The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020, contains many beneficial provisions for healthcare providers dealing with the operational and business challenges of the COVID-19...more
When misconduct occurs within an organization, it is often reported and interpreted as an anecdote involving a few rogue employees who are quickly identified and appropriately disciplined. Misconduct derives, at least in...more
H.R. 1314, the Bipartisan Budget Act of 2015, was signed into law by President Obama on November 2, 2015. The two-year budget framework, which raises the federal debt limit through March 2017, partially rolls back the Budget...more
The Environmental Protection Agency (EPA) recently issued a pre-publication Proposed Rule (40 C.F.R. part 266, subpart P) regulating the management and disposal of drugs deemed “hazardous waste pharmaceuticals” by healthcare...more
The NLRB, in an August 27, 2015, decision, held that two nurses who were requested to voluntarily appear before a hospital’s Nursing Peer Review Committee were entitled to have their union representatives attend the peer...more
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 Care Providers ,
Health Insurance ,
Healthcare ,
Hospitals ,
Kickbacks ,
Medical Reimbursement ,
Out of Network Provider ,
Patients ,
Third-Party ,
Waivers
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 ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medical Malpractice ,
Non-Compete Agreements ,
Physicians ,
Recruitment Policies ,
Tortious Interference ,
TX Supreme Court
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Hospitals ,
ICD Codes ,
Medicare ,
Outpatient Quality Reporting ,
Patient Prospective Payment System ,
Physician Payments ,
PQRS ,
Value-Based Purchasing
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
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