Health Law

Office of Inspector General pOIG Guidance on Physician-owned Distributorships "PODs"

Posted on April 30, 2013
On March 26, 2013, the Office of Inspector General published much-awaited guidance on physician-owned medical device distributorships (commonly known as "PODs") in the form of a Special Fraud Alert.  The OIG makes no bones about where it stands on PODs which it describes as "physician-owned entities that derive revenue from selling, or arranging for the sale of, implantable medical devices ordered by their physician-owners for use in procedures the physician-owners perform on their own patients at hospitals or ambulatory surgical centers...

President Proposes Eliminating Stark In-Office Ancillary Services Exception For Therapy and Advanced Imaging

Posted on April 29, 2013
In what would undoubtedly be a devastating blow to many medical practices that rely on the Stark in-office ancillary services exception (which allows physicians to refer within their practices for Stark services), President Obama's proposed FY 2014 would seek to eliminate the exception for physical therapy, radiation therapy and advanced imaging such as CT and MRI...

FTC Sues to Block Hospital Acquisition of Medical Practice

Posted on March 29, 2013
Adding an interesting wrinkle to an already complex environment, the Federal Trade Commission filed a suit this month to block an Idaho hospital from acquiring a physician practice.  According to an article on thomsonreuters.com, the FTC and the IDAHO Attorney General have filed an antitrust complaint  seeking to block St...

Budget Sequester Brings Bad News for Physicians

Posted on March 13, 2013
Unless you've been living under a rock for the last several weeks, you are likely well aware of the budget sequester that took effect on March 1.  The sequestration requires "across the board" cuts in federal spending.  That, in and of itself, may not be such a bad news...

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Hospitals Should Think Outside the Box When Employing Physicians

Posted on February 27, 2013
Over the last several years, hospitals have been acquiring specialty physician practices in response to a number of market forces.  However, these types of acquisitions are not new to the American health care system and those who have been around long enough know that these arrangements can and badly...

CMS Releases Final "Sunshine Act" Regulations

Posted on February 26, 2013
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released final regulations implementing the federal Physician Payment Sunshine Act contained in the Federal Accountable Care Act.  Among other things, the Sunshine Act requires manufacturers of drugs, biologics, devices and medical supplies to track and report payments (including anything of value) made to physicians...

DOJ Announces Record Fraud Settlement Against Physician

Posted on February 12, 2013
Yesterday the U.S. Department of Justice announced that it has entered into a $26M False Claims settlement with a dermatologist in Florida.  According to the DOJ, this is one of the largest False Claims settlements against an individual in history...

2012 is Record Year for Fraud Recovery

Posted on February 11, 2013
The Obama administration announced today that as a result of increased federal health care fraud and abuse enforcement efforts, the federal government recovered $4.2 billion in 2012, setting a new record.  According to the Department of Health and Human Services, for every $1 spent on enforcement efforts, they recouped $7...

State's "More Stringent" Stark Law Restrictions Upheld By Court

Posted on January 30, 2013
Today I am focusing on the self-referral ban under the federal Stark laws. In particular, a recent case – Fresenius Medical Care Holdings, Inc. v. Tucker (Dkt. No. 4:03-cv-00411-SPM-GRJ (Jan. 10, 2013, 11th Cir.)) – discussed the interplay between those laws and a State's attempt to impose more stringent requirements...

Physician Unions - An Unintended Consequence of Health Reform?

Posted on January 30, 2013
I imagine that few physicians contemplated being part of organized labor when they enrolled in medical school but as more and more physicians make the leap from private practice to hospital employment, perhaps large-scale unionization of the physician workforce could become a reality...

Health and Human Services Releases New HIPAA Regulations

Posted on January 28, 2013
Last week the U.S. Department of Health and Human Services (HHS) released final regulations modifying existing HIPAA enforcement, privacy and security regulations. Although a number of the changes merely serve as clarification of existing regulations, the modifications impose a number of new requirements on covered entities and business associates...

OIG Offers Guidance on Cardiology Co-Management Agreement

Posted on January 08, 2013
This week the Office of Inspector General published an interesting Advisory Opinion (AO 12-22) dealing with a cardiology co-management agreement between a hospital and a private cardiology group practice. Under the arrangement, the hospital would compensate the physicians for certain management, oversight, strategic planning and medical direction services in connection with the hospital's four catheterization labs...

OIG Announces 2013 Priorities

Posted on January 03, 2013
Now that the new year is upon us, today's post will look at the Department of Health and Human Services' Office of Inspector General (OIG), in particular, OIG's priorities for 2013.   According to OIG's Fiscal Year 2013 Work Plan, it will be focusing upon a number of topics of interest – including some items not addressed last year...

Eleventh Hour and No "Doc Fix" - What Else is New?

Posted on December 31, 2012
It appears to be business as usual on Capitaol Hill this New Year's Eve.  Once again, Congress has failed to fix the sustainable growth rate formula in the Medicare physician fee schedule. Unless at least a temporary "patch" is put in place to keep Medicare physician payment rates steady, physicians will experience a 27% cut starting January 1, 2013...

Don't Expect Hospital Employment to be Free from Economic Pressures

Posted on December 27, 2012
Finding it increasingly difficult to remain profitable in private practice, many physicians are turning to hospital employment to avoid the economic realities of running a small business. However, as a recent article in the New York Times illustrates (see "A Hospital War Reflects a Bind for Doctors"), physicians should bear in mind that even under hospital employment, economic pressures -- though perhaps different from those in private practice -- will continue to exist...

