May - August 2011

• The HLP is proud to announce that Abby Pendleton, Esq.  has been named one of the 2011 Women in the Law by the Michigan Lawyers Weekly.   Pendleton is one of twenty (20) women lawyers selected around the State of Michigan for this award.    The list of honorees will be featured in the upcoming September 12, 2011 issue of Michigan Lawyers Weekly.  The HLP congratulates her on this great achievement!

• The HLP also congratulates Adrienne Dresevic, Esq. as she has been appointed the chair of the American Bar Association’s (ABA) Health Law Section’s Health eSource during the 2011-12 Bar Year.  The ABA Health eSource is a monthly electronic newsletter with articles on the most recent updates in health law.

• The HLP congratulates Robert S. Iwrey, Esq. for being recognized as a 2011 Michigan Super Lawyer in Healthcare as selected by his peers.  No more than five (5%) percent of the lawyers in Michigan are selected for inclusion each year.  Iwrey was also selected as a Super Lawyer in Healthcare in 2010.

• The HLP moved its Atlanta office to larger quarters! Please take note of the new Atlanta address and phone number:

• The HLP's New York office has also expanded to a new location.  Please take note of the new New York address:

 

• The HLP is excited to welcome Alan G. Gilchrist, Esq. as a Partner in the firm.  Gilchrist joined the HLP in May from Foster, Swift, Collins & Smith, P.C. and leads the firm’s Civil False Claims and White Collar Criminal Defense Practice Group.  His nearly-40-years of experience and highly respected reputation in the legal community, locally and nationally, represents a coveted new addition to the firm.

• The HLP welcomes the newest addition to its team of attorneys: Timothy Burkhard, Esq.  Burkhard joined the firm in June from Foster, Swift, Collins & Smith, P.C. and practices in all areas of health care law, including Civil False Claims Act and white collar criminal defense and representing providers and suppliers in third party payor audit appeals.

• Upcoming Speeches – The HLP’s attorneys are invited to speak at conferences nationally regarding the most recent developments in healthcare law.  Please click here for a list of all of HLP’s upcoming speaking engagements, as well as a list of our past speaking engagements.

The Future of the Recovery Audit Contractor Program

by Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., ABA eSource, August 2011.

Are You Questioning My Authority? With Increased Scrutiny of Pharmacy Claims, Physicians Should Not Be Surprised when the Pharmacist Calls

by Robert S. Iwrey, Esq. Michigan Medical Law Report, Summer 2011.

CMS Finally Speaks: The Accountable Care Organization (ACO) Proposed Regulations and What They Mean for Anesthesiologists

by Kathryn Hickner-Cruz, Esq. and Neda Mirafzali, Esq., Communique, Summer 2011.

Since the passage of the Affordable Care Act and the establishment of the Medicare Shared Savings Program (the “Shared Savings Program”), ACOs have become the new hot topic.  Section 3022 of the Affordable Care Act provides that Medicare shall establish the Shared Savings Program and that healthcare providers and suppliers will participate in the Shared Savings Program through ACOs. According to CMS, “ACOs create incentives for healthcare providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Shared Savings Program will reward ACOs that lower growth in healthcare costs while meeting performance standards on quality of care and putting patients first.”  If an ACO saves money by providing patients with efficient care, then the ACOs can share in a percentage of the savings with Medicare. However, should an ACO fail to provide efficient and cost-effective care, it may be required to pay money back to Medicare.  Learn more >

Professional Component Cuts Proposed for 2012

by Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq., AHRA Link, August 2011.

On July 19, 2011, the Centers for Medicare and Medicaid Services (CMS) published the 2012 Proposed Physician Fee Schedule (PPFS), which includes the proposed application of a multiple procedure payment reduction (MPPR) to the professional component (PC) of advanced imaging tests if (i) furnished to the same patient, (ii) by the same physician, (iii) during the same session. This proposal is responsive to the Medicare Payment Advisory Commission (MedPAC) recommendations to Congress regarding ancillary imaging services (see the July Regulatory Review column, which analyzes MedPAC’s 2011 recommendations to Congress in greater detail). CMS estimates that this PC payment reduction would reduce payments for these services by approximately $100 million.   Learn more >

MedPAC Recommends Changes to Diagnostic Imaging Payments and Policy

by Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq., AHRA Link, July 2011.

The provision of physician in-office diagnostic imaging services has continued to expand in recent years, accounting for a significant share of Medicare Part B revenue for certain specialties. In its June 2011 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) asked Congress to reevaluate the reimbursement and provision of ancillary imaging services by making recommendations designed to improve payment accuracy for imaging and other diagnostic tests, and ensure the appropriate use of advanced imaging studies.  Learn More >

Taking a Bite into Oral Appliance Therapy

by Daniel B. Brown, Esq., Sleep Review Magazine, July-August 2011.

CMS Issues Final Rule on Credentialing and Privileging for Telemedicine

by Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq., AHRA Link, June 2011.

The Centers for Medicare and Medicaid Services (CMS) issued its final rule for telemedicine credentialing and privileging for hospitals and critical access hospitals (CAHs) on May 5, 2011. The Final Rule is effective July 5, 2011 and amends the conditions of participation (CoPs) for hospitals and CAHs, creating a more streamlined process for credentialing and privileging of telemedicine physicians.  Learn more >

Fraud, Waste and Abuse Education: Avoid Becoming a Target Despite Increasing Government Scrutiny of Michigan Providers

by Robert S. Iwrey, Esq., Health Plus Pharmacy News Bulletin, May 2011.

On February 17, 2011, 111 defendants were charged in 9 different cities with defrauding Medicare for more than $225 million, 21 of which are from the Detroit area. This marked the largest coordinated Medicare fraud action ever taken. The Healthcare Fraud Prevention & Enforcement Action Team (aka “HEAT”) has been active in the Detroit area since March 2009. HEAT is an intra-agency effort whereby agents from the OIG, DOJ, FBI, DEA, and other federal and local law enforcement agencies have shared information and resources to investigate and prosecute fraudulent health care matters in both the criminal, civil and administrative realms.  Learn more >

May - August 2011