May - August 2011
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  • 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:
1530 Dunwoody Village Parkway
Suite 209
Atlanta, Georgia 30338
Phone: (770) 804-4700
Fax: (678) 666-5667

  • The HLP's New York office has also expanded to a new location.  Please take note of the new New York address:
590 Madison Avenue
18th Floor
New York, New York 10022
Phone: (212) 734-0128
Fax: (917) 210-2952

  • 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 attorneys of the HLP regularly author articles in publications nationwide.  We invite you to read a selection of the articles we have published in May through August of this year regarding developments in healthcare law and what it can mean for your future business decisions.  As always, we encourage you to visit our website and our blog for timely guidance on regulatory developments and government actions, as well as contacting us directly by phone or e-mail to address your specific needs.
by Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., ABA eSource, August 2011.
In fiscal year 2010 alone, the Government Accountability Office estimates that $70 billion in improper Medicare and Medicaid payments were made. In March 2010, President Obama issued a Memorandum directing federal agencies to expand their use of recovery audits in an effort to reduce such improper payments. Days later, the Patient Protection and Affordable Care Act (“PPACA”) was signed into law, expanding the Recovery Audit Contractor (“RAC”) program to include claims submitted under Medicare Part C (i.e., Medicare Advantage), Medicare Part D (i.e., prescription drug benefit), and Medicaid. Although implementation of the statutory mandate to expand the RAC program has been slower than expected, the Centers for Medicare & Medicaid Services (“CMS”) is now actively moving forward with RAC program expansion. Legal counsel representing healthcare providers and suppliers ought to be mindful of this forthcoming claims scrutiny.  Learn more >
by Robert S. Iwrey, Esq. Michigan Medical Law Report, Summer 2011.
Lately, the news has been filled with stories of increased health care fraud enforcement activity on a national and local level. If misery loves company, then physicians should be comforted in knowing that they are not alone—the pharmacists are being scrutinized in unprecedented ways as well. With federal and state recognition of the widespread abuse of prescription medication, law enforcement and third party payors are focusing their attention on the source of these medications—the pharmacies and the pharmacists dispensing them—due to their role as gatekeepers of our communities.  Learn more >
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 >
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 >
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 >
by Daniel B. Brown, Esq., Sleep Review Magazine, July-August 2011.
The rise in oral appliance therapy for the treatment of obstructive sleep apnea is becoming more than an alternative to positive airway pressure (PAP) treatment. It is also becoming a natural adjunct to many dental practices. But bringing sleep into dentistry and dentistry into sleep demands the coordination of two sets of distinctively different professional skills—medicine and dentistry. Practitioners must also be sensitive to the reimbursement requirements and limitations of each. The key to a successful sleep dentistry program is for both the dentist and the sleep physician to know their roles and perform them in concert for the patient's benefit.  Learn more >
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 >
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 >
We have extensive experience with RAC audits and appeals, working directly with healthcare entities subject to RAC audits.
We represent Independent Diagnostic Testing Facilities ("IDTFs"), mobile leasing entities, radiology group practices, and other imaging providers.
We provide assistance and guidance through the legal process focused on the goal of resolving your matter successfully and efficiently.
The RAC Corner
Connect with The HLP

We regularly provide guidance to health care providers and suppliers subject to RAC audits, assisting health care providers and suppliers to successfully navigate the appeals process.

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It is our goal to provide high quality health care legal services, employing a client-focused approach emphasizing excellence in quality, responsiveness and attentiveness to our clients' business objectives.

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May - August 2011
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29566 Northwestern Highway,
Suite 200
Southfield, Michigan 48034
Phone: (248) 996-8510
Fax: (248) 996-8525
590 Madison Avenue
18th Floor
New York, NY 10022
Phone: (212) 734-0128
Fax: (917) 210-2952
1530 Dunwoody Village Parkway,
Ste. 209
Atlanta, GA 30338
Phone: (770) 804-4700
Fax: (678) 666-5667

The Health Law Partners, P.C. | Phone: (248) 996-8510 | Fax: (248) 996-8525
29566 Northwestern Highway, Suite 200, Southfield, Michigan 48034 |

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