In this week’s episode, Mary Beth Johnston, Carolyn Merritt and Leah Richardson discuss the ways in which the Centers for Medicare and Medicaid Services’ (CMS) response to the ongoing COVID-19 outbreak is easing certain...more
4/2/2020
/ Accelerated Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Financial Distress ,
Health Care Providers ,
Medicaid ,
Medicare ,
Physicians ,
Secretary of HHS ,
Self-Referral Disclosure Protocol ,
Stark Law ,
Waivers
In 2019, the False Claims Act (“FCA”) remained the federal government’s (“Government”) primary method of civil fraud enforcement. While the more than $3 billion in civil fraud recoveries in Fiscal Year (“FY”) 2019 resulted...more
In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the...more
On June 25, 2018, the Centers for Medicare and Medicaid Services (“CMS”) published a request for information (“RFI”) seeking public input on how to address “undue regulatory impact and burden” of the federal physician...more
We expect 2018 to be another year of rapid change within the health care industry. In this episode, Mary Beth Johnston highlights some of the key topics that the health care practice group will monitor in the coming year,...more
2/28/2018
/ Bundled Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Cybersecurity ,
Data Privacy ,
Drug Pricing ,
Employee Retirement Income Security Act (ERISA) ,
Exclusions ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Fraud and Abuse ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Audits ,
Materiality ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
OCR ,
OIG ,
ONC ,
Opioid ,
Out of Network Provider ,
Overpayment ,
Pharmaceutical Industry ,
Physician Medicare Reimbursements ,
Prescription Drugs ,
Provider Payments ,
Quality Payment Program (QPP) ,
Section 340B ,
Stark Law ,
State Medicaid Programs ,
Telemedicine ,
Underpayment ,
Universal Health Services Inc v United States ex rel Escobar ,
Value-Based Care
Originally published in Haig, Business and Commercial Litigation in Federal Courts, Fourth Edition §§ 87:1 et seq. © 2016 American Bar Association.
This chapter discusses federal court litigation relating to health care...more
12/30/2016
/ Administrative Law Judge (ALJ) ,
Anti-Kickback Statute ,
Breach of Duty ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
Data Protection ,
Department of Health and Human Services (HHS) ,
Employee Retirement Income Security Act (ERISA) ,
EMTALA ,
False Claims Act (FCA) ,
Fiduciary Duty ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicaid ,
Medicare ,
OIG ,
Preemption ,
Price-Fixing ,
Recovery Audit Contractors (RACs) ,
Reimbursements ,
Stark Law
On June 25, 2015, the U.S. Supreme Court ended the latest legal challenge to the Affordable Care Act (“ACA”) with its 6–3 ruling in King v. Burwell. With Chief Justice Roberts writing for the majority, the Supreme Court held...more
9/4/2015
/ Affordable Care Act ,
Cadillac Tax ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
IRS ,
King v Burwell ,
Medicaid ,
Medical Device Tax ,
Medicare ,
Popular ,
Public Health Insurance Marketplace ,
SCOTUS ,
Tax Credits
On June 12, 2015, the U.S. Court of Appeals for the District of Columbia (the “Court”) issued an opinion questioning the Department of Health & Human Services’ (“HHS”) interpretation of congressional intent when it...more
On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed regulations governing policies and payments made under the Physician Fee Schedule (“PFS”) for calendar year 2016 (the “Proposed...more
7/27/2015
/ CDS ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
Opt-Outs ,
Physician Fee Schedule ,
Physicians ,
Stark Law ,
Telemedicine
This week, a federal district court in Florida concluded that a hospital violated Stark as a matter of law by entering into employment agreements with physicians that included bonus compensation that was not based exclusively...more