November 2011 Archives

November 30, 2011

CMS Reinstates Previous Rule Regarding Signatures on Requisitions: No Signature Required


In the November 28, 2011 Federal Register, the Centers for Medicare and Medicaid Services ("CMS") retracted its requirement that physicians or non-physician practitioners ("NPPs") sign requisitions for clinical laboratory tests paid under the Clinical Laboratory Fee Schedule ("CLFS").

When it was first enacted ten years ago, in 2001, CMS revised 42 CFR 410.32(d)(2) to require that "[t]he physician or [sic] (qualified nonphysician practitioner, as defined in paragraph (a)(3) of this section), who orders the service must maintain documentation of medical necessity in the beneficiary's medical record." In its comments, CMS repeatedly noted that "[w]hile the signature of a physician on a requisition is one way of documenting that the treating physician ordered the test, it is not the only permissible way of documenting that the test has been ordered." Until CMS' release of the final CY 2011 Physician Fee Schedule ("PFS"), this remained CMS' position and the healthcare industry's practice.

In the CY 2011 PFS, CMS proposed and finalized a rule to require a physician's or NPP's signature on requisitions for clinical diagnostic laboratory tests paid on the basis of CLFS. However, after becoming increasingly aware of the difficulty with which this new requirement was being implemented and realizing the potential negative impact it could have on the delivery of care, CMS retracted its new signature requirements, reinstating the old rule:

After consideration of the public comments received, we are finalizing our proposal to retract the policy that was finalized in the CY 2011 PFS final rule with comment period, which required a physician's or NPP's signature on a requisition for clinical diagnostic laboratory tests paid under the CLFS (75 FR 73483) and to reinstate our prior policy that the signature of the physician or NPP is not required on a requisition for a clinical diagnostic laboratory test paid under the CLFS for Medicare purposes.

Therefore, physician or NPP signatures are no longer required on requisitions for clinical laboratory tests paid under CLFS.

Continue reading "CMS Reinstates Previous Rule Regarding Signatures on Requisitions: No Signature Required" »

November 30, 2011

RAC Part A/B Rebilling Demonstration Call Held

Today, CMS held its Open Door Forum related to the CMS A/B Rebilling Demonstration. General information related to the CMS call is available at http://go.cms.gov/cert-demos. This website includes a Frequently Asked Question document, slides related to the call, and the enrollment application.

CMS outlines the process for the rebilling demonstration as follows:

Once a provider submits a short stay inpatient (Part A) claim, defined as two days or less within the same spell of illness
• Inpatient admission is deemed not medically necessary by MAC, Recovery Auditor, CERT, or Provider self-audit (should have been outpatient)
• Denials and voluntary refunds are for full amount
• If part of the demonstration, providers can re-bill for all outpatient services
- Payment will be made at 90% after co-insurance and deductible.

The demonstration will be limited to 380 hospitals, accepted on a first come, first served basis. The 380 hospitals will be broken down as follows:
• 80 "Large Facilities," defined as 300+ beds
• 120 "Moderate Facilities," defined as 100-299 beds
• 180 "Small Facilities," defined as fewer than 100 beds

Applications will be accepted beginning December 12, 2011 at 2:00 p.m. Applications will not be accepted prior to this. If a hospital is not one of the first 380 hospitals to apply, they will be placed on a waiting list. Additional information regarding this process is available at http://go.cms.gov/cert-demos.

There are two provisions of this demonstration project that may prove particularly troubling to hospitals, and may give some hospitals pause prior to applying to participate in this demonstration:
If a hospital chooses to participate in the demonstration program, then the hospital must agree not to appeal any Part A short stay inpatient claim (defined as a claim for inpatient hospital services 2-days or less).
• Also, if the hospital chooses to re-bill, it may not re-bill for observation services.

Given the above considerations and also given many hospitals' success rate during the appeals process, many hospitals may choose not to participate in this demonstration.

