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- Audience: Physicians and Physician Group Practices
Events
11th Annual ASC and Health Care Management Symposium
Garfunkel Wild's 11th Annual ASC and Health Care Management Virtual Symposium is dedicated to the most important business, legal, clinical, and operational issues facing the ASC and health care management community.
Alerts
NJ Supreme Court Vacates $23.4M Award Against Valley Hospital
On April 16, 2024, the Supreme Court of New Jersey issued its decision in Comprehensive Neurosurgical, P.C. v. The Valley Hospital. In an over 60-page unanimous opinion, the Court vacated a 23.4 million dollar award against Valley Hospital.
Alerts
OIG Allows Patient Assistance Programs Funded by Drug Manufacturers
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (24-02) permitting a non-profit organization (Non-Profit) to provide financial support to eligible patients with specific rare diseases through assistance programs (Programs) it operates.
Alerts
CMS Announces Payment Program for Providers Impacted by Change Healthcare Cyberattack
On March 9, 2024, CMS announced it will make available Change Healthcare/Optum Payment Disruption accelerated payments to providers experiencing potentially significant cash-flow problems as a result of the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare/Optum .
Alerts
OIG Issues New Resource for Single Audits
The United States Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently posted a new educational resource on its website about Single Audits. HHS is the largest grant-making agency in the Federal government, and OIG’s new resource is designed to help key stakeholders understand the scope of Single Audits, as well as improve the overall quality of such audits.
Alerts
New York OMIG Updates Self-Disclosure Guidance
The New York State Office of the Medicaid Inspector General (OMIG) recently updated its Self-Disclosure Guidance and Frequently Asked Questions (collectively, “Updates”). These Updates give participating providers and entities additional insight into how to report overpayments involving unresponsive Medicaid Managed Care Organizations (MMCOs) or multiple entities, as well as those that are untimely, have adjusted or voided claims, or lost or damaged records.
Alerts
Favorable OIG Advisory Opinion Allows Subsidies for FDA-Approved Clinical Studies
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (23-11) that allows a medical device manufacturer (Manufacturer) to subsidize Medicare cost-sharing obligations as part of a U.S. Food & Drug Administration (FDA)-approved clinical study involving a Category B Investigational Device Exemption.
Alerts
OIG Approves Creative Approach to Restructuring Medical Practice Partnerships
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (23-12) that allows a limited liability partnership (the Partnership) consisting of two classes of physician partners to make a one-time, voluntary redemption offer (offer) to individual partners when they reach age 67.
Alerts
OIG Approves Use of Gift Cards for Referrals in Certification-Heavy Advisory Opinion
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted a favorable Advisory Opinion (23-15) permitting a consulting company’s (Consultant) proposal to offer gift cards to its current physician practice customers for referring potential new physician practice customers to Consultant. Notably, OIG determined that the proposed arrangement did not implicate the Anti-Kickback Statute (AKS).
Alerts
OIG Issues Toolkit for Medicare Advantage Organizations
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a new toolkit to help Medicare Advantage (MA) organizations replicate OIG audit methodologies to detect and correct inaccurate diagnosis codes in their own systems.
Alerts
OIG’s Newest Strategic Plan Prioritizes Managed Care Oversight
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently designated oversight of managed care as a “priority area”, and developed a coordinated strategic plan (the Plan) to better align its audits, evaluations, investigations, and enforcement of managed care.
Alerts
OMIG’s 2024 Work Plan Gives Critical Insights into Program Integrity Initiatives
The New York State Office of the Medicaid Inspector General (OMIG) released its 2024 work plan in furtherance of its mission to coordinate and conduct activities to prevent, detect and investigate medical assistance program fraud, waste and abuse, and to recover improperly expended Medicaid funds.
Alerts
More Provider “Nuggets” From OIG’s Year-End Reporting Blitz
Continuing its year-end reporting blitz, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its Semiannual Report (SAR) to Congress on December 1, 2023.
