THE BUSINESS OF MEDICINE
Strategies for Financial Stability, Digital Protection, Regulatory Readiness, and Long-Term Success
EXECUTIVE VICE PRESIDENT &
Jon R. Roth, MS, CAE
EDITORIAL STAFF
EDITOR,
Stephanie Jennings
DESIGNED
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Business Development
COMMUNICATIONS COMMITTEE
Ravindra Mohan Bharadwaj, MD, Chair
Sumana Gangi, MD
Jawahar Jagarapu, MD
Dylan Jacob Kruse
Ravina R. Linenfelser, DO
Sina Najafi, DO
Erin D. Roe, MD, MBA
Katelyn Williams, MD
BOARD OF DIRECTORS
Gates B. Colbert, MD, President
Vijay V. Giridhar, MD, President-elect
Sheila Chhutani, MD, Secretary/Treasurer
Shaina M. Drummond, MD, Immediate Past President
Kimulique Harkley Allen, MD
Justin M. Bishop, MD
Max I. Galvan, MD
Nazish Saeed Islahi, MD
Benjamin C. Lee, MD
Allison Moore Liddell, MD
Riva Louise Rahl, MD
Thomas Schlieve, MD
Why Advance Care Planning Matters
LET OUR PRACTICE HELP YOUR PRACTICE
With four attorneys Board Certified in Health Law by the Texas Board of Legal Specialization, Gray Reed provides focused support for physician practices.
We deliver integrated guidance on operations, employment, mergers and acquisitions, litigation, tax, and real estate matters. Our regulatory expertise ranges from compliance program design and implementation to enforcement defense.
Our team brings more than 100 years of combined experience resolving and preventing the legal and business challenges physician practices face. This mirrors the way you diagnose, treat, and prevent health issues for your patients every day.
The Financially Confident Physician
Gates B. Colbert, MD 2026 President, Dallas County Medical Society
PHYSICIANS ARE OFTEN KNOWN FOR THEIR clinical expertise but can struggle to manage their finances. This reputation stems not from carelessness but from years spent focused solely on medical training, with little education on personal finance. Throughout this demanding path of becoming a physician, mentors often reassure us, “Don’t worry about finances; ignore that massive debt in forbearance, and the rewards will come in the future.” This ingrained mindset shapes physicians to become high earners, but not always aware of how to be stewards of their income.
A typical physician will work 25 to 30 years, from training until a modest retirement at 63, and can earn over five million dollars in career earnings – some well into the 8 figures. However, some physicians need assistance with saving and investing. Shockingly, almost 25% of retirement-age physicians with successful careers have less than one million dollars in total savings and home equity (net worth). This provides an opportunity that we need to discuss more openly. When we are early in our careers, it is easy to love what we do. Physicians are dedicated to our patients and do not think about retirement, pushing ourselves to be the best physicians we can be. But after 10 to 20 years of practice, as the healthcare system shifts in their favor, physicians’ circumstances and goals may change. The demand for excellent, high-quality care does not, and should not, ease up, but this is one of the biggest drivers of physician burnout. After a decade or two of providing excellent care, we may begin to consider change. Physicians can only make practice changes, such as cutting back to what most Americans consider a full-time work schedule, if we have a strong financial foundation. As Jim Dahle, MD, explains, “most Americans consider 35 to 40 hours a week to be a full-time job.”
Physicians should to be conscious of their savings rate and finan-
cial goals throughout their careers. If you aren’t managing your finances, you may become one of the many physicians in their sixties facing burnout and an insufficient financial foundation to support a comfortable retirement. It is imperative that a strong physician and healthcare team leader be wise with their medical knowledge and practice, but also with their personal finances and retirement horizon. A physician who is foundationally strong on all pillars: knowledge, care implementation, team communication, and financial security, provides optimal care with clear eyes.
I realize that not all of our ~9,500+ DCMS members and their spouses have the time nor interest to monitor and strategize their finances. In those cases, there are excellent financial advisors and planners available,through the DCMS Partner Program. You can also find reliable resources online. I personally enjoy Jim Dahle, MD, who runs WhiteCoatInvestor.com and a podcast focused on physician finance. Money Meets Medicine is a podcast by Jimmy Turner, MD. Earn and Invest, by a palliative care physician, explores the human side of finances. Do-it-yourself guides such as Your Money or Your Life, Bogleheads Guide to Investing, and A Simple Path to Wealth are also helpful. One thing I learned through resources such as these, is you don’t need a side practice or investment empire to succeed financially.
Graduating from medical school with over $160,000 in debt, I needed a plan. I chose the do-it-yourself route, but I fully understand the value of seeking a professional financial planner. Continue to practice excellent medicine, but also build a strong financial foundation and enjoy your career. At a minimum, I learned to save a portion of my take-home pay and invest in index funds within my retirement and brokerage accounts. There are many different strategies for achieving your financial health, and I want you to achieve your personal and financial goals! DMJ
New Tools, New Rules: Navigating the Legal Landscape of AI in Clinical Practice
Jon R. Roth, MS, CAE, Managing Editor
THE EXAMINATION ROOM LOOKS DIFFERENT today than it did five years ago. In many practices across Dallas County, a physician opens an encounter, activates an ambient listening tool on a smartphone or workstation, and begins talking with their patient while an AI model quietly transcribes, organizes, and populates the electronic health record in the background. Before the visit ends, clinical decision support algorithms have flagged potential drug interactions, risk-stratification scores have updated, and in some cases, a diagnostic imaging AI has already pre-read that morning’s CT. Artificial intelligence has not arrived in medicine. It has moved in.
As managing editor of the Dallas Medical Journal, I have watched this transformation with a mixture of genuine admiration and appropriate concern. The tools are remarkable. The benefits are real. And yet the legal terrain physicians are being asked to navigate has never been more complex or consequential. This April edition, our annual focus on legal and financial matters, examines the legal dimensions of AI integration in clinical practice,
a subject the Dallas County Medical Society (DCMS) believes every physician in North Texas needs to understand, whether they have embraced these tools or simply found them deployed around them.
