Fall 2010

Volume 6, Issue 3

Physician Advocate (ISSN 1555-5054) is published quarterly (winter, spring, fall, summer) by the Medical Society of New Jersey (MSNJ),2 Princess Road, Lawrenceville, NJ 08648. Free to MSNJ Members. Periodicals postage paid at Trenton, NJ, and at additional mailingoffices. POSTMASTER: send address changes to Physician Advocate, 2 Princess Road, Lawrenceville, NJ 08648

1

Michael T. KornettChief Executive Officer

roviding exceptional value and world-class service is what every successful business looks to do for itscustomers. The Medical Society of New Jersey continuously works toward putting forth high qualityproducts and service for you, our customers, our physicians and their medical practice managers herein the Garden State.

It has been said that there is no other medical society in the country that provides more benefits andservices for their membership than MSNJ. This is a statement that we were proud to hear, but alsoexcited to build upon.

So, in the new paradigm of healthcare reform with a federal government hiring more auditors, attorneysand monitors to analyze the business practices of physicians, MSNJ now offers an array of importantbenefits to make sure that our members are in compliance with a wave of new federal laws. Some ofthese reforms you may not even be aware of, but trust me when I say that the government could come knocking at your door. MSNJ has hired a certified professional coder to answer any questionsmembers may have on business, billing or coding procedures. MSNJ is available to provide consultativeservices in the wake of an audit from one of the federal organizations such as the Centers forMedicare & Medicaid Services. These services are provided in addition to all of the other personal andprofessional products MSNJ has designed to save you money.

On January 1, 2011, MSNJ will launch a Legal Defense Benefit which is included with your membership dues. This benefit offers an initial legal defense at the beginning stages of an investigationby organizations such as the: New Jersey Attorney General, NJ State Board of Medical Examiners,CMS and a host of other federal and state organizations.

MSNJ offers an initial interview, a comprehensive legal review, an initial written response as well as apreliminary appearance, if needed.

Other medical associations have offered such a program at reduced rates, but participation can stillcost hundreds of dollars. MSNJ’s Legal Defense Benefit is included with your membership. Manycomplaints against physicians can be resolved quickly with proper representation. However, should a case remain unresolved after a preliminary appearance, we have arranged for discounted legal fees for MSNJ members with many of our Corporate Partner law firms.

For more information on these and other important services that MSNJ provides for little or no cost, I encourage you to visit our website or call the Member Resource Center at 609.896.1766.

You’ve invested in membership in the Medical Society of New Jersey. We’ve invested in assuring thatMSNJ members receive maximum value.

Michael T. Kornett Chief Executive Officer

P

“What is good for our customers is also, in the long run, good for us.”

— Ingvar KampradFounder and former CEO of IKEA

The Medical Society of New Jersey, established 1766 � “Leaders in healthcare, leaders in life”

2Physician Advocate � Fall 2010

The Medical Society of New Jersey engages in legal advocacy in areas of importance to the entire profession. TheSociety regularly appears in court representing the physician and patient interests. Courts look to MSNJ for informationthat will assist in the resolution of controversies in the medical arena.

The Medical Society partners with the AMA to expand our legal advocacy resources and reach. Larry Downs, MSNJ’sGeneral Counsel serves on the AMA Litigation Center’s Executive Committee. The Litigation Center has contributed more than $18,000, to assist MSNJ in the following cases.

Medical Malpractice Malpractice Affidavit of Merit Decision by NJ Supreme CourtRyan v. Renny

The New Jersey Supreme Court recently considered thequestion of whether the statutory requirement for aboard-certified same-specialty physician’s affidavit ofmerit had been met in a malpractice case against aboard-certified gastroenterologist.

The physician in this case had perforated the patient’sbowel during a routine colonoscopy. The physician recognized the perforation and referred the patient tosurgery where the perforation was repaired without incident. Bowel perforations are a known complicationof colonoscopy procedures.

The patient sued the doctor for malpractice. To move thecase forward, the plaintiff’s attorneys sought out severalgastroenterologists to certify in an affidavit of merit thatthe treating physician breached a standard of care duringthe course of his treatment of the patient. After several attempts the plaintiff was unable to secure a certification from a board certified gastroenterologist. The plaintiff’s then presented an affidavit of merit signed by a board certifiedgeneral surgeon.

This case presented the question of whether or not the plaintiff’s simple inability to secure a same specialty board certified physician to execute an affidavit of merit allows a party to exercise an exception in the statute allowing a malpractice case to proceed. MSNJ argued that the exception should be construed narrowly and that only in exceptional circumstances should the exception be granted.

The court found that the plaintiffs met the requirements of the exception language contained in the affidavit of meritstatute because they put forth sufficient effort to retain a same specialty board certified physician. The Court deferred tothe broad discretion of the trial court to consider applications for a waiver of the same-specialty requirement and foundthat the “good faith effort” standard had been satisfied.

MSNJ and the AMA Litigation Center make a powerful partnership representing physicians in legal matters.

3The Medical Society of New Jersey, established 1766 � “Leaders in healthcare, leaders in life”

Scope of Practice PAs May Not Perform Needle EMG Studies Selective Insurance v. Rothman

The New Jersey Appellate Division ruled that physician assistants arenot permitted to perform needle electromyography (EMG) studies underNJ statutes. MSNJ filed an amicus curiae brief with the appellate courtbecause the opinion of the trial court could have increased the scope ofpractice of PA’s.

The trial court’s reasoning in its opinion upholding an underlying arbitrationaward concerned MSNJ because the language indicated that the scopeof practice under the Medical Practice Act for physicians and physicianassistants was the same.

The Appellate Division reversed the trial court’s opinion. The underlyingarbitration award would not ordinarily be subject to appellate review. However, the Appellate Division was “satisfied that thetrial court's erroneous determination that physician assistants are authorized to perform needle EMG tests is a matter of significant public concern.

The Appellate Division held "[] The Legislature has unambiguously provided in N.J.S.A. 45:9-5.2(a) that needle EMG tests may onlybe performed by persons who are licensed to ‘practice medicine and surgery in this State pursuant to chapter 9 of Title 45[.]’"

Out of NetworkGarcia v. HealthNet, Wayne Surgical CenterThe New Jersey Supreme Court declined to hear HealthNet’s appeal from the decision in Garcia v. HealthNet, an opinion onwhich we previously reported. MSNJ participated as amicus curiae. The AMA’s Litigation Center provided support for theappeal. MSNJ and the AMA opposed certification.

The Garcia case addressed both billing practices at the Wayne Surgical Center and self-referral issues. The rulings on self-referralissues are no longer significant as they have been addressed by subsequent legislation.