Alerts
OIG’s Favorable Advisory Opinions Allow Incentives to Medigap Plan Policyholders
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) posted two favorable Advisory Opinions (23-09 and 23-10) to allow a licensed offeror of Medicare Supplemental Health Insurance (Medigap Plan) policies and a preferred health organization (PHO) (collectively, “the requestors”) to incentivize Medigap Plan policyholders to seek inpatient care from a hospital within the PHO’s network. Notably, OIG issued these favorable opinions even though the proposed incentives implicated the Anti-Kickback Statute (AKS) and the Beneficiary Inducement Civil Money Penalty (CMP), and there was no applicable exception or safe harbor.
Alerts
DOJ/HHS Jointly Release "Highlight Reel" Report
This week, the United States Department of Justice (DOJ) and the United States Department of Health and Human Services (HHS) fulfilled its annual statutory obligation by releasing its jointly-authored Health Care Fraud and Abuse Control Program (HCFAC) Report for Fiscal Year 2022.
Alerts
OIG Provides Roadmap to Hot-Button Issues
The OIG fulfilled its annual statutory obligation by releasing its Top Management and Performance Challenges (TMC) document. Providers should take note because the document provides important insight into the specific areas over which HHS (and the OIG) will remain focused.
Events
The Federal No Surprises Act – Its Impact on Florida Physicians
On January 1, 2022, the Federal No Surprises Act (NSA) went into effect to protect patients from surprise bills for out-of-network services but the law’s impact on physicians has been significant. Join us as we walk you through what you need to know about the NSA.
Events
FCMA and HCMA Webinar - Website and Online Pitfalls: A Prescription for Physicians and Other Heathcare Providers
Join Garfunkel Wild's Zachary B. Cohen and Taras M. Czebiniak for an informative and eye-opening session that will delve into some of the most common compliance issues physicians must navigate in the digital age.
Alerts
OIG Releases New General Compliance Program Reference Guide
On November 6, 2023, the OIG released its General Compliance Program Guidance, the first in a series of new, non-binding reference guides designed to share information with health care compliance professionals and other health care industry stakeholders
Alerts
OIG Finds Lab to Lab Technical Component Arrangement Poses Anti-Kickback Risk
In Advisory Opinion No. 23-06, the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) declined to approve a proposed arrangement in which an anatomic pathology laboratory operator would purchase the technical component of anatomic pathology services from Physician and Non-Physician Laboratories for commercial payors.
Alerts
CMS Releases Updated Request for Applications for New Making Care Primary Model
On August 14, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a request for applications for the Making Care Primary (MCP) Model, its newest innovation program aimed at improving patient care by supporting the delivery of advanced primary care services
Alerts
Temporary Health Care Staffing Agencies Now Required to Register in New York
In what appears to follow a multi-state trend to protect “temporary” workers, as part of the New York Budget for FY 2023-2024, a new law went into effect that requires any entity that provides temporary staff to health care entities to register with the Department of Health (DOH).
Alerts
Connecticut Signals Increased Scrutiny of Physician Practice Acquisitions
On July 21, 2023, the Executive Director of the Connecticut Office of Health Strategy (“OHS”), sent a letter to Connecticut physicians reminding them of the requirement for certain practice transactions to obtain Certificate of Need (“CON”) approval prior to closing.
Alerts
Connecticut Modifies Physician Non-Compete Law, Extends Protections to APRNs and PAs
Effective July 1, 2023, Connecticut modifies its law governing physician covenants not to compete and extends non-compete protections to advanced practice registered nurses (“APRNs”) and physician assistants (“PAs”). Physicians, APRNs, PAs, and their employers will need to evaluate current non-competition provisions and revise, as needed, to comply with the new law.
Events
Florida Telehealth – What Florida and Non-Florida Practitioners Need to Know
Garfunkel Wild’s Susan L. St. John will present the Webinar “Florida Telehealth – What Florida and Non-Florida Practitioners Need to Know” on February 28, 2023 from 12:00 PM - 1:00 PM ET.
