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Medicare Enrollment Deadline For Dentists and Physicians in MA

Have you made a decision on Medicare enrollment?

June 1, 2016 is the deadline for all the providers to either enroll or opt out of Medicare. Traditionally, most physicians, including dentists, have been enrolling in Medicare in order to provide covered services to Medicare eligible beneficiaries through the Medicare Part D plan or Medicare Advantage plan benefits. However, with the implementation of Section 6405 of the Affordable Care Act, physicians, including dentists, need to enroll in the Medicare program for the purpose of certifying or ordering services for Medicare eligible beneficiaries. These doctors do not provide actual services to Medicare eligible beneficiaries, but rather they write prescriptions for these patients that need to be covered when they go to the pharmacy.

Stethoscope 2

The following categories of physicians must enroll in Medicare by the June 1, 2016 deadline:

• Physicians employed by the Department of Veteran’s Affairs;
• Physicians employed by the Public Health   Service;
• Physicians employed by the Department of     Defense Tricare Program;
• Physicians employed by the Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Critical Access Hospitals (CAHs);
• Physicians in a Fellowship;
• Dentists, including Oral Surgeons.

The biggest question that arises for all of the physicians, including dentists, if they have not enrolled in Medicare yet, should they enroll? How does one decide whether they should enroll or opt out of the enrollment by June 1, 2016?

Physicians, including dentists, have 3 options to choose from when making a decision with their status with Medicare:

1. Enroll as a Medicare provider;
2. Opt-out of the Medicare program;
3. Enroll as an ordering/referring provider.

Enrolling as a Medicare provider means that the physician/dentist will accept the Medicare fee schedule for all the services covered by Medicare. As a side note, a lot of the dental procedures in the dental office are not covered by Medicare.
Opting out as a Medicare provider means that the physician/dentist agrees not to bill Medicare for any service for a period of two years. This is an important decision, as the physician/dentist will have to formally let all of their patients know about their decision to opt out. This would mean that the physician/dentist, while not being bound by Medicare schedule, can bill the patients directly. However, should a claim be submitted by mistake on behalf of Medicare patient to Medicare, the physician’s/dentist’s status with Medicare may be jeopardized.

Enrolling as an ordering/referring provider means that the physician/dentist will not perform or bill for the services done at his/her office, but would be able to refer Medicare eligible beneficiaries to other facilities for services, as well as will be able to prescribe medications that would be covered by the Medicare Part D plan or Medicare Advantage plan.

The decision on whether to enroll in or opt out of the Medicare enrollment should be based on the following criteria:

• If a physician or a dentist already provides services covered by Medicare, then it’s easy for them to enroll in Medicare using form CMS-8551. In this case, they also have an option of formally opting out of Medicare all together.
• If a physician or a dentist does not currently provide services covered by Medicare, the next question they should ask is whether they order Medicare covered Clinical Laboratory Services (for example, sending biopsies to a pathology lab), Imaging Services, etc?

o If the answer to the above is yes, then they can enroll in Medicare using form CMS-8551. In this case, they also have an option of formally opting out of Medicare all together.
o If the answer to the above is no, they do not need to enroll in Medicare or formally opt out if they do not provide any services covered by Medicare or order/refer patients to covered clinical laboratory services.

One caveat that a physician/dentist should know is that if they choose to formally opt out of Medicare, or do not enroll in Medicare, as of February 1, 2017 any and all prescriptions this physician and/or dentist writes will not be paid for by Medicare Part D of the plan and/or Medicare Advantage plan for the Medicare eligible beneficiaries. Further, if a dentist opts out of Medicare, neither the dentist nor the patient will be able to submit a claim to Medicare Advantage plan.

Medicare has many complex regulations that can affect your practice greatly. The health law attorneys at Shapiro Law Group can work with you to determine the approach that suites you and your business best.