However, the ruling on billing practices still has precedential value. At issue in Garcia was whether the providers had violatedthe Insurance Fraud Protection Act (IFPA) by waiving co-insurance payments. In Garcia the Appellate Division decision affirmedthe trial court’s finding that Wayne Surgical Center providers who waived their right to collect co–insurance did not misrepre-sent their charges. The opinion affirmed the trial court’s finding that there is no legal authority barring a provider of healthcareservices from waiving their contractual right to collect co-insurance. The ruling is important to the state’s physicians who wishto exercise their own discretion when deciding whether to waive co-insurance based on an individual patient’s situation.

MSNJ and the AMA were represented by David Stone, Esq. formerly of Boies, Schiller & Flexner and now at Stone & Magnanini.

MSNJ in partnership with the AMA Litigation Center will continue to look for and participate in cases that impact on the pro-fession. Legal advocacy, works together with MSNJ’s legislative and regulatory affairs efforts to create a better practice envi-ronment for our members.

By Sharlene A. Hunt, Esq.

Changes�made� to� the� federal� laws� over� the� past� year� and� a� half� have�

greatly� increased� the� exposure� of� medical� practices� under� the� federal

False�Claims�Act.��As�part�of�these�changes,�it�is�now�a�violation�of�the

False�Claims�Act�to�retain�an�overpayment�received�from�the�Medicare�or

Medicaid�program,�and�physicians�and�other�health�care�providers�now

have�an�affirmative�obligation�to�report�and�refund�any�overpayments�of

which� they�become�aware.� �A�violation�of� the�antikickback� law�or� the

physician� self-referral� law� (the� “Stark”� law)� is� also� a� violation� of� the

False�Claims�Act.� �Before�your�practice�gets�a�visit�from�the�Office�of�

the�Inspector�General,�you�should�put�in�place�policies�and�practices�to

avoid�overpayments�and�to�identify�them�and�take�appropriate�steps�if�an

overpayment�is�received.��

The�False�Claims�Act�authorizes�the�imposition�of�civil�monetary�penalties�(including

treble�damages)�for�a�violation�of�the�statute.��The�government�may�also�seek�exclusion

from�participation�for�a�practice�that�violates�the�statute�or�for�obstructing�an�investigation.

Being�excluded�from�Medicare�would�not�only�bar�the�practice�from�providing�services

to� Medicare� and� Medicaid� beneficiaries,� but� could� also� have� a� negative� impact� on

Medical�Staff�privileges�and�the�ability�to�participate�with�private�insurance�companies

and�managed�care�companies.

To�make�this�situation�even�worse,�statutory�changes�adopted�as�part�of�the�federal�health

care� reform� law� now�make� it� easier� for� qui� tam� relators� (whistleblowers)� to� pursue

claims�on�behalf�of�the�federal�government.��The�health�care�reform�bill�also�provided

additional� funds� to� the� federal�government� to� fund�enforcement�action.� �Between� the

change� in� the� rules� making� it� easier� for� a� whistleblower� to� pursue� a� claim� and� the

increased�funding�for�government�enforcement�agencies,�there�is�an�increased�likelihood

that�an�overpayment�will�come�to�the�attention�of�the�OIG.��

Thus,�if�a�practice�becomes�aware�that�it�has�received�an�overpayment�from�Medicare�or

Medicaid�for�any�reason,�including�a�violation�of�the�Stark�law,�it�is�incumbent�upon�the

practice�to�immediately�address�the�situation.��Under�the�statute,�a�practice�has�sixty�days

following�the�date�the�overpayment�was�identified�to�report�and�refund�an�overpayment.

Where� this� time� frame� is� not� met,� there� is� a� self-disclosure� protocol� that� may�

be�advantageous�for�the�practice�to�follow.��In�light�of�the�very�high�stakes�involved,�we

recommend�a�practice�that�has�identified�an�overpayment�contact�their�attorney�immediately

to�discuss�the�best�way�to�proceed�in�the�circumstances.

The� OIG� posts� on� its� website� certain� settlements� under� the� provider� self-disclosure�

protocol.� � These� postings� include� the� name� of� the� provider� disclosing� the� violation,�

the�nature�of�the�violation�and�the�amount�of�money�the�provider�agrees�to�repay�the�

government.��Reviewing�these�postings�provides�some�insight�into�the�types�of�issues

being�reported�and�settled�under�the�self-disclosure�protocol.��

“In�light�of�

the�very�high

stakes�involved,

we�recommend�

a�practice�that�

has�identified�

an�overpayment�

contact�their�

attorney�

immediately

to�discuss�the

best�way�to�

proceed�in�the

circumstances.”


For�example,�of�the�33�settlements�posted�for�2009�and�the�first�part�of�2010,�over

half�involved�the�employment�of�an�excluded�individual�that�the�provider�knew�or

should� have� known�was� excluded� from�participation� in� federal� health� care� pro-

grams.��The�prohibition�on�employing�excluded�individuals�is�not�well�known�in�the

physician�community�and�can�result�in�significant�overpayments�without�the�prac-

tice�being�aware.��A�practice�who�employs�someone�who�has�been�excluded�from

the� Medicare� program� cannot� bill� for� any� services� such� an� individual�

provides,�even�if�the�services�are�administrative�in�nature.��For�example,�if�a�practice

hires�a�billing�clerk�who�has�been�excluded,�the�practice�is�not�entitled�to�payment

for�any�Medicare�claims�the�clerk�processes.��

Every�practice�should�have�in�place�employment�and�billing�policies�to�minimize

the�chances�of�the�practice�receiving�an�overpayment,�and�to�set�forth�the�steps�to

take�if�an�overpayment�is�identified.��Working�with�a�reputable�billing�or�compliance

company� to� review�billing�practices�or� to�conduct�a�billing�audit� is�another�step�

practices�can�take�to�limit�their�risk�of�overpayments.��While�it�takes�time�and�money

to�develop�and�implement�policies�or�to�hire�a�compliance�company,�it�is�better�to

have�these�policies�in�place�than�to�wait�for�the�OIG�to�come�knocking.��

Sharlene�A.�Hunt�is�a�Shareholder�at�the�law�firm�of�Giordano,�Halleran�&�Ciesla

and� has� been� practicing�Health� Care� Law� for� over� 25� years.� She� is� also� the�

co-author� of� the� blog,� www.njhealthcareblog.com.� She� can� be� reached� at

[email protected]�or�(732)�741-3900.�Giordano,�Halleran�&�Ciesla�is�a�MSNJ

Gold�Corporate�Partner.

“Every�practice

should�have�in

place�employment

and�billing�policies

to�minimize�the

chances�of�the

practice�receiving

an�overpayment,

and�to�set�forth�the

steps�to�take�if�an

overpayment�is

identified.”�


The�Patient�Protection�and�Affordable�Care�Act�of�2010� (PPACA)�H.R.�3590,�as�amended�by�

the�Health�Care� and�Education� and�Reconciliation�Act� of� 2010� (HCERA)�H.R.� 4872� resulted�

in� substantial� changes� to� the�America�healthcare� system�affecting� all� sectors�of� the�healthcare

industry.�Due�to�the�dynamic�nature�of�the�regulations,�it�is�not�only�important�for�all�physicians�to

understand�the�obligations�imposed�by�the�statutes,�but�also�to�closely�monitor�the�implementation�of

these�statutes�through�the�regulatory�process�as�it�is�rolled�out�over�the�next�ten�years.�This�arti-

cle�provides�an�overview�of�the�Health�Reform�Law�(PPACA�and�HCERA)�and�the�implications�of

the�legislation�for�physician’s�practices�now�and�into�the�future.

