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64 Results for Articles by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
In The Blue Ink Blog.

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CMS Recommendations Regarding Protection from Cybersecurity Risks

Posted on February 22, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued Recommendations to Providers Regarding Cyber Security.  In general, the Recommendations are intended to remind providers and suppliers to keep current with best practices rega…

House Republicans and Trump Administration File Joint Motion to Delay Suit Challenging Obamacare Subsidies

Posted on February 23, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

An interesting development transpired Tuesday, February 21, 2017 in a case pending in Federal District Court in the District of Columbia that challenges subsidy payments from the Federal Treasury to support Obamacare.  The case was originally filed by Ho…

Department of Justice Issues Principles of an Effective Compliance Program

Posted on February 24, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

The Department of Justice issued a directive entitled “Evaluation of Corporate Compliance Programs.”  The document provides insight into the analysis used by the DOJ to assess the effectiveness of a corporate compliance program when making sentencing rec…

Chiropractic Service Overpayment for Lack of Medical Necessity

Posted on February 27, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic group in Kansas.  The revi…

The Case of the Very Very Impossibly Long, Terrible, Horrible, No Good, Very Bad Day

Posted on February 28, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

How Fraud and Abuse Cases Arise in a Medical Practice It is no secret many doctors work very long days.  Some days are worse and some are better than others.  As a compliance lawyer, my job is to attempt to prevent doctors from having Terrible, Horrib…

Recent Changes to Medicare “Incident To” Billing Rules

Posted on March 2, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules.  The "incident to" rules permit services or supplies furnished as an in…

Setting Up Your Compliance Internal Reporting Mechanism

Posted on March 3, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

One of the primary elements in a Compliance Program is the creation of a system that permits employees and others to provide information regarding potential compliance issues without fear of retaliation.  In larger organizations, multiple pathways per…

Enforcing ASC Exclusion Provisions While Minimizing Legal Risk – Rethinking Strict Application of the Safe Harbors to Exclusion Decisions

Posted on March 3, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedures in the surgery center as others.  Under performing physicians can create political issues in ASCs because investors who…

Physician Practice Compliance Programs

Posted on March 15, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

In today’s environment of complex regulations, aggressive prosecution, exorbitant penalties, and hungry whistleblower attorneys, it is necessary for medical practices to maintain effective compliance programs.  Failure to do so puts the practice at a gre…

Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

Posted on March 21, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty (CMP) authorities.  The 2013 …

Defining the Duty of the Board of Directors over Compliance Functions

Posted on March 22, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

I recently posted a blog article about a document released by the Department of Justice entitled “Evaluation of Compliance Programs.”  As the title of the document might suggest, the DOJ release covers a variety of issues it looks at when evaluating the …

When is a Physician Liable for Stark Law Violations?

Posted on March 30, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians.  This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group.  In this context it is limit…

Compliance Budgeting – Put Your Money Where Your Mouth is

Posted on March 31, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

You have adopted your basic compliance policies and procedures, established a reporting system and visibly rolled out your new compliance program.  Your board of directors has passed a resolution decisively stating its commitment to compliance.  The CEO …

When to Use the OIG’s Self Disclosure Protocols

Posted on April 3, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

The HHS Office of Inspector General offers providers an opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations.  Even though the OIG’s Provider S…

CMS Extends Compliance Date for New Home Health Conditions of Participation

Posted on April 4, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

In February, we reported on revisions to the Conditions of Participation for Home Health Agencies (HHA) released by the Centers for Medicare & Medicaid Services (CMS).  CMS has now proposed the effective date of new Conditions of Participation (CoP) be d…

Best Practices in Compliance Program Operation

Posted on April 4, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

Given the increased importance of compliance, it is helpful for providers to get a feel for what constitutes “best practice” when operating a compliance program.  “Best Practices” is a term thrown around all of the time in the business world.  It is used…

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

Posted on April 5, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices.  These risk areas include: Improper use of multiple removal CPT codes; Billing for “impossibly long da…

Exercising Reasonable Care to Identify and Address Potential Overpayments

Posted on April 5, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

When the Center for Medicare and Medicaid Services (CMS) finally issued final regulations under the 60-day repayment rule, it implemented a new standard requiring a provider to affirmatively exercise reasonable diligence to identify potential overpayment…

Sally Yates was Already Famous for Changing the Focus of Compliance Investigations - The Yates Memorandum

Posted on April 5, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

By now the whole world knows about Sally Yates.  We are likely to see a lot more of her as a central figure in Congressional investigations.  For some of us who deal with compliance investigations, Sally Yates was famous long before her refusal to defend…

Disputing Inaccurate Reports Under the Physician Payment Sunshine Act

Posted on April 6, 2017, Authored by John H. Fisher, II
John H. Fisher, II
Attorney
Wausau Office
, Filed under Health Care

The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical supplies and certain group purchasi…