Category: Legal Watch
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Appropriate Use Criteria for Advanced Diagnostic Imaging
Contributed by: Gregg Everett, Gilpin Givhan The Protecting Access to Medicare Act (PAMA) was passed in 2014. PAMA required the Centers for Medicare and Medicaid Services (CMS) to establish a program that promotes “Appropriate Use Criteria” (AUC) for advanced diagnostic imaging. AUC’s are evidence-based criteria that assist professionals who order and furnish certain imaging services…
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Changes Coming to AKS, Stark and CMP Laws
On October 9, 2019, the Office of Inspector General (“OIG”) and the Centers for Medicare and Medicaid Services (“CMS”) published proposed rules to revise the Stark Law, Anti-Kickback Statute and Civil Monetary Penalty Statute. These statutes create criminal and civil penalties for certain financial arrangements involving providers. According to OIG and CMS, the goal of…
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Fraud and Abuse Facelift: Proposed Changes to Stark, AKS, and Beneficiary Inducements CMP
As part of its “Regulatory Sprint to Coordinated Care,” the Centers for Medicare and Medicaid Services (“CMS”) and the Health and Human Services Office of Inspector General (“OIG”) released proposals to modernize the Medicare Physician Self-Referral Law (“Stark Law”), Anti-Kickback Statute (“AKS”), and Beneficiary Inducements Civil Money Penalty (“CMP”) (collectively, the “Proposed Rules”). The Proposed…
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CMS Is Expanding Its Enforcement Ability
Pursuant to a new rule, entitled Program Integrity Enhancements to the Provider Enrollment Process, the Centers for Medicare & Medicaid Services (“CMS”) is expanding its ability to combat fraud and abuse within the healthcare industry. Under the new rule, CMS will be able to identify individuals and entities that pose a fraud and abuse risk…
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Guidance on Practice and Ethical Issues
The Medical Association’s Office of General Counsel can help guide members on certain practice and ethical issues. The Office is comprised of the General Counsel, Cheairs Porter, and Paralegal, Angela Barentine. The General Counsel is the chief legal advisor to the Board of Censors, and provides legal advice daily to the Executive Director. Mr. Porter,…
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Employee vs. Independent Contractor: What’s the Difference and Why’s it Important?
If you are reading this article, then you likely own or administer a health care practice. It may include workers of many stripes: some may be treated as employees and others as independent contractors. But do you know why they are treated that way? If the IRS or the Alabama Department of Revenue audits your…
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Do You Understand Due Diligence In Physician Practice Acquisitions?
Often in the sale of a physician’s practice, the owner of the selling practice (the “Selling Practice”) may desire to structure the transaction as what some refer to as a “handshake deal” – using minimal documentation and providing minimal diligence for review. Although this may be advantageous for the Selling Practice and its owner (depending on…
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A New Anti-Kickback Law Targets Clinical Lab Marketing Arrangements
Some very important and potentially game-changing legislation was recently passed. On Oct. 24, 2018, Congress enacted the Eliminating Kickbacks in Recovery Act of 2018 (or EKRA) – a statute that potentially eliminates legal protections (i.e., “safe harbors”) used by clinical laboratories to market their services. EKRA is part of the “Support for Patients and Communities…
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Is Your Corporate Compliance Plan Up-to-Date?
As 2019 kicks off, it is wise to review various aspects of your practice to ensure everything is up to date and continues to operate in compliance with applicable laws. One area of focus for such review is your corporate compliance plan. Compliance plans are written policies and procedures, adopted by a health care provider,…
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Can I Get a Witness? Do You Use Chaperones in the Exam Room?
In 2018, the world of sports was rocked with the revelation that Larry Nassar, a physician for USA Gymnastics, used medical examinations as a pretext to molest nearly three hundred female gymnasts over a twenty-year period. Many of these young athletes were abused while their parents were in the examination room. News coverage of the…