Continue reading "RAC Part A/B Rebilling Demonstration Call Held" »

November 28, 2011

OIG Does Not View Favorably Proposed Arrangement of a Laboratory Management Company Providing Services in PCP Offices

In Advisory Opinion 11-17, the Office of Inspector General ("OIG") reviewed an arrangement in which a laboratory services management company ("Requestor") "proposes to provide allergy testing and immunotherapy laboratory services and related items to primary care physicians and physician practices ("Physicians") within the Physicians' medical offices. Specifically, Requestor would enter into exclusive contracts with the Physicians to operate an allergy testing laboratory on the Physicians' behalf" ("Proposed Arrangement"). Requestor proposes it provide all of the necessities to conduct the testing (i.e., personnel, equipment, supplies, training, billing and collection services, etc.) and assist Physicians with marketing the services by reviewing patient files to identify candidates for Requestor's services. In consideration for Requestor's services, under the Proposed Arrangement, Physicians would pay Requestor a fee equal to 60% of the Physicians' gross collections from the testing and services, a fee that Requestor states is equal to fair market value.

The OIG determined that because Requestor would be paid a percentage of gross collections for the tests (i.e., compensation would not be set in advance) the Proposed Arrangement did not fit within any of the Anti-Kickback Statute ("AKS") safe harbors. Notwithstanding the fact that an arrangement does not fit within an AKS safe harbor, the arrangement could still be permissible if the OIG determines that it poses a low enough risk to be offered protection. However, for the following reasons, the OIG determined that the Proposed Arrangement would not be afforded protection:


  1. Requestor's fee would not be tied to actual and necessary services provided by Requestor to Physicians; rather, Requestor's fee would be based upon a percentage of gross collections for the allergy testing and immunotherapy services; and

  2. Requestor's review of patient files to identify candidates for its services would be "a suspect marketing activity," leading to unnecessary testing and overutilization.


Please note: While Requestor stated that the Proposed Arrangement was structured to comply with the Stark Law's In-Office Ancillary Services Exception, the OIG did not opine on the Proposed Arrangement's compliance with the exception. The OIG stated, "[e]ven if some features of the Proposed Arrangement were to comply with the Stark Law, such compliance would not affect our analysis under the anti-kickback statute."

Continue reading "OIG Does Not View Favorably Proposed Arrangement of a Laboratory Management Company Providing Services in PCP Offices" »

November 23, 2011

Marilyn Tavenner to Replace Donald Berwick as CMS Administrator

The Obama Administration announced that Centers for Medicare and Medicaid Services ("CMS") Administrator, Donald Berwick, MD, would be stepping down on December 2. His replacement, Marilyn Tavenner, served as Virginia's Secretary of Health and Human Services from 2006 to 2010 and then served as the CMS Principal Deputy Administrator and Chief Operating Officer.

Continue reading "Marilyn Tavenner to Replace Donald Berwick as CMS Administrator" »

November 23, 2011

Providers and Suppliers Beware: Medicare Patients Now Looking for Fraud, Too

According to a press release, the Department of Health and Human Services ("HHS") announced that it will be awarding $9 million from the Centers for Medicare and Medicaid Services ("CMS") to Senior Medicare Patrol ("SMP") programs across the country tasked at fighting Medicare fraud. SMP is operated by the Administration on Aging in close partnership with CMS and the HHS Office of Inspector General. The new grants will allow for increased awareness for Medicare beneficiaries about how to prevent, detect and report healthcare fraud.

According to the press release:

The SMP volunteers work in their communities to educate Medicare beneficiaries, family members, and caregivers about the importance of reviewing their Medicare notices, and Medicaid claims if dually-eligible, to identify errors and potentially fraudulent activity. Program volunteers also encourage seniors to make inquiries to the SMP Program when such issues are identified, so that the project may ensure appropriate resolution or referral.

Therefore, providers must continue to emphasize compliance within their practices and also have strong communications with patients to avoid misunderstandings by patients as scrutiny has spread beyond just government officials. The government is investing in patients to help them in the fight against Medicare fraud.

