Legal News
Please select the links below for complete Legal News articles and documents for 2009. View Legal News Archive
01.18.10 MAG encouraging physicians to report DEA number abuse
The Medical Association of Georgia (MAG) has discovered that some insurance companies are withholding payment to pharmacists for non-controlled substance prescriptions that do not contain a physician’s Drug Enforcement Administration (DEA) registration number -- even though a physician's DEA permit number is only required when the prescription is for a controlled substance in Georgia.
Read news article
Download form letter to Commissioner Oxendine
DEA letter to MAG (2004)
DEA consensus statement
AMA & MAG policies
01.11.10 New AMA resource on identity theft
Identity theft has become increasingly common as the prevalence of Internet and other non-face-to-face transactions have proliferated. The AMA has developed an educational resource, "Steps physicians should take if in danger of identity theft," to help physicians protect themselves if they believe their identity may have been stolen.
Click here for AMA resource
11.04.09 FTC delays Red Flags rule until June 1, 2010
Click here for details
07.31.09 FTC "red flag" rules deadline extended until November 1
The Federal Trade Commission (FTC) has extended the deadline for compliance with its "red flags" rule to November 1. The rule requires creditors to institute policies to identify, detect and respond to potential risks of identity theft.
Arnall Golden Gregory LLP Draft "Guidelines for creating an identity theft prevention program for health care providers"
07.27.09 H.B. 509 Medical Practice Act and Physician Assistant Act updates summary
H.B. 509, passed during the 2009 session of the Georgia General Assembly, made substantial revisions to the Medical Practice Act and Physician Assistant Act.
Click here to familiarize yourself with the notable changes to the law governing the practice of medicine
07.21.09 Supreme Court for Georgia to hear medical malpractice case in September
The Supreme Court for the State of Georgia has set oral argument for the Nestlehutt v. Atlanta Oculoplastic Surgery on September 15, 2009. In the Nestlehutt case, a Fulton County Superior Court found the medical malpractice cap on non-economic damages was unconstitutional. MAG and the American Medical Association are prepared to file an amicus brief to support the physicians and patients of Georgia.
07.10.09 Tennessee Medical Association sues collections firm
According to American Medical News, the Tennessee Medical Association has filed a lawsuit against a collections company working in several states to take back reimbursements paid to doctors. The lawsuit alleges fraud and asks a state court to block the company from trying to collect any more money from physicians.
In the article, the Medical Association of Georgia was quoted as supporting the actions of the Tennessee Medical Association, but hasn't taken any formal action against HRI itself.
Read AMN article
07.09.09 Georgia Supreme Court finds jury instruction in medical malpractice cases "misleading"
On June 29, 2009, in Smith, et al. v. Finch, et al., the Georgia Supreme Court found part of the "hindsight" jury instruction "inaccurate and misleading" and disapproved use of the final two sentences.
The Medical Association of Georgia filed an amicus brief urging the Court to uphold the jury instruction.
Read full news article
06.19.09 WellPoint settlement agreement terms to expire July 15
The terms of a settlement agreement between physicians and WellPoint, Inc./BlueCross BlueShield of Georgia will expire on July 15, 2009.
Some 900,000 physicians and WellPoint/BlueCross BlueShield of Georgia settled two national class action law suits that were pending in federal court in 2005. Pursuant to the settlement agreement, WellPoint implemented a number of changes that benefitted physicians that were in effect for four years.
MAG members who are experiencing any problems with WellPoint/BlueCross BlueShield of Georgia are encouraged to contact MAG’s Office of the General Counsel at 800.282.0224 or 678.303.9271 before July 15 to determine if the problem is covered by the settlement agreement.
05.27.09 MAG's Palmisano member of Leadership Atlanta Class of 2010
Donald J. Palmisano Jr., general counsel and director of government relations for the Medical Association of Georgia, was recently selected as a member of Leadership Atlanta’s Class of 2010. Leadership Atlanta is an eight-month program that cultivates leaders in the community.
Each class includes about 70 participants, which consists of "an accomplished group of men and women whose collective background reflects the diversity of metro Atlanta." The program includes a series of programs that are designed to give them "exposure and perspective in a variety of areas such as criminal justice, poverty, education, and race relations."