THE LANDSCAPE HAS ALREADY CHANGED
AI has arrived in clinical settings through multiple channels. Ambient scribes, like those deployed system-wide at Baylor Scott & White Health, use large language models (LLMs) to record clinical encounters, generate structured notes, and integrate them directly into the EHR. Early data show meaningful reductions in burnout and documentation time: Baylor Scott & White has reported positive feedback from both patients and providers, and the profession broadly is beginning to see these tools as more than a novelty. Meanwhile, diagnostic AI models are being embedded into imaging workflows to predict risk scores and guide therapeutic decisions. At UT Southwestern Medical Center, Dr. Payal Kapur, M.D., Professor of Pathology and Urology and co-leader of the Kidney Cancer Program at the Harold C. Simmons Comprehensive Cancer Center, has led the development of an AI-powered analysis of histopathological slides that can predict which kidney cancer patients are likely to respond to anti-angiogenic therapy. This work could spare
patients from ineffective treatments and unnecessary toxicity. AI is also reshaping administrative workflows: coding support, prior authorization assistance, and clinical documentation integrity tools are now common infrastructure in many health systems.
Each of these modalities offers genuine value to the physician’s practice and to the patient. Each also introduces legal exposure that the profession has only begun to fully reckon with.
THE LIABILITY QUESTION NO ONE HAS FULLY ANSWERED
The law has not kept pace with technology. Courts have not yet definitively resolved who bears responsibility when an AI-assisted decision contributes to patient harm. What is becoming clear, however, is that physicians retain primary liability for clinical decisions regardless of what an algorithm recommended, flagged, or failed to flag. The physician signs the chart. The physician makes the call. That accountability has not transferred to a software vendor.
This creates a paradox that the house of medicine must confront directly. Failure to use an available AI tool that demonstrably reduces diagnostic errors could, in some contexts, be argued as a breach of the evolving standard of care. At the same time, over-reliance on AI output, such as accepting ambient scribe notes without critical review or deferring to a diagnostic algorithm without applying independent clinical judgment, leaves the physician equally exposed when those tools misinterpret context, introduce hallucinated content, or reflect biases embedded in their training data. The malpractice risk cuts in both directions. There is no safe harbor in passivity.
PROTECTING YOURSELF AND YOUR PATIENTS
Whether a physician has chosen to adopt AI tools or is required to use them as part of a health system’s standard workflow, individual risk management must be active and intentional. Several principles apply across all settings.
First, document clinical reasoning explicitly. Regardless of what an AI model recommends, the physician’s independent thought process, including any departure from AI-generated suggestions, and the clinical rationale for that departure, should be clearly reflected in the record. AI-generated content should be labeled as such and noted as having been reviewed and verified by the treating physician. When a malpractice claim is reviewed, what matters most is not which tool was used but whether the physician exercised and documented their own judgment.
Second, confirm HIPAA compliance and execute a Business Associate Agreement with every AI vendor whose platform processes protected health information. Sharing patient data with generalpurpose AI tools such as any widely available public LLM, without such an agreement, is a HIPAA violation regardless of intent. Physicians should not assume institutional adoption implies institutional compliance on their behalf; individual due diligence matters.
Third, treat patient disclosure as both a legal and ethical floor. Ambient listening tools that record clinical encounters require clear patient notification at a minimum, and in many contexts, explicit informed consent. Patients have always had the right to
know what is happening in their care. That right does not diminish because the process has become algorithmic.
Fourth, when AI tools are mandated by an employer or health system, and a physician has limited authority over their selection, that does not eliminate individual accountability. The physicians who will fare best in this environment are those who take time to understand what any required tool actually does, know its limitations, actively review its outputs, and advocate within their institutions for appropriate governance structures, audit mechanisms, and the ability to override AI recommendations when clinical judgment demands it.
WHAT DCMS IS WATCHING
The Dallas County Medical Society and Texas Medical Association are monitoring the legal and legislative landscape as it evolves. Texas has not yet enacted the specific AI healthcare statutes seen in states like California, but federal guidance from the Department of Health and Human Services, continued FDA oversight of AI-enabled medical devices, and emerging malpractice litigation are already shaping the operating environment here. DCMS will continue to provide members with education, advocacy, and practical resources as this landscape develops, including resources that can provide guidance on vendor agreements, documentation standards, and informed consent frameworks tailored to Texas law.
THE PHYSICIAN’S ENDURING ROLE
In nearly every conversation I have had with physician members of DCMS about AI, one theme emerges consistently: the technology is a tool, not a replacement for judgment, relationships, or accountability. The house of medicine has adapted to every significant technological transformation in its history, from the stethoscope to the HER, to telemedicine, and it will adapt to this one with the same disciplined professionalism that has always defined the profession.
The physicians of Dallas County are already asking the right questions, and that matters more than it may seem. Every inquiry about liability exposure, every demand for clearer governance, every push for patient-centered disclosure is an act of professional stewardship that protects patients and the integrity of medicine at the same time.
The tools are new. The values are not. And as any seasoned litigator will tell you: in matters of professional accountability, it is not what technology you used, it is what you knew, what you reviewed, and what you owned. The physician who approaches AI the same way they approach every other dimension of their practice - with curiosity, discipline, and an unshakeable commitment to the patient in front of them - will find themselves on the right side of both the law and the bedside.
As the old Texas saying goes: trust the technology, but ride your own horse. DMJ
Jon R. Roth, MS, CAE DCMS EVP/CEO
Why Advance Care Planning Matters
Advance care planning empowers patients and their loved ones to plan for future medical decisions guided by their values and wishes.
by Emily Pearcy, LCSW-S, OSW-C; Director, Social Work, Texas Oncology
CANCER CARE, OR LIVING
with any illness, involves countless decisions. As a patient, you should be able to clearly share your wishes with your care team, leading to treatment planning that supports your priorities and preferences. Advance care planning is an approach that helps you think about and plan for the type of care that aligns with your values, should you ever be in a position where you are unable to communicate on your own. All adults, not just those with chronic and serious illnesses, can benefit from engaging in advance care planning.
This process of thinking about and planning for future care can prevent unnecessary stress by
mapping a path forward. Advance care planning is a gift for your future self and the people who care about you, so difficult decisions don’t have to be faced without knowledge of your values and wishes. Gaining the tools and resources now to plan for the future ensures your priorities and decisions will be respected by your medical team and others involved in your care.
