It is obvious to everyone that the issue of bills from out-of-network hospital-based physicians – now commonly labeled “surprise medical bills” – is picking up momentum. Continue reading →

On February 14, 2019, the U.S. Department of Health and Human Services (HHS) Center for Medicare and Medicaid Innovation, announced the launch of an innovative payment model with new treatment and transport options to more appropriately and effectively meet Medicare beneficiaries’ emergency needs.   The Emergency Triage, Treat and Transport (ET3) Model is a voluntary, five-year payment model that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place. Continue reading →

A ruling from the federal district court in the Northern District of Texas, penned by Judge Reed O’Connor, held a part of the Patient Protection and Affordable Care Act (“ACA”) (commonly referred to as Obamacare) unconstitutional, and the remaining parts invalid. Unsurprisingly, this decision has attracted much attention and quickly become one of the most watched cases. Continue reading →

On August 8, 2018, the U.S. Attorney’s Office for the District of Massachusetts announced that two physicians had agreed to settle allegations of improper dispensing of controlled substances and improper billing. According to this press release, a physician and his addiction treatment clinic, H.K.D. Treatment Options, agreed to pay $23,000 to settle claims of improper billing of medical services under the Controlled Substances Act and the False Claims Act. A physician employed by the pain treatment clinic also agreed to pay a $12,500 civil penalty for issuing invalid prescriptions for controlled substance under the Controlled Substance Act.

The government alleged that under the direction of the physician-owner of the pain management clinic, another physician signed hundreds of blank prescriptions for use by unsupervised non-physician staff while the physician signing the prescriptions was on vacation. The non-physician staff issued over 600 prescriptions for controlled substances using the pre-signed blank prescriptions. The government also alleged that the pain treatment center billed Medicare improperly for services related to the prescriptions that non-physician staff provided in the other physician’s absence and that the physician-owner falsely reported to Medicare that the physician on vacation had supervised the services by the non-physician practitioners. A copy of the press release on the settlement can be found here.

Written by: Clay J. Countryman

Co-authored by Cecilia G. Vazquez, Summer Law Clerk, Breazeale, Sachse & Wilson, L.L.P.

Depending on how a Texas federal court rules in a lawsuit filed February 2018, by 20 state attorneys general (including Louisiana), all or part of the Affordable Care Act (ACA) could be declared unconstitutional. On June 7, 2018, the Justice Department filed a brief in Texas v. the United States (N.D. Texas 2018) (the “Texas lawsuit”) that largely supported the challenge to the constitutionality of the Individual Mandate in the ACA requiring individuals to maintain essential health insurance coverage. Continue reading →