care. Lawyers can advise on liability insurance, documentation practices, and defense in the event of a claim.
• Employment issues – Employment laws related to discrimination, leave, compensation, and more apply to PTs. Lawyers can assist with employment contracts, non-competes, disputes, and termination.
• Operating a private practice – Those running their own clinic must comply with business laws and healthcare regulations covering issues like Stark law, anti-kickback statutes, billing, HIPAA, and taxes.
• Responding to complaints or audits – Lawyers can defend PTs if they receive a complaint from a patient, payer audit, or notice of disciplinary action from a licensing board.
• Buying, selling, or merging a practice – Legal assistance is crucial when entering partnerships, buying or selling a practice, merging, adding locations, bringing on investors, and more.

Key Healthcare Laws Impacting Physical Therapists

Physical therapists must comply with various federal and state healthcare laws and regulations. Having a lawyer familiar with these key laws can help PTs avoid violations and penalties:

• HIPAA – The Health Insurance Portability and Accountability Act protects patient privacy and sets rules for handling protected health information (PHI). Fines for HIPAA violations can be steep.
• Stark Law – This federal law prohibits physician self-referrals to entities with which they have a financial relationship. It impacts PT private practice owners who refer to their own clinics.
• Anti-Kickback Statute – This federal law bans paying or receiving remuneration to induce or reward referrals for federal healthcare program business. PTs must avoid improper financial relationships.
• State practice acts – Each state has laws governing PT licensure, scope of practice, continuing education, and discipline. Lawyers can advise on compliance.
• Insurance laws – Complex state and federal laws govern areas like reimbursement, network participation, balance billing, utilization review, and more. Legal expertise is key to navigating insurance requirements.
• Labor laws – Federal and state laws related to wage and hour rules, leave, discrimination, disability, workers’ comp, unemployment, and more apply to PTs as employers or employees.

Key Practice Areas for Physical Therapy Lawyers

Experienced healthcare lawyers can provide legal assistance to physical therapists in many aspects of professional and business operations:

Healthcare Regulatory Compliance

• Advising on federal and state healthcare laws and regulations
• Conducting risk assessments and implementing compliance programs
• Updating policies and procedures to meet legal requirements
• Training staff on properly handling PHI, documentation, coding, billing, etc.

Professional Licensure Defense

• Responding to licensing board complaints and investigations
• Guiding defense in disciplinary hearings and appeals
• Advising on compliance with practice act requirements
• Appealing improper licensure denial or discipline

Malpractice Litigation

• Managing liability risks through proper documentation, informed consent, etc.
• Advising on liability insurance needs
• Responding to claims of negligence or malpractice
• Defending PTs in mediation, arbitration, or trial

Private Practice Business Law

• Structuring a practice entity and addressing Stark Law, Anti-Kickback Statute, etc.
• Handling mergers, acquisitions, partnerships, adding locations, bringing on investors
• Navigating contracts with payers, vendors, management services organizations, etc.
• Advising on employment matters, leases, taxes, and other business issues

Payor Reimbursement Disputes

• Appealing denied claims and fighting improper recoupment attempts
• Challenging audits and defending against allegations of fraud
• Negotiating out-of-network status and reimbursement rates
• Complying with payor documentation and billing rules

Employment Law Services

• Drafting employee contracts and agreements with independent contractors
• Advising on wage and hour, leave, discrimination, disability, and safety issues
• Responding to EEOC charges or lawsuits over termination, harassment, etc.
• Handling unemployment insurance hearings and workers’ comp claims

Questions to Ask When Selecting a Lawyer

Not all attorneys have relevant experience assisting physical therapists. When choosing legal counsel, PTs should ask:

• Do you have experience working with physical therapists and physical therapy practices?
• What is your knowledge of healthcare regulations like HIPAA, Stark Law, Anti-Kickback Statute?
• How familiar are you with physical therapy licensing laws and disciplinary processes?
• Have you handled cases involving physical therapy liability, malpractice, or reimbursement disputes?
• What is your experience advising physical therapy private practice owners?
• Do you have experience with employment law issues relevant to physical therapists?
• Will you provide training for me and my staff on key healthcare regulatory compliance issues?