Continue reading "Providers and Suppliers Beware: Medicare Patients Now Looking for Fraud, Too" »

November 22, 2011

CMS Announced 90-Day Discretionary Enforcement Period for Compliance with New HIPAA Standards


On November 17, 2011, the Centers for Medicare and Medicaid Services ("CMS") announced that it will delay enforcement action until March 31, 2012 for those Health Information Portability and Accountability Act ("HIPAA") covered entities that are not in compliance with the ASC X12 Version 5010, NCPDP Telecom D.0 and NCPDP Medicaid Subrogation 3.0 standards. CMS stated, however, that the compliance date remains January 1, 2012, but it will have discretionary application of its enforcement authority. In fact, according to an FAQ posted on the CMS website:

What will be the level of enforcement during the enforcement discretion period for X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) implementation?

The compliance date for implementation of these updated standards remains January 1, 2012. Because trading partner testing has not reached a threshold whereby a majority of covered entities may be able to comply by the compliance date, the Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS), has announced that it would exercise its enforcement discretion with respect to any HIPAA covered entity that a complaint is filed against for violation of compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 standards. The enforcement discretionary period is for 90 days after the January 1, 2012 compliance date.

If a complaint is received by CMS after January 1, 2012, the entity against which the complaint has been filed will be evaluated to determine its level of compliance. An assessment will be made of the filed-against entity's efforts to test and become compliant. OESS will take appropriate actions as permitted under the authority of the HIPAA enforcement rule, but will not assess any penalties and/or civil monetary penalties during this 90-day period.

Please note: this requirement applies to everyone who is covered by HIPAA, not just those who submit Medicare or Medicaid claims.

CMS' ICD-10 page may be found here.

Continue reading "CMS Announced 90-Day Discretionary Enforcement Period for Compliance with New HIPAA Standards" »

November 22, 2011

Cost of Administering Sipuleucel-T (PROVENGE®) is Now Reimbursable by Medicare

On November 2, 2011, the Centers for Medicare and Medicaid Services ("CMS") issued a Medicare Learning Network Matters article entitled Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer ("CR 7431") wherein it "instructs that, effective for services performed on or after June 30, 2011, CMS concludes that the evidence is adequate to support the use of autologous cellular immunotherapy treatment - Sipuleucel-T; PROVENGE® for Medicare beneficiaries with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone refractory) prostate cancer." Reimbursement for PROVENGE® (with a new HCPCS code of Q2043, replacing C9273), for the above-noted indication, is limited to one treatment regimen for the patient's lifetime, which consists of three doses that are administered roughly two weeks apart. The treatment period may not exceed 30 weeks from the first administration. Administration of the treatments is not included in Q2043.

On November 7, 2011, CMS revised CR 7431, in which it specifically affirmed that that the cost of administering PROVENGE® is not included in Q2043, but separate payment for the cost of administration is permissible.

Q2043 is all-inclusive and represents routine costs, except for the cost of administration. Please note that the cost of administration can now be billed separately.

Continue reading "Cost of Administering Sipuleucel-T (PROVENGE®) is Now Reimbursable by Medicare" »

November 22, 2011

Supreme Court to Review Healthcare Reform Challenge

In its November 14, 2011 Order List, the Supreme Court granted certiorari to hear the challenge to the Patient Protection and Affordable Care Act ("PPACA"). Challenges to the law have ranged on issues from the individual mandate, Medicaid expansion, the employer mandate and health benefits exchange. The Court will hear 5.5 hours of oral arguments on the issues and questions raised. According to the National Conference of State Legislatures, "between January and early November 2011, a total of 44 states had more than 200 measures filed, opposing elements of health reform or proposing alternative policies."

Continue reading "Supreme Court to Review Healthcare Reform Challenge" »

November 22, 2011

CMS Changes Medicare Overpayment Notification Process


The Centers for Medicare and Medicaid Services ("CMS") defines an overpayment as a payment to a provider or supplier that exceeds the amounts payable under Medicare statutes and regulations. If CMS identifies an overpayment made to a provider or supplier, it will initiate a recovery process for those identified overpayments.

CMS' recovery process begins by sending the provider or supplier a demand letter, which requests overpayments it believes a provider or supplier wrongfully possesses. Typically, three notification letters are sent to providers/suppliers: (1) the demand letter, (2) a follow-up letter, and (3) an intent to refer letter.

