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Qui Tam Case Against Physicians and Hospital Advances on What May Have Been a Technical Oversight

A U.S. District Judge found that two agreements between a set of doctors and a University of Pittsburgh Medical Center-owned hospital ran afoul of the Stark Law and the False Claims Act, the former of which prohibits a physician from referring Medicare patients for designated health services to an entity with which the physician (or immediate family member) has a financial relationship, and the latter of which prohibits the filing of...

Why Accounting Firms Need HIPAA Compliance Plans

It has been over two decades since the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA or Act), but only in the past six years have enforcement actions demonstrated the fervor with which the government intends to compel compliance. With trends leaning toward a continued increase in enforcement activities, entities governed by HIPAA must be aware of their duties under the Act. Prior to 2009, HIPAA...

Physician Integration Strategies: Super Groups, Clinically Integrated Networks (CINs) and Alternative Payment Models

In order for small, private medical practices to survive and thrive in the current healthcare environment, with the increased emphasis on cost, quality and compliance, most physicians will likely need to become part of larger networks of physicians able to engage in alternative payment relationships with commercial insurers or self-insured employer plans as a group. These groups must be sufficiently integrated to avoid a Federal anti-trust violation, and to be...

Can EHR Vendors Block or Terminate a Medical Practice’s Access to Patient Information?

We have seen numerous instances in which a medical practice notifies an EHR vendor that it plans to terminate the relationship with the vendor, and the EHR vendor refuses to transfer patient information or otherwise provide the practice with access to patient information, unless the practice pays an exorbitant fee. These situations raise the question of whether such behavior by the EHR vendor is legal and permissible. This question arises...

What You Need to Know About Forming a Super Group

This article was originally published in the Autumn 2016 issue of Viewpoint Magazine and is reprinted here with permission. View PDF version of this article. The increased emphasis on cost, quality and compliance in the delivery of healthcare has simultaneously promised to save our healthcare system, while adding immense complexity to the private practice of medicine. The advent of MACRA and all of the intricate payment methodologies proposed by CMS...