Health Care and Life Sciences Law Blog

The Centers for Medicare and Medicaid Services (“CMS”) is increasing its efforts to transform Medicare from a fee-for-service payment system to a payment system that pays based on the value, quality, and outcome of the services provided.

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In a previous blog post, we highlighted the significant delays a practitioner must endure before the resolution of their appeal of a Medicare demand for overpayment. An apparent function of a huge backlog of such appeals, health care practitioners are routinely forced to wait many years before finally having their appeals heard by an Administrative Law Judge.» Read More

Pennsylvania legislators have announced their intention to introduce a series of anti-fraud measures this session, which includes a new state false claims act. Citing the impact of the federal False Claims Act, the proposal represents a bi-partisan effort to curb fraud, waste, and abuse in Commonwealth programs, including Medicaid.» Read More

The consolidation of health care practices and health systems continues to be a paramount theme underlying the industry. Spurred by hyper-regulation, overbearing pressure by commercial and government payors and the trend towards value-based reimbursement schemes, practitioners found that affiliating with larger entities able to coordinate care more efficiently provided them the stability required to optimally treat patients.» Read More

On July 29, 2019 Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule on modifications to the Stark Law advisory opinion regulations.  The proposed rule responds to comments CMS received in response to its July 25, 2018 Request for Information, seeking recommendations from the public on how CMS might address any undue impact and burden of the Stark Law.» Read More

Medical offices throughout the country are being targeted for the conversion of their data for illegal purposes. Most of what we hear about in the news concerns data breaches experienced by large corporations, involving information belonging to millions of individuals. Although these breaches affect many more people, they make privacy efforts of individual and group practitioners no less important.» Read More

The all-too-common experience of a patient refusing treatment or testing, or simply being non-compliant has become rampant. In order for practitioners to protect themselves, medical documentation must be more diligent than ever. Patient non-compliance can result in a multitude of negative ramifications to the practitioner.» Read More

Surveys reveal that the overwhelming majority of physicians have, at some point in their careers, received requests from family members for medical advice, diagnosis, or treatment.  Doing so creates a variety of risks to both the physician as well as the patient. » Read More

With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, business associates became directly liable for certain privacy and security requirements under the Health Insurance Portability and Accountability Act (HIPAA).  Business associates are those individuals or entities (other than employees) who perform functions or activities on behalf of, or provide certain services to, covered entities which require access to protected health information (PHI).» Read More

Considering the significant financial incentives and awards provided to whistleblowers, it should come as no surprise that there has been a marked increase in the number of health care fraud investigations commenced by federal and state agencies.  The New York State Medicaid Fraud Control Unit (“MFCU”) is one such agency and is increasingly worthy of the attention of health care practitioners who treat Medicaid patients in the state. » Read More