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Independent Hospitals Innovating, Finding New Partnerships in Response to Market Pressures

Standard & Poor’s (S&P) Rating Services recently warned the health care sector was at “a tipping point where negative forces have started to outweigh many providers’ ability to implement sufficient countermeasures.” S&P noted...more

9/9/2014 - Affordable Care Act Anti-Kickback Statute Competition False Claims Act Health Care Providers Healthcare Hospitals Regulatory Standards S&P

Indian Health Service Recovery Efforts Against Commercial Health Plans

Health plans across the country are increasingly receiving demands for payment from the Indian Health Service (“IHS”), tribal health programs (collectively “Indian Organizations”) and the U.S. Department of the Treasury for...more

8/15/2014 - Healthcare IHS Native American Issues U.S. Treasury

The Reformed Health Care Industry: Creative Structures and Alliances Can Yield Great Benefits, but Also Great Risks

Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more

8/8/2014 - ACOs Affordable Care Act Blue Cross CIGNA Healthcare Healthcare Providers Healthcare Reform Highmark Hospital Mergers Hospitals Humana Joint Operating Agreement Joint Venture United Healthcare Insurance Co. WellPoint

Driving Health Care Efficiencies through Consolidation: Despite Reforms, The Usual Rules Apply

With almost 18 percent of U.S. GDP spent on health care, experts see consolidation as fundamental to reducing costs—by integrating care coordination and delivery, and by increasing scale to drive efficiencies, including with...more

7/18/2014 - Anti-Kickback Statute Antitrust Litigation Antitrust Provisions Healthcare Healthcare Reform Hospitals Stark Law

Two Health Care Organizations Pay Largest HIPAA Fine at $4.8 Million Resulting from Unsecured Shared Network

New York-Presbyterian Hospital and Columbia University entered into a settlement with the Department of Health and Human Services’ Office of Civil Rights (OCR) to resolve allegations that the organizations had violated the...more

5/9/2014 - Covered Entities Data Breach Electronic Medical Records Fines HHS HIPAA Hospitals Non-Judicial Settlement Agreements OCR Patient Confidentiality Breaches Patient Privacy Rights

Halifax Pays $85 Million to Resolve Improper Physician Compensation Arrangement Claims Brought by Employee-Whistleblower

Since January 2009, the DOJ has recovered more than $13.4 billion through False Claims Act cases involving fraud against federal health care programs, and last month, Halifax Hospital Medical Center and Halifax Staffing, Inc....more

4/29/2014 - Corporate Integrity Agreement DOJ Employment Contract False Claims Act Halifax Hospital Healthcare HHS Hiring & Firing Medicare Settlement Stark Law Whistleblower Awards

Third Party Valuation No Silver Bullet in Health Care Deals

Drakeford v. Tuomey and U.S. vs. Bradford Regional Medical Center - With the Affordable Care Act and market forces driving consolidation and creative transactions across the health care industry, health care...more

12/5/2013 - Affordable Care Act Anti-Kickback Statute False Claims Act Healthcare Stark Law Third-Party Relationships Valuation

CMS Announces Proposed Rule Implementing the ACA's MLR Requirements for MA and Prescription Drug Plans

On February 15, the Centers for Medicare & Medicaid Services (CMS) released its Proposed Rule, effective calendar year (CY) 2014, implementing the Medical Loss Ratio (MLR) requirements for Medicare Advantage (MA)...more

2/22/2013 - Affordable Care Act Benefit Plan Sponsors CMS Compliance Health Insurance Marketing Medical Loss Ratio Medicare Medicare Advantage Medicare Part D Prescription Drugs

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