Medical Education

HLB regularly counsels academic medical centers and teaching hospitals concerning reimbursement, affiliations, accreditation, and other operational requirements impacting medical education programs. Our ability to help clients navigate these complex legal and regulatory issues is particularly strengthened by both our broad health law expertise and our nuanced understanding of reimbursement, compliance, and medical staff issues in this complex area of the law.

In particular, HLB regularly advises AMC/TH clients on direct graduate medical education (DGME) and indirect medical education (IME) reimbursement issues (i.e., intern and resident full time equivalent (FTE) cap and per-resident amount issues, including resident rotator issues), teaching physician supervision guidelines, moonlighting compliance, accreditation matters, GME affiliation agreements, and resident rotation and employment issues. HLB serves as Provider Reimbursement Review Board (PRRB) appeal counsel for medical education-related issues, among others. And our team will work to ensure compliance with medical education laws.

Some of the routine services that our Medical Education attorneys may provide include:

• Advocating for appropriate medical education reimbursement through PRRB appeals and/or other regulator communication
• Counseling with regard to IME/DGME reimbursement issues
• Drafting GME affiliation agreements, resident and medical student rotation agreements, and resident employment agreements
• Advising on application of federal and state fraud and abuse and physician self-referral laws in the medical education context
• Advising teaching hospitals on legislative and regulatory opportunities to expand GME reimbursement
• Medical Staffing issues, including advising with regard to residents/fellows employment issues, dealing with licensure issues and faculty specific issues, and advising on moonlighting restrictions for residents and fellows
• Advising hospitals concerning billing for teaching physician services under Medicare and Medicaid and handling self-disclosures concerning these issues

HLB Medical Education Intelligence

• CMS Issues Proposed Rule on Interoperability, Patient Information, by Jeremy Sherer and Amy Joseph, March 2019
• CMS Proposes Coverage with Evidence Development for CAR T-Cell Therapies, by Amy Joseph and Katrina Pagonis, March 2019 
• OHRP Provides Draft Guidance Regarding the Revised Common Rule Implementation Timeline and Transition of Existing Studies, by Amy Joseph and Andrea Frey, January 2019
• HIPAA RFI – HHS Office of Civil Rights Seeks Input on HIPAA Changes, by Amy Joseph and Alicia Macklin, January 2019
• Hooper, Lundy & Bookman Authors Newest Edition of the Essential Monograph on Stark Law, January 2019

• 2018 Year-End Review of Graduate Medical Education Reimbursement, by David Vernon, Health Law Perspective, December 2018

• Preparing for Upcoming Changes to ACGME Common Program Requirements, by Amy Joseph and David Vernon, Health Law Perspective, November 2018
• Applications Due Soon for Two New Rounds of Residency Slot Redistribution, David Vernon, July 15, 2018
• CMS Proposes Changes to Telehealth Reimbursement, Stark, Substance Use Disorder Treatment Reimbursement, and Evaluation & Management Reimbursement in the  CY 2019 Physician Fee Schedule Proposed Rule, Katrina A. Pagonis and Contributing Authors: Jeremy Sherer and Amy Joseph (Telemedicine), Charles Oppenheim (Stark), Alicia Macklin (Opioid Treatment), Paul Garcia (E/M Documentation & Payment), David Vernon (Teaching Physician E/M Documentation), July 14, 2018
• What the Tax Cuts and Jobs Act of 2017 means for Tax-Exempt Health Care Entities, Terri Wagner Cammarano, David Hatch and Brett Moodie, January 11, 2018
• Three New Rounds of Residency Slot Redistribution; Applications Due Soon, David Vernon, October 5, 2016