Alerts
Payment Error Rate Measurement Program for Florida Medicaid and Chip Providers
On February 17, 2023, Florida Medicaid released a Health Care Alert reminding providers of their obligations under the Centers for Medicare and Medicaid Services (“CMS”) Payment Error Rate Measurement (“PERM”) program.
Alerts
New York Proposes Law To Approve Transactions Involving Physician Practices and MSOs
The New York State Executive Budget for fiscal year 2024 includes a proposed law to review and approve material transactions involving physician practices, Management Services Organizations (MSOs), and other health care entities.
Podcasts
Health Information Technology Podcast - Termination and Transition Periods
Garfunkel Wild's Health Care Information and Technology Practice Group's Podcast Series "Health Information Technology Podcast- Termination and Transition Periods".
Alerts
Online Tracking Technologies Can Lead to HIPAA Violations
The Department of Health and Human Services, Office of Civil Rights (“OCR”) has published a Bulletin which officially states that incorporating certain tracking technologies into websites and mobile applications may cause HIPAA violations that could result in breach notification obligations as well as penalties. This includes platforms and services provided by companies like Meta (formerly Facebook) and Google.
Events
NY Chapter ACS/Manhattan Council Annual Dinner: Does Your Practice Have Sufficient Protocols and Training with Regard to How Staff Must Accommodate Deaf or Hard of Hearing Patients?
Garfunkel Wild’s Marc A. Sittenreich will present “Does Your Practice Have Sufficient Protocols and Training with Regard to How Staff Must Accommodate Deaf or Hard of Hearing Patients?” at the New York Chapter American College of Surgeons – Manhattan Council Annual Dinner on November 10, 2022.
Alerts
Florida Medical Practice Pays Hefty Price for Alleged Kickback Payments From Pharmaceutical Distributor
On October 3, 2022, the Department of Justice (“DOJ”) announced that a hematology and oncology practice in Fort Lauderdale, Florida will pay $130,000 to settle allegations that the practice violated the False Claims Act and Anti-Kickback statute by accepting illegal kickbacks from its pharmaceutical distributor.
Events
Health Care Hot Topics: Florida’s New Minimum Wage Requirements For Medicaid Providers
Garfunkel Wild's Susan St. John discusses the things providers need to know about the new minimum wage requirements, and a new civil cause of action for non-compliance.
Alerts
New York Court of Appeals Resolves MLMIC Dispute by Concluding That Employee-Physicians are Entitled to Conversion Funds
This case involves the 2018 demutualization of the medical malpractice insurer Medical Liability Mutual Insurance Company (“MLMIC”) and who was entitled to the more than $2.5 billion in cash consideration that was to be distributed as a result of that demutualization.
Events
Garfunkel Wild Webinar – Federal No Surprises Act – One Month In. What Have We Learned? What Questions Remain?
Garfunkel Wild’s Debra Silverman and John Martin will present the webinar “Federal No Surprises Act – One month in. What have we learned? What questions remain?" on February 1, 2022, from 12:00 pm – 1:00 pm (EST).
Events
Leading Age Annual Meeting
Garfunkel Wild Partner Director Debra Silverman will present at the Leading Age Annual Meeting on October 25, 2021.
Events
Behavioral Health News Webinar “This Will Only Hurt a Little – Stoicism in the Face of EHR Implementations”
Garfunkel Wild Partner Terence Russo will present at Behavioral Health News Webinar “This Will Only Hurt a Little – Stoicism in the Face of EHR Implementations” on October 13, 2021 from 1:00 pm – 2:00 pm EDT.
Alerts
COVID Health Care Worker Mandates: New York, New Jersey and Connecticut
As the Delta variant of COVID-19 continues to spread, New York, New Jersey, and Connecticut have mandated that certain health care workers be vaccinated against COVID-19.
Alerts
The NJ Health Care Transparency Act: Time is Running Out
The New Jersey Health Care Transparency Act (the “Act”) becomes effective on July 1, 2021. The Act requires health care professionals to clearly inform patients of their training and qualifications when they are providing in-person care to patients and when advertising their practice.
Alerts
Cuomo Announces End of State of Emergency in New York
On June 23, 2021, Governor Cuomo announced that the State-of-Emergency in New York declared as a result of the COVID-19 pandemic ends June 24, 2021.
