Firm News & Legal Alerts

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.
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Wednesday, June 1, 2011

IS THE ROUTINE WAIVER OF PATIENT OUT-OF-POCKET COSTS FRAUD


This question is addressed in numerous opinions issued by the Office of General Counsel of the New York State Department of Insurance, e.g. December 14, 2000; April 14, 2003; April 8, 2005; March 27, 2008 and April 2, 2008 1. In the letter of April 8, 2005, for example, the Office of General Counsel of the Department of Insurance stated:

“As we have previously stated, a physician who as a general business practice, waives otherwise applicable co-insurance, co-payments, or deductibles, where such waiver would affect the amount the insurer would pay might be guilty of fraud…”

“For example, if an individual was insured under a health insurance policy obligating the insurer to reimburse the insured 80% of the physician’s usual and customary charges and were the physician to inform the insurer that his or her usual and customary charge for a procedure was $100, the insurer would, in anticipation that the physician would require the patient to pay him or her $20, reimburse the insured $80. If, however, the physician was to, as a general business practice, waive the $20 co-payment, the physician’s usual and customary charge would not be $100, but would be $80.
Read more . . .


Sunday, May 1, 2011

LICENSURE AND CREDENTIALING CONSEQUENCES OF A STATE HEALTH CARE FRAUD CONVICTION IN NEW JERSEY


When a practitioner faces a criminal charge related to health care fraud, it is important to keep in mind not only the potential direct consequences of a conviction – term of imprisonment, fines, restitution, probation, etc., it is also important to be aware of collateral and administrative consequences that will, or may, flow from a criminal conviction. Often times in a criminal case the most important decision any defendant will have to make is whether to accept a plea offer made by the prosecutor, or proceed to defend oneself in trial. Knowing the indirect consequences to a physician - such as impact on licensure and credentialing - that may result from a conviction is imperative in making that decision.

In regard to New Jersey’s Health Care Claims Fraud Statute, found at N.
Read more . . .


Friday, April 1, 2011

THE WAGE THEFT PREVENTION ACT - NEW WAGE NOTICE REQUIREMENTS FOR EMPLOYERS


The Wage Theft Prevention Act (WTPA), which goes into effect April 9, 2011, amends the notice of wage rate requirements under Section 195 of the Labor Law. The law covers all private sector employers in New York State. For more information go to the New York State Department of Labor website.

Section 195 of the Labor Law requires employers to provide a written notice to employees regarding their rate(s) of pay, designated pay day, the employer’s intent to claim certain allowances as part of the minimum wage (e.g.


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Thursday, March 31, 2011

Proposed Regulations for the Medicare Shared Savings Program

On March 31, 2011, CMS issued the much anticipated proposed regulations for the Medicare Shared Savings Program: Accountable Care Organizations (“ACO”), in accordance with the requirements of the Affordable Care Act (“Health Reform”) (Proposed ACO Regs Fed Reg). The four-hundred plus page proposed regulations set forth the rules for implementation of ACO’s in the Medicare program. The purpose of the regulations is to encourage and set forth the framework for the creating of ACO’s for the stated purpose of “promoting accountability” for a set of Medicare patients in a population, while coordinating care and thereby decrease costs and increasing quality. Costs and quality would be monitored for a three-year period at the end of which if certain goals are met the provider would receive an incentive/bonus payment. What this all means is yet to be determined and it could be some time before the final regulations are issued as there are numerous interested parties who we expect will submit substantive comments; including the AHA, insurance payors, and the AMA to name a few. What we do know is that ACO’s have the potential to forever change the healthcare delivery and reimbursement models as we know them. The public comment period for the proposed regulations ends on June 6, 2011.


Read more . . .


Tuesday, February 1, 2011

HOW REIMBURSEMENTS FOR OVER-THE-COUNTER MEDICATIONS WILL AFFECT PHYSICIANS: NEW RULES AND REQUIREMENTS

As part of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, patients are now subject to new rules governing reimbursement of the cost of certain over-the-counter (OTC) medications. These rules affect reimbursements under employer-sponsored health plans, health flexible spending arrangements (health FSAs), and health reimbursement arrangements (HRAs), as well as health savings accounts (HSAs) and Archer medical savings accounts (Archer MSAs).


Read more . . .


Thursday, October 21, 2010

CareCore National Law Suits

Weiss & Zarett, P.C. serves as co-counsel for plaintiff radiology groups, who have sued CareCore National and others for federal antitrust law violations. The case has been pending for several years, and on October 21, 2010, the Court issued a lengthy decision denying CareCore’s motion for summary judgment dismissing the action. Accordingly, the case will be proceeding to trial.  The court’s decision addresses issues of antitrust standing, injury and conspiracy, and provides meaningful guidance regarding the contours of federal antitrust jurisprudence in the healthcare industry.  For a copy of the decision, please click here


Thursday, October 21, 2010

St. Vincent’s Bankruptcy Case

Weiss & Zarett, P.C. is pleased to announce that on October 21, 2010, Bankruptcy Judge Cecilia G. Morris approved a settlement in the St. Vincent’s bankruptcy case – reached by the firm on behalf of hundreds of former St. Vincent’s medical residents and attending physicians – challenging the hospital’s initial refusal to purchase “tail” medical malpractice insurance coverage for those former physician employees. Absent this settlement, hundreds of the hospital’s prior residents and attending physicians would have been uninsured for future potential medical malpractice losses and accompanying damages.  The Order was issued out of the Southern District of New York Bankruptcy Court, following motion practice and settlement negotiations orchestrated by Weiss & Zarett, P.C., partner Michael D. Brofman, Esq.  Click here for a copy of the settlement news release


Sunday, August 1, 2010

TOP REASONS PHYSICIANS ARE SUED FOR MALPRACTICE


A primary, if not preeminent, goal of every physician in practice today is the avoidance of a lawsuit for medical malpractice. In pursuit of that goal, the hard reality of practice dictates that risk management of medical malpractice claims falls directly upon, and is ever present with, every physician throughout each moment of rendering care. Understanding where the highest risk areas lie, and taking affirmative and aggressive measures to risk manage those prioritized threats, will provide physicians with the greatest protection toward avoiding a claim and/or being prepared to defend, and defeat, a claim that arises in spite of these measures.

 

  • 1Creating Medical Records That Are Not “Self-Protective” The initial “triage” of a potential medical malpractice claim is normally carried out by a physician or nurse retained by the attorneys representing the patient. These attorneys, seeking a financial recovery/gain, are not desirous of investing large sums of capital, resources and time into a claim which presents with a strong, defensible set of medical records.
    Read more . . .


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