Pennsylvania Health Law Lawyer & Attorney : Fox Rothschild LLP : serving Philadelphia, Pittsburgh, Allentown, Erie, Upper Darby Twp

Those of you keeping a close watch on Pennsylvania MCARE developments may be interested to know that the Commission on the MCARE Fund will be holding a public hearing to give citizens and organizations the opportunity to provide relevant information, opinions and suggestions that concentrate on the Commission's guiding principles.  The Commission was formed to make recommendations to the Governor and General Assembly by November 15, 2006, regarding the continuation of the MCARE assessment abatement and the elimination or phase-out of the MCARE Fund.  The hearing is scheduled for Thursday, November 2, 2006, from 9 a.m. to 12 p.m. and will be held at the Pennsylvania Housing Finance Agency, 211 North Front Street, Harrisburg, PA.  The public notice can be found here [Public Notice].

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According to a recent press release by the U.S. Attorney for the District of Colorado, Pediatrix Medical Group, Inc. has agreed to pay the government $25,078,918 to settle government claims of upcoding under the False Claims Act.  Specifically, the government alleged that Peiatrix billed for critical care services when patients were not critically ill.   This should serve as a strong reminder to physician groups of the importance of maintaining an effective compliance program.

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Welcome to the Physician Law Blog.  Here you will find commentary on and links to important legal and business issues affecting physicians and other non-institutional providers.  I expect that content will change on a regular basis so you are encouraged to check back often.  To view previous posts, you can click on any of the "Topics" listed on the right hand side of the page.  Should you have any questions about how to use the Blog or if you have suggestions for improving it, please let me know.

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If the Proposed 2007 Medicare Physician Fee Schedule is adopted in final, Physicians can expect a 5.1% decrease in Medicare reimbursement which CMS claims is in response to the fact that spending on physicians’ services and other Part B services has been growing at a much faster rate than target spending.  The 2007 Fee Schedule as proposed would also continue to impose the 25% reduction in payment for the technical component of multiple imaging procedures on contiguous body parts which was first imposed in 2006.

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Pending PA legislation would limit most insurance refund demands and retroactive payment denials by third party payors to a one-year lookback period except where fraud or miscoding occurs. The full text of the bill can be viewed here:physicianlaw.foxrothschild.com/HB2178P4462(1).pdf . The bill was passed by the House by a vote of 195 to 2 on June 30. It's still pending before the Senate and was referred to the Senate Banking Committee on July 5. For more information on this possible development, contact Bill Maruca at Fox Rothschild LLP.

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For any number of reasons longtime (and sometimes not-so-longtime) medical practice partners may decide that they can no practice together.  Diverging practice styles and patterns, unexpected health problems, and mounting economic and administrative burdens are only a few examples of issues that can drive a wedge between practice colleagues.  Unfortunately, as with many small businesses, dissolving a medical practice can be fraught with emotion -- in addition to a host of legal and ethical considerations.  The following article from Physician's News Digest discusses some the issues likely to arise in a medical practice split-up and offers suggestions for addressing them. www.physiciansnews.com/law/1004.html 

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Building and/or investing in an ambulatory surgery center (ASC) is a great way to gain control over the surgical side of your practice and can also be an excellent source of ancillary revenue.  However, start-up costs can be prohibitive and building and running an ASC can be time consuming.  Not surprisingly, many physicians are tempted to "partner" with other investors as a way of sharing the start-up costs and the administrative burdens.  As discussed in the following Physician's News Digest article, there are a host of considerations you should take into account in choosing the right ASC partner. www.physiciansnews.com/law/806riviezzo.html

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