The�framework�of�the�legislation�is�predicated�on�changing�the�delivery�of�healthcare�with�empha-

sis�on�wellness�and�preventive�care�through�the�primary�care�physician�and�improvement�of�the

quality�of�patient�care.��The�system�devised�includes�significant�incentives�for�those�physicians

who�are�participatory�with�the�programs�available�and�those�who�comply�with�the�regulations.

The�regulations�also�entail�changes�to�the�system�of�penalties�under�the�waste,�fraud�and�abuse

laws�with�substantial�exposure�for�those�physicians�who�violate�the�legislative�mandates.

The�change�in�the�delivery�of�health�care�will�be�based�upon�the�collection�and�analysis�of�data.

The�emphasis�on�obtaining�and�analyzing�accurate�information�will�have�a�direct�impact�on�the

way�physicians�are�paid�and�the�methods�by�which�the�government�remedies�waste,�fraud�and

abuse.��Physicians�will�play�an�important�role�in�collecting,�maintaining�and�reporting�accurate

data�in�the�practice�setting.��

Medical�providers�who�bill�Medicare,�Medicaid�or�SCHIP�will�need�to�include�a�provider�identifier

on�enrollment�applications�and�claims�submitted�under�CMS�or�SCHIP.��A�participant�cannot

enroll�or� transfer�an�enrolled� individual� from�one�plan� to�another�without� the�consent�of� the

enrollee.�A� provider� cannot� employ� or� contract�with� any� individual� or� entity�who� engages� in�

that�conduct.��

The�Physician�Quality�Reporting�Initiative,�which�provides�incentives�to�physicians�who�provide

accurate� reporting�on�quality�measures�of�healthcare� rendered� to�Medicare�consumers,�will�be

extended�through�2014.��The�incentives�are�1.0%�in�2011�and�0.5�%�for�2012,�2013�and�2014.�In

addition,�a�0.5%�payment�bonus�is�offered�to�those�physicians�who�accurately�report�quality�meas-

ures�to�the�Office�of�Actuary�of�the�Centers�for�Medicare�and�Medicaid�Services�Center1.�The

intent� of� this� aspect� of� the� legislation� is� that� the� efficiencies� obtained� from� accurate� data�

collection�and�analysis�will�decrease�the�overall�cost�of�healthcare�by�providing�incentives�to�those

physicians�who�practice�quality�care.��Starting�in�2015,�physicians�who�do�not�accurately�report

quality�measures�will�have�their�fees�cut�by�1.5%.��

The�physician�payment�system�incorporated�in�the�Health�Reform�Law�is�based�on�a�model�of

RIGHT ON

TARGETTHE�IMPLICATIONS�OF�THE�HEALTH�REFORM�ACT�FOR�PHYSICIAN�PRACTICES


comprehensive�management�of�a�patient�through�the�promotion�of

primary�care,�disease�prevention�and�wellness.��The�government

will�provide�incentives�to�recruit�primary�care�physician�prac-

tices�to�promote�wellness.��The�legislation�provides�funding

for� training� in� family�medicine,� general� internal�medicine,

general�pediatrics,�physician�assistantship�and�dentistry,�as

well�as�education�for�primary�care�providers�for�preventive

medicine,�health�promotion,�chronic�disease�management,

mental� health� services� and� evidence-based� therapies.�

By� January� 2011,�Medicare�will� pay�100%�of� the� cost� of�

preventative�services.��

Primary�care�physicians�will�be�eligible�for�a�10%bonus/increase

for�reimbursement.��By�2014,�under�a�fully�funded�program,�the

government� will� compensate� primary� care� physicians� no� less

than�the�Medicare�payment�rates�in�2013�and�2014.�

Beginning�January�2015,�Medicare�physicians’�payments�will�be� the

subject�of�a�value�based�payment�modifier�adjusted�for�risk�and�geographic

area.��The�value-based�modifier�will�be�derived�from�the�analysis�and�auditing

of�the�healthcare�data.�The�modifier�rate�will�be�based�upon�a�set�performance�period

and�the�quality�and�cost�of�care.��Physicians�who�provide�higher�value�care�will�receive

higher�payments�than�those�physicians�who�provide�a�measured�lower�quality�care.�

Claim�processing�will�be�affected�in�terms�of�timing�and�certain�perquisites.�The�time�for�sub-

mitting a�claim�has�been�reduced�from�three�years�to�one�year.��The�time�to�submit�a�claim

for�an�overpayment�has�been�lengthened�to�1�year.�A�face-to-face�encounter�between�the

patient�and�medical�provider�will�be�required�to�certify�patients’�eligibility�for�items�and

services�for�which�Medicare�makes�payments.��

Physicians�should�be�aware�that�the�Health�Reform�Law�includes�measures�that�revise

existing�legislation�to�strengthen�the�ability�of�the�government�to�crack�down�on�“waste,

fraud�and�abuse”.��Funding�has�been�increased�substantially�to�allow�for�greater�enforce-

ment�activity�in�these�areas.�The�regulations�mandate�that�governmental�departments

improve� the�way�the�data� is�collected�and� increase�provider�audit�participation� in

order�to�eliminate�waste,�fraud�and�abuse.��The�measures�include�increased�access

to�health�care�data�for�compliance,�increased�power�to�remove�certain�providers�and

increased�penalties�to�punish�criminal�acts.��A�provider�can�be�excluded�from�a

program,�and�penalties�for�making�a�false�or�fraudulent�claim,�or�prescribing�a

service�when�one�is�excluded�from�a�federal�program�have�been�increased.

The� sentencing� guidelines� for� criminal� violations� have� been� enhanced

based�upon�the�monetary�level�of�fraud.��

Compliance�with� the�need� for�access� to� information� is�mandatory.�Any�

practitioner�who�fails� to�provide� information�or�allow�an�examination�of

their�records�may�be�excluded�from�the�program.��Physician�providers�must

permit�the�government�access�to�their�records.��Any�provider�who�fails�to�allow�timely

access�to�records�upon�a�reasonable�request�for�audits�and�evaluations�will�be�fined

$15,000�per�day�of�delay.��The�sharing�of�information�will�also�aid�the�government in

identifying�and�removing�ineligible�providers.��

“Starting in 2015,

physicians who

do not accurately

report quality

measures will

have their fees

cut by 1.5%.”

