Norman Tabler, Jr.

Norman Tabler, Jr.

Faegre Baker Daniels

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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

Minn. Sup. Court: Med Staff Bylaws Are a Contract & Staff May Sue

On the last day of 2014 the Minnesota Supreme Court gave a hospital medical staff a double victory, ruling that (1) medical staff bylaws constitute a contract between the hospital and medical staff members and (2) the medical...more

1/8/2015 - Bylaws Contract Formation Hospitals Physicians Standing

Debate Intensifies Over Medicare Advantage Plans’ Removal of Providers

Which is more important in a Medicare Advantage plan: the plan’s flexibility to change its provider list during the plan year, or the enrollees’ right to confidence that their providers won’t be removed from the plan after...more

1/7/2015 - CMS Health Care Providers Healthcare Medicare Medicare Advantage

Annual Penny-Wise, Pound-Foolish Award Winner Announced

When it comes to the annual Penny-Wise, Pound-Foolish Award, don’t ever bet against the United States Congress. This year, Congress lay back in the weeds until the year was almost over before making its move for the trophy. ...more

12/24/2014 - Appropriations Bill Healthcare Medicaid

Hospital For-Profit Conversion Hits Bicoastal Speed Bumps

Over the past decade or so, the conversion of nonprofit hospitals to for-profit status seemed to be an inexorable trend. But in the last couple of weeks the movement has run into speed bumps on both coasts....more

12/23/2014 - Corporate Conversions Hospitals Non-Profits

Hospital Fires Back: Accuses Whistleblowers of Violating Patient Confidentiality

Hospitals have long seethed over employees who exploit their inside information to become whistleblowers. There’s generally not much they can do besides seethe unless the employee has some special duty of confidentiality...more

12/22/2014 - Healthcare Fraud Hospitals Medicaid Patient Confidentiality Breaches PHI Whistleblowers

Hospitals and Health Insurers Prodded on Same-Sex and Transgender Issues

In separate actions yesterday, CMS and the New York State insurance regulatory authority took steps to (a) assure equal treatment of same-sex spouses by hospitals and (b) insurance coverage of medically necessary transgender...more

12/15/2014 - CMS Health Insurance Hospitals Insurers Same-Sex Marriage Transgender

Government Applauds Gainsharing, But It's Still Illegal

It's frustrating enough when the government opposes a good idea and makes it illegal. But "gainsharing" presents an even more frustrating situation for hospitals. Why? Because the government continually signals its agreement...more

12/12/2014 - CMS Gainsharing Hospitals Medicare

AHA Proposes Putting RACs on the Rack

The American Hospital Association formally proposed last week that Recovery Audit Contractors (RACs) be fined when their denials are overturned on appeal....more

12/11/2014 - Administrative Appeals American Hospital Association Hospitals RACs

Supreme Court Rejects Whistleblower’s Double-Dip Attempt

On Monday the United States Supreme Court declined to hear Danny Smart’s appeal of the Fifth Circuit’s rejection of his attempt to share in the proceeds of a $5 million settlement of a False Claims Act suit brought by another...more

12/10/2014 - Christus Health Commercial Leases False Billing False Claims Act Hospitals Physicians Popular SCOTUS Whistleblower Awards Whistleblowers

It’s Risky to Bill Over 24 Hours in a Day

Remember the old joke about the lawyer standing at the pearly gates? He says he’s 52. St. Peter answers, “That’s strange. According to your time records, you’re 89.”...more

12/1/2014 - Criminal Prosecution Healthcare Fraud

GAO Takes Aim at GPOs

The GAO had drawn a bead on GPOs. In a report issued yesterday the Government Accountability Office expressed concern over the effect of GPOs (group purchasing organizations) on Medicare rates. The report recommended that...more

11/26/2014 - GAO GPOs HHS Hospitals Medicare

Growing Safety Risk for Hospitals: Spiraling Medical Device Recalls

Everyone knows that the number of medical device recalls is on the rise. Here are two telling examples of the growth. In 2003 a total of 604 recalls were reported to the FDA, while last August a single manufacturer recalled...more

11/25/2014 - FDA Healthcare Hospitals Medical Devices Product Recalls

Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and...more

11/21/2014 - Ambulatory Surgery Centers Healthcare Healthcare Fraud Hospitals Medicare

CFO’s Thirst for Wine Club Invitation Costs Hospital Millions

You can’t make this stuff up. Last Monday a federal court in Rhode Island ordered two insurance companies to pay a $30 million claim by hospital management company Lifespan Corp. Lifespan filed the claim after being ordered...more

11/20/2014 - CFOs D&O Insurance Fiduciary Duty Hospitals Insurers Interest Rate Swaps Management Companies

Where All the Hospitals Are Above Average

According to the report, 1,224 hospitals are “top performers.” The report was released in Chicago – not Lake Wobegon – but the number of top performers represents about 37% of all hospitals in the sample, which consists of...more

11/18/2014 - Healthcare hosp Ratings

Seventh Circuit: No Fraud in Billing Medicaid More than Private Insurers for Drugs

Last Wednesday the Seventh Circuit affirmed the dismissal of a whistleblower suit brought by a pharmacist against his former employer, the Shopko pharmacy chain, for what he alleged was fraudulent billing of Medicaid by...more

11/17/2014 - Dismissals False Claims Act Fraud Medicaid Pharmacies Retailers Whistleblowers

November Generality-in-Pleading Award

We’re only one-third of the way through the month of November, but we already have a winner of November’s Generality-in-Pleading Award. The hands-down winner is Dr. Warren Troxler, whose False Claims Act whistleblower suit...more

11/12/2014 - False Claims Act Pleadings Whistleblowers

HIPAA Isn’t the Only Standard for Confidentiality

Nobody knows better than hospitals how difficult, complicated and expensive it is to comply with the confidentiality requirements of HIPAA (for Health Insurance Portability & Accountability Act). And hospitals and their...more

11/7/2014 - HIPAA Hospitals Patient Confidentiality Breaches

CME Payments Exposed to Sunshine, But Not Too Much

Sometimes there’s less to life than meets the eye. Take the final rule issued last Friday by CMS on reporting CME (for continuing medical education) payments under the Physician Payments Sunshine Act....more

11/6/2014 - CME CMS Healthcare Healthcare Reform Sunshine Act

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