Kathleen McDermott

Kathleen McDermott

Morgan Lewis

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Senate Finance Committee Examines Repeal of the Stark Law

A new report suggests that the Stark law is obsolete in new payment models. On June 30, the US Senate Committee on Finance (the Committee) released the report Why Stark, Why Now? Suggestions to Improve the Stark Law to...more

7/7/2016 - Affordable Care Act AHLA Alternative Payment Models (APM) Anti-Kickback Statute Civil Monetary Penalty False Claims Act (FCA) Fraud Abuse and Waste Health Care Providers Legislative Agendas Medicare Medicare Access and CHIP Reauthorization (MACRA) Physicians Repeal Stark Law

Senate Finance Committee Updates Report on Physician-Owned Distributorships

The report finds that PODs increase overutilization, lack transparency, and increase the risk of patient harm and warns that hospitals must combat the growing threat of PODs. On May 10, the US Senate Committee on Finance...more

5/11/2016 - Anti-Kickback Statute False Claims Act (FCA) Hospitals Legislative Committees Physician-Owned Distributors

False Claims Act Trial Sets Precedent for Future Cases

The DOJ’s theory of falsity based on clinical disagreement alone fails as a matter of law. In a closely watched False Claims Act (FCA) proceeding by the healthcare industry and FCA practitioners, the US District Court...more

4/1/2016 - Dismissals DOJ False Claims Act (FCA) Hospice Medicare Physicians

Fourth Circuit's Triple Canopy False Claims Act Decision

The decision unexpectedly expands potential liability. On January 8, the U.S. Court of Appeals for the Fourth Circuit issued a panel decision that established a new and potentially significant False Claims Act (FCA)...more

1/21/2015 - Appeals Breach of Contract Defense Sector False Claims Act (FCA) Federal Contractors Implied Certification Qui Tam Scienter Triple Canopy Whistleblowers

OIG Comes Down Hard on Physician-Owned Distributorship Arrangements

Hospitals and physician-owned entities should consider new report’s cost and utilization concerns. On October 24, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released...more

10/25/2013 - Anti-Kickback Statute Healthcare Fraud HHS Medicare OIG Physician-Owned Distributors

HHS Publishes Final Rule on Exchanges, SHOPs, and Eligibility Appeals

Final regulations required for October 1, 2013 open enrollment are largely unchanged from the proposed rule. On August 30, the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human...more

9/11/2013 - Affordable Care Act CMS Employer Mandates Health Insurance Exchanges Healthcare HHS Open Enrollment Shared Responsibility Rule SHOP Program

Transparency Update: U.S. Sunshine Collection Obligations Take Effect

Many organizations continue to face challenges with the technology and integration of some of the more complex interpretations. On August 1, the U.S. Sunshine Act and its data collection obligations took effect....more

8/7/2013 - CMS Data Collection Joint Purchasing Programs Medicaid Medicare Sunshine Act Transparency

CMS Rule Complicates Long-Term Care Facility and Hospice Relationships

Final rule aims to improve the quality and consistency of care between long-term care facilities and hospice providers but may increase conflict between facility and provider staff. ...more

7/1/2013 - CMS Compliance Final Rules Healthcare Hospice Long-Term Care Medicaid Medicare New Legislation

CMS Proposes Rule for Exchanges and SHOPs Under the Affordable Care Act

New marketing integrity and oversight provisions warrant review and comment. On June 14, the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services (HHS) published its...more

6/19/2013 - Affordable Care Act CMS Employer Group Health Plans Federally Facilitated Exchanges Healthcare Qualified Health Plans SHOP Program

Hospitals and Doctors Beware: OIG Issues Special Fraud Alert on Physician-Owned Entities

Alert notes attributes and practices that produce substantial fraud and abuse risk. On March 26, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its "Special Fraud...more

3/28/2013 - Anti-Kickback Statute Fraud HHS Medical Devices OIG Physician-Owned Distributors Physicians Sunshine Act

OIG Recommends Increased CMS Enforcement of SNF Standards

Amid alleged failures of skilled nursing facilities to meet care and discharge planning requirements, OIG identifies substantial payment errors....more

3/22/2013 - Affordable Care Act CMS Compliance Ethics Healthcare Medical Liability Medicare Nursing Homes OIG Overpayment Quality of Care Standards

Final Sunshine Act Arrives: Now the Hard Part

The Centers for Medicare and Medicaid Services (CMS) issued the final regulations on the U.S. Sunshine Act on February 8, 2013. Transparency Reports and Reporting of Physician Ownership or Investment Interests, 78 Fed. Reg....more

3/8/2013 - Affordable Care Act CMS Healthcare Manufacturers Medical Devices Pharmaceutical Industry Physicians Reporting Requirements Sunshine Act

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