Michael Cassidy

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In a recent decision that has been making headlines across the country, a Pennsylvania federal court held that a local Cambria County company conducted over 300 unlawful pre-offer medical exams in violation of the ADA.  Cambria Care Center (“CCC”) had purchased the former Cambria County owned nursing home and engaged Grane Healthcare (a separate, but…

March 31, 2014 – Special Alert:

 

Senate approves House-passed SGR patch
Today, by a vote of 64-35, the Senate agreed to legislation passed by the House of Representatives, H.R. 4302, which delays for one year a 24% cut to Medicare physician payments resulting from the sustainable growth rate (SGR) formula. The legislation is expected to

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March 27, 2014 – Special Alert

 

House passes one-year SGR patch 
Today the House of Representatives passed by voice vote H.R. 4302, which would temporarily delay the 24% cut to Medicare physician payments resulting from the sustainable growth rate (SGR) formula for one year. MGMA has joined with physician organizations in Washington to continue

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Practical considerations to protect against being ‘out of network’

The disengagement of Highmark and UPMC is looming on the horizon; most of the hospital participation agreements between these two competing healthcare systems end on December 31, 2014.  There are some hospital agreements that continue, such as those at Children’s and Magee, but the focus of…

Despite the many cases acknowledging the right of hospitals to enter into exclusive contracts, there is always the issue of what happens with the existing clinical privileges and medical staff memberships of the physicians who are being replaced, assuming they are not the physicians receiving the exclusive contract.  Defenders of physician rights have typically argued …

Attorneys routinely advise clients conducting audits and investigations that the audit or investigation should be conducted by outside counsel in order to establish attorney client privilege. 

One of the problems with the OIG Self Disclosure protocol is that it requires the waiver of attorney client privilege.  Now a federal district court has decided that audits …

In Fahlen v. Sutter Central Valley Hospitals, the California Supreme Court found:

  1. A physician is not required to first exhaust his administrative remedies through the medical staff appeals process in order to challenge sham peer review as whistleblower retaliation; and
  2. Dr. Fahlen qualified as a whistleblower for purposes of the California Whistleblower Act.

The…

The 2014 OIG Work Plan includes the following:

Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home residents during stays not paid under Part A (for example, stays during which benefits are exhausted or the 3-day prior-inpatient-stay requirement is not

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