Effective November 1, 2011, a second, follow-up letter (Day 30), will no longer be sent to providers/suppliers.

Those providers and suppliers receiving demand letters and wishing to appeal the audit decision should be prepared for part or all of this timeline

Continue reading "CMS Changes Medicare Overpayment Notification Process" »

November 21, 2011

HIPAA Audit Pilot Program Underway

In August, we posted an entry regarding the newly announced Health Information Portability and Accountability Act of 1996 ("HIPAA") audits that would be underway, pursuant to Section 13411 of the Health Information Technology for Economic and Clinical Health Act ("HITECH"). Section 13411 provides, in its entirety:

SEC. 13411. AUDITS.
The Secretary shall provide for periodic audits to ensure that covered entities and business associates that are subject to the requirements of this subtitle and subparts C and E of part 164 of title 45, Code of Federal Regulations, as such provisions are in effect as of the date of enactment of this Act, comply with such requirements.

In implementing this provision, the Office of Civil Rights ("OCR") is conducting a pilot program ("Pilot") in which it will "perform up to 150 audits of covered entities to assess privacy and security compliance. Audits conducted during the Pilot will begin November 2011 and conclude by December 2012." Business associates will not be audited at this time.

The OCR has promulgated a 3-step process for the Pilot:

(1) Developing audit protocols,
(2) Conducting a limited number of audits (20) to test the protocols, which includes the following four steps:
a. Auditee selection
b. Auditee notification
c. Test of protocol
d. Period of review and adjustment of protocols

(3) Conducting a full range of audits using revised protocol materials

The OCR aims at auditing a wide range of types and sizes of covered entities, including covered individual and organizational providers, health plans and healthcare clearing houses.

Covered entities being audited by the OCR can generally expect the following:


  • Written notification by OCR that the covered entity has been selected for an audit and a request to provide documentation of the covered entity's privacy and security compliance efforts (OCR provides this sample Initial Notification Letter on its website)

  • The covered entity will have 10 business days to supply the requested information

  • Within 30-90 days from the date of the initial written notification, the OCR will conduct a site visit (lasting between 3 and 10 business days) involving interviews of key personnel and observations of processes and operations to determine compliance

  • The auditors will develop a draft audit report and share it with the covered entity

  • The covered entity will have 10 business days to discuss the identified concerns and describe corrective actions it has implemented to address the identified concerns

  • Within 30 business days after receipt of the covered entity's response, the OCR will submit a final audit report, which will incorporate the steps the covered entity has already taken to resolve compliance issues

According to the OCR, "[a]udits are primarily a compliance improvement activity....Generally, OCR will use the audit reports to determine what types of technical assistance should be developed, and what types of corrective action are most effective. Should an audit report indicate a serious compliance issue, OCR may initiate a compliance review to address the problem."

Continue reading "HIPAA Audit Pilot Program Underway" »

November 15, 2011

RAC Program Further Expanding

The Medicare RAC program is expanding even further. By way of a Fact Sheet issued on November 15, 2011, CMS announced three new initiatives with respect to its Medicare RAC program. Beginning January 1, 2012, CMS will conduct demonstration projects with the goal to eliminate fraud, waste, and abuse in the Medicare program. The three demonstration projects are described by CMS as follows:

• Recovery Audit Prepayment Review: The Recovery Audit Prepayment Review demonstration will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional "pay and chase" methods of looking for improper payments after they have been made.

• Prior Authorization for Certain Medical Equipment: The second demonstration... will require Prior Authorization for certain medical equipment for all people with Medicare who reside in seven states with high populations of fraud- and error-prone providers (CA, FL, IL, MI, NY, NC and TX). This is an important step toward paying appropriately for certain medical equipment that has a high error rate. This demonstration will help ensure that a beneficiary's medical condition warrants their medical equipment under existing coverage guidelines...

• Part A to Part B Rebilling: The third initiative will allow hospitals to rebill for 90 percent of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary due to the hospital billing for the wrong setting. Currently, when outpatient services are billed as inpatient services, the entire claim is denied in full...

