Administrative Law, Health Law, Civil Procedure

Court Grants Unexpected Victory to Providers on Medicare DSH Adjustment

by Thomas W. Coons, Mark A. Stanley | Ober|Kaler on 4/18/2013

The United States District Court for the Eastern District of Pennsylvania’s opinion in Nazareth Hosp. v. Sebelius, slip op. no. 10-3513 furnished a surprising victory to two providers that challenged the calculation of the...more

Compounding Animal Drugs from Bulk Ingredients

by Duane Morris LLP on 4/17/2013

Recent public discussion about the federal role in regulating compounding pharmacies has focused on compounded drugs for human use. Compounded drugs are also vital to companion animal health (like pets). In the world of...more

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

by Womble Carlyle Sandridge & Rice, PLLC on 4/17/2013

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

Resubmission of Hospital Claims

by Thomas Hess, Tyler N. Williams | Dinsmore & Shohl LLP on 3/13/2013

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

High court scales back antitrust exemption

by Jarod Bona on 2/28/2013

This Daily Journal article analyzes the United States Supreme Court decision of Federal Trade Commission v. Phoebe Putney Health System, Inc, which held that a state's grant of general corporate powers to government entities...more

Payment Matters: No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

by Mark A. Stanley | Ober|Kaler on 2/11/2013

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

U.S. Supreme Court Holds Equitable Tolling Doctrine Does Not Apply To Administrative Appeal Deadline

by Anastasia (Ana) K. Anderson, Renee M. Howard, David B. Robbins | Perkins Coie on 1/28/2013

On January 22, 2013, the U.S. Supreme Court issued a unanimous decision in Sebelius v. Auburn Regional Medical Center, 568 U.S. _____ (2013), holding that hospitals cannot appeal Medicare inpatient reimbursement...more

Vegan Employee May Proceed with Religious Discrimination Claim

by Maria Greco Danaher | Ogletree, Deakins, Nash, Smoak & Stewart,... on 1/17/2013

A federal district court in Ohio has refused to dismiss a complaint for religious discrimination made by a hospital employee after the employee was fired for refusing to be vaccinated for the flu. The basis of the refusal to...more

A Reduction in the Utility of Civil Investigative Demands and the Interpretive Narrowing of "Person" under the False Claims Act

by Steve Cave | Womble Carlyle Sandridge & Rice, PLLC on 1/15/2013

Executive Summary: False Claims Act actions against government contractors are on the rise. But two recent decisions offer potential limitations to false claims exposure, and may aid defendants in future FCA litigation....more

Stengel Tangles MDA Preemption: Ninth Circuit Decision Creates Split on Buckman Preemption of Post-Market Reporting Requirements

by Erin M. Bosman, Julie Y. Park, Joanna Simon | Morrison & Foerster LLP on 1/15/2013

Last week the Ninth Circuit created a new state-law cause of action against medical device manufacturers: “failure to warn the FDA.” The en banc opinion in Stengel v. Medtronic Inc., __ F.3d __, 2013 WL 106144, 13 C.D.O.S....more

Sending the Privilege Away: Attorney-Client E-Mails in the Corporate Setting

by Amy Garrigues, Bryan Rohm, Mark A. Rush, Joseph Valenti | K&L Gates LLP on 1/8/2013

In a pending False Claims Act (“FCA”) case involving allegations of noncompliance with the federal physician self-referral law (the “Stark Law”), 42 U.S.C. § 1395nn, the United States District Court for the Middle District of...more

The False Claims Act and Healthcare Providers: Key Results from 2012 and Likely Trends for 2013

by Ty Howard | Bradley Arant Boult Cummings LLP on 1/7/2013

From the perspective of False Claims Act (FCA) results, 2012 was a decidedly mixed year for healthcare providers. The bad news was quite bad—increased FCA scrutiny by the Department of Justice (DOJ) led to $3 billion of...more

BLG Monthly Update for December 2012

by Neil Guthrie on 12/19/2012

UGG boots, thieving drug addicts, misappropriated sheep and the usual neat contracts cases: all this and more in the BLG Monthly Update for December....more