Continued on Page 87

The Medical Society of New Jersey, established 1766 � “Leaders in healthcare, leaders in life”

Any�physician�convicted�of�a�crime�will�automatically�be�excluded�from

the� program.� � The� Office� of� the� Inspector� General� has� the� power�

to� exclude� participants�who�make� false� statements.�The� permissive

exclusionary power�of� the�Office�of� Inspector�General�has�been

expanded� to� permit� the� exclusion� of� any� provider� who�

make� false� statements� or�materially�misrepresent� facts� on� an

application,�bid�contract�to�participate�or�enroll�as�a�provider�of

services.� �The�permissive�exclusionary�authority�applies� to�a

healthcare�provider�even�if�that�provider�is�a�referral�source.��

The�Health�Reform�Law�has�increased�the�ability�to�detect�and

prevent�fraud�and�has�increased�penalties�of�those�who�engage

in� fraudulent� behavior.� � There� are� several� examples� of� how�

the�laws�have�been�modified�to�aid�the�government’s�ability�to

combat�fraud�and�to�recover�misappropriated�funds.��For�example,

the� definition� of� a� reverse� false� claim,� an� obligation� to� return�

an� overpayment� when� an� obligation� exists� has� been� clarified.� A�

physician�will�have�an�obligation�to�both�report�and�return�overpayments

within�60�days�of�discovery,�or�be�subject�to�an�automatic�violation�of�the

False�Claims�Act..��The�Anti-Kickback�Statute�no�longer�requires�a�physician�to

have� actual� knowledge� of� the� specific� intent� to� commit� a� violation� of� the� statute.2

Physician�owned�hospitals�must�have�provider�agreements� in�place�with�Medicare�to�be�exempt�from�the

Stark�Self-Referral�prohibition.��Similarly,�the�affirmative�defenses�that�were�available�to�a�provider�sued�by

a�whistleblower�under�the�False�Claim�Act�have�been�narrowed�in�an�effort�to�maximize�the�government’s

ability�to�recover�monies.�

Physicians�must�prepare�for�the�sweeping�changes�created�by�the�Health�Reform�Law�and�its�implications�to

the�day�to�day�practice�of�medicine.��Those�practitioners�who�meet�the�standards�of�higher�value�and�quality

of�patient�care�as�defined�by�the�regulations�will�be�able�to�maximize�benefitting�from�the�incentives�available.

The�impact�on�the�delivery�of�patient�care,�the�increased�emphasis�on�value�and�quality,�payment�mechanisms,

an�ever-increasing�focus�on�compliance�and�the�prevention�of�fraud�and�abuse�are�all�issues�that�practitioners

are�well�advised�to�understand�and�monitor�as�the�regulations�are�introduced�over�the�next�decade.��

Catherine�J.�Flynn�is�a�partner�at�the�law�firm�of�Weber�Gallagher�Simpson�Stapleton�Fires�&�Newby�LLP�as

well�as�the�Chair�of�Weber�Gallagher’s�Health�Law�Group.��As�an�active�malpractice�defense�lawyer�for�over

22�years,�Ms.�Flynn�has�successfully�argued�cases�before�the�New�Jersey�Supreme�Court�and�the�Appellate

Division�representing�physicians,�nurses�and�other�allied�health�professionals�in�over�100�jury�trials.��She�can

be� reached� at� (973)� 854-1070� or� via� email� at� [email protected].� Weber� Gallagher� is� a� MSNJ� Gold

Corporate�Partner.

1 The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services.

CMS is the federal agency that administers the Medicare program and monitors the Medicaid programs offered by

each state.

2 Safe�harbor��provisions�have�been�enacted�in�cases�that�promote�access�to�care�and�poses�a�low�risk�of�harm�to�patients

and�the�program�or�may�have�a�reasonable�connection�to�the�medical�care�of�the�individual�and�are�provided�after�the

person�determines�in�good�faith�that�the�individual�is�in�financial�need.�

THE�IMPLICATIONS�OF�THE�HEALTH�REFORM�ACT�FOR�PHYSICIAN�PRACTICES

Right on Target—

Continued from Page 5

“Physicians must

prepare for the

sweeping changes

created by the Health

Reform Law and its

implications to the

day to day practice

of medicine.”


Beginning January 1, 2011, MSNJ members will be entitled to a legal defense benefit included with membership. This valuable benefit is designed to provide you, our member,

with high quality legal representation at the earliest stage of a legal action; the most critical stage when you are the target of an investigation.

When a member is the subject of an investigation or disciplinary action, MSNJ will arrange for initial legal representation to file your response to disputes with the following entities:

The NJ Attorney General’s OfficeThe NJ State Board of Medical ExaminersThe Medical Practitioner Review PanelThe NJ Office of the Insurance Fraud ProsecutorNJ State Medicaid InvestigationOffice of the Medicaid Inspector GeneralThe United States Attorney’s OfficeThe Office of the Inspector GeneralThe Centers for Medicare and Medicaid ServicesHospitalsNursing HomesExtended care facilitiesAmbulatory Surgery Centers

The preliminary legal defense benefit is comprised of the following services:

Initial interviewComprehensive legal review of the matterInitial written response to the entity bringing the disputePreliminary appearance

If the matter is not fully resolved or dismissed at the conclusion of the preliminary representation members havethe option to retain their own counsel. MSNJ will not cover additional legal services under this benefit. MSNJ willarrange for discounted legal fees when possible.

If you are the subject of a complaint or an investigation call the Member Resource Center at 609.896.1766 or email [email protected].

The Medical Society of New Jersey, established 1766 � “Leaders in healthcare, leaders in life”9

Under�the�American�Recovery�and�Reinvestment�Act�0f�2009(Recovery�Act),�each�physician�and�other�“eligible�professionals”�are�eligible�for�a�grant�of�up�to�$44,000�under�Medicare�and�up�to$63,750�per�eligible�professional�under�Medicaid,�if�they�are�orpromptly�become�“meaningful�users”�of�electronic�health�records(EHR).��The�Recovery�Act�allocated�$10�billion�for�these�subsidies�and�delegated�to�the�Centers�for�Medicare�&�Medicaid�Services�(CMS)�the�obligation�to�develop�an�implementation�framework.

After�a�15-month�process,�CMS�this�summer�issued�final�rules�thatfinally�establish�the�qualifications�for�the�subsidies,�at�least�for�the�program’s�“Stage�1”�in�2011�and�2012.�CMS�will�issue�subsequent�regulations�to�cover�the�final�four�years�of�the�Recovery�Act�EHR�program.�This�article�focuses�on�qualification�requirements�for�physicians�and�other�eligible�professionals�and�practices.�There�are�a�related,�but�distinct,�set�of�rules�that�apply�to�hospitals�that�are�not�discussed�in�this�article.

