ALICE G. GOSFIELD, Esq.’s entire legal career has been devoted to health law with an emphasis on representation of physicians and their group configurations and a focus on non-institutional reimbursement including Medicare; managed care; fraud and abuse compliance and avoidance; medical staff issues, clinical integration and value and quality.
A graduate of Barnard College and New York University School of Law, since 1973 her varied health law career has ranged from an OEO ("War on Poverty") and then DHEW funded research program to develop a consumer-oriented analysis of the PSRO law, to drafting codes of regulations for state health care agencies, and since 1978 to include the private practice of law.
Ms. Gosfield served as Chairman of the Board of Directors of the National Committee for Quality Assurance, reelected to serve five terms from 1998 through 2002. She served on the Board for twelve years from1992 through 2003. In the public policy arena, she has served on four committees of the Institute of Medicine of the National Academy of Sciences studying issues involving utilization management and clinical practice guidelines and has served as an advisor to the Agency for Health Care Policy and Research in both evaluating one of their first three clinical practice guidelines and in developing methodologies to translate guidelines into medical review criteria, performance measures and standards of quality.
She was the first Chairman of the Board of PROMETHEUS Payment®, Inc. a not-for-profit, national, multi-stakeholder project to develop a new provider payment model (PROMETHEUS Payment®) that bases provider payment on the cost of delivering guidelines based care as measured in a comprehensive scorecard. She was the first Chairman of the Board of the Health Care Incentives Improvement Institute, Inc (HCI3) a not for profit organization which is the merger of Bridges to Excellence and PROMETHEUS Payment®.
She has been called on by the Congressional Budget Office, the General Accounting Office, the Robert Wood Johnson Foundation, the Federal Agency for Healthcare Research and Quality, the Joint Commission, and others to advise on issues pertaining to Medicare reimbursement, medical evidence, legislation dealing with medical necessity in managed care and tort reform. Ms. Gosfield served as President of the American Health Law Association (formerly the National Health Lawyers Association), from 1992-1993 and chaired their Physician and Physician Organizations Institute from 2001 through 2006.
A highly sought after speaker, Ms. Gosfield has been invited to lecture throughout the country and internationally to diverse audiences including physicians and other health care professionals, chief executives and chief financial officers, boards of trustees and directors, group managers, managed care executives and others throughout the health care industry. She is noted for her practical yet provocative, incisive, down-to-earth style and ability to make complex technical information understandable as well as entertaining. She lectures often for a variety of organizations which have included the American Health Law Association (AHLA), the American Medical Association (AMA), the Medical Group Management Association (MGMA), America’s Health Insurance Plans (AHIP), the Healthcare Compliance Association, and the American College of Cardiology as well as other national, state and regional groups.
A frequent author in a wide range of health care publications, she has authored or co-authored more than 190 published articles, 13 monographs and four books. Her first book “PSROs: The Law and The Health Consumer, was published in 1975 by Ballinger Publishing Company. Her second book – Guide to Key Legal Issues in Managed Care Quality– was written primarily for non-lawyers and was published in 1996 by Faulkner and Gray. Since 1989, she has been the editor of the annual HEALTH LAW HANDBOOK published by WestGroup, a Thomson Company which issues a completely new book each year. She also authors with Dan Shay, MEDICARE AND MEDICAID FRAUD AND ABUSE, an annually updated treatise also published by WestGroup. She serves on the editorial advisory boards of multiple diverse journals and newsletters including Medical Economics. She is a contributing editor to Family Practice Management.
She was named as one of the Top Thirty Health Lawyers in the Country in 2007 by the Best of the Best and among the Top Twenty-five Health Lawyers in the Country in their second and last listing in 2009. She was named the first Health Lawyer of the Year (Philadelphia) for 2010 by the Best Lawyers in America. She is a Pennsylvania Super Lawyer, and has been one of the Top 50 Women Lawyers in Pennsylvania. She has been listed in The Best Lawyers in America (Health Law) in every edition since the inception of the health law category in 1991. She has been recognized internationally for her health law expertise by the International Centre for Commercial Law in the United Kingdom as one of The Legal 500, a select group of 500 law firms in the United States recommended for their specific abilities in particular areas of the law. She is a Fellow of the American Health Law Association.