Med Law Blog : Pennsylvania Health Care Lawyers & Attorneys : Tucker Arensberg Law Firm : Employee Benefits, HIPAA & HIT in Pittsburgh, PA

On June 22, 2006, CMS announced proposed changes for the Medicare Physician Fee Schedule. The proposed changes will appear in the June 29, 2006 Federal Register. The proposed changes include a comprehensive review of the RVU work component for Evaluation and Management Codes, which is projected to increase Medicare expenditures by $4 billion, and a reevaluation of practice expense RVUs. The changes are intended to be phased in over 4 years. Additional details and links are available at the Veritus Web site. The Med Law Blog will provide greater analysis after the proposed is published.

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The District Court of Appeal of the State of Florida affirmed a lower state court holding that certain aspects of a restricted covenant were not enforceable. In Florida Hematology and Oncology v. Rambabu Tummala, M.D., the Practice had terminated Dr. Tummala allegedly after he began questioning certain billing practices. Although Dr. Tummala was subject to a restrictive covenant prohibiting competition for two years within fifteen (15) miles of any office of the Practice, Dr. Tummala immediately opened a competing practice within the proscribed area. The Practice sought an injunction forcing the restrictive covenant. 

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In a recent discovery order of The United States District Court, the Southern District of Texas confirms the relevance and discoverability of patient records in credentialing disputes involving comparative peer review, i.e., the peer review disputes where the penalties imposed one physician are dissimilar or unequal to those imposed on others. 

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FOR HIGH VOLUME PROCEDURES

In an effort to facilitate consumer directed healthcare, CMS has begun posting the payments that Medicare will make for certain high volume procedures. At this point, the approved Medicare Payments are included in the segment of the CMS website constructed to provide consumer information. Although informative, reports of the action express reservations regarding the usefulness for consumers because the information:

*Provides ranges for payments in large geographic locations;

*It does not provide hospital specific information; and

*It does not provide relative information regarding payments by private insurance carriers.

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Under Medicare Part D Regulations, employers who sponsor health plans must: (1) determine whether the plan's prescription drug coverage is equivalent to Medicare Part D ("Creditable"); (2) send notice of the status at least to Medicare-eligible participants and dependents' and; (3) must report the status to CMS. These reporting requirements help Medicare-eligible individuals decide whether to enroll in or to delay enrollment in Medicare Part D.

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