Who is Eligible for EHR Subsidies?Any�physician�or�other�“eligible�professional”�who�sees�Medicare�patients�iseligible�for�the�subsidies,�as�are�eligible�professionals�who�see�a�significantnumber�of�Medicaid�patients�are�also�eligible.�The�statute�uses�relativelybroad�definitions�of�eligible�professionals.��For�example,�the�Medicare�provisions�include�notonly�doctors�of�medicine�but�also�doctors�of�osteopathy,�dental�surgery,�dentalmedicine,�podiatric�medicine,�optometry�and,�in�certain�states�–�dependingon�state�lawregulation�and�authorization,�chiropractors.

Physician-extenders,�such�as�nurse�practitioners�and�physician�assistants,�aregenerally ineligible,�but�may�be�eligible�if�they�work�in�a�federally�fundedhealth�clinic�or�a�rural�health�center�and�if�they�more�than�30�percent�of�thepatients�they�see�are�Medicaid�patients.��

Physicians�practicing�part-time�are�also�eligible,�as�neither�the�Recovery�Actnor�the�regulations�require�a�minimum�continuity�of�practice�to�qualify�forthese�subsidies.��However,�there�is�an�effective�minimum�practice�insofar�aspayment�is�limited�to�three-fourths�of�the�eligible�professional’s�Medicare�Part�B�billings.��Additionally,as�discussed�below,�each�professional�can�only�get�one�payment�per�year,�so�this�may�be�an�importantnegotiation�point�for�eligible�professionals�with�multiple�employers�or�billers.��

How Much Does Each Doctor Get?The�amount�of�money�available�to�each�eligible�professional�will�depend�on�the�year�for�which�he�

Continued on

“...each�physician�

and�other�“eligible

professionals”�

are�eligible�for�a

grant�of�up�to

$44,000�under

Medicare�and�up�

to�$63,750�per�

eligible�professional

under�Medicaid...”



“Global resources for NJ’s insurance needs”

For more information visit:www.msnjia.com or call 866-963-0698

MERCEDES-BENZ OFFERS EXCLUSIVE DISCOUNT TO MSNJ MEMBERS ON SELECT 2011 MODELS

As a valued member of the Medical Society of New Jersey, Mercedes-Benz is offering you the opportunity to purchase or lease one of their luxuryvehicles through a special member-only fleet incentive program. It’s never been easier for you to get on the road to a driving experience that isuniquely Mercedes-Benz. Here's how easy it is:

1) Visit www.msnj.org and download the Mercedes-Benz benefit forms andinformation

2) Go to your local Mercedes-Benz dealership and negotiate the best priceon your selected 2011 vehicle

3) Advise the dealer that you’re a member of the Medical Society of NewJersey. You will need to show your membership card and the form downloaded from www.msnj.org

4) Your MSNJ member incentive will be deducted from the transaction price

5) Your MSNJ member incentive can also be combined with any special leaseor finance program in place at the time of purchase

To be eligible for this Mercedes-Benz Fleet member benefit, vehicles must be new and unused. MSNJ discounts on select 2011 models range from $750 – $2000. Mercedes-Benz Certified Pre-Owned vehicles are not eligible.

For more information contact MSNJ at 609.896.1766 x203.

or�she�first�qualifies�and�applies�for�funding�(the�mechanics�of�which,�to�the�extent�they�have�been�specified,�are�detailed�below).��Under�Medicare,�each�eligible�professional�is�eligible�for�the�lesser�of�(i)�the�cappedamount�under�the�chart�below�or�(ii)�75�percent�of�the�that�eligible�professional’s�Medicare�Part�B�billings�for�the�given�year.��

A�similar�structure�is�in�place�for�Medicaid,�although�the�dollars�can�be�higher,�with�the�maximum�paymentunder�Medicaid�exceeding�$63,000�over�five�years.

What Qualifies as Meaningful Use?The�Recovery�Act�requires�that�each�professional�who�seeks�Medicare�or�Medicaid�subsidies�must�demonstrate“meaningful�use”�of�EHR.��While�these�will�evolve�in�later�years,�the�Stage�1�criteria�is�focused�on�electronicallycapturing�health�information�in�a�coded�format,�using�the�information�to�track�key�clinical�measures,�and�reportingthe�information�for�care�coordination�and�public�health�information.��

CMS�has�published�25�criteria�for�each�eligible�professional�and�has�separated�the�list�into�15�“core”�items�and10�“menu”�items.�To�qualify�as�a�meaningful�user�of�EHR,�each�eligible�professional�must�meet�all�15�core�itemsand�any�five�of�the�ten�menu�items.��

The�core�criteria,�which�every�eligible�professional�must�meet�to�qualify,�relate�to�computerized�physician�orderentry,�drug-drug�and�drug-allergy�interaction�checks,�electronic�prescribing,�demographic�recording,�maintainingactive�lists�of�diagnoses,�medications,�medication�allergies,�smoking�status,�and�vital�signs,�implementing�at�leastone�clinical�decision�support�rule,�providing�patients�with�their�electronic�records�on�request,�providing�patientswith�clinical�summaries,�and�protecting�and�sharing�EHR�as�required�by�law.��

The�menu�criteria,�half�of�which�each�eligible�professional�must�meet�to�qualify,�relate�to�drug�formulary�checks,patient�reminders,�integration�of�clinical�lab�results,�reporting�functions�by�condition,�patient�education�efforts,patient�access�to�certain�of�their�own�records,�medication�reconciliation,�patient�record�transfers,�and�submissionsof�data�to�immunization�registries�and�public�health�agencies.

A�more�complete�summary�of�the�Core�and�Menu�Sets�are�available�athttp://www.flastergreenberg.com/home/multimedia/articles.aspx?d=1025

When Must an Eligible Professional be Employed to be Eligible?Except�for�the�expiration�of�the�program,�and�the�decrease�in�funding�as�time�passes,�there�is�no�express�deadline�for�employment,�except�that�entry�into�the�program�is�closed�at�the�end�of�2014.

Each�eligible�professional’s�first�year�of�meaningful�use�need�only�be�90�continuous�days.��Thus,�a�practice�orphysician�that�becomes�a�meaningful�user�by�October�3,�2011,�qualifies�for�a�2011�subsidy.��For�second�andsubsequent�years�for�an�eligible�professional,�he�or�she�must�be�a�meaningful�user�for�the�entire�year.��

First 2011 2012 2013 2014 2015 2016 Payment Year Payment Payment Payment Payment Payment Payment

2011 $18,000 $12,000 $8,000 $4,000 $2,000 $0

2012 $18,000 $12,000 $8,000 $4,000 $2,000

2013 $15,000 $12,000 $8,000 $4,000

2014 $12,000 $8,000 $4,000

How�to�Qualify�for�EHR�Subsidies Continued from Page 10


How Do the Regulations Address Physicians Who Change Practices?Each�year,�every�eligible�professional�will�be�able�to�designate,�within�limited�parameters,�whether�the�paymentis�to�go�directly�to�the�physician�or�whether�it�should�be�sent�to�certain�practices�or�hospitals.�An�eligible�profession-al is�not�allowed�to�use�these�payments�as�collateral,�or�to�direct�payment�to�anyone�other�than�(i)�him/herself,(ii)�an�employer,�or�(iii)�“an�entity�with�which�[the�professional�has]�a�contractual�arrangement�allowing�theemployer�or�entity�to�bill�and�receive�payment�for�…�covered�professional�services.”��

