Firm News & Legal Alerts

Thursday, February 14, 2013

AMA Issues Principles for Physician Employment By Hospitals

The AMA House of Delegates recently adopted, at its 2012 Interim Meeting, the AMA Principles for Physician Employment, which are designed to “help physicians, those who employ physicians, and their respective advisors identify and address some of the unique challenges to professionalism and the practice of medicine arising in the face of physician employment.” (http://www.ama-assn.org/resources/doc/hod/ama-principles-for-physician-employment.pdf).

While the Principles are not binding for disciplinary purposes, in the same manner as the AMA Code of Medical Ethics, the House of Delegates intended to “provide broad guidance for employed physicians and their employers as they collaborate to provide safe, high-quality, and cost-effective patient care.”


Read more . . .


Thursday, January 10, 2013

Hospital Bankruptcy Risks for Physicians

The recent Chapter 11 bankruptcy filing by Interfaith Medical Center, Inc., serves as a reminder to physicians (and other healthcare providers) of the importance of doing a thorough investigation, and asking the right questions, before entering into contractual relationships (such as an employment contract) with hospitals in New York.  In our experience through representation of physicians in the bankruptcy cases involving various hospitals, it is not unusual for physicians or residents to learn - - unfortunately, after the fact - - that hospitals have provided insufficient or no medical malpractice insurance despite being promised in the employment contract.  In some cases, the hospital held itself out as “self insured,” but did not segregate the funds needed to actually cover malpractice claims.  In other cases, there was inadequate funding to purchase tail coverage.


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Wednesday, October 24, 2012

Court Affirms 2004 Ruling Pursuant to Federal Privacy Act

As a physician, learning that you are the subject of an Adverse Action Report filed with the National Practitioner Data Bank (NPDB) is distressing, to say the least. It can have significantly negative ramifications on a physician’s professional practice and reputation. The NPDB is a federal clearing house, maintained by the United States Department of Health and Human Services, which collects information on every physician who has been the subject of a medical malpractice payment, adverse medical staff privileging action, Board or Professional Society discipline and/or state licensure penalty. Whenever a physician seeks to obtain or renew his/her professional credentials, such as for a medical license, hospital privileges, or malpractice insurance, the NPDB is

“queried,” which in turn could lead to adverse credentialing decisions. Needless to say, these issues are particularly upsetting if the physician believes the original report filed with the NPDB was inaccurate or misleading in the first place.


Read more . . .


Wednesday, October 3, 2012

Commercial and Governmental Payer Audits and Withholds

The withholding by commercial and governmental payers of proper reimbursement for the provision of healthcare services, based on allegations of improper billing or fraud, continues to be a major financial hurdle facing healthcare providers.  For instance, New York Insurance Law § 3224-b allows commercial health plans to provide no more than 30 days written notice to physicians before engaging in “overpayment recovery efforts,” which can be justified after they “suspect” fraud, intentional misconduct, or abusive billing.
Read more . . .


Monday, October 1, 2012

Recent Healthcare Law Developments: Court Affirms 2004 Ruling

Court Affirms 2004 Ruling that Healthcare Providers Can Challenge Inaccurate National Practitioner Data Bank Reports Pursuant to the Federal Privacy Act.  As a physician, learning that you are the subject of an Adverse Action Report filed with the National Practitioner Data Bank (NPDB) is distressing, to say the least. It can have significantly negative ramifications on a physician’s professional practice and reputation.  The NPDB is a federal clearing house, maintained by the United States Department of Health and Human Services, which collects information on every physician who has been the subject of a medical malpractice payment, adverse medical staff privileging action, Board or Professional Society discipline and/or state licensure penalty. Whenever a physician seeks to obtain or renew his/her professional credentials, such as for a medical license, hospital privileges, or malpractice insurance, the NPDB is “queried,” which in turn could lead to adverse credentialing decisions.  Needless to say, these issues are particularly upsetting if the physician believes the original report filed with the NPDB was inaccurate or misleading in the first place.


Read more . . .


Friday, September 7, 2012

Ziad Akl, M.D. Case Revisited

Recently, on September 7, 2012, the United States District Court, for the District of Columbia, revisited the issue in a case filed by plaintiff, Ziad Akl, M.D., who argued that the summary suspension of his hospital privileges was motivated by malice and bad faith, and therefore the resulting Adverse Action Report should either be voided or amended. (Case No: 08-0461).  In Akl, the Court dismissed the action, finding that the plaintiff failed to meet his burden of proof in showing the inaccuracy of the NPDB reports at issue.  Nevertheless, the Court re-affirmed the Doe Court’s general holding that the Act does provide a viable legal theory to challenge the factual accuracy of an Adverse Action Report, where the internal review processes contained in the NPDB regulations have been unsuccessfully exhausted.