Alerts
CMS Requires Health Plans To Pay For Diagnostic COVID-19 Tests
In response to tremendous confusion as to whether patients can be required to pay any amount “out of pocket” for COVID-19 tests, CMS clarified prior guidance
Alerts
Connecticut Proposes To Limit Further The Scope Of Non-Compete Provisions In Physician Employment Contracts
In Connecticut, non-compete provisions in physician employment agreements, also known as restrictive covenants, have long been considered reasonable restrictions on competition and enforceable. In order to pass muster, such provisions must be found reasonable based upon an analysis of several factors...
Events
Garfunkel Wild Webinar – Handling COVID-19 Employee Vaccinations, Updated Leave Entitlements & Addressing Violations of COVID-19 Protocols
Garfunkel Wild’s Marianne Monroy, Salvatore Puccio, and Lauren Levine will present the webinar “Handling COVID-19 Employee Vaccinations, Updated Leave Entitlements & Addressing Violations of COVID-19 Protocols” on January 26, 2021.
Alerts
Changes To New York State Compliance Program Certification Requirements
Separate Annual SSL and DRA Certifications On OMIG’s Website No Longer Required; Replaced By Annual Certification Statements
Events
New York State Society of Orthopaedic Surgeons Virtual Annual Meeting and Symposium
Barry Cepelewicz will present at the New York State Society Of Orthopaedic Surgeons Virtual Annual Meeting and Symposium – November 7, 2020.
Alerts
Borrowers of Large PPP Loans to Receive Loan Necessity Questionnaire
The Small Business Administration (“SBA”) has announced that it intends to issue two questionnaires which will be required to be completed by borrowers of Paycheck Protection Program (“PPP”) loans with principal amounts in excess of two million dollars ($2,000,000.00)
Alerts
New York Physician Practice Settings Must Inform Patients How To Report to OPMC
In legislation enacted on October 7, 2020, New York State is requiring physicians’ practice settings to post notice, visible to patients, that direct patients to the Office of Professional Medical Conduct’s (“OPMC’s”) website to obtain information about their rights and how to file a complaint regarding professional misconduct. The requirement is effective immediately.
Alerts
CMS Releases Guidance On Emergency Preparedness Testing Exercises For Inpatient And Outpatient Facilities
In a memo, dated September 28, 2020, the Director of the Quality, Safety & Oversight Group in CMS’ Center for Clinical Standards and Quality clarified that facilities that activated their emergency plans due to the COVID-19 Public Health Emergency (PHE) are exempt from their next required full-scale community-based or individual, facility-based functional exercise.
Alerts
New York Proposes to Lift the Cap on Therapy Services Provided to Medicaid Recipients
On September 2, 2020, the New York State Department of Health submitted a proposal to the Centers for Medicare & Medicaid Services (“CMS”) to remove the annual Medicaid caps for physical therapy, occupational therapy, and speech therapy visits available to Medicaid recipients. The change, planned to take effect on October 1, 2020, would remove the current limitation on the number of therapy visits a Medicaid recipient may have and, in its place, allow medical necessity to dictate the number of visits a recipient can receive in a year.
Alerts
Appellate Division, Third Department Finds That Physicians are Entitled to Receive MLMIC Demutualization Funds
On June 18, 2020, the Appellate Division’s Third Judicial Department issued a decision in the case Schoch v. Lake Champlain Ob-Gyn, P.C., No. 529615, concerning entitlement to MLMIC funds distributed in connection with MLMIC’s purchase in 2018 by National Indemnity Company, a Berkshire Hathaway subsidiary.
Events
Garfunkel Wild Webinar – Returning to Work in the COVID-Era: Employee Issues, What to Expect and How to Prepare
Garfunkel Wild’s Andrew Zwerling, Marianne Monroy, Salvatore Puccio and Lauren Levine will present the webinar “Returning to Work in the COVID-Era: Employee Issues, What to Expect and How to Prepare” on June 12, 2020.