A panel of top investors comprised of Nancy Brown, Managing Director at Oak HC/FT, Dan Gebremehdin, Managing Director at Flare Capital, and Laura Veroneau, Managing Director at Optum Ventures, convened in a webcast on January...more
Starting January 1, 2023, Medicare will expand and increase coverage of certain services and providers to advance access to prevention and treatment services for substance use disorders (SUD) and mental health services. These...more
In the 12-month period starting in April 2021, over 100,000 people have died from drug overdoses, a 28.5% increase from the same period the year before. While the opioid crisis has been a declared public health emergency...more
Payment misalignment in Medicare FFS for Substance Use Disorder (SUD) treatment as the subject of potential legislative and/or regulatory reforms -
New opportunities for investor-backed behavioral health platforms in...more
3/3/2021
/ Biden Administration ,
Coronavirus/COVID-19 ,
Drug Treatment ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part D ,
Mental Health Parity Rule ,
Opioid ,
Substance Abuse
Between various blanket Section 1135 waivers and state specific waivers issued by CMS, provisions of the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) and numerous state, local and accreditation body...more
The United States Court of Appeals for the Third Circuit ruled last week that whistleblower relators need not show “objective falsity” to prove their claims, and that a dispute among physician experts about a clinical...more
3/12/2020
/ False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Insurance Fraud ,
Life Sciences ,
Medicare ,
Objective Falsity ,
Physicians ,
Professional Liability ,
Qui Tam ,
Relators ,
Scienter ,
Triable Issue of Fact ,
Whistleblowers
All hospice providers routinely should assess risk exposure under the False Claims Act — now with the benefit of the U.S. Court of Appeals for the Eleventh Circuit’s long-awaited decision in United States v. AseraCare Inc. ...more
2/4/2020
/ Appeals ,
Evidence ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospice ,
Jury Verdicts ,
Medical Experts ,
Medical Records ,
Medicare ,
Objective Falsity ,
Physicians ,
Summary Judgment ,
Terminal Illness Treatments ,
Trial Court Orders ,
Vacated
Welcome to Foley & Lardner LLP’s Health Care MarketTrends. In this issue, we examine private equity investment in specialty areas of the health care industry, specifically dermatology and orthopedics....more
9/17/2019
/ Anti-Kickback Statute ,
Audits ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Coding ,
Health Care Providers ,
Hospitals ,
Investors ,
Medicaid ,
Medicare ,
Private Equity ,
Private Equity Firms ,
Specialty Healthcare ,
Stark Law
Providers and suppliers who have been assessed overpayments for Medicare services are entitled, by statute, to a stay of recoupment while the provider or supplier’s appeal is pending – but only at the first two levels of...more
7/19/2018
/ Administrative Appeals ,
Administrative Law Judge (ALJ) ,
Centers for Medicare & Medicaid Services (CMS) ,
Due Process ,
Health Care Providers ,
Medicare ,
Medicare Provider Agreements ,
Overpayment ,
Physician Medicare Reimbursements ,
Recoupment ,
ZPIC
Whether in an auction or proprietary transaction, risk allocation has typically been a function of indemnities tied to reps and warranties and the type of credit supporting the type of supporting credit. Holdbacks, earnouts,...more
7/16/2015
/ Asset Deals ,
Auction ,
Buyers ,
Exit Strategies ,
Health Care Providers ,
Healthcare ,
Indemnification ,
Medicaid ,
Medicare ,
Private Equity ,
Recoupment ,
Risk Allocation ,
Risk Management ,
Sellers ,
Stark Law ,
Underwriting ,
Warranty Insurance
Much has been written about hospital consolidation premised upon the search for efficiencies driven by scale and integration as reflected in the white hot hospital merger market over the last several years. While no doubt...more