The Allegheny County Medical Society has reported that the Pennsylvania House of Representatives has passed a bill to bar non-compete agreements in healthcare employment....more
When negotiating physician compensation issues, hospitals frequently rely upon the premise they must pay fair market value compensation in order to comply with the provisions of the Stark Act prohibiting referrals in exchange...more
Since the private equity issue was last addressed in the Bulletin in the Summer of 2022, the volume of healthcare private equity deals has subsided somewhat, according to statistics presented at the March 2023 Pennsylvania...more
5/1/2023
/ Acquisitions ,
Centers for Medicare & Medicaid Services (CMS) ,
Congressional Investigations & Hearings ,
Corporate Practice of Medicine ,
Health Care Providers ,
Hospitals ,
Investment ,
Investors ,
Motor Vehicle Safety Whistleblower Program (MVSWP) ,
Private Equity ,
Private Equity Firms
On June 23, 2020, the United States District Court for the District of Columbia denied the American Hospital Association’s (AHA) summary judgment motion claiming the Trump Administration had exceeded its authority and...more
While we are waiting for final disposition of the AKS Safe Harbors and Stark Exceptions proposed in October of 2019, since the comment period expired December 31, 2019 and final rules have not been issued, I thought we should...more
3/6/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Department of Health and Human Services (HHS) ,
Exceptions ,
Fair Market Value ,
Hospitals ,
Medicare ,
Physicians ,
Proposed Rules ,
Safe Harbors ,
Stark Law
Attached are links to the CMS Press Release and the Trump Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.
The Trump Executive Order was first issued on June 21,...more
As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019.
CMS explained...more
Peer Review Confidentiality will become much more complicated with the addition of economic evaluation to physicians’ quality and efficiency. Physicians will be surprised to learn that many “reviews” to which they may...more
On January 11, 2018, CMS announced a new voluntary episode payment model (bundled payments for care improvement advanced–BPCI Advanced) that will test a new iteration of bundled payment for the following thirty-two (32)...more
In the January 11, 2018 issue of MLN Connects, CMS has now widely publicized that it issued billing guidance for major joint replacements (hip or knee) in May 2017 at ICN909065.
CMS reports that major joint replacement is...more
CMS released the proposed update for the Hospital Outpatient Perspective Payment System and the Ambulatory Surgery Center System on July 13, 2017, and the release has generated some unexpected controversy regarding the...more
Emanuele v. Medicor Associates, was presented to the United States District Court for the Western District of Pennsylvania as cross motions for summary judgment, and provides some guidance regarding the Stark requirements for...more
When physicians have finally completed the medical education journey, many are confronted with a “physician employment contract,” usually from a hospital or medical practice, which could define the essential terms of their...more
The ink was barely dry on the Medicare Physician Sustainable Growth Rate (SGR) fix, and it has already been changed.
One component of the SGR fix, which was just passed in April of this year, was freezing Medicare...more
The Pennsylvania Superior Court has decided the Pennsylvania Peer Review Protection Act does not apply to alleged peer review activity conducted by Blue Cross of Northeastern Pennsylvania, because Blue Cross is not a...more
In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. Over the next few days, I will post comment on what I consider the most significant new...more
In July 2015, CMS released proposals to provide several new Stark Law exceptions and to clarify issues regarding existing exceptions. Over the next few days, I will post comments on what I consider the most significant new...more
On June 9, 2015, the OIG issued a Fraud Alert entitled “Fraud Alert: Physician Compensation Arrangements May Result in Significant Liability”. This is just a one page letter warning hospitals and physicians by stating the...more
Cooper v. Pottstown Hospital is another case where a dissatisfied party is attempting to use the federal Anti-Kickback Statute or the Stark Law in litigation arising out of the contracts to which they were willing parties at...more
The ruling by Judge Ward of the Allegheny County Court of Common Pleas highlights another facet of the ongoing dispute between UPMC and Highmark.
On February 18, 2015, Judge Ward of the Allegheny County Court of Common...more
All states have some degree of confidentiality protection for peer review activities and the information generated by those activities, and there is additional federal protection for information gathered and created by...more
In Kates v. Doylestown Hospital, the Pennsylvania Superior Court, in a non-precedential decision, held back the Pennsylvania Peer Review Protection Act does not provide confidentiality protection for certain records....more
In United States ex rel. Martin et al. v. Life Care Centers of American, Inc., the Court held that the government could extrapolate from a random sample in order to impose False Claims Act (FCA) liability against Life Care...more
It should come as no surprise there are cases in which hospitals seek to and actually do recover income guarantee payments made to physicians whom, either through termination of employment or loss of hospital privileges, fail...more
A Hospital in Ohio tried to prevent access to a patient incident report on the basis of Peer Review Privilege. The Hospital claimed that, since the incident report was reviewed by the Hospital Peer Review Committee, the...more