Health Law

No Long Term Fix for Medicare Physician Fee Cuts

Posted on October 22, 2009
Despite efforts by Senator Harry Reid to pass legislation which would have effectively frozen Medicare payment rates for physicians, it looks like Congress will once again look to freeze physician payment rates with a one-year patch. According to an article published by the Wall Street Journal, Senator Reid's proposed bill would have permanently prevented Medicare payment cuts to doctors...

Substantial Reduction in Medicare Payment Rates Under Baucus Bill

Posted on October 08, 2009
According to the Congressional Budget Office (CBO), the Chairman's mark for the Healthy Futures Act of 2009 proposed by Senator Max Baucus will be paid for, in part, through a reduction in Medicare payment rates.  Specifically, according to a blog post by the CBO,  the legislation would "substantially reduce the growth of Medicare's payment rates for most services"...

Doctor to Return to U.S. to Face Fraud Charges

Posted on October 07, 2009
According to an article in the News Tribune, the long arm of the federal government has tracked a Washington state doctor to Madagascar and brought him back to the U.S. to face fraud charges.  The doctor, who operated four clinics in Washington, will be charged with conspiracy to commit health care fraud following an audit of the doctor's Medicaid billing practices...

No More "Under Arrangements" Effective October 1, 2009

Posted on September 30, 2009
In case you somehow missed the news, effective October 1, 2009 (that's right, tomorrow), 'under arrangements' ventures involving Stark services are no longer permissible.  An under arrangements venture usually involves provision of a diagnostic or therapeutic service on a turn-key basis by an outside supplier (often a physician office) on behalf of a hospital...

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OIG Blesses Chiropractic Referral Network

Posted on September 30, 2009
In the recently released OIG Advisory Opinion No. 09-16, the OIG found that participation by chiropractors in a referral network would not run afoul of the federal antikickback statute.  In AO 09-16, the OIG reviewed a proposed arrangement whereby chiropractors who are members of an association would each pay $200 per month to participate in a "network" that would advertise chiropractic services through internet, print, radio, or television advertising and provide referrals for such services...

Medicare Rules on Preventive Care Services

Posted on September 26, 2009
It is apparent that preventive care will take on greater importance in the "reformed " health care system and while Medicare historically did not cover routine or preventive screening services, the list of preventive services now covered by Medicare has grown in recent years...

Physician Owned Hospitals Targeted in Baucus Reform Proposal

Posted on September 25, 2009
The original Stark II regulations included an 18 month moratorium on an exception to Stark that would have permitted physician to invest in specialty hospitals. Since expiration of that moratorium some physicians seeking more control over their practice environments have embarked on a mission to develop specialty hospitals as an alternative to the traditional acute care hospital setting...

Get Your COmments In the the 2010 Proposed Physician Fee Schedule

Posted on August 27, 2009
As reported previously on this Blog, the Centers for Medicare and Medicaid Services published the proposed Medicare Physician Fee Schedule CY 2010 on July 13, 2009 in the Federal Register.  Unless Congress takes action before the end of the year, physician payment rates with be reduced by an average of 21...

Hospital/Physician Employment Compensation May Run Afoul of Stark

Posted on August 26, 2009
The number of physicians seeking employment with hospitals seems once again to be on the rise and not surprisingly, physicians negotiating those arrangements will do their best to ensure that they are paid fairly for their services.  In light of the recent settlement of a federal False Claims case, however, physicians should be careful to ensure that their compensation - even as W-2 employees of a hospital - is consistent with fair market value and commercially reasonable...

Stuff You Didn't Know About Medicare: Physician Signature Requirements

Posted on August 25, 2009
With the rollout of the Recovery Audit Contractor (RAC) audit program in full swing, physicians should be paying close attention to their medical record documentation efforts.  One of the Medicare documentation requirement that many physicians don't fully appreciate is the requirement that all medical records be signed by the performing physician...

FTC Delays "Red Flags" Rule Compliance Date Until November 1, 2009

Posted on July 30, 2009
Citing lingering confusion over to whom the identity theft rules apply, the FTC announced yesterday that it is delaying the Red Flags Rule compliance date for a third time.  The compliance date, which was August 1, is now November 1, 2009.  The FTC intends to use the additional time to further educate industry about the rules and specifically to whom they apply...

Physician/Medical Device Manufacturer Financial Arrangements Continue to Draw Scrutiny

Posted on July 30, 2009
Physician/Medical Device financial arrangements continue to draw scrutiny by regulators. According to an article in the New York Times, Senator Charles Grassley has instituted an inquiry into payments between device-maker Medtronic and Dr. David Polly that Grassley says were not disclosed by Dr...

Insurance Department to Investigate the Blues in Pennsylvania

Posted on July 23, 2009
In what many Pennsylvania physicians feel is a long overdue move, the Pennsylvania Insurance Commissioner has announced that the Department of Insurance will investigate whether any of Pennsylvania's Blue Cross-Blue Shield insurers have engaged in anti-competitive behavior in violation of the Unfair Trade Practices act...

Proposed FY 2010 Medicare Physician Fee Schedule: The Rise of Primary Care

Posted on July 02, 2009
On July 1, 2009 CMS released a display copy of the Proposed FY 2010 Medicare Physician Fee Schedule. It is evident from a variety of the proposed policy changes that CMS intends to force primary care into a more prominent role – in some cases at the expense of specialists...

HITECH Act Fact Sheet

Posted on June 30, 2009
On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (Recovery Act), which, among other things, created financial incentives for physicians and other providers to adopt and utilize electronic health records (EHR) and penalties for those physicians who do not...