BASICS OF ADVANCE CARE PLANNING
Advance care planning is a process that may take place over several conversations. These discussions can happen with different members of your care team, such as a social worker, advanced practice provider, physician, or nurse. During this process, you will have the opportunity to learn about choices for your future medical care and decide how you want to be treated if you cannot communicate your wishes.
The goal of the process is to empower you to take control of your health and plan for the unknown, while allowing you to document
your wishes. The outcome of these conversations often includes written documents that will be saved in your medical file and shared with those closest to you. An equally important part of the process is determining who you would want to make decisions on your behalf and what those decisions should be. Open communication with those you identify as future decision-makers leads to a shared understanding of what matters most to you.
While these directives are intended only to guide care if you become unable to communicate, they are best discussed when you can reflect on and share your values and goals with your family and healthcare team. These conversations can feel difficult, but they are essential to help ease the stress for your loved ones if decisions ever need to be made on your behalf.
COMMON MISCONCEPTIONS
One of the biggest misconceptions of advance care planning after a cancer diagnosis is that it means surrendering hope or ending treatment. In reality, planning ahead ensures that your future care aligns with your values and preferences, whether that means continuing treatment or focusing on quality of life. These conversations are about empowerment, not limitation.
Similarly, some people may think that writing down their wishes prevents them from choosing a different course of action in the future. However, advance directives can be changed at any time, and you can have advance care planning conversations with your care team as frequently as you need.
Another common reason people avoid advance care planning is the idea it is only for the end of your life. Advance care planning is an important process for all adults to undertake, not just near the end of life. Having an open conversation to state your wishes ahead of time offers peace of mind for any number of future scenarios, so you know your decisions will be honored, and your loved ones won’t face difficult choices alone.
Finally, some patients may think that they have few choices to make, or that they will rely on their care team to decide for them. Life history, personal values, family, culture, and religion can all play a role in shared decision-making. Exploring options can help you identify how you would like to be treated both now and in the future, if circumstances change.
April 16 is National Healthcare Decisions Day, making it an ideal time to begin these conversations. Whether you are healthy or managing an illness, planning ahead empowers you to make informed choices. Talk to your care team to schedule an appointment for help with advance care planning.
Advance care planning is about clarity, dignity, and empowerment. The process equips patients, loved ones, and care teams to prepare for unknown or unexpected situations. By starting the conversation today, you ensure that your future healthcare plan reflects your values and wishes for whatever lies ahead. DMJ
TIPS FOR MEANINGFUL CONVERSATIONS
As you consider advance care planning, create productive and meaningful discussions with a few guides:
Remember you’re not alone:
Advance care planning is highly personal, but it shouldn’t be done in isolation.
Family and friends can provide emotional support or serve as a sounding board, and healthcare professionals can guide you through future care planning.
Share what’s important to you:
Your values and beliefs reflect who you are, and your principles should inform your healthcare decisions.
Explore your options:
Your cancer care is personalized to you, and advance care planning should be part of that individualized treatment plan. Discussing medical directives openly allows you to maintain control and provides peace of mind for caregivers and loved ones.
The CMS Cannabis Access Initiative
CMS Launches the Substance Access Beneficiary Engagement Incentive Program (BEI): How It Marries the Healthcare and Cannabis Industries
by Richard Y. Cheng, Esq., CHC
THE CENTERS FOR MEDICARE & MEDICAID Services (CMS) has authorized the use of hemp products through the guidance of healthcare providers. Last month, the CMS Innovation Center (CMMI) announced the launch of multiple hemp policy initiatives, effective April 1, 2026. The Substance Access Beneficiary Engagement Incentive (BEI) created a federal pathway for patients to access hemp products within certain Medicare value-based care models, accountable care organizations (ACOs), and hemp businesses.
OVERVIEW OF THE BEI
The BEI is available to healthcare organizations participating in specific CMMI models. CMS implemented the BEI under Section 1115A of the Social Security Act, which grants CMMI broad discretion to test new payment and service delivery models aimed at cost control and quality of care.
The BEI is provided through three models:
• ACO REACH Model (effective April 1, 2026);
• Enhancing Oncology Model (EOM) (effective April 1, 2026); and
• Long-Term Enhanced ACO Design (LEAD) Model (effective January 1, 2027).
Under the BEI, model participants may, at their own expense, consult with and advise eligible Medicare beneficiaries on the use of federally legal hemp products to address medical conditions and their symptoms. Participants may provide eligible hemp products to certain beneficiaries, up to a
$500 value per eligible beneficiary per year, in states where eligible hemp products are legal, subject to safeguards and regulatory requirements. Participation is optional, and only model participants who elect the BEI and receive CMS approval may offer it to eligible beneficiaries. Implementing the BEI, model participants must submit and maintain a CMS approved implementation plan. The plan must address several key elements, including (a) distribution amount and frequency; (b) eligible hemp products to be offered and dosing information; (c) safeguards, oversight, and monitoring mechanisms; (d) beneficiary eligibility criteria; and (e) other requirements in applicable participation agreements. Quarterly reports must be submitted by model participants on the BEI, including the information requested by CMS.
HEMP PRODUCTS ALLOWED
The BEI defines eligible hemp products as federally legal hemp-derived products that:
• Contain no more than 0.3% delta-9 tetrahydrocannabinols (THC), as required by the 2018 Farm Bill;
• Contain no more than 3 mg per serving of total THC, including THC acid, delta-8 THC, and delta-10 THC, in orally administered form; and
• Any products containing cannabinoids not naturally produced or capable of being produced by or in the cannabis plant during its cultivation.
The burden of procuring eligible hemp products rests on model participants, who must fully comply with applicable state and federal laws. The BEI requires eligible hemp products to be provided directly by a qualified physician affiliated with the model participant, as specified by the model participation agreements.
The hemp products used by model participants must meet certain quality and safety requirements. The hemp products must meet federal, state, and local production, quality, and safety laws and mandated standards and be tested by a third party for potency, contaminants, and microbial hazards.
BENEFICIARY ELIGIBILITY
Only Medicare beneficiaries currently aligned to an approved model participant may receive the BEI. Beneficiary eligibility criteria include alignment with an approved organization. Beneficiaries who are pregnant or breastfeeding are not eligible to participate. Specific criteria are defined within each model’s participation documentation.
