Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program got good news from The Centers for Medicare and Medicaid Services (CMS) related to widespread fraud involving urinary catheters that...more
On 8 June 2023, in Health and Hospital Corporation of Marion County v. Talevski, the United States Supreme Court ruled that the rights set out in the Federal Nursing Home Reform Act (FNHRA) can be enforced under 42 U.S.C. §...more
The 1 May 2023 Federal Register contains a proposal from the Centers for Medicare & Medicaid Services (CMS) to revise the scoring methodology under the Hospital Value-Based Purchasing Program (Hospital VBP Program) as part of...more
Cybersecurity is not simply a technical issue of interest only to information technology departments. Cybersecurity issues create risk throughout health care entities and must be managed as a core business risk; at a minimum,...more
As we emerge from the COVID health emergency, there is widespread agreement that Americans are suffering from inadequate access to mental health care. To shore up community mental health systems, on 23 March 2023, the...more
BACKGROUND - As we noted in prior health care alerts in 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) significantly overhauled the federal law that governs the confidentiality of substance use...more
For the year ending August 2020, provisional data from the Centers for Disease Control and Prevention shows that opioid overdose deaths increased 26.8 percent compared to the previous 12 months, with opioid overdoses...more
On this week’s episode, Carla DewBerry and Sarah Carlins discuss a recent California Federal District Court decision in David Wit v. United Behavioral Health, in which the court found that the defendant insurer violated ERISA...more
12/11/2020
/ Denial of Insurance Coverage ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Health Claims ,
Health Insurance ,
Health Plan Sponsors ,
Insurance Claims ,
Insurance Industry ,
Insurance Litigation ,
Mental Health ,
Plan Administrators ,
Scope of Coverage ,
Standard of Care ,
Substance Abuse
In this week’s episode, Carla DewBerry and Kelsey Jernigan discuss issues in mental health parity in the context of recent California legislation. In particular, the presenters discuss how a new California bill has sparked a...more
9/29/2020
/ Affordable Care Act ,
Denial of Insurance Coverage ,
Essential Health Benefits ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
Medical Necessity ,
Mental Health ,
Mental Health Parity Rule ,
Pending Legislation ,
Substance Abuse
In this week’s episode, Carla DewBerry is joined by with Carlos Olivares, Executive Director of the Yakima Valley Farm Workers Clinic, a community based health center in the Pacific Northwest serving low-income, migrant and...more
In this week’s episode, Carla Dewberry, Sarah Carlins, and Cheryl Choice discuss the ways in which the COVID-19 emergency has changed the landscape of behavioral health in the United States. The presenters address the ways in...more
On 11 May 2020, the Centers for Medicare & Medicaid Services (CMS) issued in pre-publication form the proposed rule for the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care...more
In this week’s episode, Limo Cherian, Carla Dewberry and Steven Pine discuss recent changes to value-based health care payment arrangements triggered by the current COVID-19 emergency. In particular, the presenters discuss...more
The Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”), [1] signed into law March 27, 2020, significantly overhauls the federal law that governs the confidentiality of substance use disorder (“SUD”) records at...more
On March 6, 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act (the “Act”) which allows physicians and other health care professionals to bill Medicare for patients covered under...more
On March 13, 2020, the American Medical Association (“AMA”) adopted Current Procedural Terminology (“CPT”) code 87635 to be used nationwide to report laboratory testing for the 2019 novel coronavirus. ...more
In this week's episode, Limo Cherian, Carla Dewberry, and Steve Pine discuss EKRA - the 'Eliminating Kickbacks in Recovery Act of 2018,' which introduces new criminal penalties for kickbacks associated with referrals to...more
In this episode, Michael McKay and Carla DewBerry discuss the practical implications of responding to an investigative inquiry by governmental officials. In particular, entities that find themselves as the subject of a...more
2/15/2019
/ Attorney-Client Privilege ,
Confidential Information ,
Corporate Counsel ,
Employee Rights ,
Employee Training ,
Employer Liability Issues ,
Employment Policies ,
Government Investigations ,
Government Officials ,
Interviews ,
Law Enforcement ,
Request For Information ,
Search Warrant ,
Subpoenas
On October 24, 2018, President Trump signed into law comprehensive opioid legislation known as the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” or the...more
Department of Labor Issues Final Rule that Expands Association Health Plans -
On June 21, 2018, the Employee Benefits Security Administration, Department of Labor (“DOL”) issued a final rule that establishes additional...more
This is the first episode in a series focused on the legal issues surrounding the nationwide opioid crisis. To begin the series, Carla DewBerry discusses the laws and regulations impacting health care providers caring for...more
2/28/2018
/ Attorney General ,
Centers for Disease Control and Prevention (CDC) ,
Controlled Substances ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Health Care Providers ,
Healthcare Fraud ,
Kickbacks ,
Medical Monitoring ,
Opioid ,
OxyContin ,
Pain Management ,
Pharmaceutical Distribution ,
Pharmaceutical Industry ,
Prescription Drugs ,
SAMHSA ,
Substance Abuse
Last week, the National Labor Relations Board reversed long-standing precedent and ruled that a company may be a joint employer of another company’s workers if it has the right to control those workers, even if that right is...more
9/4/2015
/ Browning-Ferris Industries of California Inc. ,
Collective Bargaining ,
Franchisee ,
Franchisors ,
Independent Contractors ,
Joint Employers ,
NLRA ,
NLRB ,
Staffing Agencies ,
Subcontractors ,
Unions
On February 10, 2015, the United States Court of Appeals for the Ninth Circuit (which covers Idaho, Montana, Oregon, Washington, California, Nevada, Alaska, Hawaii and Arizona) ordered St. Luke’s Health System, Ltd. (“St....more
On December 23, 2013, the Washington State Department of Health (the “Department”) adopted two regulatory changes that impact hospitals. As discussed below, one change impacts Certificate of Need (CoN) review when there is a...more
As the healthcare community readies itself for patients securing health coverage through the exchanges, various techniques are being considered to encourage and facilitate patient enrollment in a health plan. One question...more