Medicine & the Law

The regulatory environment is now ripe for hospital-physician ASC joint venture arrangements. A new ruling clarifies how a non-profit health care system can participate in an ancillary for-profit joint venture while maintaining its tax-exempt and public charity status.

HHS' Office of Inspector General has issued its final "Compliance Program Guidance for Individual and Small Group Physician Practices" to help protect doctors from Medicare Fraud & Abuse prosecution. We offer some guidance on the guidance, in five easy pieces.

Analysis of the first Pennsylvania judicial decision in which a court has determined that due process rights may apply to a physician when that physician is de-selected from an HMO provider panel.

The legality of the well-honed tradition of professional courtesy has been called into question due to an upsurge in government's efforts to ensure accurate billing of claims, new federal laws addressing physician referral and patient relationships and the novel application of existing laws. Perhaps even more unfortunate, no one clear viewpoint has arisen as to its continuing legal viability.

Ill-equipped to undertake systemic health care reform directed at achieving greater power, physicians should consider radical, long-term proposals that foster a more equitable distribution of power at the state and federal levels.

The legal and business issues which a retiring physician must resolve will vary depending upon their practice arrangement: sole shareholder, partner in a practice or employed physician.

With increasing frequency, courts are being called upon to evaluate the legality of relationships between providers and third-parties in the context of civil litigation. The facts and outcome in Zimmer illustrate a number of important observations that derive from the line of cases involving civil enforcement of the fraud and abuse laws.

An HMO and its physicians cannot be sued in federal court for breaching their fiduciary duties to patients when they implement a managed care program in which the physicians receive financial incentives to contain costs.

Physicians are rightfully concerned that unfiltered access to online ratings of them without appropriate safeguards may be detrimental to informed patient decision making, and may have distorting effects on patient access to care.

The draft compliance program guidance will likely become the standard of care for all physician practices and those practices without some formal plan will be extremely vulnerable when responding to any third party audit for billing purposes.