Whether using the term anti-aging medicine, aesthetic medicine, functional medicine, integrative medicine, longevity medicine, or anything other than “cookbook conventional care,” physicians, chiropractors, other providers, and clinical practices can buttress their legal fortress with solid legal and regulatory advice.
As with other emerging sectors of the multi-trillion dollar, health and wellness industry, the law governing anti-aging, longevity, and functional medicine practices continues to evolve as the emerging healthcare trend is away from cookbook, conventional medicine and toward personalized medicine with a systems-based approach.
Patients want their medical doctors to help them stay youthful, fit, radiant, and beautiful. Today’s patient is not interested in a pharmaceutical “magic bullet,” but rather understands health in its totality, as the synergistic result of multi-factorial inputs, including diet, nutrition, lifestyle, environment, mind-body-spirit health, attitude, habits, exercise, relationships, and everything else that impacts physical, mental, emotional and spiritual well-being.
Our Anti-aging and functional medicine lawyers provide legal advice to physicians and other clinicians involved in innovative and emerging diagnostic and therapeutic methods, including anti-aging medicine and functional medicine.
Functional medicine physicians and other clinicians have a particular dilemma, as pioneers in a medical system that is heavily dependent on healthcare insurance.
Providers are successfully applying the Functional Medicine model in many different settings: small, large, cash-based, insurance-based, institutional, and private. Some of the more common models in which Functional Medicine is being practiced are listed below. However, no single, optimal model for practicing Functional Medicine exists, and in reality, clinicians tend to practice a hybrid of two or more models.
Among other legal and regulatory challenges facing the functional medicine doctor is how to deal with insurance, when the functional medicine recommendations to the patient are much more encompassing than those insurance covers.
For the medical doctor who is participating (or even non-participating) in Medicare, their Medicare status poses an immediate legal challenge.
Unless opted out, a clinician within the Medicare system (par or non-par) cannot charge the patient for a Medicare-covered service. Where the functional medicine doctor is effectively practicing primary care, doing a wellness exam, or otherwise offering medical services that Medicare may cover, the functional medicine MD must take care not to double-bill the patient through a membership fee on one hand, and Medicare reimbursement on the other. When par or non-par, the MD can only offer clearly Medicare non-covered services to Medicare beneficiaries.
Often there is a slippery slope between covered and non-covered services and great legal care must be taken not to cross the line. As well, often physicians are not even aware of their Medicare obligations or that, unless opted out, they have such obligations to Medicare. Our healthcare lawyers have counseled physicians in Medicare fraud investigations, where the physician has received a letter from Medicare citing violations and raising the prospect of hefty penalties.
Some physicians have a cash-only practice, effectively eliminating risk that comes from participation in commercial insurance; however, they still have to navigate the patient agreement, legal issues governing subscriptions and automatic renewals, and even issues governing provision of superbills and liability and regulatory risk surrounding the membership-based practice. Our health care legal team counsels functional and anti-aging doctors, whether their practice falls with Medicare and commercial insurance, is only a cash-based practice, or is a hybrid practice that combines reimbursement and cash only models.
Our healthcare and FDA lawyers have represented many functional medicine doctors and functional medicine practices.
Our founder, attorney Michael H. Cohen, has also served as Institute for Functional Medicine (IFM) faculty (IFM – Michael H. Cohen, JD, MBA).
engaged in a collaboration with Dan Kalish and the Kalish Institute of Functional Medicine to develop online course materials specifically geared to functional medicine physicians.
We understand that Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership.
Our deep experience in holistic healthcare, complementary and integrative medical therapies, and general well-being outside of (or integrated with) conventional, cookbook medicine and affinity for emerging therapies is a hallmark of our legal practice.
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As a functional medicine practitioner you’re dealing with very difficult cases often where patients have failed with conventional approaches, so you’re putting together the clinic Rubik’s cube. My job is to support you by putting together the legal and regulatory Rubik’s cube, so that you can keep doing what you’re doing in a safe way.