Ober, Kaler, Grimes & Shriver, A Professional Corporation  
Ober|Kaler Health Law Alert - Spring 2005




In this Issue

From the Chair

Congratulations

Guide to Terms

Ober|Kaler in Print

OIG Activity
OIG Approves Six Gainsharing Arrangements

OIG Advisory Opinions

OIG 2005 Work Plan

CMS Developments
CMS Proposes Plan to Pay Unpaid Costs of Emergency Health Care

Trailblazer Fraud Alert Reveals Provider Identity Theft

Long Term Care
Discerning the New Pressure Ulcer Guidelines

Pharma
TAP Pharmaceuticals Settles with Lupron Consumers

Hospitals
Pay for Performance: Will Your Hospital Be Ready?

Nonphysician Practitioners
"Incident To" Rule Changes

Compliance
OIG Finalizes Supplemental Hospital Compliance Guidance

OIG's Supplemental Hospital CPG Looks at Hospital-based Physicians

OIG/AHLA Release Second Compliance Resource

Reimbursement
IRF "75 Percent Rule" Blocked

Correct Minor Errors and Omissions Without Appeals

Self-referral
Hospitals Meet "Under-development"

FCA
Courts Apply Strict Interpretation of Officer or Employee Under FCA

Lack of Pharmaceutical Recycling Guidance Precludes FCA Liability

Questionable Incentive Program Raises FCA Liability

Enforcement
Supreme Court Declares Sentencing Guidelines "Advisory"

Tax
IRS Penalizes Health System for PAC/Payroll Deduction Plan

Antitrust
DOJ/FTC Report on Antitrust in Health Care

Physican Focus
Physician Retention Arrangements: Stark and Antikickback Issues

Employment
Alien Certification Exemption to Avert Staffing Crisis

 

Ober|Kaler in Print

  • Chambers USA, America's Leading Lawyers for Business 2004 The Client's Guide recognized Ober|Kaler's Health Law Department as one of the nation's leading health care practices, making particular note of our strengths in reimbursement and regulatory issues and our "star performers" Len Homer and Sandy Teplitzky.

  • Nightingale's Healthcare News named Leon Rodriguez as one of twelve "Outstanding Healthcare Litigators-2004," a list culled from a national selection.

  • Tom Hyatt edited, coordinated, and authored a chapter in Ober|Kaler's The Nonprofit Legal Landscape, recently released by BoardSource. Additional chapter authors included Marty Rogers, Leon Rodriguez, Patrick O'Hare, and Steve Smith.

  • Tom Coons' article, "New Changes to Medicare Medical Education Rules," appeared in the March 4, 2005 issue of Health Lawyers Weekly, American Health Lawyers Association's online newsletter.

  • Carel Hedlund's article, "FY 2005 Wage Index and Geographic Classifications: Where Are You Now?" appeared in the November 2004 issue of Dennis Barry's Reimbursement Advisor.

  • Bill Berlin's article, "The July 2004 Joint DOJ/FTC Antitrust in Healthcare Report's Practical Implications for Hospitals and Physicians," appeared in the February 2005 issue of AHLA's Health Lawyers News and in the January 14, 2005, issue of AHLA's online newsletter, Health Lawyers Weekly.

  • Bill Mathias' article, "Notes from the HIPAA Enforcement Road," has appeared in Health Information Management Manual 2nd edition, AAMS News and Views, (newsletter of the Association of Air Medical Services); VAHC Newsletter (Virginia Home Care Association); Kansas Home Care Association Newsletter; CAHSAH Bulletin (California Association for Health Services at Home); and Bulletin on Long-Term Care Law.

  • Donna Senft's article, "Meeting Resident Needs: Trained Feeding Assistants," appeared in the September 2004 issue of Health Lawyers Weekly, the AHLA's online newsletter.

  • National Intelligence Report quoted Rob Mazer in "OIG Adds New Twist to Hospital-based Physician Pay," a February 21, 2005, article discussing the OIG's treatment of relationships between hospitals and hospital-based physicians in its final supplemental compliance program guidance for hospitals.