Formed in 1969 by a group of concerned citizens, Leadership Atlanta is the oldest continuously-running training program of its kind in the country.
05.22.09 Court rules that MAG can join 'rental networks' lawsuit
The U.S. District Court for the Southern District of Georgia in Augusta has ruled that the Medical Association of Georgia (MAG) can join the case of Rivell and Whitehouse v. PHCS, Inc. and the Capella Group, Inc. - which is related to "rental networks" - as a plaintiff, according to MAG General Counsel Donald J. Palmisano Jr.
Palmisano says that "rental networks" are created when a company assembles a group of physicians who are willing to participate in a network at a discounted rate and later transfers the access to those discounted rates to a third party. He explains that the networks are often formed without the knowledge or consent of the physician. Palmisano says rental networks represent an additional administrative burden for physicians.
Click here to read more
05.21.09 AMA, AAPPO offering provider contracting resource
The American Association of Preferred Provider Organizations (AAPPO) and the American Medical Association (AMA) have developed the Provider Contracting Toolkit.
Click here to read more
05.19.09 Compliance process in BCBS settlement in effect; Make sure you are being paid correctly
The class action lawsuits brought by several state and county medical societies and physicians against the for-profit health insurers resulted in settlements which required the health insurers to significantly change the way they conduct business. The Physicians' Advocacy Institute (PAI) is charged with enforcing the settlements on behalf of physicians. Currently all the provisions in the Blue Cross Blue Shield Settlement Agreement have taken effect. PAI is offering a Webinar on the topic on Wednesday, June 10.
Read PAI article for more details
Download BCBS dispute form
Click here for information on PAI Webinars on topic
04.20.09 Georgia-Pacific halts HRI payment recoupment pending evaluation
Georgia-Pacific has asked Health Research Insights, Inc. (HRI) to temporarily halt its efforts to recoup payments from physicians in Georgia on its behalf following the Medical Association of Georgia's intervention.
Read full news article
04.17.09 FTC to begin enforcing Red Flag Rule on May 1
On May 1, 2009, the Federal Trade Commission will begin the enforcement of the Red Flag Rule. The Red Flag Rule requires creditors and financial institutions to review their business to determine if they fit within the definition of this rule. If so, the entity must have a written Identity Theft Program in place. Unfortunately, the Federal Trade Commission believes physician practices fit within the rule. Tracy Field of Arnall Golden Gregory LLP has developed a sample Identity Theft Program and the attached document is meant for educational purposes. Each practice must develop a program that best fit its needs and should consult with an attorney.
Arnall Golden Gregory LLP Draft "Guidelines for creating an identity theft prevention program for health care providers"
AMA resource: "Protect your patients, protect your practice: What you need to know about the Red Flags Rule"
04.14.09 Medical Association of Georgia fights for physicians in the Georgia Supreme Court
On February 20, 2009, MAG filed an amicus curiae brief with the Georgia Supreme Court in the medical malpractice case of Condra v. Atlanta Orthopedic Group.
The issue before the Georgia Supreme Court is whether evidence that the defense expert witness' personal conduct would have been different from the defendant-physicians' conduct is admissible to impeach the defense expert's testimony that the defendant-physician's conduct complied with the standard of care.
The plaintiffs have argued, in part, that the adoption of O.C.G.A. 24-9-67.1 as part of the 2005 tort reforms overturned the long-standing rule that evidence of an expert witness' personal practices are irrelevant to the issue of whether the defendant complied with the standard of care and is therefore inadmissible.
In its brief MAG argues the rule prohibiting evidence of an expert witness' personal practices is consistent with the provisions of O.C.G.A. 24-9-67.1 and the General Assembly had no intent to overturn the long-standing rule. Additionally, the rule prohibiting such evidence remains logically correct as the mere fact that two physicians would treat the same medical condition differently bears no relevance to the question of whether the standard of care was deviated from because both practices may comply with the standard of care.
Read amicus curiae brief
04.14.09 OIG refines self-disclosure protocol
Read OIG's open letter to physicians
03.25.09 Georgia doctors join class-action lawsuit against WellPoint
The Medical Association of Georgia (MAG) announced today that it has joined the American Medical Association (AMA) and three additional state medical societies in filing a class-action lawsuit against WellPoint, Inc. - the largest health insurer in the U.S. - as part of its ongoing legal advocacy efforts to protect physicians and their patients in the state.
