Archive for November, 2020

Op-ed: Physicians are no longer on the front lines of this pandemic. You are.

Op-ed:  Physicians are no longer on the front lines of this pandemic. You are.

John Meigs, Jr. – President, Medical Association of the State of Alabama

State Health Officer is a difficult role to fill, especially this year. While partisanship and conspiracies continue to divide us, it is the job of the State Health Officer to make decisions for the good of all people throughout Alabama. This is exactly what Dr. Scott Harris has done for Alabamians during (and before) the COVID-19 pandemic.

After reading a recent article about Dr. Harris, I was appalled but not surprised by the fact that he has received death threats over mask mandates and other preventative measures to slow the spread of COVID-19. Governor Kay Ivey enacted the first mask mandate on July 16, 2020, at the recommendation of Dr. Harris and others. After the initial mandate, Alabama’s case average and death rates quickly fell. Neighboring states without mask mandates – including Mississippi, Georgia, Florida, and Tennessee – all continued to rise above Alabama’s average.

As President of the Medical Association of the State of Alabama, I would like to proudly declare my support of Dr. Harris and Governor Ivey in regard to the mask ordinance, social distancing guidelines, and other measures to protect the citizens of Alabama. Science and data have shown us time and time again that these guidelines work. That being said, why are there still Alabamians who push against these life-saving initiatives?

While appealing to a sense of personal responsibility should be effective enough, it has proved not to be. What happens when personal responsibility is not enough, and people are endangering others? Mask mandates. Social distancing guidelines. Occupancy limitations.

Physicians and other health care providers have worked tirelessly to serve our patients, even at the cost of our own health and safety. What if I told you that we are no longer on the front lines of this pandemic, but you are? You have the power and capability to stop the spread of the Coronavirus that has taken over 3,450 lives in Alabama and 1.39 million lives worldwide. All you have to do to potentially save a life is to wear a mask in public, socially distance, and wash your hands. These simple actions not only save lives but can also help our physicians and hospital systems not get overwhelmed with patients. You can help keep your family and our families safe at the same time.

As we head into this holiday season, we can’t require people to keep themselves safe, but we are asking them to keep other people safe. Many people could be infected and transmit the disease to others without even knowing they are sick. I just hope that we can recontextualize the mask mandate and see it as a simple act of kindness to protect those around you. It seems like the least we can do for our families, friends, loved ones, physicians, nurses, and communities as a whole.

Posted in: Coronavirus

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Advocacy in Action: Recapping AAFP’s “Day on the Hill”

Advocacy in Action: Recapping AAFP’s “Day on the Hill”

Why Advocacy Matters

Multiple times each legislative session, the Medical Association’s Government Relations team calls and emails physicians asking them to contact their legislator(s) regarding a specific bill or amendment. As evidenced by the Association’s track record of advocacy successes each year, a number of physicians respond to these “calls to action,” but not near as many as needed.

Unfortunately, there is a belief (not only amongst physicians) that an individual’s voice doesn’t matter; that emails to legislators won’t be read; that phone calls to legislators won’t be passed along; or that legislators won’t listen. Whatever the reason, the underlying premise – that an individual’s voice can’t make a difference – is incorrect.

Not only do legislators desire to hear from constituents, they desperately need to hear from physician-constituents on important health topics. Still, many legislators are surprised when they hear from local physicians at all. This must change.

Heeding the Medical Association’s calls to action could not only have lasting impacts on legislators’ positions on a particular issue, but it could also open the door for physicians to weigh in on other health-related topics.

As the old adage goes, “If you’re not at the table, you’re on the menu.” The Medical Association makes it a priority to ensure physicians are at the table, but medicine can’t get there without individual physicians doing their part; our likelihood of continued success on state health policy issues depends on your advocacy.  

AAFP's Advocacy Efforts

In early March – shortly before the legislature shutdown due to COVID concerns – the Medical Association teamed up with the Alabama Academy of Family Physicians (AAFP) and the UAB Rural Scholars Program for a day of advocacy at the State House. Particular topics spotlighted throughout the day were the need for updates to the Rural Physician Tax Credit and increasing funding for the BMSA.

