Although WACHLER & ASSOCIATES, P.C. is a full-service healthcare law firm, the following is a sampling of WACHLER & ASSOCIATES, P.C.'s specialty areas. If you have any questions or would like to retain our services, please call (248) 544-0888.
Be sure to visit our Stark Law/Fraud and Abuse specialty page, our HIPAA specialty page and our Medicare & RAC Audits specialty page for background information, Web links, and the latest developments in these important areas of health law.
Anesthesia and Pain:
Attorneys in the firm specialize in the legal and regulatory issues surrounding the provision and billing requirements for anesthesia and chronic pain management services. Our firm has worked on the development and implementation of numerous anesthesia and pain management specific compliance programs for groups of all sizes across the country. We continue to provide counseling to anesthesia and pain management groups relative to maintaining the effectiveness of their compliance programs. We also work with billing companies that specialize in anesthesia and pain management billing with regard to billing compliance and contract matters. We regularly counsel and represent anesthesia and pain management groups with regard to contracting matters, audit defense, staff privilege matters and other healthcare matters.
Attorneys Andrew Wachler and Abby Pendleton regularly speak and write on anesthesia and pain management healthcare law topics.
For anesthesia condition of participation information, click here, and for an explanation of the guidelines, refer to pages 275-6 of the State Operations Manual.
For rules and definitions for CRNAs and AAs, click here.
For more information on anesthesia, see the Medicare Claims Processing Manual.
Ambulatory Surgery Centers:
WACHLER & ASSOCIATES, P.C. has specific expertise in counseling and representing ASC clients, in all aspects of healthcare law, including:
- fraud and abuse (including advising on structure and governance documents);
- billing and compliance issues;
- third party payor audits;
- corporate formation;
- CON;
- licensure and certification;
- HIPAA privacy and security; and
- other healthcare legal matters.
Attorneys at WACHLER & ASSOCIATES, P.C. have authored a HIPAA privacy and security manual specific to the ASC market for the Federated Ambulatory Surgery Association (FASA). Andrew Wachler and Abby Pendleton have presented for FASA numerous times in the area of HIPAA Compliance. Mr. Wachler has also presented on other billing and regulatory issues for ASCs.
For news and updates on ASCs, visit the Center for Medicare & Medicaid Services' ASC Quarterly Provider Update.
For information on Medicare certification, visit the Center for Medicare & Medicaid Services' ASC Certification in the Medicare Program page.
For information on ASC payments, visit the Center for Medicare & Medicaid Services' Ambulatory Surgery Center Payment Information page.
Hospice:
The attorneys of WACHLER & ASSOCIATES, P.C. have expertise in the legal and regulatory areas impacting hospice providers. We regularly assist hospice providers regarding:
- compliance issues;
- Medicare appeals and edits;
- contracts;
- Fraud and Abuse counseling; and
- other health care law matters
For information on being certified as a Medicare or Medicaid hospice provider, visit the Center for Medicare and Medicaid Services' Certification and Compliance: Hospice page.
For amendments to coverage and payment regulations, click here.
For the Proposed Rule for Hospice Conditions of Participation, click here.
Corporate & Transactional Law:
The attorneys of WACHLER & ASSOCIATES, P.C. provide a wide variety of clients with advice and counsel regarding their corporate structure and business relationships. In addition to the fraud, abuse and compliance analyses we perform with respect to our healthcare clients' contractual relationships, we prepare, review, and negotiate corporate transactions for both healthcare and non-healthcare industry clients, including:
- Joint ventures;
- Mergers, acquisitions, affiliations and divestitures;
- Sale and purchases of provider practices and healthcare entities;
- Employment, independent contractor and management relationships;
- Confidentiality and non-competition agreements;
- Shareholder and partnership agreements; and
- Equipment sales, leasing and financing.
Licensure/Medical Staff Privilege Matters:
Our attorneys counsel and represent healthcare provider clients in sensitive licensure and medical staff privilege matters. Our firm handles such matters on behalf of physicians, dentists, podiatrists, chiropractors, nurses and other healthcare providers, both in state and abroad. The consequences that State licensing actions or hospital adverse actions may have against a healthcare provider are numerous, including, but not limited to, criminal actions, additional actions by other states and/or hospitals, reports to state and national databanks, and third party payor de-participation. A healthcare provider facing a State healthcare investigation/administrative action or a potential adverse action by a hospital against his or her staff privileges cannot afford to take a myopic view of his or her predicament. Due to the domino effect that often accompanies the imposition of state-imposed sanctions and/or hospital disciplinary action, such providers are well advised to obtain experienced healthcare counsel who will take an expansive view of the matter in order to assess the collateral damage that could result from a proposed settlement. Any settlement strategy should take into consideration all of the collateral sanctions and enforcement actions that could arise as a result of a settlement. WACHLER & ASSOCIATES, P.C. understands this and has the experience necessary to resolve these matters with minimum collateral effect.
