MSSNYeNews: Stupid Insurance Tricks, Continued – February 21, 2020

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

February 21, 2020

Vol. 23  Number 8




Apparently, Meyer Lansky chose the wrong racket. Case in point – Advanced Gynecology and Laparoscopy of North Jersey, et al v CIGNA Health and Life Insurance.

In summary, the lawsuit alleges that CIGNA accepts the out-of-network provider’s claims at the full billed amount and requests the same amount from the self-insured health plan. However, instead of paying the medical provider or member, CIGNA hires a Repricing Company to try and negotiate a reduction. If the provider refuses to negotiate, CIGNA pays the claim at an exorbitantly low level but appears to keep the difference between what was removed from the self-insured health plan and what was paid to the medical providers. In an attempt to conceal this from the patient and self-insured health plan, CIGNA issued Electronic Remittance Advice or paper Explanation of Benefits forms (collectively, the “EOB”) misrepresent the balance as “Discount” to the members, certifying the member is not responsible for the balance, while simultaneously representing the balance to the Plaintiffs as member liability or “Amount Not Covered”.

Curiously, CIGNA has been actively suing out-of-network physicians for not collecting patient liabilities in full. Moreover, the complaint includes allegations of RICO violations as well. You can read the whole thing at the above link.

Yes, as through this world I’ve wandered
I’ve seen lots of funny men;
Some will rob you with a six gun.
And some with a fountain pen.
–Woody Guthrie, Pretty Boy Floyd

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President

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Urge Your Legislators to Reject Undermining Physician Due Process
With Part L of Governor’s proposed Health/Mental Hygiene Budget bill containing extremely troubling measures to bypass important due process protections for physicians during disciplinary proceedings, all physicians are urged to continue to contact their legislators to urge that the Legislature reject this unfair proposal, and plan to be in Albany on March 4 for Physician Advocacy Day.

The proposal would, among many other provisions, make it far easier for the Commissioner of Health to disclose to the public that a physician is under disciplinary investigation or summarily suspend a physician with only a minimal finding of risk to the public, as opposed to the much stronger “imminent danger” standard now required for bypassing existing due process protections.  That is particularly troubling given that only a small percentage of complaints to OPMC result in a disciplinary sanction.  MSSNY has indicated that we agree with the importance of acting quickly when it is imperative, but these proposals would completely undermine important and longstanding due process protections. Given that most complaints are dismissed without any sanction or action, this series of proposed changes to bypass these rights would create a substantial possibility of unfairly destroying an innocent physician’s career.   

MSSNY has joined with 16 state specialty societies in a communication to the Legislature setting forth our concerns in greater detail. Moreover, MSSNY President Dr. Art Fougner recently appeared on the WCNY “Capitol Pressroom” radio program to discuss MSSNY’s concerns with this proposal.

Please urge your legislators to reject this proposal from the Budget.

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One-Sided Surprise Bill Proposals Advance in Congress – Contact Your Representatives Today
All physicians are urged to continue to contact New York’s Senators Schumer and Gillibrand, as well as their respective Representative to express strong concerns with the various proposals before Congress that would substantially limit insurer responsibility for coverage of out of network emergency and surprise medical bills.  A letter can be sent here.

While MSSNY supports the goals of legislation to prevent surprise medical bills, most proposals advanced so far are steered heavily to the benefit of insurance companies, and do not have the balance of New York’s law.  Last week the House Ways & Means Committee and Education & Labor Committee advanced separate proposals.  While the Ed & Labor proposal was very similar to Energy & Commerce proposal advanced last year strongly opposed by MSSNY and many other physician organizations, the W&M proposal did make a few marginal improvements including rejecting a benchmark payment and permitting the consideration of many factors.

However, the IDR mechanism identified in the legislation would also prohibit the consideration of physician charge data and require the consideration of median in-network data, which in all certainty will skew the results towards the insurance companies.  In fact, when the proposal was scored by the Congressional Budget Office (CBO), it was noted that “in facilities where surprise bills are likely, average payment rates for both in- and out-of-network care would move toward the median in-network rate.  Moreover, the proposal only provides for a minimal review of insurer networks, which is the major contributing factor to the problem of surprise bills.

Therefore, this proposal remains highly problematic, and MSSNY President Dr. Art Fougner offered this statement supporting efforts to “ensure a fair federal legislative solution to protect patients from surprise out of network bills”, but that “far more balance is needed in what has been put forward so far”, and that the proposal released Friday by the US House Ways & Means “provides a few marginal steps forward but would still hand an enormous gift to already market dominant health insurance companies by tilting the factors in its dispute resolution mechanism towards the insurance industry.”