View complaint filed against WellPoint
Read MAG's press release on lawsuit
Health Care Report: The consumer reimbursement system is code blue
(State of New York, Office of the Attorney General, January 2009)
03.18.09 HRI will not place any physician in collections pending outcome of MAG inquiry
In order to clarify earlier e-mails and a posting on MAG's Web site, Health Research Insights, Inc. (HRI) has told the Medical Association of Georgia (MAG) that it will not place any physicians or their practices in collections until HRI and MAG have further communications, which are scheduled for sometime next week. MAG will provide additional information as it becomes available.
03.16.09 UnitedHealthcare announces changes to its physician designation program for oncology
UnitedHealthcare has made changes to the UnitedHealth Premium physician designation program for oncology. In the past, oncologists were invited to participate in our program by completing a survey about important clinical characteristics regarding their individual practice. Those who submitted a survey response and met the program requirements were recognized in our online Web sites with the Quality designation. We appreciate all oncologists who participated in our program.
The UnitedHealthcare Premium designation program, which has evaluated physicians in 21 different specialties, continues to evolve based upon the input of practicing physicians and medical specialty societies. As a result of their input, UnitedHealthcare has decided to discontinue the current, survey-based approach to Premium designation for oncology. All of our contracted oncologists will receive a letter this week notifying them of the change in our program. What this means for oncologists:
- This spring, our online directories will display "Specialty Not Evaluated" next to the name of network oncologists. This is how we currently display the names of other physicians who are in specialties that are not evaluated in the Premium designation program.
- We will continue to work with oncologists and their specialty organizations to develop useful performance assessment programs. For example, in the future, we will recognize physicians on our consumer Web sites, for their participation in the American Society of Clinical Oncology's Quality Oncology Practice Initiative program.
- We are also testing a set of measures for oncology quality and cost efficiency based on national standards from specialty societies and the National Comprehensive Cancer Network. Only after these measures are validated, will they be used in future releases of the UnitedHealth Premium designation program for oncology.
- Because we are discontinuing our current program, we are no longer accepting new surveys from oncologists.
03.09.09 Payment problems with Aetna, Cigna or WellPoint?
The American Medical Association and several other state medical associations filed a lawsuit against Aetna Health Inc. and CIGNA Corp., alleging the insurers used "a corrupt system" to underpay physicians and patients.
MAG wants to know if you have experienced payment problems with Aetna, CIGNA or WellPoint (aka Blue Cross Blue Shield of Georgia) with the following questions in mind ...
- Are you in or out of network with Aetna, CIGNA or WellPoint?
- Do you get an assignment of benefits from your patients?
- Did you submit out-of-network bills to Aetna, CIGNA or WellPoint that weren’t paid?
- Did you exhaust the appeals process?
Physicians who have experienced payment problems with Aetna, CIGNA or WellPoint should contact MAG General Counsel Donald J. Palmisano Jr. at 678.303.9280 or dpalmisano@mag.org.
03.05.09 AMA unveils Model Medical Staff/Code of Conduct
Effective January 1, 2009 the new Joint Commission Leadership Standard (LD.03.01.01), Elements of Performance 4 and 5 require that hospitals have a code of conduct that defines acceptable, inappropriate and disruptive behavior; and, that Leaders create and implement a process for managing disruptive and inappropriate behaviors. The Joint Commission identified those disruptive behaviors which it believes undermine a culture of safety in a July 9, 2008 Sentinel Event Alert.
In response to these actions by The Joint Commission, the American Medical Association adopted policy H-225.956, "Behaviors That Undermine Safety," which calls for medical staffs to develop and implement their own code of conduct in the medical staff bylaws, and that hospitals also have a code of conduct applicable to members of the board, management and all employees.
To assist medical staffs with implementation of a code of conduct in accordance with AMA Policy, and consistent with The Joint Commission Leadership Standard, the AMA Office of the General Counsel with the assistance of Elizabeth Snelson, Esq., in conjunction with the AMA-OMSS, drafted a model code of conduct for insertion in medical staff bylaws.
