The Office of Inspector General (OIG) recently issued a new favorable advisory opinion regarding patient assistance programs (PAP) for 12 specific disease funds. PAPs help patients pay high cost-sharing obligations for...more
On Friday, December 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued an FAQ regarding the Good Faith Estimate (GFE) and Convening Provider/Facility requirements in the Federal No Surprises Act. The issued...more
The Office of Inspector General of the U.S. Department of the Health and Human Services (OIG) recently changed the language describing a compliance officer’s role in relation to other responsibilities he or she may have...more
On July 5, 2022, the Commonwealth of Massachusetts re-extended the implementation and enforcement date for the “Patients First Act”, sometimes referred to as the Massachusetts No Surprises Act, to January 1, 2025. As...more
Many hospital, health systems and other health care providers have seen benefits in sponsoring sports teams, stadiums and athletic tournaments. Considerations include general branding in the community, recruitment of staff or...more
2/10/2022
/ Advertising ,
Compliance ,
Corporate Branding ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Hospitals ,
Marketing ,
Medicare ,
Reporting Requirements ,
Sponsors ,
Sponsorship Agreements
As discussed in detail in a prior post, U.S. Health and Human Services Secretary Alex M. Azar II (the Secretary) issued blanket waivers of sanctions under the federal Physician Self-Referral Law (Section 1877 of the Act),...more
Massachusetts Governor Charlie Baker has restarted the discussion on health care cost containment in the Commonwealth with a proposed bill that contains a raft of initiatives. This is the first in a series of blog posts to...more
12/12/2019
/ Blue Cross ,
Blue Shield ,
Centers for Medicare & Medicaid Services (CMS) ,
Employer Group Health Plans ,
False Claims Act (FCA) ,
Fees ,
Governor Baker ,
Health Care Providers ,
Health Insurance ,
Healthcare Facilities ,
HMOs ,
Hospitals ,
Insurance Industry ,
Medicare ,
PPOs ,
Proposed Legislation ,
Site-Neutral Exception
The U.S. healthcare industry remains at a crossroads. The healthcare reform legislation passed under President Barack Obama in 2010, officially called the Patient Protection and Affordable Care Act (ACA) but widely referred...more
10/11/2019
/ Accreditation ,
Affordable Care Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Certificate of Need ,
Civil Monetary Penalty ,
Co-Management ,
Corporate Practice of Medicine ,
Department of Health and Human Services (HHS) ,
Electronic Protected Health Information (ePHI) ,
False Claims Act (FCA) ,
HCQIA ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Facilities ,
Healthcare Reform ,
HMOs ,
Hospitals ,
HSA ,
Individual Mandate ,
Medicaid ,
Medical Certification Requests ,
Medical License ,
Medicare ,
Medicare Shared Savings Program ,
Nurses ,
Obama Administration ,
OIG ,
Outpatient Prospective Payment System (OPPS) ,
Physician-Owned Hospitals ,
Preexisting Conditions ,
Stark Law ,
Trump Administration ,
Value-Based Care
This is an uncomfortable summer for health care providers in Florida! The legal landscape changed dramatically over the 4th of July holiday. Buried in Florida’s HB 369 regarding substance abuse services was a dramatic...more
Hospitals with off-campus provider-based departments (PBDs) may want to rethink their end of summer vacation plans in order to focus on a recent slate of proposed regulations from the Center for Medicare and Medicaid Services...more
On June 19 and 20, 2018, more than 60 innovators and thought leaders came together for the 13th annual, invitation-only CEO/Innovators Roundtable (Roundtable), hosted by Foley & Lardner LLP and BDC Advisors, LLC. The overall...more
6/28/2018
/ Artificial Intelligence ,
Big Data ,
CEOs ,
Digital Health ,
Health Care Providers ,
Health Information Technologies ,
Healthcare ,
Innovative Technology ,
Investors ,
Patient Referrals ,
Patients ,
Pharmacies ,
Roundtable ,
Telemedicine
On March 30, 2018, Massachusetts Governor Charlie Baker signed into law a bill intended to provide individuals with more privacy protection from their health insurance companies.
The “Protecting Access to Confidential...more
CMS issued its Outpatient Prospective Payment System (“OPPS”) Proposed Rule for 2017 (the “Proposed Rule”) on July 6, 2016. The Proposed Rule will be published in the Federal Register on July 14, 2016. One highly-anticipated...more
7/13/2016
/ Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Grandfathered Status ,
Health Care Providers ,
Hospitals ,
Medicare ,
MPFS ,
Off-Campus Departments ,
OPPS ,
Proposed Legislation ,
Proposed Regulation ,
Section 340B
Legislation being drafted as part of a budget deal between members of Congress and the White House includes language that will significantly alter the future of hospital-based outpatient care. The “discussion draft” of the...more
10/30/2015
/ Ambulatory Surgery Centers ,
Federal Budget ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicare ,
MedPAC ,
OIG ,
OPPS ,
Pending Legislation ,
Physician Fee Schedule ,
Reimbursements
This past June, leaders from health systems, outpatient services companies, health insurers, IT and equipment suppliers, health retailers, home care providers, pharmaceutical companies, and investors gathered in Chicago for...more
10/1/2015
/ CEOs ,
Complete Genomics ,
Cost-Sharing ,
Ethics ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Reform ,
Personal Data ,
Personalized Medicine ,
PricewaterhouseCoopers ,
Public Health Insurance Marketplace ,
Purchase Price ,
Retail Market ,
Social Media ,
Telehealth ,
Thought Leadership ,
Value-Based Purchasing ,
Venture Capital ,
Walgreens ,
Wellness Programs
A New York Federal District Court issued an Opinion and Order, on August 3, 2015, in a closely-watched False Claims Act (FCA) case, Kane v. Healthfirst, Inc. The Court refused to dismiss the whistleblower complaint in which...more
In this video, Foley Partner Lawrence Vernaglia discusses the biggest obstacle to realizing a value-based system of health care, and what realistically can be done in the industry by taking "measured steps."...more