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I may be wrong but I am timely. After my article was written for publication in the June 1 Newsletter, the CMS came out stating they will place the specialty hospitals in the same hopper as other ventures that may not be done under the Stark mandates. This probably means that soon the physicians that own these ventures will have to either sell them or not refer patients to them. The CMS has decided to carve out specialty hospitals from the whole hospital exception to the Stark Bill. I am sure there will be a law suit to determine whether or not the CMS may do this without legislative backing. To date, it appears the hospital lobby has more money and clout than the AMA. Top
The Medical Board of California has moved against the license of Dr. Moon. Dr. Moon is one of the two physicians at Tenet's Redding Hospital who was accused in the press of doing unnecessary cardiac work. The Medical Board attempted before of taking the license but was rebuked by the courts as not giving due process. They are attempting again to go after the license based on several cases. This time the physician will have the right to fight the Board's accusations.
In Washington, the insurance commissioner is attempting to strong arm physicians who do boutique medicine. There is a law that prohibits physicians in the state from charging additional fees for services already covered by insurance. A deputy insurance commissioner in the state believes that physicians may be acting as insurers if they bill patients for all services as a set fee. The Deputy is acting as a stooge for the insurance companies who don't like that more physicians are dropping insurance companies and doing boutique medicine. In boutique medicine patients are charge fees to cover items that are not covered by insurance. Medicare and all states that have looked at this up to date have stated it is legal. Even in Washington, the large Blue Shield carrier Regence believes the fees are legal.
The AMA states that physicians are not to be afraid of discipline for prescribing pain meds. My counsel is to be afraid. Be very Afraid!! The article stated that 38 Boards have stopped taking into account how may drugs were prescribed but are using whether or not the physicians are using the state guidelines or not. The guidelines often sat one thing but the Boards do another. The executive director of the National Foundation for the treatment of Pain states the Boards are making sweeps into offices and then trumping up charges against the physicians. The article used Board perceptions and not reality. How it got published I'll never know. Top
Texas has passed a malpractice bill that sets a $250,000 cap on non-economic damages. It also does much more both to limit liability for public hospitals professionals and ED physicians. It also changes discovery and expert reports.
The Pennsylvania House has passed the first step in a constitutional amendment to limit malpractice awards. It will take three years to even get to the voters. There was an attempt to make this an emergency measure but that failed the 2/3 majority needed.
A Kentucky state legislative study stated that limiting caps will not decrease insurance premiums. This study was not accepted by the legislators stating the study needs more work. Top
CMS has just finalized the outlier rule for hospitals and long term facilities. This rule was developed because of the California Tenet outlier charges. This means that Tenet did nothing legally wrong. Top
Maine has passed universal health insurance for 180,000 uninsured state residents. This would set up a quasi public department to help get insurance from private insurers. The premiums would be based on the person's income and the amount of coverage requested. The funding for this program would come from a tax on the insurance companies and state money. It should be interesting to see how many insurance companies remain in the sate after the amount of tax is known. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.