June 2007

The Office of Inspector General (OIG) has issued advisory opinion number 07-05 concluding that a proposal by a group of physicians owning an ambulatory surgery center to sell 40% of the ambulatory surgery center to a hospital has the potential to generate unlawful remuneration and is therefore not eligible for a safe harbor advisory opinion. The…

Following is the text of a post from Alan Goldberg  identifying the CMS hospital report card. My thanks to Alan.

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The Illinois Attorney General has filed price fixing charges against the two largest physician groups in Champaign County, Illinois, charging them with boycotting Medicaid patients in order to raise prices. Carle Clinic Associates, P.C. has 300 physicians, 200 of which are in Champaign County, Illinois, representing a 60% market share. Christie Clinic, P.C. has 100 physicians, all…

The Oklahoma Supreme Court has decided  the Oklahoma Peer Review statute (Professional Review Bodies – Protection From Liability Act) does not provide blanket immunity to peer review bodies in Oklahoma. The statute is only a defense to liability if the peer review body meets all of the requirements of the Act. In Smith v. Deaconess Hospital…

KEY FACTS: PHYSICIAN QUALITY REPORTING INITIATIVE (PQRI)

PQRI is a precursor to Medicare pay for performance (P4P) or quality incentives established by the Tax Relief and Healthcare Act of 2006 (TRHCA). The first quality reporting period will be July 1, 2007 through December 31, 2007.

Payment Amount: Congress budgeted $1.35 billion but the payment amount per provider…

Dr. John C. Perry and his practice, Teddy Bear Obstetrics & Gynecology, P.S., sued Kadlec Medical Center (which you may recall is the hospital that obtained a negligent credentialing judgment against Lakeview Medical Center in Louisiana for failing to provide credentialing information) and several members of the medical staff alleging that his credentials at Kadlec…

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