Amy Garrigues

Amy Garrigues

K&L Gates LLP

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Latest Publications


The 60 Day Rule — Identification and Knowing Avoidance

On August 3, 2015, the United States District Court for the Southern District of New York issued an opinion and order in Kane v. Healthfirst, Inc., et al.[1] that provides the first judicial interpretation of the requirement...more

8/26/2015 - 60-Day Rule Affordable Care Act Attorney-Client Privilege CID Civil Investigation Demand CMS False Claims Act (FCA) Health Care Providers Healthcare Hospitals Medicaid Medicare Motion to Dismiss Overpayment Overpayment Recovery Time Limits Physicians

SGR Law Creates Merit-based Incentive Payment System and Incentives for Alternative Payment Model Participation

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA” or the “Act”), signed into law by President Barrack Obama on April 16, has been touted as one of the most significant Medicare payment reforms in decades, with...more

5/11/2015 - CHIP Health Care Providers Healthcare Hospitals Medicare Access and CHIP Reauthorization (MACRA) Physician Medicare Reimbursements Physician SGR Formula

MACRA Brings Modifications to the Recovery Audit Program

This is the second K&L Gates Health Care Client Alert discussing the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA), signed into law by President Barack Obama on April 16, 2015. This alert focuses on...more

5/6/2015 - CHIP CMS Health Care Providers Healthcare Hospitals Medicare Access and CHIP Reauthorization (MACRA) Recovery Audit Recovery Audit Contractors (RACs) Two-Midnight Rule

OIG Issues Compliance Oversight Guidance for Governing Boards of Health Care Organizations

On April 20, 2015, the Office of Inspector General (OIG), in collaboration with the Association of Healthcare Internal Auditors, the American Health Lawyers Association, and the Health Care Compliance Association, issued...more

5/4/2015 - Board of Directors Chief Compliance Officers Corporate Governance Health Care Providers Hospitals New Guidance OIG Oversight Committee

SGR Law Brings Changes to CMP Prohibition on Gainsharing

On April 16, President Barack Obama signed into law the “Medicare Access and CHIP Reauthorization Act of 2015,” ending a perennial struggle over the Medicare reimbursement formula for physicians. Although the law is most...more

4/20/2015 - Affordable Care Act CHIP CMP Law Gainsharing Health Care Providers Health Insurance Healthcare Hospitals Medicare New Legislation OIG Physician SGR Formula Physicians Rulemaking Process

Uncertain Privilege: Implied Waiver of the Attorney-Client Privilege in False Claims Act Litigation

In a pending False Claims Act (“FCA”) case stemming from alleged violations of the physician self-referral law (the “Stark Law”), 42 U.S.C. § 1395nn, and the federal Anti-Kickback Statute (“AKS”), 42 U.S.C. §1320a-7b, the...more

11/17/2014 - Anti-Kickback Statute Attorney-Client Privilege Document Productions False Claims Act (FCA) Motion to Compel Privilege Waivers Stark Law

Blurring the Lines between False Claims Act Litigation and Putative Federal Malpractice Law: The DOJ Quietly Invokes “Worthless...

On October 10, 2014, the United States Department of Justice (“DOJ”) announced a civil settlement agreement (the “Settlement”) with Extendicare Heath Services, Inc. and its subsidiary Progress Step Corporation (collectively,...more

10/23/2014 - Corporate Integrity Agreement DOJ False Claims Act (FCA) Healthcare HHS Medicaid Medical Malpractice Medical Reimbursement Medicare Non-Judicial Settlement Agreements OIG Skilled-Care Providers Standard of Care Worthless Services Claims

Proposed Updates to the Civil Monetary Penalties Law for Health Care Providers

On October 3, 2014, the Office of Inspector General of the Department of Health and Human Services (“OIG”) published a proposed rule and request for comments (“Proposed Rule”) that would amend certain rules under the Civil...more

10/20/2014 - Affordable Care Act Ambulance Providers Anti-Kickback Statute CMP Law Gainsharing Hospitals OIG Pharmacies Physicians Proposed Regulation Safe Harbors

A Possible Green Light for Patient Transportation Services: OIG Proposes Revised Safe Harbors to the Anti-Kickback Statute for...

On October 3, 2014, the Office of Inspector General of the Department of Health and Human Services (“OIG”) published a proposed rule and request for comments (“Proposed Rule”), which would amend the Anti-Kickback Statute...more

10/13/2014 - Ambulance Providers Anti-Kickback Statute Civil Monetary Penalty Health Care Providers Healthcare Medicare Part D OIG Pharmacies Prescription Drugs Safe Harbors

New Flexibility Under the Medicare Conditions of Participation: A Single Medical Staff Option for a Multi-Hospital System and...

As described in our prior alert, the Centers for Medicare & Medicaid Services (“CMS”) has, for the past several years, been seeking ways to reduce its regulatory burden on health care providers. In furthering this initiative,...more

7/16/2014 - CMS Healthcare Healthcare Reform Hospitals Medicare

Bonuses for Physician Employees: Lessons Learned from the Halifax Hospital Case

This week, a federal district court in Florida concluded that a hospital violated Stark as a matter of law by entering into employment agreements with physicians that included bonus compensation that was not based exclusively...more

11/22/2013 - Bonuses Healthcare Medicare Patient Referrals Physicians Profit Sharing Stark Law

CMS Issues New Guidance on 2-Midnights Standard and Delays Audits

Centers for Medicare and Medicaid Services (CMS) finalized a new rule, effective October 1, 2013, under which hospital inpatient admissions are considered reasonable and medically necessary if the physician expects a...more

11/18/2013 - Admissions CMS Healthcare Inpatient Prospective Payment System (IPPS) MACs

Sending the Privilege Away: Attorney-Client E-Mails in the Corporate Setting

In a pending False Claims Act (“FCA”) case involving allegations of noncompliance with the federal physician self-referral law (the “Stark Law”), 42 U.S.C. § 1395nn, the United States District Court for the Middle District of...more

1/8/2013 - Attorney-Client Privilege Corporate Counsel Crime-Fraud Exception Email False Claims Act (FCA) Stark Law Whistleblowers Work Product Privilege

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