Obama Administration Turns Up Heat On Medicare Fraud

Posted on June 25, 2009
According to a statement by Secretary of HHS Catherine Sebelius in a June 24 HHS Press Release, "the Obama Administration is committed to turning up the heat on Medicare fraud..."  As evidence of this commitment, the Press Release announced the indictment of 53 individuals, including physicians and health care executives, accused of various Medicare fraud offenses ranging from conspiracy to defraud the Medicare program, false claims anti-kickback statute violations...

Health Reform May Be Just Around The Corner - Details to Follow

Posted on June 04, 2009
According to a June 2, 2009 letter from President Obama to key Democrat Congressman, the President is pushing for major health care reform legislation by October 2009. Given that this is only a few months away, it is remarkable how little detail exists with regard to the President's plan for reform...

Are You 'Red Flag' Ready?

Posted on June 03, 2009
On Nov. 9, 2007, The Federal Trade Commission (FTC) created the Red Flags Rule requiring creditors to develop and implement written identity theft prevention programs within their organizations. The rule defines a 'Creditor' any person who regularly extends, renews, or continues credit; any person who regularly arranges for the extension, renewal or continuation of credit...

OIG Blesses Physician On-Call Compensation Arrangement

Posted on May 29, 2009
In its recent Advisory Opinion No. 09-05, the OIG reviewed a proposed arrangement whereby a hospital would compensate physicians for on-call services performed on behalf of the hospital's uninsured patients. The OIG concluded that while the Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute, if the requisite intent to induce or reward referrals of Federal health care program business were present, the Office of Inspector General ('OIG') would not impose administrative sanctions on the arrangement...

Local Podiatrist Gets Sentenced in Medicare Fraud Case

Posted on May 27, 2009
Major Medicare fraud and false claims settlements against large providers and pharmaceutical and device companies are reported in the news on a regular basis these days.  Unfortunately this trend may lead many physicians to believe that their billing and collection activities are under the radar of federal and state enforcement authorities...

Should You Consider Selling Your Practice to a Hospital?

Posted on May 20, 2009
Without a doubt, times are tough for physicians in private practice. Operating costs continue to rise at a staggering pace and reimbursements are simply not keeping up. Recruiting and retaining physician talent continues to be a challenge and as the regulatory landscape continues to change and become more complex, compliance is becoming ever-more important...

Proposed Pennsylvania Legislation Would Prohibit Physician Referrals for Ancillary Services

Posted on May 20, 2009
Pennsylvania physicians need to be aware that legislation (House Bill 1405) has once again been introduced in the Pennsylvania House which would severely limit the ability of physicians to refer to entities in which they have investment interests. As drafted, this Bill would create an outright prohibition on the referral by a health care provider of any patient to an entity in which the health care provider is an investor or has an investment interest for a provision of 'designated health services'...

Some Good News for Pennsylvania Physicians - Malpractice Claims Way Down

Posted on April 30, 2009
According to a statement by Governor Edward G. Rendell as reported by the PR Newsire, malpractice reform in Pennsylvania has been a dramatic success.  Governor Rendell noted that malpractice filings statewide declined by 41% between 2002 and 2008...

West Penn Allegheny Health System Inc. Files Anti-trust Lawsuit Against University of Pittsburgh Medical Center and Highmark Inc.

Posted on April 23, 2009
Things appear to be heating up between the lagest health system and the second largest health system in the Pittsburgh health care market.  West Penn Allegheny Health System Inc. has filed and anti-trust lawsuit against the University of Pittsburgh Medical Center and Highmark Inc...

Pennsylvania Gives Nurse Midwives Authority to Prescribe

Posted on April 14, 2009
The Pennsylvania Board of Nursing has published regulations implementing a 2007 law which gives nurse midwives the authority to prescribe, administer, and dispense drugs pursuant to collaborative agreement with a physician. The law and regulations also apply to medical devices, immunizing agents, and laboratory tests...

Independent Drug Education and Outreach Act Re-Introduced

Posted on April 07, 2009
Several Congressman, including Senator Ted Kennedy, are renewing their efforts to change the way physicians receive information about new prescription drugs.  Re-introduced in Bill form this month, the Independent Drug Education and Outreach Act would put an academic spin on the dissemination of drug information by providing grant money to organizations to produce educational materials on the safety, efficacy, and cost of prescription drugs...

Pennsylvania Qui Tam Case Highlights Dangers in Physician/Hospital Arrangements

Posted on March 25, 2009
A recent whistleblower case out of the federal 3rd Circuit in Pennsylvania highlights some of the dangers in not properly documenting financial relationships between physicians and hospitals. Specifically, in US ex. rel. Kosenske v. Carlisle HMA, Inc...

Massachusett's Regulations Ban Gifts to Physicians

Posted on March 12, 2009
Massachusetts has joined the small but growing list of states regulating gifts and payments by pharmaceutical and device manufacturers to physicians.  According to a Boston Globe article, Massachusetts regulators have adopted regulations banning gifts to physician and mandating disclosure of consulting/speaking payments to doctors in excess of $50...

Medical Device Company Settles with Feds over Alleged Kickbacks to Physicians

Posted on March 10, 2009
As yet another warning to physicians and the medical device industry, the Department of Justice has entered into a Deferred Prosecution Agreement with medical device maker Neuromtrix in connection with an alleged kickback arrangement with referring physicians...

Federal Authorities to Begin Prosecuting Physicians for Taking Money from Drug and Device Companies

Posted on March 06, 2009
Those of us in the health care industry are, by now, quite used to reading about major prosecutions and settlements by the federal government against drug and device companies for improper relationships with physicians.  It is far less common, however, to read about the physicians on the receiving end of those relationships...

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