What Industries Use Respiratory Mandatory Signs?

The need to use respiratory protection in the workplace is critical. A workplace needs to have the right respiratory materials on hand and the best possible signs that list information on where to wear such items in.

There are many industries that will use these signs in their working environments. These are places that ask for people to use the right components to ensure that they are properly protected at all times. When used properly, it should be very easy for a place to let people know that they need to come in with the right protective materials on.

Chemical Factories

Places that manufacture or use chemicals will have to be reviewed carefully. Many chemicals can create an immense amount of fumes that can be dangerous if not handled properly. It will be critical to get all chemicals maintained properly but it is even more important to have protective materials on hand. Respiratory masks can be used to keep people from breathing in all these fumes.

Asbestos Removal Sites

There are many times people might have to report to different locations to remove asbestos materials from older items. Mandatory signs may be brought into locations where asbestos is being removed from. This is to protect people from the extremely thin and potentially dangerous fibers that can come out of the walls and other surfaces that the asbestos has gotten into.

Lead Paint Removal Sites

On a related note, lead paint removal sites are good places that can use respiratory mandatory signs. The lead paint chips and particles that are removed can easily become airborne and possibly cause some real harm to one’s body if not cleared out properly.

Garbage Disposal Stations

It’s easy for garbage disposal spots like landfills to develop immense odors that are often dangerous to bear with. These can be irritating and potentially harmful to anyone’s airways. A garbage disposal location will require people to wear protective masks to keep them from inhaling many of the harmful odors that can come around in such a site. These can also protect people from bearing with annoying effects that often come from the garbage in a site, thus making it easier for people to get their work done in such a spot as this.

Car Manufacturing Stations

The heat and immense odors that can come from many mechanical devices in a car manufacturing station can be bothersome. Protective respiratory materials are needed to not only keep people from inhaling fumes but also from being at risk of accidentally getting in contact with various fluids like oils, paints and other items used when getting cars ready and tested. The manufacturing process can be intense but it doesn’t have to be too hard to handle when used the right way and with enough care.

The Anti-Kickback Statute: What Constitutes a “Referral”?

The Federal Anti-Kickback Statute, 42 USCS ยง 1320a-7b(b) states, in pertinent part, that a person may not knowingly or willfully solicit or receive any remuneration in cash or in kind, directly or indirectly, overtly or covertly, in cash or in kind, in return for referring an individual for the furnishing of a healthcare item or service that is payable in whole or in part by a Federal healthcare program. In laymen’s terms, a person cannot pay or receive anything of value in return for furnishing a Medicare patient to receive a healthcare item or service. (Note, however, that the law does set forth examples of permissible payments, or “safe harbors,” but we won’t address those in this article.)

In United States v. Patel, 778 F.3d 607 (7th Cir. 2015), the United States Court of Appeals for the Seventh Circuit (presiding over Wisconsin, Illinois and Indiana) was asked to determine if the following facts ran afoul of the Anti-Kickback Statute. Dr. Patel was an internal medicine physician who occasionally his patients for home health care services. The vast majority of his patient population is insured by Medicare. Once Dr. Patel made the referral, his patients would independently choose which home health provider to use. Dr. Patel never recommended a particular home health care provider, and was never involved in helping a patient choose a particular home health care service. Once the patient chose his/her provider, he would then certify on an appropriate Medicare form that the patient qualified for home health care services. The home health care provider would then bill and collect from Medicare for the services it provided to the patient. For each patient that chose to procure home health services from a provider named Grand Home Health Care (“Grand”), Grand would pay Dr. Patel $400 in cash. If Dr. Patel later recertified the patient for additional home health care services, Grand would pay him $300 in cash. Regardless of the payments made by Grand to Dr. Patel, the parties all agreed that all of the patients treated by Grand were in need of home health care services.

