RBMA Conference: Managing Legal Exposure in Radiology

RBMA Conference: Managing Legal Exposure in Radiology October 15-17, 2008 The Law. Black, White or Shades of Gray? When it comes to staying legal, the answers should be black or white. However, in radiology there are times when things may fall into the gray area. Do you know what to do to stay compliant and within the law? The two-day seminar will address the gray areas and outline how to stay within the law; what risks you may be taking and how to protect your self and your practice from litigation. You can’t afford to miss this valuable seminar. Loews Philadelphia Hotel 1200 Market Street Philadelphia, Pennsylvania 215.627.1200 Please visit the RBMA's (Radiology Business Management Association) website for more details - Click here
DETAILS: PRE-CONFERENCE Wednesday, October 15, 2008 9:00 am – 4:30 pm The ABCs of MCOs* Michael Lowe, Esq. This program is geared towards attendees who have some basic background in dealing with managed care contracting, negotiation, reimbursement and credentialing matters. This session will focus on the legal review of a managed care contract, with significant emphasis on educating participants on the types of issues that radiology group practices, diagnostic imaging facilities, hospitals, IDTFs, physicians and other radiology providers and billing companies face when dealing with managed care companies, and in particular during managed care contract negotiation, preparation and review. Mr. Lowe will draw upon and apply what he has learned during more than 12 years in representing health care providers and professionals in matters involving managed care companies and will address areas such as prompt pay laws, silent PPOs, HMO/provider contracting laws, credentialing, reimbursement and other matters. His presentation will include reviewing and discussing the key provisions to be aware of when reviewing and negotiating managed care contracts such as what constitutes covered and emergency services, all product clauses, retroactive denial provisions, termination clauses, key definitions, payment and rates, and other contract issues and provisions. He will actually provide and review a representative, sample managed care agreement with the participants and discuss what to look for in managed care contracts and how to negotiate them. In addition to reviewing and discussing managed care contracting matters, the presentation will focus on how to detect and prevent silent PPOs, how to handle reimbursement disputes with managed care companies and in particular HMOs, and the types of typical state statutes such as prompt pay, continuing care, emergency services, balance billing and other laws which govern health care providers and professionals in their business relationships with HMOs, PPOs and other managed care organizations. Designed for a smaller group setting in order to enhance the attendees’ learning experience, the presentation will allow for a large amount of question and answer sessions as well. *Separate fee required
SCHEDULE Wednesday, October 15, 2008 7:30 am – 4:30 pm Pre-Conference Registration 8:00 am – 9:00 am Pre-Conference Continental Breakfast 9:00 am – 4:30 pm PRE-CONFERENCE SESSION The ABCs of MCOs Michael Lowe, Esq. Thursday, October 16, 2008 7:30 am – 4:45 pm Registration Open 7:30 am – 8:30 am Continental Breakfast 8:30 am – 8:45 am General Welcome 8:45 am – 9:45 am GENERAL SESSION Introduction to Health Law: A Practical Guide to the Basic Concepts and Principles C. Mitchell Goldman, JD 9:45 am – 10:00 am Break with Sponsors 10:00 am – 11:30 am GENERAL SESSION Mock Deposition Leonard Berlin, MD, FACR and Lawrence R. Muroff, MD, FACR 11:30 am – 1:00 pm Lunch 1:00 pm – 2:15 pm CONCURRENT SESSIONS Employment Law 101 Eartha Jean Johnson, JD, SPHR The Laws Keep Changing: Ask the Speaker How to Market in a Compliant Fashion W. Kenneth Davis, Jr., JD 2:15 pm – 2:45 pm Break with Sponsors 2:45 pm – 3:45 pm GENERAL SESSION Legalities of Radiology as a Business Mitchell Gerstein, CPA, MST 3:45 pm – 4:45 pm GENERAL SESSION What Radiology Practices Should Know About the Antitrust Laws John J. Miles, MS, JD 4:45 pm – 6:00 pm Reception Friday, October 17, 2008 7:00 am – 4:30 pm Registration Open 7:00 am – 8:00 am Continental Breakfast 8:00 am – 9:15 am GENERAL SESSION Roles