Five Things Physicians Should Know

February 12, 2011 Steven M. Goldstein Healthcare Law

The medical profession’s ever-changing legal and regulatory landscape constantly introduces new challenges into the practice of medicine

To help you meet some of the myriad regulatory challenges, here are five important things with which physicians should be familiar.


As of January 1, 2010, if you provide CT, MRI or PET services in your office, you need to provide written disclosure to your patients, at the time you refer them to your own imaging service, informing them of the name, address and telephone number of at least five unrelated providers of that service that are located within a 25-mile radius of your office. In most cases, the list does not need to include hospitals within the area. Written documentation of compliance with this requirement is required, and you can meet that requirement by making a notation in the patient’s chart. Failure to comply could constitute a violation of the federal Stark law.


If you identify an overpayment from Medicare, you must refund it within 60 days of the determination. An overpayment is defined as any funds a person receives or retains under Medicare or Medicaid to which the person, “after applicable reconciliation,” is not entitled. It is still unclear what constitutes a “determination” of an overpayment. Failure to comply with this 60-day deadline makes the overpayment amount a false claim, which can subject you to treble damages and penalties.


Physicians are no longer defined as “creditors” under the Red Flag Rules and, therefore, do not have to comply with those burdensome requirements. However, if you obtain a credit report or submit information to a consumer credit reporting agency as part of credit transactions with your patients, you would be subject to the rules. Consider this carefully before adopting such a policy.


Under the Health Care Reform law, as a condition of enrollment in Medicare, Medicaid or CHIP, physicians must develop and implement a compliance program. While it has been good practice for some time to establish and follow a compliance plan, many physician practices have not done so. Regulations on this requirement have not yet been issued, but it will soon be not only good practice but an obligation to have a compliance plan for your practice.


Payment incentives are available for “meaningful use” of electronic health records systems under Medicare ($44,000 per eligible professional) and Medicaid ($63,750 per qualifying practitioner), although you cannot receive both. Online registration for the incentives began on January 3, 2011, and is continuing. More information is available at the Centers for Medicare and Medicaid Services “Path to Payment” website.


Any one of these items could make a big difference in the way you practice. If you would like more information about any of them, please contact Steve Goldstein at 480-425-2613 or