Anna Shapiro, Esq., LLM is a Chief Executive Officer at the Shapiro Law Group, who focuses her practice on health law, business and corporate law, family law, domestic relations and complex litigation. Anna may be reached at [email protected]

Protecting the Online Reputation of Your Business is More Important than Ever

Anna Shapiro, Esq., CEO

More and more, the online reputation of your business matters. According to BrightLocal’s 2014 Local Consumer Review Survey, “88% of consumers trust online reviews as much as personal recommendations.” Reviews have an increasingly big impact on customer decisions and your bottom line. A single bad review can do a lot of damage, especially if it is malicious and false.

Smart businesses address legitimate customer complaints before they turn into major problems. If the experience your customer received was not up to standard, you can offer something like a discount on the next visit. Airlines overbook on purpose and then give out vouchers to compensate passengers on oversold flights. Restaurants give free meals to compensate those who have experienced poor service. Consumers are usually willing to forgive businesses that acknowledge problems and make amends.

But what if the complaint or bad review isn’t legitimate? What if it is made up? I was given a one-star review by someone who was never a client! The platform where the review appeared said that it wasn’t their problem – they acted like they were Switzerland, declaring neutrality. The only option I was given was to comment on the review, which I did. But the bad review was never removed. Whether the writer was confused or malicious, I have no idea. But I do know that my reputation took an undeserved hit, and I was an innocent victim.

How Trustworthy are Online Reviews, and How Damaging Can They Be?

Given the increasing number of people of all ages who look online for guidance, trustworthiness is extremely important. Yet a 2015 study by two Harvard and Boston University professors found that 16% of Boston restaurant reviews on the popular site Yelp were “false” or “suspicious.” In “Fake It Till You Make It: Reputation, Competition, and Yelp Review Fraud,” they analyzed numerous ways restaurants were gaming the system. What they reported wasn’t pretty. Advertising for fake reviews was an open secret. Overzealous restaurant owners were paying people to disparage the competition or pump their own business. Those caught were penalized by Yelp. 

In another case where someone went too far, the authors of a very negative social media campaign about a Norwood car dealership (Clay Corporation) inflicted significant economic damage. In Clay Corp. v. Colter, Mass. Superior Court 2012, Judge Renee Dupuis wrote that “Clay’s business has been severely and adversely impacted.” She found the defendants liable to the tune of $1,500,000 for their defamatory comments. However, the judge did not force the authors to remove their social media posts due to the First Amendment right to free speech. Despite the economic relief awarded, the negative comments remained for all to see. And in the world of the Internet, these comments can remain for years to come.

Remedies for Setting the Record Straight

If you are the victim of false, malicious, or defamatory comments, contacting the site where the information appears or asking the writer to remove the comments is sometimes enough. However, in cases like mine, and you can’t get the review changed or removed, what should you do?

There are a growing number of online Reputation Management companies that promise to restore the reputation of your business, for a fee, of course. Typically, they write positive articles about your company and in time, they are supposed to replace the negative ones that show up on the first page of Google. These methods often have limited usefulness, though, and some of these Reputation Management companies have even been tied to companies that post maliciously.

Do You Need an Attorney to Restore Your Reputation?

To restore your personal or business reputation, you may need to file a lawsuit. If the amount in damages you are seeking is less than $7,000, you can file a Small Claims court action. It’s important to be aware that Massachusetts law (MGL c.218, s.21) does not give Small Claims court jurisdiction over slander or libel. If your claim is based on evidence of those concerns, you may want to take your case to a higher court, as Clay Corporation did. If you’re claiming libel, under Massachusetts law you “must ordinarily establish” that the defendant published a written statement concerning you that was both defamatory and false, and either caused economic loss or is actionable without proof of economic loss. (See Clay Corp. v. Colter, Mass. Superior Court 2012.)

While you can certainly act as your own attorney and file pro se for your personal reputation law suit, if you are looking to protect a reputation for your business, you would be required to engage a Massachusetts Attorney to do so. The court system has many rules and regulations that can be foreign or even intimidating to the layperson. Every case is different, and we at Shapiro Law Group can work with you to determine the approach that suits your business best. If we don’t think you have a case, we will tell you that so that you don’t waste your time. Or we can work to have the offending reviews and defamatory content removed for your business, and if necessary seek damages on your behalf as a business owner.

