Keith Roberts

A member of the healthcare team at Brach Eichler, Keith is often called upon to represent hospital systems, surgical centers, medical practices, and a wide array of healthcare professionals in complex litigation matters. Keith is widely recognized by his peers for successful outcomes at jury trials, contested administrative hearings before state licensing boards, and medical arbitrations. He is an expert in healthcare-law-related litigation matters including payors disputes, insurance fraud, and coding audits, as well regulatory and compliance disputes. Keith is also recognized by many as a “go to” expert in all matters relating to New Jersey No Fault Insurance which often involves navigating physicians through regulatory challenges.

 

QUESTION
What do you see as some of the hot button issues providers will have to deal with this year?

ANSWER

With regard to the business of health care, private equity will continue to be a force in New Jersey spurring widespread consolidation in the physician practice space. And it is likely that we’ll see two large hospital systems in NJ compete by targeting and acquiring various specialties and practices.

On the clinical side, the opioid crisis will still present challenges for providers in New Jersey as enforcement actions continue at a great pace, both by state and federal authorities. Accordingly, it’s imperative that practitioners who may not be experienced in managing patients on opioid medications become acquainted with their responsibilities under the law and seek guidance, if necessary, when treating patients outside of their comfort zone in that area.

QUESTION
What effect does the current environment potentially have on the quality of care?

ANSWER

Hopefully, there will be no impact upon the quality of care. I think that health care compliance issues, treatment protocols, and the push by the New Jersey Board of Medical Examiners for Continuing Medical Education are critically important and will have a positive impact on the quality of care.

On one hand, quality of care bodes well considering the new realm of alternative reimbursement structures focused on coordination, quality, and care management. The other side of the coin is that some feel overreliance on strict protocols could strip the system of independent physician judgment which could have a negative effect on patient care. It can be a balancing act between practice management and efficiency and quality of care, but I think that most practitioners get it right.

QUESTION
Let’s talk about the recently passed out-of-network (OON) law. Word on the street is that many providers still don’t understand their obligations under the new law. What’s the most important thing practitioners need to be aware of?

ANSWER

The recent out-of-network law is confusing to many and it’s a piece of legislation that evolved over a long struggle between the provider and carrier communities. It is a law that is still widely misunderstood even thought it was passed some time ago. Although we may see expansion of the law, or revision, the current focus of the law is very limited — it centers on patient notification in the event of emergent and inadvertent care and does not extend to outpatient or elective care. The basic premise is transparency and patient notification so that emergent care doesn’t result in a surprise invoice and subsequent sticker shock.

QUESTION
Do you see any other legislation coming out of Trenton this year with a similar scope or impact?

ANSWER

I think it is likely that there will be some type of revision or expansion to the out-of-network law as it pertains to the arbitration process. I’m also expecting more to happen on the opioid front, either by way of board regulation or legislation that will help further push the public crisis toward stabilization. I also think that additional oversight of ambulatory surgical centers, with the advent of licensed one-room centers, will result in new regulations that providers will have to be aware of and comply with. The practice of health care in New Jersey will continue to be tightly regulated, courtesy of the Department of Health, DOBI, and an active Board of Medical Examiners. Providers will have to stay vigilant to ensure compliance with an ever-growing, complex body of laws.

QUESTION
What about increased scrutiny on the Federal level? Do we expect this to continue and what should providers and facilities be most mindful of as a result?

ANSWER

At the federal level, sweeping legislation was passed under the Obama administration to deal with the prosecution, both civilly and criminally, of provider billing fraud. It was expansive and agencies are still ramping up enforcement. The focus here is recovery of federal dollars. In addition, the current administration will continue to struggle with how Obamacare should either be revamped, discarded, or otherwise rewritten and that story remains to be told.

QUESTION
You are well known as a physician advocate defending fraud actions filed by carriers and disciplinary matters filed by the Board of Medical Examiners. What do you see happening on those fronts this year?

ANSWER

I anticipate insurance carriers to continue to be aggressive by filing Insurance Fraud Prevention Act complaints against medical providers within the state. On the books, we have the most powerful fraud enforcement statute in the country and the carriers wield it as a potent weapon on a routine basis. The BME continues its focus on professional misconduct and the indiscriminate prescription of opioid medications. I expect to see vigorous board actions in both of these areas to continue.

QUESTION
Brach Eichler is coming up on its 10th New Jersey Health Market Review Conference this September in Atlantic City. What kinds of topics can attendees look forward to hearing about?

ANSWER

First, I’m pleased to report that our keynote speaker will be Barry Ostrowsky, President and Chief Executive Officer of RWJBarnabas Health.

The goal of the conference is to cover the latest issues and trends in the New Jersey health care marketplace. This is more important than ever as relationships in the market become more intricate and continue to evolve. All market segments including health systems, physician practices, hospitals, and ASCs can look forward to hearing what the thought leaders in the New Jersey health care space have to say about the current and future states of the market and how their entities can grow and capitalize on emerging opportunities.