Firm News & Legal Alerts

Wednesday, March 7, 2012

New York Department of Financial Services Report

On Wednesday, March 7, 2012, the New York Department of Financial Services released a report entitled "An Unwelcome Surprise: How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers."  The report found an overwhelming need for increased transparency from insurers and healthcare providers, as well as improved consumer protection measures to ensure New Yorkers stop receiving unexpected medical bills from out-of-network providers.  The report proposes a number of reforms, such as: (i) increased disclosure by insurers of their methodology for determining out-of-network reimbursements; (ii) increased disclosures from insurers and medical providers regarding anticipated out-of-network costs associated with the provision of non-emergency care; (iii) a prohibition on excessive fees charged in emergency care situations; (iv) improving network adequacy protections for PPO and EPO subscribers (such as those enjoyed by HMO subscribers); and (v) minimum standards for out-of-network coverage.


Thursday, February 16, 2012

ICD-10 Diagnostic and Procedural Coding System Delay

On February 16, 2012, Health and Human Services (“HHS”) Secretary Kathleen G. Sebelius announced that the federal government will delay for an unspecified time the implementation date for the ICD-10 diagnostic and procedural coding system.  ICD-10, which has been widely used in many other countries for years, was scheduled to replace ICD-9 in the United States in October 2011.  During the 2008 public comment period, providers received a delay until Oct. 1, 2013.  According to the press release, federal officials are acting on providers' concerns "about the administrative burdens they face in the years ahead.”  HHS said it will "announce a new compliance date moving forward."


Thursday, February 9, 2012

NYS Comptroller to Audit a Non-Participating Provider of Medical Services

February 9, 2012.  Late last year, a decision was rendered by the Appellate Division, Third Department, which reversed a lower court, and upheld the authority of the NYS Comptroller to audit a non-participating provider of medical services to beneficiaries of the Empire Plan.  Under the Empire Plan, the New York State Insurance Program contracts with United Health Care Insurance Company of New York, a commercial insurer, to provide health insurance coverage to State employees and retirees. 
Read more . . .


Wednesday, February 1, 2012

Are You Ready for the New ICD-10 and Electronic Version 5010? Changes Start Taking Effect in Early 2012...


The International Classification of Diseases (10th edition) (ICD-10) codes will take effect on October 1, 2013. While this may seem far off, according to the Centers for Medicare and Medicaid Services (CMS), physicians should begin preparing for the changes immediately. In addition, the CMS will require use of the new Version 5010 for the electronic submission of claims beginning in early 2012. Although the Version 5010 represents less of a structural transformation than ICD-10, its impact will come in just a few months. Failure to prepare for either change can (and most likely will) result in unpaid claims.
Read more . . .


Sunday, January 1, 2012

NY Supreme Court Upholds Authority of Comptroller to Audit Doctor

The NYS Supreme Court, Appellate Division, Third Department, in its written decision, upheld the authority of the NYS Comptroller to audit Marvin Handler, MD. The audit primarily focused on whether Dr. Handler had routinely waved Empire Plan members’ out-of-pocket costs. MSSNY wrote an amicus brief urging the Appellate Division to hold that the Comptroller has no constitutional authority to audit private practice physician offices.


Read more . . .


Thursday, December 1, 2011

When the FBI, OIG, IRS, OSHA (etc., etc.) Knocks on Your Door


Unfortunately for physicians, then list of entities, agencies and organizations empowered to take adverse action against them continues to grow at an alarming rate. Understanding, from the very beginning, what they are, what they are not and how to handle their intrusion/investigations are the keys to risk managing the threat they inherently carry.

Anti-Physician Acronyms

  • ·  BOM – Board of Medicine
  • ·  DEA – Drug Enforcement Agency
  • ·  AG/FCA – Attorney General/False Claims Act
  • ·  CMS – Centers for Medicare Services
  • ·  OIG/FBI – Office of the Inspector General/Federal Bureau of Investigation
  • ·  HMO – Health Maintenance Organization
  • ·  FTC – Federal Trade Commission
  • ·  HIPAA – Health Insurance Portability and Accountability Act
  • ·  CLIA – Clinical Laboratory Improvement Act
  • ·  EMTALA – Emergency Medical Treatment and Active Labor Act
  • ·  OSHA – Occupational Safety and Health Administration
  • ·  MEC – Medical Executive Committees
  • ·  IRS – Internal Revenue Service

What also ties these entities together in such an unprecedented manner is the mandatory cross-referral, cross reporting and intra-communications they are required to engage in whenever a complaint, an investigation and/or an action involves a physicians or medical practice. To facilitate this legal interweaving, each of these entities also has direct access to a central, physician based depository of data as to each and every practicing physician in the United States.

