Today, the Departments of Health and Human Services (HHS), Labor, and Treasury (the Departments) published an interim final rule (the Interim Final Rule) implementing certain provisions of the No Surprises Act,[1] which aims...more
7/13/2021
/ Consent ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Disclosure Requirements ,
Dispute Resolution ,
Exceptions ,
Government Agencies ,
Health Care Providers ,
Insurance Industry ,
Interim Final Rules (IFR) ,
Notice Requirements ,
Out of Network Provider ,
Patients ,
Price Transparency ,
Surprise Medical Bills ,
U.S. Treasury
Tennessee healthcare providers will soon have a very different certificate of need (CON) law to consider as they plan new facilities and services. Tennessee’s legislature and governor recently enacted Public Chapter 557,...more
6/22/2021
/ Ambulatory Surgery Centers ,
Assisted Living Facilities (ALFs) ,
Certificate of Need ,
Dedicated Emergency Departments ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Reform ,
Home Health Care ,
Hospitals ,
Inpatient Rehab Facilities ,
Long Term Care Facilities ,
New Legislation ,
Nursing Homes ,
Regulatory Agenda ,
Reviewability Determinations ,
State and Local Government
The Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule went into effect on January 1, 2021, but whether it will succeed in making prices readily comparable for healthcare consumers remains to be...more
5/13/2021
/ Administrative Procedure Act ,
Affordable Care Act ,
American Hospital Association ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Enforcement ,
Final Rules ,
Health Care Providers ,
Healthcare Reform ,
Hospitals ,
Payment Systems ,
Price Transparency ,
Reporting Requirements
Uncertain. What better word to describe a year in which a new administration came to power and began to chart a new course for health policy, the fate of the Affordable Care Act (ACA) hung in the balance, and courts grappled...more
1/25/2018
/ Affordable Care Act ,
Alternative Payment Models (APM) ,
Cooperative Compliance Regime ,
Department of Justice (DOJ) ,
Electronic Health Record Incentives ,
False Claims Act (FCA) ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Reform ,
Hospital Mergers ,
Meaningful Use ,
OIG ,
Prescription Drug Coverage ,
Repeal ,
Section 340B ,
Stark Law ,
Trump Administration ,
Universal Health Services Inc v United States ex rel Escobar
The rules that govern participation in the Medicare program are notoriously voluminous and complex. Indeed, courts have described them as akin to a “[body of] law written by James Joyce and edited by E.E. Cummings” and “among...more
After 30 years as a fixture in the federal healthcare regulatory landscape, the Emergency Medical Treatment and Labor Act—more commonly known as EMTALA—has been in the news again. In the past year, the U.S. Department of...more
We are pleased to present our annual review of developments in the field of health law. The year was marked by key changes in False Claims Act jurisprudence and Medicare payment policy. 2016 also brought with it focused...more
1/25/2017
/ 60-Day Rule ,
ACOs ,
Centers for Medicare & Medicaid Services (CMS) ,
Corporate Executives ,
Corporate Misconduct ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
ESRD ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Trade Commission (FTC) ,
Final Rules ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Reform ,
Hospital Mergers ,
Long Term Care Facilities ,
Materiality ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Shared Savings Program ,
MIPS ,
OCR ,
Off-Campus Departments ,
OPPS ,
Personal Liability ,
Physician Payments ,
Presidential Elections ,
SCOTUS ,
Stark Law ,
Trump Administration ,
Universal Health Services Inc v United States ex rel Escobar ,
Yates Memorandum
We are pleased to present Bradley’s annual review of significant False Claims Act (FCA) cases, developments, and trends. From a relatively short article several years ago, the Review has grown to a significant publication...more
1/10/2017
/ Anti-Kickback Statute ,
Appeals ,
Calculation of Damages ,
Civil Monetary Penalty ,
Defense Contracts ,
False Claims Act (FCA) ,
False-Certification of Conformance ,
Federal Contractors ,
FRCP 9(b) ,
Healthcare Fraud ,
Materiality ,
Objective Falsity ,
Off-Label Promotion ,
Overpayment ,
Public Disclosure ,
Qui Tam ,
Retaliation ,
SCOTUS ,
Standard of Review ,
Successor Liability ,
Transfer of Venue ,
United States ex rel Nelson v Sanford-Brown ,
Universal Health Services Inc v United States ex rel Escobar ,
Whistleblowers ,
Yates Memorandum
On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final rule (Final Rule) implementing sweeping changes to the Medicare physician payment system mandated by the Medicare Access and CHIP...more
On June 23, 2016, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule making major changes in the way Medicare will pay for clinical diagnostic laboratory tests (CDLTs). The changes were...more
1. Executive Summary -
With the dirt barely settled on the unmourned grave of the Medicare sustainable growth rate (SGR) methodology for updating physician fee schedule payments, CMS published a proposed rule that would...more
Earlier this year, the Federal Trade Commission (FTC) and the Antitrust Division of the Department of Justice (DOJ) released their formal recommendation that South Carolina repeal its certificate of need (CON) law regulating...more