Norman Tabler, Jr.

Norman Tabler, Jr.

Faegre Baker Daniels

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Attention Seniors! Check Into a Hospital and Get $100!

OIG Advisory Opinion 15-03 approves a Medigap insurer’s program that, among other things, calls for (a) network hospitals to waive the deductible for Medicare enrollees, (b) the insurer to pay the hospital network a fee each...more

3/4/2015 - Health Insurance Healthcare Hospitals Medicare Medigap OIG

Florida Hospitals Face Glenn Close-Like Threat

Remember the evil Glenn Close character in Fatal Attraction? We were sure Michael Douglas had drowned her in the bathtub, but she popped up again, still alive and scary as all get-out. Class actions by uninsured...more

3/3/2015 - Breach of Contract Class Action Hospitals Unfair or Deceptive Trade Practices

Peer Review Concludes with Termination of Reviewer

You read that correctly: the hospital fired the physician who did the reviewing in a medical staff peer review proceeding. Hospital executives present at the proceeding felt the reviewing physician was too harsh in...more

2/27/2015 - Confidentiality Hiring & Firing Hospitals NM Supreme Court Peer Review Physicians Private Right of Action Termination

These Doctors Work Hard – Over 24 Hours a Day

Sir Arthur Conan Doyle might have called it “The Case of the Doctors Who Work More than 24 Hours a Day.” Unfortunately for the physician group in question, Sir Arthur wasn’t the author; the federal court for the Northern...more

2/26/2015 - False Claims Act Health Care Providers Healthcare Hospitals Physician Medicare Reimbursements Physicians

Black Tuesday Falls on a Friday for Nation’s Nursing Homes

If you think of CMS quality ratings as the Dow Jones index, then last Friday, February 20, was the equivalent of Black Tuesday, October 29, 1929, the day the stock market collapsed. Why? ...more

2/24/2015 - CMS Healthcare Nursing Homes Rating System

Can an Arbitrator Rule Against a Hospital for Not Violating the Anti-Kickback Statute?

Here’s a nightmare. An arbitrator rules against your hospital for failing to honor an agreement to refer Medicare patients to a home health agency. Why? Because the home health agency paid your hospital good money for the...more

2/17/2015 - Anti-Kickback Statute Arbitration Arbitrators Healthcare Home Health Agencies Hospitals Medicare Patient Referrals Petition for Writ of Certiorari SCOTUS

A Risk Manager with a Law Degree Is Still a Risk Manager

In the health care industry the line between attorneys and risk managers is often blurred. That’s only natural because a key duty of risk management is to avoid and mitigate legal liability. And it’s increasingly common for...more

2/17/2015 - Employer Liability Issues Health Care Providers Risk Management Sex Discrimination

Seventh Circuit Adopts Broad Definition of Anti-Kickback “Referral”

The federal Anti-Kickback Statute makes it a crime to give or receive anything of value in return for “referral” of a Medicare patient. But exactly what is a “referral”? That’s the issue decided by the Seventh Circuit last...more

2/13/2015 - Anti-Kickback Statute Healthcare Home Health Care Medicare Patient Referrals

Cayman Insurance Law Amendments Enhance Captive Flexibility

On January 16, 2015, the Cayman Islands published new insurance regulations affecting portfolio insurance companies (PICs). The regulations are designed to provide more flexibility to insurance companies incorporated as...more

2/12/2015 - Cayman Islands Insurance Industry Portfolio Insurance Companies

This Just in: OIG Rules Free Diapers Are Not an Illegal Kickback

The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services. In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider...more

2/12/2015 - Children's Products Healthcare Healthcare Providers HHS Kickbacks Medicaid OIG

Rip Van Winkle Fails in Effort to Enjoin Peer Review Process

Okay, it wasn’t really Rip Van Winkle. Rip slept for only twenty years. It was Dr. Legrand Belnap who sued a Salt Lake City hospital and its medical executive committee members. ...more

2/9/2015 - Healthcare Hospitals Peer Review Physicians

No False Claim Despite Violation of Licensing Law and Medicare Conditions of Participation

Last week a federal court in Florida granted a radiology practice’s motion for judgment in its favor in a False Claims Act case, despite these formidable obstacles: (1) the practice had billed Medicare for services performed...more

2/5/2015 - False Claims Act Health Care Providers Healthcare Licensing Rules Medicare Summary Judgment

