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Physicians and Group Practices Archives

NJ healthcare insurance negotiation deal: 3 lessons

New Jersey healthcare company Humana Inc. recently adjusted its insurance offerings to expand in-network access for members. After much negotiations with local healthcare providers, the private insurance provider agreed to expand its terms to include additional physician practices.

How serious are allegations of overpayment?

Medical professionals who receive a notice of overpayment from Medicare or commercial insurance companies may find themselves facing a massive bill. These letters demand repayment, sometimes asking the health care professional to pay millions of dollars back to the insurance provider. Government agents and those who work for these commercial providers will take aggressive actions to recoup these funds, potentially including invasive investigations.

Why are private equity firms purchasing physician groups?

The purchase of physician groups by private equity firms has soared in recent years. According to a recent publication in the Journal of the American Medical Association (JAMA), private equity firms acquired 1,426 sites and almost 6,000 physicians from 2013 through 2016. Multispecialty and anesthesiology practices make up the largest portion, at 19% each, followed by emergency medicine at 12%, family practice at 11% and dermatology at 10%. Recently, increases are also noted in the fields of radiology, obstetrics/gynecology, ophthalmology and cardiology.  

CMS announces resumption of enforcement efforts

The United States Centers for Medicare and Medicaid Services (CMS) recently announced it will resume enforcement and routine inspection efforts. The agency had suspended the efforts in response to the current coronavirus pandemic in an effort to help reduce the risk of spreading the disease while also allocating resources to help with efforts for infection control and Immediate Jeopardy situations.

Are hospitals on the hook for $1B in government aid?

The current coronavirus pandemic has hit medical institutions in various ways throughout the country. Some are busy, working hard to serve patients and provide needed care. Others have slowed down as many elective procedures are on hold. Both are facing increased expenses as medical professionals and others who come into contact with patients need to wear additional personal protective equipment to reduce the risk of exposure to the virus.

Private practice and rebranding: When is the right time?

Branding is an important part of a business plan - regardless of the business. Retail stores, tech businesses and even medical practices can benefit from a solid brand. In some cases, an initial branding strategy may not achieve the expected results, or the goal of the group may change. At what point is it time to change a branding strategy? The answer will vary for each practice, but now may be a good time to review your practice's goals.

What happens if a patient accuses a NY doctor of misconduct?

Regulating boards hold physicians to high standards. State law requires these medical professionals to provide quality care to their patients while staying abreast of changes within the medical profession. Patients who are unhappy with their care may file a complaint against the physician. In many cases, this involves a filing with New York’s Office of Professional Medical Conduct (OPMC).

3 key pieces of evidence used to support healthcare fraud case

A recent healthcare fraud case out of New York, New Jersey and Pennsylvania involves two physicians and multiple other individuals who allegedly used illegal kickback payments to conduct and bill Medicare for unnecessary genetic testing. The government claims to have multiple pieces of evidence to support the claims, including:

Important lesson from recent arrest of NY doctor

New York state authorities recently attempted to move forward with criminal drug charges against a neurologist out of Brooklyn. The doctor states officers falsely placed him under arrest and wrongly sent him to prison for a week. Although the prosecution could not gather enough evidence to support criminal charges, Dr. Itay Keshet states the experience destroyed his career.

Not just for the mafia: Racketeering in medicine

The Racketeer Influenced and Corrupt Organizations (RICO) Act is a federal law that triggers visions of the mafia and other forms of organized crime. Although this law is likely most popular for those types of cases, it can play a role in health care law. Individuals or the government may use RICO charges against those who use legitimate enterprises to engage in criminal activity.

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