Of those in attendance were Dr. Bill Coleman, Dr. David Bramm, Dr. Holly McCaleb, Dr. Drake Lavender, Wesley Minor, and Whitney Lee. Every single one of these individuals made their presence known throughout the State House and displayed an energy for advocacy. Whether it was a short introduction in the hallway or a private meeting in a legislator’s office, the conviction and effectiveness with which they spoke made a lasting impression on every individual they met.

And their work paid off.

In fact, just a couple months later, when COVID had shut down most government bodies and future budgets were being slashed, state legislators decided not only fully fund the BMSA, but to increase its appropriation by over half-a-million dollars.

In a follow-up email to one of the participants from that day, said this:

You lay out your proof in detail not only as to why BMSA has been a good investment, but why it deserves increased funding based on sound business principles using ROI comparisons. I have been a supporter in the House since the issue was presented, passed, then enacted as statutory law.  I will be a willing ally in keeping these programs funded and growing. . . Thanks for “making my day” with your excellent communication!

 

We are extremely appreciative these individuals took time out of their day to travel to Montgomery and advocate on issues important to them and their peers. We also appreciate Jeff Arrington, Executive Director of AAFP, for his tireless efforts in helping to coordinate this event. The increased funding for BMSA is, no doubt, a direct result of their hard work.

Wesley Minor meets with his Senator, Majority Leader Greg Reed (R-Jasper)

Whitney Lee and Dr. David Bramm meet with Rep. Mike Holmes (R-Wetumpka)

Wesley Minor and Dr. Bill Coleman meet with Rep. Tim Wadsworth (R-Winston)

From left to right: Dr. Holly McCaleb, Dr. Drake Lavender, Dr. David Bramm, Senator Larry Stutts, M.D. ( R-Tuscumbia), Wesley Minor, Whitney Lee, Dr. Bill Coleman, and Jeff Arrington, who discussed the importance of increasing access to care in rural areas through programs like the Board of Medical Scholarship Awards and the Rural Medical Scholars Program.

Posted in: Advocacy, Members, Scholarship

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Discussions with Decisionmakers: Rep. Howard Sanderford

Discussions with Decisionmakers: Rep. Howard Sanderford

1. Please tell us a little bit about yourself – Primary occupation? Interests? Hobbies?

I’m an accountant by education, and received my bachelor’s degree from Mississippi State University. Following college, I served as an officer in the U.S. Marine Corps. From there, I went to work with IBM and eventually left to open my own company, Computer Leasing Company, Inc.

In the community, I have served in various roles with various organizations, including past President of the Huntsville Rotary Club, past Chairman of the Madison County Republican Executive Committee, past Co-chairman of the Chamber of Commerce Free Enterprise Committee, past Vice President of the Metropolitan YMCA Board, and I was a member of the Alabama Commission on Aerospace Sciences and the Alabama Management Improvement Program.

Today, I am a board member of the Alabama Space and Rocket Center, Volunteers of America of North Alabama, YMCA, Alabama Men’s Hall of Fame, and Alabama Board of Medical Scholarship Awards (BMSA).

Finally, I would be remiss if I didn’t also mention my wife, Dot, and our three children: Mary Ann, Peggy, and Betty.

2. What first prompted you to consider running for your House District seat and how do you believe your background and experiences help you serve in the legislature?

Following retirement from IBM, I became more involved in political organizations in the Huntsville area. When then-representative and democrat, Stephen Hettinger, left the seat in 1988 to become mayor of Huntsville, the Madison County GOP was looking for a candidate to run for the seat. As it turned out, nobody wanted to do it; so, the Executive Committee asked me to run for District 20 as a republican.

Frankly, the last thing I wanted to do is run the highway from Huntsville to Montgomery. Now, 32 years (1988 – Present) later, I guess the position was meant for me.

3. Every legislative session, you are a leading voice in bringing awareness to one of the Medical Association’s top priorities – increasing funding for the Board of Medical Scholarship Awards (BMSA) and ensuring there are primary care physicians working in rural, medically underserved areas of the state.  Tell us a little about why this issue is so important to you. 

