Tag Archives: physicians

Employee Reference Releases: Who’s In and Who’s Out?

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
A recent Indiana defamation case, Manhas v. Franciscan Hammond Clinic, serves as a critical reminder of the importance of scrutinizing physician and employee reference forms and releases. Dr. Sheila Manhas and Franciscan Hammond Clinic (FHC) were parties to a settlement agreement that included a provision whereby Dr. Manhas would direct inquiries from prospective employers to … Continue Reading

Resistance Is Futile: CMS Gets Serious About Antibiotic-Resistant Bacteria

Photo of Kyle GregoryPhoto of Emily CrosbyBy Kyle Gregory, Greg Fosheim and Emily Crosby on Posted in Uncategorized
Antibiotics and similar drugs, known more broadly as antimicrobial agents, are an instrumental weapon in the healthcare armory, rendering once-lethal infections treatable, and dramatically reducing instances of sepsis and secondary infections associated with cancer chemotherapy and organ transplants. However, sub-therapeutic use of antimicrobial agents in livestock, over-prescription, bacterial evolution and myriad other factors have contributed … Continue Reading

Deeper Dive: Integrating Physician Practices into a Health System’s HIPAA Privacy and Security Program

By Paulette Thomas on Posted in Uncategorized
The health system needs to understand its IT capabilities and operating competencies and develop the required infrastructure to support clinical integration of the physician practices The healthcare industry shift to a value-based business model is resulting in greater alignment between hospitals and physicians to provide quality, outcomes driven care in order to receive payment for … Continue Reading

Does the Medical-School-to-Prison Pipeline Widen in Middle Age?

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The trend of holding physicians personally responsible for healthcare crimes has continued unabated over the past year. As noted in a previous article, physicians are particularly attractive targets for federal prosecutors due to the “special skill” and “abuse of trust” sentencing enhancements found in the U.S. Sentencing Commission Guidelines. While measuring physician participation in illegal activity … Continue Reading

Debt Collector for Affiliated Physician Group Can Rely on Patient Contact Consent Obtained by Hospital

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
Careful drafting of consent and information release provisions can ensure that providers and affiliated physicians and their debt collectors can contact patient cell phones using automatic telephone dialing systems or artificial or prerecorded voices. The Sixth Circuit recently held that a hospital-based anesthesia group’s debt collector did not violate the Telephone Consumer Protection Act (TCPA) when it … Continue Reading

CMS Pitches Controversial Payment Model for Medicare Part B Drugs

Photo of Lee H. RosebushBy Lee H. Rosebush and Nita Garg on Posted in Uncategorized
CMS recently announced a proposed rule that would potentially create a new Medicare Part B prescription drug payment model. The proposed model is intended to improve quality of care and deliver better value for Medicare Part B beneficiaries. However, many providers and drug manufacturers have expressed concern that the new payment model will emphasize cost-cutting measures at … Continue Reading

CMS Finalizes Revisions to Stark to Ease Burden on Providers, Refines “Incident to” Requirements

Photo of Kristen McDermott WoodrumBy Kristen McDermott Woodrum, Darby C. Allen and Donna S. Clark on Posted in Uncategorized
In its calendar year 2016 Physician Fee Schedule Final Rule published in the Federal Register on November 16, 2015 (Final Rule), the Centers for Medicare and Medicaid Services (CMS) finalized amendments to the federal physician self-referral (Stark) regulations proposed in the Physician Fee Schedule proposed rule released in July. Among the significant provisions contained in the Final Rule are … Continue Reading

Meaningful Use Stage 3 Final Rule Reduces Provider Burdens

Photo of Lynn SessionsBy Lynn Sessions and Suchismita Pahi on Posted in Uncategorized
CMS and the Office of the National Coordinator for Health Information (ONC) recently released the 752-page final rule for Meaningful Use Stages 2 (MU2) and 3 (MU3). The final rule provides a flexible timeline for providers and reduces the number of objectives and accompanying clinical quality measures required for reporting. The rule further provides that: … Continue Reading

Proposed Rule Aims to Refine Stark Regulations and Clarify “Incident To”

Photo of Kristen McDermott WoodrumBy Kristen McDermott Woodrum and Darby C. Allen on Posted in Uncategorized
On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2016 Physician Fee Schedule Proposed Rule. In addition to updating several traditional Part B payment policies, the proposed rule contains significant changes to the physician self-referral regulations (Stark regulations) and the Medicare “incident to” coverage rule. The comment … Continue Reading

OIG Fraud Alert Cautions Against Sham Medical Director Arrangements

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
The HHS OIG recently issued a brief fraud alert (Fraud Alert) reminding physicians that inappropriate compensation arrangements may lead to enforcement actions under the federal anti-kickback statute and Civil Monetary Penalties Law. Although not mentioned in the Fraud Alert, improper compensation arrangements also raise issues under the federal self-referral law known as the Stark Law. … Continue Reading

