CMS Releases Final MACRA Rules

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two…

Firm Secures Dismissal of Medi-Cal and Medicare Fraud Charges

September 23, 2016:  Following a two-day preliminary hearing, a Kern County Superior Court Judge dismissed all charges against a physician accused by the California Attorney General of Medi-Cal and Medicare fraud and related theft and tax offenses.  Led by Steven Goldsobel, the firm fought a more than two-year long battle…

What Did The “Doc Fix” Fix?:
MACRA’s Medicare Physician Payment Changes

The Medicare Access and CHIP Reauthorization Act (MACRA) makes two major changes in how Medicare will pay physicians and other clinicians. First, it implemented the so-called “Doc Fix.” That is, MACRA ended the flawed and much-maligned Sustainable Growth Rate (SGR) formula for determining Medicare payments and the annual ritual of…

CMS Issues New ACO Regulations

Shared Savings Program Proposed Rule reflects focus on primary care and improved incentives for participation, quality, and efficiency. Read the full press release here.

Jeremy Miller Discusses the Legality of Your Medical Director Agreement

On April 5, a jury in Kansas City, Mo., convicted two physicians, Robert LaHue, DO, and Ronald LaHue, DO, and two former Baptist Medical Center administrators of violating the Medicare- Medicaid antikickback law. The physicians were convicted of receiving illegal kickbacks for referring their nursing home patients to the hospital….

Jeremy Miller Discusses Illegal Referrals

Without realizing it, physicians may be making illegal referrals to their own group. Learn how to prevent making illegal referrals at: Are you Making Illegal Referrals? American Medical News, January 18, 1999

Jeremy Miller on the Move to Captiation

Even in markets heavily penetrated by managed care, most specialists until recently still have been paid on a fee-for-service basis. Increasingly, however, specialists are being “carved out” or “subcapitated,” where they are paid a flat amount per member per month. Learn about steps you can take to reduce the dangers…