"The Challenges of the Practitioner-Laboratory Relationship"

February 12, 2016

News

Jane Pine Wood and Richard Cooper, both partners at McDonald Hopkins, generously sat down with us to share their expertise on healthcare compliance laws. Nearly half of the states in the nation have laws that limit the practitioner-laboratory relationship by regulating re-billing, and both federal and state governments have some form of anti-kickback, Stark, or Stark-like law on the books. Misconceptions abound regarding exactly who is and who is not under their jurisdiction. As Wood and Cooper explain, regulators are strict and penalties are severe, so it’s essential for all practitioners who work with labs to familiarize themselves with the laws that dictate these relationships.

Practitioners with Medicare Relationship

Any practitioner with Medicare, Medicaid, or CHAMPUS involvement has to deal directly with the Federal Stark Law and Anti-Kickback Laws. As Cooper explains, even if the financial arrangement doesn't relate to Medicare/Medicaid/CHAMPUS patients, “If there's a referral of those type of patients between the lab and the group, practitioners can still be tagged for federal law violations.”

Click here for the full article by Hint Health.

Over the past 24 months, the U.S. Department of Health and Human Services Office for Civil Rights has brought notable enforcement efforts against several non-profit covered entities and business associates, resulting in instances of six and seven-figure penalties against providers across the county for incidents involving breaches of protected health information.

A new amendment to New York state law, which would have required all healthcare providers to obtain separate consents from patients for treatment and payment is on hold until further guidance is released, according to the New York Department of Health.

On November 1, 2024, the Centers for Medicare & Medicaid Services issued the Medicare Physician Fee Schedule 2025 final rule, which establishes new advanced primary care management billing codes that will expand opportunities for physician practices, federally qualified health centers, rural health clinics and other health care providers to get paid for services provided by clinical staff under the direction of a physician, nurse practitioner or physician assistant beginning January 1, 2025.

"The Challenges of the Practitioner-Laboratory Relationship"

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