August 5th, 2024

NY Court Finds Unlawful Fee Splitting in Practice Acquisition

Benjamin P. Malerba of Rivkin Radler LLP reports that in New York, the prohibition against professional fee splitting remains stringent, as demonstrated by the case of Advanced Dental of Ardsley v. Brown. The appellate court ruled that a dental practice sale violated this prohibition because part of the purchase price was based on a percentage of future revenue. Consequently, the court dismissed allegations of non-payment and refused to enforce the contract due to its illegality. This decision underscores the crucial role of legal professionals in structuring professional practice transactions to comply with legal regulations, requiring careful consideration and attention to detail.

Link: https://bit.ly/3YwPaXi

Stark II Webinar: Post Tuomey, Intermountain Health, Akron General, Prime Healthcare, and Kalispell Regional

Join William Mack Copeland, MS, JD, PhD, FACHE Copeland Law LLC for the upcoming webinar for a comprehensive overview of the physician anti-referral law, Stark II, and its critical exceptions. This session will not only examine how violations of Stark II can lead to concerns about the False Claims Act and assess recent enforcement trends and case law to highlight potential risks for participants but also provide practical insights into navigating Stark II regulations and safeguarding your organization against legal pitfalls. By attending, you will gain a clear understanding of what the Stark II Act prohibits, the criteria for compliance with its exceptions, and how recent cases have shaped judicial interpretations. Tailored for healthcare executives, physicians, and providers, this webinar will equip you with essential knowledge to protect your organization and enhance your professional practice.

Register here: https://bit.ly/4dvD44G

What You Can Learn From Recent Fraud and Abuse Settlements

Angie Cameron Smith of Burr & Forman reports that fraud and abuse actions have surged, with fiscal year 2023 seeing over $2.68 billion in settlements and judgments under the False Claims Act, underscoring the need for healthcare organizations to understand and comply with fraud and abuse laws. Recent cases highlight risks in telehealth billing, medically necessary services, and kickback arrangements, emphasizing the importance of accurate billing, compliance with service requirements, and fair compensation practices. Establishing a robust compliance program, including regular audits and legal counsel, is crucial for preventing and addressing potential fraud and abuse issues.

Source: https://bit.ly/3A8Nzg5

Stark Law Litigation Strategy Using Loper Bright

ArentFox Schiff's Pascal Naples, D. Jacques Smith, and Hillary Stemple report that the Supreme Court's decision in Loper Bright mandates that courts independently evaluate an agency's interpretation of statutes instead of deferring to the agency's view under Chevron. In the context of the Stark Law, which regulates physician referrals and financial relationships, Loper Bright could enhance the ability of healthcare providers to challenge broad or restrictive agency regulations. For instance, in the case of United States ex rel. Raven v. Georgia Cancer Specialists I, the Court's application of Loper Bright could allow for more flexible interpretations of exceptions under the Stark Law. However, Loper Bright's impact is limited by existing Chevron precedents and the Court's acknowledgment of statutory delegations to agencies, meaning that not all agency regulations may be subject to the same level of judicial scrutiny.

Source: https://bit.ly/3WPFLJ1

Eye Practice and Its Physician Owner Agree to Pay More Than $460,000 to Resolve Allegations of False Claims and Receiving Illegal Kickbacks

The U.S. Attorney’s Office in the District of Massachusetts reports that Burlington County Eye Physicians (BCEP) and its owner, Dr. Gregory H. Scimeca, have agreed to pay $469,232 to settle allegations of submitting false claims for unnecessary transcranial doppler (TCD) tests to Medicare and the Federal Employee Health Benefits Program. The false claims involved billing for tests that were not medically necessary or performed by BCEP and claiming payment for interpreting tests that another company read. The arrangement between BCEP and the diagnostics company also violated the Anti-Kickback Statute, as BCEP received kickbacks by billing for services it did not perform. The settlement resolves allegations brought under the False Claims Act, with a whistleblower receiving approximately $84,460 as part of the resolution.

Link: https://bit.ly/3SBvGgu

California CPOM Case

The American Academy of Emergency Medicine Physician Group (AAEM-PG) resolved its lawsuit against Envision Healthcare, which alleged that Envision's "friendly PC" business model violated California's corporate practice of medicine (CPOM) laws. Envision agreed to withdraw from its operations in California as part of the settlement, avoiding a potentially significant legal precedent. CPOM laws prevent non-physicians from controlling medical practices, and the case's resolution could still influence future private equity investments in physician practice management platforms. King & Spalding healthcare attorney Catherine Behnke wrote a nice article explaining the details of the case.

Link: https://bit.ly/4ccliCH

Catherine Behnke is an Associate at King & Spalding in their Corporate, Finance, and Investments practice. Her practice focuses on transactional matters, including venture financings, private and public mergers and acquisitions, and general corporate governance

Utilization Management in Healthcare

Utilization management (UM) in healthcare is a process for evaluating the necessity, efficiency, and appropriateness of medical treatments and services on a case-by-case basis.

Lindsey Brown (Fetzer) from Bass, Bass, Berry & Sims provides an insightful overview of utilization management (UM) in healthcare. She explains that UM aims to balance cost reduction with ensuring quality care by delivering the right care at the right time. Lindsey highlights the historical context of UM and its ongoing importance in preventing overutilization and waste of healthcare resources. Her article underscores the critical role UM plays in optimizing patient outcomes and maintaining sustainable healthcare systems.

Link: https://bit.ly/46vcJBP