In my next post, we’ll look at a recent case involving Yelp and a Boston retailer that has widespread implications for Massachusetts businesses. The court’s ruling was a victory for business and shattered the notion that reviewers and the platforms that host reviews can hide behind the cloak of anonymity.


Massachusetts Appeals Court Says Child Support Law Requires Inclusion of All Parents’ Income

Navigating the divorce process is often like wading through a minefield:  Even when you think you’re on sure footing, your next step may prove treacherous.  In the author’s experience, when parents divorce, resolving finances and determining child support dominate throughout the negotiations.  A ruling from the Massachusetts Appeals Court recently resolved and expanded the scope of gross income that must be included determine a parent’s potential Child Support obligation.

In Hoegen v. Hoegen, No. 14-P-1491 (Mass.App.Ct. Jan. 22, 2016), Judge Hanlon held that income derived from vested restricted stock units—essentially, stock options—must be considered as gross annual employment income for the purposes of calculating Child Support Orders.

By way of background, Christine Hoegen (the “Mother”) and Patrick Hoegen (the “Father”) were divorced by a Judgment of the Worcester Probate and Family Court.  The Court’s Judgment incorporated a Separation Agreement which provided that, among many other things, (1) the Father would pay the Mother Child Support in the amount of $1,020 every other week for the parties 2 children; and (2) the parents would confer every April 1 to reevaluate whether the Child Support should be adjusted given the parents’ respective incomes.  The Separation Agreement also provided that that Mother was aware that the Father participated in a stock plan through his employer, and the Mother waived all rights to the Father’s stock plan account.

Around 1-2 years after the parties’ divorced, the Father filed a Complaint for Modification in which he sought to expand his parenting time.  In response to the Father’s Complaint, the Mother filed an Answer with the Court in which she sought to recalculate Child Support to include “all” of the Father’s income.

At trial, the only issue left that the parties disputed was whether to include the income the Father received from his stock options, held in the stock plan through his employer, as “gross income” for purposes of calculating the Father’s Child Support obligation.  The Mother argued that the Child Support law is expansive and requires the Court to include income from any and all the Father’s sources.  The Father argued, however, that the stock plan was properly identified in the underlying divorce case, and the Mother freely negotiated her rights away from claiming against the Father’s account.

Judge Hanlon ruled for the Mother.  In his opinion—which is now the law of the Commonwealth of Massachusetts—Judge Hanlon ruled that (1) income derived from stock options is considered gross annual employment income for the purposes of calculating a parent’s Child Support obligation, and (2) a parent cannot waive or bargain away her child(ren)’s right to appropriate Child Support.


A Good Family Law Attorney Can Spot Hidden, but Important, Issues. From the Father’s perspective, this case was about modifying his parenting plan.  However, we will forever remember this case for its Child Support ruling.  A good lawyer knows the law and knows the right questions to ask to maximize your day in Court.

At SLG, we have exhaustive experience representing parents in Child Custody and Alimony battles, Grandparents seeking visitation, and Husbands and Wives suing for Divorce.

Allow us to share our experience with you.

If you need a professional on your side, call the Shapiro Law Group today. 339-200-9933

U.S. Supreme Court to Decide Lawsuit Challenging DACA and DAPA Expansion-Immigration Law MA

On January 19, 2016, the United States Supreme Court accepted the Obama administration’s request to review the question as to the validity of the Immigration expansion program.
Throughout President Obama’s campaigns, he made numerous promises to try to “fix” the United States immigration system. In November 2014, President Obama announced that he would use his Presidential Executive power to expand the Deferred Action for Childhood Arrivals (DACA) program to include more people who came to the United States as children. He wanted to remove the age cap so that people over age 31 could apply, allow people who entered before January 10, 2010 to apply, and increase the length of employment authorization from 2-3 years.