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“Coronaviruses 2020” CME Webinar on March 18th Registration Now Open
There have been 29 confirmed cases of COVID-19 in the United State as of February 20, 2020.  Learn more about this and other coronaviruses by signing up for Medical Matters: Coronaviruses 2020 on March 18th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Become familiar with the epidemiology and clinical features of coronaviruses
  • Understand the physician’s role int eh public health response to an infectious disease outbreak
  • Identify the circumstances that have contributed to the rapid spread of COVID-19

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.Coronavirus Flyer

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Registration Now Open for Steps to Physician Wellness and Resiliency
MSSNY’s Committee on Physician Wellness and Resiliency will hold its first webinar, entitled Steps to Physician Wellness and Resiliency on February 25th from 7:30-8:30am. Jeffrey Selzer, MD will serve as faculty for this webinar.

Educational Objectives are:

  • Review the warning signs that stress, depression, anxiety or substance use may impact work or personal life
  • Identify strategies to increase personal empowerment toward making positive change, including self-assessment tools
  • Recognize self-monitoring strategies for stress related problems and know when to seek professional assistance

Register by clicking here.  Please click here to view the flyer for this program.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Several NY Counties Pushing Back Against Gov.’s Medicaid Cost-Shifting Plan
The Buffalo (NY) News (2/14) reported, “Officials from Erie County, New York City and elsewhere are pushing back on an additional Medicaid cost-shifting plan that they say could be even worse than what Gov. Andrew M. Cuomo recently proposed in his new budget.” This “latest fight is over millions of dollars counties receive each year from the federal government for additional Medicaid services and costs under the Affordable Care Act.”


Dr. Pinto

Saratoga County President Greg Pinto, MD with Assemblywoman Carrie Woerner, Assembly District 113 (Saratoga) at 2-19-2020 Legislative Update meeting of the Saratoga County Medical Society.

NYS DOH Flu Tracker

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Unregulated/Deeply Discounted Insulin Sales Common on Craigslist
Reuters (2/17) reports, “Unregulated and deeply discounted sales of insulin are common on Craigslist,” research indicated. Over the course of “a two-week period, researchers turned up 327 ads from private parties selling insulin at a fraction of the retail price,” investigators found. The study’s co-author said, “The take home message from this study is that patients (with diabetes) should not have to go to Craigslist to find affordable insulin.” She added, “There has to be a better way than patients going out on their own and seeking out potentially harmful products.” The findings were published online in a research letter in JAMA Internal Medicine (subscription required).

Grandparents May Be Bad Influence on Children’s Weight
Grandparents can be a bad influence on kids’ weight,” investigators concluded after analyzing data from “23 studies conducted in the United States and eight other countries.” That analysis revealed that children “who were cared for by grandparents had nearly 30% higher odds for being overweight or obese.” The findings of the systematic review and meta-analysis were published online in the journal Childhood Obesity.

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MSSNY Young Physicians, Resident Fellow, Med Student Social
Friday, 2/28/2020, 6pm-9pm
Sessions 73 – 73rd St. and 1st Ave. New York, NY
RSVP for social here

Just One Dose of HPV Vaccine May Help Prevent Cervical Disease

A single dose of human papillomavirus (HPV) vaccine is associated with a significant reduction in cervical disease, according to a retrospective study in Cancer. The CDC generally recommends two doses for those vaccinated between ages 9 and 14, and three doses for those vaccinated later.

Using a U.S. insurance claims database, researchers matched nearly 67,000 females aged 9 to 26 who received at least one dose of the quadrivalent HPV vaccine with 67,000 unvaccinated controls.

The estimated rate of preinvasive cervical disease at 5 years was 2.65% in the unvaccinated group, versus 1.62%, 1.99%, and 1.86% among those who received one, two, and three vaccine doses, respectively, between ages 15 and 19. After multivariable adjustment, one vaccine dose was associated with a 36% risk reduction; two doses, a 28% reduction; and three doses, a 34% reduction.

Editorialists say the findings “add to the growing evidence suggesting that there may truly be no major difference in protection against cervical preinvasive lesions … conferred by 1, 2, or 3 doses of HPV vaccination.”

Cancer article
Background: Prior Physician’s First Watch coverage of single-dose HPV vaccination

Considering a Run for Office for Yourself?
AMPAC Candidate Workshop February 28 – March 1, 2020

Ever wonder how Doctors get elected to Congress or your state legislature? The AMPAC Candidate Workshop will teach you how to run a winning political campaign, just like we taught many of your AMA colleagues over the years.

