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Join panelist Jessica L. Gustafson, Esq. on September 25, 2019 at 1pm EDT for the Strafford Webinar ‘Agency Deference and the Impact of Kisor in Healthcare: Challenging CMS and Other Agency Actions’.

Jessica will be joined by co-panelists Mimi Hu Brouillette of Greenberg Traurig and Daniel Jarcho of Alston & Bird to discuss these important topics:

  • What are the practical implications of the Supreme Court’s decision in Kisor v. Wilkie for the healthcare industry
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The Health Law Partners, P.C., congratulates Robert S. Iwrey, Esq. for his inclusion in the DBusiness Top Lawyers for 2020 due to his achievements in health care law.

Robert S. Iwrey has been named a Top Lawyer for his achievements in health care law 8 out of the last 10 years.  For 2020, DBusiness polled 19,000 attorneys in Wayne, Oakland, Macomb, Washtenaw, and Livingston Counties in Michigan and asked them to nominate lawyers among 50 different legal specialties.  His award was celebrated at DBusiness Magazine’s Top Lawyers party presented by Cauley Ferrari of Detroit on September 12, 2019.

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The Health Law Partners (HLP) is proud to be part of the upcoming Physician Legal Issues Conference co-sponsored by the American Bar Association Health Law Section and Chicago Medical Society.  The conference will take place at the InterContinental Hotel in Chicago on September 12-14, 2019.  Adrienne Dresevic, Esq., a founding partner of the HLP, will be a featured speaker at the conference. Ms. Dresevic will be speaking twice at this year’s PLI Conference:

  • Structuring Physician Compensation and Incentives – Part 2: Playing to Survive (and Win) in a Value-Based Payment World, Friday, September 13, 1:15pm-2:15pm
  • Practical Skills Workshop: Contract Negotiation, Physician Compensation and Risk Management, Saturday, September 14, 9:00am-10:15am
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The Health Law Partners, P.C. congratulates Robert S. Iwrey, Esq. and Jessica L. Gustafson, Esq. for their inclusion in the 2019 Michigan Super Lawyers list as a Super Lawyer and a Rising Star, respectively.

Robert S. Iwrey has been named a Super Lawyer for his achievements in health care law every year since 2010. This award marks his 10th consecutive year. Only 5% of attorneys in the state receive this distinction, an honor reserved for lawyers who exhibit excellence in practice.

Jessica L. Gustafson has been named a Rising Star for her achievements in health care law every year since 2012. Each year, no more than 2.5% of lawyers in the state are selected by the research team at Super Lawyers to receive this honor.

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An Ashland, KY addiction treatment specialist, Dr. Rose O. Uradu, and her substance abuse treatment center, Ultimate Care Medical Services, LLC d/b/a Ultimate Treatment Center, have agreed to pay $1.4 million to resolve civil allegations that they violated the Controlled Substances Act, and defrauded the Medicare and Kentucky Medicaid programs.

The settlement resolved a civil lawsuit alleging that Ultimate Treatment Center, at the direction of Dr. Uradu, sought and received payments from Medicare and Kentucky Medicaid for services that were not actually provided to patients. According to the Complaint, between January 2013 and September 2014, defendants billed these government programs for “evaluation and management” services, purportedly provided to patients who visited the clinic to receive daily methadone doses. The United States alleged that Ultimate Treatment Center did not actually perform these services when patients received their methadone doses, but falsely documented the performance of these services, in the patients’ medical records, in order to create the false appearance that the reimbursement was justified.

The United States further alleged that, during the period July 2013 and December 2014, defendants billed Medicare and Kentucky Medicaid for complex urine testing that the clinic’s equipment was incapable of performing, therefore violating the False Claims Act.

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We are excited to announce HLP’s Robert S. Iwrey‘s inclusion in the 26th Edition of The Best Lawyers in America for his work in Health Care Law! With this distinction, Rob now ranks among the top 5% of private practice attorneys nationwide.

