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Cancer care represents a major segment of health care expenditures in the USA and the payment to physicians has been perversely oriented around the drugs they administer rather than the services they perform in meeting the complex needs of their patients. Recent history has demonstrated multiple attempts at reforming this payment, including most recently in CMS’ Oncology Care Model which will become Oncology First Model after 2021. In “Paying Physicians for Cancer Care”, Alice explains the inception of this out of whack system, considers reform efforts in commercial payment, looks closely at the OCM and criticisms of it and then sets forth the principles which apply in a new design suggestion which has been presented to CMS. She also sets forth contractual issues to make cancer care payment viable. The new proposal, initially presented in a White Paper which set forth five principles for program design, also figured as the focus of a Health Affairs blog post and an interview with Alice and two other members of the design team.

For most of her career, Alice has had to call on and be called on by valuators and accountants to meet the needs of her clients. She has worked extensively with David Glusman of Marcum LLP and in September 2019, he interviewed her about her views on forthcoming government efforts regarding enforcement of matters involving fraud and abuse, fair market value and the like.

We have written extensively on the voluntary repayment rules and Dan has added to that with his new publication “Key Questions and Answers for Medicare Voluntary Repayments,”. Alice focuses on a specific unappreciated trap lurking in the audit process as it relates to voluntary repayments in “Heightened Peril From Physician Audits” because an external audit by one of the myriad federal contractors is prima facie credible evidence there is something to be looked at. It is more important today than ever to approach an audit properly in order to come out with a positive result. Internal audits create their own separate obligations to take action. Physician practices and anyone else paid under Parts A and B would do well to take heed.

As a tiny, boutique law firm, we were delighted that Acquisition International, based in the UK, named us the Leading Boutique Personal Service Health Law Firm of the Year chose to profile us and our approach to work because of our dedication to excellence. We strive to provide stellar service to our clients and to have collaborative relationships with them, for which we are willing to be held accountable in Our Attorney Client Compact. We have also been recognized for ten consecutive years as a Best Law Firm by Best Lawyers.

Electronic health records (“EHRs”) are a fact of life in the current healthcare industry, with adoption of EHRs having increased steadily since the early 2000s, and especially in connection to Medicare’s Meaningful Use program. But most physician practices will not keep the same EHR software forever. Changes in certification requirements, software obsolescence and patches that change how the software functions, as well as practice mergers and sales can all lead physicians and physician practices to switch EHRs. In “Maintaining EHR Records Access – Legal and Technical Risks”, Dan discusses what happens to physicians’ records when switching EHRs. It is a physician’s duty to maintain access to their records, and this article provides insight into issues surrounding this subject.

Participation in the Medicare system is an issue that trips up many health care practitioners, and is one on which Dan has written previously 4 separate times. Medicare Enrollment: A Never-Ending High Hurdles Race, Successfully navigating the Medicare enrollment appeals process, Potential problems exist in the Medicare enrollment process, The Medicare Part-B Enrollment Obstacle Course: It Hasn't Gotten Any Easier While obtaining Medicare billing privileges is complicated in and of itself, maintaining such privileges on an ongoing basis can likewise prove complicated. A failure to adequately maintain Medicare enrollment records can lead to a loss or suspension of billing privileges, which can lead to denied claims and potential Medicare overpayments. In two new articles, Dan comes at the issue of Medicare enrollment from opposite angles. In “The Ongoing Ordeal of Maintaining Medicare Enrollment,” Dan addresses the many hurdles which physicians must clear just to maintain Medicare billing privileges. In “Medicare and Non-Covered Services,” Dan examines how physicians provide services outside of the Medicare system, and what that can mean for their continued participation with Medicare.

Diagnostic testing in Medicare is a thorny, complicated subject that touches on multiple different regulatory schemes, requirements, and prohibitions. Many physicians and their managers are confused by the interplay of Stark, anti-kickback, incident-to, and supervision rules. If not managed effectively, this issue can lead to overpayments, denied claims, and false claims liability. Dan explores these issues in two articles. In “Stark, Diagnostic Testing, and Group Compensation,” Dan examines how diagnostic testing can affect a physician group’s compliance with Stark, especially with regards to how the group pays its physicians. In “Navigating Spaghetti Junction: The Intersection of Medicare’s Diagnostic Testing Rules,” Dan takes a much deeper dive into the topic and explores a broader range of Medicare regulations and how they intersect in diagnostic testing. The article offers both legal analysis, and touches on real-world experiences our clients have had in this area.

Young physicians coming out of training will confront a range of challenges for which most are unprepared. One of the first real challenges young physicians confront is their first employment agreement. From compensation, to term and termination, restrictive covenants and “tail insurance,” many issues are unfamiliar to them. Then there is the matter of how to approach negotiation of any of the provisions. Dan brings his special interest in working with young physicians to bear in “The First Employment Agreement: Common Clauses and Practical Tips for Residents.” The article is oriented towards physicians just leaving training, but it includes advice that even veteran physicians may find helpful.

Although the federal government has not changed its stance, many states have begun to liberalize their laws regarding the use of marijuana, especially in a medical context. This has sparked curiosity among physicians about whether and how to provide medical marijuana. The legal landscape varies from state to state, though, with some states permitting recreational use of cannabis, while others only permit such use for medical purposes and then only for specific conditions. In “Peering Through the Haze of Medical Marijuana Laws,” Dan examines state laws regarding certifying patients for medical cannabis use, as well as the implications of staff usage in states that permit either recreational or medicinal use of marijuana.

In “What Are the Legal Risks Associated with Social Media and Online Review Sites?”, Dan examines potential problems for health care practitioners in the social media context, and with respect to online review sites. Managing one’s online reputation is a relatively new business aspect for those in health care, and sometimes one’s initial instincts may not be the smartest move. This article discusses both practical and legal considerations that health care practitioners should bear in mind before deciding how and when to respond online.