On December 23, 2005, CMS implemented a streamlined PVRP by reducing the number of quality indicators to be reported using G-Code indicators from the original 36 to a “core set” of 16 special quality indicators. The revision was described in a new MedLearn Matters Release (MM 4183) and was implemented as of January 3, 2006.
Continue Reading CMS Revises Physician Voluntary Reporting Program (PVRP)

Credentialing Developments: U.S. Supreme Court Refuses To Review Hearing Officer Authority Ruling; Ohio Court Of Appeals Allows Discovery Of Peer Review Records Under Prior Law

Hearing Officer Authority

In California, a Medical Staff Hearing Officer terminated a Medical Staff Hearing on the grounds the physician was “repeatedly disruptive, disdainful of the Hearing Officer’s authority, and flagrantly violated the rules pertaining to discovery and documentary exhibits.” This ruling allows the ruling by a California State Court that the termination did not violate the physician’s due process rights to stand. Meleikowsky v. Tenet Healthsystem, U.S. No. 05-638.
Continue Reading Credentialing Developments

AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006; CMS ADVISES DELAYED SUBMISSION TO EXPEDITE PLANNED “ZERO UPDATE”

CMS officials suggested that physicians intentionally delay submitting claims to await passage of the “zero update” feature of the proposed Deficit Reduction Act of 2005.
Continue Reading AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006

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

In Bocobo v. Radiology Consultants of South Jersey, et al, a federal district court granted summary judgment to the radiology group and hospital defendants on eleven counts including the denial of a medical staff hearing. The radiologist was employed by the radiology group and the exclusive contract between the hospital and the group provided that…

Medical Staff By-Laws, and the Hospital policies enacted by the Board pursuant to those By-Laws, constitute a contract between the Hospital…
Continue Reading Medical Staff Bylaws and Policies Are Contracts But No Due Process Rights Triggered by Exclusive Contract

For those who doubt the possibility of OIG enforcement regarding fraud and abuse violations, the OIG Semi-Annual Report lists the following enforcement results:

$2.8 billion on audit and investigative receivables;

3,806 individual and entity; receivables;

537 criminal actions; and

262 civil actions

The report is accessible on the OIG Web site.

Electronic Health Records (EHR) are touted by proponents within the healthcare industry as a means to both improve quality and reduce cost through a combination of reduced errors and improved communication. The drive to standardize the process for the utilization of electronic healthcare records gained its greatest impetus from the electronic transaction standards of HIPAA,…

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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.