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CMS Reimbursement Changes

Posted on by mgoldberg

The Centers for Medicare and Medicaid Services (“CMS”) proposes that physicians will be reimbursed for coordinating patient care following patient discharge, starting in 2013.  This includes payments for patient care management, such as phone calls, for which physicians are not…

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Aetna Sued By Physicians Over Out-Of-Network Dispute

Posted on by mgoldberg

A group of over 50 physicians, the Los Angeles County Medical Association and the California Medical Association are suing Aetna Inc. (“Aetna”) for allegedly underpaying out-of-network physicians, regularly refusing to authorize various out-of-network services, and illegally terminating contracts with physicians…

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Illinois Medicaid Investigates Planned Parenthood

Posted on by mgoldberg

The Illinois Medicaid inspector general is currently investigating the billing practices of Dr. Caroline Hoke, the medical director of Planned Parenthood of Illinois (“PPIL”). PPIL, a non-profit organization for reproductive health and child services, received over half of its $25…

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U.S. Reaches Largest Healthcare Fraud Settlement With Pharmaceutical Company

Posted on by mgoldberg

GlaxoSmithKline (“GSK”), a British pharmaceutical company, plead guilty to criminal and civil charges of promoting unapproved drugs and agreed to pay a $3 billion settlement with the US government. GSK allegedly engaged in illegal schemes in marketing and pricing of…

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Governor Quinn Signs Military Family Licensing Act

Posted on by mgoldberg

Illinois Governor Pat Quinn, with the support of First Lady Michelle Obama, signed the Military Family Licensing Act, which makes it easier for military spouses to transfer out-of-state occupational licenses to Illinois. The bill, which takes effect on January 1,…

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Supreme Court Upholds Obama Health Care Mandate

Posted on by mgoldberg

This morning the Supreme Court, in a 5-4 decision, upheld President Obama’s health care individual mandate requiring essentially all US citizens to purchase health insurance that meets minimum federal standards or to pay a fine. While the fine was found…

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Expert Witness Successfully Challenges Medical Society Discipline

Posted on by mgoldberg

Steven Graboff, MD, a California orthopedic surgeon, successfully sued the American Academy of Orthopaedic Surgeons (“AAOS”) after the society suspended him for allegedly providing improper expert testimony in a medical negligence case. The jury verdict in favor of Dr. Graboff…

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Raghuveer Nayak accused of paying hundreds of thousands of dollars in exchange for patient referrals

Posted on by mgoldberg

This morning, Raghuveer Nayak, a former fundraiser for U.S. Rep. Jesse Jackson Jr. and Rod Blagojevich, was arrested by the FBI at his Oakbrook home and charged with bribing physicians to send patients to his outpatient surgery centers. Nayak is…

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Medicare Part D “Overall Success” Since Inception, But Issues Remain

Posted on by mgoldberg

On June 6th, policy experts at a Kaiser Family Foundation workshop reported that the Medicare Part D drug benefit has proven an overall success since the program was passed as part of the Medicare Prescription Drug, Improvement, and Modernization Act…

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Illinois Lawmakers Pass Legislation to ‘Rescue’ Medicaid

Posted on by mgoldberg

On May 24, 2012, the Illinois General Assembly approved Senate Bill 2840, an extensive package of Medicaid reductions that Governor Quinn says represents “the first step toward saving Medicaid for those who rely on it.” The package was just one…

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