This is a funny story. I actually had no idea that I was being appointed. In fact, I found out at a legislative reception one evening years ago when Governor Hunt approached me and said, “I appointed to you a board today. I forgot which one but I’ll send you a letter.” It just so happened to be the BMSA.

BMSA is a tremendous program. I’m extremely glad Governor Hunt decided – for whatever reason – to appoint me to this board. The program deserves more money to put more physicians in areas of need because year after year we have more applicants than we do scholarships. And every one of these applicants is the “best of the best.”

4. By increasing funding for the BMSA, if Alabama is able to reverse the trend of having a shortage of primary care physicians, what kind of message does that send for the state’s ability to tackle other troubling health care issues?

This program has a major impact on healthcare in Alabama. Most physicians in these areas struggle to pay of their loans or succeed. Those who are selected for the BMSA are typically the top of their class and have a true desire to give back to communities who lack proper access. These young men and women want to go serve rural Alabama; it’s unfortunate we cannot provide them with the money to help them do it.

5. If you could change one thing about our state’s health care system, what would it be?

More physicians. Even I have struggled to find a physician, and I live in Huntsville. Those in areas with one or two – or even zero – physicians face even more burdensome hurdles.

6. How can the Medical Association – and physicians statewide – help better address Alabama’s health challenges?

Whether it be bills before my Committee – Boards, Agencies, and Commissions – or others being considered by the entire House, the Medical Association has always been there to provide us with much needed information. Continuing to do so is needed and much appreciated.

7. What’s the one thing you would like to say to physicians in your district?

We appreciate you. My wife and I have seen a fair share of physicians over the years – from broken bones of our children to our own personal illnesses – and we are grateful for the care we received. These are unique times, but we will make it through. Keep up the good work.

Posted in: Advocacy

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The Perfect Storm for Litigation Resulting From the Paycheck Protection Program (PPP) and Coronavirus Aid, Relief and Economic Security (CARES) Act

The Perfect Storm for Litigation Resulting From the Paycheck Protection Program (PPP) and Coronavirus Aid, Relief and Economic Security (CARES) Act

By: Jim Hoover

Millions of American businesses and self-employed individuals applied for and received Paycheck Protection Program (PPP) loans authorized by the CARES Act. PPP loans are obtained from a bank and guaranteed by the Small Business Administration (SBA). The processes for obtaining loans and loan forgiveness are ripe for many types of possible litigation including administrative, civil, and criminal. 

Businesses and individuals were required to provide documents and information and make important certifications to their bank when they applied for a PPP loan. The certifications included the eligibility of the business or individual for a PPP loan meeting the many requirements of the CARES Act. In a PPP loan application a borrower also had to certify that “[c]urrent economic uncertainty make this loan request necessary to support the ongoing operations of the Applicant.” 

The CARES Act also allows PPP loans to potentially be forgiven subject to many conditions. Businesses and individuals seeking PPP loan forgiveness must provide additional documents and yet more certifications through an application filed with their PPP lending bank. It is the responsibility of the borrower to provide an accurate calculation of loan forgiveness and to attest to the accuracy of its reported information.

PPP loans under the CARES Act will be audited. The Department of the Treasury announced that all PPP loans over $2 million will be audited; other PPP loans will also certainly be audited.  For example, borrowers that seek forgiveness of a PPP loan increase their likelihood of being audited, and not limited just to forgiveness, but eligibility of the borrower for the loan and the accuracy of certifications made by the borrower in the borrower’s PPP loan application. 

The SBA also reserves the right to review and audit all PPP loans and related loan issues, including eligibility, borrower certifications, and forgiveness. The SBA may review whether a borrower calculated its loan amount correctly and whether the borrower used loan proceeds for allowable purposes. The SBA issued guidance stating that a borrower who received a PPP loan of less than $2 million will be deemed to have made this required certification in good faith. For borrowers who received a PPP loan of $2 million or more, the borrower may have to prove that its application was based on current economic uncertainty and that the PPP loan was necessary to support ongoing operations of the borrower.  If the SBA determines in the course of its audit/review that a borrower lacked an adequate basis for the required certification concerning the eligibility of the loan request, the SBA will seek repayment of the outstanding PPP loan balance and determine that the borrower is not eligible for loan forgiveness. If the borrower repays the loan after receiving notification, the SBA has announced that it will not pursue administrative enforcement or make referrals for enforcement to other agencies. 

