Category Archives: Physicians

2016 Hot Compliance Areas For Physician Practices

Physician practices should pay attention to the recent reports released by the Department of Justice (DOJ), OIG and other agencies regarding their enforcement actions in 2015 and priorities in 2016. These reports and recent settlements reveal hot compliance areas that physician practices should focus on in 2016.

The following are some of the hot compliance areas in 2016 for physician practices based on recent reports such as the DOJ Health Care Fraud and Abuse Control Program Annual Report for 2015 and settlements and other enforcement actions involving physicians. Continue reading

Final 2016 Medicare Physician Fee Schedule Released

CMS released on October 30th the final Medicare Physician Fee Schedule for 2016, which contains several payment changes related to physicians services, and a large section finalizing several changes and clarifications to the Stark Law. It will be in the November 16th Federal Register.

Written by: Clay J. Countryman

Clay Countryman_cropped

New OIG Fraud Alert Out on June 9, 2015 Cautions That Physician Compensation Arrangements May Result in Significant Liability

Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide. Although many compensation arrangements are legitimate, a compensation arrangement may violate the anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of Federal health care program business.”

http://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf

Written by: Traci Thompson

 

Clay J. Countryman and Alec Alexander to Present at 2015 Physicians Legal Issues Conference

Clay J. Countryman and Alec Alexander, partners in the firm’s Healthcare Group will give presentations at the Physicians Legal Issues Conference to be held June 10-12, 2015 at the Palmer House Hilton in Chicago, IL. The Physicians Legal Issues Conference is co-sponsored by the American Bar Association Health Law Section, Chicago Medical Society and the American Association for Physician Leadership®.  Mr. Countryman is Co-Chair of the conference and he will present as part of a panel on a session titled, “Community Clinics and Pharmacies: Opportunities for Physicians and Attorneys to Work Together” on June 11.  Mr. Alexander will be presenting on a panel for a session titled “Navigating the Perilous Waters of the False Claims Act From Medical Necessity to the Anti-Kickback Statute and Beyond” on June 11.

Alexander, Alec headshot     Countryman, Clay headshot
Alec Alexander                      Clay Countryman

 

Does a Hospital Have a Brady Obligation to Turn Over Exculpatory Evidence?

A recent decision by the United States Court of Appeals for the Tenth Circuit answered whether hospitals under state contract have Brady obligations. Established by the Supreme Court decision of Brady v. Maryland, a Brady obligation imposes on government agents the duty to turn over exculpatory evidence to a requesting criminal defendant.  373 U.S. 83, 83 S. Ct. 1194 (1963). In Tiscareno v. Frasier, the Tenth Circuit held that a hospital did not have an actionable Brady obligation because there was no clearly established constitutional obligation of the hospital to locate and disclose the exculpatory evidence to the criminal defendant. No. 13-4156, 2015 WL 735668, at *1 (10th Cir. Feb. 23, 2015). Continue reading

A Broader Definition of “Referral” for Anti-Kickback Violations

In U.S. v. Patel, whether a violation of the Anti-Kickback Statute was present depended on the United States Court of Appeals for the Seventh Circuit’s interpretation of the term “referring,” a term not specifically defined in the statute.  2015 WL 527549 (7th Cir. 2/10/15). The Seventh Circuit considered whether Dr. Kamal Patel had “referred” patients to a home health care provider in violation of the Anti-Kickback statute when Dr. Patel signed Form 485 certifications and recertifications for his patients, though did not recommend a specific home health care provider, in exchange for cash. Continue reading

Medical Malpractice Liability for Management Companies

When can a company that manages a hospital be liable for the medical malpractice of the institution and its physicians?  According to one recent New Mexico decision, when its agents knew of pattern of sub-standard conduct and didn’t act to address it.  The case involved one physician performing experimental surgery on over 100 patients over a period of years.  The decision allowing the claim against the manager was rendered in the hospital’s bankruptcy proceeding, which it filed in an attempt to survive the patients’ claims. Review this article on Insurance News Net for a more complete discussion.

Written by: Greg Frost

Frost Gregory headshot

 

The Intersection of HIPAA and Negligence: Pharmacist’s Violation Cost Walgreens $1.44 Million

On November 14, 2014, the Court of Appeals of Indiana affirmed a $1.44 million judgment against Walgreens Company based on a HIPAA violation committed by a Walgreens pharmacist. Walgreen Co. v. Hinchy, 2014 WL 6130795 at *1 (Ind. Ct. App. 2014). In Walgreen Co. v. Hinchy, Walgreens’ pharmacist Audra Withers looked up the prescription information of Walgreens’ customer Abigail Hinchy. Withers then used the prescription information of Hinchy for personal reasons, which allegedly included allowing Withers’ husband to use the private information to pressure Hinchy into not asking Withers’ husband for child support. Upon figuring out how Withers’ husband obtained the private information, Hinchy contacted Walgreens’ regional office to report the matter.

During the investigation, Withers admitted to purposely accessing the information for personal use. Walgreens confirmed to Hinchy that a HIPAA violation had occurred. Id. Per Walgreens, “Withers received a written warning and was required to retake a computer training program regarding HIPAA.” Continue reading

Thinking Outside the Country: Recruiting Foreign Physicians

In recruiting doctors, hospitals must navigate several minefields which include Stark law and the Anti-Kickback Statute. Yet, a rarely considered issue when recruiting physicians is whether immigration laws have been violated. Generally, non-resident aliens who have completed a residency or fellowship training program in the United States must return to their home country for two years before they can work in the United States. Continue reading