StatLaw – April 2016

CMS’ New Primary-Care Payment Model Projected to Affect 20,000 Physicians: The CMS’ new primary-care model seeks to reimburse practices with a monthly fee to manage care for as many as 25 million patients. This move marks the CMS’ largest plan to transform and improve how primary care is delivered and reimbursed across the nation. Titled […]

Continue reading…

Defending the “Impossible Day” Healthcare Fraud Prosecution

Defending the “Impossible Day” Healthcare Fraud Prosecution is featured within the April 2016 issue of the New Jersey State Bar Association (NJSBA) publication, New Jersey Lawyer. Mr. Giaquinto is a Partner with Kern Augustine, P.C., where he heads the firm’s white collar criminal law section. He focuses his practice on the defense of healthcare professionals […]

Continue reading…

StatLaw – March 2016

Physicians Question Whether CMS’ Part B Drug Proposal Plan Usurps Clinical Judgment, Cripples Specialists: Medicare’s overhaul of the way it reimburses doctors for more than $20 billion worth of outpatient drugs they administer each year has drawn criticism from physicians. Financially, although some physicians will receive higher payments, the current plan is economically disastrous to […]

Continue reading…

StatLaw – February 2016

District of Columbia Circuit Court Ruling Aims to Reduce RAC Appeals Backlog: After having its case dismissed by the trial court in December of 2014, the American Hospital Association’s (“AHA”) lawsuit seeking to force HHS to speed up RAC appeal decisions gained new life. The U.S. Court of Appeals for the District of Columbia Circuit reversed […]

Continue reading…

SBME Reporter – Winter 2016

OD M.D.? Volume 5, Issue 1 GROSS DEVIATION FROM STANDARD OF CARE AND INDISCRIMINATE PRESCRIBING RESULTS IN PERMANENT REVOCATION OF LICENSE The New Jersey State Board of Medical Examiners (“Board”) filed a Complaint alleging gross deviations from the standard of care by a physician in connection with his treatment of three New Jersey residents to […]

Continue reading…

StatLaw – January 2016

New York State Department of Health Announces Online Medical Marijuana System:  The New York State Department of Health (“DOH”) announced the launch of its online Medical Marijuana Patient Certification and Registration System. The online system allows qualified patients to enroll in the Medical Marijuana Program so they will be able to purchase medical marijuana when […]

Continue reading…

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 […]

Continue reading…

StatLaw – December 2015

Supreme Court to Rule on Theory Underlying False Claims Act Suits: The United States Supreme Court recently granted certiorari in the case of Universal Health Services v. United States ex rel. Escobar. The case before the court focuses on one theory whistle-blowers and the government use in bringing False Claims Act (“FCA”) cases to court […]

Continue reading…

OPMC Reporter – Fall 2015

Doc No More?Volume 4, Issue 4 Conviction of Murder and Tampering with Physical Evidence License Surrender. The physician admitted guilt to the charge of having been convicted in the County Court, Onondaga County, New York of Murder in the second degree and Tampering with Physical Evidence.  IN OTHER NEWS… Abusing Patients and Engaging In Conduct Which […]

Continue reading…

StatLaw – November 2015

CMS admits to underpaying dual-eligible health plans; issues with star ratings: The CMS recently released a highly technical document that, among other things, reveals it underpays health plans which enroll large numbers of people who are dually eligible for Medicare and Medicaid. To remedy that, the agency announced that it plans to modify its risk-adjustment […]

Continue reading…

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. The central allegation in all of the lawsuits is […]

Continue reading…

StatLaw – October 2015

Medicare Unveils $30 Million Phantom Ambulance Rides: A federal audit released earlier this month revealed the pervasive problem with payments for patient transport. Primarily, the audit found numerous Medicare ambulance rides for which no records existed that the patients received any medical care at the hospital or facility where the patient was transported to. The […]

Continue reading…

Understanding General Business Lease Agreements

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq. Email the Author Overview: When evaluating a business, the lease is often considered one of the most important assets as location is crucial to the success of a business, and the lease is often one of the largest expenses.  While a favorable lease can certainly increase […]

Continue reading…

Emergency Services and Surprise Bills

By: Mathew J. Levy, Esq.Email the Author In order to avoid patients receiving “surprise bills” from out-of-network providers and to help patients make informed decisions with respect to care, as of March 31, 2015, physicians and other healthcare professionals are now required to make certain disclosures to patients with respect to out-of-network providers (Public Health […]

Continue reading…

Understanding Physician Lease Agreements

By: Mathew J. Levy, Esq. & Stacey Lipitz Marder, Esq.Email the Author Overview: When evaluating a medical practice, the lease is often considered one of the most important assets as location is crucial to the success of a practice, and the lease is often one of the largest expenses.  While a favorable lease can certainly […]

Continue reading…