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Civil enforcement of fraud and abuse laws

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.

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Semi-retirement options for senior MDs

One option might entail a semi-retired doctor electing to work a certain percentage of a full workload (e.g., day schedule, weekend call, night call, etc.). Another option might entail the semi-retiring doctor dropping procedures (e.g., dropping OB, no longer doing surgical cases, etc.), while maintaining an office-only practice.

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MD online ratings raise concerns

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.

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Blues bend on publicized policies

While Independence Blue Cross and Highmark Blue Cross Blue Shield have recently ceded ground on coding and reimbursement methodologies, it remains to be seen whether insurers and physicians will be able to develop the necessary level of trust and collaboration to make innovative systems work.

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