Answering the Call (or Mail)
What should you do first when you receive a legal inquiry?
Healthcare anti-fraud and abuse enforcement remains alive and well in 2018. The anti-fraud provisions in the Patient Protection and Affordable Care Act (ACA), such as mandatory reporting and returning overpayments, continue after Congress failed to repeal the ACA in 2017. In addition, federal and state investigators and prosecutors have applied the longstanding framework of the False Claims Act and the Anti-Kickback Statute in many high-profile cases against physicians. As imaging remains central to patient care, ACR members must run their practices carefully to protect their patients’ interests and avoid claims being brought against the group.
The Dangers of Delegation
Can you delegate informed consent to another professional? Pennsylvania court says no.
Patients rely on their physicians, including ACR members, to share clinically relevant information. You apply your medical judgment when you decide what to tell a patient about a particular study or procedure she or he may undergo.
The AMA, a Physician’s Rights, and the Radiologist
The AMA is fighting for your rights and responsibilities as a radiologist and a physician within a practicing medical community. Will you join them in representing your interests?
Radiologists often ask why they should become members of the AMA in addition to the ACR®. After all, doesn’t the ACR represent their interests with state and local governments and regulators, while also providing voluminous materials on practice matters?
Antitrust in Medicine
Recent legal changes are altering the competitive landscape in health care.
In the past, we have written extensively about the concept of antitrust law while noting that the government seemed to show little interest in using it to regulate consolidation in the hospital and medical insurance areas.1, 2
The National Practitioner Data Bank
What are the reporting requirements and how do they impact your practice?
The National Practitioner Data Bank (NPDB) is a federal information repository that tracks malpractice claims, disciplinary actions, state licensing actions, and privileging restrictions against U.S. health care practitioners.
Corporate Practice of Medicine
What do radiologists need to understand about corporate entities and radiology?
The ACR Legal Office receives occasional inquiries regarding the corporate practice of medicine. Most often, the caller is looking for a way to block a corporate entity not owned by radiologists from practicing radiology using employed radiologists. They want to know if such arrangements are prohibited by law.
Practices must identify reasons for non-payment and find ways to capture revenue.
Claim denials can be a major source of frustration for physicians and their practice managers and can have a real impact on cash flow and the financial performance of a practice.
ACR is taking steps to manage risk and protect itself. But how do you protect your own practice?
Under the leadership of Lawrence A.Liebscher, MD, FACR, the ACR Audit Committee has focused its most recent efforts on a risk assessment of the College.
A court invalidates a health system's acquisition of a physician group.
An Idaho federal court ordered in January that a major health system unwind its acquisition of a prominent medical practice. The court ruled that the transaction violated federal and state antitrust laws.
ACR legal counsel responds to questions from residents and fellows.
An old saying emphasizes that man is a social animal. That fits most lawyers — the social part, that is — and we're no exception!
Gone but Not Forgotten
Malpractice claims can be kept out of court, but not the National Practitioner Data Bank.
A Note from ACR Legal Counsel
Medical malpractice claims are settled for many reasons, whether or not the claims are actually valid. Among those reasons is the desire to avoid a liability report on the physician’s record.
The OIG Work Plan
What are the HHS areas of focus this year?
In past columns, we outlined the history, authority, and structure of the Office of the Inspector General (OIG) of the federal Department of Health and Human Services (read more at http://bit.ly/May12RADLAW) and explained the OIG Advisory Opinion process (read more at http://bit.ly/June12RADLAW).
Working with an outdated OS could cost you more than just an upgrade.
Isn’t technology always — or virtually always — ahead of the law? Frequently, yes. Courts and administrative agencies regularly decide cases in which a technological solution presents a unique legal issue.
The ACR – It’s More Than You Know
When they think about it at all, many radiologists see the ACR as an amorphous something far away and with only a tangential relation to their daily lives. Others know it as an accrediting body, a standards organization, or simply as a lobbying group for the profession.
Health Insurance Exchanges
As the ACA rollout continues, what should you know about the disputes and litigation?
First you have the problem and then you have the litigation. This more-or-less iron rule of American life will be honored once again in the aftermath of the rollout of Obamacare.
Why Does the ACR Accredit Self-Referring Facilities?!
The College fights self-referral through various avenues but, legally, accreditation cannot be one of them.
Some members have asked this provocative question of the ACR Legal Department. They express concern — and frustration — that their College offers accreditation to imaging and radiation therapy facilities owned and operated by non-radiologists.
Intensity-Modulated Radiation Therapy and Self-Referral
What is behind new criticisms and liabilities?
A number of recent publications regarding urology services have ignited a storm of discussion about the propriety and effects of self-referral by urologists.
Would your practice's corporate compliance program pass the test?
