Tuesday, November 13, 2012
Department of Health and Human Services (HHS) under greater fire from American Hospital Association (AHA), hospitals, and other entities for RAC audits
Thursday, November 1, 2012
Any director or officer of a hospital system or primary care doctor with his/her own practice will tell you--without Medicare reimbursements, your overall reimbursement will be low regardless of the diversity of your payer mix. It is a chance many won't take. One bad audit can set a company back for months despite the outcome of the appeals process.
Tuesday, October 30, 2012
Thursday, October 25, 2012
Law Review CLE has combined its training seminar with a Wisconsin Bar Seminar on Trademarks on October 30th, 2012. For those who wish to attend, the following details can be found below:
- Initial Interview
- Asset Purchase and Sale Agreement
- Employment Contract
- Independent Contractor Agreement
- Commercial Lease
- Conflicts of Interest: ABA MRPC Rule 1.7, 1.8
- Duties to Former Clients: Rule 1.9
- Imputation of Conflicts: Rule 1.10
- Confidentiality of Information: Rule 1.6
- Communications: Rule 1.4
- Fees and Expenses: Rule 1.5
- Contingency Fee Agreements: Rule 1.5(c)
- Misconduct: Rule 8.4
- Reporting Professional Misconduct: Rule 8.3
- Candor Toward the Tribunal: Rule 3.3
Monday, October 15, 2012
“We have a great line-up of experts on the topic representing all stakeholder categories..." listing Mr. Kasmikha as one of those experts. It should be a great event.
Monday, September 24, 2012
Sponsored by Running Man Courier & Process Services, Steward Media, Bienenstock Court Rep
Thursday, June 28, 2012
However, on Thursday, June 28, 2012, the Court issued a 193 page opinion, by Chief Justice Roberts, stating that although it violates the Commerce Clause, Congress did not act unconstitutionally in its power to tax Americans who choose not to buy health insurance and it was not the court's "role to forbid it, or pass upon its wisdom or fairness." The "mandate" is in fact a tax that would be imposed on those who choose not to purchase health insurance. While the broad, 900+ bill encompasses far more than just the individual mandate, including free mammograms for Medicare recipients, eligibility requirements, coverage for Americans until 26 years of age, and more, the individual mandate was the center of attention in this long anticipated opinion.
Read the full opinion here.
The court upheld the mandate in a split 5-4 opinion in favor of the provision. Many analysts, political commentators, and lawmakers anticipate this will not be the last legal battle involving President Obama's health care reform bill, and this will not be the only provision in question.
Friday, February 10, 2012
After massive uproar, Obama administration gives in on requiring religious institutions to provide coverage for contraception.
With a divided White House staff having weighed in publicly on the issue, President Obama announced today in a press conference a compromise that both Planned Parenthood and the Catholic Health Association approved of regarding employee coverage for contraception.
The compromise would allow for women to obtain birth control directly from their insurance companies rather than requiring religious institutions like Catholic hospitals and universities to provide free contraception.
Vice President Joe Biden and Defense Secretary Leon Panetta, both Catholics, were very opposed to the initial proposal of requiring Catholic institutions to provide free contraception. At issue was whether employers should be required to broaden the scope of their coverage to include medication or procedures that violate some of their core tenants. While proponents of such a measure argue that Catholic hospitals and universities employ many non-Catholics, opponents argue that the employees are aware they are working for a Catholic institution with a Catholic mission. Also, many of the hospitals and universities in the United States are private or religiously affiliated, and would not want such mandates as part of their health coverage for their employees. Such a requirement may significantly change the dynamic of health care employers.
While their has been a massive backlash by various organizations against this law and the administration for its support of it, the Obama administration has recently voiced its confidence that the issue would be resolved. Other lawmakers, such as Senator John Kerry, also a Catholic and opposed to the mandate, believed it would be resolved. Today, President Obama announced that a compromise had been reached, but time will tell whether the debate will continue and whether all parties will be satisfied. While proponents of the language believe that President Obama has once again caved to the right, and in this case the religious right, Catholic Bishops and other organizations may decide that the compromise does not go far enough.
Pfizer Recalls 1 million Birth Control Pills- Both sides brace themselves for potential lawsuits and legal arguments
Many women taking this pill could potentially be pregnant, but does this mean that Pfizer needs to rush to the phone to contact every woman who has taken the pill and start talking settlement? This is one of the many questions the legal experts are now exploring, with mass tort and product liability attorneys in a frenzy to execute an effective marketing plan to bring in the clients.
Pfizer is probably not looking to quickly resolve the matter with 1 million customers. Potential clients will be screened by attorneys and their medical experts to show that they took the drug, got pregnant when they took the drug, took the correct or recommended dosage, and that Pfizer’s negligence was a but-for proximate cause of the pregnancy. Pfizer’s attorneys undoubtedly have been very busy strategizing how to structure settlement packages. Fighting faulty birth control packages in trial could be disastrous for the company that has already been seeing recent diminishing profit margins.
Wednesday, January 18, 2012
Conflict of Interest: Onus put on drug firms this time to report on financial relationship with doctors
What has recently become major news for the public regarding the government’s latest steps in healthcare reform has been an ongoing legal matter followed by healthcare attorneys for years.
