Michael Cassidy

Michael Cassidy

Tucker Arensberg, P.C.

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Pennsylvania Superior Court Rejects Peer Review Confidential for “Business Records”

In Kates v. Doylestown Hospital, the Pennsylvania Superior Court, in a non-precedential decision, held back the Pennsylvania Peer Review Protection Act does not provide confidentiality protection for certain records....more

12/24/2014 - Business Records confidential Hospitals Peer Review Physicians

Washington State Court Recognizes Prospective Patient Relationships as Protected Contracts

42 U.S.C. § 1981 prohibits discrimination affecting citizens rights to make contracts. In the credentialing field, § 1981 has been used to circumvent the immunities provided by the Health Care Quality Improvement Act (HCQIA)...more

12/16/2014 - HCQIA Patient Prospective Payment System

Pa. Dept. of Health Establishes Website (stayinformed.pa.gov) for Highmark – UPMC Information

The Pa. Departments of Health and Insurance have established a website in an attempt to provide ongoing information and guidance regarding the termination of the Highmark...more

12/12/2014 - Department of Health Websites

CMS Proposes Rules to Improve Accountable Care Organizations (ACOs)

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule intended to make ACOs and Medicare Shared Savings Plans more practical and attractive to potential providers. The proposed rule was released on...more

12/9/2014 - ACOs CMS Medicare Shared Savings Program Proposed Regulation

Global Surgery and 2015 Medicare Physician Fee Schedule

On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery. On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and...more

12/3/2014 - CMS Healthcare Medicare Physician Fee Schedule Physicians Surgery

Pennsylvania Workers Compensation Prescription Drug Reimbursement Restrictions

On October 27, 2014, the Governor signed Pennsylvania General Assembly enacted House Bill 1846, which limits both the authority and the reimbursement of physicians and providers other than pharmacies for prescription drugs. ...more

11/6/2014 - New Legislation Pharmacies Physicians Prescription Drugs Workplace Injury

District Court Approves Government’s Use of Sampling and Extrapolation to Prove False Claims Act Liability

In United States ex rel. Martin et al. v. Life Care Centers of American, Inc., the Court held that the government could extrapolate from a random sample in order to impose False Claims Act (FCA) liability against Life Care...more

10/15/2014 - False Claims Act Hospitals Statistical Sampling

Face-to-Face Medicare Reimbursement Requirements for Home Health Certification

CMS has announced its concern regarding the level of compliance for documenting the face-to-face elements necessary for home health care certification....more

9/18/2014 - CMS Healthcare Home Health Care Physicians

Hospital Recovers Income Guarantee Payments from Suspended Physician

It should come as no surprise there are cases in which hospitals seek to and actually do recover income guarantee payments made to physicians whom, either through termination of employment or loss of hospital privileges, fail...more

9/3/2014 - Employer Liability Issues Hiring & Firing Hospitals Physicians Reimbursements

OIG Rejects Specialty Pharmacy Request to Pay “Per-Fill” Payents to Retail Pharmacies

In OIG Advisory Opinion 14-06, the Office of Inspector General (OIG) concluded that payment by a specialty pharmacy to a retail pharmacy on a “per-fill” basis for services provided by the retail pharmacy could violate the...more

8/27/2014 - Advisory Opinions Anti-Kickback Statute OIG Patient Referrals Pharmacies Referral Fees Retailers

OIG Finds Privacy and Security Risks with ONC EHR Certification Process

It is ironic to learn the Office of Inspector General (OIG) believes the Office of the National Coordinator for Health Information Technology (ONC) essentially has an insufficient compliance program to maintain the privacy...more

8/8/2014 - EHR NIST OIG ONC PHI Policies and Procedures

Highmark and UPMC Consent Decree

Highmark and UPMC took a major step toward resolving network participation issues June 27, 2014, by executing a Consent Decree with the Commonwealth of Pennsylvania Departments of Insurance and Health. The Consent...more

7/29/2014 - Consent Decrees HIghmark v UPMC

CMS Designates Global Surgery as “Potentially Misvalued Services”

