Healthcare Law Blog : Medical Groups, Health Plans, Hospital & Facility Lawyers & Attorneys: Sheppard Mullin Law Firm

By Karie Rego

The most difficult issue a hospital can face involves allegations of poor quality coupled with billing fraud. These allegations can be devastating to a hospital's operations and its reputation. It is essential that hospital administration, the medical staff, legal and compliance officers work together quickly and efficiently to verify and address allegations.  Hospitals should have at least an informal plan in place to address allegations. This prevents misunderstandings and potential duplication of roles that can result in further allegations that the hospital or medical staff isn't addressing the potential issue as happened in the notorious "Redding" case.
 

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By Karie Rego

Ever since the Redding Medical Center government investigation found inappropriate percutanteous coronary interventions (PCI), the medically necessity of PCI has been a highly debated topic. This past year, there have been two other similar cases involving providers in Maryland and Pennsylvania. In Maryland, the state even considered adopting it's own quality guidelines. This is a high risk area for providers an can impact both reputation and reimbursement.

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By Eric A. Klein

Healthcare providers must continue to wait for the Centers for Medicare and Medicaid Services (CMS) to release regulations governing accountable care organizations (ACOs), despite predictions the regulations would be issued last week. The regulations were not forthcoming, possibly due to the tense atmosphere in Washington over the federal budget. ACOs, created by a provision in the healthcare reform law, encourage care coordination by allowing physicians to integrate with other members of the health care system in order to reduce unnecessary costs and improve the quality of care for Medicare fee-for-service beneficiaries.   The regulations should address important open questions about ACOs not answered in the healthcare reform law.
 

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By Ken Yood and Lynsey Mitchel

The mission of the Office of the Inspector General ("OIG") is to protect the integrity of the programs and operations of the Department of Health & Human Services, for example Medicare, by detecting and preventing waste, fraud and abuse, and identifying opportunities to improve program economy, efficiency and effectiveness. The Work Plan describes both the ongoing and new audits and evaluations that the OIG plans to address in fiscal year 2011.
 

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