PHYSICIANS AND QUALIFIED CLINICIANS
CMS has made clear that a physician or other qualified clinician must determine that the approach is safe and appropriate and must document shared decision-making with the beneficiary. The physician or clinician must show the discussion included potential benefits and risks, beneficiary goals and preferences, and a review of current medications and possible drug interactions. Physicians must ensure their recommendations for hemp products are within their licensure and scope of practice under applicable state law. Although hemp CBD products are not controlled substances under federal law, state laws and medical board guid-
ance differ from state to state regarding how healthcare providers may recommend hemp products.
The shared decision-making documentation is deemed a medical record obligation. Physicians should demonstrate the consultation as an encounter that reflects an individually tailored evaluation of whether hemp product use is clinically appropriate, consistent with the patient’s plan of care, and aligned with the patient's goals. Failure to adequately document exposes the physician and the ACO to program integrity scrutiny and potential False Claims Act (FCA) liability if the CMS-approved implementation plan is not followed as represented.
DISPENSING AND SUPPLY CHAIN OBLIGATIONS
Under the BEI, hemp products must be furnished directly by qualified physicians or other clinical staff affiliated with the participant organization. Beneficiaries cannot be directed to retail stores. As such, physicians and ACOs, in effect, act as distributors of hemp products—requiring procurement, storage, inventory control, and chain-of-custody workflows that most clinical practices are not structured to handle. Robust internal policies governing product sourcing, storage conditions, and patient dispensing documentation should be developed by a legal or compliance expert.
ANTI-INDUCEMENT PROHIBITIONS AND FRAUD AND ABUSE ISSUES
CMS has imposed anti-inducement safeguards within the BEI framework, which require the following:
• The BEI and product availability must not be marketed to induce beneficiaries to select or remain aligned with a participant organization;
• Participants may not enter into arrangements that provide remuneration to induce the selection of a particular manufacturer or seller; and
• Payments to manufacturers or sellers must be consistent with fair market value (FMV) and not tied to the volume or value of referrals or business otherwise generated.
The intersection of hemp product distribution and the federal healthcare program framework creates a complex fraud and abuse landscape that both physicians and hemp businesses must carefully navigate. The federal Anti-Kickback Statute (42 U.S.C. § 1320a7b) prohibits the knowing and willful exchange of anything of value to induce or reward referrals of items or services reimbursable by a federal healthcare program. Violations are felonies punishable by up to 5 years of imprisonment, a $25,000 fine per violation, and exclusion from federal healthcare programs.
The AKS presents two critical risk areas within the BEI context:
• Physician–Supplier Arrangements: If a hemp supplier enters into an arrangement with a participating ACO or its affiliated physicians that provides value beyond FMV—whether in the form of discounted pricing, consulting fees, speaking arrangements, or oth-
PRACTICAL RECOMMENDATIONS FOR HEALTHCARE PROVIDERS AND ACOS:
• Verify model eligibility. Confirm that the organization is an active participant in ACO REACH, EOM, or LEAD for the applicable performance period before electing the BEI.
• Develop a rigorous implementation plan. Treat the CMS implementation plan as a compliance document. It is highly recommended to engage competent healthcare regulatory counsel to ensure it addresses all required elements and withstands a program integrity review.
• Conduct a state law assessment. Evaluate whether the contemplated hemp products are legal under applicable state and local law before program launch in each state where the organization operates.
• Establish clinical governance protocols. Implement policies requiring individualized physician assessment and detailed shared decision-making documentation for each beneficiary considered for the BEI. Integrate BEI-related documentation into the EHR workflow.
• Structure supplier arrangements carefully. All supplier contracts must reflect FMV, must not be conditioned on volume or value of referral, or business otherwise generated, and must include regulatory change provisions addressing the November 2026 statutory changes. Conduct AKS and Stark analysis of any financial relationships with suppliers.
• Monitor the litigation. The outcome of Smart Approaches to Marijuana v. Kennedy et al., Case No. 1:26-cv-01081 (D.D.C.) could materially affect the BEI’s continued availability.
PRACTICAL RECOMMENDATIONS FOR HEMP BUSINESSES:
• Invest in compliance infrastructure. Implement third-party testing, accurate labeling, and robust quality management systems to maximize BEI eligibility. These efforts protect against both regulatory liability and product liability claims.
• Engage healthcare regulatory counsel early. Structure supply arrangements with CMMI participants to protect against exposure to federal fraud and abuse laws. Efforts to comply with anti-inducement and FMV requirements embedded in the BEI framework are paramount.
• Account for regulatory uncertainty in contracts. Supply agreements should include provisions addressing the November 2026 statutory change, state law changes, and regulatory definition shifts.
• Monitor congressional and regulatory developments. The legal definition of hemp—and eligible BEI products—may shift before the end of 2026. Active monitoring of both the litigation and the legislative effort is critical.
er benefits—such an arrangement could be characterized as a kickback if one purpose is to induce the ACO to select that supplier’s products for the BEI program. CMS’s own program integrity requirements explicitly prohibit payments tied to the volume or value of referrals, mirroring AKS principles.
• Beneficiary Inducements: The AKS’s beneficiary inducement provisions (42 U.S.C. § 1320a-7a(a)(5)) prohibit offering or transferring remuneration to a Medicare beneficiary that the offering party knows or should know is likely to influence the beneficiary’s decision to select a particular provider. Given that the BEI expressly prohibits marketing the hemp products to retain beneficiary alignment, organizations must ensure that all patient communications and outreach are clinically driven rather than enrollment-driven.
The Physician Self-Referral Law (“Stark”) (42 U.S.C. § 1395nn) prohibits physicians from referring Medicare patients for certain designated health services (DHS) to entities with which the physician or an immediate family member has a financial relationship, unless a specific exception applies. Importantly, Stark is a strict liability statute—intent is not required for a violation to occur. Hemp products distributed under the BEI are not themselves a DHS. However, if a physician has a financial interest in a hemp supplier participating in the BEI program—even an indirect ownership interest—the Stark Law’s referral restrictions and financial relationship analysis must be carefully evaluated. Organizations establishing supply chain arrangements with affiliated entities should conduct a Stark analysis before finalizing any such arrangements. In addition, certain states have “Stark-like” statutes that may limit a physician’s ability to have a financial relationship with a venture that receives the physician’s referral.
