By Donald Moy, Matthew Talty

Effective January 1, 2011, referring physicians (non-radiologists) who provide MRI, CT and PET scans in their office practices will be required to make certain disclosures and provide information to their Medicare patients or risk violation of the physician self-referral law (Social Security Act Section 1877, also know as the "Stark Law").

By Michael J. Schoppmann

Physicians typically, and traditionally, practice in small groups. According to the AMA Physician Practice Information Survey (2007-2008), 78 percent of office based physicians in the U.S. are in practices in sizes of nine physicians and under, with a majority of those physicians being in either solo practice or in practices of between 2 and 4 physicians. Under the antitrust laws separate groups of physicians that practice in the same or related specialty and are in the same geographic market are considered "competitors". Therefore, if individuals and different physician groups come together and engage in certain concerted activities, such as collective negotiation of fees with individual payors, such action would be considered an illegal conspiracy among competitors and could be held to be a per se violation of the antitrust laws.

By Jeff Segal

Pause for a second, stop reading this article and close your eyes. Imagine living life as one of the 1.3 million blind people in the United States. Think about how you would access information exchanged over the Internet. For 60-year old New York resident Mindy Jacobsen, this is her reality. She has been blind since birth.

Thanks to the American for Disabilities Act ("ADA") it is easier for Mindy to navigate around New York City. She can walk sidewalk to sidewalk, hop on a train and live a fully functional life, except when it comes to navigating through the internet.

By Douglas M. Nadjari

The cornerstone of New York Gov. Andrew Cuomo’s Medicaid Redesign Team is the creation of a new fund designed to pay particular (and limited) medical expenses for neurologically damaged infants. Its success is anything but guaranteed.

By Lisa English Hinkle

During 2008, the AMA projected that physicians incurred $24 billion in charity and uncompensated expense. By expanding health insurance coverage for 32 million uninsured Americans, the Federal Healthcare Reform Law ("Reform Law") should reduce this expense. The AMA also projects that the Reform Law's standardization of administrative processes will create more than $68,00 in yearly savings per physician by reducing the 58 hours a week that physicians and their staff devote to administrative matters. Despite the financial benefits of increased physician utilization and expanded coverage, the Reform Law creates complicated regulatory and compliance issues for physicians. With the Reform Law's additional $250 million commitment to enforcement activities starting in 2011 and continuing for the next five years, physicians should take immediate steps to make informed decisions to identify and manage their risks.

By Steven Kern

Since the passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) brought about the introduction of a previously heretofore unheard of concept known as a "accountable care organizations" (ACOs), there has been a growing conversation in the medical community centered around two primary questions - what are ACO's and what do the foretell as to the future of medicine? ACOs were introduced as a Medicare savings program, intended to enhance quality, improve beneficiary outcomes and increase the value of care through incentives to healthcare providers. Although PPACA mandates that the federal government establish an ACO-based Medicare shared savings program by January 1, 2012, at this juncture there has been little guidance issued by the federal government with respect to these ACOs and how they will be structured.

By Douglas M. Nadjari

The federal government estimates that Medicare paid out over $29 billion for evaluation and management services for 2003. Accordingly, in its quest to ferret out what it characterizes as “fraud and abuse,” The Office of the Inspector General for the United States Department of Health and Human Services (“OIG”) recently issued its work plan for 2005 and identified, once again, the coding of evaluation and management (“E&M”) services as a prime target for investigation in the upcoming year. Not surprisingly, OIG will attempt to balance Medicare’s book on the backs of the very physicians that make the program work by targeting family practitioners and other Medicare providers for audit and, ultimately, demands for repayment. While the battle lines have been drawn, physicians need not allow themselves to become the victim of government abuse or incompetence.

By Steven Kern

In 1996, as part of the Health Insurance Portability and Accountability Act (HIPAA), Congress established the Medicare Integrity Program which authorized the Centers for Medicare and Medicaid Services (CMS) to contract with Program Safeguard Contractors to identify fraud and improper billing.

By Lisa English Hinkle

With the release of new standards for medical staff governance, the Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") has attempted to address and ameliorate the historic tension between hospitals and physicians in a way that will require most hospitals to substantially revise their Medical Staff Bylaws and revisit the relationship between doctors, hospital administration, and the hospital's governing board. After seven years of contentious debate with both the AMA and the AHA weighing in, the JCAHO's new standards are supposed to "contribute to patient safety and quality of care through the support of a well-functioning, positive relationship between a hospital's medical staff and governing body." Because physicians stand to lose substantial rights with the amendment of Medical Staff Bylaws, physicians should actively engage in the process and carefully evaluate the implications of conformance with the new standards, particularly in the area of credentialing and ongoing quality review to insure that new procedures are fair and adequately understood.

By Michael J. Schoppmann

A primary, if not preeminent, goal of every physician in practice today is the avoidance of a lawsuit for medical malpractice. However, the hard reality of practice dictates that risk management of medical malpractice claims falls directly upon, and is ever present with, every physician throughout each moment of rendering care. Therefore, understanding where the highest risk areas lie, and taking affirmative and aggressive measures to risk mange those prioritized threats, will provide physicians with the greatest protection toward avoiding a claim and/or being better prepared to defend, and defeat, a claim that arises in spite of these measures.