Follow the rules

Tampa attorney Bruce Lamb has carved a successful niche in a growing area of health care law: helping doctors and hospitals comply with the ever-growing number of state and federal rules.
Recently, he stood out in another way. Lamb was one of 56 lawyers in Florida, and the only one from the Gulf Coast, to receive board-certified status in State and Federal Government and Administrative Practice (SFGAP) Law through the Florida Bar Association.

This inaugural class is one of the first in the nation certified in the specialty of state and federal government and administrative law. As a board-certified attorney, Lamb becomes a recognized expert in his specific legal field.

The bar established the certification in response to the ever-increasing complexity of rulemaking, licensing and regulatory matters and the fact that state and federal government law and administrative practice differ significantly from other areas of the practice.

Lamb, 52, a Tampa native, concentrates his practice in the representation of professionals and health care entities before regulatory bodies, and in liability defense. He has experience in health care litigation for hospitals, physicians and other health care providers who are involved in disputes with various government agencies, facilities and others. '¯
In order to establish board certification, Lamb met requirements, which include at least five years practicing SFGAP law, involvement in state and federal and administrative practice, experience as lead advocate for a private client or government entity in one or more categories specified by the Bar, a peer review assessment and continuing education hours requirements.

Increasing rules
Lamb represents doctors and hospitals and hospital groups, such as Baycare.

The regulations try to insure that the relations between hospitals and physicians are appropriate. For example, one federal law limits how hospitals pay physicians for services. The doctors are supposed to get fair market value, but not be over-compensated so that one hospital has an unfair advantage.

“The government wants appropriate, but not unnecessary, health care services,” Lamb says.

Lamb started working as a law clerk after graduating from Florida State University law school. He worked in the Florida Department of Professional Regulation for 10 years before going into private practice in Tampa in 1989. He's been practicing health care administrative law since graduating from law school.

Although doctors and hospitals are highly regulated, Lamb estimates there are well under 100 attorneys in Florida who practice administrative health law.
The regulations cover standards of care, safety and economic relationships so there's no opportunity for abuse of Medicare and Medicaid systems and there are no unnecessary charges.
“Compliance with those is a nightmare,” Lamb says. “There is a lot of scrutiny.”

And some of the rules need fine-tuning. For example, one federal pilot program that started in 2005 allows for the hiring of Recovery Audit Contractors, independent companies hired to review payments from Medicare and audit the bills. They look at records and try to determine whether the billing is appropriate.
The problem is that contractors are given a percentage of the recovery, so they have an incentive to find things they can criticize. They are also allowed to keep their fee money even if the decision is overturned. Congress is thinking of changing it.

“I can overturn the decision of the RAC and the government still has an obligation to pay the contractor,” Lamb says. “It needs to be modified.”

Growing practice
Because of the pressures by government to make sure it is not overpaying, coupled with pressures by facilities to provide services, more regulations may be coming, Lamb says.

Ruden McClosky has a large health care group, with attorneys in other offices throughout Florida. Lamb's work overlaps other lawyers working in contract law and litigation.

Future legal changes include patient confidentiality. Lamb and his competitors have to learn about those changes and tell their clients.

“It's a growing field and some joke it's like the Lawyer Relief Act because the regulations also generate jobs for consultants,” Lamb says. “For good or bad, it's here to stay. It's challenging.”
Doctors or hospitals under investigation by the Florida Department of Health go through an extensive reporting system when there's a death or injury of a patient. But more than 80% of the suspected violations are unfounded.

Lamb also represents physicians and facilities in contracts for services and real estate transactions, such as the sale of a hospital.

For example, hospitals contract for radiology services and other services to make sure patients are cared for. Lamb puts those contracts together.

“I enjoy working with physicians,” he says. “I have to educate them on why things are so technically challenging in contracts. As a group, they are very, very dedicated, very selfless. They work hard. They are in a tough spot economically. Reimbursement rates are getting lower.”

Does he get calls at strange hours? Yes. That's why his Blackberry device comes in handy.

“They are better for me than a cell phone,” Lamb says. “When I'm away from the office, I can look at the Blackberry and keep up.”
Lamb's competitors recognize him for the work he's done.

“Bruce is, if not the best, one of the best at what he does,” says attorney Jerome Hoffman, who practices health care law in Tallahassee with Holland & Knight.
Earlier this month, the Florida Supreme Court issued an opinion on patients' rights to know health care information. It will likely have a dramatic affect on hospitals doing peer review.
“There are tons more state and federal rules to come,” says Hoffman, noting that attorneys have even started specializing within health care administrative law.
“The regulatory structure is so complex, it's hard for lawyers to have expertise across the board, in hospitals vs. nursing homes and other facilities,” he says. “It's a very, very difficult area to master. It should attract more lawyers.”