and Responsibilities of a Radiologist When Serving as Medical Director Thomas W. Greeson, JD 9:15 am – 10:15 am GENERAL SESSION Pensions, Investments and Taxation – Legal Ways to Defer Income Mitchell Gerstein, CPA, MST and Lawrence R. Fiorini, CFP® 10:15 am – 10:30 am Break with Sponsors 10:30 am – 11:30 am CONCURRENT SESSIONS How to stay out of Court, Negative Headlines and Jail Eartha Jean Johnson, JD, SPHR Hazards of Government Healthcare Programs: Compliance, Whistleblowers, and the False Claims Act Robert Vogel, JD 11:30 am – 1:00 pm Lunch 1:00 pm – 2:00 pm CONCURRENT SESSIONS Tax-Exempt Laws and Radiology Groups: Myth versus Reality W. Kenneth Davis, Jr., JD Practice Corporate Documents Tune-up: Employment and Buy-Sell Agreements and Bylaws Jeremy N. Miller, JD 2:00 pm – 2:15 pm Break with Sponsors 2:15 pm – 3:15 pm GENERAL SESSION ACR Hot Legal Issues Thomas R. Hoffman, JD, CAE 3:15 pm – 4:15 pm GENERAL SESSION Keys to Managing Risk in the Radiology Setting Brenda Gilbert Wynkoop, CPHQ 4:15 pm – 4:30 pm Closing Remarks
SESSIONS Thursday, October 16, 2008 8:30 – 8:45 am General Welcome 8:45 am – 9:45 am GENERAL SESSION Introduction to Health Law: A Practical Guide to the Basic Concepts and Principles C. Mitchell Goldman, JD This introductory session will focus on the basic legal concepts that impact healthcare providers and that all practitioners should know. Some of the issues to be addressed will be HIPAA (health care privacy), Medicare and Medicaid fraud and abuse compliance, and corporate practice of medicine issues. A brief update on recent regulatory changes will also be discussed. 9:45 am – 10:00 am Break with Sponsors 10:00 am – 11:30 am GENERAL SESSION Mock Deposition Leonard Berlin, MD, FACR, and Lawrence R. Muroff, MD, FACR No one wants to find themselves involved in a deposition. Documentation, standards of care, adherence to policies and procedures, patient communication – all are the subject of extreme focus when a medical malpractice lawsuit occurs. This “mock deposition” will role play both a radiologist and a practice administrator being deposed, and will illustrate the importance of clear documentation and compliance with policies. 11:30 am – 1:00 pm Lunch 1:00 pm – 2:15 pm CONCURRENT SESSIONS Employment Law 101 Eartha Jean Johnson, JD, SPHR This session provides management with a working knowledge of various employment laws so they can effectively address concerns and conduct that expose them and the company to liability. Employment Acts covered include Americans with Disabilities, Age Discrimination in Employment, Family Medical Leave and Pregnancy Discrimination, as well as Title VII. We also address the impact of retaliatory behavior and the necessity of proper documentation practices. The Laws Keep Changing: Ask the Speaker How to Market in a Compliant Fashion W. Kenneth Davis, Jr., JD With reimbursement sliding, marketing your practice is an absolute, but it can create legal problems for your practice if you don’t understand the laws or if you fail to take proactive steps to stay compliant. Initially, this session will briefly review common marketing tools used by radiology businesses and the key laws that are potentially implicated. For example, it will examine the Stark Phase III changes to the non-monetary compensation exception. It will next lay out practical guidelines for structuring your marketing and related compliance efforts. Most of the session will then be devoted to an extended question and answer opportunity for the participants. The intent is to provide an informal environment in which participants can ask about real world situations they have faced, and then obtain guidance on the legal issues, with all of the participants benefiting by hearing what their colleagues are experiencing and how the legal limitations can be addressed. 2:15 pm – 2:45 pm Break with Sponsors 2:45 pm – 3:45 pm GENERAL SESSION Legalities of Radiology as a Business Mitchell Gerstein, CPA, MST The establishment of a radiology business is full of questions and decisions. For example, determining which entity is most appropriate for your practice – corporation, partnership or LLC. What are some legitimate asset protection ways to minimize radiologists’ personal liability in regards to nonprofessional matters, and safeguarding medical practice assets? What limited liability is afforded a corporate shareholder versus a LLC partner? What is the difference between a shareholder, an officer or director, and a general or limited partner? All this and more will be addressed in the session. 