New Jersey - Volume VI, Number 4 - April, 1997

PHYSICIANS MAY HAVE NEW DEFENSE TO NO CAUSE TERMINATION

In a recent decision involving, of all things, a clam boat operator, the New Jersey Supreme Court may have provided physicians with their greatest protection yet against arbitrary deselection from managed care contracts. According to the New Jersey Supreme Court, a party terminating a contract pursuant to a "termination without cause" provision may still be held liable for damages if its dealings with the other party violated the contract's implied covenant of good faith and fair dealing.

STATE BOARD PROPOSES CHANGES TO PATIENT RECORD RULES

The State Board of Medical Examiners has proposed several changes to the rule governing patient records: 1) a parent or guardian is no longer an "authorized representative" (for purposes of obtaining a patient's records) in the case of a minor child who seeks treatment related to pregnancy, sexually transmitted diseases or substance abuse; 2) only an employee - not an agent - of an insurance company qualifies as an "authorized representative"; 3) businesses acting as agents for insurance companies in obtaining patient records must first obtain an appropriate release, and may only charge a Board-established reasonable fee for the costs of reproduction and summaries of patient records; 4) patient records may be released to a government reimbursement program or its agent for purposes of utilization or quality care review; 5) a physician who decides to release a patient's records to either a law enforcement agency or another health care professional, under the "imminent danger" exception to confidentiality mandate, must obtain a court order to do so if the patient's record reflects treatment for AIDS or HIV infection; and 6) a physician who ceases to practice may elect to provide a requesting patient with the original records instead of copies, but he or she may not charge a fee for providing the originals and, if the physician does not retain a copy, he or she must obtain a receipt from the patient and retain the receipt for seven years. The Board has also proposed amendments to its rules regarding physician prescribing, dispensing, and CDS dosage limits, and those amendments will be reported on in the next issue of Statlaw.

KACS GRANTED HIGHEST RATING FROM LEADING, INDEPENDENT LEGAL RATING FIRM

KACS has been awarded Martindale-Hubbell's (MH) most coveted rating of AV, meaning that they have rated the firm's legal ability as very high to preeminent and its general ethics as very high. This is the highest rating that MH gives any firm.

HHS OUTLINES PROCESS FOR ADVISORY OPINION REQUESTS

As discussed in the Sept. 9, 1996 Statlaw, the U.S. Department of Health & Human Services (HHS) and the Justice Department must now issue advisory opinions regarding the interpretation and applicability of the Medicare and Medicaid Anti-Kickback Statute (and safe harbor provisions) as well as other healthcare fraud and abuse sanctions. The process is not particularly user-friendly, though.