While we are waiting for final disposition of the AKS Safe Harbors and Stark Exceptions proposed in October of 2019, since the comment period expired December 31, 2019 and final rules have not been issued, I thought we should reflect on the comments made and proposed regulations regarding physician compensation. Physicians have become accustomed to … Continue Reading
You can now tell that telemedicine is a mature industry, because it has achieved enough critical mass that the fraud has started and the OIG is beginning to prosecute. There is a lag time between when the cash flow and profit achieves sufficient critical mass to attract the criminals, the OIG identifies the problems, and … Continue Reading
Tucker Arensberg is pleased to be a gold sponsor of the 26th Annual Pennsylvania Bar Institute (PBI) Health Law Institute taking place from March 11–12, 2020 in Philadelphia, PA. Jerry J. Russo, Chair of the White Collar Criminal Defense Group and Kathleen A. Nandan, a former litigator with the U.S. Attorney’s Office in the Eastern District of New … Continue Reading
Click the link to view the 2020 Pennsylvania Medical Record Fees: https://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol49/49-49/1816.html# … Continue Reading
A bipartisan group of senators has introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019. A summary produced by that bipartisan group is attached. If enacted, the CONNECT for Health Act solutions would be as follows: Create a bridge program to help providers transition to the goals … Continue Reading
Click on the link to an article published in the New York Times (12/4, Abelson) reporting the American Hospital Association and other hospital groups filed a lawsuit against the Trump Administration “over a new federal rule that would require them to disclose the discounted prices they give insurers for all sorts of procedures.” The hospital groups … Continue Reading
Attached are links to the CMS Press Release and the Trump Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. The Trump Executive Order was first issued on June 21, 2019. The CMS Press Release indicates action on two rules. First, the “proposed” transparency and coverage rule would require … Continue Reading
As another part of the Regulatory Sprint to Coordinated Care, OIG proposed revisions to the existing EHR Anti-Kickback Safe Harbor and added a cybersecurity component. The initial EHR Safe Harbor was developed in response to President George W. Bush’s 2004 initiative to extend EHR nationwide within 10 years, i.e. 2014. The proponents of those EHR … Continue Reading
On November 7, 2019, the U.S. Department of Health and Human Services, Office for Civil Rights (“HHS”) announced a $1,600,000 civil money penalty for violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security and Breach Notification Rules. According to HHS, the Texas Health and Human Services Commission (TX HHSC) “operates state … Continue Reading
On October 22, 2019, CMS and OIG (Office of Inspector General) released new proposed rules regarding Stark Law Exceptions and Anti-Kickback Safe Harbors in response to what has universally been christened as the “Regulatory Sprint to Coordinated Care”, first announced by HHS in June of 2018. As background, please remember that, although the Anti-Kickback Safe … Continue Reading
The federal government/Trump administration announced today a delay regarding a proposed rule requiring hospitals to disclose actual negotiated price rates. See WSJ News. In January, 2019, as reported in the MedLaw Blog on January 10, 2019, CMS added a rule requiring hospitals to publish their standard charges beginning January 2019. As noted in that blog … Continue Reading
On October 23, 2019, the U.S. Department of Health and Human Services, Office for Civil Rights (“HHS”) announced a $2,154,000 civil money penalty for numerous violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security and Breach Notification Rules between 2013 and 2016. According to HHS, Jackson Health System (“JHS”) is a … Continue Reading
HHS has long admitted that the Anti-Kickback Statute (AKS) and the Stark law have not evolved to keep pace with the transition to value based care. In June of 2018, HHS issued an RFI seeking additional information and HHS also issued a release on December 12, 2018 seeking input on improving care coordination and reducing … Continue Reading
Click here to read Mike Cassidy’s article which was featured in the Legal Report section of the September 2019 edition of the Allegheny County Medical Society Bulletin.… Continue Reading
The Pennsylvania Commonwealth Court, on remand from the Pennsylvania Supreme Court, has again decided that the previously agreed termination date of the access provisions contained in the UPMC/Highmark Consent Decrees, i.e. June 30, 2019, is not a term subject to the modification provisions of those Consent Decrees, and is definite. The adjudication of the Commonwealth … Continue Reading
The Patient Test Result Information Act was effective December 23, 2018. The Act requires entities performing diagnostic imaging services, defined to include any medical imaging test intended to diagnose the presence or absence of a disease, to provide notice of the results to patients. The operative language states: “When, in the judgment of the entity … Continue Reading
Although there have been a number of issues raised by the Pennsylvania Attorney General in the UPMC/Highmark situation, including UPMC’s status as a charitable institution, the primary issue in the Attorney General’s lawsuit was a request to extend the June 30, 2019 termination date for the UPMC-Highmark Consent Decrees. The Commonwealth Court declined to extend … Continue Reading
Below is a summary of UPMC-Highmark dispute as of March 4, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012. May 1, 2012 – Parties enter into mediated agreement which states … Continue Reading
Below is a summary of UPMC-Highmark dispute as of February 22, 2019. This information is limited to litigation proceedings with no discussion about prior contracts or negotiations. March 2011 – UPMC announces it will not renew UPMC-Highmark contract due to expire December 31, 2012. May 1, 2012 – Parties enter into mediated agreement which states … Continue Reading
“Eliminating Kick-Backs and Recovery Act of 2018” (EKRA) is a part of a group of laws recently passed by Congress to expand the law enforcement spectrum available to fight the opioid epidemic. EKRA is part of approximately 70 separate actions referred to as the SUPPORT Act, i.e. Substance Use-Disorder Prevention that Promotes Opioid Recovery and … Continue Reading
A new Telemedicine Act is wending its way through the legislative process in Pennsylvania. Senate Bill 780 of 2017 (attached hereto as a PDF) has been unanimously passed by the Senate and referred to the House Professional Licensure Committee on June 19, 2018. Pennsylvania is one of the few states that does not have a … Continue Reading
Peer Review Confidentiality will become much more complicated with the addition of economic evaluation to physicians’ quality and efficiency. Physicians will be surprised to learn that many “reviews” to which they may currently be subject to could have “quality implications”, and they should be concerned if those reviews were available to other third parties instead … Continue Reading
The Pennsylvania Commonwealth Court, on remand from the Pennsylvania Supreme Court, has again decided that the previously agreed termination date of the access provisions contained in the UPMC/Highmark Consent Decrees, i.e. June 30, 2019, is not a term subject to the modification provisions of those Consent Decrees, and is definite. The adjudication of the Commonwealth … Continue Reading
