Panelist: "Emerging Trends in ASC Reimbursement, Regulation” (Investment & Operations Conference, February 19, 2025)
Speaker: "Artificial Intelligence and Related Compliance Considerations” (Representing the Physician 2025, February 7, 2025)
Speaker: "HHS Section 504 Final Rule: New Antidiscrimination Measures in Healthcare Treatment and Accessibility” (Strafford live video webinar, January 8, 2025)
Speaker: "Palliative Care Programs: Where to Start and How to Maintain Them,” (Virtual Annual Conference for the Virginia Association for Home Care and Hospice, November, 2024)
Speaker: "Palliative Care Programs,” (LifeSpan Maryland Conference, September 25, 2024)
Speaker: "Legal Consideration for AI in Health Care,” (American Alliance of Orthopedic Executives Virtual AI Summit, August 28, 2024)
Author:
Summary of Medicare Advantage, Part D Rate Changes for CY 2025 (American Health Law Association, 2024)
ARTICLES
February 19, 2025
Ambulatory Surgery Centers (ASCs) are experiencing significant shifts in regulation, reimbursement, and operational practices. These changes are driven by evolving healthcare policies, technological advancements, and the increasing preference for outpatient procedures. This article explores the current trends in ASCs, focusing on regulatory changes, reimbursement shifts, and revenue-sharing models. Additionally, it addresses compliance and legal concerns, specifically anti-kickback issues, and provides practical tips for maintaining compliance.
January 23, 2025
Value-based care (VBC) is a healthcare delivery model that prioritizes patient outcomes over the volume of services provided. This approach aims to enhance the quality of care while controlling costs by incentivizing healthcare providers to focus on delivering efficient, effective, and patient-centered care.
December 16, 2024
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute) for Medicare Parts A and B as part of the
Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule.
November 11, 2024
The IRS has recently been urging healthcare entities, particularly those involving physicians and private investors, to seek private letter rulings (PLRs) to clarify the tax implications of their ownership structures. This encouragement comes in light of the complexities and ambiguities surrounding the "friendly doctor" or "friendly PC" models, where a physician-owned professional corporation (PC) is managed by a separate management service organization (MSO).
October 31, 2024
In 2024, Stark Law enforcement remains a critical focus for healthcare providers and regulatory bodies, with a continued focus on excessive compensation and productivity bonuses. Compliance with Stark Law is essential to avoid significant penalties, including repayment obligations, civil monetary penalties, and potential exclusion from federal healthcare programs.
September 18, 2024
The California Department of Public Health (CDPH) issued a letter on September 6, 2024, to all general acute care hospitals clarifying the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) following confusion and issues at hospitals in Modesto, California earlier this year.
August 1, 2024
The American Academy of Emergency Medicine Physician Group (AAEM-PG) recently settled a lawsuit in United States District Court for the Northern District of California against Envision Healthcare and Envision Physician Services, accusing them of violating the corporate practice of medicine (CPOM) laws in California.
[1] The lawsuit alleged the “friendly physician” model used by Envision to control medical practices through management services agreements interfered with the medical judgment and autonomy of the medical entities Envision served. The model is commonly used in physician practice transactions with private equity investors.
[2] The suit was unusual in that it was a private entity, not a government entity, requesting relief and asked the court to find models and those alike illegal in California.
July 17, 2024
The Department of Health and Human Services (HHS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is striving to alleviate the financial strain of medication costs on the elderly and disabled populations who rely on Medicare with the Medicare Prescription Drug Payment Plan. CMS has
released final part two guidance for CY 2025 on July 16, 2024, to prepare stakeholders for its implementation.
July 2, 2024
The article provides an overview of the CMS Interoperability and Prior Authorization final rule and its implications for different types of providers. It summarizes the main requirements and deadlines for the rule, which aims to improve the efficiency and transparency of healthcare delivery by requiring the use of standardized APIs for data exchange among payers, providers, and patients.
June 12, 2024
The Federal Trade Commission (FTC) issued a final rule to amend its Health Breach Notification Rule (HBN Rule). The HBN Rule requires certain entities that handle unsecured personally identifiable health data to notify individuals, the FTC, and sometimes, the media of a breach of security.
May 28, 2024
On May 21, the Centers for Medicare and Medicaid Services (CMS)
announced a new option on CMS.gov to allow individuals to more easily file an Emergency Medical Treatment and Labor Act (EMTALA) complaint.
May 7, 2024
On May 1, 2024, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), finalized a rule that prohibits discrimination on the basis of disability. This rule (“Final Rule”), titled Discrimination on the Basis of Disability in Health and Human Service Programs or Activities, more explicitly and specifically provides protections for people under Section 504 of the Rehabilitation Act (Section 504).
April 26, 2024
Even after a large amount of industry pushback, CMS issued the final rule for minimum staffing requirements and institutional payment transparency for long-term care (LTC) facilities. While stakeholders have indicated that the rule could put more pressure on current staff and lead to further workforce burnout, CMS insists the regulations are needed to ensure safety of the nation’s vulnerable populations.
April 23, 2024
Even after a large amount of industry pushback, CMS issued the final rule for minimum staffing requirements and institutional payment transparency for long-term care (LTC) facilities.
April 2, 2024
Centers for Medicare & Medicaid Service (
CMS) revised hospital interpretive guidance in the State Operations Manual, Appendix A-Hospitals on April 1, 2024 in response to media stories of nation’s teaching hospitals and medical schools repeatedly performing sensitive examinations while under anesthesia without informed consent. Highlighted sensitive exams include but are not limited to pelvic, breast, prostate, and rectal examinations. The new guidance is effective immediately.
February 26, 2024
Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that don’t match plan-determined diagnosis or that denied payment for post-acute care that exceed AI-predicted lengths of stays. The criticism has been that these decisions are not based on proper criteria or made in compliance with regulations.
December 13, 2023
Violence against healthcare workers has been a steadily growing concern. The industry is working towards addressing these dangers.
November 9, 2023
The U.S. Attorney’s Office for the Eastern District of Pennsylvania recently announced that it had reached a settlement with Cigna Group (Cigna) to resolve allegations that Cigna had violated the False Claims Act.
PRESENTATIONS
January 8, 2024
This webinar highlights trending obstacles in healthcare recruitment, examines the legal considerations for mechanisms used to entice recruits, and provides practical tips for compliance with specific healthcare and employment laws.