3:45 pm – 4:45 pm GENERAL SESSION What Radiology Practices Should Know About the Antitrust Laws John J. Miles, MS, JD This presentation will explain general antitrust-law principles, particularly as they apply to radiology practices. The presentation will explain the basic purposes of the antitrust laws and the types of conduct violating sections 1 and 2 of the Sherman Act and section 7 of the Clayton Act. Specific topics covered relating to radiology practices that will be covered include staff-privilege denials, exclusive contracts between hospitals and radiology practices, boycotts of hospitals by radiology groups, radiology practice mergers, joint ventures between radiology practices and hospitals, radiology society activities, single-specialty radiology IPAs and contracting networks, managed-care organization mergers, and lawful ways to avoid managed-care market power. 4:45 pm – 6:00 pm Reception Friday, October 17, 2008 8:00 am – 9:15 am GENERAL SESSION Roles and Responsibilities of a Radiologist When Serving as Medical Director Thomas W. Greeson, JD In this session, various settings where radiologists assume medical director responsibilities, i.e., hospitals, IDTFs and physicians offices, will be considered and new CMS requirements for supervision in Independent Diagnostic Testing Facilities (IDTFs) will be examined. 9:15 am – 10:15 am GENERAL SESSION Pensions, Investments and Taxation – Legal Ways to Defer Income Mitchell Gerstein, CPA, MST and Lawrence R. Fiorini, CFP® The focus of this session is on gaining a better understanding of the types of retirement plans that exist today, specifically highlighting Cash Balance and ESOP plans. Plans available to all size businesses and individuals including available investment choices and the fiduciary responsibilities will be outlined. The goal is to present the positive impact retirement plans have on meeting retirement goals while rewarding long-time employees. Retirement plans are one of the last remaining legal tax shelters reducing current personal and corporate income taxes. This session will explore the tax benefits of retirement plan contributions. 10:15 am – 10:30 am Break with Sponsors 10:30 am – 11:30 am CONCURRENT SESSIONS How to stay out of Court, Negative Headlines and Jail Eartha Jean Johnson, JD, SPHR This session will train personnel at all levels on how to avoid making mistakes that often lead to costly settlements, litigation, regulatory sanctions and criminal liability. Your key personnel will learn practices to reduce liability associated with their actions and communications, with an emphasis on documentation. Hazards of Government Healthcare Programs: Compliance, Whistleblowers, and the False Claims Act Robert Vogel, JD The civil False Claims Act has been the Government’s preferred tool for recovering funds from health care providers who “knowingly” submit false claims to Medicare or Medicaid. A Florida radiologist recently paid the Government $7 million – of which a whistleblower received 25% -- to settle claims that imaging centers were billing for CT scans that were not ordered, not medically necessary, and sometimes not performed. The Government is currently pursuing another case alleging that outpatient diagnostic radiology centers and their owner billed Medicare for venograms that were not provided. This session will explain the Act, as well as some compliance strategies for avoiding its consequences. 