Showing 63 posts in Physicians.
NPDB Guide for Reporting Clinical Privileges Actions
The National Practitioner Data Bank (NPDB) has published a quick guide to assist hospitals and health care entities in reporting actions that adversely affect clinical privileges held by physicians, dentists and other health professionals.
The guide (We have identified that the following link is no longer active, and it has been removed) lists several “reporting scenarios” and indicates the type of report that may be required (initial adverse action report, revision-to-action report, correction report, or no report). The guide also summarizes the reasons for voiding a previous report (report was erroneously submitted, action was not reportable, or action was reversed or overturned).
The guide is a helpful starting point for a hospital or health care entity that is involved in a privileging action. However, the scope and timing of reporting requirements under the NPDB regulations can be quite complex. Considering the very serious implications from reporting—or not reporting—an adverse privileging action, it would be prudent to only use the guide as a quick reference and not as a decision-making tool.
If you have any questions about the guide, please contact Richard Kraus at 517.371.8104 or by using the email form below.
Categories: Hospitals, Physicians
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Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud
So far, July has been a busy month for health care fraud enforcement across the country.
On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›
Categories: Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians
Pioneer ACOs Find Blazing New Trails Isn't Always Easy
According to a recent Modern Healthcare article, up to 9 of the 32 Pioneer Accountable Care Organizations ("ACOs") may be leaving the program. Four have already notified providers of such withdrawal. Of the 9, 4 of the departing ACOs tentatively say they will be joining Medicare's lower- risk ACO alternative – the Medicare shared savings program. The deadline for deciding whether or not to remain in the Pioneer program is July 31, 2013. Read More ›
Categories: Accountable Care Organizations, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians
New LARA Policy for Professional Services Corporations
The Michigan Department of Licensing and Regulatory Affairs (LARA) Corporations Division has recently implemented a new policy for professional service corporations requiring that the purpose clause in the articles of incorporation includes the type of license held. Previously, only the type of services provided was required.
For example, the purpose clause for a dental practice must now state that the purpose of the corporation is to provide "dental services through a licensed dentist."
This new policy is not stated in any of the LARA materials. However, Foster Swift attorneys and paralegals frequently work with LARA and can help streamline the creation of a professional services corporation by knowing these LARA policy insights.
If you have questions about the new policy or would like assistance with starting a professional services corporation, please contact an attorney at Foster Swift.
Julie C. LaVille authored this article as a Law Clerk.
Categories: Licensing, Physicians, Regulatory
Walgreens Agrees to Record $80 Million Settlement with DEA
On Tuesday, June 11, 2013, the Drug Enforcement Administration (“DEA”) announced that it had reached an $80 million civil settlement agreement, the largest in DEA history, with Walgreen Co. (“Walgreens”) to resolve allegations involving an “unprecedented number” of record-keeping and dispensing violations under the Controlled Substance Act (“CSA”). According to the DEA’s Press Release, Walgreens negligently allowed controlled substances, including Oxycodone and other prescription painkillers, to be diverted into the black market. Read More ›
Categories: Compliance, Fraud & Abuse, Hospitals, Pharmacy, Physicians, Regulatory
IRS Issues New Regulations Affecting the “Blues” Under Health Reform
The Treasury Department and IRS continue to roll out new regulations related to the implementation of the Patient Protection and Affordable Care Act ("PPACA"). On May 10, 2013, the Treasury Department and IRS released the draft regulations, "Computation of, and Rules Relating to, Medical Loss Ratio", which are intended to help Blue Cross and Blue Shield ("BCBS") organizations comply with the Medical Loss Ratio (“MLR”) rules created by the PPACA. Here's the background ›
Categories: Health Care Reform, Hospitals, Insurance, Physicians, Regulatory
Recap From the 2013 Health Law Institute
On March 7 and 8, 2013, the members of Foster Swift’s Health Care Law Group attended the 19th Annual Health Law Institute. This two-day institute, which is co-sponsored by the Institute for Continuing Legal Education and the Health Care Law Section of the State Bar of Michigan, focused on recent legal developments in health care law. Specific topics addressed at this year’s Health Law Institute included: Read More ›
Categories: Health Care Reform, Health Insurance Exchange, HIPAA, Hospitals, Insurance, Physicians, Regulatory
Payments to Doctors Will Soon be Public Knowledge
Under the Patient Protection and Affordable Care Act, companies that provide drugs, medical devices, biologicals or other medical supplies covered by certain government programs (Medicare, Medicaid or the Children's Health Insurance Program) are required to annually report certain payments they make to physicians. According to a recently issued final rule, payment categories will include: Read More ›
Categories: Compliance, Hospitals, Physicians, Regulatory
Delayed Deadline: Employer Notice Regarding Health Insurance Exchanges
As previously discussed, the Patient Protection and Affordable Care Act requires employers to provide notice to their employees related to Health Insurance Exchanges (the “Notice”). The specifics concerning the Notice may be found here. The Notice was required to be given to each current employee not later than March 1, 2013. Read more about the delay ›
Categories: Health Care Reform, Health Insurance Exchange, Hospitals, Insurance, Physicians, Regulatory
Health Care Benefits Provided to Same Sex Couples in Michigan - Are the Laws Changing?
In 2008, the Michigan Supreme Court concluded that domestic partnership policies intended to provide health care benefits to same sex couples violated Michigan law. Specifically, National Pride at Work v Governor held that such policies violated the Michigan Marriage Amendment (“Marriage Amendment”) by recognizing same sex domestic partnerships as analogous to a marriage or similar union. (The Marriage Amendment recognizes the union of one man and one woman as the only agreement recognized as a marriage and also prohibits public employers from providing health insurance benefits to their employees' same-sex domestic partners.) Since the decision in National Pride... ›
Categories: Employee Benefits, Employment, Hospitals, Physicians
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.