Medicine & the Law

Regulators and prosecutors, as well as some leading physician and private interest groups, have called for a new prescription for quality patient care: the reform of inappropriate marketing practices.

Unlike claims for out-of-network services submitted to commercial health plans – which are often paid based on a percentage of charges or some other negotiated process – payment for out-of-network services provided to Medicare Advantage enrollees are dictated by Medicare law and regulations.

Physicians must take particular care to ensure that the arrangements not only comply with the anti-kickback statute but, wherever possible, do not have the “suspect” attributes identified by the OIG.

Act 169 represents an effort to remedy the deficiencies in the system by allowing for decision-making even in the absence of an advance directive.

States need to reevaluate the prohibition on the corporate practice of medicine and recognize that in order to truly move toward a health care system that encourages technological advancement, improved patient care, and cost-efficiencies, corporate medicine not only has a place in the system, but could ultimately benefit such a system.

Often-times the reality of successfully bringing a claim under your group LTD policy is such a distortion of reality, it’s more like Alice ’s trip through “Wonderland.”

Not only do new regulations require additional information to be submitted during the enrollment process, they also create new obligations for hospitals, physician practices, and other health care providers and suppliers to report changes to the government.

The good news is that we understand more than ever before how to impact this liability. The open question is, Will we do anything about it? Two of the leading the areas of risk are physician-patient relationship and appropriate disclosure after an adverse event.

The Prabhu case demonstrates that physicians should stand their ground when they have not done anything wrong, and that the court system can effectuate justice and acquit a physician of baseless charges of fraud and false claims.

Consider the issues facing a physician-employer when hiring a new physician, and employees who are reviewing employment agreements with physician-employers.