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Showing 60 posts in Physicians.

New Physician Assistant Statute Requires Practice Agreements by March 22, 2017

Under the new statute, a PA cannot engage in practice as a physician assistant unless a practice agreement is in place.Significant changes to practice by physician assistants in Michigan will take effect on March 22, 2017. Any physicians (medical, osteopathic and podiatric), health facilities, and health agencies that work with PAs should take the steps needed to ensure compliance with the requirement by the effective date. Read More ›

Categories: Physicians

DOJ Starts Cracking Down on Individual Health Care Executives for False Claims Act and Stark Law Violations Committed by Their Companies

Healthcare executives and physicians take note: The Department of Justice is now cracking down on individuals, and not just companies, for False Claims Act, Stark law, and anti-kickback statute violations. Read More ›

Categories: Hospitals, Medicare/Medicaid, News & Events, Physicians

CMS Issues Proposed Provider-Based Status Rules

On July 6, 2016, the Centers for Medicare & Medicaid Services ("CMS") released the 2017 Outpatient Prospective Payment System ("OPPS") Proposed Rule (the "Proposed Rule"). The Proposed Rule explains how CMS plans to implement Section 603 of the Bipartisan Budget Act of 2015 ("Section 603"), which established a new site neutral payment policy for certain off-campus hospital outpatient departments.

Section 603 provides that, as of January 1, 2017, certain items and services provided by off-campus hospital outpatient departments will no longer be reimbursed under the more favorable OPPS, and will instead be paid under another "applicable payment system." Read More ›

Categories: Billing/Payment, Medicare/Medicaid, News & Events, Physicians, Providers

Is Losing Money by Employing Physicians a Stark Violation?

losing money by employing physiciansModern Health Care has reported that hospitals often lose approximately $176,000 a year per each employed physician.

While this initially seems like a surprising statistic, it is understandable that hospitals lose money when they employ physicians. Physicians in private practice often pay their staff less than comparable hospital employees. When a hospital buys a physician’s practice, the benefit costs typically increase if the staff receives the hospital’s fringe benefit package. Moreover, hospital overhead is typically higher than a private physician practice with regard to HR costs and other support services.

Many systems claim that the only way to manage the health of a given population (which is what ACO and other similar payment structures are requiring) is to be fully integrated with employed physicians, so covering the losses incurred by employing physicians is the necessary cost of preparing for the new paradigm. The ugly, and legally problematic, truth is that most health systems look beyond the income generated by physicians for treating patients but also at income from physician ancillary referrals to justify the economic losses caused by acquiring physician practices. This raises concerns under the Stark law. Read More ›

Categories: Billing/Payment, Compliance, Hospitals, Medicare/Medicaid, Physicians

Department of Justice Enters Into Record-Breaking Stark Law Settlement

The U.S. Department of Justice (DOJ), and a handful of states, recently reached a settlement agreement with Adventist Health System (Adventist), resolving Stark Law issues, as well as allegations in two separate qui tam actions that included false claims. Generally speaking, the Stark Law limits physician referrals of designated health services or “DHS” for Medicare and Medicaid patients in instances where the physician - or an immediate family member of the physician - has a financial relationship with the DHS entity.  Read More ›

Categories: Billing/Payment, Medicare/Medicaid, News & Events, Physicians

Virginia Man Wins $500,000 After Recording Surgical Team’s Insulting Comments

healthcare lawsuitTalk about adding insult to injury. A Virginia man woke up after his colonoscopy to learn that the surgical team had mocked, belittled and insulted him throughout the procedure.

Fearful that he would not remember the doctor’s post-op instructions, the man pressed record on his smartphone before receiving anesthesia. Upon listening to the recording after the procedure, he realized that the members of the surgical team began their rant as soon as he drifted off to sleep. Read More ›

Categories: Hospitals, News & Events, Physicians

Tuomey Health Loses Appeal, Facing $237 Million in Fees and Damages

A very long legal battle may be nearing its final chapter after the U.S. Court of Appeals for the Fourth Circuit upheld a $237 million judgment against Tuomey Healthcare System in South Carolina. The judgment is an enormous sum for the regional health system and hospital, with even one of the Court of Appeals judges calling it a "death sentence." A three-judge panel heard the case at the Court of Appeals, so Tuomey could still seek reconsideration from all the judges of that Court or take the case to the U.S. Supreme Court. It may also opt to find a new partnership to keep the hospital afloat. Read More ›

Categories: Compliance, News & Events, Physicians, Providers

Health Care Trends

health care trendsRural hospitals across the United States struggling to stay open

According to the National Rural Health Association, approximately 50 hospitals in the rural United States have closed since 2010. The number of annual closures is growing. Congressional healthcare budget cuts and policy changes significantly affect rural hospitals because rural hospitals often have a disproportionate number of patients who are covered under Medicare, Medicaid or who are uninsured. A number of factors affect and pose challenges to rural hospitals. One challenge is the difficulty of attracting talent, which often means paying more to healthcare professionals in order to recruit them for employment at a rural hospital.  Other challenges facing rural hospitals include:

  • changing demographics;
  • advances in medical practice that the hospital may be unable to implement;
  • new federal regulations and standards that create additional compliance related pressure; and
  • lower reimbursement rates for Medicare and Medicaid.

Closures of rural hospitals may force individuals to travel long distances for medical care, which may lead to an increase in mortality rates. The closures may discourage business ventures in rural areas due to the increased costs associated with not having a healthcare facility nearby. Metropolitan hospital closings have increased recently, but the existence of medical care alternatives in metropolitan areas typically reduces the effects that closures have on patients.  Read More ›

Categories: Health Care Reform, Hospitals, Insurance, News & Events, Physicians, Tax

The Updated April 2015 National Practitioner Data Bank Guidebook has been Released

The DHHS Health Resources and Services Administration (“HRSA”) has finally published the new National Practitioner Data Bank (“NPDB”) Guidebook.  The original Guidebook had not been updated since September 2001. 

The updated April 2015 NPDB Guidebook is available here.

The new Guidebook extensively covers the changes resulting from the 2013 merger of the NPDB and the Healthcare Integrity and Protection Data Bank (“HIPDB”).  The HIPDB was a separate data bank that received and disclosed reports of final adverse actions by federal and state agencies and health plans against practitioners, entities, providers, and suppliers.  After the merger, there were significant changes in the entities eligible to query and report, as well as the individuals and entities subject to reports.  Read More ›

Categories: Criminal, Hospitals, Licensing, News & Events, Physicians, Providers

Recap from the 2015 Health Law Institute

Recap from the 2015 Health Law InstituteFoster Swift health care attorneys recently attended and presented at the 21st Annual Health Law Institute on March 12 and 13, 2015. The two-day institute, which was co-sponsored by the Institute for Continuing Legal Education and the Health Care Law Section of the State Bar of Michigan, included presentations on recent statutory, regulatory, and case law developments in the health care industry.

Foster Swift Attorney Jennifer Van Regenmorter co-presented the “Michigan Health Law Update,” which provided an overview of Michigan’s most significant health law developments from the past year. This was Van Regenmorter’s third time presenting this yearly update at the Institute. Read More ›

Categories: Fraud & Abuse, HIPAA, News & Events, Physicians