In addition, and more excitingly, he wanted to introduce a new Deferred Action for Parental Accountability (DAPA) program, which would allow parents of U.S. Citizens and Lawful Permanent Residents (children with green cards) who have lived peacefully and without problem in the United States for at least five years to apply for a renewable, temporary status with employment authorization.

Very quickly, however, several states filed a lawsuit challenging President Obama’s power to make these decisions. Over the past year, these issues have been fought in several courts. Unfortunately, the courts have blocked the executive actions on immigration. However, now that the U.S. Supreme Court has accepted the request to hear the case, there is a chance that they will side with President Obama’s administration and decide that the prior actions were legal and should be enforced.

Although nothing can be stated with certain, the immigration attorneys at Shapiro Law Group, PC are hopeful that President Obama’s immigration reform will be enforced by the U.S. Supreme Court. Should you feel that you may be eligible for either the expanded DACA program or the new DAPA program, please contact the Immigration Division at Shapiro Law Group, PC for a free consultation.

Vivian Salib Crowell, Esq.

Gregory T. Magazu & Another v. Department of Children and Families, Supreme Judicial Court – 1186

The Massachusetts Supreme Judicial Court opened 2016 with a decisive statement against the crusaders of religious freedom. The matter of Magazu, et al. v. Department of Children of Families, SJC – 11864 set a strong precedent upon aspiring foster parents with deeply held religious convictions, who employ the use of corporal punishment.

The Magazus were a married couple, who maintained a strict adherence to the tenets of the Christian faith. The Magazu family consisted of mother, father, and two (2) daughters. In September of 2012, the Magazus determine that they wanted to adopt one or more of the foster children already placed in their care. Concomitant with this desire, the Magazus filed an application with the department of children and families for a “family resource license”, which would enable them to become foster and preadoptive parents.

During their application process, they completed the “Massachusetts Approach to Partnership in Parenting”, as well as the “Family Resource License Study”, as required by the Department of Children and Families (hereinafter “DCF”). Among other things, the study asked the Magazus about their personal histories, parenting experiences and attitudes, including methods of discipline.

The Magazus reported that they “‘have used physical discipline on their daughters,’” and that such discipline is “‘appropriate when there is a continuous pattern of disobedience.’ “(quoting slip opinion of Magazu, et al. v. Department of Children of Families, SJC – 11864). The Magazus specifically indicated that their preferred method of corporal punishment was “ ‘spanking on the buttocks, using Greg or Melanie’s hand, in the privacy of their bed room so that [the children] are not humiliated in front of others.’ ”(Ibid.) Notably, the Magazus confirmed that physical discipline “‘is a small part of their parenting style, and only used when necessary.’”

The following winter, on February 7, 2013, the Magazus were notified that their application had been denied because of their use of corporal punishment. DCF further stated that they had failed to meet certain licensing standards, including the ability to sign DCF’s written agreement prohibiting the use of any corporal punishment.

Frustrated by their denial, the Magazus filed a timely request for a “fair heaving”. Three months later in May of 2013, the hearing occurred. One June 24, 2013, the hearing officer affirmed the decision of DCF not to approve their application to become foster parents. As grounds for denying their petition, the hearing officer opined that the Magazus failed to prove by a preponderance of the evidence that somehow DCF’s decision did not confirm with its’ written rules and regulations, or that the decision was somehow unreasonable.

1 The Magazus claimed their religious faith would not allow them to affirm they would not engage in corporal punishment, but maintained that they did not physically discipline either of their children in the presence of the other, and certainly would not do so in the presence of the foster children in their care.

Evidently unsatisfied, the Magazus then appealed this administrative decision, seeking judicial review, by filing a complaint in the Superior Court pursuant to MGL Ch. 30A §14.

Enter the constitutional argument.

