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OIG Challenges Hospital Ã‚â€“ Physician "Gainsharing" Arrangements What Is Left For Hospitals?
John Oakes 1 of Paul, Hastings, Janofsky & Walker LLP
This Client Alert considers the implications of the Summary of the Office of the Inspector General (OIG) Bulletin regarding Gainsharing agreements.
Health Industry Alert--October 6, 1999
Akin Gump Strauss Hauer & Feld LLP
On September 27, 1999, California Governor Gray Davis signed into law an impressive "package" of new health care bills affecting the managed care industry in California. Although many of the 21 new laws take effect as late as January 1, 2001, there is little question that the new legislation will have immediate and far-reaching effects on the managed care industry throughout the country.
Doctors and the NLRB
Thomas J. Bender of Buchanan Ingersoll & Rooney PC
I. INTRODUCTION Today, only about 5 percent of the nation's physicians are union members, but the storm of chan.
PAYERID: More Than A Number
Dept. of Health and Human Services
Publication from the Department of Health and Human Services which outlines the development of PAYERID in order to simplify, standardize, and otherwise improve the process of exchanging electronic health care information.
Small Business Health Insurance
Small Business Administration
This Small Business Administration publication provides information on the health insurance options available to small businesses.
Fraud In Managed Care Part I
Cadwalader, Wickersham & Taft LLP
This is the first of several columns that will analyze the emerging issue of fraud in the world of managed care. .
Managed Care Contracts - Key Provisions for Providers
Susan Leach DeBlasio of Tillinghast Licht LLP
The contract between a physician or other health care professional and a managed care organization (MCO) such as a provider-sponsored network, integrated delivery system, health maintenance organization, or other health care plan, is the fundamental document which frames, defines and governs their relationship. Contractual provisions can affect payment, office organization, practices and procedures, and confidential records as well as clinical decision-making.
Managed Care: Managed Costs or Managed Medicine?
Tillinghast Licht LLP
Many people believe that the rising costs of medical care in the United States, and the increasing numbers of ordinary citizens who cannot afford it, have combined to threaten this country's social and economic health. By the year 2000, unless fundamental changes occur in the health care delivery and financing system, these costs will rise to $1.6 trillion, or 16.4 percent of the GNP.
The Truth About Texas' Prompt Payment Laws For Healthcare Providers
T. Daniel Hollaway of Hollaway & Gumbert, PC
The intent of this article is twofold. First, I hope to set the record straight about the legal .
Latest Advisory Opinion Questions Percentage Fee Arrangement with Physician Practice Management Company
David H. Eisenstat,David B. Palmer,Jorge Lopez and Eugene E. Elder of Akin Gump Strauss Hauer & Feld LLP
This article discuses the Office of the Inspector General's Advisory Opinion No. 98-4 which is considered significant because it suggests that a physician who pays a practice management company a percentage of the physician's net revenues may violate the federal Anti-Kickback Statute when the services provided by the practice management company include marketing and billing activities.
Managed Care Challenged in Class Action Lawsuit
Pillsbury Winthrop Shaw Pittman LLP
This alert summarizes the allegations in the Humana Class Action Suit.
Where Managed Care Plans Have Decided Not to Renew Their Medicare Contracts
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which outlines for consumers their options when a health care providers decides to non-renew a Medicare contract.
Program of All-Inclusive Care for the Elderly (PACE) History
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which describes the history of the All-Inclusive Care for the Elderly program under Medicare and Medicaid.
New Florida Legislation Insulates Health Care Entities from Liability and Reduces Costs for Credentialing Certification
Michael P. DeVoe of Broad and Cassel
Credentialing is the process of assessing and validating the qualifications of a licensed health care professional..
Fraud In Managed Care Part II
Cadwalader, Wickersham & Taft LLP
This is the second of three columns that discuss fraud in managed care programs. The first, published on Sept. 30,.
OIG Issues Ten New Safe Harbors and Clarifies Six Existing Safe Harbors
James Fabian,Stephen D. Zubiago and Richard T. Yarmel of Nixon Peabody LLP
This article reviews the U.S. Department of Health and Human Services? Office of Inspector General's (OIG) safe harbor regulations to the Anti-Kickback statute
Medicare + Choice
Railroad Retirement Board
Brochure from the Railroad Retirement Board which discusses how Railroad retirement beneficiaries, like social security beneficiaries, are being offered additional health care options under the new Medicare + Choice Program provided by the Balanced Budget Act of 1997.
Underuse Regulation of Physician Incentive Plans
Howard M Robinson of Broad and Cassel
For years, the Federal anti-kickback and self-referral laws have been the primary vehicles for health care fraud en.
Changes in Physician Incentive Plan Regulations
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services to Medicare Managed Care Organizations State Medicaid Agencies which outlines changes made in the regulations regarding physician incentive plans.
Revised Policy Statements on Health Care Antitrust Enforcement Signal Green Light for Physician and Multi-Provider Network Development
Gabriel L. Imperato of Broad and Cassel
The Department of Justice ("DOJ") and Federal Trade Commission's ("FTC") revised statements of antitrust enforcemen.
Fraud in Managed Care Part III

This is the last of three columns that discuss fraud in managed-care programs. The first, published Sept. 30, pres.
Guidance for States Considering the Development of Medicaid Managed Care Programs for Persons With Special Health Care Needs
Dept. of Health and Human Services
Guide prepared by the Department of Health and Human Services for states considering the development of Medicaid managed care programs for persons with special health care needs.
Medicare Has More To Offer
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which generally describes new benefits to consumers under Medicare.
Top Twenty Medicare/Medicaid Questions
Dept. of Health and Human Services
Brochure from the Department of Health and Human Services which answers for consumers the top twenty 20 questions most frequently asked by callers to the Medicare + Choice toll free line.
Operational Policy Letter: Notice of Discharge and Medicare Appeal Rights
Dept. of Health and Human Services
Operational policy letter from the Department of Health and Human Services which provides model language for Notice of Discharge and Medicare Appeal Rights (Formerly known as the Notice of Non-coverage - NONC).
Insurance and Managed Care Companies have 280 Million reasons to Deny Care
Williams DeClark Tuschman Co. L.P.A.
On August 3, the American Psychological Association (APA) released an analysis of the profits that insurance and .
Striking OutÃ‚Â… Modern Healthcare
Womble Carlyle Sandridge & Rice, PLLC
Federal agencies have been striking out when they step up to the plate to challenge a hospital merger in court. Li.
The Feds Cast Doubt on Perventage-Based Management Contract
Broad and Cassel
The Office of Inspector General of the Department of Health and Human Services (the "OIG") issued Advisory Opinion .

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