Wisdom. Applied.

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.