The third demonstration project, allowing hospitals to rebill for 90 percent of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary will have important financial implications for hospitals. Currently, if a RAC issues this type of denial, the entire claim is denied in full. In order to obtain reimbursement, the hospitals need to appeal the claim and seek relief through the Medicare appeals process. According to an FAQ on the CMS website:


Providers can re-bill for Inpatient Part B services, also known as ancillary services, but only for the services on the list in the Benefit Policy Manual. That list can be found in Ch. 6, Section 10: http://www.cms.hhs.gov/manuals/Downloads/bp102c06.pdf. Rebilling for any service will only be allowed if all claim processing rules and claim timeliness rules are met. There are no exceptions to the rules in the national program. Normal timely filing rules can be found in the Claims Processing Manual, Chapter 1, Section 70: http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf.

Of note, the third demonstration listed above, which would allow hospitals to rebill Part B claims when an inpatient hospital claim is denied as not reasonable and necessary due to the hospital billing for the wrong setting, will be limited to a representative sample of 380 hospitals nationwide that volunteer to be part of the program. A Fact Sheet regarding the rebilling initiative is also available on the CMS website.

Continue reading "RAC Program Further Expanding " »

November 11, 2011

CMS Expands MPPR to Professional Component of Advanced Diagnostic Imaging


On July 19, 2011, the Centers for Medicare and Medicaid Services ("CMS") published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule ("Proposed Rule"). On November 1, 2011, CMS issued its CY 2012 Physician Fee Schedule Final Rule ("Final Rule"), in part, to "address changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services." Most notably for providers and suppliers of radiology services, is the expansion of the multiple procedure payment reduction ("MPPR") policy to the professional component ("PC") of certain advanced diagnostic imaging services (e.g., CT, MRI and Ultrasound). For a more detailed explanation regarding the MPPR and the Proposed Rule, please see this article published by The HLP founding shareholders, Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq.

In response to an overwhelming majority of negative feedback CMS received on the Proposed Rule with respect to the MPPR, CMS determined that a 25% reduction in the PC of second and subsequent advanced imaging services was appropriate (versus the proposed-50% reduction). Therefore, beginning January 1, 2012, the MPRR would apply to the PC of certain advanced imaging services.

Radiology providers and suppliers are being called upon to urge their Representatives to support HR 3269, the "Diagnostic Imaging Services Access Protection Act of 2011," which, if enacted, would prevent the MPPR from being applied to the PC of imaging services.

Continue reading "CMS Expands MPPR to Professional Component of Advanced Diagnostic Imaging " »

November 11, 2011

CMS Issues 2012 Final Physician Fee Schedule

On July 19, 2011, the Centers for Medicare and Medicaid Services ("CMS") published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule ("Proposed Rule"). On November 1, 2011, CMS issued its 2012 Final Physician Fee Schedule ("Final Rule"), in part, to "address changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services." Some key provisions of the Final Rule are set forth below:


  • Payment Reduction Pursuant to the Sustainable Growth Rate - Payments to providers under the Medicare Physician Fee Schedule is set to be reduced by 27.4%, as required by the Sustainable Growth Rate formula, beginning January 1, 2012 absent legislative measures to block to reduction.

  • Addition of Certain Telehealth Services - Generally speaking, CMS reimburses providers for telehealth services--located at a distant site--furnished to an eligible telehealth beneficiary in an originating site. In the Final Rule, CMS proposes adding smoking cessation services to the services to the list of Medicare telehealth services, but notably, chose not to include online evaluation and management ("E&M") services (i.e., to add CPT code 99444) because "(1) these services are non-face-to-face; and (2) the code descriptor includes language that recognizes the provision of services to parties other than the beneficiary and for whom Medicare does not provide coverage (for example, a guardian)."

  • Expansion of the Multiple Procedure Payment Reduction ("MPPR") - The MPPR has been expanded to include the professional component of certain advanced diagnostic imaging services. For a more detailed explanation of this change, please see this blog entry.