Any misrepresentation in an implementation plan submitted to CMS— whether regarding product specifications, clinical oversight protocols, or beneficiary eligibility determinations—could give rise to False Claims Act (FCA) (31 U.S.C. §§ 3729–3733) liability. The FCA imposes treble damages and per-claim penalties on those who knowingly submit false or fraudulent claims to the federal government. Because the implementation plan is a CMS-required submission that forms the basis for program approval and ongoing participation, organizations must ensure that all representations made therein are accurate, complete, and updated as circumstances change. The FCA’s qui tam provisions further expose organizations to whistleblower suits brought by disgruntled employees or competitors.
IMPACT ON HEMP BUSINESSES
The BEI represents the first federal pathway into the Medicare-adjacent market for hemp businesses. The pilot program could generate substantial new revenue for compliant hemp CBD product manufacturers, depending on the amount of ACO participation. However, realizing this opportunity requires hemp businesses to satisfy demanding eligibility, quality, and documentation standards, which include:
• Third-party testing for potency and contaminants is mandatory, and test results must conform to federal and state standards;
• Products must comply with applicable federal, state, and local laws, including state hemp regulations that vary significantly across jurisdictions; and
• Supplier arrangements with participating ACOs must be structured at FMV and must not be conditioned on the volume or value of referrals.
Several states impose hemp regulations more restrictive than the federal BEI definition. Some states impose a zero-THC standard for certain hemp-derived products, effectively blocking most products from the market that would otherwise be BEI-eligible. Hemp businesses seeking to supply ACOs in restrictive states must conduct a state-specific legal analysis before entering into supply arrangements. Because participating ACOs must procure, store, and directly furnish eligible hemp products to beneficiaries, hemp businesses should anticipate that their ACO customers will require contractual commitments regarding the following: (a) product specifications and THC compliance; (b) chain-of-custody documentation; (c) quality control and recall procedures; (d) representations regarding regulatory status; and (e) indemnification for product liability.
CONCLUSION
The BEI represents a trailblazing federal policy effort by CMS. In fact, it is the first time a federal health program has created a pathway for access to hemp-derived products within the Medicare framework. This pilot program will allow the healthcare industry and affected communities to evaluate whether integrating patient-managed chronic and oncologic condition care with hemp-derived products is effective and feasible within value-based care models. In addition, hemp businesses may be well-positioned to pursue a federally recognized market pathway.
Concurrently, the BEI is filled with legal complexity. The program operates at the intersection of unsettled hemp law, federal fraud and abuse prohibitions, the Administrative Procedure Act’s procedural requirements, and a regulatory change that could fundamentally alter the eligible product landscape by November 12, 2026. Healthcare providers and hemp businesses that approach the BEI as a simple add-on to existing operations do so at significant legal risk. Those that approach it with rigorous compliance planning, experienced counsel, and realistic contingency frameworks will be best positioned to benefit from what could be a transformative shift in federal health policy. DMJ
Ritter Spencer Cheng, PLLC (RSC) regularly advises clients on healthcare transactions, healthcare regulatory issues, and compliance matters involving alternative substances in Texas and throughout the country. The RSC healthcare and alternative substances teams will continue to monitor the BEI and its associated rules while advising clients on regulatory, corporate, and transactional matters. Our clients benefit from informed strategic advice and guidance on the regulatory burdens associated with healthcare and hemp-related transactions. For questions, reach out to Richard Y. Cheng, Esq., CHC at rcheng@ritterspencercheng.com.
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Money Strategies for Modern Physicians
by Brianne Huedepohl, Monument Realty
PHYSICIANS SPEND YEARS BUILDING THEIR careers, sacrificing time, energy, and often personal finances in the process. Yet despite strong earning potential, many clinicians find themselves too busy to create a structured financial strategy. Between demanding schedules, student loan obligations, practice responsibilities, and family commitments, financial planning can easily become something pushed to “later.”
The reality is that building a financially secure future is not simply about earning more income. It requires intentional planning, strategic investing, and creating systems that work even when time is limited.
No matter where a physician is in their career, from residency to retirement planning, taking a proactive approach to financial wellness can create long-term stability and opportunities for future growth.
Physicians routinely advise patients to seek preventative care rather than waiting for problems to develop. Financial planning works much the same way.
Start with a Clear Financial Picture
One of the most overlooked steps in building a financial future is understanding your current financial position. Before developing investment strategies or retirement goals, physicians should assess their overall financial health, including:
• Income sources and cash flow
• Monthly and annual expenses
• Student loan obligations
• Retirement accounts and investments
• Insurance coverage
• Real estate holdings
• Estate planning documents
Having a clear understanding of where finances stand today creates the foundation for informed decision-making tomorrow. Many physicians are surprised to discover opportunities to improve cash flow, reduce tax burdens, or better align investments with long-term goals.
Working with experienced financial professionals can help simplify complex decisions and create a more coordinated strategy around investments, taxes, lending, insurance, and long-term planning. A trusted advisor can also help physicians stay focused on long-term goals during changing market conditions or major life transitions.
For many clinicians, the biggest challenge is not a lack of income potential. It is simply finding the time to organize and implement a comprehensive financial plan.
Financial stress impacts more than bank accounts. It can contribute to burnout, anxiety, and ongoing stress for physicians already balancing demanding careers.
Creating a financial plan can provide greater clarity, confidence, and peace of mind. Even small steps taken consistently over time can have a meaningful long-term impact.
Creating financial security is a process, not a single decision. The earlier physicians begin building intentional financial habits, the more flexibility and opportunity they create for the future. DMJ
Maximize Tax-Advantaged Accounts
Physicians often fall into higher tax brackets, making tax-efficient planning especially important. Utilizing tax-advantaged accounts can help reduce taxable income while simultaneously building long-term wealth. Depending on career stage and employment structure, physicians may benefit from strategies involving:
• 401(k) or 403(b) retirement plans
• Health Savings Accounts (HSAs)
• Backdoor Roth IRAs
• SEP IRAs or Solo 401(k)s for independent contractors
• Deferred compensation plans
• 529 education savings plans
For physicians with practice ownership or additional business income, advanced tax strategies may also create opportunities for long-term savings and wealth preservation.