11:30 am – 1:00 pm Lunch 1:00 pm – 2:00 pm CONCURRENT SESSIONS Tax-Exempt Laws and Radiology Groups: Myth versus Reality W. Kenneth Davis, Jr., JD There’s no doubt that 501(c)(3) tax-exempt hospitals are under much greater scrutiny today than they’ve ever been in the past. The plaintiffs’ bar has come after them, some state attorneys general are calling into question their tax treatment under state laws, and key members of Congress are considering whether the Federal tax laws should demand more in return for granting tax-exemption. As a result, so-called “(c)(3)” issues are frequently raised by hospitals with respect to their relationships and dealings with physicians. This session will provide participants with a general understanding of the basic (c)(3) principles and requirements, with an examination of the contexts in which the issues often arise. With this basic understanding, the session will then seek to separate myth from what really is legally required so that radiology groups can be more effective when negotiating with tax-exempt hospitals. Practice Corporate Documents Tune-up: Employment and Buy-Sell Agreements and Bylaws Jeremy N. Miller, JD Every radiology group needs to insure that its key corporate documents are well written and up-to-date. This session will explain the key provisions that need to be addressed in every group's employment and buy-sell agreements and corporate bylaws- and the risks of not doing so. 2:00 pm – 2:15 pm Break with Exhibitors 2:15 pm – 3:15 pm GENERAL SESSION ACR Hot Legal Issues Thomas R. Hoffman, JD, CAE In the volatile world of medical imaging in 2008, any proposed or current business arrangement with other physicians and providers carries legal meaning. The American College of Radiology Legal Office has a birds-eye view of many hot legal issues that confront radiologists around the U.S. Learn in this session what ACR’s Legal Office does for ACR and RBMA members. Hear about some hot legal topics we tackle such as teleradiology, self-referral and ethics. Gain practical tips on what questions to ask of your radiologists and other parties about an arrangement – and where to go for legal counsel. 3:15 pm – 4:15 pm GENERAL SESSION Keys to Managing Risk in the Radiology Setting Brenda Gilbert Wynkoop, CPHQ This session will provide managers and executives with key concepts and basic information to incorporate risk management strategies into their day to day activities. The session will provide practical information on areas of risk for the radiology business and provide a link between quality and performance improvement efforts and their risk management efforts. The session will provide information for managers on reinforcing staff compliance to the risk management efforts of the business. 4:15 pm – 4:30 pm Closing Remarks
SPEAKERS Leonard Berlin, MD, FACR, is Radiology Chairman at Rush North Shore Medical Center in Skokie, IL, and Professor of Radiology at Rush Medical College in Chicago. Dr. Berlin has authored more than 275 scientific articles plus a book, and has delivered more than 260 lectures nationally and internationally, on the topic of radiologic malpractice and risk management. A consultant to malpractice insurance companies, Dr. Berlin is President of the Illinois Radiologic Society, Chairman of the American College of Radiology’s Ethics Committee, and past president of the Chicago Radiological Society. Dr. Berlin has been awarded the Gold Medals for distinguished service to radiology by both the American Roentgen Ray Society and the Chicago Radiological Society. W. Kenneth Davis, Jr., JD is a partner in the law firm of Katten Muchin Rosenman LLP. He counsels health care providers on the structuring, growth and ongoing operations of all types of businesses and relationships including initial business model development, analysis of regulatory, compliance and reimbursement issues, negotiation of contracts, various types of financings, and mergers and acquisitions. Mr. Davis received his Bachelor of Arts degree in Economics from the University of Chicago and his law degree with honor from DePaul University College of Law. Lawrence R. Fiorini, CFP® is a Principal and Senior Wealth Advisor with LarsonAllen Financial, LLC., bringing more than 18 years of professional experience to the financial service industry. Larry specializes in providing comprehensive Total Wealth Advisory to individual and business clients through asset management, estate, insurance and retirement planning. Prior to joining LarsonAllen Financial, he was a branch manager with Raymond James and the director of Ostroff Fair WealthQuest for the past five years. Mr. Fiorini holds a bachelor’s degree from Widner University and is a Certified Financial Planner (CFP®). Mitchell Gerstein, CPA, MST, is a Tax Principal with LarsonAllen specializing in tax compliance and planning consultation and is the primary advisor for many clients around the country. He has provided tax compliance