Michael Cassidy

Michael Cassidy

Tucker Arensberg, P.C.

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Medical Staff Bylaws Are Not Contracts in Delaware

One of the fundamental issues in credentialing disputes is whether the Medical Staff Bylaws constitute contracts between the Hospital and the individual physicians. If the Medical Staff Bylaws do constitute a contract, then...more

4/15/2014 - Bylaws Contract Disputes Credentialing HCQIA Hospitals Physicians

President Obama Signs the Protecting Access to Medicare Act of 2014

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from...more

4/3/2014 - Healthcare Healthcare Reform Medicare

MGMA Special Alert – SGR Repeal

Senate approves House-passed SGR patch - Today, by a vote of 64-35, the Senate agreed to legislation passed by the House of Representatives, H.R. 4302, which delays for one year a 24% cut to Medicare physician...more

4/1/2014 - Healthcare Medicare Physician SGR Formula

Latest SGR Repeal News from MGMA

Today the House of Representatives passed by voice vote H.R. 4302, which would temporarily delay the 24% cut to Medicare physician payments resulting from the sustainable growth rate (SGR) formula for one year. MGMA has...more

3/28/2014 - Affordable Care Act Healthcare Healthcare Reform Physician SGR Formula

Practical considerations to protect against being ‘out of network’

Practical considerations to protect against being ‘out of network’ The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare...more

3/25/2014 - Healthcare Hospitals Out of Network Provider

Federation of State Medical Boards to Vote on Telemedicine Policy

The March 20th edition of Modern Healthcare reports on a “patient centered telemedicine policy” to be voted on by the Federation of State Medical Boards (FSMB). I’ve attached links to both the article and to the FSMB model...more

3/25/2014 - Healthcare Medical Liability Medical Malpractice Telemedicine

Physician Obtains Injunction Preserving Clinical Privileges Despite Attempted Exclusive Contract

Despite the many cases acknowledging the right of hospitals to enter into exclusive contracts, there is always the issue of what happens with the existing clinical privileges and medical staff memberships of the physicians...more

3/21/2014 - Contract Formation Exclusive Dealing Agreements Healthcare Injunctions Physicians

Compliance Audit Information May Not Be Attorney Client Privileged

Attorneys routinely advise clients conducting audits and investigations that the audit or investigation should be conducted by outside counsel in order to establish attorney client privilege. ...more

3/20/2014 - Attorney-Client Privilege Audits Compliance Corporate Counsel

California Decision Allows Physician to Challenge Sham Peer Review as Whistleblower Retaliation

In Fahlen v. Sutter Central Valley Hospitals, the California Supreme Court found: A physician is not required to first exhaust his administrative remedies through the medical staff appeals process in order to...more

3/11/2014 - Healthcare Peer Review Physicians Retaliation Whistleblower Protection Policies Whistleblowers

2014 OIG Work Plan: Questionable Billing Patterns for Part B Services During Nursing Home Stays

The 2014 OIG Work Plan includes the following: Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home...more

2/17/2014 - Billing False Billing Medicare Medicare Part B Nursing Homes OIG Work Plans

2014 OIG Work Plan: Impact of Provider-Based Status on Medicare Billing

The 2014 OIG Work Plan includes the following: Policies and Practices. We will determine the impact of subordinate facilities in hospitals billing Medicare as being hospital based (provider based) and the extent to...more

2/17/2014 - Healthcare Hospitals Medicare OIG Work Plans

2014 OIG Work Plan: Oversight of Hospital Privileging

The 2014 OIG Work Plan includes the following: Quality of Care and Safety. We will determine how hospitals assess medical staff candidates prior to granting initial privileges, including verification of credentials and...more

2/17/2014 - Healthcare Healthcare Reform Hospitals OIG

Joint SGR Repeal Bill Agreed Upon, Moving to Full Congress

New joint legislation to repeal Medicare’s failed SGR formula is advancing to both chambers of Congress following an agreement announced Thursday by the three committees that put forth repeal bills earlier this...more