Wednesday, August 29, 2012

Recent Healthcare Law Developments: Commercial and Governmental Payer Audits and Withholds

The withholding by commercial and governmental payers of proper reimbursement for the provision of healthcare services, based on allegations of improper billing or fraud, continues to be a major financial hurdle facing healthcare providers.  For instance, New York Insurance Law § 3224-b allows commercial health plans to provide no more than 30 days written notice to physicians before engaging in “overpayment recovery efforts,” which can be justified after they “suspect” fraud, intentional misconduct, or abusive billing.


Wednesday, August 22, 2012

Amended Regulations to the Patient Protection and Affordable Care Act

Effective August 22, 2012, the Office of Medicaid Inspector General (“OMIG”) amended its regulations (Sections 518.7 and 518.9 of Title 18) to implement sections of the Patient Protection and Affordable Care Act (“ACA”), to require the state to withhold payments to medical assistance (Medicaid) program providers after the agency determines or is notified that a “credible allegation” of fraud exists involving the provider and for which there is a pending investigation. In both instances, untested and unproven allegations of fraud are enough to justify the withholding of payment for services rendered, and the burden is effectively shifted to the physician or provider to rebut these allegations in order to put a freeze to the ongoing recoupment efforts – all while the underlying investigation remains underway.  Since fraud is certainly in the eye of the beholder in these types of circumstances, a certain amount of discretion exists to further complicate this financially disruptive situation.


Wednesday, August 1, 2012

DEA ADMINISTRATIVE INSPECTIONS - CONSENT OR NOT CONSENT?


Your Office Manager comes into your office and tells you there are two DEA agents in the waiting area who want to inspect your office and ask you some questions. You go out to meet them, they briefly present official credentials and tell you they wish to conduct an audit or administrative inspection. You inform them that you have patient hours that day and ask them what gives them the right to come in and disrupt your practice without warning. They answer that since you have a DEA Registration they have a right to inspect and “today is your lucky day.” They then hand you a form that states if they uncover any evidence of criminality during the “administrative inspection” it can be used against you in a criminal prosecution.
Read more . . .


Friday, June 15, 2012

Centers for Medicare and Medicaid Services (“CMS”) Update

On June 15, 2012, the Centers for Medicare and Medicaid Services (“CMS”) issued an update regarding Regulation 42 C.F.R. 482.12, which effective July 16, 2012, requires participating Hospitals to have one or more members of the medical staff as a member of the Hospital’s governing body.  CMS received a number of comments against the proposed regulation, including from the American Hospital Association (AHA). In particular, the AHA argued that in some states there are laws which would conflict with this provision on the appointment or election of such governing bodies.  On the other hand the American Medical Association (AMA) has publicly supported this regulation and urges CMS to go forward with the rule.  In the June 15 notice, CMS stated that due to the comments from organizations like the AHA, CMS would review and reconsider this requirement in their future rule making.  CMS furthermore instructed the three CMS-approved accreditation organizations, the American Osteopathic Association, Det Norske Veritas Healthcare, and the Joint Commission, not to amend their accreditation standards related to this rule on the makeup of a Hospital’s governing body until CMS has completely addressed the issue.


Friday, June 1, 2012

PAYMENT DISCLOSURES UNDER THE SUNSHINE LAW: IS THE FORECAST CLOUDY?


Section 6002 of the Patient Protection and Affordable Care Act (PPACA), pursuant to a provision referred to as the “Sunshine Law”, requires certain manufacturers (“applicable manufacturers”) of drugs, devices, biologicals, or medical devices covered under Medicare, Medicaid or the Children’s Health Insurance Program (“CHIP”) to report annually certain payments or other transfers of value to physicians and teaching hospitals (referred to in the statute as “covered recipients”) during the course of the preceding calendar year. Applicable manufacturers must report the required payment and other transfer of value information to the Center for Medicare and Medicaid Services (CMS) to an electronic format by March 31, 2013, and on the 90th day of each calendar year thereafter. Applicable Manufacturers are subject to civil monetary penalties for failing to comply with the reporting requirements. CMS is required by the statute to publish the reported data on a public website. The data must be downloadable, searchable and easily aggregated.
Read more . . .


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