Mid-Atlantic Health Law TOPICS

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Did You Know? Winter 1999

Dually Eligible: Did you know that the Court of Appeals for the District of Columbia has upheld a lower court decision that validated the District of Columbia's practice of reimbursing physicians at the lower Medicaid rate for services provided to patients dually eligible for Medicare and Medicaid? The decision was the result of a suit filed by local physicians and the D.C. Medical Society.

Peer Review Immunity: Did you know that the U.S. Court of Appeals for the Fourth Circuit ruled, in a Maryland case, that a physician conducting a peer review at the request of the Board of Physician Quality Assurance is immune from suit? The court found that the reviewer was acting in a "prosecutorial capacity," and was therefore entitled to absolute immunity regarding his participation in the peer review process.

Fraud Net Expands: Did you know that a False Claims Act whistleblower suit regarding Columbia/HCA Healthcare Corp. includes charges against Columbia's outside account-ants?

Physical Restraints: Did you know that HCFA has issued regulations providing for a "Patients' Rights" component to the Medicare Conditions of Participation for hospitals? Of particular interest are provisions relating to the use of physical restraints on hospital patients. Even previously approved hospitals must assure compliance with the new rules, or risk loss of Medicare/Medicaid certification. A federal judge in Washington, D.C., has rejected a hospital request for a temporary restraining order to block the restraint provision of the new rules.

Disclosure Liability: Did you know that an Illinois patient has sued her late husband's physician for breaching a fiduciary duty to the patient? The charges are based on allegations that the physician's HMO contract provided the physician with an incentive to limit tests and referrals, and that no disclosure of this fact was made to the patient.

Fee-Splitting: Did you know that the Florida Board of Medicine has corrected "misinterpretations" arising from a prior decision that appeared to prohibit the splitting of physician fees with physician practice management companies? In a more recent decision, the Board has approved a percentage payment to a management company where the managers are not rewarded for referrals, and where incentives to grow the practice are capped. Clearly, the Florida Board has opened the door for a case-by-case evaluation of management arrangements.

Stark Changes: Did you know that bills have been introduced in Congress to change the "Stark" self-referral law? One bill would limit the application of the law to situations where the referring physician holds an ownership interest in the entity to which he or she is referring a patient, eliminating issues related to "compensation arrangements" between the referrer and the entity to which the patient is referred.

Credentialing Reports: Did you know that the Office of the Inspector General of DHHS is urging Congress to enact legislation that will provide for fines against hospitals that fail to report adverse credentialing actions against physicians? The fines would go as high as $10,000 for each reporting failure.


December 21, 1999




Rosen, Barry F.


Health Care