In this Issue
From the Chair
Guide to Terms
Welcome
Ober|Kaler in Print
Hospitals
Hospital Discounts to Uninsured Patients
OIG Activity
OIG Advisory Opinions
OIG Alert: Added Charges for Covered Services
CMS Developments
Unsolicited/Voluntary Medicare Refund Requirements
CMS Accepts Electronic Comments
Pharma
CMP Rule, Guidance Set Gauge for Drug Card Sponsors
Medco Settlement Excludes FCA Claim Citing Compliance Plan Deficiencies
Nonphysician Practitioners
Hospital "Credentialing" of Nonphysician Employees
Compliance
The Evolution of Risk Management to Corporate Compliance and Beyond
OIG Updates Hospital Compliance Program Guidance
AdvaMed Code Curtails Lavish Spending
Reimbursement
CMS Proposes Changes to Reimbursement Appeal Rules
Revised Policies Affect Direct Deposit Medicare Funds
New Changes to Medicare Medical Education Rules
FY 2005 Wage Index: Where Are You Now?
Self-Referral
CMS Sets Criteria for Specialty Hospital Moratorium
EMTALA
New EMTALA Guidance
EMTALA Compliance - Practical Considerations
FCA
First Circuit: Rule 9(b) Applies to FCA Actions
Standard for Dismissal Misapplied in Qui Tam Case
Government Required to Exhaust Administrative Remedies in Non-FCA Case
Litigation/ADR
University of Washington PATH Settlement is Largest Yet
Fraud Statute Unconstitutional
Tax
Beyond Saber Rattling: Congress Threatens Aggressive Regulation of Nonprofits
Business
Consider Broker-Dealer Compliance in Stock and Securities Sales
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Ober|Kaler in Print
- Ober|Kaler's Health Law Department is one of the nation's leading health care practices, according to Chambers USA, America's Leading Lawyers for Business 2004, The Client's Guide, with Len Homer and Sandy Teplitzky as "star performers."
- Nightingale's Healthcare News ranked Ober|Kaler's Health Law Department among 20 of the Nation's Largest Healthcare Law Practices in its April/May 2004 issue. The same issue named Sandy Teplitzky as one of twelve Outstanding Fraud and Compliance Lawyers - 2004.
- Jullie Kass was named among the nation's "Outstanding Young Healthcare Lawyers 2004" in the September/October 2004 issue of Nightingale's Healthcare News.
- Nightingale's Healthcare News selected Steve Smith as one of twelve "Outstanding Hospital Lawyers - 2004," a list culled from a national selection, in the June/July 2004 issue.
- Tom Coons, Carel Hedlund, and Leslie Goldsmith co-authored "Beneath the Hype: MMA Provisions You Need to Know," an article appearing in the June 2004 issue of Healthcare Financial Management.
- Medicare Compliance Alert quoted Craig Holden in "Voluntary Disclosures: Providers Tell What They Went Through," a May 3, 2004, article discussing the experiences of providers who voluntarily self-reported compliance problems through the OIG's self-disclosure protocol.
- The Baltimore Business Journal "In Depth: Health Care" report featured Sandy Teplitzky in the May 28, 2004, article, "Health Care's Problems Take Money Maryland Doesn't Have," in which he discusses a multitude of health care-related issues, including health care access, the impact that the Medicare and Medicaid programs have on businesses, and health care legislation.
- Laboratory Compliance Insider quoted Bill Mathias in "What Labs Need to Know About New Stark Phase II Regs," a June 2004 article in which he discusses provisions of the Phase II final Stark regulations that may be relevant to laboratories.
- Rob Mazer was quoted by the September 2004 Laboratory Compliance Insider in "Train Phlebotomists to Avoid Activities that Appear to Induce Referrals," and "Get Referring Physicians to Comply with Policy," in which he discusses the policies that laboratories should set for phlebotomist duties and advises laboratories placing phlebotomists in physician offices to make sure those policies are communicated to the physicians.
- Tom Hyatt was quoted by BNA's Health Law Reporter in the May 13, 2004, article, "Revenue Ruling Gives IRS Blessing to Joint Venture with Shared Control," discussing the implications of the IRS's revenue ruling approving an ancillary joint venture between an exempt university and a for-profit corporation specializing in interactive video training.
- Laboratory Compliance Insider quoted Leslie Goldsmith in "Understand the Switch from LMRPs to LCDs," a September 2004 article discussing Medicare contractors' transition from local medical review policies to local coverage determinations.
- Craig Holden was quoted by Medicare Compliance Alert in the May 24, 2004, article, "Compliance Effectiveness: CMS Program Raises Some Hospital Fears," in which he discusses provider skepticism regarding CMS's pilot project measuring the effectiveness of hospital compliance programs.
