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Health Care Law Archives

Nonprofits and conflicts of interest

When a nonprofit discusses conflicts of interest, it usually focuses on the financial benefit a board member could receive that could also be detrimental to the nonprofit. While some examples of conflicts of interest are cut and dried, such as hiring an unqualified family member of one of the board members at a salary that is too high, there are other situations that are not as easily identified.

What physicians should know about allegations of misconduct -- II

In our previous post, we started discussing how complaints alleging misconduct by licensed physicians are managed by the New York State Health Department's Office of Professional Medical Conduct and the Board of Professional Medical Conduct.

What physicians should know about allegations of misconduct

Those people who make the decision to become a physician know from the outset that it won't be an easy endeavor, as the process requires a substantial investment of time, money and energy. Nevertheless, all this hard work ultimately pays off once they have their medical license, as they are free to start caring for patients, building a practice and, of course, providing for their family in earnest.

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.

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