The question at issue before the Court was whether Dr. Patel violated the Anti-Kickback Statute by receiving payment in return for referring his patients to Grand. The Anti-Kickback Statute does not define the term “referral”. Dr. Patel contended that a physician cannot refer a patient when the patient, with no input from the physician, independently chooses a provider. The Government argued for a more expansive view of the word “referral”- mainly, that the term includes not only a recommendation of a provider, but also a doctor’s authorization of care by a particular provider. The Government’s interpretation of the term “referral” meant that each time Dr. Patel certified or recertified for a patient to receive home health care services from Grand on the appropriate Medicare form, he was “referring” that patient to Grand.

The Court noted that, when interpreting the meaning of undefined terms in a statute, the rule is that words should be given their ordinary and plain meaning. After examining the various definitions for the term “referral” and he main purposes of the Anti-Kickback Statute, the Court held that the term “referral” includes not only a recommendation of a healthcare provider, but also the authorization or certification of care by that provider. In a medical context, people often use the word “referral” to describe a doctor’s authorization to receive medical care. The physician acts as a gatekeeper for certain specialized medical services. For example, once a patient chose a home health provider, Dr. Patel’s office would fax that patient’s information to Grand under a cover sheet titled “New Referral” even though Dr. Patel played no part in the patient’s selection of Grand.

The Reality of the “Economic Realities Test”

On July 15, 2015 the Administrator of the Department of Labor’s Wage and Hour Division (WHD) provided additional guidance regarding the application of the standards for determining who is an employee under the Fair Labor Standards Act (FLSA). The goal of the guidance is to help the regulated community in classifying workers and decreasing misclassification. The Administrator’s Interpretation reviews the pertinent FLSA definitions and the breadth of employment relationships covered by the FLSA. The Administrator’s Interpretation then addresses each of the factors of the “economic realities test”.

According to the Administrator, when determining whether a worker is an employee or independent contractor, the application of the economic realities factors should be guided by the FLSA’s statutory directive that the scope of the employment is very broad. The FLSA’s definitions establish the scope of the employment relationship under the Act and provide the basis for distinguishing between employees and independent contractor.

The Supreme Court and Circuit Court of Appeals have developed a multi-factorial “economic realities” test to make the determination whether a worker is an employee or an independent contractor under the FLSA. The test focuses on whether the worker is economically dependent on the employer or in business for him or herself. The factors include:

1. The extent to which the work performed is an integral part of the employer’s business.
2. The worker’s opportunity for profit or loss depending on his or her managerial skill.
3. The extent of the relative investments of the employer and the worker.
4. Whether the work performed requires special skills and initiative.
5. The permanency of the relationship.
6. The degree of control exercised or retained by the employer.

When completing the analysis, no single factor is determinative. Each factor is examined and analyzed in relation to one another. According to the guidance, the factors should not be applied in a mechanical fashion, but with an understanding that the factors are indicators of the broader concept of economic dependence. “The factors are a guide to make this ultimate determination of economic dependence or independence.”

Correctly structuring the relationship between businesses and workers within the healthcare industry is especially important for both tax and compliance reasons. For instance, upon an audit, the IRS may find that an arrangement between a group practice and independently contracted physician is actually an employment relationship because the employer has complete control over when and where the physician performs and the arrangement happens to be the physician’s only source of income. In that case, the employer would be subject to payment for back employment taxes and interest on those unpaid taxes.

Moreover, relationships that are subject to the Anti-Kickback Law or the Stark Law are often constructed to comply with pertinent exceptions or safe harbors to those laws. The criteria for full compliance with any applicable exception differs for employees and independent contractors. For example, a part time employed marketer with a relationship structured to fit within the Anti-Kickback Statute’s safe harbor for bona fide employees might be determined to be an independent contractor whose relationship falls outside the safe harbor for personal services.

Several states have also issued their own guidance regarding whether a worker should be classified as an employee or independent contractor. For example, the New York State Department of Labor’s website contains information regarding the distinction between independent contractors and employees. It is important for each business proposing to employ or contract with a worker to have an understanding not only of the Federal guidance, but also guidance issued by the State, if any.