Physician Who Prescribed Opiates Not Liable for Robbery and Murder Committed by Patients: In Ferguson v. Laffer, No. 02967, slip op. (N.Y. App. Div., 2d Dept. Apr. 19, 2017), the Supreme Court of New York, Appellate Division, Second Department, reversed the trial court’s denial of a motion to dismiss an action against a physician, Stan […]

Medical Malpractice Action Dismissed for Inadequate Certificate of Merit: In Calcagno v. Orthopedic Associates of Dutchess County, P.C., No. 523454, slip op. (N.Y. App. Div., 3d Dept. Mar. 2, 2017), the Supreme Court of New York, Appellate Division, Third Department, affirmed the trial court’s dismissal of a medical malpractice action on the basis of an […]

OIG Announces Large 12 Year Fraud Settlement: The U.S. Attorney for the Southern District of New York on March 1, 2017 announced criminal and civil actions relating to an alleged 12 year scheme to defraud Medicare, Medicaid and other private health insurance companies of more than $50 million. The defendants named in the indictment include […]

A physician received a written notice from the Office of the Attorney General Medicaid Fraud Control Unit: The agreement the physician had entered into with a billing company is in violation of State and Federal Medicaid regulations, as it bases compensation upon a percentage of the value of claims. The notice cites an article in […]

Overtime Rule in Effect in New York State: On September 22, 2016, a U.S. District Court judge in Texas granted an Emergency Motion for Preliminary Injunction and enjoined the U.S. Department of Labor from implementing and enforcing the Federal Overtime Final Rule that was scheduled to go into effect on December 1, 2016. The Federal […]

Former Doctor Sentenced to Prison for Health Care Fraud: A former physician from Illinois who had been convicted in Federal Court of falsely certifying elderly patients for in-home care has recently been sentenced to Federal prison and required to reimburse the government for $1.5 million in losses which he was found to have caused. Banio […]

HHS Targets Increases in Drug Prices: The Office of the Inspector General (“OIG”) of the Health and Human Services Department (“HHS”) has released a list of items which it intends to look into, on a priority basis, in 2017. Prominently featured on this list is the goal of reducing costs for prescription drugs. The release […]

CMS Issues Final MACRA Rule, Expanding Exemptions and Adding Flexibility: On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (“CMS”) issued the long-awaited final rule under the Medicare Access and CHIP Reauthorization Act (“MACRA”). Now referred to as the “Quality Payment Program” (“QPP”), it still consists of two “pathways:” the Merit-based Incentive […]

CMS  Announces MACRA Refinements: Although final regulations have yet to be promulgated under the Medicare Access and CHIP Reauthorization Act (“MACRA”), and are not scheduled to be issued until November, 2016, in a recent blog post, Andrew Slavitt, the Acting Administrator of the Centers for Medicare and Medicaid Services (“CMS”), announced options which physicians could […]

MACRA Model Forcing Physicians to Evaluate Risk: Practices are now in the process of deciding which of the two possible reimbursement paths they will take under the Medicare Access and CHIP Reauthorization Act (MACRA). The shift from the much maligned sustainable growth rate formula (SGR) to MACRA is forcing physicians to think about issues typically […]