The National Practitioner Data Bank

  • ·  Medical malpractice
  • ·  Hospital actions
  • ·  Licensing actions
  • ·  Health Plans/Managed Care Company actions
  • ·  Government actions

As each and every physician, regardless of guilt or innocence, faces even the most seemingly benign or innocuous inquiry by any of these entities, certain questions and considerations must be preeminent in their minds.
Read more . . .


Thursday, October 20, 2011

Final Regulations for the Medicare Shared Savings Program: Accountable Care

On October 20, 2011, CMS issued the final regulations for the Medicare Shared Savings Program: Accountable Care Organizations (“ACO”), in accordance with the requirements of the Affordable Care Act (“Health Reform”). The significant changes in the final regulations compared to  proposed regulations issued in March, resulted from an outpouring of over 1000 comments on the draft regulations. In addition, the DOJ and FTC issued the final version of their joint policy statement (See: policy statement) detailing how these agencies will enforce the antitrust laws in light of the ACO. The final policy includes certain antitrust “safety zones” for ACO’s.


Thursday, September 15, 2011

St. Vincents Medical Bankruptcy Agreement

Weiss & Zarett, P.C. is pleased to announce that on September 15, 2011, Bankruptcy Judge Cecilia G. Morris approved an agreement to add the attending physicians at the facility formerly known as St. Vincents Medical Center Westchester, to the October 21, 2010 settlement with physicians in the St. Vincents bankruptcy case. This settlement established a fund for the payment of medical malpractice claims against the former St. Vincent employee physicians, and provided for an injunction against uncovered medical malpractice claims being asserted against those physicians.  St. Vincents Medical Center Westchester was acquired by St. Joseph's Hospital in October 2010 and most of these newly added physicians to the settlement remain employed at that facility. 


Read more . . .


Friday, July 1, 2011

THE TARGETING OF PHYSICIANS’: INSIGHTS, REALITIES & RISK MANAGEMENT


In order to survive (and God willing, even possibly succeed) in today’s medicine, every physician must come to accept certain key insights and recognize certain hard realities.

First insight: The number of agencies, entities and authorities who earn their living every day (and all day) regulating, auditing, monitoring disciplining, prosecuting and punishing physicians continues to grow every day.

Hard Reality: Any action, by any of these entities, will certainly be costly to defend, may well be career ending and may even place the physician’s liberty at stake.

Risk Management: Every physician must:

  • 1Obtain the “ground rules” for every entity/agency under which they exist, operate and/or practice,
  • 2Review and analyze the “ground rules”,
  • 3Decide if they can comply with these “ground rules”, and
  • 4If they cannot comply with the “ground rules”, every physician should immediately end any role or responsibilities they hold under that entity/agency.

Anti-Physician Acronyms

 

Second Insight: All of the entities adverse to physicians have the ready ability, and in some cases the legal obligation, to communicate and coordinate with each other as to the action they are taking against a physician or practice.
Read more . . .


Friday, July 1, 2011

Gotcha! When Malpractice Plaintiffs Fake or Exaggerate Injuries




A video presented at a malpractice trial showed a pitiful 56-year-old man grimacing in pain, hobbling on crutches, unable to even brush his teeth without his wife's assistance. His sex life was over. His disabilities were caused by a botched back operation, he testified.

The defendant neurosurgeon and his insurer were convinced the man was lying. But how to prove it? Investigators with video cameras staked out his house for 3 days, but the man stayed inside.
Read more . . .


Wednesday, June 1, 2011

MSSNY FILES AMICUS CURIAE BRIEF-NYS COMPTROLLER HAS NO AUTHORITY TO AUDIT PRIVATE MEDICAL PRACTICE


MSSNY has received permission from the New York State Supreme Court, Appellate Division, Third Department to file an amicus curiae brief in Marvin H. Handler, MD., P.C., v.
Read more . . .


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