2/7/2014 - Healthcare Medicare Physician SGR Formula Physicians

OIG Extends Electronic Health Records AKS Safe Harbor

The Office of Inspector General (OIG) has amended the Safe Harbor Regulation regarding electronic health record (EHR) items and services. The primary purpose of the amendment is to extend the Safe Harbor, which was scheduled...more

12/30/2013 - anti-k EHR Healthcare OIG PHI Safe Harbors

President Obama Signs the Pathway for SGR Reform Act of 2013

On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking...more

12/27/2013 - Healthcare Professionals Medicare Physician Medicare Reimbursements Physician SGR Formula

NPDB Guidebook revision would clarify investigation reporting issues

Physicians always have been justifiably concerned about reports to the National Practitioner Data Bank (NPDB) regarding malpractice payments and adverse peer review actions. Two areas of frequent uncertainty have...more

12/27/2013 - Dismissals HCQIA Healthcare Healthcare Professionals HHS HRSA Medical Malpractice NPDB Peer Review Reporting Requirements Settlement

Physician Employment Termination Without Cause Reported to NPDB

A strange result in Langenberg v. Warren General Hospital, suggests you should pay close attention to the termination language in hospital-physician employment contracts. Warren General Hospital terminated Dr. Langenberg...more

12/24/2013 - Healthcare Healthcare Professionals Hospitals NPDB Physicians Termination

Congress Passes 3 Month SGR Reprieve: .5% Medicare Physician Increase

The AMA Wire reports action on the Medicare Physician Fee Schedule. The payment increase staves off a 24 percent cut required by the failed SGR formula and buys three months for Congress to complete its work on SGR repeal...more

12/19/2013 - Healthcare Healthcare Professionals Medicare Physician SGR Formula Physicians

SGR Update

I recently posted the SGR White Paper published jointly by the Senate Finance Committee and the House Ways and Means Committee. Earlier this week, both committees endorsed legislation enacting those concepts....more

12/16/2013 - Healthcare Physician SGR Formula Ways and Means Committee

Exclusive Contracts Raise Anti-Kickback Issues

A new OIG Advisory Opinion 13-15, the OIG has resurrected the issue of whether awarding exclusive contracts to hospital based providers involves remuneration in exchange for referrals, because it grants the opportunity for...more

12/12/2013 - Anti-Kickback Statute Exclusive Dealing Agreements Hospitals OIG Patient Referrals Safe Harbors

Joint House and Senate SGR White Paper Proposes Permanent SGR Repeal

The House Ways and Means Committee and the Senate Finance Committee have jointly issued a White Paper proposing the repeal of the Medicare Sustainable Growth Rate Formula, entitled “SGR Repeal and Medicare Physician Payment...more

12/11/2013 - Healthcare Medicare Physician SGR Formula

Louisiana Becomes Medical Staff Bylaws Equal Contract State

In Granger v. Christus Health Central Louisiana d/b/a Christus St. Francis Cabrini, the Louisiana Supreme Court ruled that medical staff bylaws are a contract between the hospital and a the medical staff member....more

11/27/2013 - HCQIA Healthcare Healthcare Professionals

OIG Rejects Pod Lab Arrangement for Non-Federal Healthcare Program Business

In OIG Advisory Opinion No. 13-03, the Office of Inspector General had the opportunity to deal with two issues which have always raised concerns in the past, i.e. pod labs and swapping. It is no surprise that OIG refused to...more

9/4/2013 - Compliance Healthcare Laboratories OIG

Peer Review "Interference" Alleged as Tortious Interference with Contract

Many sham peer review cases are based upon breach of contract in states in which the medical staff bylaws are treated as contracts between the hospital and/or medical staff and the individual physicians. Typically, the cause...more

7/11/2013 - Breach of Contract Peer Review Tortious Interference

CMS Proposes 2014 Medicare Physician Fee Schedule; SGR Reduction Projected @ 24.4%

CMS has issued the poroposed Medicare Physician Fee Schedule. Without Comf=gressional intervention, the SGR will mandate a 24>4% decrease. CMS sent its calcuations to the Medare Payment Advisory Commission....more

7/10/2013 - CMS Medicare Physician Fee Schedule

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