“These are my patients – how can you stop me from seeing them?” This is a familiar refrain heard when medical practices break up or physicians leave an ongoing practice. Almost everyone knows that nobody “owns” patients and that patients have absolute freedom of choice as to what doctors they choose to see (excluding health plan participation issues). However, the fact that patients may be free to see the physician of their choice does not necessarily mean that physician will be just as free to see them. This issue is not about patient ownership; it is an issue about restrictive covenants, ownership of medical records, privacy and confidentiality, and ownership of confidential intellectual property or trade secrets.
Continue Reading Whose Patients Are They Anyway?

The U.S. District Court from the District of Columbia ruled on March 7, 2006 that the Renal Physicians Association (RPA), a national non-profit specialty society of dialysis facility medical directors, lacked standing to challenge the Stark regulations regarding fair market value compensation.
Continue Reading Renal Physicians Association Lacks Standing To Challenge Stark Regulations

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

The Highmark Blue Shield Prior Authorization requirement for enumerated diagnostic imaging procedures will become effective April 1, 2006. The Prior Authorization Guide (Guide) is available on the Highmark Provider Resource Center Web site.
Continue Reading Highmark Prior Authorization Requirement For Diagnostic Imaging: April 1, 2006

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…

ARKANSAS SUPREME COURT RULES ECONOMIC CREDENTIALING POLICIES COULD VIOLATE FRAUD AND ABUSE RULES IN BAPTIST HEALTH CASE

The Arkansas Supreme Court affirmed a state appellate court ruling issuing a temporary injunction prohibiting Baptist Health, enjoining the hospital from enforcing its economic credentialing policies. The basis of this injunction is that the Baptist Health economic credentialing policy, which would prohibit physicians from owning financial interest in competitive facilities from maintaining Medical Staff membership and clinical privileges at Baptist Health, is the following;
Continue Reading ECONOMIC CREDENTIALING POLICIES COULD VIOLATE FRAUD AND ABUSE RULES

The American Medical Association has signed pact with Congress “agreeing” as follows:

*The parties will develop a total of 140 quality measures covering 34 clinical areas.

*Doctors will voluntarily report on at least 3 to 5 quality measures per physician by 2007.

*Doctors should receive additional reimbursement to cover administrative costs.
Continue Reading AMA AND CONGRESS SIGN P4P AGREEMENT

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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.