Investing Should Match Your Lifestyle and Career Stage
Financial planning for physicians is not one-sizefits-all. A resident, a mid-career physician, and a physician preparing for retirement all have very different financial priorities.
Early-career physicians may consider focusing on:
• Debt management
• Emergency savings
• Establishing retirement contributions
• Protecting income with disability insurance
Mid-career physicians often shift toward:
• Investment diversification
• Real estate opportunities
• College planning
• Tax optimization strategies
Late-career physicians may prioritize:
• Retirement income planning
• Estate planning
• Wealth transfer strategies
• Risk reduction and asset preservation
The key is creating a strategy that supports both personal and professional goals while remaining realistic with a busy clinical schedule.
This article is intended for educational and informational purposes only and is not to be considered financial, tax, legal, or investment advice. Readers should consult qualified professionals regarding their individual situations.
Social Engineering Fraud: Protecting Your Practice from Manipulative Cyber Threats
by Frost Bank
FRAUD ATTACKS THAT EXPLOIT EMPLOYEE TRUST
are among the most effective and costly threats facing medical practices today. Understanding how these schemes work, as well as the warning signs to watch for, is essential to protecting your organization. Genuine kindness and trust are admirable qualities in any workplace, but they are also frequently exploited. Social engineering, as defined by the National Institute of Standards and Technology (NIST), is the process of “revealing sensitive information, obtaining unauthorized access, or committing fraud by associating with the individual to gain confidence and trust.”1 Rather than targeting computer systems directly, these attacks target people, convincing employees to take actions they would not otherwise consider: navigating to malicious websites, wiring funds to fraudulent accounts, or surrendering sensitive organizational or patient data.
For physician practices and health care organizations, the stakes are particularly high. The consequences of a successful attack extend well beyond financial loss; they can include regulatory liability under HIPAA, reputational damage, and significant disruption to patient care operations.2
THE SCALE OF THE PROBLEM
The financial toll of social engineering fraud is staggering. According to the Federal Bureau of Investigation, fraud schemes of this nature generated more than $43 billion in losses between 2016 and 2021. That figure was accompanied by a 65 percent increase in both actual and attempted
losses between July 2019 and December 2021 alone.3 These numbers reflect not only successful attacks but the growing sophistication and frequency of attempts.
Beyond direct financial loss, a successful attack can expose a business to civil liability, regulatory fines, and legal action, particularly when confidential patient or employee information is compromised. Downtime and lost productivity compound the damage further.4,5
HOW ATTACKERS EXPLOIT TRUST
Social engineering attacks are effective precisely because they work with human nature rather than against it. Scammers exploit the instinct to trust authority figures, respond to urgency, and extend good faith to colleagues.6 The most common techniques include the following:
Phishing. Attackers send fraudulent emails or text messages designed to resemble communications from trusted sources such as banks, insurers, or employers. These messages typically include links that redirect users to counterfeit websites or that install malicious software when clicked. Once on a fake site, victims are prompted to enter sensitive credentials or financial information.
Spear Phishing. A more targeted variant of phishing in which attackers craft messages that appear to originate from a known individual, such as a colleague, supervisor, or vendor. These messages are often personalized with accurate details, including real names, titles, and sometimes genuine marketing materials from the organization being impersonated. Employees should verify sender email addresses and phone numbers independently before acting on any unusual request.
Phone Scams. Fraudsters impersonate financial institutions using caller ID spoofing technology that causes a bank’s name to appear on the recipient’s phone. The goal is typically to obtain enough information, such as a phone number, email address, or the last four digits of a debit card, to facilitate unauthorized account access or fraudulent wire transfers.
RECOGNIZING THE WARNING SIGNS
While no security measure is foolproof, awareness of common red flags significantly reduces an organization’s vulnerability. Staff training should emphasize the ability to recognize the following patterns:
Artificial urgency. Messages that create time pressure, demand an immediate response, or warn of severe consequences for inaction are a hallmark of social engineering. The goal is to prevent the recipient from pausing to verify the request.
Unusual or out-of-character communications. A request that seems inconsistent with the sender’s normal behavior, particularly one that involves a financial transaction, account access, or sensitive information, should be verified through a separate, known communication channel.
Unprofessional language or formatting. Poor grammar, unusual punctuation, inconsistent formatting, and misspelled words can indicate a fraudulent communication, particularly when the supposed sender is a professional institution.
Suspicious websites or domain names. Fraudulent websites may closely mimic legitimate ones but often contain subtle inconsistencies, such as broken links, missing pages, inconsistent branding, or slightly altered domain names (e.g., “dallas-cms. org” versus “dallascms.org”). Users should scrutinize URLs before entering any information.
Unexpected attachments or download requests. Files disguised as invoices, financial reports, or clinical documents are a common vehicle for malware, spyware, and ransomware. Employees should be trained never to open unexpected attachments without independent verification.
BUILDING A SECURITY-AWARE CULTURE
Technical safeguards such as multi-factor authentication (MFA) and secure browsing tools provide an important layer of defense.7,8,9 However, the most reliable protection is a workforce that is trained to recognize and respond appropriately to suspicious activity. Organizations should consider formal cybersecurity awareness training,10 clear internal protocols for verifying unusual financial requests, and a culture that empowers staff to question and escalate rather than comply reflexively.
Although no organization can guarantee complete immunity from social engineering attacks, recognizing red flags and fostering a security-conscious environment are foundational to protecting both the financial integrity and operational continuity of any medical practice.11,12 DMJ
This information was provided to Dallas Medicine Journal by Frost Bank, a DCMS partner company. For additional information, please contact Elva Yanez at elva.yanez@frostbank.com or 214-515-4525.
