Jones Health Law Podcast

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

Peptides have surged in popularity across weight loss, wellness, and medical practice, but their legal status is far from straightforward. While some peptides are FDA-approved medications, others fall into a gray area, marketed as "for research use only" while being sold in ways that suggest human use. This creates real legal exposure for healthcare providers and organizations working in this space.

Regulation of peptides operates at both the federal and state level. The FDA oversees peptide drugs and restricts which substances compounding pharmacies can legally use, while states like Florida rely on existing medical, pharmacy, and prescribing rules rather than a single peptide-specific law. Recent FDA advisory committee action to expand the approved compounding list signals change on the horizon, but full approval and clearer legal pathways are still developing. Healthcare organizations need to stay ahead of this shifting landscape to remain compliant.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

Revenue cycle management (RCM) refers to the financial process used by healthcare organizations to track and collect incoming patients, and encompasses the entire revenue lifecycle: from the initial patient scheduling to the final payment collection. Deficiencies in an organization’s RCMprocesses such as timeliness, accuracy and missing documentation can lead to lost revenue. According to a report by Change Healthcare, healthcare providers lose Approximately $262 billion in revenue every year due to payer denials. Payer denials stem from a variety of reasons including discrepancies in an organization’s RCM process, some of which will be discussed in this post.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

Healthcare organizations are responsible for implementing appropriate training and internal procedures to facilitate a high-quality and compliant environment. Quality of care is not limited to the medical services or products provided to patients; it also stems from the way the employees perform their duties, and the work process they follow. The work processes should be continuously monitored and adapt to the evolving operational requirements and trends in healthcare.

Standard Operating Procedures (SOPs)
Standard Operating Procedures (SOPs) are detailed written instructions that explain how employees should conduct routine business processes. SOPs help simplify complicated processes into manageable steps for employees to perform their duties more efficiently.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

What is a Payer Audit?

For Applied Behavior Analysis (ABA) providers–those who offer research-based behavioral therapy–receiving notice of a payer audit or payment suspension can be one of the most disruptive events their practices face. An ABA payer audit occurs when a health insurance company conducts a formal review of a provider’s claims, documentation, and billing practices to verify that its services are correctly coded and documented, and that they align with the payer’s policies.

When an audit identifies potential concerns, providers may face payment suspensions, contract termination, prepayment review, or even fraud investigations. These challenges can hinder cash flow or create staffing difficulties, impacting patient care. While audits can be stressful for practice owners, staying proactive and maintaining strong compliance practices can position them better to respond effectively to such operational challenges.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

An Income Guarantee Agreement is a type of forgivable loan provided by a hospital to a physician who is newly entering practice. Under this agreement, the hospital offers financial support to help the physician establish their practice within the community. If the physician makes the guaranteed amount under the agreement and continues to practice in the community for the pre-determined duration as established under the agreement (also known as the “forgiveness period”), the hospital will forgive the loan. These agreements are commonly used in communities with a greater need for physicians or specialists, as they help support building their patient base during the early stages.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

When starting a Limited Liability Company (LLC) in Florida,an operating agreement is strongly recommended but not legallyrequired under the Florida Revised Limited Liability Company Act under Chapter605 of the 2025 Florida Statutes.

What is an Operating Agreement?

An operating agreement is a writtendocument that essentially serves as the LLC’s Constitution, or governingdocument. An operating agreement prevents default statutory rules from applyingand helps avoid disputes. The operating agreement should align with theArticles of Organization and reflect the specific needs of the business.

Before drafting an operating agreement, membersof an LLC should consider the purpose, membership structure, and managementstructure of the LLC. The purposes of an LLC may be broad for flexibility ornarrow for liability or conflict control concerns. The membership structureshould identify a single or multi-member structure and/or identify differentclasses of membership interests (for example: economic, voting rights, etc.).The management structure default for LLC’s is member-managed, unless otherwisespecified. Some members may prefer manager-managed or board-managed structures,but can specify that distinction in the operating agreement.

The Department of Justice defines methadone asa synthetic narcotic, dispensed in tablet, oral solution, or injectable liquidform. Methadone is legally used to treat narcotic addiction and relieve severepain, often in individuals who have cancer or terminal illnesses.  

A methadone clinic is a facility that providesmedication-assisted treatment (MAT) for individuals with opioid use disorders(OUDs), and the clinic specifically uses methadone as part of the treatmentplan.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

The Department of Justice defines methadone asa synthetic narcotic, dispensed in tablet, oral solution, or injectable liquidform. Methadone is legally used to treat narcotic addiction and relieve severepain, often in individuals who have cancer or terminal illnesses.  

A methadone clinic is a facility that providesmedication-assisted treatment (MAT) for individuals with opioid use disorders(OUDs), and the clinic specifically uses methadone as part of the treatmentplan.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

Soon after its enactment, the Tennessee law was challenged in federal court. Opponents argue that the law violates the U.S. Constitution’s guarantees of due process and equal protection, citing that similar treatments are allowed fornon-gender-related reasons.

Although the Sixth Circuit Court of Appeals upheld the law’s constitutionality, the case – United States v. Skrmetti – was accepted by the United States Supreme Court for furtherreview on the issue of equal protection. The Court heard arguments on December 4, 2024, and a decision is expected by summer 2025.

The case has attracted national attention, with public statements from political figures highlighting its divisive nature. President Trump voiced support for the law in early 2025, a position contrary to that of former President Biden, who opposed such state-level bans.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

An Emergency Suspension Order (ESO) is one of the most serious enforcement actions taken by the FloridaAgency for Health Care Administration (AHCA). When an ESO is issued, it immediately suspends a licensee's ability to operate—without prior notice or a hearing—due to concerns about immediate threats to the health, safety, or welfare of residents. For operators of Adult Family-Care Homes (AFCHs), it is crucial to understand what an ESO is, why it may be issued, and how to respond effectively.

Web: www.JonesHealthLaw.com

Phone: (305)877-5054

Instagram: @JonesHealthLaw

Facebook: @JonesHealthLaw

YouTube: @JonesHealthLaw

The No Surprises Act is a federal law in the United Statesthat went into effect on January 1, 2022. Enacted as part of the Consolidated Appropriations Act, the NSA is designed to protect patients from unexpected medical bills occurring inemergency situations or when they receive care from out-of-network providers at the facilities of in-network providers. This type of billing is commonly referred to as “surprise billing.” The Act prohibits out-of-network providersfrom directly billing patients for certain services and instead requires them to seek payment from the patient’s health plan. If a patient is uninsured or opts for self-pay for a service, the NSA’s protections often provide the opportunity to get a good faith estimate of the cost of care up front.