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New York Health Care Law Blog

New proposal could impact hospital billing practices

The House Energy and Commerce Committee recently released a proposal that targets “unexpected charges” to patients for care received at hospitals. The lawmakers behind the bill state they are attempting to remove the issue of surprise billing for patients in both emergency and non-emergency situations.

Buying a medical practice? Tips for success.

Although due diligence is important in any merger or acquisition transaction, deals that involve purchasing a physician practice offers unique obstacles. Whether a new physician looking to take over another doctor’s practice or a private equity firm looking for an investment, an interested buyer can mitigate the risk that comes with these hurdles by including these questions in the due diligence process:

Medical practices and succession plans: 3 triggers

Building a business is a labor of love. Entrepreneurs spend long hours researching their market and making sure their operations are in compliance with applicable rules and regulations. Although all business owners work hard to get their enterprises up and running, those who start a medical practice are balancing more than just their business' success, they are also balancing the interest of the patient.

A medical practice is more than just a successful business, it is a facility that provides care to patients. This makes it even more important for medical practice owners to have a succession plan. Without a succession plan not only will the owners put themselves at risk for business failure, but they also risk their patient's ability to receive medical care.

New York doctor arrested as part of federal sting

Federal agents recently arrested a New York cardiologist as part of a large national sting. Prosecutors have accused the physician of illegally distributing prescription pain pills. The prosecutors state the physician, who has worked at a hospital in the Syracuse area for approximately three months, worked with another doctor and nurse practitioner while employed at his previous practice in Tennessee to improperly prescribe opioids.

Although not yet convicted of the crime, the hospital has put the medical professional on administrative leave.

Patient accuses doctor of causing nerve damage with epidural

A woman hospitalized for severe back pain has accused her physician of causing nerve damage when he administered an epidural injection for pain management. The treatment occurred in 2015 and the case is scheduled to begin in May of 2019.

Will the billion-dollar fraud case lead to even more charges?

The government recently announced a billion-dollar health care fraud case. The scam allegedly involved sending Medicare recipients shoulder, knee, ankle, wrist and back braces. In most cases, the patients did not need the braces. In others, the patients never received the braces. The companies would then charge Medicare for the cost of the braces, whether patients received them or not. Ultimately, the government states the scheme resulted in a loss of over one billion dollars.

NY labs: New rule goes into effect in October

The Eliminating Kickbacks in Recovery Act of 2018 (EKRA) is a new federal law that applies to diagnostic and clinical labs throughout the country. The law is a part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT). It takes effect October 24, 2019.

What exactly does EKRA cover? Lawmakers wrote the law to expand the ability of prosecution to go after kickbacks in the medical field.

Home health company sues HHS and federal contractor

Home health companies often rely on payments from Medicare to continue operations. Even a brief suspension in these payments can be detrimental to patient care and business. In this case, a home health company alleges a federal contractor wrongly continued a suspension of Medicare payments for months, ultimately leading the home health business to shut down.

DOJ accuses dozens of doctors of exchanging sex for prescriptions

The United States Department of Justice (DOJ) continues to crackdown on opioid prescription violations. Most recently, the government has accused multiple medical professionals of illegally prescribing these medications in exchange for financial gain and sexual favors.

Overall, the government has alleged the case involves 31 doctors behind over 350,000 illegal opioid prescriptions.

Paramedic gets fired after following patient's wishes

A paramedic alleges his employer terminated his position because he followed a patient’s request instead of adhering to conventional medical practices. The patient was suffering from a serious infection and asked the paramedic not to move forward with an intraosseous infusion (IO). The procedure, which essentially involves using a drill like device to insert an IV into the patient's bone, would be the conventional practice recommended in this instance. The patient declined treatment. Instead of pushing or forcing the issue, the paramedic honored the patient's wishes.

Supervisors disagreed with the paramedic’s decision. As a result, the paramedic has accused the employer of wrongful termination.

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