In drafting recruitment agreements, providers should separate the employment agreement from the other agreements to help diffuse breach of employment agreement arguments as a defense to the repayment of recruitment...more
The Emergency Medical Treatment and Active Labor Act (EMTALA), despite being enacted more than 30 years ago, has produced a case examining the applicability of malpractice damages limitations that bears watching.
In...more
This case demonstrates the need for providers to know and follow the notification provisions set forth in their insurance policies in order to avoid an inadvertent loss of coverage.
Once again, the terms of a hospital’s...more
Careful drafting of consent and information release provisions can ensure that providers and affiliated physicians and their debt collectors can contact patient cell phones using automatic telephone dialing systems or...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
In recent years, the U.S. Department of Justice (DOJ) has been criticized for failing to prosecute executives for fraud, particularly in the financial sector. In response, the DOJ has begun to more heavily emphasize...more
6/29/2015
/ Ambulance Providers ,
CEOs ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
Enforcement ,
Enforcement Actions ,
Fraud ,
Healthcare Fraud ,
Home Health Agencies ,
Hospitals ,
Medicare ,
Personal Liability ,
Pharmaceutical Industry ,
Pharmacies ,
White Collar Crimes
H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), was signed into law by President Obama on April 16, 2015. A broad bipartisan compromise measure, MACRA repeals the much-maligned sustainable growth rate (SGR)...more
On November 10, 2014, the Centers for Medicare and Medicaid Services (CMS) published the Outpatient Prospective Payment System (OPPS) final rule for 2015. The rule updates CMS’s payment rates and policies, value-based...more
Providers and health professionals face many challenges in the shifting sands of the Ebola response, including the extent of their duties to each other and their patients and their obligations under a myriad of laws,...more
11/3/2014
/ Americans with Disabilities Act (ADA) ,
Best Management Practices ,
Centers for Disease Control and Prevention (CDC) ,
Ebola ,
Employer Liability Issues ,
EMTALA ,
Ethics ,
Family and Medical Leave Act (FMLA) ,
Health Care Providers ,
Hospitals ,
OSHA ,
Physicians ,
Title VII
Hospitals, remarkably, are one of the most hazardous places to work. According to the U.S. Bureau of Labor Statistics, hospital workers have an estimated rate of 8.3 assaults per 10,000 workers compared to an estimated 2...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
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 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
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
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
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