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Medicare Shared Savings Program Grows by 106 ACOs in 2013

Yesterday the Centers for Medicare & Medicaid Services formally announced the 106 new Accountable Care Organizations (ACOs) participating in the 2013 Medicare Shared Savings Program (MSSP) cycle. CMS also announced that 15...more

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

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

Navigating the Provider Self-Disclosure Protocol

Providers can voluntarily disclose potential fraud with respect to Federal health care programs — Medicare, Medicaid, and potentially private insurers to the extent Federal or state funds are involved — by following the...more

ACOs and Long-Term Care: Don't Get Left Behind

With the U.S. Supreme Court decision ratifying President Obama's Patient Protection and Affordable Care Act (the "Affordable Care Act"), the implementation and development of accountable care organizations (ACOs) continued in...more

Policy Recommendations for States to Promote Accountable Care in Medicaid Programs

Federal and state health reform efforts present compelling opportunities to advance new payment and delivery system models to improve the quality of healthcare services and reign in costs. An emerging challenge for...more

CWP 14597 of 2007

Judgement - Hookah/ Sheesha Bar Case

Putting an end to the abuse of Nicotine, thriving across Punjab and Haryana in the name of serving Hookah/ Sheesha/ Water-Pipe, the Punjab and Haryana High court has ordered closure of all such outlets besides creation of a...more

Chancery Court Finds Management Services Agreement Key in Establishing Jurisdiction

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

Coordinated Care and Contracting: Pathology Participation in ACO's and Other Forms of Clinical Integration (Presentation)

In This Presentation: Learning Objectives: • Provide examples of alternative delivery and alternative payment mechanisms • Review the legal and business structures and risks of ACO type organizations • Help...more

Impact of Health Care Reform on Provider Liability: Issues and Proposed Solutions

In this presentation: - The Changing Healthcare Landscape - Examples of Quality Standards - Corporate Responsibility in Health Care Quality - Examples of Quality Enforcement Efforts - So Now...more

Mandatory Compliance Programs for Healthcare Companies

The healthcare industry always has taken the lead in compliance issues, developing innovative compliance tools and programs. Anti-corruption compliance borrows heavily from many healthcare compliance ideas....more

Senators Push CMS to Implement Physician Payments Sunshine Act

In a roundtable discussion of the Senate Special Committee on Aging last week, Senators Chuck Grassley and Herb Kohl called on CMS to issue final regulations implementing the Physician Payment Sunshine Act, which was enacted...more

Articles in Legal Industry Publications Continue to Qualify as Public Disclosure Under the False Claims Act

A Texas federal judge recently tossed a Federal False Claims Act (FCA) qui tam because the substance of the underlying allegations was previously disclosed in several legal industry publications, U.S. ex rel. Pharma Fraud...more

Closure of Stark Whole Hospital Exception Survives Court Challenge

On August 16, 2012, the United States Court of Appeals for the Fifth Circuit dismissed a challenge to the constitutionality of the Affordable Care Act ("ACA") provision that effectively eliminates the "whole hospital"...more

The Supreme Court Rules on Health Reform – Now Operationalize that ACO!

While many providers forged ahead with the development of accountable care organizations ("ACOs") prior to the Supreme Court's ruling in National Federation of Independent Businesses et. al. v. Sebelius, the Court's...more

The Supreme Court Ruled on Health Reform – What's Next for Medicaid and Medicare Managed Care Plans

The Affordable Care Act will present significant challenges and opportunities for Medicaid and Medicare managed care organizations. The Affordable Care Act ("ACA") is the single biggest overhaul of the United States...more

CMS Revised Hospital Conditions of Participation Now in Effect

On July 16, 2012, in response to the President’s Executive Order directing federal agencies to achieve a more streamlined and efficient regulatory framework for hospitals, a final rule revising hospital and critical access...more

No Change in Course on ACA Federal Antifraud and Transparency Provisions

Healthcare companies should work to comply with current provisions and prepare for those that will be implemented in the near future. The U.S. Supreme Court's decision that the Patient Protection and Affordable Care Act...more

New Public-Private Partnership Seeks to Combat Fraud

On July 26, 2012, in further efforts to combat healthcare fraud, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced a new partnership among the federal government, state officials, private healthcare...more

Telemedicine Amidst Healthcare Reform: Practicalities and Pitfalls

The Supreme Court’s recent decision upholding the Patient Protection and Affordable Care Act underscores the need to deliver and make accessible quality healthcare to patients throughout the United States in an efficient and...more

False Claims Act Compliance and Health Care

Doctors and health care service providers are under the False Claims Act microscope. The risks are significant and the costs can be astronomical. For all the obvious risks, doctors, hospitals, PPOs, HMOs, and health care...more

New ACO Developments Announced

In two new Accountable Care Organization (ACO) developments, 15 of the 89 ACOs recently announced by CMS have been approved as “advance-payment” ACOs, which means they will receive some of their anticipated savings upfront to...more

340B Drug Pricing Program Experiencing Unprecedented Compliance Scrutiny

Participants in the 340B Drug Pricing Program (340B Program) should be aware that over the last several months, the 340B Program has witnessed an unprecedented focus on oversight, integrity and enforcement. Although the 340B...more

CMS Approves 89 New ACOs

On July 9, 2012, HHS announced the approval of 89 new accountable care organizations (ACOs) for participation in the Medicare Shared Savings Program. These new ACOs began participating in the Shared Savings Program on July...more

Health Care Reform Update -- July 16, 2012

In This Issue: Implementation of the Affordable Care Act (ACA); Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearing & Markups...more

IRS Issues Proposed Regulations for Charitable Hospitals Regarding Section 501(r) Financial Assistance and Other Requirements

On June 26, 2012, the Internal Revenue Service (IRS) published in the Federal Register proposed regulations and a detailed preamble regarding the Internal Revenue Code (IRC) Section 501(r) requirements for charitable hospital...more