Applicable to forgiveness, the SBA states that, to receive loan forgiveness, a borrower must complete and submit the Loan Forgiveness Application (or equivalent bank form) to the PPP lending bank (or the lender that is servicing the PPP loan). The bank will review the application and make a decision regarding loan forgiveness. Banks are expected to perform a good-faith review, in a reasonable time, of the borrower’s calculations and supporting documents concerning amounts eligible for loan forgiveness. The lender must issue a decision to the SBA regarding a loan forgiveness no later than 60 days after receipt of a completed loan forgiveness application.

That decision may take the form of an approval (in whole or in part), denial, or (if directed by the SBA), a denial without prejudice due to a pending SBA review of the loan for which forgiveness is sought. In the case of a denial without prejudice, the borrower may subsequently request that the bank reconsider its application for loan forgiveness, unless the SBA has determined that the borrower is ineligible for a PPP loan. If the bank determines that the borrower is entitled to forgiveness of some or all of the amount applied for, the SBA will, subject to any SBA audit or review of the loan or loan application, remit the appropriate forgiveness amount to the bank. If the bank denies forgiveness, in whole or in part, the bank must notify the borrower in writing that the lender has issued a decision to the SBA denying the loan forgiveness application. The SBA reserves the right to review the bank’s decision in its sole discretion. Within 30 days of notice from the bank, a borrower may request that the SBA review the bank’s decision.

In the event the SBA reviews or audits a borrower’s PPP loan, the SBA will notify the bank, who is required to notify the borrower in writing within five (5) business days of receipt of notice from the SBA and to request information from the borrower. The SBA may also request information directly from the borrower. A borrower’s failure to respond to the SBA may result in a determination that the borrower was ineligible for a PPP loan or ineligible to receive the loan amount or loan forgiveness.

If the SBA determines in the course of its audit or review that the borrower was ineligible for a PPP loan, the loan will not be eligible for forgiveness. If only a portion of the loan is forgiven, or if the forgiveness request is denied, any remaining balance due on the loan must be repaid by the borrower on or before the two-year maturity of the PPP loan. 

The CARES Act created the new “Office of the Special Inspector General for Pandemic Recovery,” whose task is to “conduct, supervise, and coordinate audits and investigations” of the financial assistance programs for businesses. Administrative appeal remedies from disputed PPP audits, including resulting litigation, are presently unclear. While adverse decisions of the Office of Hearings and Appeals are appealable to federal courts, more guidance from the SBA concerning PPP audits and appeal remedies will be issued. 

Borrowers must also be aware of the Federal False Claims Act (“FCA”).  Under the FCA, a claim generally means any request or demand, whether under a contract or otherwise, for money or property that–(i) is presented to an officer, employee, or agent of the United States; or (ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government’s behalf or to advance a Government program or interest, or (iii) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.  31 U.S.C. § 3729.  Federal courts have ruled that loan applications are “claims” for FCA purposes.  Thus, a PPP loan and any corresponding forgiveness is subject to the “False Claims Act.” In fact, government authorities are beginning to focus substantial resources on CARES Act fraud and abuse. Although the U.S. Department of Justice began indicting borrowers in connection with PPP fraud as early as May of this year, on September 10, 2020, federal authorities charged 57 people in jurisdictions across the U.S. with “stealing” $175 million from the PPP.  Additionally, a government report issued in September found “tens of thousands of loans could be subject to fraud, waste, or abuse.” The U.S. Government Accountability Office further reported to the U.S. House of Representatives that the SBA’s fraud hotline had received more than 42,000 reports of alleged fraud. 

Because of the many types of litigation, it is important that recipients of PPP loans and other financial assistance programs, carefully review their applications and requests for forgiveness to ensure they have met all of the programs’ requirements. 

Jim Hoover practices with Burr & Forman LLP and works exclusively within the firm’s Health Care Industry Group and primarily handles healthcare litigation and compliance matters.

Posted in: Coronavirus, Legal Watch, Management

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