Wisdom. Applied.

Bureaucratic sorts are drawn to numbers because numbers can be gathered and processed and manipulated, all with the goal of lifetime employment for those bean counters.

Certainly, Oregon is a small state in terms of medical practice, but what's happened in Oregon could, and some say will, spread across the country.

Was it a scam or an error? A settlement is just that and there's been no determination of liability. Neither you nor I can know for sure what went on, but either way, there's a lesson here about billing compliance.

Considering honey bees have been on earth for between 40 to 150 million years, it pays to consider their hive strategy for success, especially because it maps perfectly onto medical groups.

There's huge danger in any arrangement in which you put your prescribing imprimatur on any script or order for any item, especially those reimbursed by Medicare.

In real life healthcare compliance, there's no get out of jail free card.

It's imperative that you get started now and that you become willing to invest in your own future.

You Must Know the No. 1 Mistake in Exclusive Contract Negotiation by Mark F. Weiss

Hospital-based medical groups, notably anesthesiology and radiology groups, are increasingly turning to creative means to provide coverage and to improve collections.

There's a reason why Medicare Advantage is fertile ground for fraud enforcement.

In healthcare, size used to signal strength. Bigger meant more services, more specialists, more veritas. But what if all that bulk is actually a liability?

As healthcare payers, tech platforms, and pricing vendors increasingly collaborate through sophisticated analytics, this case is a clear reminder: if you're coordinating decisions that competitors used to make...

Supervisory requirements aren't just administrative niceties; they're the difference between compliant practice and a lawsuit waiting to happen.

It's not news to you that there's a huge shortage of physicians in many medical specialties, such as in anesthesiology and radiology. With the overall aging of the physician population, shortages in other medical specialties, including those that are office-based, will intensify.

There are dumb crimes, and then there are crimes so dumb they come with a built-in paper trail leading straight to prison.

Even in the face of the provider shortage, during which you think that you have substantial negotiating leverage, when a significant chunk of your revenue comes from the hospital, you're no longer just a contractor. You're an appendage.

Over the past several weeks, I've seen multiple posts and comments on LinkedIn about the horrors of practicing as a cog in the wheel of Big Medicine, employment schemes facetiously referred to as “medical groups” by their health system or insurance company owners.

From insurance commissioner to healthcare fraudster to federal prison inmate.

According to Bain & Co, nearly one-quarter of physicians employed in health-system-led organizations are considering switching employers.

If you thought health care fraud required medical knowledge, think again.

Nudge Triggers a $17 Million False Claims Act Settlement by Mark F. Weiss

Buying a healthcare business, from a medical practice to a medicine manufacturer, is a lot like buying a house—you hope for the best, but sometimes, there's wood rot hiding under that fresh paint.

The False Claims Act (“FCA”) is a powerful tool to fight fraud against the government, especially in healthcare. It contains a “qui tam” provision that lets regular people—called “relators” or whistleblowers—sue individuals and entities for fraud on behalf of the government.

There are, depending upon the particular arrangement, potential end runs around contractual pass-through billing prohibitions, but they are highly fact specific and technical.

Although any particular crisis can't be predicted, classes of crisis are capable of prediction and, even if that is not true of a specific situation, the way in which your group or business will respond to a crisis can, should, and must be planned far in advance.

Are you sure those consultants are helping to improve your business? Or are they potentially sending you to jail?

Re-frame the issue for what it really is: Surprise physician services stealing. Now's the time for the No Surprises Act, and each state counterpart, to go.

Although no one is going to do time as a result of thinking that wet sidewalks cause rain, in the case of the federal Anti-Kickback Statute, confusion over correlation can put you in jail.

After having represented medical groups with a particular emphasis on hospital-based groups for 30 years, it has become strikingly clear that what distinguishes the most successful groups, from the great majority of the mediocre.

Medical group organizers generally confine their entity's business structure to a corporate or partnership type entity and then proceed to conduct business through it.

People are internally inconsistent. Many contracts in the healthcare sphere are inconsistent, too. The first causes grief, the second shifts power.

The volleys in this battle move slowly--think pendulum as opposed to ping-pong. And right now, despite the appeal, the pendulum is still on the side of “state law controls”.

Uncover the history of the whistleblower provisions in the False Claims Act and their significance in fighting fraud.

Fueled by the failure of large medical groups, the disappointments of hospital employment, and the ratcheting down of care by private equity, physicians are increasingly seeking alternatives to their current practice arrangements.

The “friendly physician.” Boy, is that's a term of art or, perhaps better said, of artifice.

There is no such thing as static demand for services over a contract's multi-year term, and it's a fool's bet, yet one many take, to believe that one can place a set value on total fair market value.

Cars go in reverse. So do ceiling fans and electric drills. But did you know that kickbacks go in reverse, too, and that there's no safe harbor for that?

There's a good chance that you can accomplish some or all of what a covenant not to compete addresses, even if the “law” says you can't.

It's no secret that hospital-based medical groups, particularly anesthesia and radiology groups, are experiencing significant trouble recruiting and retaining their professional staff due to increasing compensation demands combined with declining reimbursement.

Many people identify with the concept of “work-life balance,” and it's valid for them.

Despite the fact that some states have strong prohibitions against the enforcement of non-competes, there are still ways to create agreements functioning as proxies for non-competes.

Certifying to Medicare that you're here when you're really there is a ticket to nowhere, or maybe to jail.

Health care fraud is far from harmless. Fraudulent activities drain billions from health care programs like Medicare and Medicaid, leading to higher taxes and less money for other important services.

Making The Bet Without Knowing The Odds by Mark F. Weiss

You're signed in to the hospital's electronic medical record system. What's the harm in just typing in the name of a friend to see what pops up?

According to 2023 reports, by 2021, nearly 70% of physicians were employed by hospitals or investor-owned corporations.

No, I don't have a crystal ball and I can't predict the future. But that doesn't mean that I'm blind and can't see a cliff dropping off on the near horizon.

Telehealth can be used to vastly improve patients' access to medical care. At the same time, it can be used to vastly improve criminals' access to Medicare dollars. It shouldn't be that difficult for physicians to assess the bona fides of their proposed participation in a telehealth “business model” when the ones doing the proposing are telemarketers.

If what the government alleged were true, it would be an emergency physician's dream job: billing for services without ever treating or even speaking with the patient.

The financial impact was immediate and momentous: Neither new nor existing claims, nor payment for them, could be processed.

The financial impact was immediate and momentous: Neither new nor existing claims, nor payment for them, could be processed.