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In this issue

PDF Icon Small New Jersey Appellate Court Holds Private Entities Lack Standing to Enforce the Codey Law
On November 17, 2009, the Appellate Division of the Superior Court of New Jersey held in Garcia v. Health Net of New Jersey, Inc. (Garcia) that private persons or entities, such as insurance companies, have no standing to enforce New Jersey�s Codey Law against physicians. The appellate court�s ruling represents a victory for physicians who feared private litigation under the Codey Law for patient referrals to ambulatory surgical centers (ASCs) in which they own a financial interest after the trial court initially held in 2007 that such referrals violate the Codey Law. (Read more...)

PDF Icon Small New Proposals for Accountable Care Organizations
Responding to an increase in errors in Medicare fee-for-services reimbursement, a group of freshmen Democratic senators has proposed an amendment to pending health care legislation which would create Accountable Care Organizations (ACOs). The amendment�s proposal would curb Medicare spending by reimbursing physicians and hospitals based on their ability to meet quality-of-care indicators and minimize overall costs, instead of reimbursing them based on the number of services they provide. (Read more...)

PDF Icon Small New Jersey Cardiologists Settled With Department of Justice in Anti-Kickback Case
The University of Medicine and Dentistry of New Jersey (UMDNJ) has settled charges brought by the U.S. Department of Justice (DOJ) related to an allegedly illegal kickback scheme for approximately $8.3 million in civil fines and penalties. The DOJ alleged that UMDNJ's compensation to several cardiologists was in fact payment for referring patients to UMDNJ's hospital. Eleven cardiologists also settled with the DOJ, with settlement amounts ranging from $30,000 to $1.4 million. (Read more...)
PDF Icon Small Physicians Face Hits to Medicare Reimbursement
Coming into the holiday season, U.S. physicians face two significant hits to their Medicare reimbursement. First, a 21.2 percent Medicare pay cut that was scheduled under the sustainable growth rate (SGR) formula has been delayed now that President Obama signed a Congressional reprieve into law on December 21, 2009. Under a provision in the defense appropriation bill, the cut has been stayed only until February 2010. Second, consultation codes historically used by specialists that resulted in higher reimbursement rates will be eliminated on January 1, 2010. (Read more...)

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