Click here for the AMA Model Medical Staff Code of Conduct Policy
02.25.09 MAG opinion says letting PA's hire supervising physicians unethical
The Judicial Council of the Medical Association of Georgia (MAG) has issued an opinion that says a recent rule adopted by the Georgia Composite State Board of Medial Examiners (Medical Board) is unethical. The Medical Board rule allows, under certain circumstances, a physician's assistant to hire his/her supervising physician.
Read full article from News from MAG
Read Judicial Council's full opinion
02.11.09 MAG issues statement following court ruling
"The Medical Association of Georgia is disappointed with Judge Bessen's ruling. Georgia's residents have been well served by S.B. 3 when it comes to increased access to health care. Physician services are far more accessible today than they were in 2005, the year S.B. 3 was enacted. S.B. 3 has been extremely effective in reducing professional liability premiums and reinforcing critical health care needs like obstetrical and general surgery services in the state. We believe that this ruling jeopardizes access to heath care for patients in the state."
Read judge's court ruling
02.02.09 Alert: UnitedHealthcare extends PDP deadline to February 11
UnitedHealthcare has notified the American Medical Association and state medical societies that it has extended the reconsideration request date for the UnitedHealth Premium physician designation program to February 11, 2009. This date gives physicians more time to submit their request for reconsideration prior to the consumer display update slated for March.
Physicians should appeal their rating in UnitedHealthcare's (UHC) Premium Designation Program (PDP) by Wednesday, February 11 if they believe it is wrong. According to a letter UHC sent January 27 to its more than 220,000 participating physicians, only appeals received by February 11 are guaranteed to be adjudicated and updated for the scheduled March release of new ratings for physicians in the PDP. Although physicians may appeal their designation status to UHC at any time, successful appeals received after that date may not be reflected in the initial release of new ratings.
Read updated memo
Download instructions
01.26.09 Alert: Physicians should appeal United Healthcare PDP by Tuesday, January 27
Physicians should appeal their rating in United Healthcare's (UHC) Premium Designation Program (PDP) by tomorrow January 27 if they believe it is wrong. According to a letter UHC sent December 23 to its more than 220,000 participating physicians, only appeals received by January 27 are guaranteed to be adjudicated and updated for the scheduled March release of new ratings for physicians in the PDP. Although physicians may appeal their designation status to UHC at any time, successful appeals received after that date may not be reflected in the initial release of new ratings.
Click here for full alert
01.15.09 MAG members obtain an important ruling in workers' compensation case
The Superior Court of Bibb County, in overturning the Appellate Board of the State Board of Workers' Compensation decision, found that under Rule 205 an insurer or self insured must respond within five days of a physicians request for treatment. Failure to respond to this request for treatment within five days will be deemed an approval of the treatment by the insurer or self-insured. In this matter, the Appellate Board of the State Board of Workers' Compensation found that an employer/insurer could avoid Rule 205's mandates by contesting the underlying compensability of the injury well after the time frame set by the Board. The Superior Court of Bibb County held this interpretation of Rule 205 was unreasonable, illogical and unfair.
Read the opinion for more information on this important case
01.01.09 MAG/GMGMA unveil Model Managed Care Contract
The Medical Association of Georgia (MAG) and the Georgia Medical Group Management Association (GMGMA) have introduced a Georgia Model Managed Care Contract on a joint basis as a resource for Georgia physicians. It's designed to help physicians contend with often-overlooked and complicated contract language. The resource is annotated with Georgia statutes and case law, and it includes language from managed care lawsuit settlements in which MAG was an original plaintiff. A Georgia Model Managed Care Contract is available online on a password-protected basis at no cost to members. The cost for non-members is $350. It can be obtained by contacting Liz Bullock with MAG at 678.303.9271 or ebullock@mag.org.
*Please note: www.mag.org has changed its login process. First-time visitors should click here to 'Retrieve Password.' A link will be instantly e-mailed to you that enables you to create an ID (your e-mail address) and a unique password.
Download a password-protected copy, which is a free member benefit.
*Some of the documents listed here are available in PDF format and can be viewed using Adobe Acrobat Reader. This free software can be downloaded from the Adobe site, http://www.adobe.com.