We counsel healthcare providers, physicians and suppliers regarding operational issues, and represent them in administrative proceedings and state and federal court litigation. We also regularly consult with counsel in other firms and in-house legal departments on transactions and litigation.
“Electronic Medical Record Documentation: Inherent Risks and Inordinate Hazards,” HEALTH LAW HANDBOOK (A. Gosfield, ed.), Thomson Reuters 2016 (in press) (co-author with Margaret M. Manning).
“Evolving Medicare Policy on Physician Orders: Fundamental Concepts But Higher Stakes,” HEALTH LAW HANDBOOK (A. Gosfield, ed.), Thomson Reuters 2014 (co-author with Margaret M. Manning).
“Expanded Exposure To False Claims and Overpayment Demands For Clinical Laboratories,” G2 COMPLIANCE ADVISOR, 2013 (co-author with Margaret M. Manning).
“Medicare Coverage Rules For Services ‘Incident To’ Physician Services: Origins, Development and Current Issues,” HEALTH LAW HANDBOOK (A. Gosfield, ed.), West 2011 (co-author with Margaret M. Manning).
“Hospital Medicare Patient Status: Continuing Problems and Potential Solutions,” HEALTH LAW HANDBOOK (A. Gosfield, ed.), West 2010 (co-author with Margaret M. Manning).
CCH LAW, EXPLANATION, AND ANALYSIS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, Wolters Kluwer, 2010 (Contributor).
“Developing Compliance Issues in OPPS Services: Supervision Requirements,” 12 CCH HEALTH CARE COMPLIANCE No. 7 (Apr. 7, 2009). “Developing Compliance Issues in OPPS Services: Facility E&M Coding,” 12 CCH HEALTH CARE COMPLIANCE No. 6 (Mar. 24, 2009).
“CMS Punts on Medical Clinical Trial Coverage Policy, What Do We Do Now?” 6 BNA Medical Research Law & Policy No. 23 (Dec. 5, 2007).
“The Deficit Reduction Act Requirements for Medicaid Compliance Policies: How Should Your Health Care Organization React?” 26 JOURNAL OF THE ASSOCIATION OF HEALTHCARE INTERNAL AUDITORS 8 (2007).
“Compliance Risks Arising from the Safe Harbor and Stark II Exceptions Allowing Donations Supporting E-prescribing and Electronic Health Record Systems,” Parts I-III, 10 CCH HEALTH CARE COMPLIANCE Nos. 2-4 (Feb. 2007).
MEDICAL RECORDS AND THE LAW, 4th ed., American Health Information Management Association—Jones and Bartlett, Inc., 2006 (Contributor).
“ ‘Medical Necessity’ Determinations—A Continuing Healthcare Policy Problem,” 37 JOURNAL OF HEALTH LAW 599 (2004).
“Monitoring Medical Necessity in Hospitals,” CCH HEALTHCARE COMPLIANCE LETTER, Vol. 7, No. 15 (July 26, 2004). “Healthcare Coding: Systems, Conventions and Compliance,” in HEALTH LAW HANDBOOK (2003 West).
“The Medicare Hospital Outpatient Prospective Payment System: Understanding Issues for Compliance,” in HEALTH LAW HANDBOOK (2002 West) (co-author).
“Civil False Claims—Qui Tam Actions and Civil Money Penalties,” CCH HEALTHCARE COMPLIANCE GUIDE, Chap. II-3 (Dec. 2002).
“Outpatient/Ambulatory Facilities,” HEALTH LAW PRACTICE GUIDE (1993-2003 West) (co-author)
“Recent Case Law Developments Narrow False Claims Act Liability of Local Government and Other Healthcare Providers,” HEALTH LAW DIGEST (American Health Lawyers Association), Vol. 29, No. 6 (June 2001).
“It’s a Miracle, But . . . Medicare’s Rules Will Make It Difficult for New Cancer Cures to Reach Everyone Who Wants Them,” Legal Times, June 18, 2001 (at 29).
“Medicare Medical Necessity Determinations Revisited: Abuse of Discretion and Abuse of Process in the War Against Medicare Fraud and Abuse,” 43 ST. LOUIS U.L.J. 91 (1999).
MEDICARE AND MEDICAID FALSE CLAIMS: LEGAL COMPLICATIONS AND DEVELOPING ISSUES, AHLA, Expert Series Monograph (1996).
“What You Need to Know About the ‘Knew or Should Have Known’ Standard in Medicare and Medicaid False Claims Proceedings: Lessons From Recent Cases and A Current Investigation,” HEALTH LAW LITIGATION No. 2, 16 (ABA Litigation Section, 1995) (co-author).
“Integrated Delivery Systems: The Second Generation,” 16 WHITTIER L. REV. 951 (1995) (co-author).
“Long-Awaited Stark I Regulations Published,” AAHA REPORTER (October 1995) (co-author).
“Diagnostic Uncertainty: Interpreting the Basic Terminology and Tenets of Medicare Coverage Policy,” ADMINISTRATIVE RADIOLOGY JOURNAL (1993).
“Medicare Reassignment Policy: The Right to Bill and Be Paid Under Part B,” ADMINISTRATIVE RADIOLOGY JOURNAL (1993).
“Medicare Part B Policy: What You Thought You Knew Can Ruin Your Practice,” ADMINISTRATIVE RADIOLOGY JOURNAL (1993).
“ ‘Medical Necessity’ Denials As A Medicare Part B Cost-Containment Strategy: Two Wrongs Don’t Make It Right Or Rational,” 34 ST. LOUIS U.L.J. 939 (1990).
“Recent Developments Give Hospitals Opportunity to Revive Medicare Appeals and Secure Additional Reimbursement,” 7 HOSPITAL LAW NEWSLETTER 1 (January 1990).
“Appeals from Medicare Part B Claims Denials,” MATTHEW BENDER HEALTH CARE LAW NEWSLETTER (September 1988).
“Strategies for Addressing Increased Denials of Medicare Part B Claims,” MATTHEW BENDER HEALTH CARE LAW NEWSLETTER (Aug. 1988).
“Capital Costs Under Medicare PPS: Myth Versus Reality,” FAHS REVIEW 41 (May/June 1987)(co-author).
“JCAH Implements Changes In General Acute Care Hospital Accreditation Criteria and Policies,” 1 MATTHEW BENDER HEALTH CARE LAW NEWSLETTER 9 (Dec. 1986).
Comment, “Strict Liability for Blood Derivative Manufacturers: Statutory Shield Incompatible With Public Health Responsibility,” 28 ST. LOUIS U.L.J. 443 (1984)(reprinted at 8 J. PRODUCTS LIABILITY 347 (1985)).