In my experience, most physician groups rely on the “in-office ancillary service” exception to the Stark Law when determining how to allocate revenues from designated health services among group members. The Stark Law is, of...more
Congress has activated a new Anti-Kickback law known as Eliminating Kickbacks in Recovery Act of 2018 (commonly referred to as EKRA). The new Anti-Kickback law applies to arrangements involving recovery homes, clinical...more
6/14/2019
/ Anti-Kickback Statute ,
Clinical Laboratories ,
Criminal Prosecution ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Reform ,
Opioid ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Safe Harbors ,
Substance Abuse
Well, it’s a start. New Medicare rules kicked in starting January 1, 2019 that are aimed at focusing less provider time on paperwork and more on patient care in inpatient rehabilitation facilities. Any change that reduces...more
At a recent Health Care Compliance Association (HCCA) compliance institute, the Office of Inspector General announced it had launched a new resource portal focused on compliance issues. A trip to the OIG's web site, and sure...more
Medical practices that routinely use laser technology are subject to some of the same legal issues as other types of practices. Use of lasers creates additional compliance issues and highlights certain compliance risk areas....more
4/10/2017
/ 60-Day Rule ,
Compliance ,
False Claims Act (FCA) ,
Fraud ,
Fraud and Abuse ,
Healthcare Fraud ,
HIPAA Audits ,
Medicare ,
Physicians ,
Risk Assessment ,
Risk Mitigation ,
Telehealth
The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical...more
4/7/2017
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Corrections ,
Medical Devices ,
Pharmaceutical Industry ,
Physician Payments ,
Physicians ,
Prescription Drugs ,
Social Security Act ,
Sunshine Act ,
Teaching Hospitals
Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more
I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians. This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group....more
In today’s environment of complex regulations, aggressive prosecution, exorbitant penalties, and hungry whistleblower attorneys, it is necessary for medical practices to maintain effective compliance programs. Failure to do...more
Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedures in the surgery center as others. Under performing physicians can create political issues...more
Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more
How Fraud and Abuse Cases Arise in a Medical Practice -
It is no secret many doctors work very long days. Some days are worse and some are better than others. As a compliance lawyer, my job is to attempt to prevent...more
On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS...more
11/3/2016
/ Binding Arbitration ,
Centers for Medicare & Medicaid Services (CMS) ,
Elder Abuse ,
Long Term Care Facilities ,
Medicaid ,
Medicare ,
Nursing Homes ,
Physicians ,
Prescription Drugs ,
Quality of Care Standards ,
Training Requirements ,
Video Recordings