and planning consultation to a wide range of businesses from small, closely-held companies to SEC reporting companies, including health care, where he currently spends over 25 percent of his time. Mr. Gerstein has more than twenty-one years of public accounting experience specializing in all areas of tax planning, research, and compliance. C. Mitchell Goldman, JD, focuses his practice on the corporate aspects of healthcare delivery, with an emphasis on structuring corporate transactions between providers, advising clients on the impact of government regulation, creating strategies to improve reimbursement and developing startup healthcare related business opportunities. He is the founder of GLS Associates, Inc., a management consulting firm that served healthcare providers for 20 years, a former vice-president of Managed Care Strategies, Inc., and a former legislative assistant in the office of former Senator Walter F. Mondale. He is a member of the American Health Lawyers Association, the American Hospital Association, the Pennsylvania Society of Hospital Attorneys and the Philadelphia and American bar associations. Mr. Goldman is a 1980 graduate of Temple University School of Law, a graduate of the University of Pennsylvania, Wharton Graduate Health Care Administration Program, where he received his M.B.A., and a graduate of Bowdoin College. Thomas W. Greeson, JD, is a partner in the healthcare practice group of Reed Smith LLP. His practice focuses on the healthcare industry representing radiologists and diagnostic imaging providers involving health and hospital law, managed care contracting, antitrust, Medicare reimbursement, fraud and abuse, not-for-profit law, legislative and regulatory, and licensure and disciplinary matters. Previously, he served as general counsel for the American College of Radiology. Mr. Greeson is a regular columnist for Magazine, serves as Secretary of the Virginia Bar Association Section Council, past-Chair of the Board of Directors of the Northern Virginia Area Health Education Center, was awarded the “2003 President’s Award” from the Radiology Business Management Association, and is listed as one of ten outstanding physician practice lawyers in the United States in 2004 by Nightingale’s Healthcare News. Thomas R. Hoffman, JD, CAE is Associate General Counsel with the American College of Radiology in Reston, Virginia. He advises College members and staff on fraud and abuse, self-referral and other federal and state compliance matters. He has served as staff to the ACR Task Forces on International Teleradiology, Medical Liability Reform and Regulatory Compliance. Mr. Hoffman also counsels College members and staff on medical legal and corporate issues. Prior to joining the ACR in 1997, Mr. Hoffman was a health care associate with the Washington, DC law firm of Michaels & Bonner, P.C. and a Litigation and Sanctions Attorney for the U.S. Department of Health and Human Services’ Office of the General Counsel in the Inspector General Division. He received his Bachelor of Arts degree magna cum laude with Integral Honors in History from Le Moyne College in Syracuse, New York and his Juris Doctorate from Georgetown University Law Center. Eartha Jean Johnson, JD, SPHR, is president and chief executive officer of LegalWATCH, a risk mitigation training company she formed in 1997 after practicing law for a Fortune 100 company, and working for the United States Department of Justice and an international law firm. She uses the knowledge and expertise she acquired practicing law to help companies avoid mistakes that can often force them into settlements or litigation. Ms. Johnson currently serves on the boards of Women Impacting Public Policy (WIPP) and National Institute for the Severely Disabled (NISH). he just completed an unprecedented eight-year term as chair/vice chair of the Women’s Lawyers Division of the National Bar Association. She also served on the National Women’s Business Council, a bi-partisan Federal government council that advises the President, Congress and the US Small Business Administration on economic issues important to women. Michael R. Lowe, Esq., is board certified in healthcare law by the Florida Bar. His practice focuses on all aspects of business, corporate, transactional, litigation, regulatory, operational and