Durable Medical Equipment:
WACHLER & ASSOCIATES, P.C. regularly works with DME and other suppliers with regard to their health care legal needs. This includes:
- corporate matters;
- compliance and regulatory;
- contracts;
- HIPAA; and
- Fraud and Abuse counseling.
To view the DMEPOS Brochure, click here.
For an explanation of information that will be used to evaluate the financial stability of bidding suppliers, visit the Center for Medicare and Medicaid Services' Competitive Acquisition for DMEPOS page.
For information on Special DME Review Considerations, See Chapter 5 of the Medicare Program Integrity Manual, and for information on the Comprehensive Error Testing Rate Program, see Chapter 12.
Radiology and Diagnostic Imaging Centers:
Our attorneys counsel and represent radiology providers, including physician groups and diagnostic imaging centers, in all aspects of healthcare law. We represent radiology providers in the areas of fraud and abuse and Stark laws; billing and compliance issues; third party payor audits; corporate formation; and other healthcare legal matters.
Attorneys at WACHLER & ASSOCIATES, P.C. counsel clients on legal issues associated with the development, acquisition, and operation of imaging centers. Imaging centers may be furnished through facilities owned by radiologists, non-radiologists, hospitals, management companies, individuals and other joint venture arrangements. The legal issues affecting the imaging center will vary depending upon the ownership interests in the center. The modalities offered at the imaging center may also implicate State CON and licensure laws.
In the recent proposed update to the Medicare Physician Fee Schedule for 2008, CMS has proposed a variety of changes that will impact the way in which radiology providers, among other providers, will be able to operate. Of importance to radiology providers include modifications to the IDTF performance standards, purchased diagnostic test rule, reassignment rules, and the physician self-referral prohibition. Most of the proposed changes result from either CMS's recognition of the need to emphasize their original intent in various rules, or their objective to close loopholes that have become evident in earlier mandated rules. Below is a brief outline of some of the changes CMS has proposed.
IDTF Performance Standards (410.33)
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Liability Insurance
- Eliminate the requirement that the insurance policy list the serial numbers of all diagnostic equipment;
- Reiterate that the insurance policy is required to provide coverage of at least $300,000 per location; and
- Require the IDTF to add its Medicare administrative contractor (MAC) as a certificate holder on its insurance policy and accordingly notify the MAC of any alterations or terminations to the policy.
- Enrollment Changes
- Alter the requirement that an IDTF report changes to its enrollment application within 30 days to apply only to changes in ownership, location, general supervision, and adverse legal actions; and
- Allow for the reporting of all other changes to be completed within 90 days.
- Beneficiary Questions and Complaints
- Mandate that the IDTF generate specific documentation of interactions with its beneficiaries to be kept on file.
Supervising Physician
- Clarify that the requirement limiting supervising physicians to supervise at most 3 IDTF sites applies to both fixed sites and mobile units.
- Enrollment Date
- Define the effective date of billing privileges as either the filing date of the Medicare enrollment application, or the date that the IDTF first provides services at its new location; whichever occurs later.
- Prohibition on Sharing
- Prohibit a fixed-base IDTF from sharing or subleasing space, equipment or staff with another individual or group.
Anti-Markup Provisions/Reassignment Rule
Significant Changes to the Stark Regulations
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- Burden of Proof
- Clarify that CMS does not have burden to prove that there was a prohibited referral.
- "In-Office Ancillary Services" Exception
- Seeking comments regarding what sorts of changes, if any, should be made to this exception.
- Per-Use Lease Payments
- Prohibit per-use lease payments in situations in which the charges reflect services provided to patients that have been referred to the lessee by the physician lessor.
- Percentage-Based Compensation
- Eliminate the ability to use percentage-based fees for office and equipment leases.
- Percentage based compensation may only be used for compensating physicians' professional services.
- Stand in the Shoes
- If a DHS entity owns or controls an entity to which a physician refers Medicare patients for DHS, the DHS entity would stand in the shoes of the entity it controls or owns.
- Ownership or Investment Interest in Retirement Plans
- Clarify, pursuant to the definition of "retirement plan," that ownership and investment interests do not include an interest in an entity because of a retirement plan offered by that entity to a physician it employs.
- Services Furnished "Under Arrangements"
- Redefine the definition of "entity" to not only the individual or group submitting claims to Medicare, but also any individual or group that actually performs the services.
If finalized, the above proposals will have a significant impact on many common imaging arrangements. If you have any questions or comments on the above proposals, please contact Adrienne Dresevic at adresevic@wachler.com or Andrew Wachler at awachler@wachler.com.
