Change Healthcare Cyberattack Disrupts Physician Payments
Med Law Blog
by Michael Cassidy
2w ago
“On February 21, 2024, Change Healthcare, a subsidiary of UnitedHealth Group was the victim of the most significant cyberattack on the US healthcare system in American history.  Change Healthcare is the predominant source of more than 100 critical functions that keep the healthcare system operating.” –American Hospital Association Letter March 4, 2024 This hack was first reported by the Wall Street Journal on February 23, 2024, in an article entitled “Hospitals and Pharmacies Reeling After Change Healthcare Attack”.  The Wall Street Journal further reported on March 1, 2024 in an a ..read more
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Penn State Health Agrees To Pay Over $11 Million Due To Violations Of Medicare Rules & Regulations
Med Law Blog
by Adam Appleberry
1M ago
Penn State Health has agreed to pay $11,712,336 to settle allegations of civil liability from submitting improper claims to Medicare for Annual Wellness Visit services. DOJ Press Release Link Penn State Health has voluntarily disclosed that between December 2015 and November 2022 claims were submitted to Medicare for Annual Wellness Visit services that were not supported by the medical record. Once the improper claims were discovered, Penn State Health promptly took corrective action and disclosed the matter to the United States Attorney’s Office ..read more
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HHS Healthcare Sector Cybersecurity
Med Law Blog
by Michael Cassidy
2M ago
In furtherance of the National Cybersecurity Strategy announced March 2023, HHS has released an Introduction to the Strategy of the U.S. Department of Health and Human Services for Healthcare Sector Cybersecurity.  Click here for the PDF ..read more
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False Claims Act (FCA) Liability for Physician Compensation Exceeding Fair Market Value (FMV)
Med Law Blog
by Michael Cassidy
3M ago
When negotiating physician compensation issues, hospitals frequently rely upon the premise they must pay fair market value compensation in order to comply with the provisions of the Stark Act prohibiting referrals in exchange for compensation, and sometimes non-profit inurement issues. Although the prohibitions are clear, determining what constitutes fair market value is often not.  Provisions allegedly enforcing fair market value by limiting compensation to the 75th percentile of some national study are clearly inapplicable; obviously, somebody is legitimately being paid in the top quart ..read more
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2024 Medicare Physician Fee Schedule
Med Law Blog
by Michael Cassidy
5M ago
CMS issued the Final Rule for the 2024 Medicare Physician Fee Schedule (PFS) on November 2, 2023, for payments to be effective on or after January 1, 2024. Fee Schedule Link The overall payment rates under the PFS will be reduced by 1.25% in calendar year 2024. The final PFS conversion factor will be $32.74, which is a decrease of 1.15 of dollar and 15% (or 3.4%) from the 2023 conversion factor of $33.89 ..read more
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Biden Administration to Appeal Surprise Billing Defeat
Med Law Blog
by Michael Cassidy
5M ago
As reported earlier in the MedLaw Blog (August 9, 2023), a federal District Court vacated portions of the No Surprises Act federal regulations.  Thereafter, CMS halted the arbitration process for resolving disputes regarding out-of-network surprise bills. On October 20, 2023, HHS, Treasury, and the US Office Personnel Management submitted a notice indicating their attempt to file a consolidated appeal in the US Court of Appeals for the Fifth Circuit, challenging the August decision in the US District Court for the Eastern District of Texas ..read more
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FTC Sues Anesthesiology Provider and PE Firm Over Anticompetitive “Roll Up” Scheme
Med Law Blog
by Adam Appleberry
6M ago
As Mike Cassidy and Adam Appleberry discussed during their presentation at PBI’s A Day in Health Law earlier this month, private equity’s involvement in healthcare will be an interesting item to watch over the next few years. Just last week, the FTC sued the U.S. Anesthesia Partners, Inc. and their private equity backer Welsh, Carson, Anderson & Stowe, alleging a “multi-year anticompetitive scheme to consolidate anesthesia practices in Texas, drive up the price of anesthesia services provided to Texas patients, and increase their own profits.” (Click here to read the article) Private equit ..read more
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Allegheny County Medical Society Bulleting Article on Contracting Essentials for all Physicians, Especially Residents and Fellows
Med Law Blog
by Michael Cassidy
7M ago
Michael A. Cassidy and Adam J. Appleberry co-wrote an article titled “Contracting Essentials for All Physicians, Especially Residents and Fellows”. This article will appear in the Legal Summary section of the August 2023 Allegheny County Medical Society (ACMS) Bulletin. The ACMS Bulletin is the Allegheny County Medical Society’s signature publication which reaches over 2,000 physicians in Southwestern Pennsylvania each month. In summary, when negotiating a physician contract, it is important to pay attention to the restrictive covenants, contract term and termination, malpractic ..read more
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Cassidy Named in 2024 Best Lawyers in America
Med Law Blog
by Michael Cassidy
7M ago
Michael Cassidy has been recognized again in the 30th edition of the Best Lawyers in America for his “exceptional work in healthcare law”.  ..read more
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CMS Halts “No Surprises Act” Arbitration
Med Law Blog
by Michael Cassidy
8M ago
CMS has halted the arbitration process for “Surprise Billing” established by the “No Surprises Act” for the second time, stating as follows: UNPLANNED OUTAGE “On August 3, 2023, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:23-cv-59-JDK (TMA IV), vacating certain portions of 45 C.F.R. § 149.510, 26 C.F.R. § 54.9816-8T, and 29 C.F.R. § 2590-716-8.  As a result of the TMA IV decision, effective immediately, the Departments have temporarily suspend ..read more
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