administrative matters in the health care law arena. Mr. Lowe’s practice also represents hospital medical staffs, IPAs, ambulatory surgery centers, durable medical equipment providers, diagnostic imaging centers, hospitals, long-term care facilities and other healthcare professionals and providers. Licensed in both Florida and Georgia, Mr. Lowe is a member of the health law sections of the Florida Bar, Georgia Bar and American Bar Associations. Additionally, he is a member of the American Health Lawyers Association. John J. Miles, MS, JD, has been practicing antitrust law for over 30 years; most of his work deals with health care sector firms, particularly hospitals, health systems, hospital networks, large physician practices and physician networks. His practice focuses primarily on antitrust counseling and on representing parties in private treble-damage litigation and governmental investigations by the Antitrust Division of the U.S. Department of Justice, the Federal Trade Commission, and various state attorneys general. He is the former chair of the American Health Lawyer’s Association’s Antitrust Practice Group and a Vice Chair of the American Bar Association Antitrust Law Section’s Health Care Committee. Mr. Miles received his J.D. from Washington State University School of Law and both his M.A. in Economics and B.S. in Public Administration and Economics from Virginia Polytechnic Institute. Jeremy N. Miller, JD, is the founder and President of Miller Health Law Group. For the past 25 years, Jeremy has specialized in counseling medical groups, individual physicians, IPAs, MSOs, healthcare facilities, companies, joint ventures and suppliers for organizational, operational and regulatory matters, managed care contracting, third party reimbursement, hospital-physician contracting, fraud and abuse, "Stark" and other federal and state compliance issues, Medicare and Medicaid audits and medical practice and facility purchases, sales, syndications, affiliations, mergers and dissolutions. Mr. Miller was recognized in 2006, 2007 and 2008 as a "Super Lawyer" by Los Angeles Magazine. The peer-based award recognizes the top 5% of health care attorneys in Los Angeles and Orange Counties. Lawrence R. Muroff, MD, FACR, is a Clinical Professor of Radiology at both the University of Florida and the University of South Florida Colleges of Medicine. Dr. Muroff is President and CEO of Imaging Consultants, Inc., providers of consulting services to radiologists, hospitals, and corporations. Dr. Muroff is an honors graduate of Dartmouth College and Harvard Medical School, a member of Phi Beta Kappa and Alpha Omega Alpha, a recipient of the Gold Medal of the Florida Radiological Society, and is listed in Who's Who in America and Who's Who in the World. He is listed in the publication, The Best Doctors in America 2000, and his radiology socio-economic expertise and his educational expertise were recognized in cover stories in Diagnostic Imaging and Imaging Economics. Robert Vogel, JD, a partner with Vogel, Slade & Goldstein, specializes in qui tam cases. He was formerly a trial attorney in DOJ’s civil commercial frauds section, handling False Claims Act cases nationwide. After graduating from Amherst College (B.A., summa cum laude, 1981) and Stanford Law School (J.D. 1985), he clerked for Judge Frank Johnson of the U.S. Court of Appeals, 11th Circuit. Brenda Gilbert Wynkoop, CPHQ, has over twenty five years experience in the healthcare industry. Her experiences range from the acute and long term care Provider setting to her current position in the health insurance industry. She is currently serving as the Manager of the Legal Compliance and Privacy Office in the Legal Division of BlueCross and BlueShield of Tennessee. Prior to working at BlueCross and BlueShield of Tennessee, she was the full-time Director of Quality and Risk Management for Cleveland Community Hospital, Kindred Hospital – Chattanooga and Bradley Memorial Hospital. She was responsible for maintaining the hospitals risk management, quality and performance improvement programs as well as regulatory compliance. She served as a liaison between patients, hospital administration, the Medical Staff, employees and the Board of Directors. Ms, Wynkoop holds a Bachelor of Science degree and is currently pursuing an RN Degree.