Nine Pietragallo Lawyers Selected as 2014 Best Lawyers in America

August 15, 2013

Nine lawyers from Pietragallo Gordon Alfano Bosick & Raspanti, LLP were recently selected by their peers for inclusion in The Best Lawyers in America® 2014 (Copyright 2013 by Woodward/White, Inc., of Aiken, S.C.).  The attorneys who received this distinguished honor are listed below: William Pietragallo, II (Bet-the-Company Litigation, Commercial Litigation, Personal Injury Litigation- Defendants) Mark Gordon (Workers’ Compensation Law- Employers) Gaetan J. Alfano (Commercial Litigation) Marc S. Raspanti (Health Care Law) Alan G. Towner (Copyright Law, Litigation-Intellectual Property, Litigation- Patent, Patent Law, Trademark Law) Joseph D. Mancano (Criminal Defense: White-Collar) Paul K. Vey (Medical Malpractice Law- Defendants) Clem C. Trischler (Commercial Litigation, Product Liability Litigation- Defendants) Francis E. Pipak, Jr. (Workers’ Compensation Law- Employers) Since its inception in 1983, Best Lawyers has become universally regarded as the definitive guide to legal excellence. Because Best Lawyers is based on an exhaustive peer-review survey in which more than 41,000 leading attorneys cast almost 3.9 million votes on the legal abilities of other lawyers in their practice areas, and because lawyers are not required or allowed to pay a fee to be listed, inclusion in Best Lawyers is considered a singular honor. Corporate Counsel magazine has called Best Lawyers “the most respected referral list of attorneys in practice.” It is important to note that the lawyers listed in Best Lawyers have no say in deciding which practice areas they are included in. They are voted into practice areas entirely as a result of the votes they receive from their peers. The subspecialties listed after their names are based on information from a variety of sources. Read More

“Investigations”, Medicare And Medicaid Fraud, 2010-2015

June 1, 2013

Kevin E. Raphael has authored a chapter, “Investigations,” which was published in Medicare and Medicaid Fraud and Abuse, (Gosfield, A, ed.), for the editions published in June 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, and 2013. Read More

Will Pennsylvania adopt the “Any Willing Provider” Law?

May 17, 2013

A California jury recently awarded a doctor $3.8 million compensatory damages after they determined that Anthem Blue Cross (“Blue Cross”) violated his right to a fair procedure after denying his application into its provider network.  The case settled before the punitive damage claim was presented to the jury.  See, Nordella v. Anthem Blue Cross, No. BC 444364 (Cal. Super. Ct. filed Dec. 15, 2010) California law requires a fair procedure when a health insurer “possesses power so substantial that the exclusion significantly impairs the ability of an ordinary, competent physician to practice medicine or a medical specialty in a particular geographic area, thereby affecting an important, substantial economic interest.”  In this case, Blue Cross contended that Nordella lacked board certification in Blue Cross’ approved specialties.  Nordella averred that Blue Cross denied his application in retaliation for his outspoken advocacy in favor of patient care and against health insurers’ overzealous denial of coverage for services deemed “not medically necessary.” This case highlights the importance of establishing and implementing objective standards for consideration of providers; and of memorializing the reasons supporting the decision to deny or terminate a provider’s network membership.  Although Nordella may be confined to California, Pennsylvania health insurers should take heed of its lessons. Indeed, Pennsylvania State House Representative Anthony M. DeLuca intends on re-introducing HB1965 of 2011 (“Any Willing Provider”) to “ensure that private practitioners and facilities remain ‘in network’ if they are qualified and willing to accept the terms of the contract.” Time will tell if Pennsylvania adopts the “Any Willing Provider” law, affording providers with legal remedies should insurers refuse access to their networks or terminate provider participation. Medical providers should always understand the credentialing process that may be due and owing to them, i.e. notice, an opportunity to be heard and a fair and impartial tribunal.  Read More

The U.S. Supreme Court Limits State’s Recovery Of Medicaid Expenses In Personal Injury Actions

