In a potentially striking blow to the Pennsylvania Medicaid (Medical Assistance)Third Party Liability (“TPL”) collection practices, the Honorable Joy Flowers Conti, Judge for the United States District Court for the Western District of Pennsylvania, issued a Memorandum Opinion dated March 25, 2009 in the Tristani v. Richman et al. proposed class action. PAWD Civil Action…

On May 1, 2009, health care providers will be subject to the "Red Flag Rules" issued by the Federal Trade Commission under the Fair and Accurate Credit Transactions Act. The Red Flag Rules apply to health care providers who allow patients to pay for health care services, for example through co-payments and deductibles, in installments.

The California Supreme Court vindicated Dr. Mileikowsky when it affirmed an appellate court decision setting aside the hospital’s governing board decision terminating Dr. Mileikowsky’s hearing and ordering the hospital to convene and conduct a new hearing in accordance with the medical staff bylaws. 

The basis of the dispute was a ruling and action by the…

Highmark has issued four new local coverage determinations, as follows:

  • Intraoperative Neurophysiological Testing
  • Sleep Disorders Testing
  • Posterior Tibial Nerve Stimulation (PTN)
  • Electromyography (EMG) and Nerve Conduction Studies

The following is the link of the full text of those LCDs: http://www.highmarkmedicareservices.com/policy/draft-status.html

On March 24, 2009, the OIG issued an open letter (pdf) to healthcare providers restricting the application of the OIG Self-Disclosure Protocol (SDP). 

The open letter states clearly that OIG is "narrowing the SDP’s scope regarding the physician’s self-referral law." This action has two components.

First, the OIG will accept providers into the SDP only when…

The 2009 Medicare Physician Fee Schedule made some changes regarding physician enrollment. The most significant change is the elimination of retroactive billing. Prior to the 2009 changes, Medicare permitted retroactive billing for up to 27 months following the effective date of a physician’s Medicare enrollment, to allow physicians to bill for services that they provided while the…

The Court of Appeals for the State of California has overruled a trial court decision holding a summary suspension was not a formal proceeding entitled to Anti-SLAPP protection. In Arunasalam v. St. Mary Medical Center, Dr. Arunasalam was summarily suspended for disruptive conduct and sought a Medical Staff Hearing, but the Medical Staff Hearing was…

In addition to the COBRA subsidy, the American Recovery and Reinvestment Act of 2009 (“ARRA”), enacted on February 17, 2009, made significant changes to HIPAA privacy and security obligations. Those changes affect covered entities, including group health plans, and also affect business associates.  Although most of the HIPAA changes are effective February 17, 2010, one change (regarding breach notifications) will become effective earlier.  A summary of the key provisions affecting group health plan covered entities and business associates is below.   

  • Requirement to Notify Individuals of HIPAA Breaches. The law changes now require covered entities to notify eachindividual whose unsecured protected health information (“PHI”) has been breached. For a breach of PHI under the control of a business associate, the business associate is required to notify the covered entity. Notice of the breach has to be provided to the Secretary of the US Department of Health and Human Services (“HHS”) and in the case of a mass breach involving more than 500 individuals, to a prominent media outlet.  Unsecured PHI means PHI that is not secured through the use of a technology or methodology specified by the Secretary of the US Department of Health and Human Services. 
    The Secretary of HHS is required to issue guidance about acceptable technology within 60 days of February 17, 2009. The law contains a default description of acceptable technology in the event that HHS does not timely issue guidance. The ARRA directs the HHS to issue regulations within 180 days of February 17, 2009. Then, the new notification requirements will apply to breaches discovered on or after the date that is 30 days after the date the regulations are published.
  • Additional Individual Rights. 

    – Accounting of Disclosures for Treatment, Payment and Health Care Operations.Under current law, individuals have the right to an accounting of disclosures of their PHI made in the previous six (6) years requiring covered entities to track the disclosures. There are certain exceptions to the accounting requirement such as disclosures that are made for treatment, payment, or health care operations. Now, a covered entity that uses or maintains an “electronic health record” with respect to PHI must account for disclosures for treatment, payment, and heath care operations. This accounting is limited to disclosures made in the previous three (3) years. HHS is required to promulgate regulations implementing this new requirement. 

There are two general effective dates: (1) with respect to electronic health records acquired by a covered entity on January 1, 2009, the effective date is January 1, 2014 and (2) with respect to electronic records acquired by a covered entity after January 1, 2009, the effective date is January 1, 2011 or, if later, the date the electronic record is acquired. 

–          Access to PHI in Electronic Form.  If a covered entity uses or maintains an electronic health record for PHI, the new law gives individuals the right to obtain a copy of the PHI in electronic format. The individual can also direct the covered entity to transmit an electronic copy directly to an entity or person designated by the individual. 
This requirement is effective as of February 17, 2010.   

–          Right to Restrict Disclosures for Payment & Health Care Operations. Under current law, individuals have the right to request that a covered entity not disclose their PHI for purposes of routine treatment, payment, or health care operations, although the covered entity is not required to agree to the restriction. Now, the covered entity must agree to the restriction for purposes of payment and health care operations (but not for purposes of treatment)  if the PHI pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full. This requirement is effective as of February 17, 2010.

Continue Reading HIPAA Changes Affecting Group Health Plans And Business Associates Made By The American Recovery And Reinvestment Act Of 2009

Today, the U.S. Department of Labor (“DOL”) issued model notices reflecting the recently enacted COBRA subsidy requirements and also issued updated FAQs on how the COBRA subsidy provisions are to work. View the model notices and FAQs. A summary of the different model notices (taken from the DOL’s descriptions) is below.

General Notice (Full version)…

Med Law Blog Editor

About Our Practice Group

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.