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Health Care Law Archives

Medicare fraud: Concern for regulators, but for doctors, too

Regulators who administer and police medical payment programs (most centrally, Medicare) often -- in fact, routinely -- speak of the great challenges they confront in identifying and preventing provider-related fraud, as well as punishing transgressors who engage in fraudulent billings and other unlawful activities.

Medicare To Pay Primary Care Doctors Up Front Incentive And Monthly Management Bucks $$$.

On April 11, the Centers for Medicare & Medicaid Services (CMS) announced its largest-ever initiative to, in its words "transform and improve how primary care is delivered and paid for in America".
The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented on January 1, 2017 in up to 20 regions. It will accommodate up to 5,000 practices, 20,000 doctors and 25 million patients.

What Are Your Rights if Your Mental Health or Addiction Treatment Claims Are Denied By Your Insurance Company?

Has your insurance company denied coverage or reimbursement of you or your family member's mental health or substance abuse service claims? In light of the recent New York Attorney General settlements with insurance companies for violations of the federal and New York state mental health parity laws, insurance companies need to take a hard look at their mental health and substance abuse service claims review processes to be sure they comply with these laws.

Physicians must beware upcoding and false billing practices

Most individuals who endure the years of schooling and training it takes to become a full-fledged medical doctor do so because they want to help people. As with many professionals, despite all of their professional training, physicians are often ill-prepared for many of the realities that come with the job.

Court Lifting of Stark Law Ban on Per Click Fees May Lead to "Sub-under Arrangements" between Physicians and Hospitals?

The Stark Law prohibits a physician who has a "financial relationship" with a provider of designated health services[i] ("DHS Entity") from referring Medicare patients to that DHS Entity. It also bars DHS Entities from receiving Medicare payments based on these prohibited referrals. Under Stark, a physician has a "financial relationship" with a DHS Entity if he or she owns or invests in it, or if he or she has a compensation agreement with the DHS Entity covering services, equipment, and the like.

Health care highlights solid October jobs growth

The health care industry in New York and the rest of the country is undergoing something of a renaissance. Some call it good. Others call it bad. Regardless of what side of the fence you might be on, the one thing that is certain is that the economic trend in health care is in flux. In the midst of change, the spectrum of possible business issues that can arise is broad. Consulting an attorney with experience in the health care arena should be a high priority.

Medicare Will Soon Pay Docs To Discuss End Of Life

The 2010 Patient Protection and Affordable Care Act (Obamacare) encourages a "medical home" model of care, which aims to improve patient access and quality of care through increased communication between physicians and patients and increased care coordination, while simultaneously reducing costs. In an effort to jump start this model, starting in 2016, Medicare will pay physicians to provide patients with advance care planning ("ACP") services, including a face to-face meeting to explain, discuss and complete advance directives such as a health care proxy. The meeting could be with a patient or his or her authorized family member, health care agent or other surrogate.

New York Patient Caregivers Law Signed Into Law

New York Hospitals, clinics and practices and the doctors, nurses and support personnel they employ, can find that the environment in which they operate changes quickly. Under an amendment to the New York Public Health Law enacted this week, starting in April of 2016, NY hospitals will be required to allow patients over the age of 18 to select a "caregiver" following entry into a hospital and prior to discharge or transfer to another facility. The caregiver" can be anyone who has a significant relationship with the patient, such as a relative, partner, friend or neighbor. See NY Public Health Law 2994hh et seq.

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