Compliance

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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…

The Commonwealth Court of Pennsylvania ruled on December 29, 2005 that a group of policyholders, subscribers, public interest groups and the City of Philadelphia did not have standing to challenge the Pennsylvania Insurance Department’s approval of reserves and surpluses for the State’s Blues plans, i.e., Capital Blue Cross, Highmark, Blue Cross of Northeastern Pennsylvania and Independence Blue Cross.
Continue Reading Pennsylvania “Blues” Win Challenge Regarding Allowable Reserves

The OSHA regulations applicable to the offices of medical professionals are aimed at creating a safe and healthy practice. Compliance creates a positive work environment and minimizes employee complaints. There are six OSHA general standards that apply to physician offices of all sizes and a seventh requirement that applies only to offices that offer X-ray services. We will discuss each in this article.
Continue Reading OSHA Requirements for Medical Professionals

The DHHS had issued guidance entitled “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons.” Several individual physicians and professional associations sought to enjoin the Guidance, but a federal district court ruled that the Guidance had not cause sufficient damage or injury nor threatened future…

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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.