Supreme Court Hears Argument in Sebelius v. Auburn Regional Medical

by King & Spalding on 12/14/2012

On December 4, 2012, the Supreme Court heard oral argument in Sebelius v. Auburn Regional Medical Center (Docket No. 11-1231), a case which presents the question whether the Medicare statute’s 180-day time limit for filing...more

Payment Matters: Providers Again Win in Medicare Disproportionate Share Adjustment Challenge

by Thomas W. Coons | Ober|Kaler on 12/13/2012

In a 2011 decision, Northeast Hospital Corp. v. Sebelius, 657 F. 3d 1 (D.C. Cir. 2011), the United States Court of Appeals for the District of Columbia Circuit ruled for the providers in a challenge to the Secretary’s...more

ALJ Appeals Frequently Favorable To Providers; OIG Calls For Reforms

by Ameena Ashfaq, B. Scott McBride | BakerHostetler on 12/11/2012

The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge (ALJ) level of appeals, the third level of the Medicare appeals system. The 2005 regulatory changes...more

Recent Federal False Claims Act Decision Undermines Attorney-Client Privilege over Certain In-House Counsel Emails

by Mary C. Pennisi, Marvin G. Pickholz | Duane Morris LLP on 12/11/2012

A federal magistrate judge's recent decision in United States ex rel. Baklid-Kunz v. Halifax Hospital Medical Center, a Civil False Claims Act (“FCA”) case pending in the United States District Court for the Middle District...more

Legal Challenges to ACA Not Quite Finished

by John LeBlanc | Barger & Wolen on 11/26/2012

If you thought that the legal battle over the constitutionality of the Patient Protection and Affordable Care Act ("ACA") was put to rest in NFIB v. Sebelius, you may want to pay attention to Liberty University v. Geithner. ...more

Court Denies Whistleblowers Motion for Summary Judgment Finding Agreements Specific Enough to Meet Anti-Kickback Statute Safe...

by King & Spalding on 11/26/2012

On October 29, 2012, the federal District Dourt for the Middle District of Florida denied a whistleblower’s summary judgment motion alleging that certain agreements failed to meet the safe harbors established under the...more

Employer Not Liable for Employee's Failure to Report Unpaid Time

by Michael A. Alaimo, Christopher M. Trebilcock | Miller Canfield on 11/13/2012

Following prior decisions of the Eighth and Ninth Circuit Courts of Appeals, in White v Baptist Memorial Health Care Corp., the Sixth Circuit Court of Appeals rejected claims brought by a former nurse seeking unpaid wages for...more

The ERISA Litigation Newsletter - November 2012

by Proskauer Rose LLP on 11/11/2012

In This Issue: - Editors' Overview - Second Circuit Rules That Amending A Multiemployer Plan Is Not a Fiduciary Act, But Leaves Many Questions Unanswered - How ACA Modifies ERISA's Benefit Claims...more

Sixth Circuit Overturns $82.6 Million Medicare Fraud Judgment

by McDermott Will & Emery on 11/5/2012

Based on the recent decision in United States, ex rel. Williams v. Renal Care Group, Inc., medical service providers in the Sixth Circuit that have established separate corporate entities to maximize corporate profits and...more

Chancery Court Finds Management Services Agreement Key in Establishing Jurisdiction

by King & Spalding on 11/3/2012

On August 28, 2012, the Delaware Court of Chancery found that a management services agreement could help establish both personal jurisdiction through a conspiracy to defraud and joint and several liability through an agency...more

Proposed DHHS Settlement: Medicare Home Health, Skilled Nursing Service, and Therapy Service Coverage

by Manatt, Phelps & Phillips, LLP on 10/25/2012

In a proposed settlement to a nationwide class action lawsuit, the Department of Health and Human Services ("DHHS") has agreed to remove the unlawful "rule of thumb" implemented through Medicare's administrative review...more

Supreme Court Will Not Review Sixth Circuit Ruling That Government May Seek Full Reimbursement of Medicare Payments to Beneficiary...

by King & Spalding on 10/17/2012

On October 1, 2012, the United States Supreme Court said it would not review a decision by the U.S. Court of Appeals for the Sixth Circuit which ruled 2-1 that, upon settlement by a Medicare beneficiary with a third-party...more

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Administrative Law › Health Law › Civil Procedure