- BNA's Health Care Program Compliance Guide quoted Sandy Teplitzky in "HHS Seeks to Clarify Medicare Implications for Limited-Means Patient Billing Practices," a May 17, 2004 article discussing hospitals' struggle to comply with applicable Medicare laws and regulations as they search for ways to accommodate financially needy patients who are unable to pay their hospital bills.
- Bill Mathias was quoted by Laboratory Compliance Insider in "What Labs Need to Know About Amended Sentencing Guidelines," a July 2004 article in which he discusses the revised compliance elements under the Federal Sentencing Guidelines.
- BNA's Health Law Reporter quoted Sandy Teplitzky in "With Little Help from Feds, Hospitals Explore Ways to Fix State Physicians' Insurance Woes," a September 23, 2004, article discussing current trends in medical malpractice insurance assistance that hospitals are offering physicians. The article quotes Mr. Teplitzky from "The Physician Malpractice Insurance Crisis: Can Your Hospital Help . . . Without Meeting the Inspector General?" the AHLA teleconference he co-presented in March 2004.
- Rob Mazer's article, "Stark II - Phase II Rulemaking: Are We There Yet? New Regulations Complete Two-Phased Rulemaking," discussing provisions of the Stark II Phase II rulemaking that are potentially significant to clinical laboratory services providers, appeared in the May 2004 G-2 Compliance Report.
- BNA's Health Law Reporter quoted Tom Hyatt in "Nonprofits Pressured to Stay 'Ahead of the Curve' on Governance," an August 5, 2004, article discussing the current legal climate that is causing nonprofit health care organizations to take a closer look at their governance.
- CCH Healthcare Compliance Letter published Sandy Teplitzky and Steve Smith's article, "EMTALA Compliance: Practical Considerations," in its June 1, 2004, "On the Front Lines" column.
- Laboratory Compliance Insider quoted Bill Mathias in the August 2004 article, "Get Updated Info on How to Make Voluntary Refunds," in which he discusses a recent CMS transmittal instructing Medicare contractors on how to process voluntary refunds received from providers.
- Sandy Teplitzky and Steve Smith's article, "Hospital 'Credentialing' of Non-physician Employees," appeared in the May 17, 2004, "On the Front Lines" column of CCH Healthcare Compliance Letter.
- Howard Sollins was quoted by the Baltimore Business Journal in the October 1, 2004, article, "Bush or Kerry: Whose Health Care Plan Is Better for Your Business?" discussing the respective plans for the nation's health care that Bush and Kerry are promoting in their presidential campaigns.
- Medical Economics quoted Sandy Teplitzky in "The Feds Take Aim at Kickback Schemes: Scrutiny is Increasing," an October 8, 2004, article in which Sandy discusses the government's more aggressive investigation of potential kickback cases and offers a standard by which to measure relationships involving an exchange of financial consideration.
and elsewhere.
- Tom Hyatt was presented with the American Health Lawyers Association's prestigious David J. Greenberg Service Award, referred to as the "lifetime achievement award" for health lawyers, at the AHLA's annual meeting in New York.
- Rob Mazer presented "Legal Issues in Health Care (Stark, Anti-kickback, Fraud and Abuse, etc.)" at the AGA GI Practice Management Skills Workshop presented by Center for GI Practice Management and Economics.
- At the AHLA Fraud & Compliance Forum, Craig Holden presented the "Fraud and Abuse Primer" and Sandy Teplitzky co-presented "Stark II - Phase II: A Discussion of Additional Exceptions Addressed by the Phase II Final Stark Regulations and Clarifications to the Phase I Final Regulations" with Kevin G. McAnaney, former Chief of the Industry Guidance Branch of the Office of Counsel to the Inspector General.
- Rob Mazer presented "Hospital-Based Pathologist Compensation: Getting What You Pay For" at the 2004 Lab Institute sponsored by Washington G-2 Reports.
- Steve Smith presented "Improving Patient Safety and Protecting the Process: Barriers, Enablers and Legal Issues" at The Quality Colloquium of Harvard University.
- Carel Hedlund co-presented the AHLA audio conference, "Annual Update of Select Provisions of the Medicare Inpatient Prospective Payment System Rule," at which she discussed the FY 2005 wage index and geographic classification changes resulting from the revised OMB designations based on the 2000 Census and other MMA-required changes.
- Howard Sollins has become one of the inaugural members of the American Health Lawyers Association Ambulance/Medical Transport/EMS group within the AHLA's Hospital and Health System Section. He has been elected as the liaison to the Association of Air Medical Services on air ambulance issues on behalf of the group.
- Leslie Goldsmith spoke at the Annual Institute of the Healthcare Financial Management Association's Maryland Chapter on October 7 regarding "Recent Legal Developments Affecting Maryland Healthcare Providers."
- Tom Hyatt presented "Legal Issues: Governance Best Practices for Nonprofit Boards" at the AHLA's 2004 Tax Issues for Healthcare Organizations.
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