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Dobbs Puts New Emphasis on Proactive Provider Transparency in Care Offerings

Months following the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, the reproductive health climate remains clouded with terms lawyers—not to mention patients—never like to hear: “wait and see,” “to be decided,” “gray area,” “it depends.” Perhaps nowhere is the information gap of more crucial import than at the moment a patient walks through … Continue Reading

House Committee Chairman Asks HHS to Develop Health Care Cyber Risk Plan

Last week, the Chairman on the House of Representatives’ Committee on Energy and Commerce, Greg Walden (R-OR), sent a formal letter to the Dept. of Health and Human Services (“HHS”) requesting that HHS “develop a plan of action for creating, deploying, and leveraging [bill of materials] for health care technologies.” Walden gave HHS until December … Continue Reading

Fundamental Right to be a Federal Healthcare Provider?

Rejecting a contrary holding in the Fourth Circuit, the Sixth Circuit decided a healthcare provider has no “fundamental right to participate in federal health care programs.” Accordingly, the Department of Health and Human Services (HHS) was correct to exclude a pharmacist from federal healthcare programs simply because he was convicted of misdemeanor misbranding.… Continue Reading

With New Primary Care Compensation Model, CMS Continues Efforts to Promote Value-Based Payments

Beginning in January 2017, primary care physicians and their practices (PCPs)  will be able to participate in a multi-payer payment reform and care delivery transformation aimed at strengthening primary care. Dubbed the Comprehensive Primary Care Plus (CPC+) initiative, the recently unveiled primary care medical home model is CMS’s latest effort to encourage value-based payment methodology, … Continue Reading

New Book Outlines Important Clinical Integration Considerations

Providers and policy makers have struggled  to find solutions to rein in health care costs while improving clinical outcomes.  Clinical integration is one approach to meet these challenges. In short, clinical integration is a legal arrangement for healthcare provider integration that involves a carefully structured collaboration of healthcare professionals to provide coordinated care across multiple … Continue Reading

OIG Puts Muscle Behind Its Alert

Only two days after releasing its latest fraud alert, a deputy director from HHS’s Office of Inspector General announced that the OIG will be hiring additional attorneys to look into taking more administrative actions against physicians in their individual capacity. This announcement emphasizes that the OIG means serious business – not only is the OIG … Continue Reading

OIG Warns Physicians Regarding Noncompliant Agreements

Tuesday, the OIG released a fraud alert advising physicians to ensure their compensation arrangements, such as medical director agreements, reflect fair market value for bona fide services the physicians actually provide, or they could potentially face liability under the Anti-Kickback Statute.  As part of the fraud alert, the OIG encouraged physicians “to carefully consider the … Continue Reading

FBI Warns of “Spear Phishing” for Your Data and Ideas

The widely reported data breach at Community Health Systems, Inc. (CHS) appears to have relied upon a “spear phish email” to launch the initial malware, according to a recent alert from the FBI. Experts engaged by CHS believe that the attacker is an “Advanced Persistent Threat.” The FBI alert provides tips for organizations to prevent … Continue Reading

CMS Issues Medicare and Medicaid Final Rule: Significant Changes to Conditions of Participation

On Wednesday, the Centers for Medicare and Medicaid Services (“CMS”) issued a second round of long-awaited red tape reduction initiatives aimed at ameliorating overly burdensome provider regulations.  The changes, memorialized within a Final Rule scheduled for publication on May 12, 2014 (available for review here: (“Unpublished Final Rule”)  include significant easing of Conditions of … Continue Reading

Is Your Name on the List?

Given the 880,000 names of physicians released by Medicare Wednesday, physicians who treat Medicare patients can expect their names to be on the list.  The list, searchable here, contains the name of the provider, the specialty area, the city, county and state as well as the total payments made to the provider by Medicare for … Continue Reading

Facing the Medical Device Tax Head On: Strategic Contracting for Hospital Cost-Reduction

With approximately two months having passed since the end of the government shutdown, the fundamental question still remains; what exactly did Congress achieve through the contentious shutdown negotiations?  The shutdown was spurred in part by certain Congressional Members’  opposition to the funding and implementation  of the Affordable Care Act (“ACA”).  A centerpiece of these oppositional … Continue Reading

Government Finds More Medical Services Unnecessary

In the September 2013 edition of the Cleveland Bar Journal, Colin Jennings and Tom Zeno described the government’s determination to challenge medical decision making as medically not necessary.   To read the article, visit Uncle Sam Becomes a Doctor:  Government Challenges to Medical Necessity. Recent prosecutions have been born out of their prediction. In October 2013, … Continue Reading

