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 […]

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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 […]

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AG Settlement with Aspen Dental, Inc.

AG Settlement with Aspen Dental May Have a Significant Impact on Other Management Services Arrangements 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 […]

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StatLaw – September 2015

Federal Appeals Court Rules on Antitrust Issues in Hospital Medical Staff Case: In an opinion issued on August 20, 2015, the United States Court of Appeals for the Third Circuit ruled, in Novak v. Somerset Hospital, that a physician who brought an antitrust case against Somerset Hospital in Somerset, Pennsylvania, the hospital’s CEO and two […]

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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 […]

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StatLaw – August 2015

CMS’ National Fraud Prevention Program Authorizes Unannounced Site Visits for Medicare Part A/B providers and suppliers: In 2011, CMS implemented a site visit verification program using a National Site Visit Contractor (NSVC). The site visit verification program is a screening mechanism to prevent questionable providers and suppliers from enrolling or maintaining enrollment in the Medicare […]

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OPMC Reporter – Summer 2015

Doc Skips TownVolume 4, Issue 3 PHYSICIAN FOUND GUILTY OF ABANDONMENT AND NEGLECT OF MULTIPLE PATIENTS A physician recently received an indefinite license suspension for a period of no less than twelve months, after which the physician may petition for a modification order staying the suspension. The physician was found to have abruptly stopped seeing patients […]

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StatLaw – July 2015

Congressional Hearing Highly Critical of CMS over Medicare Fraud and Opioid Abuse: At a recent Congressional Hearing, CMS was slammed for its failure to implement “commonsense recommendations.” Rep. Tim Murphy (R-Pa.), chair of the House Energy and Commerce Subcommittee on Oversight and Investigations, further alleged that CMS’ failure to implement such measures “has led to […]

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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 […]

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StatLaw – June 2015

OIG Issues Fraud Alert Concerning Physician Contracts that Violate the Anti-Kickback Statute: The Department of Health and Human Services’ Office of Inspector General recently issued a fraud alert on the heels of a dozen recent settlements involving physician contracts. The alert likely indicates that the OIG is increasingly pursuing allegations against individual doctors, not just […]

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StatLaw – May 2015

The Office of the National Coordinator for Health Information Technology (ONC) Releases Version 2.0 of its Guide to Privacy and Security of Electronic Health Information: The ONC’s updated Guide provides valuable information and offers practical scenarios that help explain, among other things, when a business associate (BA) relationship forms. The Guide offers suggested questions health […]

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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 Professionals1 who attest to meeting certain Medicare meaningful use requirements2 (“Meaningful Use”). In order to receive the payments, Eligible Professionals must attest to achievement of “meaningful use” of their EHR […]

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OPMC Reporter – Spring 2015

Doctor DeathVolume 4, Issue 2 CONVICTION OF MANSLAUGHTER; RECKLESS ENDANGERMENT; CRIMINAL SALE OF A PRESCRIPTION FOR A CONTROLLED SUBSTANCE; SCHEME TO DEFRAUD; FALSIFYING BUSINESS RECORDS AND OFFERING A FALSE DOCUMENT FOR FILING License surrender. The physician did not contest the charge of having been convicted in the New York State Supreme Court, New York County of […]

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StatLaw – April 2015

Open Payments Physician Review and Dispute Period Began on April 6 and will last for 45 days: As part of the Open Payments program (“Sunshine Law”) physicians and teaching hospitals can review payments attributed to them beginning on April 6, 2015. Drug and medical device makers (“Applicable Manufacturers”) are required to report certain payments made […]

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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 […]

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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 […]

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