Robert Wolin

Robert Wolin

BakerHostetler

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Clash of the Circuits: Federal Exchange Subsidies at Risk?

These four words “established by the state,” at first blush do not appear obtuse or particularly vague. But these four words form the basis for the latest challenges to the Affordable Care Act (ACA) and have resulted in two...more

7/25/2014 - Affordable Care Act Halbig v Burwell Health Insurance Exchanges Healthcare IRS King v Burwell Subsidies Tax Credits

Changing Financial Landscape for Medical Debts of the Uninsured

The implementation of the ACA has afforded many with the opportunity to obtain insurance coverage. Despite the opportunity, a large number of individuals have either chosen not to enroll in a health plan or have been unable...more

6/17/2014 - Affordable Care Act Health Insurance Exchanges Healthcare HFMA Medical Expenses

Federally Qualified Health Centers: Welcome to PPS

CMS recently finalized a new PPS for Federally Qualified Health Center (FQHC) services. The implementation of the PPS was mandated by the ACA. Medicare currently pays FQHCs an all-inclusive rate for the professional...more

5/19/2014 - CMS FQHC Healthcare Medicare Advantage Patient Prospective Payment System

IPPS Proposed Rule: Read Once, Then Take an Aspirin

The Centers for Medicare and Medicaid Services (CMS) has set its sights on the quality of care during hospital inpatient stays and much, much more. On May 15, 2014, CMS published a proposed rule that would update Medicare...more

5/16/2014 - CMS Healthcare Healthcare Reform Hospitals Inpatient Billing IPPS Long-Term Care Medicare

So Much for Stop, Drop and Roll: CMS Proposes New Fire Safety Update

CMS has announced a proposed rule updating Medicare/Medicaid fire safety standards. In particular, CMS proposes to adopt the National Fire Protection Association’s (NFPA) 2012 edition of the Life Safety Code (LSC) and the...more

5/8/2014 - CMS Medicaid Medicare Safety Precautions

Do You Know What Your Hospital Board Members Are Doing?

David Chandler was appointed to serve as chairman of Tri-Lakes Medical Center (TLMC), a community hospital in Panola County, Mississippi. As chairman, Chandler set board meeting agendas, regularly dealt with the administrator...more

4/7/2014 - Anti-Kickback Statute Board of Directors Compliance Fraud Healthcare Hospitals Kickbacks Personal Liability

CMS’s Civil Defense Won’t Let You Hide Under Your Desk

The Centers for Medicare and Medicaid Services (CMS) have proposed new emergency preparedness requirements for healthcare providers and suppliers. These new requirements are designed to address the effect of a broad range of...more

3/21/2014 - CMS Disaster Preparedness Healthcare Natural Disasters

Never Fear Regulatory Violations – Focus on Conditions to Payment

The U.S. Court of Appeals for the Fourth Circuit recently upheld the dismissal of a False Claims Act (FCA) suit against Omnicare, Inc., in which the relator alleged that certain drugs repackaged by Omnicare’s subsidiary were...more

3/11/2014 - False Claims Act FDA Healthcare Medicaid Medical Reimbursement Medicare Pharmaceutical Prescription Drugs

Tell Me About Your Family. On Second Thought, Don’t Tell Me

Founders Pavilion, Inc., a skilled nursing facility, sent prospective employees for preemployment physicals. As part of the physicals, an independent physician requested the prospective employee’s family medical history as...more

1/30/2014 - EEOC Genetic Discrimination GINA

Tell Me About Your Family. On Second Thought, Don't Tell Me

Founders Pavilion, Inc., a skilled nursing facility, sent prospective employees for preemployment physicals. As part of the physicals, an independent physician requested the prospective employee's family medical history as...more

1/28/2014 - EEOC Genetic Discrimination GINA

CMS – Doc, if You Want a Free Book Go to the Library

The Centers for Medicare and Medicaid Services (CMS) recently denied a request from a bipartisan group of 23 members of congress to exempt the distribution of textbooks and scientific peer-reviewed medical journal materials...more

1/24/2014 - CMS Medicare Physician Medicare Reimbursements Reporting Requirements Textbooks

CMS Outpatient and Physician Payment Rules: Don't Miss the Efficient Quality of Care Reform Forest for the Dollar Trees

The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more

12/13/2013 - ACOs Ambulatory Surgery Centers CMS Healthcare Hospitals ICD Codes Medicare Outpatient Quality Reporting Patient Prospective Payment System Physician Payments PQRS Value-Based Purchasing

OIG Advisory Opinion 13-15 - Anesthesiologists: Chickens or Eggs?

