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UPMC/Washington Health System Merger Agreement Limits Non-Competes

The Press has announced that the Merger Agreement between UPMC and Washington Health System was approved by the Pennsylvania Attorney General with certain conditions, one of which was that UPMC would honor existing employment contracts and not impose restrictive covenants or non-compete agreements more restrictive than those that currently exist. We will be researching that … Continue Reading

U.S. Department of Justice (DOJ) Provides Corporate Fraud Enforcement Update

During the American Bar Association’s 39th National Institute on White Collar Crime, the most senior executives of the DOJ (Attorney General Merrick B. Garland and Deputy Attorney General Lisa Monaco) delivered remarks promoting the success of DOJ compliance and enforcement by: Here are links to the remarks of Attorney General Garland and Deputy Attorney General … Continue Reading

Change Healthcare Cyberattack Disrupts Physician Payments

“On February 21, 2024, Change Healthcare, a subsidiary of UnitedHealth Group was the victim of the most significant cyberattack on the US healthcare system in American history.  Change Healthcare is the predominant source of more than 100 critical functions that keep the healthcare system operating.” –American Hospital Association Letter March 4, 2024 This hack was … Continue Reading

Penn State Health Agrees To Pay Over $11 Million Due To Violations Of Medicare Rules & Regulations

Penn State Health has agreed to pay $11,712,336 to settle allegations of civil liability from submitting improper claims to Medicare for Annual Wellness Visit services. DOJ Press Release Link Penn State Health has voluntarily disclosed that between December 2015 and November 2022 claims were submitted to Medicare for Annual Wellness Visit services that were not … Continue Reading

False Claims Act (FCA) Liability for Physician Compensation Exceeding Fair Market Value (FMV)

When negotiating physician compensation issues, hospitals frequently rely upon the premise they must pay fair market value compensation in order to comply with the provisions of the Stark Act prohibiting referrals in exchange for compensation, and sometimes non-profit inurement issues. Although the prohibitions are clear, determining what constitutes fair market value is often not.  Provisions … Continue Reading

Biden Administration to Appeal Surprise Billing Defeat

As reported earlier in the MedLaw Blog (August 9, 2023), a federal District Court vacated portions of the No Surprises Act federal regulations.  Thereafter, CMS halted the arbitration process for resolving disputes regarding out-of-network surprise bills. On October 20, 2023, HHS, Treasury, and the US Office Personnel Management submitted a notice indicating their attempt to … Continue Reading

FTC Sues Anesthesiology Provider and PE Firm Over Anticompetitive “Roll Up” Scheme

As Mike Cassidy and Adam Appleberry discussed during their presentation at PBI’s A Day in Health Law earlier this month, private equity’s involvement in healthcare will be an interesting item to watch over the next few years. Just last week, the FTC sued the U.S. Anesthesia Partners, Inc. and their private equity backer Welsh, Carson, … Continue Reading

Allegheny County Medical Society Bulleting Article on Contracting Essentials for all Physicians, Especially Residents and Fellows

Michael A. Cassidy and Adam J. Appleberry co-wrote an article titled “Contracting Essentials for All Physicians, Especially Residents and Fellows”. This article will appear in the Legal Summary section of the August 2023 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania … Continue Reading

CMS Halts “No Surprises Act” Arbitration

CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows: UNPLANNED OUTAGE “On August 3, 2023, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. v. United States Department of Health … Continue Reading

Private Equity: Investigation and Enforcement

Since the private equity issue was last addressed in the Bulletin in the Summer of 2022, the volume of healthcare private equity deals has subsided somewhat, according to statistics presented at the March 2023 Pennsylvania Bar Institute Health Law Conference, and that has generally been attributed to unfavorable market conditions affecting investments of all types.  … Continue Reading

FTC Proposes a Rule to Prohibit Non-Compete Agreements

On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved, takes sweeping action to prohibit employers from entering into non-compete agreements with both employees and independent contractors. And the proposed … Continue Reading

Medicare Physician Fee Schedule Reductions Partially Offset

The final “2023 Omnibus Bill” which is the spending bill passed by Congress and signed by President Biden at the end of 2022, provides partial relief from the scheduled Medicare Physician Fee Schedule Conversion Factor cuts. As previously reported, the changes to the Medicare Physician Schedule Conversion Factor would have reduced physician reimbursement by 4.5%. … Continue Reading

Reforming Prior Authorization Process: Federal and Pennsylvania

Both the federal government and the Pennsylvania state government are taking steps to reform the prior authorization process.  Take a look at the Pennsylvania Insurance Department press release that was issued November 3, 2022, touting the passage and signing of Pennsylvania Act 146, which is described as creating a new and more effective process for prior authorization … Continue Reading

Telemedicine Special Fraud Alert

The US Office of Inspector General (OIG) released another in a series of Special Fraud Alerts on July 20, 2022, this one directed to potentially fraudulent telehealth, telemedicine, and telemarketing service fraud schemes, collectively referred to as “Telemedicine Companies”.  The alert is based upon OIG’s perception that these Telemedicine Companies are engaged in schemes to … Continue Reading

Mike Cassidy Published in the Allegheny County Medical Society’s Signature Publication

Mike Cassidy recently wrote an article entitled, “Private Equity Deals Offer Both Potential Significant Return and Significant Challenges” in the Legal Summary section of the July 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to … Continue Reading

Tucker Attorneys Jeremy Farrell and Rebecca Moran Published in the Allegheny County Medical Society’s Signature Publication

Jeremy Farrell and Rebecca Moran recently wrote an article entitled, “Pregnancy-Related Protections for New Physicians” in the Legal Summary section of the June 2022 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. Click here to read the article … Continue Reading
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