  • Patrick O'Hare was quoted by BNA's Health Law Reporter in the March 10, 2005, article, "Stakeholders Confront Host of Issues Attendant on Pay for Performance Systems," and by BNA's Medicare Report in the March 11, 2005, article, "Stakeholders Confront Issues on Pay for Performance Systems." In the articles, Patrick discusses the implications of recent initiatives promoting payment programs that base physician contracting or physician compensation on certain quality measures.

  • John Lessner's article, "Unsolicited/Voluntary Medicare Refund Requirements," appeared in the December 2004 issue of Health Lawyers Weekly, the AHLA's online newsletter.

  • Tom Hyatt was quoted by BNA's Health Law Reporter in the February 10, 2005, article, "IG OKs Gainsharing Arrangement Between Hospital, Surgeons Group," in which he discusses potential changes to the IRS's treatment of gainsharing arrangements in light of the OIG's recent approval of such an arrangement between a hospital and a group of heart surgeons.

  • Patrick O'Hare's article, "How to Structure Your Next Equipment Lease," appeared in the September 2004 issue of Health Lawyers Weekly, the AHLA's online newsletter.

  • Medical Economics quoted Sandy Teplitzky in "The Feds Take Aim at Kickback Schemes," an October 8, 2004 article discussing various types of physician referral relationships that may appear illegitimate when placed under government scrutiny.

  • BNA's Health Law Reporter quoted Bill Mathias in "OIG Final Hospital Compliance Guidance: Helpful Advice, Debatable Interpretations," a February 24, 2005, article discussing the implications of the OIG's final supplemental compliance program guidance for hospitals.

  • Steve Smith's article, "Hospital Credentialing of Non-physician Employees," appeared in the March 2005 issue of AHLA's online newsletter, Health Lawyers Weekly.

  • Patrick O'Hare and Tom Hyatt's article, "Beyond Saber Rattling," discussing new legislative proposals that are threatening aggressive regulation of tax-exempt health care providers, appeared in the February 2005 HFM Magazine.

  • Christine Morse's article, "Hospital Discounts to Uninsured Patients," appeared in the March 2005 issue of AHLA's online newsletter, Health Lawyers Weekly.

    and elsewhere.

  • Len Homer, Sandy Teplitzky, and Tom Hyatt have been invited to become Charter Fellows in the inaugural class of the American Health Lawyers Association's Health Fellows Program, a highly selective program recognizing the substantial contributions of the AHLA's lifetime members. Nominated by AHLA's Board of Directors, only candidates who are regarded among the top health lawyers in their communities and who have actively served in the organization for at least 15 years are considered. Only 40 former AHLA presidents and past leaders were nominated for the program's inaugural class.

  • Rob Mazer presented "Self-referral Laws" at the Maryland Medical Group Management Association's seminar, Compliance: Touching All the Bases.

  • Craig Holden presented a general session on fraud and abuse issues affecting children's hospitals at the Child Health Corporation of America 2005 Corporate Compliance Forum.

  • Jeff Miles co-presented "The Agencies' 2004 Report on Improving Health Care: Comments on the Report and Its Aftermath" at the ABA Antitrust Law Section's 2005 Spring Meeting held March 30 - April 1, 2005.

  • Carel Hedlund presented "Medicare Fundamentals Parts A, B, C, and D" at the Introduction to Health Law Series sponsored by the District of Columbia Bar and George Washington University School of Public Health and Health Services.

  • Rob Mazer presented "Key Compliance Concerns for Labs in 2005," a Tips on Tape audiotape recorded by Washington G-2 Reports for its G-2 Compliance Report subscribers.

  • Craig Holden presented "Hospital-physician Recruitment and Retention: What You Can and Can't Do" at UCG's 9th Annual Compliance Strategies program.

  • At the AHLA's Long Term Care and the Law conference, Leon Rodriguez presented "Compliance and Cooperation Under the Thompson Memo and the New Organizational Sentencing Guidelines," and Howard Sollins co-presented "Special Considerations in the Care of Non-Geriatric/ Non-Traditional Residents of Long Term Care Facilities" with Wendy Kronmiller, Director of Federal Programs at the Maryland Office of Health Care Quality.

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