Health Law

Another Device-Maker To Disclose Physician Payments

Posted on February 26, 2009
Medtronic Inc. announced this week that beginning in 2011, it will start disclosing payments of more than $5,000 per year to physicians for consulting fees, royalties or honoraria.  According to an article by the Associated Press, Medtronic's decision comes in response to pressure from federal legislators to disclose the information...

The Obama Prescription For Health Care Begins To Take Shape: Doctors Get Ready to Tighten Your Belts

Posted on February 26, 2009
President Obama's prescription for health reform is beginning to take shape and the early prognosis is that physicians will be on the losing end.  According to an article in the Washington Post, Obama's Budget is going to include a $634 billion reserve fund as a downpayment on a $1 trillion health system overhaul...

Secretary of HHS: Daschle Is Out, But Who Is In?

Posted on February 19, 2009
Now that Tom Daschle is out of the running for Secretary of HHS, there's been much buzz about who President Obama's next choice will be.  Even Howard Dean's name has come up.  According to a recent New York Times article, however, it looks like it might be Gov...

Stimulus Bill and Health Care Reform

Posted on February 18, 2009
Yesterday President Obama signed the much touted stimulus bill into law.  Although not much is publicly being said about health care reform yet, sweeping changes to the health care system are quietly taking place. In fact, over $150 billion of the stimulus bill funds are earmarked for health care related projects...

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IBC and Highmark Call Off Merger

Posted on January 21, 2009
In what is surely to be a bright spot for most physician in Pennsylvania, Independence Blue Cross and Highmark announced today that they are withdrawing their request to merge.  According to a report by the Philadelphia Inquirer this afternoon, the boards of two companies met today and decided they could not live with the condition that the Pennsylvania Insurance Department would have imposed on the merged entity...

Highmark Blue Shield and Independence Blue Cross Merger in the News

Posted on January 21, 2009
According to an article in today's Philadelphia Inquirer, the Pennsylvania Insurance Department has apparently unofficially informed Highmark Blue Shield and Independence Blue Cross of certain conditions it will place on the merger.  One condition, according to the Inquirer, would be that the combined company use only the Blue Shield trademark, but cease using the Blue Cross trademark so that another health insurer could compete statewide using the Blue Cross trademark...

What Does Obama's Healthcare Reform Plan Mean for Physicians

Posted on January 06, 2009
So much has been said and so little done over the last ten or more years about healthcare reform that many of us have stopped listening.  However, with the heavy emphasis placed by President-elect Obama on the issue of healthcare reform, and the astronomical rate at which health care costs are rising, it would seem that the chances of sweeping reform are greater now than ever before...

OIG Solicits Public Comment For New Anti-kickback Safe Harbors

Posted on December 17, 2008
pThe Office of Inspector General of the Department of Health and Human Services (OIG) published a notice today seeking proposals and recommendations for developing new and modifying existing safe harbor provisions under the Federal anti-kickback statutenbsp;and fornbsp;developing new OIG Special Fraud Alerts...

OIG Solicits Public Comment For New Anti-kickback Safe Harbors

Posted on December 17, 2008
The Office of Inspector General of the Department of Health and Human Services (OIG) published a notice today seeking proposals and recommendations for developing new and modifying existing safe harbor provisions under the Federal anti-kickback statute and for developing new OIG Special Fraud Alerts...

OIG Blesses Physician Employment Arrangements

Posted on December 15, 2008
In response to an unusually straightforward fact pattern, the OIG today released an advisory opinion blessing certain part-time physician employment arrangements. The advisory opinion comes in response to a nonprofit, tax-exempt corporation’s proposal to employ two physicians on a part-time basis to perform endoscopies on the requestor’s own premises...

Changes In Medicare Enrollment Rules

Posted on December 09, 2008
Physicians enrolling in the Medicare program should be aware that Medicare recently changed the rules applicable to when a physician's enrollment is deemed to take effect. Specifically, the FY 2009 Medicare Physician Fee Schedule establishes that the effective date of billing for physicians and non-physician practitioners is the later of: (1) the date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or (2) the date an enrolled physician or non-physician practitioner first started furnishing services at a new practice location...

Changes to Medicare Anti-Markup Rules Effective January 1, 2009

Posted on December 02, 2008
Does your practice bill Medicare for diagnostic tests? If so, you have until January 1, 2009 to make sure your arrangements comply with the now very complicated anti-markup rule. The Centers for Medicare and Medicaid Services (CMS) published the Final Medicare Physician Fee Schedule for 2009 in the Federal register on November 19, 2009...

Physician Detailing By Pharmaceutical Manufacturers: The Winds of Change Continue to Blow

Posted on October 21, 2008
It's pretty clear that the good old days of detailing prescribing physicians with freebies are gone.  Lavish golf trips and expensive meals have gone the way of the dinosaurs (for the most part), and it looks like even more change is likely to come...

Highmark/IBC Merger Ruling Delayed

Posted on October 21, 2008
According to a recent article in the Philadelphia Business Journal, the Pennsylvania Insurance Department will not issue a ruling on the merger until early next year.  This is because the Insurance Department must wait 105 days from the end of the public comment period...

Medicare Updates Overpayment Interest Rate

Posted on October 21, 2008
Under Medicare regulations,  the interest rate that may be charged on Medicare overpayments and underpayments is the higher of the current value of funds rate (five percent for calendar year 2008) or the private consumer rate as fixed by the Department of the Treasury...