It is often said that advisory opinions are requested from the U.S. Office of Inspector General (OIG) when one wants a very safe deal blessed or when one wants to dissuade a competitor or counter-party from entering into or...more

11/20/2013 - Healthcare Healthcare Professionals OIG Physicians

Collateral Damage: Medicaid Inspector General Says You're Fired!

The New York Court of Appeals recently ruled that the Office of the Medicaid Inspector General (OMIG) has discretion to exclude a physician from New York's medical assistance program (Medicaid) based solely on a consent order...more

11/6/2013 - Inspector General Medicaid Physicians Termination

Doctors Corralled for Kickbacks

The U.S. Department of Health and Human Services Office of Inspector General's (OIG) chief counsel indicated in 2007 that the government's fraud enforcement focus on large organizations was an "ineffective strategy" and that...more

11/5/2013 - Enforcement Actions Fraud Healthcare Fraud HHS Kickbacks OIG Pharmaceutical Physicians

Telemarketing: HIPAA Can Reverse the Charges Under the TCPA

The Telephone Consumer Protection Act (TCPA) generally limits automatically dialed and prerecorded telemarketing calls to wireless and residential phones. In the past, healthcare providers and other "advertisers" could rely...more

10/23/2013 - Exemptions FCC HIPAA Robocalling Spam TCPA Telemarketing Written Consent

Computer Crime Insurance Coverage: Can It Cover Fraudulent Entries Submitted by an Authorized User?

In a recent decision, New York's appellate court considered whether a "Computer Systems Fraud" insurance policy rider (Policy) covered losses that Universal American suffered as a result of fraudulent claims electronically...more

10/21/2013 - Crime Insurance Policies Fraud

CMS's Two-Dog Night - Doctor Told Me Not to Stay as an Inpatient for Less Than Two Nights

The Centers for Medicare and Medicaid Services (CMS) recently issued controversial new criteria for hospitals to use to determine whether a patient's stay in a hospital should be treated as an outpatient observation stay or...more

10/10/2013 - CMS Healthcare Hospitals Patient Prospective Payment System

Two for Me; Many Times More for the Government in the Largest Whistleblower Award Against a Community Hospital

A U.S. district judge in South Carolina approved the government's request for a civil penalty award and ordered Tuomey Healthcare System, Inc. (Tuomey) to pay more than $237 million in damages and fines in a whistleblower...more

10/7/2013 - FCA Healthcare Professionals Hospitals Medical Liability Stark Law Whistleblowers

Doc Wishes He Showed Up at the Office — But . . .

Imagimed LLC, an MRI Center, its owners and chief radiologist, agreed to pay the government $3.57 million to settle false claims allegations for MRI services. The government alleged that Imagimed billed for MRI scans...more

9/26/2013 - Anti-Kickback Statute Billing Healthcare Professionals Physicians Settlement Stark Law Supervision

Pay to Play Quickly — CMS's New Slow Motion Surveys for Acquirers Rejecting Assumption of Medicare Agreements

The Center for Medicare and Medicaid Services (CMS) recently issued a policy memorandum to state survey agency (SSA) directors regarding the effect of rejecting a Medicare agreement in connection with the acquisition of a...more

9/23/2013 - Affordable Care Act CMS Healthcare Reform Medicare Pay or Play

Physicians Are My Friends; Surely I Can Get Paid to Talk to Them!

On April 26, 2013, the U. S. Department of Justice (DOJ) intervened in a whistleblower case alleging Novartis Pharmaceuticals Corporation (Novartis) knowingly and willfully violated the federal FCA by inducing physicians to...more

6/19/2013 - Corporate Integrity Agreement DOJ False Claims Act Kickbacks Novartis Prescription Drugs Whistleblowers

Physician Medicare Data: Has the Drought Ended?

After 34 years, a federal district court in Florida has overturned a 1979 injunction which prevented the Centers for Medicare and Medicaid Services (CMS) from releasing to the public Medicare data related to physician billing...more

6/18/2013 - CMS Disclosure FOIA Medicare Physician Payments Physicians Privacy Laws

Bringing Sunlight to Healthcare Pricing: The CMS Release of Hospital Charge Data

Former U.S. Supreme Court Justice Louis D. Brandeis once said that "Sunlight is the best disinfectant." The release of charges billed by some 3,337 Medicare hospitals for 100 of the most common inpatient diagnosis related...more

5/17/2013 - Affordable Care Act CMS Healthcare Hospitals Medicare Payment Plans

Novel “Bad Faith Admission” EMTALA Theory Survives Motion to Dismiss

The U.S. District Court for the Northern District of California recently denied Contra Costa Regional Medical Center’s (CCRMC) motion to dismiss regarding an alleged violation of the Emergency Medical Treatment and Labor Act...more

5/3/2013 - EMTALA Liability Motion to Dismiss

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