Physicians

News & Analysis as of

Take 5 Newsletter: Five Labor and Employment Issues Faced by Health Care Employers

As the Affordable Care Act and the challenges of reimbursement and funding for health care services drive changes in the health care delivery system and employment in the industry, new issues in labor and employment law are...more

Anatomy of an Independent Primary Care ACO – Part II

Our Secret Weapon and Our Biggest Disappointment - In our last column, we highlighted the Rio Grande Valley Health Alliance, an accountable care organization in McAllen, Tex., composed of 14 independent primary care...more

Congress Sends Mixed Messages to Health Care Providers

Recent federal health care legislation sent mixed signals to health care providers. Pursuant to HR 4302, signed by President Obama on April 2, planned Medicare reimbursement cuts of 24 percent and the implementation of a...more

New Massachusetts Law Targets Self-Referrals of Clinical Laboratory Services

The Fiscal Year 2015 budget for the Commonwealth of Massachusetts, which was signed into law earlier in the week, included a broad prohibition on clinical laboratory self-referrals. This legislation (the “Bill”) originally...more

Doctors' Headaches

Despite optimism early this week over a Senate budget conference position proposal that made serious concessions to the House budget position, we are at a new stalemate Friday....more

Anatomy of an Independent Primary Care ACO, Part I

While concepts and theories can go a long way, sometimes the best way to understand something is through a concrete example. So, from time to time, ACO Insider will check in on a new accountable care organization composed of...more

Why Franchising Benefits Physicians

Healthcare is one of the fastest growing businesses within the United States. According to the American Bar Association, by the year 2019, healthcare spending will reach $4.5 trillion; nearly 19% of the gross domestic...more

News from the Health Law Gurus™: July 2014

Survey of ACA Navigators Finds 10.6 Million People Sought Enrollment Help — In a survey released this week, the Kaiser Family Foundation (“Kaiser”) estimates that approximately 10.6 million people received assistance...more

OIG issues special fraud alert on laboratory payments to referring physicians

On June 25, 2014, the U.S. Department of Health and Human Services Office of the Inspector General (“OIG”) released a Special Fraud Alert addressing Laboratory Payments to Referring Physicians. ...more

Five Steps to Becoming a Primary Care Leader

With ever more data demonstrating that patient-centered medical homes are the core of successful Accountable Care Organizations (ACO), it’s becoming clear that primary care physicians can have a meaningful role in the...more

Physician Affiliations With Hospitals: Practical Tips for the Physician Practice When Entering Into a PSA

Due to the continuing uncertainties surrounding the health care delivery landscape, physicians are increasingly looking at alternatives to secure their survival. Historically, physicians have turned to their local hospital...more

You Are Now on the Clock — Sunshine Act Dispute Window Now Open

Beginning Monday, July 14, 2014, the review, dispute and correction process outlined the National Physician Payment Transparency Program (also known as the "Sunshine Act") opens on CMS's Open Payments website. Physicians and...more

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

OIG Report Recommends Increased Scrutiny of Over 1000 Laboratories With Questionable Billing for Medicare Part B Clinical...

According to a recently released report by the HHS Office of Inspector General (OIG), over 1,000 labs had unusually high billing for Medicare Part B Clinical Laboratory Services for dates of service in 2010. Increased...more

CMS Releases New Resources, Schedules Teleconference for Sunshine Review and Dispute Process

As we informed you last week, the Open Payments review, dispute and correction process started today and will continue through September 11, 2014. This is the process that allows physicians and teaching hospitals to review...more

OIG Sticks It to Physician Specimen Collectors

On June 25, the U.S. Department of Health & Human Services, Office of the Inspector General ("OIG") issued a Special Fraud Alert updating the previous guidelines concerning compensation by clinical laboratories to referring...more

CMS Proposes Relief for HH Face-to-Face and Therapy Reassessment Requirements

In the last issue, we reported on the difficulties faced by home health agencies (HHAs) in complying with the documentation requirements for the face-to-face (F2F) encounter between a patient and a physician before or shortly...more

Mississippi CON Report - July 2014

In this Report: - I. June 2014 – Mississippi Certificate of Need Meeting - II. Certificate of Need Program Report – Filings/Reports Since June 2014 - A. Letters of Intent to Change Ownership - B....more

New OIG Special Fraud Alert Aimed at Laboratory Payments to Referring Physicians

On June 25, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert entitled "Laboratory Payments to Referring Physicians."...more

Strategic Perspectives: When is Telemedicine "Practicing Medicine" in Violation of the Law? An Emerging Framework for Compliance

Telemedicine is the future of health care, but under current law there is an open question: when does telemedicine constitute the unlawful “practice of medicine” in violation of state or other law? This question is critical...more

CMS Proposes Changes to Sunshine Act Reporting

Drug and device manufacturers breathing a sigh of relief after completing their 2013 data submissions under the Physician Payment Sunshine Act (the “Sunshine Act’) must now contend with four proposed changes to the Sunshine...more

California Court Limits Liability for Loss of Certain Patient Information under CMIA

California appellate courts are clarifying potential liability under California’s Confidentiality of Medical Information Act, Cal. Civ. Code § 56 et seq. (“CMIA”) of health care providers, health plans, pharmaceutical...more

OIG issues Special Fraud Alert on laboratory payments to referring physicians

The Health and Human Services Office of the Inspector General (OIG) recently issued a Special Fraud Alert on laboratory payments to referring physicians. Specifically, the alert is concerned with Specimen Processing...more

Torts – Standard for Elder Abuse v. Professional Negligence

Gregory Worsham v. O’Connor Hospital, et. al. - Court of Appeal, Sixth District (May 20, 2014) - The Elder Abuse Act (“Act”) does not apply to simple or gross negligence by health care providers. This case...more

Fair Share Fees Unconstitutional in the Public Sector? Not So Fast

The United States Supreme Court has been issuing employment-law related decisions like a boss over the past week or so. Many observers thought that the Court's decision in Harris v. Quinn, a case examining the...more

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