Physicians Need to Make Sure Their Stark Arrangements Are In Order ASAP

Posted on October 14, 2008
Physicians, Do you have financial relationships (think joint venture, medical director stipends, lease arrangements, AS&T agreements) with a hospital? If so, your referrals to that hospital for inpatient and outpatient services may violate the federal Stark self referral law unless they fall within one of the exceptions to Stark...

The Office of Inspector General (OIG) Releases FY2009 Workplan

Posted on October 02, 2008
The Office of Inspector General (OIG) of the Dept of Health and Human Services released its FY2009 Workplan yesterday. The Workplan outlines the initiatives and audits that the OIG expects to undertake in the coming fiscal year.  Below are some of the key initiatives that the OIG expects to undertake with regard to physicians...

More Changes to the Stark Self-referral Regulations

Posted on September 30, 2008
For those of you who have not been watching your Stark radar screen closely, be aware that CMS recently made a number of substantial changes to the Stark self-referral regulations that may affect your practice arrangements. Some of these changes will not take effect until October 1, 2009, but others changes will take effect on October 1, 2008...

Altering Medical Records: What Not To Do When Being Audited By Medicare

Posted on August 08, 2008
Document, document, document! is the cry of health care attorneys and consultants across the Country when asked what physicians can do to protect their practices from fraud and abuse liability.  But what happens if you receive a Medicare audit request and you find out that your documentation isn't so good or even non-existent?  Many physicians when faced with this prospect are tempted to recreate or alter medical record documentation...

Some Physicians Elect Not To Accept Gifts From Industry

Posted on May 21, 2008
It is no secret that the federal government is very interested in the connection between gifts and other remuneration from drug and device manufacturers and physician decision-making when it comes to ordering those items.  At least one Senator has gone so far as to introduce legislation which would require disclosure of these financial relationships...

Meet the New Doc: Researchers Develop Computerized Anesthesiologist

Posted on May 14, 2008
Canadian researchers may have solved the looming physician shortage crisis -- at least as it would apply to the administration of  surgical anesthesia.  According to an article in the Canadian Press, scientists at McGill University in Montreal have developed a software system that administers anesthesia during surgery...

MCARE Abatement Program Still A Political Football

Posted on May 12, 2008
According to a recent article in the Patriot News, Governor Rendell has outlined the costs associated with his plan to provide health insurance for Pennsylvania's uninsured population.  The plan calls for increases in taxes on tobacco products and would tap into the MCARE fund to cover the health insurance costs...

Feds Challenge Physician/Hospital Cardiology Arrangement

Posted on May 07, 2008
The federal government was apparently not kidding when it said it planned to take a closer look at physician/hospital arrangements.  According to a recent Department of Justice Press Release, the DOJ has elected to intervene in a whistle-blower lawsuit against Christ Hospital and the Ohio Heart Health Center, a large cardiology group in Ohio...

Free Rent, False Claims and Self-Disclosures

Posted on April 15, 2008
Proving the theory that no good deed goes unpunished, according to a March 17, 2008 Department of Justice press release, Hardeman County Memorial Hospital in Texas agreed to pay the federal government a total of $398,230 to resolve allegations that it violated the federal False Claims Act by submitting improper claims for payment to the Medicare program for healthcare items and services that were provided as a result of improper physician referrals...

Appeals Court Clears Way for Physician Lawsuit Against MCO

Posted on April 15, 2008
Under a recent decision by the U.S. Court of Appeals for the 11th Circuit, a case brought by a group of physicians against a PPO discount card company and a managed care company for appropriation of the doctors’ names and identities in connection with a plan to market and sell medical discount cards will be permitted to proceed in court...

CMS Withdraws Stark Physician/Hospital Survey

Posted on April 15, 2008
As previously reported on this blog, the Centers for Medicare and Medicaid Services (CMS) had announced in 2007 that they intended to send requests for information to all Medicare participating hospitals for details regarding the investment/ownership and compensation arrangements between those hospitals and physicians to determine whether the arrangements were in compliance with the federal Stark statute...

Healthcare in the Workplace - Walgreen Announces Plans

Posted on March 18, 2008
According to a recent online Wall Street Journal article, Walgreen Co. is taking definitive steps to expand further into the workplace health center arena. Specifically, Walgreen has announced its plans to acquire two worksite health-center companies in an effort to build its business as a manager of on-site health centers at large companies...

Healthcare in the Workplace - Walgreen Announces Plans

Posted on March 18, 2008
According to a recent online Wall Street Journal article, Walgreen Co. is taking definitive steps to expand further into the workplace health center arena. Specifically, Walgreen has announced its plans to acquire two worksite health-center companies in an effort to build its business as a manager of on-site health centers at large companies...

Medicare Issues New Advance Beneficiary Notice (ABN) Form

Posted on March 12, 2008
According to a recent alert on the Centers for Medicare and Medicaid Services (CMS) website, physicians and other providers are required to begin using a new ABN form when services are expected to not be covered by medicare.  According to the alert, beginning Monday, March 3, 2008, physicians may use the revised ABN for all situations where Medicare payment is expected to be denied...

Be On the Lookout for Better Educated Patients

Posted on March 12, 2008
According to an article in the New York Times, Aetna will soon begin offering a new service to help enable patients to research their own specific medical conditions. Specifically, Aetna’s SmartSource Service will allow patients to link online research with their own medical records and claims data...

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