| About Alice G. Gosfield (Agosfield@gosfield.com)
ALICE G. GOSFIELD, Esq.’s entire legal career has been restricted
to health law with an emphasis on representation of physicians and
their group configurations and a focus on non-institutional reimbursement
including Medicare; managed care; fraud and abuse compliance and
avoidance; medical staff issues and utilization management and quality
issues. A graduate of Barnard College and New York University School
of Law, since 1973 her varied health law career has ranged from an
OEO ("War on Poverty") and then DHEW funded research program
to develop a consumer-oriented analysis of the PSRO law, to drafting
codes of regulations for state health care agencies, and since 1978
to include the private practice of law.
Ms. Gosfield served as Chairman of the Board of Directors of the
National Committee for Quality Assurance, reelected to serve five
terms from 1998 through 2002. She served on the Board for twelve
years from1992 through 2003. In the public policy arena, she has
served on four committees of the Institute of Medicine of the National
Academy of Sciences studying issues involving utilization management
and clinical practice guidelines and has served as an advisor to
the Agency for Health Care Policy and Research in both evaluating
one of their first three clinical practice guidelines and in developing
methodologies to translate guidelines into medical review criteria,
performance measures and standards of quality. She has been named
to the Ethics and Professionalism Task Force of the American Board
of Medical Specialties. She participated as an Advisory Board Member
of a small group convened by the American College of Physicians to
serve for three years in developing an approach to pay for performance.
She was the first Chairman of the Board of PROMETHEUS Payment®,
Inc. (www.prometheuspayment.org) a not-for-profit, national, multi-stakeholder
project to develop a new provider payment model (PROMETHEUS Payment®)
that bases provider payment on the cost of delivering guidelines
based care as measured in a comprehensive scorecard. The model is
designed for and expected to lower administrative burdens in the
system over time, while improving the quality of care by paying for
what science says patients should be treated with for their condition.
She is the first Chairman of the Board of the Health Care Incentives
Improvement Institute, Inc (HCI3) a new not for profit organization
which is the merger of Bridges to Excellence and PROMETHEUS Payment®.
She has been called on by the Congressional Budget Office, the General
Accounting Office, the Robert Wood Johnson Foundation, the Federal
Agency for Healthcare Research and Quality, the Joint Commission
on Accreditation of Healthcare Organizations, and others to advise
on issues pertaining to Medicare reimbursement, medical evidence,
legislation dealing with medical necessity in managed care and tort
reform. Ms. Gosfield served as President of the American Health Lawyers
Association (formerly the National Health Lawyers Association), from
1992-1993 and chaired their Physician and Physician Organizations
Institute from 2001 through 2006.
A highly sought after speaker, Ms. Gosfield has been invited to lecture
throughout the country and internationally to diverse audiences including
physicians and other health care professionals, chief executives
and chief financial officers, boards of trustees and directors, group
managers, managed care executives and others throughout the health
care industry. She is noted for her practical yet provocative, incisive,
down-to-earth style and ability to make complex technical information
understandable as well as entertaining. She lectures often for a
variety of organizations including the American Health Lawyers Association
(AHLA), the American Medical Association (AMA), the Medical Group
Management Association (MGMA), America’s Health Insurance Plans
(AHIP), the Healthcare Compliance Association, and the American College
of Cardiology as well as other national, state and regional groups. She
is faculty and an author of their white paper on the subject for
the Institute for Healthcare Improvement’s (IHI) programs on “Engaging
with Physicians.”
A frequent author in a wide range of health care publications, her
second book – Guide to Key Legal Issues in Managed Care
Quality– was
written primarily for non-lawyers and was published in 1996 by Faulkner
and Gray. Since 1989, she has been the editor of the annual HEALTH
LAW HANDBOOK published by WestGroup, a Thomson Company which issues
a completely new book each year . She also now authors MEDICARE AND
MEDICAID FRAUD AND ABUSE, an annually updated treatise also published
by WestGroup. She serves on the editorial advisory boards of multiple
diverse journals and newsletters including Medical
Economics, Managed Care, and several Brownstone Publisher
newsletters . She is a contributing
editor to Family Practice Management.
She has been a member of several physician-organization sponsored
consulting networks including those of the AMA, the American College
of Physicians, the American Academy of Family Physicians, and the
American Society of Plastic and Reconstructive Surgeons.
She was named as one of the Top Thirty Health Lawyers in the Country
in 2007 by the Best of the Best and among the Top Twenty-five Health
Lawyers in the Country in their second listing in 2009. She was named
the first Health Lawyer of the Year (Philadelphia) for 2010 by the
Best Lawyers in America. She is a Pennsylvania Super Lawyer, and
one of the Top 50 Women Lawyers in Pennsylvania.
She has been listed in The Best Lawyers in America (Health
Law) in every edition since the inception of the health law category.
She
has been recognized internationally for her health law expertise
by the International Centre for Commercial Law in the United Kingdom
as one of The
Legal 500, a select group of 500 law firms in the United
States recommended for their specific abilities in particular areas
of the law. She is a Fellow of the American Health Lawyers.
About Daniel F. Shay
(dshay@gosfield.com)
DANIEL F. SHAY joined the firm in 2003 as an associate focusing primarily
on physician representation, fraud and abuse compliance, Medicare
Part B reimbursement, and HIPAA compliance in the physician context.
He
also has a keen interest in intellectual property issues, including
copyright, trademark, data control, and confidentiality. He has focused
on HIPAA privacy and security compliance and software and information
technology licenses. His HEALTH LAW HANDBOOK chapters have looked
closely at issues including provider control of and  commerce
in data, electronic health
records license agreements, and
most recently on legal
issues associated with physician advertising, especially
around quality.
Mr. Shay received his bachelor of science degree cum laude in
2000 from Vanderbilt University and his juris doctorate degree
from Emory University School
of Law
in 2003. Mr. Shay was named Regional Champion, and given the “Best
Brief” award in the 2003 Philip C. Jessup International Law
Moot Court Competition and competed in the National/International
round.
Mr. Shay is a member of the Pennsylvania Bar and the American Health
Lawyers Association. |