OIG Issues Favorable Advisory Opinion on Free Technology from Hospital

Posted on December 26, 2012
Physicians in private practice are increasingly relying upon their local hospitals for assistance in making the transition to full-fledged electronic medical records. The Office of Inspector General (OIG) of the Department of Health and Human Services recently gave the nod to a proposed arrangement which would enhance electronic communication between private practices and a community hospital...

Can Concierge Medicine be Affordable for the Masses?

Posted on November 30, 2012
 The term "concierge medicine" conjures images of exclusivity, special treatment and high cost.  But can the concept be adapted to appeal to the masses?  With an impending shortages of doctors - particularly in primary care - and many more patients covered by insurance than ever before (under the Affordable Care Act), there is a reasonably good chance that patients will need to wait longer for an appointment with their doctor and be able to spend less time visiting with him or her...

Does It Make Financial Sense To Go Into Medicine?

Posted on November 29, 2012
According to a recent study published in the Journal of the Association of American Medical Colleges, a primary care physician who graduates with education debt of $160,000 should be able to raise a family, live in an expensive urban area, and repay their debt in 10 years without incurring additional debt, as long as their household income and spending are consistent with median statistics...

In Making Important Practice Decisions, Treat Dissenters With Respect

Posted on November 27, 2012
If you're like most physicians, you have probably given some recent thought to selling your practice or merging with one or more other groups.  If you are part of a group practice, it's quite possible that all members of the group might not agree on a single course of action...

MedPAC Site-Neutral Payment Proposal Could Level Outpatient Reimbursement Playing Field

Posted on November 05, 2012
It's no secret that Medicare pays significantly more for certain services when they are performed in a hospital outpatient department than when they are performed in a physician office.  In fact, this is one of the reasons privately practicing physicians have been folding up shop in favor of hospital employment...

OIG Blesses On-Call Compensation Arrangement

Posted on October 31, 2012
This week the Office of Inspector General of the Department of Health and Human Services published Advisory Opinion 12-15 in which it blessed an on-call compensation arrangement between a hospital and specialist physicians on its staff.  In finding that it would not prosecute the arrangement, the OIG pointed to several "safeguards" which it felt would adequately protect against a violation of the anti-kickback statute...

2013 Pennsylvania MCARE Insurance Assessment Announced

Posted on October 30, 2012
The Pennsylvania Insurance Department has announced that the Medical Care Availability and Reduction of Error (MCARE) Act annual assessment for calendar year 2013 will be 25% applied to the prevailing primary premium for each participating health care provider...

Is Concierge Medicine Right for You?

Posted on October 25, 2012
As administrative burdens and costs associated with the practice of medicine continue to grow, many physicians are wondering out loud whether now is the time to make the leap to cash-only concierge medicine.  In its purest form, concierge medicine is a model where patients pay a recurring cash fee (e...

J-1 Physician Waivers in Pennsylvania: Change in Processing Times

Posted on October 23, 2012
On October 9, the Pennsylvania Department of Health (PA DOH) announced that it has changed the Pennsylvania rules regarding the J-1 Physician Waiver Program. DOH has established three filing periods, which could result in the Conrad 30 numbers being assigned earlier in the fiscal year...

Don't Ignore Billing and Coding Rules

Posted on October 01, 2012
Many physicians were once content (and a few still are) to let their coders select their codes for billing purposes.  At a time when enforcement authorities have some heavy-duty technological weapons for identifying improper billing, physicians can no longer avoid learning the billing rules applicable to their services...

Fair Market Value Really Does Matter

Posted on September 20, 2012
In my experience, many healthcare providers fail to take seriously the importance of fair market value in their business arrangements.  In fact, one of the most important means of ensuring compliance with federal and state fraud and abuse laws such as the federal anti-kickback and Stark is to ensure that financial arrangements - particularly where there are referrals relationships -are consistent with fair market value...

FTC Takes Interest in Hospital/Physician Integration

Posted on August 30, 2012
Federal antitrust enforcement authorities have historically not gotten too excited about hospitals acquiring physician practices.  However, it is apparent from recent enforcement activity that the Federal Trade Commission (FTC) is keeping a wary eye on physician/hospital integration...

Take an Active Role in Defining Your Payer Relationships

Posted on August 27, 2012
If you're not sure what your managed care payers want from you, maybe you need to tell them. Many physicians are (understandably) complacent about taking an active role in defining in their payer relationships. Not surprisingly, managed care payers have had very little incentive or ability to negotiate special arrangements with a diverse and disintegrated physician practice marketplace...

Physician Shortage Crisis May Not Be All Bad for Physicians

Posted on August 22, 2012
According to a a major study published in the Archives of Internal Medicine this week, almost half of physicians surveyed (over 7,000 physicians were surveyed), reported at least one symptom of burnout.  As a recent article in the Atlantic points out, although physician burnout may not be news to most physicians who are living with the realities of shrinking reimbursements, growing costs and increasing administrative burdens, the general public may not have a real understanding of what this means for them...

Is your practice OSHA compliant?

Posted on August 13, 2012
By Randy Schauer, Esquire Is your office OSHA (Occupational Safety and Health Administration) compliant?  Few physicians realize that OSHA violations can result in significant penalties.  Fox attorneys recently advised a medical practice cited by OSHA after an inspection of one of its offices...

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