In the recently proposed 2015 Physician Fee Schedule, CMS devoted significant resources to discussing potentially misvalued services, which I believe is code for places where CMS would like to reduce reimbursement. One of the...more

7/22/2014 - CMS Healthcare Physician Medicare Reimbursements Surgery

CMS Seeking Comments Regarding Expanding Coverage for Secondary Interpretation of Images

In the proposed 2015 Medicare Physician Fee Schedule, CMS is seeking comments regarding expanding coverage for secondary interpretation of diagnostic imaging....more

7/22/2014 - CMS Diagnostic Imaging Services Healthcare Physician Medicare Reimbursements

CMS Releases Proposed 2015 Physician Fee Schedule and Pojects 20.9% SGR Reduction

CMS has issued the Proposed 2015 Physician Fee Schedule and Fact Sheets for specific issues (ASC, ESRD, Home Health, Physician Quality Programs)....more

7/16/2014 - CMS Healthcare Physician Fee Schedule Physician SGR Formula Physicians

OIG Report: Questionable Billing for Medicare Part B Clinical Laboratory Services

Perhaps not coincidentally, immediately following the release of the Questionable Laboratory Payments Special Fraud Alert by the OIG, posted yesterday on the Med Law Blog, the OIG has followed up with Audit Report OIG –...more

7/11/2014 - Clinical Laboratories CMS Healthcare Medicare Medicare Part B OIG

Anti-Kickback Laboratory Enforcement Actions – Special Fraud Alert

There has been significantly enhanced scrutiny of financial relationships between referring physicians by both the Office of Inspector General (OIG) and Pennsylvania authorities....more

7/11/2014 - Anti-Kickback Statute Enforcement Enforcement Actions Fraud Kickbacks OIG

AMA Issues New Telemedicine Policy

Last week, the American Medical Association (AMA) issued a new report regarding coverage of and payment for telemedicine (CMS Report 7-A-14). The report recognizes the telemedicine is a “key innovation in support of health...more

6/17/2014 - American Medical Association CMS Healthcare Telemedicine

Ohio Court Reiterates Peer Review Privilege Applies Only to Formal Peer Review Actions

A Hospital in Ohio tried to prevent access to a patient incident report on the basis of Peer Review Privilege. The Hospital claimed that, since the incident report was reviewed by the Hospital Peer Review Committee, the...more

6/6/2014 - Healthcare Hospitals Peer Review Privilege Waivers

New CMS Rules Reduce Role of Medical Staff

The American Health Lawyers Association Regulatory Accreditation and Payment Practice Group (RAPPG) has issued an email alert regarding the issuance of a final rule by CMS intending to streamline Medicare regulatory...more

5/22/2014 - CMS Healthcare Healthcare Professionals Medicaid Expansion Medicare

CMS Cancels ICD-10 Testing

The MLN Connects™ Provider eNews contains important news, announcements, and updates for health care professionals. ICD-10 Compliance Date - On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA)...more

5/5/2014 - CMS HHS HIPAA ICD Codes MACs Protecting Access to Medicare Act

Physical Therapy Provider Enters into HIPAA Settlement

U.S. Department of Health and Human Services Office for Civil Rights (OCR) recently announced yet another enforcement action. Specifically, OCR opened a compliance review of Concentra Health Services (Concentra) upon...more

4/25/2014 - Compliance Data Breach Data Protection Encryption Enforcement Actions Healthcare HHS HIPAA OCR

Medical Staff Application Release Bars Physician Credentialing Claim

In Copeland v. MidMichigan Regional Medical Center, a Michigan State Appellate Court affirmed a trial court’s grant of summary judgment in favor of the Hospital, based upon both HCQIA immunity and a general release signed by...more

4/24/2014 - HCQIA Healthcare Healthcare Professionals Hospitals Release Agreements Summary Judgment

New York Federal Court Takes Different Stance on Medical Staff Bylaws

On April 14, MedLaw Blog posted a comment about Villare v. Beebe Medical Center, a case in which a Delaware trial court granted summary judgment on the basis that the medical staff bylaws were held not to constitute a...more

4/18/2014 - Beebe Medical Center Bylaws Due Process Hospitals Physician Ownership Summary Judgment

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

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