Within their §14 Complaint, the Magazus alleged that their substantial rights had been prejudiced because, inter alia,  DCF’s decision violated their constitutional rights, insofar as DCF violated their right to the free exercise of religion under the Federal and State Constitutions. DCF (evidently content with their prior work) filed their administrative record as its answer.

Shortly thereafter, the Magazus filed a Motion for Judgment on the pleadings. After hearing, the judge denied the Magazus’ motion for judgment on the pleadings, and dismissed the complaint from which it spawned.

The Magazus appealed, and shortly thereafter, by way of motion, the Supreme Judicial Court, sua sponte, transferred the matter to its own house.

The central argument lodged by the Magazus on appeal was that because physical discipline is an integral part of their faith, DCF’s decision impermissibly infringed on their constitutional right to the free exercise of religion.

The Supreme Judicial Court rightfully opened their opinion by re-stating the Magazus obligation of showing by a preponderance of the evidence that DCF’s decision ‘was not in conformity with [its] policies and/or regulations and resulted in substantial prejudice to the [Magazus].’ (Ibid., citing MGL Ch. 119 § 1). The Court continued its reasoning: “Consonant with its enabling legislation, the department has determined that an application for licensure as a foster parent must demonstrate, among other qualities, the ability to ‘promote the physical, mental, and emotional well-being of a child placed in his or her care.’” (quoting slip opinion of Magazu, et al. v. Department of Children of Families, SJC – 11864, citing 11 Code Mass. Regs. §7.104(1)(d)

When it is alleged that the Commonwealth has violated one’s free exercise of religion, a balancing test is triggered. See Desilets, 418 Mass. at 321-323. The test requires that the Court determine whether the State action about which a party has complained “substantially burdens [the] free exercise of religion, and, if it does, whether the Commonwealth has shown that it has an interest sufficiently compelling to justify that burden.” (Desilets, 418 Mass. at 322)

The Court applied the balancing test as follows:

“Here, because the department’s prohibition against the use of corporal punishment in a foster home is inherently incompatible with the Magazus’ religious beliefs, the Magazus are compelled to make a choice.  On the one hand, they can adhere to the teachings of their religion

2 Notably, the Magazus also alleged that DCF’s decision exceeded the Department’s own authority, was based on errors of law, was arbitrary and capricious, and was not supported by substantial evidence.

and use corporal punishment as a form of discipline in their home, thereby forfeiting the opportunity to become foster parents.  On the other hand, they can abandon this particular religious tenet in the hope of being approved as foster parents.  We conclude that, by conditioning the Magazus’ opportunity to become foster parents on their willingness to forsake a sincerely held religious belief, the department has substantially burdened the Magazus’ constitutional right under art. 46, § 1, of the Amendments to the free exercise of religion.” (quoting slip opinion of Magazu, et al. v. Department of Children of Families, SJC – 11864

Determining a violation exists, the Court must then determine whether the Commonwealth – that is, DCF –  has demonstrated “a sufficiently compelling interest to justify this burden.” (Ibid.)

The Court sides with DCF, by concluding:

“Based on the department’s compelling interest in protecting the welfare of foster children, we conclude that its prohibition against the use of corporal punishment in a foster home outweighs the burden on the Magazus’ right to employ physical discipline in accordance with their religious beliefs.  Accordingly, the Magazus are not entitled to relief under G. L. c. 30A, § 14 (7) (a).”

While the Magazu decision can be construed as a defeat for champions of religious freedom, it also unquestionably emboldens the autonomous authority possessed by administrative law officers.  The decision by Jamie Caron, regional clinical director for the Department of Children of Families, was subsequently and unequivocally affirmed by two (2) courts. Her testimony that corporal punishment is not appropriate for children in need of alternative care and placement, has galvanized the nexus between religious tolerance and the best interests of the children, with the later maintaining its apparent prominence.

Anthony J. Low, Esq. is a Senior Partner at the Shapiro Law Group. Mr. Low focuses his practice on all areas of matrimonial law, including guardianship, highly charged child custody disputes, complex asset division, divorce, and modifications.