Robert Wolin

Robert Wolin

BakerHostetler

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Waivers of Co-Pays and Deductibles: Insurance Benefit Exclusions Grow

Recent changes to policy and plan language and increased litigation by third-party payers suggests that out-of-network providers who waive co-pays and deductibles may be in for some rough sailing. Providers must be aware of...more

8/19/2015 - Co-payments Health Insurance Healthcare Healthcare Providers Hospitals Kickbacks Medical Reimbursement Out of Network Provider Patients Third-Party Waivers

The Deeper Dive in Texas: Recent Appellate Court Decisions Affecting Providers

For this edition of the Deeper Dive, we travel to Texas for a look at some interesting cases involving healthcare providers decided on appeal in 2015. Some of these decisions may be surprising – and perhaps even troubling –...more

8/4/2015 - Anti-Competitive Breach of Duty Fiduciary Duty Fraud Healthcare Healthcare Professionals Healthcare Providers Hospitals Medical Liability Non-Compete Agreements Physicians Recruitment Policies Tortious Interference TX Supreme Court

Texas Medicaid Managed Care: Expedited Credentialing Requirement Added Along With Additional Oversight and Accountability

The Texas Legislature in Senate Bill 760 removed barriers to Medicaid recipients receiving healthcare services and required improved access for services through managed care plans. Expedited Provider Credentialing - The...more

7/13/2015 - Compliance Credentialing Healthcare Healthcare Providers Managed Care Contracts MCOs Medicaid

The Medical-School-to-Prison Pipeline Continues to Widen

Physicians now appear to be more than ever at a greater risk of investigation for healthcare crimes, largely due to their “gatekeeping” function concerning a patient’s need for medical services and the government’s increased...more

4/28/2015 - Criminal Prosecution Healthcare Physicians

Volunteer Directors and Officers Liable to Facility Creditors

The Third Circuit Court of Appeals recently upheld a trial court’s jury verdict finding the individual board members and officers of a non-profit healthcare facility personally liable to the facility’s creditors. The board...more

3/31/2015 - Board of Directors Breach of Duty Corporate Officers Healthcare Healthcare Facilities Insolvency Non-Profits Personal Liability Volunteers

“PhysTexting” Is Not Enough to Form a Patient-Physician Relationship

The Texas Medical Board is proposing to modify its disciplinary rules to more specifically define the requisites for a physician-patient relationship required for prescribing. Under the proposed revision to 22 T.A.C. § 190.8,...more

2/19/2015 - Electronic Prescribing Healthcare Physicians Text Messages

Who Decides When Medicaid Payment Rates Are Not Enough?

In 2005, the Florida Pediatric Society, the Florida Association of Pediatric Dentists, and a number of parents and guardians on behalf of their individual children in the Medicaid program brought suit against the state of...more

1/19/2015 - Affordable Care Act Healthcare Medicaid Medical Reimbursement

Dot-com: A Health Professional's Website Is Not Just Another Website

Many physicians and other health professionals maintain a robust Internet presence, including websites and portals to provide patients with information. However, I was recently reminded of how easy it is to overlook the...more

9/23/2014 - Healthcare Healthcare Professionals Physicians Websites

Blog Exclusive: Government Sues Hospital for Birthing Mama’s Babies

The Clinica de la Mama case could well serve as an instruction manual of what not to do to stay out of the government’s crosshairs. In this case, several hospitals entered into contracts for Clinica de la Mama to provide...more

8/26/2014 - Anti-Kickback Statute Federal Contractors Healthcare Hospitals

Government Sues Hospital for Birthing Mama’s Babies

The Clinica de la Mama case could well serve as an instruction manual of what not to do to stay out of the government’s crosshairs. In this case, several hospitals entered into contracts for Clinica de la Mama to provide...more

8/19/2014 - Healthcare Healthcare Fraud Hospitals Medicare

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 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

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

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

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

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

Health Law Update — January 10, 2013

In This Issue: - Healthcare Provisions in the American Taxpayer Relief Act - the Good, the Bad and the Ugly - American Taxpayer Relief Act Amends Overpayment Recovery Time Limits - OIG Advisory Opinion Sheds...more

1/14/2013 - American Taxpayer Relief Act CMS Data Breach Electronic Medical Records Fraud Healthcare OCR OIG Overpayment Recovery Time Limits Pay-for-Performance Reporting Requirements Settlement

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