What Does this Mean to a Physician Practice?Given�the�process�of�getting�these�funds,�every�practice�should�review�its�employment,�shareholder,�and�partnership�agreements�and�all�other�employment-related�documents,�such�as�offer�letters,�to�be�clear�as�towho�will�be�responsible�for�providing�the�technology�and�who�will�receive�these�payments,�particularly�in�ayear�when�a�professional�may�have�more�than�one�job.��Every�eligible�employee�should�also�be�required�tomeaningfully�use�EHR�and�the�relevant�employment�documents�should�be�clear�about�remedies�if�the�eligibleprofessional�does�not�designate�the�employer�as�the�recipient�of�the�subsidy.

The�regulations�should�also�be�actively�considered�when�drafting�contracts,�and�structuring�relationshipsbetween�partners,�practices,�and�hospitals.

When Will We See the Money?The�mechanical�framework�for�these�payments�have�not�been�set�and�will�incorporate�physician�attestation,qualifying�electronic�reporting�of�quality�information,�and�direct�submission�to�CMS�in�a�form�that�CMS�has�notyet�established.��

CMS�has�specified�that�a�professional�will�have�until�the�end�of�February�to�submit�Medicare/Medicaid�billings(against�which�the�75�percent�threshold�is�applied).��The�payments�then�will�be�made�by�the�states�followingthe�receipt�and�processing�of�the�bills�through�December�31.��Although�the�timeline�will�vary�by�state,�moststates�likely�will�be�able�to�process�these�payments�in�or�about�April�of�each�year.

CMS�has�also�specified�that�an�electronic�application�will�be�required�and�it�will�have�to�include�informationabout�the�physician,�the�payee,�an�election�between�Medicare�and�Medicaid�qualification,�and�proof�of�qualifi-cation.��For�2011,�proof�will�consist�of�an�attestation�by�the�professional,�but�by�2012,�CMS�will�have�a�systemin�place�that�can�confirm�the�professional’s�meaningful�use�of�EHR.

How Do the Regulations Address Physicians Who Change Practices?Each�eligible�professional�will�be�able�to�designate,�within�limited�parameters,�whether�the�payment�is�to�godirectly�to�the�physician�or�whether�it�should�be�sent�to�certain�practices�or�hospitals.��An�eligible�professionalmay�assign,�and�may�only�assign,�these�payments�to�an�employer�or�“an�entity�with�which�[the�eligible�profes-sional�has]�a�contractual�arrangement�allowing�the�employer�or�entity�to�bill�and�receive�payment�for�the�[pro-fessional’s�medical]�services.”��

Additionally,�in�terms�of�determining�the�amount�of�payments�against�with�the�75�percent�threshold�is�applied,the�calculation�is�based�on�claims�submitted�no�later�than�two�months�after�the�end�of�the�payment�year�and�isdetermined�across�all�practices�where�the�professional�worked�during�the�year.

Should I Apply Through Medicaid or Medicare?This�is�a�decision�that�each�professional�will�have�to�make,�in�coordination�with�his�or�her�hospital,�practiceand�accountant.��There�are�enhanced�payments�available�through�Medicaid,�but�they�only�apply�to�Medicaidbillings.��Each�eligible�professional�will�be�allowed�to�switch�between�Medicare�and�Medicaid�only�once�dur-ing�the�program.

Kevin�Greenberg�is�a�business�and�corporate�attorney�at�Flaster/Greenberg,�P.C.�where�he�also�co-chairs�theGovernment�Relations�and�Regulatory�Law�practice�group.��He�was�a�member�of�President�Obama’s�transitionteam,�which�initially�proposed�inclusion�of�the�EHR�subsidies�as�part�of�the�Recovery�Act.��


Many physicians have witnessed a friend or colleague endure an investigation conducted by his or her state

medical licensing board for alleged violations of laws or regulations governing medical practice. Many have been

asked to turn over information to such board or provide testimony regarding that friend or colleague. It is never

a pleasant experience.

Board Investigations

Board investigations can involve records inspections, interviews with patients and co-workers, concurrent involvement

of federal agencies such as the DEA or FDA, or a full hearing before board members (or an administrative agency

assigned to conduct such a tribunal on the board’s behalf).

The subject of these investigations can involve quality of care, misconduct, fraud, boundary issues or any number

of alleged violations. The term "alleged" is often appropriate since the matter itself may be based on fact or fiction,

reliable witnesses or pure innuendo. The potential sources of such referral to a board are abundant. The information

may have been referred to the board anonymously or through a source known to the doctor involved.

One of the most memorable cases that I handled as a Deputy Attorney General in New Jersey involved an obstetrician

who performed a hysteroscopy which resulted in a patient’s death due to hemolysis. The physician involved had

utilized sterile water as a distending fluid for the procedure. That referral to the Board, albeit legitimate, came

from the physician’s former partner who had sued the accused physician over financial issues relating to their

partnership.

In such cases, referring physicians may initially be motivated by anger or vengeance. However, in many states,

such physicians are increasingly being compelled by law to make such referrals. This is due to mandatory notification

laws and regulations.

Notification Alarms

Many states have created increasingly strict notification systems that alert other states’ medical licensing boards

when a physician’s license is the subject of a regulatory action affecting their practice. How this reporting system

works is not much different from an alarm system on a house. Just as home alarms are triggered by untoward

events, such as breaking window glass or a forced-in door, alarm systems within the medical regulatory structure

are designed to "trip" whenever a physician commits a significant violation of board or hospital rules. These

“tripwires”, are laws and regulations, at both the state and federal level, which mandate reporting of these doctors

by other doctors who become aware of their misconduct.

A current trend in state law is mandated reporting by a physician of known violations of Board regulations

by a fellow doctor or colleague. It has been an effective means to detect violations that is being duplicated in

many states. Another is a requirement that hospitals report to the Medical Board whenever a doctor’s hospital

privileges are limited in any way.

In the world of private health entities, there are additional tripwires serving the same purpose. All insurance

contracts between doctors and their malpractice liability insurer, (as well as Medicare, Medicaid and private

health care payer/providers that cover their patients), require that the doctor notify the insurers immediately

whenever their license or hospital privileges are affected in any manner. Provisions within such contracts have

evolved to require notification whenever a physician has undergone a “restriction, limitation, loss, surrender,

modification, censure, suspension, revocation or

probation” of his or her license to practice. In other words, almost any action against the doctor, however mild


or routine, that results in a change of privilege or

licensing status.