Ministry Motivation Costs Hospital $59 Million

Sometimes doing the right thing for the right reason can be costly. Last week it cost nonprofit Via Christi Regional Medical Center $59 million....more

2/5/2015 - Hospital Mergers Hospitals Non-Profits Provider Reimbursement Review Board

Court Rejects AG-Approved Partners HealthCare Acquisitions

It took three years for Massachusetts hospital giant Partners HealthCare System to negotiate the state attorney general’s approval of its plan to acquire three more hospitals to add to its current 12. But last Thursday a...more

2/3/2015 - Antitrust Provisions Consent Decrees Hospital Mergers Hospitals

Does Med Mal Statute of Limitations Apply to Indemnification Claims?

Last week the South Carolina Supreme Court issued an opinion addressing the issue whether an indemnification claim is subject to that state’s medical malpractice statute of limitations, when the claim is for recovery of a...more

2/2/2015 - Indemnification Medical Malpractice Settlement Statute of Limitations

It Was the Economy, Stupid!

Remember Bill Clinton’s 1992 campaign mantra, “It’s the economy, stupid!” A study released today by the Robert Wood Johnson Foundation indicates those four words are the best answer to the question, “Why are so many...more

1/31/2015 - Economic Downturn Employer Group Health Plans Health Insurance

QNHII Regs Due Thursday—After Only Five Years

When the Affordable Care Act (ACA) was signed into law back in 2010, it directed the Centers for Medicare & Medicaid Services (CMS) to establish the Consumer Operated & Oriented Program (CO-OP). The point of the CO-OP is to...more

1/29/2015 - Affordable Care Act CMS Health Insurance Healthcare Non-Profits QNHII

CMS Announces Goals and Timeline for Shift to Value-Based Medicare Payments

On January 26, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a news release reporting Health & Human Services (HHS) Secretary Sylvia Burwell’s announcement earlier in the day of measurable goals and a...more

1/28/2015 - CMS HHS Medicare Provider Payments Quality of Care Standards

Want to Be Part of the State? Depends on Why You Ask

Some questions can’t be answered in a vacuum. That’s the situation when the question is whether an entity wants to be part of the state or separate from it. If the specific issue is whether its board meetings are open to...more

1/28/2015 - False Claims Act Medicaid Medical School Qui Tam University of Massachussets

NIH Announces New One-Grant-at-a-Time Policy

In a move designed to stretch budget dollars and spread the research wealth, the National Institute of General Medical Sciences (NIGMS) announced last week that starting next year, it will impose a one-grant-at-a-time policy...more

1/21/2015 - Grants Healthcare Medical Research NIH Research Funding

CMS Announces 20 Repairs to RAC Program

Ever face the choice between trading in your old car or paying for multiple repairs? CMS faced that kind of choice with its Recovery Audit Contractor (RAC) program. Under the RAC program, contract auditors audit hospitals...more

1/16/2015 - CMS Health Care Providers Hospitals RAC Audits RACs

When Is a Pharmacist Not a Pharmacist?

On January 14 the Texas Supreme Court will hear argument in an appeal that asks the question, When is a pharmacist not a pharmacist? The appeal is from a Texas Court of Appeals decision that answered the question this way: ...more

1/14/2015 - Bulk Purchasing Pharmacies Pharmacist Physicians Popular Prescription Drugs

New IRS Ruling Benefits Investor-Owned Hospitals

Last month, the Internal Revenue Service (IRS) issued a private letter ruling providing a tax benefit to hospitals that own physician practices. The ruling should be of particular interest to hospitals with physician...more

1/13/2015 - Affiliates Hospitals IRS Parent Corporation Physicians Private Letter Rulings Professional Corporation Shareholders

Physician Plaintiff Bound by Arbitration Clause in Nonparty’s Contract

Today’s riddle: A physician sues defendants for defamation. The defendants move to compel the arbitration clause of a contract the physician used to have with a nonparty. The defendants win the argument. What’s the...more

1/12/2015 - Arbitration Defamation Mandatory Arbitration Clauses Non-Parties Physicians United Healthcare Insurance Co.

Pain Clinic Sues CMS Over $25 Million Repayment Demand

Alabama Pain Center thought it knew all about pain, but nothing had prepared it for the bill it received when CMS decided to retroactively “reprice” certain compounded drugs: $25 million....more

1/9/2015 - CMS Drug Compounding Healthcare Healthcare Facilities

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