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.
Some select industries are just different.
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.
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.
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.
The law is a dynamic thing. With perhaps only a few exceptions there is no such thing as a one-and-done piece of legislation. This can be particularly true for rules and regulations that cover health care delivery in New York.