Physicians should carefully scrutinize the contractual

provisions within their agreements with insurers to

gain familiarity with the scope of the mandatory reporting

requirements within. Violations of these provisions can

result in the physician being dropped from coverage.

Prescribing

Over the past decade, the U.S. Drug Enforcement

Agency has expanded their investigations to include

excessive prescribing of CDS by licensed physicians.

Medical Boards have followed suit.

The unfortunate result has been fewer

and fewer physicians willing to become

involved in the field of pain management.

Physicians should pay close attention

to state and federal laws regarding

prescribing, particularly with regard

to Schedule II and III prescriptions.

Though too numerous to mention here

at length, some are worth repeating.

When not in use, prescription blanks

should be secured in a secure cabinet

or safe with physician-only access. Lost

or stolen blanks should be reporting to

the DEA immediately. Strict vigilance

should be maintained when treating

patients with a history of substance abuse. Remain

alert for drug-seeking behavior and carefully monitor

the patient’s condition, documenting the amount and

rationale for every single prescription in clear and

unequivocal terms.

Examinations and Medical Recordkeeping

All doctors understand the importance of complete

and concise documentation with regard to a patient’s

physical examination. Few components of medical

treatment come under more close and searching

examination from medical boards. Yet in the current

climate of managed care, perhaps no aspect of medicine

has been as short-changed. Given the amount of time

and resources dedicated to this area in medical education,

it is surprising just how many medical exams are found

wanting. Many doctors brought before the board on

issues unrelated to treatment are chastised for failure

to document a full social/family history, physical exam,

differential diagnosis or diagnostic plan.

One of the most wrenching allegations against a doctor

is inappropriate touching from patients with little

medical acumen or a suspicious state of mind. This can

best be avoided by use of a chaperone and sensitivity

when examining—particularly with regard to pelvic

and rectal exams.

Illegible records of physicians have become stereotypical.

Some will say it is a minor and insignificant issue.

Having attended board hearings where

physicians were asked: “What if you

were to be incapacitated?—who will

be able to decipher this mess later?”, I

respectfully disagree. I’ve also witnessed

practitioners struggling, without success,

to decipher handwritten notes that they

wrote several years back.

Discharge of a Patient from Care.

The release of patient from care

should be handled with care and

consideration. Most states have specific

requirements regarding information

provided to the patient and subsequent

care. At a minimum, all states require

that adequate notice be provided to

patient regarding the decision to sever the doctor-patient

relationship. They also mandate that emergency care be

provided until the date on which services are terminated,

including the writing of prescriptions. Most states

require that the physician assist the patient in

finding a qualified physician who can assume care

of the patient.

Conclusion

Increasing scrutiny will be the trend on every level of

health care, as reform results in greater efforts to cut

costs and improve quality of care. Physicians must

familiarize themselves with the relevant laws and

regulations concerning their practice, as well as the

requirements of their contractual agreements with

their insurers. An ounce of prevention is worth a

pound of cure.

A current trend in state law is mandated

reporting by a physician of knownviolations of Board

regulations by a fellowdoctor or colleague.

It has been an effectivemeans to detect violations that is

being duplicated inmany states

Alex J. Keoskey is a partner in the Teaneck office of DeCotiis. He is a member of the Litigation and Healthcare Law

practice groups handling a variety of complex litigation, including tort, civil rights and contract matters on behalf of

public and private clients. He can be reached at [email protected] or by telephone: (201) 347-2107.

DeCotiis is a MSNJ Gold Corporate Partner.



One of the most important decisions a physician needs to make each year is the medical malpractice

insurance policy form they choose to purchase. Although many physicians believe the cost for a medical malpractice policycan be determined by simply reading the invoice each year, the reality is that the ultimate costs to a physician may actuallydepend upon the policy form that the physician purchases as well.

Essentially, there are only two types of professional liability insurance policies that are offered to physicians throughout theUnited States: (1) The occurrence-type policy; (2) the claims-made policy.

To summarize the differences, the most traditional policy prevalent in other lines of insurance is an occurrence-type policy.In an occurrence-type policy you are covered against any patient who sues you for medical malpractice so long as the incidentoccurred when you were insured with the carrier. This is similar to a typical auto insurance policy, where if you rear-endanother car in December of 2005 and you sell your car in January of 2006, you would still be covered against the claim evenif the person does not file a lawsuit against you until June of 2006, because the alleged “negligent act” occurred when youhad a policy in effect.

By contrast, in a claims-made policy you are covered against a person who sues you for medical malpractice if two conditionsare met: if the incident occurred when you were insured with the carrier, and if, at the time the lawsuit is filed, you are stillinsured with the carrier. In this policy, the key component is when the “claim” is made, and ensuring you have insuranceat the time that claim is made, whereas in the occurrence-type policy it is the focus on when the incident “occurred.” Usingthe example of auto insurance, if you were to be involved in the same accident described previously, you would not be cov-ered because at the time the claim was filed against you, you were no longer insured with the insurance carrier.

The Free “Tail” However, in a claims-made policy you can protect yourself against such a lawsuit, even if it was filed after you left the insurer,if you purchase a supplemental extended reporting period (ERP) “endorsement”, often referred to as a “tail.” This optionaltail endorsement typically costs 2 to 3 times the physicians’ prior year’s premium cost at the time they leave the insurancecarrier. Often physicians are told they can avoid this very costly tail if they meet one of three conditions: (1) if the physiciandies during the policy, their estate does not need to purchase the tail endorsement (2) if the physician becomes permanentlydisabled, or (3) if the physician is with the insurance carrier for at least the five previous years, is over 60 years old and decidesto permanently retire. If one of these conditions is met, often the insurer will provide the tail at no cost.

Although the free tail endorsement is what typically entices a physician to purchase a claims-made policy, it also the mostoften misunderstood portion of the policy. The primary benefit to a physician in the claims-made policy is the immediatecost savings. The cost savings in a claims-made policy is generally 65% in comparison to an occurrence-type policy in theinitial year. However, the savings automatically diminishes for the physician each year until the fifth year of the claims-madepolicy, when the cost becomes the same as the occurrence-type policy.

The escalation in cost of a claims-made policy is filed and approved by the Department of Insurance, and is termed, “stepup factors.” In general the automatic escalating costs, step-up factors, in the claims-made policy translate into a savings of65% from the cost of the occurrence-type policy in the first year, 35% savings in the second year, to 20% in the third year,and only a 10% savings in the fourth year.

By Eric S. Poe, Esq., CPAChief Marketing and Business Development OfficerNJ PURE


One of the most important advantages to the insurance company, is that it can raise rates to its policyholders at a morerapid pace, while ensuring that most physicians will be forced to pay those rate increases or face costly “tail” endorse-ment costs in order to switch carriers. The burden of the exorbitant tail cost faced by physicians can increase the likelihood that a physician policyholder will stay with the insurer despite the rate increase, essentially locking them in.