When a Custodian of Records Has a Fifth Amendment Privilege

Photo of Gregory S. SaikinBy Gregory S. Saikin and Casey Holder on Posted in Uncategorized
In a recent decision, the U.S. Court of Appeals for the Third Circuit held that a physician acting as custodian of records may not withhold records subpoenaed from his professional association on Fifth Amendment self-incrimination grounds. Importantly, the court did not address, as we do below, certain circumstances in which this physician could have invoked … Continue Reading

The Medical-School-to-Prison Pipeline Continues to Widen

Photo of Robert M. WolinPhoto of Gregory S. SaikinBy Robert M. Wolin and Gregory S. Saikin on Posted in Uncategorized
Pysicians 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 willingness to pursue cases tied to questionable medical necessity. In fact, the recent Medicare fraud indictment of Dr. Solomon E. Melgen … Continue Reading

Five Things to Know About the Medicare SGR Fix

Photo of Robert M. WolinPhoto of Kathleen P. RubinsteinBy Robert M. Wolin, Susan Feigin Harris and Kathleen P. Rubinstein on Posted in Uncategorized
H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), was signed into law by President Obama on April 16, 2015. A broad bipartisan compromise measure, MACRA repeals the much-maligned sustainable growth rate (SGR) formula used to determine physician payment rates and replaces it with a new incentive payment system; extends funding for the Children’s … Continue Reading

“PhysTexting” Is Not Enough to Form a Patient-Physician Relationship

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
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, before a physician can prescribe medications, the physician must establish a “defined physician-patient relationship.” A defined physician-patient relationship requires that the physician … Continue Reading

CMS Releases New Proposal to Improve Accountable Care Organizations

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule aimed at revitalizing accountable care organizations (ACOs) under the Medicare Shared Savings Program (MSSP). Given the low level of ACOs receiving shared savings payments in their first year, CMS is making several proposals to adjust participants’ risk levels to encourage continued participation. … Continue Reading

It Is Finally Here─the Sun Shines on a New Era

Photo of Lee H. RosebushBy Lee H. Rosebush and Dena Kessler on Posted in Uncategorized
The Centers for Medicare and Medicaid Services (CMS) publicly launched a database this week detailing the payments doctors and teaching hospitals have received from drug and medical device manufacturers. Under the Physician Payments Sunshine Act—a provision of the 2010 Affordable Care Act—CMS is required to collect and make available information about these payments, which certain manufacturers … Continue Reading

Dot-com: A Health Professional’s Website Is Not Just Another Website

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
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 regulatory requirements in the web design process after reviewing one of my physician client’s websites. Even in states that do not have … Continue Reading

Washington, D.C., Joins the Ban-the-Box Movement for Private Employers

Photo of Todd LebowitzBy Todd Lebowitz on Posted in Uncategorized
Editor’s note:  This post originally appeared on BakerHostetler’s Employment Law Spotlight blog. The District of Columbia has passed one of the most stringent ban-the-box laws in the nation.  The D.C. law includes the typical prohibition on asking questions about criminal background during the application process, but it also adds a requirement, similar to New York … Continue Reading

Summer Fraud and Abuse Roundup

By Darby C. Allen, Donna S. Clark and B. Scott McBride on Posted in Uncategorized
The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to healthcare fraud and abuse. Group Practice Pays Over $1 Million for Improper Compensation Formula The New York Heart Center, a cardiology … Continue Reading

Academic Medical Centers: Clinical Care, Research and Teaching (or Maybe Not?)─Graduate Medical Education and the Future

By Susan Feigin Harris on Posted in Uncategorized
In the world of healthcare policy and law, we usually discuss issues impacting providers, but don’t often report about the training and infrastructure behind what allows our healthcare system to treat patients in our facilities. Many warnings have come and gone about how we are not training enough physicians for primary care, and the ACA … Continue Reading

Background Check Lawsuits: If It’s Not One Thing, It’s Another

Photo of Pat MuldowneyBy Pat Muldowney on Posted in Uncategorized
Editor’s Note:  This post originally appeared on BakerHostetler’s Employment Law Spotlight blog. As we previously have written, employer use of criminal records and background checks with respect to applicants and employees has been the subject of challenge on the grounds that such checks tend to discriminate against African-American, Hispanic, and male applicants.  Indeed, on July … Continue Reading

Background Check Questions: Illinois Joins Ban-the-Box States; New Jersey May Be Next

Photo of Todd LebowitzBy Todd Lebowitz and Melissa Siebert on Posted in Uncategorized
Editor’s Note:  This post originally appeared on BakerHostetler’s Employment Law Spotlight blog. Illinois Criminal background questions on employment applications will no longer be permitted in Illinois, effective January 1, 2015. On July 19, Governor Quinn signed the Job Opportunities for Qualified Applicants Act, making Illinois the fifth state to prohibit private employers from asking criminal … Continue Reading
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