Since 1976, our litigators have effectively and efficiently represented clients in federal and state courts in business litigation, municipal law, employment law, personal injury and a variety of complex litigation.
Since 1976, our litigators have effectively and efficiently represented clients in federal and state courts in business litigation, municipal law, employment law, personal injury and a variety of complex litigation.
Since 1976, our litigators have effectively and efficiently represented clients in federal and state courts in business litigation, municipal law, employment law, personal injury and a variety of complex litigation.
As a part of the "American Recovery and Reinvestment Act of 2009" a civil penalty structure was put in place for Health Insurace Portability and Asccountability Act (HIPAA) violations.
Our experience uniquely qualifies us to advise in governmental issues: Annexation, Associations/Non-Profits, Cities, Towns, & Counties, Colleges & Universities, Economic Development, Elections and more.
We provide legal advice for businesses in the following areas: Agribusiness Energy, Diversified Businesses, Emerging Businesses, Federal & State Tax, Finance, and more.
Probate is the court procedure by which a decedent’s property is administered for the purpose of passing ownership of assets remaining in the decedent’s name at his/her death.
Since 1976, our litigators have effectively and efficiently represented clients in federal and state courts in business litigation, municipal law, employment law, personal injury and a variety of complex litigation.
CMS issued a proposed rule for next year reducing readmission payments and payments for hospital acquired conditions, but do not provide any change or relief to the ‘two-midnight’ rule. Generally, the rule increases payments for inpatient stays at acute care hospitals by 1.3% in FY 2015, and .8% for long term care hospitals. The readmission reduction rate changes from 2% to 3% for FY 2015, and a 1% reduction in Medicare inpatient payments that rank in the top 25% for preventable conditions.
HHS recently announced the release of “tools” to assist you in risk assessments as required under HIPAA and HITECH. The first “tool” is a security risk assessment for administrative safeguards. Printed out, the assessment is 185 pages. The other “tools” are not particularly compact either. I recommend, however, that you review these ‘tools’ to get a clear understanding of the depth and breadth of the risk assessments that HIPAA expects you to have already undertaken prior to audit.
Despite continuing enforcement pressures and publicity for HIPAA, some medical practices and hospitals fail to implement basic HIPAA security procedures. Recently AvMed, a Florida based insurer reported the theft of two unencrypted laptops with PHI affecting more than one million customers. As part of the settlement in this case, AvMed agrees:
FTC WATCHING HOSPITAL ACQUISITION OF PHYSICIAN PRACTICES
A recent Idaho Federal District Court Case, along with two prior litigation successes by the FTC, raise significant questions about hospital acquisitions of physician practices.
The recent decision of the Idaho Federal Court required the unwinding of the hospital’s acquisition of a physician owned group. This order was given despite the Court’s prior order in 2012, allowing the acquisition.
Many insurers have been rolling out “narrow networks”. We have previously reported on concerns that the networks were too narrow and cause significant displacements among policyholders seeking not only to maintain relationships with doctors, but also seeking any type of out of the ordinary services, treatment or prescriptions. HHS released new regulations on March 14th. While these regulations are still being analyzed in detail, it appears that these new regulations will require the following:
This week the United States Supreme Court opined that whistleblower protections apply not just to publicly traded companies, but also to subcontractors that do business with them. The Justices were interpreting part of the Sarbanes-Oxley Act of 2002 to reform Wall Street and set standards for all U.S. publicly traded companies, boards, managements and public accounting firms.
Changes in health provider relationships continue. The last year alone has dramatically changed provider relationships with insurance companies/payors. Our experience is that insurance company payors have stopped any pretense of negotiations, much less good faith negotiations, with providers over reimbursement rates. We see primarily that providers may take it or leave it, be in or out of network, but will have no opportunity to have intelligent discussions of fair reimbursement rates with their insurance company payors.
Medicare wants a new rule giving CMS the power to bar physicians and other providers who engage in abusive prescribing, CMS also wants to require all physicians prescribing Part D patients pharmaceuticals to have to enroll in Medicare, verifying their credentials, and disclosing professional discipline and criminal history. The proposal would take effect January 1, 2015.
In recent years we have been faced with at least a yearly crisis over Sustainable Growth Rate (SGR) mandated cuts in Medicare payments for doctors.
Physicians are normally paid on a fee for service basis as opposed to the bundled service model used for many other services provided under Medicare. Usually when a physician’s services are bundled, it is with a hospital based or ACO model. Therefore, the SGR formal based spending limits tend to have a higher impact on physicians.
HHS has long prohibited waivers of cost sharing amounts for recipients of Medicare or other federal healthcare programs. HHS has characterized such general waivers as violations of the anti kick back statutes (AKS). While the reasoning may or may not be valid, HHS’ position is longstanding.
Recently, a county fire department sought approval of waiver of co-pays or cost sharing for emergency ambulance services. OIG approved this. Truly, it is a no brainer given that there is an existing rule which specifically approves such arrangements.
Congratulations Paul Wallace of Jones • Wallace, LLC who received the Client Distinction Award! Paul Wallace has earned a Client Review Rating Score of 4.5 or higher on a scale of 1-5.
A new OIG Opinion posted November 12th indicates, once again, that cross ownership between two practices that provide services for each will almost automatically generate an objection to the arrangement based upon the anti-kickback and Stark laws.
Physician online ratings are becoming a fact of life. These websites usually offer the opportunity for anonymous or near anonymous posters to post their vision and opinion, whether accurate and fair or not, about a physician and their offices.
State and Federal laws may offer some limited protection against incorrect factual statements about a physician, but dealing with bad or inaccurate reviews remains a troublesome area.
For years insurers and other payors have generally opposed “any willing provider” laws. Any willing provider laws require hospitals, insurers and other payors to allow any provider willing to, in essence, match price and quality goals to participate in any health insurance plan.
In one of the more compelling, ironic events of recent history, insurers in Pennsylvania wish to require hospitals and hospital owned doctor practices to contract with any willing insurer.