The Candidate Workshop is designed to help you make the leap from the exam room to the campaign trail and give you the skills and strategic approach you will need to make a run for public office.

Additional details below

This one-and-a-half-day workshop is designed to provide you with the skills and strategic approach you will need to make a run for public office. Some of the topics include: how and when to make the decision to run; the importance of a disciplined campaign plan and message; the secrets of effective fundraising; what kinds of media advertising are right for your campaign; how to handle the inevitable crises that emerge for every campaign; the role of your spouse and your family; and how to become a better public speaker.

Registration is now open. There are still a few spots remaining but don’t delay. The registration fee is $250 for AMA members ($1,000 non-members), spouses and state medical society staff. The fee is waived for students/residents, however, there are limited slots and the AMPAC Board will review and select from the pool of qualified applicants. For more information visit AMPAC online. To apply, simply fill out the online registration form or email your questions to:

Med Schools Recruit LGBTQ Students to Improve Care for LGBTQ Patients
The AP (2/19) reports on efforts to increase the number of LGBTQ physicians, which LGBTQ advocates say should improve the quality of care received by LGBTQ patients. The article says that “when being heterosexual is presumed even in doctors’ offices, those who identify otherwise can feel marginalized and less likely to seek medical care, contributing to health problems” such as mental health issues, alcohol and drug use, and forgone preventive care, according to LGBTQ advocates.

The article adds that some medical schools are pushing to recruit more LGBTQ students citing “research showing that patients often get better care when treated by doctors more like them.” Exact numbers of LGBTQ medical students and doctors are unknown. In 2018, the AMA added sexual orientation and gender identity as an option for members to include in demographic profiles the group compiles.

Of the 15,000 doctors and students who have volunteered that information so far, about 4% identify as LGBTQ. That is similar to Gallup estimates for the general U.S. population, although LGBTQ advocates believe the numbers are higher and rising as more people are willing to “out” themselves. This past fall, Harvard’s entering class of medical students was 15% LGBTQ, a milestone that is no accident.

Bill Correctly for Medicare Telehealth Services
In a recent report, the Office of Inspector General (OIG) determined that the CMS improperly paid practitioners for some telehealth claims associated with services that did not meet Medicare requirements. CMS released the Medicare Telehealth Services video to help you bill correctly.

Additional resources:

·       Telehealth Services (PDF) Medicare Learning Network Booklet

·       Medicare Claims Processing Manual, Chapter 12 (PDF), Section 190

·       Medicare Telehealth Payment Eligibility Analyzer

·       List of Covered Telehealth Services webpage

·       CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements OIG Report



MSSNY Grassroots Banner

When you subscribe to the Medical Society of the State of New York Grassroots Action Center, the Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.

Accordingly, contact from constituents would be vital to influencing the path and future of that legislation or issue.

Alerts will be accompanied by recommended actions you or your designee can take to have maximum impact such as calling, tweeting and emailing a customizable letter to your legislators.

If you are concerned with health care policy formation in New York State, please subscribe today by texting MSSNY to 52886 and you will be prompted to enter your email address.  When you sign up, it is best to use your NY-based voting address or practice address (if you do not reside in NY) for your alerts.

Contact the Division of Governmental Affairs at 518-465-8085 or if you have questions or comments.  Thank you.

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Office Rental 30 Central Park South
Three exam rooms, consultation, reception and secretarial rooms. Ground floor next to Plaza Hotel.
Elegantly decorated and fully equipped with operating suite on site. Part or full time. $1280/month for each exam plus consultation room.213.371.0468

Midtown Medical Office for Rent
Beautiful office for rent in midtown Manhattan located opposite Grand Central Station on 42nd Street and Madison avenue. ideal for medical and surgical specialists as there are five spacious exam rooms with an accredited quad a certified operating room with anesthesia services. You can perform procedures and see patients. Rent for three days a week is $3,200 and 4 days a week is $4,100 Interested physicians please email or call 914-582-0749.

Practice Coach AdThe Practice Coach –  We Help Physicians Help More Patients
We improve the employee and patient experience to help you achieve your goals and grow your practice. How? With strategic processes that support you, your staff, and your patients! We integrate your values into all areas of your practice including hiring, training, communication and operational strategies. Whether you’re independent or part of a group, we have an approach that will work for you. If you’re ready to strengthen your practice, we can help.

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Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties. Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
Please call or text 929 316-1032





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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: Contact: or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.