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“We serve patients poorly when government regulations gather dust in the attic: they become even more stale and liable to wreak havoc throughout the health care system. Administrative costs are driving up the cost of health care in America – to the tune of hundreds of billions of dollars. The Stark proposed rule is an important next step in President Trump’s health care agenda for Americans. We are updating our antiquated regulations to decrease burden for providers and helping bring down these increasingly escalating costs.”

– Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.

The Department of Health and Human Services (HHS) announced today the release of several proposed changes to the regulations that interpret the Physician Self-Referral Law (the Stark Law), the Civil Monetary Penalty Law (CMP), and the Federal Anti-Kickback Statute (AKS). The proposed revisions are intended to provide greater clarity to health care professionals.

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By Adrienne Dresevic, Esq. and Carey Kalmowitz, Esq. of The Health Law Partners, P.C.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the agency’s ability to stop fraud by barring unscrupulous providers out of federal health insurance programs. This rule is unlike past rules in that it stops providers before they get paid. This is a momentous step on CMS’s part to end “pay and chase” in federal health care fraud efforts and replace it with proactive measures.

The final rule, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC), becomes effective November 4, 2019 and establishes novel revocation and denial authorities to buttress CMS’ efforts to stop waste, fraud and abuse. This rule is applicable to the entire provider community, including radiologists.

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Please join The Health Law Partners, P.C. in congratulating Robert S. Iwrey, Esq. and Arturo Trafny, Esq. for their publication of Licensing Health Care Providers in Michigan: Requirements and Ramifications by The State Bar of Michigan Health Care Law Section (HCLS).

This white paper, an updated edition of a previous HCLS publication, discusses the various requirements for licensure, certification, and registration for Michigan health care professionals. It also provides an overview of the typical investigation process followed by Michigan’s Bureau Professional Licensing for alleged violations of Michigan’s Public Health Code.

Download the PDF of Licensing Health Care Providers in Michigan: Requirements and Ramifications here.

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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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