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Physicians in the Bulls-eye

Several recently reported cases highlight the growing risk physicians face if they succumb to competitive pressures, especially offers of remuneration from labs, pharmacies, home health agencies and other providers to whom...more

OIG Signs Up for Customer Loyalty Program

In Advisory Opinion 17-05, posted by the U.S. Department of Health and Human Services Office of Inspector General (OIG) on September 7, 2017, the OIG approved a pharmacy’s customer loyalty/discount program (Benefit Program)....more

Is the Dam Breaking? Over-the-Counter Hearing Aids

The FDA Reauthorization Act (H.R. 2430), recently signed into law by President Donald Trump, included the Over-the-Counter (OTC) Hearing Aid Act, which requires the Food and Drug Administration (FDA) to develop regulations...more

Breaching Physician Doubles Down on His Debt

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

Doc, Can You Hear Me Now? Telehealth Finally Comes of Age in Texas

After many years of heated and contentious debate, and opposition by the Texas Medical Association and the executive director of the Texas Medical Board, Texas has significantly revised its telemedicine statute to permit the...more

Specificity Sometimes Key; Sometimes Not

Time spent drafting and negotiating an agreement often pays dividends in assuring that each party gets the benefits they desire through the agreement and incurs obligations no greater than they intended. Two recent cases,...more

EMTALA Laboring Along 30 Years Later

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

We Cured the Breach of Contract! Oh No, You Didn’t

A recent decision from a North Carolina federal court raises interesting lessons for providers surrounding contractual cure and damages provisions. Cone Health entered into a contract with Conifer Physician Services for the...more

Darwinian Insurance

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

Electronic Signature Pads: I Didn’t See Those Terms

Although we healthcare lawyers generally view ourselves as a pretty healthy lot, there are times when we are patients too. In a recent experience I was asked by a provider’s employee to sign several registration and privacy...more

You Can’t Fire Me for Drug Diversion If I Am Personally Consuming the Drugs

A nurse employed by a major medical center was suspected of illegally diverting medications. When confronted by her employer with evidence of suspicious transactions recorded by the provider’s medication monitoring systems,...more

Employee Reference Releases: Who’s In and Who’s Out?

A recent Indiana defamation case, Manhas v. Franciscan Hammond Clinic, serves as a critical reminder of the importance of scrutinizing physician and employee reference forms and releases. Dr. Sheila Manhas and Franciscan...more

Improvidently Granted Appeal Statistically Yields Sampling Uncertainty

The Fourth Circuit Court of Appeals agreed in 2015 to hear an interlocutory appeal of a district court’s decision to prohibit a qui tam relator from using statistical sampling to prove liability and damages in a False Claims...more

Dialing for Dollars Yields Conviction for Home Health Telemarketer

Sundae Williams, the owner of Serenity Marketing Inc., made unsolicited phone calls to recruit patients, including Medicare beneficiaries, for contracted home health agencies. Williams and Serenity then referred those...more

Obstruction of a Medicare Audit Doesn’t Require Direct Obstruction of a Federal Agent

A registered pharmacist, the owner of two Alabama pharmacies, pleaded guilty to obstructing a 2012 federal audit of Medicare claims and agreed to pay a $2.5 million penalty to the government. The submission of the false and...more

Medicare Advantage Plan Arbitration Clauses Preempted by Medicare Appeals Process

The Arizona Supreme Court, in an interesting case involving a Medicare-related coverage dispute between a Medicare Advantage plan administrator, United Behavioral Health (UBH), and two inpatient psychiatric care providers,...more

Assault of Home Health Worker by a Patient’s Father Prompts OSHA Violation

A provider of pediatric home health, Epic Health Services, was recently fined $98,000 by the Occupational Safety and Health Administration (OSHA) in connection with the sexual assault of a home health employee by a patient’s...more

Ambulance and Home Health Moratorium Continued and Expanded

The Centers for Medicare and Medicaid Services (CMS) recently announced an extension of its temporary moratorium on enrolling new nonemergency ambulance suppliers in New Jersey, Pennsylvania and Texas and new home health...more

Does the Medical-School-to-Prison Pipeline Widen in Middle Age?

The trend of holding physicians personally responsible for healthcare crimes has continued unabated over the past year. As noted in a previous article, physicians are particularly attractive targets for federal prosecutors...more

Insurer Actions Cut the Heart Out of Out-of-Network Providers

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

I’ll Gladly Pay You 10 Years From Today for Care Already Provided

Most providers whose claims have been determined to be improper by the Recovery Audit Contractors (RACs) under the Medicare Recovery Audit Program have discovered that the appeals backlog “is incontrovertibly grotesque.”...more

Kickbacks and Commercial Bribery: Another Touchstone to Consider

The latest indictment confirms that fraud and abuse analysis is about more than just the federal and state healthcare anti-kickback statutes. The U.S. Attorney for the Northern District of New Jersey has just charged the 26th...more

Debt Collector for Affiliated Physician Group Can Rely on Patient Contact Consent Obtained by Hospital

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

Drug Manufacturer Discount Cards: Accept With Caution

Pharmaceutical manufacturer discount card usage by government program beneficiaries has been an active area for government action in recent years. In a September 2014 Special Advisory Bulletin, the U.S. Department of Health...more

Medicare: Congress Ends 2015 With Some Last-Minute Reforms

Congress chose to end 2015 with some last-minute Medicare reforms impacting healthcare providers. Significantly, the Patient Access and Medicare Protection Act, signed into law by President Obama on December 28, 2015,...more

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