REFERENCES
1. National Institute of Standards and Technology. Social Engineering. September 2020.
2. U.S. Department of Health and Human Services. Summary of the HIPAA Security Rule. October 19, 2022.
3. Federal Bureau of Investigation. Business Email Compromise: The $43 Billion Scam. May 4, 2022.
4. ITSecuritywire. Social Engineering Attacks. May 26, 2023.
5. Express Computer. Protect Businesses from the Dangers of Social Engineering. April 6, 2023.
6. Psychology Today. The Neuroscience of Trust. August 12, 2015.
7. Forbes Advisor. Most Secure Browsers of 2023. August 11, 2023.
8. The Verge. The Seven Best Secure Messaging Apps. June 30, 2022.
9. TechRadar. Best Secure Email Providers of 2023. May 3, 2023.
10. Forbes. How Providing Staff Awareness Training Improves a Company’s Security Posture. January 27, 2023.
11. Security Magazine. How Can Companies Keep Up with Social Engineering Attacks? September 6, 2022.
12. National Institute of Standards and Technology. Cybersecurity Framework. April 23, 2023.
How to Reduce Your Second-Largest Cost
by Medical Space Advisors
FOR MOST MEDICAL PRACTICES, RENEWING A LEASE
is a major financial decision, yet it is often not handled with enough preparation. There are only rare chances to reduce overhead, maybe once every five or ten years. Still, physicians often wait until just before the lease expires to talk to the landlord. This approach weakens their negotiation leverage and reduces their options for better terms. Over the average lease term, a 2,000-square-foot practice can lose $20,000 to $40,000 simply by not negotiating effectively.
Landlords often know these patterns better than tenants do. Healthcare practices stay in one place for an average of 18 years. Building owners use that loyalty as an advantage. They understand that physicians are busy, rarely check their leases until rent goes up, and usually want to avoid lengthy talks. This leads to renewals with little real negotiation.
To change this, always negotiate as if you plan to leave. In every email, call, and casual remark, show that you are seriously considering other options, such as relocating or buying an office condominium. Make sure your staff knows the plan. A side comment could spoil the message. The landlord must believe vacancy is a real risk. It is not free for them to re-lease: they lose rent, need to fix the space, and pay commissions. Renewing your lease is almost always cheaper for them, but only if they know they must compete for your business.
Medical tenants are at a disadvantage from the start. Interior build-out costs can reach $80 to $150 per square foot. Technology and moving add another $5 to $10 per square foot. Worries about patient confusion and moving inertia can make practices hesitate. Landlords count on this hesitation.
The best way to gain leverage is to hire a commercial real estate broker who works with medical tenants. Start this process at least 9 months before your lease ends. A good broker manages the process, takes almost none of your time, and works only for you. The landlord pays their fee. Some building owners may not want to work with a broker. Still, the broker’s fee is small compared to the savings from better negotiations.
Renewal time is also a good moment to review your whole lease. You might remove an old personal guarantee, recover your security deposit, or update your Base Year on a full-service lease. This could remove added pass-through charges. You may also be able to get money for upgrades, use unused funds for rent, or receive improvement dollars early.
You only get a few shots at this within a career. Take these negotiations seriously: proactively prepare, engage an expert medical real estate broker well in advance, and approach renewal as a true negotiation. With focused effort, you can secure major longterm savings and optimize your practice's financial future. DMJ
Navigating Texas’s New AI Laws: A Compliance Guide for Physicians
by Darrell Armer, Rachel Poynter, and Kristi Harbord; Gray Reed Law Firm
AI HAS RAPIDLY EVOLVED from emerging technology to embedded clinical infrastructure. Physicians now routinely rely on AI-powered tools for diagnostic support, ambient documentation, patient engagement, workflow automation, and administrative functions. Considering the increasing integration of AI and digital systems in health care, the 89th Texas Legislature enacted two major laws that directly affect how physicians deploy AI in clinical practice. This article provides a practical overview of each law and concrete steps Texas physicians should take now.
SENATE BILL 1188: USE OF AI FOR DIAGNOSTIC PURPOSES
Effective September 1, 2025, Senate Bill 1188 creates Chapter 183 of the Texas Health and Safety Code and establishes sweeping new obligations for “covered entities,” including all Texas-licensed physicians.1 Among other requirements, SB 1188 establishes the conditions under which a physician may use AI for diag-
nostic purposes, including the use of AI for recommendations on a diagnosis or course of treatment based on a patient’s medical record. Under SB 1188, a physician may use AI for these diagnostic purposes if the following conditions are met:
Scope of License: The physician is acting within the scope of their license, certification, or other authorization to provide health care services.
No Legal Prohibition: The particular use of AI is not otherwise restricted or prohibited by state or federal law.
Review of AI-Created Records: The physician reviews all AI-generated records in accordance with medical records standards established by the Texas Medical Board.
Disclosure: The physician must disclose their use of AI technology to patients.
HOUSE BILL 149: THE TEXAS RESPONSIBLE ARTIFICIAL INTELLIGENCE GOVERNANCE ACT
Effective January 1, 2026, House Bill 149, known as the Texas Responsible Artificial Intelligence Governance Act (“TRAIGA”), estab-
lishes one of the most comprehensive state laws on AI use in the country.2 Although TRAIGA applies across many industries, several requirements directly affect physicians.
TRAIGA applies to “AI systems”, which are defined as machine-based systems that infer from the inputs they receive how to generate outputs, including content, decisions, predictions, or recommendations that can influence physical or virtual environments. If a tool learns from data and influences care, assume TRAIGA applies. For physicians, AI systems can include:
• Clinical decision-support algorithms
• Diagnostic imaging AI (radiology, dermatology, cardiology, ophthalmology)
• Ambient documentation tools and AI scribes
• Patient-portal chatbots
• Prior-authorization or coverage-prediction tools
• Predictive scheduling, triage, or no-show forecasting tools
• Risk-stratification or population-health algorithms
TRAIGA requires that when an AI system is used in connection with health care service or treatment, the provider of the service or treatment notify the patient or the patient’s personal
representative. The disclosure must satisfy the following requirements:
• It must be clear and conspicuous.
• It must be written in plain language.
• It must be free of dark patterns (meaning it may not use a user interface designed to subvert or impair user autonomy, decision-making, or choice).
• It must be provided to the patient or the patient's personal representative no later than the first day services are provided.
• In emergencies, the disclosure must be provided as soon as reasonably possible.
Notably, the disclosure requirement applies regardless of whether a reasonable consumer would recognize that they are interacting with an AI system.