  • Anesthesia Fee Schedule Conversion Factor - For 2012, the anesthesia conversion factor is $24.6712 with the national average anesthesia conversion factor equal to $15.5264, a decrease of 26.2% from 2011.

  • Additions to the Physician Self-Referral List of CPT/HCPCS Codes - Beginning January 1, 2012, the following tables provide the codes will be added and removed as designated health services ("DHS") for purposes of the physician self-referral law (a/k/a the Stark Law):


Table 82.bmp

Table 83.bmp

Continue reading "CMS Issues 2012 Final Physician Fee Schedule" »

November 10, 2011

Yet Again, the SGR Comes Knocking and, This Time, with a 27.4% Cut to Physician Services


The Balanced Budget Act of 1997 enacted the much-despised Medicare sustainable growth rate ("SGR"), which was established to control Medicare spending on physician services. To achieve the SGR target, each year in its report to the Medicare Payment Advisory Commission, the Centers for Medicare and Medicaid Services ("CMS") includes a conversion factor that will change the payment for physician services for the next year to match the target SGR. According to CMS:

The SGR targets are not direct limits on expenditures. Payments for services are not withheld if the SGR target is exceeded by actual expenditures. Rather, the fee schedule update, as specified in section 1848(d)(4) of the [Social Security] Act, is adjusted to reflect the comparison of actual expenditures to target expenditures. If expenditures exceed the target, the update is reduced. If expenditures are less than the target, the update is increased. Under the statute, the update for a year is determined by comparing cumulative actual expenditures to cumulative target expenditures (referred to as "allowed expenditures" in the statute) from April 1, 1996 through the end of the year preceding the year at issue. For instance, the 2010 update reflects a comparison of cumulative actual to cumulative target expenditures from April 1, 1996 through December 31, 2009. Target expenditures for each year are equal to target expenditures from the previous year increased by the SGR.

As can be expected, when the SGR and, by extension, the conversion factor fall into the negative percentages (i.e., where physicians will experience a decrease in reimbursement for their services), controversy ensues. Almost every year in this millennium, physicians have been faced with the threat of decreased reimbursement for their services. Each of these years, Congress has implemented a "doc fix" (oftentimes last minute) wherein it temporarily prevents the implementation of the SGR. However, this temporary delay only temporarily silences opponents of the SGR who are calling for a permanent fix. In December 2010, President Obama signed into law the Medicare and Medicaid Extenders Act of 2010, which delayed the SGR until January 1, 2012. Now, nearly one year later, we are faced, yet again, with the SGR as 2012 is quickly drawing nearer.

In the 2012 Final Physician Fee Schedule, CMS announced that physician payments in 2012 will be cut by 27.4%, which is less than the proposed-29.5%. Conversely, outpatient services will experience a 1.9% increase in reimbursement and ambulatory surgical centers will experience a 1.6% increase. According to the American Medical Association, "without congressional intervention, Medicare physician payment rates will be cut about 40 percent by 2016."

Continue reading "Yet Again, the SGR Comes Knocking and, This Time, with a 27.4% Cut to Physician Services" »

November 3, 2011

Robert S. Iwrey, Esq., Again, Named a d'Business Magazine Top Lawyer in Healthcare in 2012

The HLP is proud to announce that founding partner, Robert S. Iwrey, Esq., was named a d'Business Magazine Top Lawyer in Healthcare for 2012. Iwrey was also named a Top Lawyer in Healthcare in 2010. d'Business polled more than 21,000 attorneys in Oakland, Macomb, Wayne, Washtenaw and Livingston counties, asking them to nominate attorneys for this recognition. HLP congratulates Robert on this achievement.

November 2, 2011

The Health Law Partners, PC Recognized as a "Best Law Firm"

The Health Law Partners, P.C. is honored to be recognized by the U.S. News as a 2011-2012 "Best Law Firm" in the area of health care law. The rankings showcase law firms ranked nationally in one or more of 75 major legal practice areas. According to a press release issued by U.S. News, achieving this distinction "signals a unique combination of excellence and breadth of expertise." The rankings in their entirety are posted online at http://bestlawfirms.usnews.com.