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. Our reason in doing this was to help physicians, who have invested so much time, money and energy into not…
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…
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. Often, their complaints and diatribes target the sheer size of government…
Some select industries are just different. Like sumo wrestling, aerial acrobatics and space exploration. And, to be sure, the health care industry. Indeed, perhaps no other realm of focus and professional endeavor is so clearly singular and distinct as the medical field. And for good reason. The industry is marked by specialized and highly trained…
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…
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…
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. Along with the physical, mental…
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…
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….
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…