Firm News & Legal Alerts

Tuesday, December 8, 2015

AG’s Office Begins Enforcing the Surprise Bill Law

This past Spring, the Surprise Bill Law took effect in New York State, imposing various disclosure and billing requirements on out-of-network providers and insurance companies. The aim of the law is to protect consumers from “surprise” or emergency out-of-network medical bills. Patients who receive surprise bills are to be held harmless, with the exception of their usual in-network co-pays and deductibles. Out-of-network providers and insurance companies are required to resolve any fee disputes in an arbitration-style format.


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Tuesday, December 1, 2015

Physician Assistants, Practices, and Social Networks: Gauging the Risks


As medical practices react to the growing market pressures to grow and/or maintain their patient populations, many are embarking upon an entry into the world of social networks.  While such environments may hold great reward for many businesses, they also hold many concerns and risks unique to physician assistants and their medical practices.  

  

A “Social Network” is defined by dictionary.com as an online service, platform or site wherein “family, friends and their families, that together create an interconnected system through which alliances are formed, help is obtained, information is transmitted, and strings are pulled. In an organizational setting, it usually constitutes the group of one's peers, seniors, and subordinates who provide information on how to get things done, how the power structure operates, and who holds the strings.
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Wednesday, October 28, 2015

Out-Of-Network Providers Score Victories Over United Healthcare

Over the past year, United Healthcare (“United”) has commenced at least four lawsuits scattered throughout Westchester and Long Island alleging very similar facts and legal claims against out-of-network physicians. Weiss, Zarett, Brofman & Sonnenklar, P.C., has represented defendant out-of-network providers in two of these four cases.


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Friday, September 4, 2015

AG Settlement with Aspen Dental, Inc.

On June 15, 2015, the New York Attorney General’s Office (“AG”) entered into a settlement agreement with Aspen Dental Management, Inc. (“ADMI”), a management services organization (“MSO”) that provides services to dental practices in New York. After receiving over 300 complaints during the past ten years, the AG launched an investigation and ultimately alleged that ADMI was improperly engaged in the corporate practice of dentistry, and that the compensation arrangements between ADMI and its dental practice clients (the “Practices”) constituted improper fee-splitting between professionals and non-professionals. 


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Tuesday, September 1, 2015

END-OF-LIFE CARE: THE NEW YORK MEDICAL ORDERS FOR LIFE SUSTAINING TREATMENT (“MOLST”)


Background

As the national conversation on health care becomes increasingly focused on end-of-life care and, more specifically, the quality of such care, states have become progressively interested in providing patients with a clear and efficient manner in which to direct their end-of-life care choices. On June 1, 2010, the New York State Department of Health updated its existing Medical Orders for Life Sustaining Treatment form, the MOLST form,1 to make it more user friendly and to align it with provisions of the Family Health Care Decisions Act (“FHCDA”)2. A MOLST form is generally for patients who have serious health conditions and have a life expectance of less than one year, want to state their wishes regarding life-sustaining treatment or patients who reside in long-term care facilities. The MOLST form is printed on bright “pulsar” pink heavy stock paper3 and is a medical order signed by a New York State (or a border state) physician.  

MOLST v.
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Wednesday, July 1, 2015

COMPLIANCE AUDITS


Legal Red Flags

It is estimated that approximately $60 billion is lost annually to fraud. During the 2014 Fiscal Year, the Federal Government recovered $2.3 billion in Federal fraud judgments and settlements. Laws that fall within the scope of fraud and abuse include: Federal False Claims Act, State False Claims Act, Federal Anti-Kickback Statute, Federal Stark Law, and NJ “Codey Law”. Similarly, there are many types of medical fraud such as; False Patients, False Claims, Unbundling, Upcoding, Self-Referrals, Criminal Activity, and Unnecessary Treatment and/or issues concerning the prescribing of Durable Medical Equipment (“DME”).
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Friday, May 1, 2015

MEANINGFUL USE AUDITS: ARE YOU PREPARED?


Background

As all participants in the EHR Incentive Program should now know, the Centers for Medicare & Medicaid Services (“CMS”) is providing incentive payments to those Eligible Professionalswho attest to meeting certain Medicare meaningful use requirements(“Meaningful Use”). In order to receive the payments, Eligible Professionals must attest to achievement of “meaningful use” of their EHR systems in each stage of the program.  There are three distinct stages of the program - appropriately called Stage 1, Stage 2 and Stage 3 - which are designed to advance the program.  For example, each stage is meant to build upon the stage that came before it to expand usage and integration of the EHR system.  If an Eligible Professional has trouble meeting the Stage 1 requirements, chances are he or she will not be able to meet the more comprehensive requirements of Stage 2 or Stage 3.
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Wednesday, April 1, 2015

PROTECTING ACCESS TO MEDICARE ACT OF 2014 PASSES: ICD-10 IMPLEMENTATION DELAYED


Background

All United States health care providers use a system known as the International Classification of Diseases, 9th Edition, Clinical Modification/Procedure Coding System (“ICD-9”), to categorize and report, or “code”, all patient encounters.  Any health care provider who is subject to the Health Insurance Portability Accountability Act (“HIPAA”) or who bills any private insurance, Medicare or Medicaid for patient services must use the ICD-9 coding system.    In recent years, a 10th Edition of the International Classification of Diseases, Clinical Modification/Procedure Coding System (“ICD-10”) has been developed with the goal of more accurately tracking patient care and more effectively reimbursing providers for same.  Under ICD-9, providers are required to select the most appropriate code from a list of approximately 14,000 codes; the number of potential codes will significantly increase - to approximately 69,000 codes.

All practices and medical professionals currently subject to ICD-9 were previously required to upgrade their systems to enable them to begin billing under the new ICD-10 codes by October 1, 2014.
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Wednesday, April 1, 2015

NEW YORK PHYSICIANS AND NON-COMPETE CLAUSES


You are just starting out in practice. You have successfully completed your residency and perhaps, your fellowship. You are finally ready to make a living and start paying off your student loans. Congratulations! Or, you have just moved to New York from another state, and you are ready to get a new start in the Empire State.

Either through a recruiter, a head-hunter, the internet, or personal connections, you are offered an employment contract with a group of physicians, or with a hospital.
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Tuesday, February 24, 2015

Surprise Medical Bills Law Set to Take Effect March 31, 2015

Last year, as part of its budget agreement, New York State set forth its plan to revamp the out-of-network reimbursement system. A previous newsletter highlighted many of these changes which are scheduled to take effect March 31, 2015. On December 31, 2014, the Department of Financial Services (“DFS”) issued the proposed new 23 N.Y.C.R.R. Part 200. The proposed regulations provide further insight on the independent dispute resolution entities (“IDRE”) as well as what providers can expect in the future.


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Thursday, February 5, 2015

CMS Makes Changes to its Overpayment Recovery Process

Physicians in New York are all too familiar with Medicare and Medicaid audits, which can result in millions of dollars in recoupment by the Centers for Medicare & Medicaid Services (“CMS”). CMS recoups money that it believes was overpaid to providers as a result of improper billing practices, among other reasons. For far too long, providers have complained that the process is tipped in CMS’ favor and deeply flawed. For example, CMS retains Recovery Audit Contractors (“RACs”) to audit Medicare claims submitted by health care providers, including physicians and hospitals, on a contingency fee basis. Thus, some would argue, improperly incentivizing the RACs.

Due to the ongoing issues with the process, CMS suspended new RAC audit activities in February 2014, until new contracts could be awarded. RACs are still permitted to conclude ongoing investigations during that time.


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