I have done a lot of work with physicians and hospitals who have had to disclose their relationship with pharmaceutical and medical device companies. Now, the New York Times has published an article on a government initiative requiring the drug makers themselves to disclose their financial relationship with doctors.
For years the legal and medical community have closely followed the potential conflict of interest issues arising from a relationship between doctors and pharmaceutical companies. While the companies don’t directly pay doctors to endorse their drugs, as that would be illegal, there are other ways around such endorsements. Certain doctors are targeted to do research, publish on, and give their expert opinion and consultation on certain drugs, their side effects, and positive results. They are to be honest and objective. However, they do this while the pharmaceutical companies pay for their trips to overseas seminars, panel discussions, lodging, speaking fees, etc. The assumption is that anything short of a ringing endorsement for the drug will likely lead to the doctor not being invited back. However, the doctors argue that they are not only objective, but base their findings on extensive research and peer reviewed studies and publications. In either case, most leading institutions, like the University of Michigan’s Hospital in Ann Arbor and the Cleveland Clinic agree that such a relationship should be disclosed. These institutions have done so publicly, including on their websites. This has been an epidemic for years with news publications in the past. See the following:
The link above is a ringing indictment on psychiatrists, who the article cites as the top profiteers of such a relationship. It has listed, along with the names, photos, and bona fides, a number of psychiatrists who gained a lot financially while not disclosing their relationship with their patients or the institution that employs them. In some cases, the results of their research was also found to be extremely skewed and flawed. That was published in 2009. One of the concerns underlying this problem was that many psychiatrists who did not work for pharmaceutical companies relied on the expert opinions of these doctors and their publications in prescribing and recommending the drug to their patients.
This past year, ABC news covered a similar story in March 2011. This was an editorial that also focused on psychiatrists.
On July 2, 2011, another article was published on Harvard Doctors being disciplined for similar issues.
That focuses on how Harvard and Mass General expected, but did not heavily monitor or enforce their physicians to report such financial relationships.
Disclaimer on Assumptions: The public may read about these stories and assume that a drug company is approaching doctors and giving them money directly to promote their drug, praise it as effective, and marginalize any potential side effects. This is not true. As stated earlier, they are hired for objective research and as consultants based on their expertise. The government has now put pressure on the drug companies themselves to report since many institutions and physicians have not done so. It is also worth noting that many of these endorsements are in fact sincere and objective and not based on any financial incentive. Many physicians may actually like the drug and base their opinion on thorough research.
Practical solutions: Institutions have agreed and the government is more intent on enforcing disclosure. Regardless of intent, how do you put aside the insinuation that if a physician is a paid consultant or has any financial arrangement with a drug company that it is impossible to give a truly objective recommendation for treatment? Many respected institutions recognize the difficulty in that and have taken serious measures. One suggestion is that the consulting or endorsing physician not be allowed to prescribe the drug to any of the patients at the institution that employs him/her. Furthermore, they may refer out any patients that may be a candidate for that drug. The key is to keep both jobs separate in order to avoid conflict.
Doctors should not be prohibited from advising pharmaceutical and medical device companies. It helps for the effectiveness of such drugs and even medical devices and may promote innovation. However, disclosure of the relationship and separating the jobs as much as possible to avoid conflict of interest issues is becoming as much a legal necessity as it is a medically ethical one.
Posted by Attorney Saif R. Kasmikha
Midwest Legal Partners, LLC
Tuesday, January 17, 2012
An article was published earlier this month about physicians in small private practices “going broke” due to a number of factors which include the evolving healthcare system, declining reimbursements, and a lack of business acumen. This article details the changes and includes a couple of anecdotes, including that of a respected oncologist.
I am inclined to agree with most experts, citing a lack of business acumen as a leading reason for the decline. However, there is also an important element left from the piece. While the article cited a change in a few laws, it did not emphasize the lack of continuous and/or effective counsel in guiding the physicians through these changes over the decades. While business acumen is important, it wasn’t always necessary to help these practices continue to thrive over the years. On many occasions, a physician’s knowledge, expertise, and exceptional quality of treatment administered among his/her patients was more than enough to not only sustain a practice, but to help it grow and expand. It brought new business and repeat business. On the same token, no amount of business expertise, marketing advice, paid advice by consultant firms, etc. could compensate for inferior care and substandard treatment.
Granted there may be a bias that this is coming from an attorney, but physicians and healthcare institutions, now more than ever, need legal counsel! Every way that a practice is being reimbursed is subject to review and reform by Federal and state government. This even includes reimbursement for prescription drugs. The passing of the Patient Protection and Affordable Care Act is not the end of this chapter. Many of its provisions will be taking effect over the next several years and will have a major impact on private practices. Those that are constantly informed and counseled will stand a better chance of weathering the storm over those who wait until something happens and require counsel for damage control. This article is especially illustrative about how even those physicians who are well respected in their locale and medical community are not safe if they are not made aware of the changes. Many of these incidents may have been prevented with a healthcare attorney advising the practice on a regular basis.
Midwest Legal Partners, LLC
Posted by Attorney Saif R. Kasmikha
Midwest Legal Partners, LLC