TRAIGA also prohibits certain uses of AI that physicians and their practices should understand. A person may not develop or deploy an AI system with the intent to unlawfully discriminate against a protected class in violation of state or federal law. “Protected class” is defined to include, but is not limited to, groups defined by race, color, national origin, sex, age, religion, or disability. These prohibitions are relevant to any physician practice that uses AI for patient engagement, care management, or administrative functions. While these restrictions target intentional and unlawful AI-driven discrimination, if a practice employs AI tools to screen patients for care eligibility or prioritize services based on patient characteristics, those tools should be reviewed to confirm they do not embed or perpetuate outcomes that could be characterized as unlawfully discriminatory.
Additionally, TRAIGA prohibits any person from deploying an AI system in a manner that intentionally aims to incite or encourage a person to commit physical self-harm, harm another person, or engage in criminal activity. While this prohibition may seem unlikely to arise in a physician’s practice, it is directly relevant to any patient-facing AI tools, such as mental health chatbots or patient engagement platforms, that could, in theory, generate harmful content.
ENFORCEMENT AND SAFE HARBOR
Both laws impose meaningful compliance risks and are subject to enforcement by the Texas Attorney General. Under SB 1188, the Attorney General may seek civil penalties of up to $5,000 per negligent violation, $25,000 per knowing or intentional violation, and $250,000 per violation involving the knowing or intentional use of protected health information for financial
gain. Regulatory agencies may also suspend or revoke a license once a covered entity has committed three or more violations.
Under TRAIGA, the Attorney General must provide 60 days’ written notice to allow the physician or practice to correct the issue prior to filing suit. Civil penalties range from $10,000–$12,000 for curable violations, $80,000–$200,000 for violations that cannot be cured, and $2,000–$40,000 per day for ongoing violations. If a person has been found in violation of TRAIGA and the Attorney General has recommended additional enforcement, the applicable state licensing agency may impose further sanctions, including monetary penalties of up to $100,000, probation, or license suspension or revocation.
Notably, TRAIGA provides defenses to enforcement. Among others, a defendant will not be liable if the defendant discovers a violation through any of the following: (a) feedback from a developer, deployer, or other person; (b) adversarial or red-team testing; (c) following applicable state agency guidelines; or (d) an internal review process, provided the defendant substantially complies with the NIST AI Risk Management Framework or another nationally or internationally recognized AI risk management framework.
AI BEST PRACTICES
SB 1188 and TRAIGA have fundamentally changed the rules governing physicians' use of AI-enabled tools in Texas. With both laws now in effect, every practice should start with a complete inventory of the AI tools currently in use (clinical and administrative) and take the following steps:
Disclose AI use to patients. SB 1188 and TRAIGA impose overlapping but distinct disclosure obligations. Under SB 1188, a physician who uses AI for diagnostic purposes must simply disclose that use to patients. Under TRAIGA, any provider who uses an AI system in connection with healthcare services or treatment must provide a disclosure to the recipient of the service or treatment, or the recipient’s personal representative, no later than the date the service or treatment is first provided (or, in emergencies, as soon as reasonably possible).
Because TRAIGA’s scope extends beyond diagnostic AI to encompass any use of an AI system in relation to health care service or treatment, physicians should treat the TRAIGA disclosure standard as the baseline for all AI-related patient disclosures. In practice, this means implementing a standardized disclosure that is clear, conspicuous, written in plain language, and free of manipulative design elements that could subvert or impair patient decision-making, delivered before or at the outset of care.
Document each AI disclosure in the patient record. Create a standardized workflow so that each AI-related disclosure is documented consistently.
Review AI-generated notes and diagnostic recommendations for accuracy. AI scribes and clinical decision-support tools can and do make errors. Develop a standardized workflow for reviewing and attesting to the accuracy of AI-generated content before it becomes part of the permanent medical record.
Audit AI tools for discriminatory outcomes. Any AI tool used to screen patients for care eligibility, prioritize services, or make decisions based on patient characteristics should be reviewed to confirm it does not embed or perpetuate outcomes that could be characterized as discriminatory.
Develop an internal AI oversight policy. Establish a process for ongoing monitoring of AI tools, including a mechanism for receiving feedback from staff and patients. This documentation matters: under TRAIGA’s safe harbor, practices that monitor AI tools, document their oversight, and promptly correct problems are in a far stronger position under any regulatory scrutiny.
By conducting a comprehensive inventory of existing and emerging AI tools, updating internal policies, and embedding compliant workflows now, physicians will be better equipped to adapt to Texas’s rapidly evolving regulatory landscape governing AI in healthcare. DMJ
REFERENCES
1 Texas Senate Bill 1188 (89th Legislature, Regular Session, 2025).
2 Texas House Bill 149, the Texas Responsible Artificial Intelligence Governance Act (89th Legislature, Regular Session, 2025).
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Dallas County Medical Society (DCMS) does not endorse or evaluate advertised products, services, or companies nor any of the claims made by advertisers. Claims made by any advertiser or by any company advertising in the Dallas Medical Journal do not constitute legal or other professional advice. You should consult your professional advisor.
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A New TMA Member Benefit
TMA Insurance Trust is announcing EverTravel, a new TMA member benefit underwritten by Zurich American Insurance Company. With a different approach to travel insurance, the plan aligns well with how physicians travel throughout the year, helping reduce the hassle of revisiting coverage decisions before each trip.
One Policy. Multiple Trips.
Here’s how it works:
• One annual, affordable policy that stays in place throughout the year
• Coverage for business and personal travel, inside and outside the U.S.
• Insurance protection that extends to up to five travel companions on the same trip, at no additional cost per person
Coverage Highlights at a Glance
What’s included when you travel:
• Trip cancellation and delay reimbursement, baggage coverage, and legal or embassy assistance
• Emergency medical and dental coverage while traveling
• Safety and security assistance during serious travel events
• 24/7 multilingual medical, legal, and travel support
TMA members receive preferred pricing compared to purchasing the same plan directly, reflecting TMA Insurance Trust’s ongoing focus on securing practical, cost-conscious coverage options for our members.
For the moments you plan and the ones you don’t, explore your new EverTravel benefit by scanning the QR code or calling an EverTravel agent at 844-843-9412, Monday through Friday, 8:00 AM to 7:00 PM CST.
