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
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
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
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently announced its annual solicitation of proposals and recommendations for developing new, and modifying existing, safe harbor provisions...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
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
The first lawsuit, in what may be a wave of antitrust litigation challenging professional board regulations in the wake of the U.S. Supreme Court’s decision in North Carolina State Board of Dental Examiners v. Federal Trade...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
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
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 enactment of the Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, represents a significant legislative milestone in healthcare reform and a continuing communications challenge for...more
Old and new regulations established by state professional boards that are composed of “active market participants” such as physicians, dentists and therapists, may be subject to antitrust challenge following the U.S. Supreme...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
The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule aimed at revitalizing accountable care organizations (ACOs) under the Medicare Shared Savings Program (MSSP). Given the low level of ACOs...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
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
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