Physicians

News & Analysis as of

It’s Time to Update Physician Noncompete Agreements in Connecticut

There have been a number of recent legislative developments that will impact physician noncompete agreements entered into in Connecticut. First, any physician noncompete agreement entered into on or after July 1, 2016, must...more

Rhode Island’s New Law Requires Health Plans Cover Telemedicine Services

Rhode Island marks the 31st state to enact a telemedicine commercial reimbursement statute. The Telemedicine Coverage Act (HB 7160B) was signed into law by Rhode Island Governor Gina Raimondo on June 28, 2016, representing a...more

Provider-Based Status Post-BBA: CMS Offers Limited Answers, Requests More Feedback

For those in the hospital industry hoping for additional clarity regarding the operation and billing of provider-based departments (PBDs), the CY 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule provides some...more

Also In The News - Health Headlines - July 2016 #2

House Committee Approves Bill Providing Relief for Rural Hospitals – On July 7, 2016, the Ways and Means Committee for the House of Representatives voted unanimously to approve the Continuing Access to Hospitals Act, as...more

Hospital/Physician Leases Compliance Checklist

LEGAL REQUIREMENTS: A "no" answer to any of the following questions may mean your lease is out of compliance with applicable laws. Is the lease in writing? Is the lease signed by both parties? Does it...more

Cramer v. Starr

A Tort Defendant May Name Plaintiff’s Subsequent Physician As A Non-Party At Fault, Despite The “Original Tortfeasor Rule” - Arizona’s comparative fault statute (UCATA) requires the trier of fact in a tort case to...more

IRS Denial of Accountable Care Organizations Raises More Questions Than It Answers

In a recent ruling, PLR 201615022, the IRS denied tax exemption to an accountable care organization on the basis that the organization was conferring private benefit on its participating physicians by negotiating shared...more

CMS Issues Proposed Rule Addressing Off-Campus Outpatient Departments

The Centers for Medicare and Medicaid Services (CMS) published its 2017 Medicare Outpatient Prospective Payment System (OPPS) proposed rule on July 14, 2016 (the Proposed Rule). In part, the Proposed Rule addresses CMS’s...more

IRS Denies Exempt Status for Non-MSSP Accountable Care Organizations

In April, the IRS released a private letter ruling denying section 501(c)(3) status to an accountable care organization (“ACO”) that contracted with third-party payers outside of the Medicare Shared Savings Program (“MSSP”)....more

Missouri Governor Signs Biosimilar Substitution Law

Last month, Missouri Governor Jay Nixon signed into law Senate Bill 875, allowing pharmacists filling prescriptions for brand name biological products to substitute a less expensive biosimilar product if the biosimilar has...more

Are Changes to the Stark Law on the Way?

Congress has acknowledged that the Stark law is standing in the way of the healthcare industry's transition to alternative, value-based payment models, and in turn, meaningful reform may soon be on the horizon. Last...more

Alaska Enacts New Telemedicine Law: What Providers Should Know

Alaska Governor Bill Walker signed SB 74 into law on June 21, 2016, expanding the use of telemedicine in the Last Frontier state. Specifically, SB 74 removes Alaska’s previous in-state presence requirements for prescribing...more

Use of Modifier 25 - 2017 Medicare Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have reviewed the use of Modifier 25 to unbundle payments for evaluation and management (E/M) services when a procedure is...more

Mid-Year Review: New Non-Compete Legislation in 2016

In the first half of 2016, we have already seen significant changes to a number of state non-compete laws. In this post, we provide a compilation of recently enacted legislation in Alabama, Connecticut, Idaho, Oregon, and...more

The State of Telehealth - Policy and Reimbursement Q&A

Foley Partner Nathaniel Lacktman, head of the firm’s telemedicine and virtual care practice, participated in a comprehensive Q&A discussing the challenges and opportunities facing the telehealth market with Healthcare...more

Biodiagnostic Laboratory Services Sentenced; Another Physician Pleads Guilty

The long-running test-referral prosecution against Biodiagnostic Laboratory Services, LLC (“BLS”), a New Jersey clinical blood testing laboratory; its owner and employees; and BLS’s referring physicians recently reached...more

CMS Proposes Changes to Provider-Based Status in CY 2017 OPPS Rule - Agency takes aggressive view of Section 603 of Bipartisan...

On July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its CY 2017 Outpatient Prospective Payment System (OPPS) Proposed Rule. The Proposed Rule includes several provisions regarding how CMS will...more

Pharmacy Settles Claim for Filling Forged Rx’s, as Trend Continues

There was a time when liability—criminal or civil—for drug abuse or forged prescriptions usually lay only with the abuser or the forger and those who actively helped them. Those days are long gone. First, we had PDMPs...more

CMS Posts Open Payment Data – $7.52 Billion in 2015

CMS published the 2015 Open Payment Data on June 30, 2015. CMS has presented tables in its press release showing the highest paid specialties and highest paying companies. ...more

OIG, CMS Focus New Scrutiny on Home Health Industry: Additional Investigative and Enforcement Activity Likely to Follow

On June 22, 2016, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a comprehensive report detailing its nationwide analysis of common characteristics in home health fraud cases. In tandem...more

Senate Finance Committee Examines Repeal of the Stark Law

A new report suggests that the Stark law is obsolete in new payment models. On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more

Clinically Integrated Networks - The New Way for Healthcare Providers to Play Together in the Sandbox

The implementation of the Affordable Care Act has shifted the attention of the healthcare industry away from fee-for-service payment toward performance-based reimbursement. This reform of the healthcare system focuses on...more

Court Declines to Prevent Merger of Washington Medical and Recreational Marijuana Markets

Over the last year, the Washington state marijuana industry has anticipated the transition from an unregulated medical marijuana market to an integrated, medical-recreational market on July 1, 2016, under the Cannabis Patient...more

Docs in Jersey, Dixie rake in pay from Big Pharma, medical device makers

Big Pharma is not just whistling Dixie, as Southern, for-profit hospitals lead the nation in rolling out the welcome mat so doctors can take meals, consulting, and promotional payments from drug and medical device companies,...more

Prescribing Pain

Each year more than 1.25 million Americans suffer from medication errors made by physicians, hospitals, and pharmacies. With the rise in the number of Americans taking prescriptions, the number of errors will only continue to...more

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