To enable healthcare entities to address the unique and exigent circumstances created by the COVID-19 public health emergency, the secretary of the Department of Health and Human Services (HHS) issued waivers of sanctions...more
Several recently reported cases highlight the growing risk physicians face if they succumb to competitive pressures, especially offers of remuneration from labs, pharmacies, home health agencies and other providers to whom...more
In drafting recruitment agreements, providers should separate the employment agreement from the other agreements to help diffuse breach of employment agreement arguments as a defense to the repayment of recruitment...more
After many years of heated and contentious debate, and opposition by the Texas Medical Association and the executive director of the Texas Medical Board, Texas has significantly revised its telemedicine statute to permit the...more
Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more
4/22/2016
/ Aetna ,
Antitrust Violations ,
False Billing ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Fraud ,
Insurance Industry ,
Kickbacks ,
Medical Reimbursement ,
Out of Network Provider ,
Physicians
For this edition of the Deeper Dive, we travel to Texas for a look at some interesting cases involving healthcare providers decided on appeal in 2015. Some of these decisions may be surprising – and perhaps even troubling –...more
8/4/2015
/ Anti-Competitive ,
Breach of Duty ,
Fiduciary Duty ,
Fraud ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medical Malpractice ,
Non-Compete Agreements ,
Physicians ,
Recruitment Policies ,
Tortious Interference ,
TX Supreme Court
The first lawsuit, in what may be a wave of antitrust litigation challenging professional board regulations in the wake of the U.S. Supreme Court’s decision in North Carolina State Board of Dental Examiners v. Federal Trade...more
Physicians now appear to be more than ever at a greater risk of investigation for healthcare crimes, largely due to their “gatekeeping” function concerning a patient’s need for medical services and the government’s increased...more
The Texas Medical Board is proposing to modify its disciplinary rules to more specifically define the requisites for a physician-patient relationship required for prescribing. Under the proposed revision to 22 T.A.C. § 190.8,...more
Providers and health professionals face many challenges in the shifting sands of the Ebola response, including the extent of their duties to each other and their patients and their obligations under a myriad of laws,...more
11/3/2014
/ Americans with Disabilities Act (ADA) ,
Best Management Practices ,
Centers for Disease Control and Prevention (CDC) ,
Ebola ,
Employer Liability Issues ,
EMTALA ,
Ethics ,
Family and Medical Leave Act (FMLA) ,
Health Care Providers ,
Hospitals ,
OSHA ,
Physicians ,
Title VII
Many physicians and other health professionals maintain a robust Internet presence, including websites and portals to provide patients with information. However, I was recently reminded of how easy it is to overlook the...more
It is often said that advisory opinions are requested from the U.S. Office of Inspector General (OIG) when one wants a very safe deal blessed or when one wants to dissuade a competitor or counter-party from entering into or...more
The New York Court of Appeals recently ruled that the Office of the Medicaid Inspector General (OMIG) has discretion to exclude a physician from New York's medical assistance program (Medicaid) based solely on a consent order...more
The U.S. Department of Health and Human Services Office of Inspector General's (OIG) chief counsel indicated in 2007 that the government's fraud enforcement focus on large organizations was an "ineffective strategy" and that...more
Imagimed LLC, an MRI Center, its owners and chief radiologist, agreed to pay the government $3.57 million to settle false claims allegations for MRI services. The government alleged that Imagimed billed for MRI scans...more
After 34 years, a federal district court in Florida has overturned a 1979 injunction which prevented the Centers for Medicare and Medicaid Services (CMS) from releasing to the public Medicare data related to physician billing...more
Health Management Associates' University Medical Center (UMC) recruited Kevin Dennis to Lebanon, Tennessee under a physician recruitment agreement that required him to "apply for, receive and maintain active medical staff...more