Radiology continues to draw government scrutiny, for better or for worse. We have written in previous columns that diagnostic imaging centers particularly have fallen under the spotlight of investigators and prosecutors (see "Beware of Those Bearing Gifts," in the June 2013 issue, at http://bit.ly/JuneRADLAW).
Don't Just Fight the Law, Change It!
Radiologists have learned to use the legislative system to counteract unfair court rulings.
In the July 2013 Bulletin column entitled "If You Fought the Law," we discussed how and why the College decided not to bring a lawsuit against the federal government over the method and information used to justify reductions in reimbursement for some types of medical imaging.
Another Challenge Lurks in the Affordable Care Act
What do you need to know about state insurance exchanges?
Time can fly, even when it comes to the law. Over three years have passed since President Obama signed the massive Patient Protection and Affordable Care Act, aka the health reform law.
Understanding the specifics of how antitrust relates to physicians.
The ACR Legal Office continues to receive questions about why federal and state authorities seem more concerned about doctors violating antitrust laws and less concerned about hospitals and insurance companies doing so.
If You Fought the Law
Suing the HHS over payment reductions probably wouldn't work in view of its close ties to Congress.
Members often ask why the College doesn't simply sue the government when Congress, the Department of Health and Human Services (HHS), or its subcomponent, the CMS, does something that harms radiology.
Beware of Those Bearing Gifts
Business practices that were legal a few years ago may get you into hot water today.
The government is increasing enforcement of health-care regulations governing physician behavior.
New HIPPA Mandates
How will the changes affect you?
The privacy — and security — of patient health information has recently become more complicated. In January, the U.S. Department of Health and Human Services issued a final rule that will formalize changes to HIPAA.1
Statutes of Limitations and Repose
What's the difference and why does it matter?
Most radiologists are at least generally familiar with the concept of a statute of limitations. Conversely, very few have heard of a statute of repose.
OIG won't penalize practices offering free pre-authorization of patients' behalf.
Does a radiology practice violate the law if it obtains an insurer's pre-authorization of an imaging study on behalf of referring physicians and patients? In a scenario that one group posed, the U.S. Department of Health and Human Services' Office in Inspector General (OIG) recently came back with a verdict: no.
Reasonable and Necessary
What does it mean and who decides?
Federal Medicare law states, "No payment may be made under part A or part B for any expenses incurred for items or services which ... are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."1
The ACR Takes on Antitrust
Protect yourself and your practice by becoming familiar with ACR's official policy.
Last month's column explained key antitrust laws and why the matter to ACR members. This month, we offer ACR's Antitrust Compliance Policy, which has been adopted by the ACR BOC. The policy applies to ACR members, staff, and the conduct of ACR meetings and other ACR activities.
In Law We Antitrust
Should radiologists be concerned about antitrust laws?
Occasionally, someone calls the ACR Legal Office with an antitrust question. Usually, the member or group has tried to take an action and has been told simply that it cannot be done as it would violate antitrust law, but isn't provided with further explanation.
It's more than just a business model.
In this column, we will examine an issue that has energized — and divided — radiology and the ACR: teleradiology.
Who Is the IG and Why Should I Care?
ACR members have a vested interest in the decisions and positions taken by the Inspector General.
In the medical world, IG is the abbreviation for the Inspector General of the U.S. Department of Health and Human Services (HHS). Radiologists should be concerned with and understand the role of the IG because he or she has immense power and influence in the medical payment world.
What's New in Supervision?
Violate imaging supervision rules, and you may lose the change to participate in Medicare.
Editor's note: This is the conclusion of a two-part series addressing the controversial subject of medical imaging supervision. The first article (http://bit.ly/RADLAWApr2012) summarized related Medicare rules.
What's new in supervision? Fines, legal expenses, and exclusion from Medicare.
Editor's Note: This is the first of a two-part article about the supervision of medical imaging. The second part will appear in the April 2012 issue of the ACR Bulletin.
Avoid Getting Burned
Affordable Care Act provisions publicize special business relationships and payments.
ACR members should pay attention to part of the Affordable Care Act health reform law that includes "sunshine provisions" for payments and other value transfers received from pharmaceutical and medical device companies.
The Riddle of Self-Referral
Take a peek at what's in store for self-referral in medical imaging.
Most radiologists have an understanding of self-referral and its negative impact on medical imaging and interpretation in the United States.
Should economic-credentialing policies leave radiologists out in the cold? Many hospitals — and courts — say 'yes.'
A recent court decision has raised visibility of the legal and ethical debate about economic credentialing.
Protecting Your Peer-Review Rights
ACR's Counsel elaborate on legal issues within the federal and local peer-review processes.
The ACR General Counsel's Office and the Quality and Safety Department are often asked whether RADPEER™ materials can be subpoenaed or "discovered" in court. As with most legal matters, the answer is more complicated than a simple "yes" or "no."