2006

The U.S. District Court from the District of Columbia ruled on March 7, 2006 that the Renal Physicians Association (RPA), a national non-profit specialty society of dialysis facility medical directors, lacked standing to challenge the Stark regulations regarding fair market value compensation.
Continue Reading Renal Physicians Association Lacks Standing To Challenge Stark Regulations

We have noticed significantly increased post-payment review audit activities on behalf of Highmark and HGSAdministrators, the Medicare side of Highmark.

When records are requested, it is critical that you do not respond cavalierly. The records you initially supply will be used to determine whether you will be subject to a refund request and further review.

If you have not been involved in this type of audit activity before, you should experienced counsel to assist you with your response. The potential for extrapolated refund requests is a serious threat.
Continue Reading Medicare And Highmark Audit Activities

Robert Wood Johnson Foundation has completed “The Synthesis Project,” which is a project summarizing certain research on hospital consolidation over the last decade. Although the report qualifies its conclusion, the Synthesis Project suggests that hospital mergers increase prices, decrease quality and were only anecdotally related to the increase in managed care. The report is available…

ARKANSAS SUPREME COURT RULES ECONOMIC CREDENTIALING POLICIES COULD VIOLATE FRAUD AND ABUSE RULES IN BAPTIST HEALTH CASE

The Arkansas Supreme Court affirmed a state appellate court ruling issuing a temporary injunction prohibiting Baptist Health, enjoining the hospital from enforcing its economic credentialing policies. The basis of this injunction is that the Baptist Health economic credentialing policy, which would prohibit physicians from owning financial interest in competitive facilities from maintaining Medical Staff membership and clinical privileges at Baptist Health, is the following;
Continue Reading ECONOMIC CREDENTIALING POLICIES COULD VIOLATE FRAUD AND ABUSE RULES

The American Medical Association has signed pact with Congress “agreeing” as follows:

*The parties will develop a total of 140 quality measures covering 34 clinical areas.

*Doctors will voluntarily report on at least 3 to 5 quality measures per physician by 2007.

*Doctors should receive additional reimbursement to cover administrative costs.
Continue Reading AMA AND CONGRESS SIGN P4P AGREEMENT

AMBULATORY SURGERY CENTER, GAIN SHARING DEMONSTRATION PROJECTS, THERAPY SERVICE, AND SPECIALTY HOSPITAL REFERRAL PROHIBITIONS

As reported last week, the House of Representatives has passed the Deficit Reduction Act of 2005 (DRA 2005), which is expected to be signed by President Bush in the very near future. When ultimately passed, we will provide a more detailed explanation of the critical issues, but the following are additional reimbursement issues impacted by DRA 2005:
Continue Reading MORE DRA 2005 REIMBURSEMENT NEWS

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Tucker Arensberg’s Healthcare Practice Group includes some of the most experienced health law attorneys in the region. We handle the legal problems so our clients can handle the important work of caring for patients. We work with physicians, physical therapists, dentists, optometrists, and all other professional care givers to help them avoid the many legal traps of running a practice. Tucker Arensberg lawyers have experience in all major health law issues.