Tuomey Ordered to Pay $237 Million

Capping a case that has drawn the attention of healthcare lawyers and hospital executives nationwide, the U.S. District Court for the District of South Carolina has ordered Tuomey Healthcare System, Inc. (“Tuomey”) to pay over $237* million for violations of the Stark Law and False Claims Act arising from certain employment agreements between Tuomey and … Continue Reading

Non-Medicare Patients Only? Not Necessarily an Excuse. New OIG Opinion Shows Government Skepticism of “Carve-Out” Arrangements

Yesterday, the U.S. Dept. of Health and Human Services Office of Inspector General (“OIG”) clarified its stance on a growing practice – provider attempts to circumvent fraud and abuse laws by structuring financial arrangements to apply only to business concerning non-Federal program beneficiaries.  The OIG reiterated its dim view of this practice, citing an underlying … Continue Reading

DC District Court Grants CMS’ Motion to Dismiss Challenge to Regulations Expanding Limitations on Physician-Hospital Joint Venture Under Arrangements

On May 24, in Council for Urological Interests v. Sebelius et al., the United States District Court for the District of Columbia granted CMS’ motion to dismiss a challenge to 2008 regulations promulgated by CMS that: expanded the definition of an entity furnishing designated health services (“DHS”) to mean not only the billing organization but … Continue Reading

President’s Budget Proposes Limits on Physician Self-Referral for Certain Services

On April 10, 2013, President Obama released his proposed federal budget for fiscal year 2014.  Buried within the budget is a proposal to limit physician self-referrals for certain ancillary services.  Specifically, the budget proposes to encourage what it calls “more appropriate” use of ancillary services by limiting those providers who may self-refer for radiation therapy, … Continue Reading

Proposed Rules Issued Extending Protections of Electronic Health Record Donations

Proposed Rules Issued Extending Protections of Electronic Health Record Donations On April 10, 2013, the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and the DHHS, Centers for Medicare & Medicaid Services (CMS) each issued a proposed rule relating to the donation of interoperable electronic health records software or information technology … Continue Reading

OIG Issues Special Fraud Alert: Physician-Owned Distributorships (PODs)

OIG Issues Special Fraud Alert: Physician-Owned Distributorships (PODs) On March 26, 2013 the Department of Health and Human Services, Office of Inspector General (OIG) issued a Special Fraud Alert: Physician-Owned Entities (Alert).  The Alert focuses on the specific attributes and practices of “physician-owned entities that derive revenue from selling, or arranging for the sale of, … Continue Reading

Article Shines Spotlight on Pharma Payments to Physicians

An article published today in the Columbus Dispatch shines a spotlight on physicians receiving payments from pharmaceutical companies for speaking and consulting engagements.  The article identifies several central Ohio physicians who have received hundreds of thousands of dollars in fees from drug companies from 2009 through 2012.  The Dispatch’s analysis, taken from data gathered by … Continue Reading

A Tale of Two (or More) Types of Physician Terminations: Ohio Muddles the Responsibility for Notifying Patients When Their Doctor Departs

On March 22, 2013, a new Ohio law will go into effect that seeks to clarify who must notify a patient that his or her physician’s employment has been terminated.  Under Ohio Revised Code Section 4731.228, the “health care entity” that employs a physician is now responsible for notifying the physician’s patients that the physician’s … Continue Reading

Four Myths That Adversely Affect Physician Asset Values

In the most recent installment of his bi-weekly blog posts for’s Practice Notes blog (free subscription required), John Erickson identifies four common “myths” that can cause physicians to request less than fair market value for their practice assets.  John’s upcoming posts will address other “myths” that cause wide variance in the determination of the fair market … Continue Reading

Considerations When Selling Physician Practice Assets

Physicians considering hospital integration through the sale of their practice’s assets and hospital employment should first take the time to review John Erickson’s bi-weekly blog posts for’s Practice Notes blog (free subscription required).  John’s posts, including his most recent entry on two essential issues that must be considered before the sale of any practice’s assets, will focus on breaking down … Continue Reading

Social Media For Health Care Providers

Should doctors follow recent trends and utilize social media to grow their practices? Social media has fundamentally shifted the way people communicate with each other.  Twitter users create approximately 50 million tweets each day, and Facebook has more than 500 million users worldwide.  Companies are embracing social media and even making business decisions based on … Continue Reading