April 18, 2013

The U.S. Supreme Court recently struck down a North Carolina law that allowed state officials to seize one-third of a medical malpractice settlement paid to a Medicaid recipient. In the case, Wos v. EMA, North Carolina claimed over $900,000 of a legal settlement won by the parents of a 13-year-old girl born with serious injuries that left her unable to live or work independently.  The case settled for $2.8 million; however, the settlement did not indicate what part of the $2.8 million was meant to cover EMA’s medical expenses, which were paid, in part, by Medicaid.  North Carolina claimed over $900,000 of that amount under a state law that allows it to recover one-third of any legal verdict or settlement as a reimbursement for the state’s Medicaid costs.  EMA’s family sued North Carolina, arguing that the amount was disproportionately large and violated the federal Medicaid law, which limits a state’s recovery to medical expenses. The federal Medicaid Act requires states to recoup their medical expenses from beneficiaries’ tort winnings.  It does not specify what percentage of tort winnings should be allocated as medical expenses if the verdict or settlement is silent on that point. The U.S. District Court for the Western District of North Carolina found the state’s method for determining its reimbursement was reasonable, but in 2012 the Fourth U.S. Circuit Court of Appeal in Richmond, Virginia disagreed.  The Supreme Court upheld the Fourth Circuit’s ruling in a 6-3 opinion, holding that North Carolina’s law conflicted with the federal law’s requirement that a state not claim more than what it paid for medical expenses, known as the anti-lien provision. Eleven states supported North Carolina in an amicus brief, arguing that the federal Medicaid law was an agreement between the federal government and the states, and did not provide Medicaid beneficiaries with a legal claim.  Read More

Off-Label Use of Medical Devices

March 16, 2013

James W. Kraus and Martin T. Durkin, two veteran health care attorneys from the law firm of Pietragallo Gordon Alfano Bosick & Raspanti LLP will review the federal government’s intensified regulation of the practice of medicine and how it affects your medical practice, including off-label use of medical devices. Some of the latest civil and criminal cases will be reviewed, providing real world examples of health care providers caught in the cross-fire between quality of care and cost containment measures. The course will conclude with an open dialogue between the participants and the attorneys regarding the legal issues discussed. Read More

PBI’s 19th Annual Health Law Institute

2013/03/12

Kevin E. Raphael will present, “Confidentiality and Behavioral Health: Current Limitations on the Mental Health Procedures Act Confidentiality Provisions and the Patient Psychotherapist Privilege – What to Know to Avoid Potential Liability,” at PBI’s 19th Annual Health Law Institute at the Philadelphia Convention Center in Philadelphia, PA on March 12-13, 2013. Related Information: Program Information Read More

AHLA Fraud and Abuse Practice Group Boot Camp Webinar

February 13, 2013

Kevin E. Raphael will present, “Introduction to Health Care Fraud and Abuse,” at the AHLA Fraud and Abuse Practice Group Boot Camp Webinar in Philadelphia, PA on February 13, 2013. Read More

Collateral Consequences Of Healthcare Prosecutions

February 1, 2013

This article was originally published in the February 2013 issue of New Jersey Lawyer Magazine, a publication of the New Jersey State Bar Association, and is reprinted here with permission. Related Information: Collateral Consequences of Healthcare Prosecutions Read More

HHS Announces First HIPAA Breach Settlement Involving Less Than 500 Patients

January 18, 2013

On January 2, 2013, the U.S. Department of Health and Human Services (“HHS”) announced the first settlement involving potential violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Security Rule involving less than 500 patients.  The $50,000 settlement resulted from a breach of unprotected electronic protected health information (“ePHI”) on a stolen laptop. The HIPAA Security Rule specifies that covered entities adopt a series of administrative, technical, and physical security procedures to ensure the confidentiality of ePHI.  The Health Information Technology for Economic and Clinical Health (“HITECH”) Act includes a mandate to improve the enforcement of the HIPAA Security Rule.  To that end, the HITECH Breach Notification Rule requires covered entities to report an impermissible use or disclosure of protected health information or a breach of 500 individuals or more to the Secretary of HHS and the media within 60 days after the discovery of the breach.  Smaller breaches affecting less than 500 individuals must be reported to the Secretary on an annual basis, within 60 days of the end of the calendar year in which the breaches occurred.  Notifications of all breaches that occurred in calendar year 2012 must be submitted by March 1, 2013. The HITECH Breach Notification Rule also requires covered entities to:  (1) have in place written policies and procedures regarding breach notification; (2) train employees on breach notification policies and procedures; and (3) develop and apply appropriate sanctions against workforce members who do not comply with the breach notification policies and procedures. After an extensive investigation by the HHS Office for Civil Rights (“OCR”), the Hospice of North Idaho (“HONI”) agreed to pay HHS $50,000 for a breach involving less than 500 patients.  The breach occurred after a HONI unencrypted laptop computer containing the ePHI of 441 patients was stolen in June 2010.  Read More

Who Is Enforcing The Stark Law Of The United States?

2012/09/01

Published in AHLA Connections (Sept. 2012) © 2012 American Health Lawyers Association. Reprint permission granted. Related Information: Who Is Enforcing the Stark Law of the United States? Read More