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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….
With the difficulties even the largest health plans are having managing risk contracts, more physicians are likely to find themselves with a substantial number of delayed or unpaid claims. In spite of these ominous trends, physicians can reduce their risk of working for free. Find out more at: Stiffed –…
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
Choosing a strategic partner is obviously a crucial decision for any physician or group. Choose the wrong partner, and the union is likely to fail. Unfortunately, many physicians and groups have only a limited understanding of how to evaluate a potential strategic partner. Physicians should consider the following key points…
The merging, affiliating and partnering of medical groups, hospitals and physician practice management companies (PPMCs) is continuing at a rapid pace. Medical groups considering entering into these arrangements should understand what potential strategic partners are looking for in them. This knowledge will help groups realistically evaluate themselves, and decide what…
Dr. Potvin’s attorney shows how precedent is made in contesting terminations without cause. Read more about the case at:Potvin v. Metropolitan Life Insurance Company California Physician, August 1997
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…
There is a disturbing trend in California, perhaps fueled to some extent by media and public pressure, to find fault with the care rendered by physicians. It appears physicians are increasingly placed at risk of having their sincere medical judgments lumped under the categories of “incompetence,” “gross negligence,” or “repeated…
Today’s competitive managed care environment has created much tension between IPAs’ physician managers and their physician members. Many IPAs (independent practice associations), under pressure to maintain quality care while controlling the costs to deliver care, are responding by reducing their membership. IPA physicians naturally feel they are being treated unfairly…
Hospitals across the country continue to approach physicians to form integrated delivery systems. There are a number of key “do’s” and “don’ts” to making the project a success. Learn more at: Creating An Integrated Delivery System – Keys to Success American Medical News, August 26, 1996
Just as there has been an increased emphasis on the prevention of sexual abuse and sexual harassment generally in the employment sector in the United States, there has also been a commensurate increase in interest on the part of the California legislature and hospital staffs in preventing and punishing sexual…
Medical groups need to rethink physician compensation in light of the shift to capitated managed care, and the impact of the new “Stark II” law restricting physician self-referral for ancillary medical services. Learn more about the change at: Physician Compensation In A Managed Care And Stark II World California Physician, September…
A recent case involving the Medical Board of California (MBC) reflects the conservative approach of California appellate courts to physician rights. In the case of Kenneally vs. Medical Board of California, the California Court of Appeal rejected the contention that physicians should be entitled to at least as much procedural…
What should you do when confronted with a denial of payment for services rendered or a request for reimbursement of payment for services already rendered? Get the answer to this question at: Wrangling With Recoupment LACMA Physician, September 19, 1994
California physicians who are considering whether to sell their practices to and join an integrated delivery system (IDS) face complex decisions. IDSs, which are generally hospital sponsored, include management services organizations (MSOs), physician hospital organizations (PHOs), and tax-exempt “foundations.” Read more about an integrated delivery system: Selling Your Practice To An…