Brian McGovern

Brian McGovern

Cadwalader, Wickersham & Taft LLP

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OIG Delivers Home Care a One – Two Punch: Release of Report and Alert on Home Health Fraud Highlights Increased OIG Scrutiny of...

On June 22, 2016, the Office of Inspector General (“OIG”) issued two communications that underscore its continued focus on fraud in home health care, along with the role of physicians as “gate keepers” in authorizing...more

6/30/2016 - Anti-Kickback Statute Companionship Exemptions Domestic Workers False Billing False Claims Act (FCA) Health Care Providers Healthcare Fraud Home Health Agencies Home Health Care Home Healthcare Workers Kickbacks Medicare OIG Physicians

IRS Ruling Sounds Alarm over Tax-Exempt Status of Nonprofit ACOs Operating outside of the Medicare Shared Savings Program

On April 8, 2016, the IRS released private letter ruling 201615022 denying tax-exempt section 501(c)(3) status to a nonprofit accountable care organization (“ACO”) that did not participate in the Medicare Shared Savings...more

5/11/2016 - 501(c)(3) ACOs Affordable Care Act Health Care Providers IRS Medicare Shared Savings Program Non-Profits Physicians Tax Exempt Entities

Trove of SNF Claims Data Released By CMS – Ready for Mining By Auditors and Whistleblowers

Over recent years, the Federal government has trained its sights on potential billing abuses in the Medicare Part A program for Skilled Nursing Facilities (“SNFs”) in the provision of rehabilitation therapy services. The...more

5/3/2016 - CMS False Billing False Claims Act (FCA) Health Care Providers Healthcare Fraud Medical Reimbursement Medicare Medicare Part A MedPAC OIG Skilled Nursing Facility

More Than a Family Affair: Six-Figure HIPAA Penalty Upheld for Unrepentant Home Care Agency due to PHI Access by Spurned Spouse of...

The Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 and the regulations promulgated thereunder (“HIPAA”) should be now well-known to health care providers and health plans. Under HIPAA’s...more

3/9/2016 - ALJ Civil Monetary Penalty Data Breach HIPAA OCR PHI Privacy Rule

CMS Issues Final Regulations to Guide Medicare Providers and Suppliers in Complying with 60-Day Mandate to Report and Return...

The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed...more

2/23/2016 - 60-Day Rule Affordable Care Act CMS False Claims Act (FCA) Health Care Providers Overpayment Recovery Time Limits

Regulations Limiting Executive Compensation and Administrative Costs of State-Funded Providers Upheld by Appellate Division,...

On December 30, 2015, the New York State Appellate Division, Second Department issued a decision in Agencies for Children’s Therapy Servs., Inc. v. N.Y. St. Dep’t of Health, upholding the regulations promulgated by the...more

1/4/2016 - Administrative Expenses Department of Health Executive Compensation Healthcare Public Health State Funding

Albany County Supreme Court Upholds $199,000 “Hard Cap” on State Funded Executive Compensation, While Striking “Soft Cap” on...

On November 13, 2015, the New York State Supreme Court, Albany County issued a decision in LeadingAge et al. v. Shah, upholding in part and invalidating in part regulations issued by the Department of Health to implement...more

11/30/2015 - Executive Compensation Health Care Providers Healthcare NY Supreme Court State Funding

Budget Legislation Repeals Affordable Care Act’s Automatic Enrollment Requirement for Large Employers

The Bipartisan Budget Act of 2015, Pub. L. No. 114-74, which was signed by President Obama on November 2, 2015, included a little-publicized provision that repealed the Affordable Care Act’s automatic enrollment requirement. ...more

11/6/2015 - Affordable Care Act Automatic Enrollment Bipartisan Agreement Bipartisan Budget DOL Employee Benefits Federal Budget FLSA Health Insurance Healthcare Healthcare Reform Insurance Industry Obama Administration Waiting Periods

Nonprofit Revitalization Act Employed Board Chair Prohibition Delayed to 2017

On October 26, 2015 Governor Cuomo signed into law Chapter 388 of the Laws of New York of 2015 (Assembly Bill A7641/Senate Bill 5738) delaying from January 1, 2016 to January 1, 2017 the effective date of the provision of the...more

10/30/2015 - New Legislation Non-Profits

In Closely Watched Case, Federal Court Upholds the Government’s Position on Provider Mandate to Report and Return Medicare and...

The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed...more

8/7/2015 - Affordable Care Act Civil Monetary Penalty CMS Compliance Department of Health False Claims Act (FCA) Health Care Providers Healthcare Managed Care Contracts Medicaid Medicare Medicare Part D Overpayment Overpayment Recovery Time Limits Reporting Requirements

Federal Appellate Court Ruling Sounds the Liability Alarm for Officers and Directors of Struggling Health Care Providers – Both...

Last month, the United States Court of Appeals for the Third Circuit issued an important, 28-page opinion that confirmed a jury verdict, holding former officers and directors of a not-for-profit health care provider in...more

3/6/2015 - Appeals Breach of Duty Commercial Bankruptcy Corporate Officers Directors Health Care Providers Jury Verdicts Non-Profits Personal Liability

First Amendment And Off-Label Promotion – Prosecute What I Do, Not What I Say

On December 3, 2012, the United States Court of Appeals for the Second Circuit vacated the conviction of Alfred Caronia (“Caronia”), who had been tried and convicted of participating in an unlawful conspiracy to introduce a...more

4/22/2014 - FDA FDCA First Amendment Interstate Commerce Misbranding Off-Label Promotion Prescription Drugs

Nonprofit Revitalization Act Of 2013 -- Best Governance Practices Made Mandatory

On December 18, 2013 Governor Cuomo signed into law the Nonprofit Revitalization Act of 2013 (the “Revitalization Act”), Assembly Bill Number 8072; Chapter 549 of the Laws of 2013. Intended “to reduce unnecessary and...more

1/27/2014 - Charitable Organizations Charitable Trusts Compliance Executive Compensation Non-Profits Reporting Requirements Transparency

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