Medicine & the Law

Many insurance companies have begun to deny claims for appropriate ancillary services based on the holding of the Commonwealth Court in the Three Rivers case.

Simple income division has shown itself to be problematic. Increasingly, practices are moving towards developing a compensation plan that accounts for the various contributions each physician makes to the group.

Working against the physician group in the employment law area is the perception that the medical practice is a "small" employer and so is exempt from many of the federal and state laws governing employees.

In a new Fraud Alert, the OIG expresses concern that some physicians are inappropriately ordering home health care and durable medical equipment for Medicare patients, and outlines the protocols they should follow for certifying the medical necessity of those items and services.

If done incorrectly, patient discharge can lead to claims of abandonment. Good documentation reduces the potential of a malpractice claim.

Now, when a Pennsylvania physician and HMO are named in a malpractice suit in state court for the negligent provision of medical care, the managed care plan will remain in the case as a co-defendant.

Parties to health care electronic data exchange must focus on a range of transactional issues and state and federal requirements.

The Act provides protection for physician interests and increases the opportunity for exercise of independent clinical judgment.

Providers should know when the law applies, what credentialing restrictions are placed on managed care organizations, what rights the providers are afforded and what are the limitations of those rights.

A disabled physician can sue a hospital that strips him of staff privileges under the public accommodation provision of Title III of the Americans with Disabilities Act.