Mike Cassidy was published in the December 2014 Allegheny County Medical Society Bulletin. You can review the article here on page 500.
Michael Cassidy
Washington State Court Recognizes Prospective Patient Relationships as Protected Contracts
By Michael Cassidy on
Posted in Credentialing and Peer Review
42 U.S.C. § 1981 prohibits discrimination affecting citizens rights to make contracts. In the credentialing field, § 1981 has been used to circumvent the immunities provided by the Health Care Quality Improvement Act (HCQIA) because HCQIA provides an express exception stating that it doesn’t apply to actions brought pursuant to Section 1981.
The premise is…
Pa. Dept. of Health Establishes Website ( stayinformed.pa.gov) for Highmark – UPMC Information
By Michael Cassidy on
Posted in Uncategorized
The Pa. Departments of Health and Insurance have established a website in an attempt to provide ongoing information and guidance regarding the termination of the Highmark – UPMC relationships.
see: Stayinformed.pa,gov
CMS Proposes Rules to Improve Accountable Care Organizations (ACOs)
By Michael Cassidy on
Posted in Medicare & Reimbursement
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule intended to make ACOs and Medicare Shared Savings Plans more practical and attractive to potential providers. The proposed rule was released on December 1, 2014, along with a CMS Fact Sheet.
Longer Lead Time to Develop
In order to provide more development…
Global Surgery and 2015 Medicare Physician Fee Schedule
By Michael Cassidy on
Posted in Medicare & Reimbursement
On July 21, 2014, I posted the proposed Medicare Physician Fee Schedule, and described the intent by CMS to eliminate global surgery.
On November 13, 2014, CMS issued the final 2015 Medicare Physician Fee Schedule, and CMS incorporated the changes regarding global surgery.
Global Surgery
There are three primary categories of global surgery…
Pennsylvania Workers Compensation Prescription Drug Reimbursement Restrictions
By Michael Cassidy on
Posted in Medicare & Reimbursement
On October 27, 2014, the Governor signed Pennsylvania General Assembly enacted House Bill 1846, which limits both the authority and the reimbursement of physicians and providers other than pharmacies for prescription drugs. It provides as follows:
- Physicians dispensing prescription drugs from their offices shall receive no more than 110% of the original average wholesale
…
District Court Approves Government’s Use of Sampling and Extrapolation to Prove False Claims Act Liability
By Michael Cassidy on
Posted in Compliance, Fraud - Stark
In United States ex rel. Martin et al. v. Life Care Centers of American, Inc., the Court held that the government could extrapolate from a random sample in order to impose False Claims Act (FCA) liability against Life Care Centers of American Inc. (Life Care) for a substantially larger universe of claims.
In order…
Mike Cassidy Included Again in America’s Best Healthcare Lawyers for 2015
By Michael Cassidy on
Posted in Uncategorized
Michael Cassidy Appointed as Counsel to the Allegheny County Medical Society
By Michael Cassidy on
Posted in Legal News
Michael Cassidy was recently appointed as counsel for the Allegheny County Medical Society (ACMS). More information can be found at the below link.
Pennsylvania Superior Court Rejects Peer Review Confidential for “Business Records”
By Michael Cassidy on
Posted in Credentialing and Peer Review
In Kates v. Doylestown Hospital, the Pennsylvania Superior Court, in a non-precedential decision, held back the Pennsylvania Peer Review Protection Act does not provide confidentiality protection for certain records, stating:
Peer review necessarily involves evaluating the quality of care provided by medical professionals or evaluating the qualifications of medical care providers. 0045cept for those
…