Historically, most physicians anticipate receiving the “free” tail endorsement, and therefore never set aside capital to purchase a tail, so when faced with rate increases they have but no choice but to absorb the rate increase. However,physicians often fail to realize when they choose to renew with a rate increase, those increases also increase the consequential physicians’ tail endorsement.

The primary advantage of the traditional occurrence-type policy is rather simple: it provides physicians the freedom tochoose different insurance each year, without incurring any additional and unpredictable costs. By purchasing anoccurrence-type policy, physicians are capable of ensuring that they can afford to shop for other insurance if their ratesincrease substantially.

Common Misconceptions about the Free TailWithout question the largest misconception for physicians is related to the conditions, which provide for the “free” tailendorsement. Most physicians believe with a claims-made policy the insured is entitled to “free” tail endorsementcoverage after five years with the carrier. Typically, they believe they can simply remain with the carrier for five years,and because they are over 60 years of age, a free tail endorsement will be provided. Unfortunately, they do not foreseethe scenarios where they will not qualify due to intervening factors. First, the physician fails to realize that remainingwith the insurance carrier for five years is not their unilateral decision as physicians are often non-renewed by theirinsurance company before reaching that five year mark. The non-renewal rights by an insurance company are generallyvery broad and physicians can often be non-renewed because they were named in a malpractice lawsuit during the year.Also, it is also a possibility that the insurance company will cease issuing policies in the state a physician practices. If this occurs, a physician will have no option in many cases but to purchase a tail.

Most importantly, physicians commonly fail to realize that the five-year requirement along with being 60 years old onlymeet 2 of the 3 conditions for the free tail. Once these two conditions are met the physician must also retire as well.The retirement requirement in the policy stipulates that the physician can never treat a patient again. Therefore, unlessa physician is prepared to retire within a short notice period from when they are non-renewed – they should set asideup two to three times their prior year’s insurance premium to purchase a tail.

These common misconceptions of claims-made policies were magnified during the 1980’s in New York. In 1982, the“claims-made” form of coverage for physicians was introduced in New York and several insurers began solely offeringthese policies to their physicians. As a result of physicians misunderstanding of the free tail, a large number of physi-cians were forced to close their businesses because they were faced with unaffordable tail costs charged by insurancecompanies that were non-renewing their policies. In 1991, as an “emergency measure” the New York InsuranceDepartment stated, “It has become apparent that there are medical malpractice situations where claims-made coveragehas proven impractical or unworkable,” and as a result promulgated a regulation requiring that every insurer offer tophysicians “occurrence-type” policies. The implementation of this regulation ended the “claims-made crisis” in NewYork in 1992.

Often physicians believe with a claims-made policy that they can buy a ‘nose’ or prior acts coverage with a new insur-ance company instead of paying an exiting tail endorsement. Unfortunately, some insurance companies do not offer“prior acts” coverage for incidents that occurred prior to your purchasing their policy, or if it is available the prior actsthey must realize that the physician will simply be postponing the same risks of a costly tail with their new insurer aswell, resetting their five year requirement with the new insurer.

Therefore, if a physician chooses to purchase a claims-made policy, it is important that they understand the fine printassociated with such a policy. Most importantly, physicians who choose a claims-made policy should always set asidea large amount of capital equal to their tail cost in order to avoid having to face closing their practice to an unexpectedretirement within 90 days of their non-renewal notice.


To benefit IOMPHNJ, the Foundation of the Medical Society of New Jersey.

"MSNJ's Fourth Annual Golf Outing raised close to $30,000 for the MSNJ Foundation, the Institute of

Medicine & Public Health of NJ. The MSNJ Foundation is a private, not-for-profit corporation working to

improve the health status of New Jersey residents through innovative public health practice and high

quality medical care. The foundation seeks to achieve these goals by developing solutions to the public

health and healthcare challenges facing New Jersey through continuing medical education, partnerships,

policy development, research, and law. The MSNJ Foundation works collaboratively with partners in public

health and medicine in all areas of government, academia, and the private sector."

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20Physician Advocate � Fall, 2010

Statement of Ownership, Management, and CirculationRequired by 39 U.S.C. 3685

1. Title of Publication: Physician Advocate

2. Publication No.: 1555-5054

3. Date of Filing: October 7, 2010

4. Frequency of Issue: Four times each year.

5. No. of Issues Published Annually: Four

6. Annual Subscription Price: $35

7. Complete Mailing Address of Known Office of Publication: 2 Princess Road, Lawrenceville, Mercer County, NJ 08648

8. Complete Mailing Address of the Headquarters of General Business Office of the Publisher: 2 Princess Road, Lawrenceville, Mercer County, NJ 08648

9. Names and addresses of publisher, editor, and managing editor: Publisher: Medical Society of New Jersey, 2 Princess Road, Lawrenceville, NJ 08648. Editor: Daniel Klim, 2 Princess Road, Lawrenceville, NJ 08648

10. Owner (if owned by a corporation, its name and address must be stated and also immediately there under the names and addresses of stockholders owning or holding 1% or more of total amount of stock. If not owned by a corporation, the names and addresses of the individual owners must be given. If owned by a partnership or other unincorporated firm, its name and address, as well as that of each individual must be given. If the publication is published by a nonprofit organization, its name and address must be stated): Medical Society of New Jersey, 2 Princess Road, Lawrenceville, NJ 08648

11. Known bondholders, mortgagees, and other security holders owning or holding 1% or more of total amount of bonds, mortagages, or other securities: None (a nonprofit corporation of New Jersey).

12. For completion by nonprofit organizations authorized to mail at special rates (dmm Section 423.12 only). The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes have not changed during preceding 12 months.

Extent and Nature of Circulation

a. Total number of copies (net press run) 6,000 6,000

b. Paid and/or requested circulation 5,413 5,126 1. and 2. Paid/Requested Mail Subscriptions Stated on Form 3541 3. Sales through Dealers and Carriers, Street Vendors, Counter Sales, and other non-USPS — — Paid Distribution 4. Other Classes Mailed through the USPS — —

c. Total paid and/or requested circulation 5,413 5,126 (sum of b1, b2, b3 & b4)

d. Free distribution by mail — — (samples, complimentary, and other free)

e. Free distribution outside the mail — — (carriers or other means)

f. Total free distribution (sum of d and e) — —

g. Total distribution (sum of c and f) 5,413 5,126

h. Copies not distributed 587 874 1. Office use, leftovers, spoiled 2. Returns from news agents — —

i. Total (sum of g, h1, and h2) 6,000 6,000 Percent paid and/or requested circulation 100% 100% (c/g x 100)

13. I certify that the statements made by me above are correct and complete. (signed) Art Weigold

AVERAGE NO.COPIES EACHISSUE DURINGPRECEDING12 MONTHS

ACTUAL NO. OFCOPIES OF SINGLEISSUE PUBLISHEDNEAREST TO FILING

DATE

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Fall 2010

Documents

Transcript of Fall 2010