Recognition by Best Lawyers is based entirely on peer review. Their methodology is designed to capture the consensus opinion of leading lawyers about the professional abilities of their colleagues within the same geographical area and legal practice area.

Please join us in congratulating Rob on this honor!

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On April 8, 2019, the American College of Physicians (“ACP”) released the clinical guideline, “Screening for Breast Cancer in Average-Risk Women: A Guidance Statement from the American College of Physicians” (the “Guideline”). The Guideline divides women into three categories based on age and offers breast cancer screening methodology guidance for each category. The Guideline offers the following guidance for women of average-risk:

  • Women aged 40-49: clinicians should discuss whether to screen for breast cancer with mammography, including a discussion on the benefits and harms of screening as well as the woman’s preference. The ACP notes that potential harms generally outweigh the benefits for most women in this category;
  • Women aged 50-74: clinicians should offer biennial screening for breast cancer with mammography;
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On July 30, 2019, a federal jury in Detroit, Michigan, found a patient recruiter guilty for his role in a scheme involving approximately $1.3 million in fraudulent Medicare claims for home health care that were procured through the payment of illegal kickbacks.

Following a six-day trial, Dominic Trumbo, 45, of Lexington, Kentucky, was found guilty of one count of conspiracy to pay and receive health care kickbacks and three counts of receipt of health care kickbacks.

According to evidence presented at trial, from 2009 to 2017, Trumbo, owner of Trumbo Consulting Agency, solicited and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at multiple home health agencies. These agencies then submitted claims to Medicare for home health services that were purportedly provided to those beneficiaries.

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This year, key information regarding the Appropriate Use Criteria (AUC) program is being released by the Centers for Medicare & Medicaid Services (CMS) via guidance documents. A Change Request was issued July 26, 2019, informing Medicare Administrative Contractors (MACs) that they are to begin accepting AUC-related modifiers and healthcare common procedure coding system (HCPCS) codes in 2020.

Under the AUC program, a practitioner must consult a qualified Clinical Decision Support Mechanism (qCDSM) at the time of an advanced diagnostic imaging service order. The qCDSM – an electronic portal through which AUC is accessed – provides a determination of whether the order adheres to AUC or if the AUC consulted was not applicable to the patient’s clinical condition.

Currently running as a voluntary program, CMS has announced an Education and Operations Testing Period to begin January 1, 2020 and running the full calendar year to give practitioners appropriate time to adjust to the system. During this period, “claims will not be denied for failing to include AUC-related information or for misreporting AUC information.” However, CMS also writes that they expect ordering professionals to begin consulting qCDSMs and providing the relevant information to the furnishing providers during the test period “as it is important for CMS to track this information.”

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On July 10, 2019, United States Attorney Matthew Schneider announced the indictment of Dr. Vasso Godiali of Bay City, charged with health care fraud in the amount of $60 million, and money laundering for financial transactions involving approximately $49 million in proceeds derived from the scheme.

According to the indictment, Dr. Godiali submitted false and fraudulent claims for the placement of stents in dialysis patients and for the treatment of arterial blood clots; exploited medical billing software to improperly maximize payments from Medicare, Medicaid, and Blue Cross Blue Shield of Michigan; submitted false and fraudulent claims to Medicaid, Medicare, and Blue Cross for services not rendered; and “unbundled” claims by exploiting modifier-59 to falsely claim he was performing many separate and distinct procedures, when in fact he was entitled to a single reimbursement for a single procedure. The indictment further alleges that Dr. Godiali utilized six corporations through which he laundered approximately $49 million, which he ultimately used to fund investment accounts at multiple financial institutions, and that he engaged in money laundering by using proceeds from his scheme to pay property taxes on a Houghton Lake, Michigan, residence.

The United States Attorney’s Office also filed a related civil lawsuit seeking the forfeiture of approximately $39.9 million seized from accounts controlled by Dr. Godiali and/or related to four separate real estate transactions.

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