By Sheila Pursglove
Legal News
Health care law attorney Gil Frimet sees a growing gap between powerful health insurance interests and narrowing consumer protection – but remains hopeful that Gov. Rick Snyder will act to preserve and even enlarge patient rights.
This hot topic is yet another wrinkle in a field that Frimet has focused on for 51 years.
A senior attorney with Foster, Swift, Collins & Smith in Farmington Hills, Frimet is a member of the Health Care Law Practice Group and specializes in Health Care, Alternative Dispute Resolution, and E-Health.
He joined the firm Of Counsel in 2003 after 7 years as president of Frimet, Rogalski & Williamson in Southfield.
Named among Best Lawyers in America (Health Care Law) and dbusiness magazine Top Lawyers in Metro Detroit, Frimet came to this niche when an innovative doctor/client wanted professionals to have the same retirement benefits as corporate executives.
“There was a big difference in the amount of income that could be deferred between professional people and corporate executives – a corporate executive had much better retirement benefits than a professional person,” Frimet explains.
An 1872, Michigan Partnership Association Law had the same needed attributes as corporations. Frank Kelly, Michigan attorney general in 1962, approved this as an entity for professionals.
“We felt this would qualify as acceptable to the IRS,” Frimet says. “This entity was followed in the mid-‘60s by the advent of Medicare and Medicaid. I wasn’t a tax lawyer and was developing a professional health care practice that was augmented by these new government programs — so health care law really became my niche. Many young lawyers, who either were law clerks of mine or associates of mine, went on to become early and successful health care lawyers. This has been great satisfaction to me.”
Frimet handled the formation and representation of an HMO and its independent practice association; and the formation of Physician-Hospital Organizations (PHOs) and Physician Organizations (POs), and with contractual undertakings re: third party insurers and government payors.
He notes that early on, HMOs with a capitation payment mode made doctors very fearful for their economic futures, and it took quite a while for the private practice professional to see opportunity, rather than a threat, in HMOs, PPOs and POs.
“For patients, the great danger of HMOs was the underutilization of services since the doctors received a fixed capitation payment periodically for their work,” he says. “With fee for service — the fear was always an overutilization of services. I’m still not satisfied we’ve dealt with the problem of overutilization or underutilization satisfactorily.”
Frimet also handled the development and finalization of managed care relationships between providers and payors including rates and methodologies of payment and service delivery; and the development of structures for inter-hospital collaboration.
He also served as general counsel for the multiple entities of a medical complex in Chelsea, from planning and building to ongoing growth and development.
He has handled the defense of providers in medical necessity audits responding to reimbursement claims from the Medicare/Medicaid programs, Blue Cross Blue Shield, and private carriers.
He explains there has been a disposition on the part of third-party payers to favor hospitals, and independent non-hospital affiliated providers suffered.
“BCBSM has always tended to favor hospitals in terms of payment and where reimbursement contained a broader range of services to be recognized for payment,” he says. “To secure greater equality in payment for the same services, whether performed in hospitals or by specialists, has always been a battleground.”
He also was successful in obtaining proper reimbursement for independent clinical laboratories.
“This was some years ago and many smaller laboratories have been gobbled up by the big ones,” he says.
Physical therapists and PT groups enjoyed his successful representation in connection with reimbursement rights and appeal rights with third party payers and insurance companies. Physical therapists, as well as physicians’ assistants and others, have needed more favorable rules for reimbursement, he notes – and securing fair treatment of health care professionals and freestanding health care facilities, such as non-hospital ambulatory surgical centers, has been an ongoing struggle.
“Much progress has been made however,” he says. “I’m fearful also for consumers: Patients who suffer from a loss of fair hearing rights under the new inadequate BCBSM regulatory legislation are a major concern. The area of patients’ rights seems to be narrowing and PA 350 rights have been diminished.”
A prolific writer, with many articles in Health Care Weekly Review and numerous health and legal publications, Frimet has seen many changes in the health care law field over the years – not always for the better.
“A computerized world requires answers to be instantaneous,” he says. “While the best working tools have become available, the expansion of the intellect has become a necessity and we have to think more rapidly. This can also be not so good — it’s often insufficient time for reflection and our use of language has also suffered. All the benefits and burdens of increasing societal complexity have brought good and less good.”
Frimet has enjoyed a long career that was his dream as early as first grade; but he came close to considering a career teaching history, and received his undergrad degree in history and English from Wayne State University, where he also earned his law degree. His closest undergraduate friends became successful historians teaching in various parts of the country. He has continued to have a strong and profound interest in history, and is a keen collector of art. He has gifted artwork to the University of Michigan Museum of Art in Ann Arbor.
“Art is an extension of history and history’s relation to other fields such as archeology, anthropology and to events in our modern era are important,” he says. “This is all fascinating to me. The growth and enlargement of the mind is the work of a lifetime. Book collecting has also been a passion sometimes to the displeasure and inconvenience of housekeepers.”
As a reader and speaker, Frimet has always been intrigued by language communication; differential styles of communication; and the simplicity of word connection.
“Since I was 16 years of age, Winston Churchill was a hero of mine and his use of the English language is a great influence on me,” he says. “History is man’s clock and the content of time tells us who we were and are.”
A native of New York City, Frimet was raised in southeastern Michigan and currently makes his home in Birmingham.
“Although I’ve been a life-long bachelor, I’ve had a wonderful life surrounded by good friends and family,” he says.
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