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What Has Fahlen Wrought?

The California Supreme Court's decision in Fahlen v. Sutter Central Valley Hospitals has confirmed (not created) a sea change in the relations between hospitals and their medical staffs on the one hand, and physicians on such...more

D.C. Circuit Requires Greater Disclosure of Changes in Medicare Regulations

The rulemaking process often accommodates a variety of interests, including the preference of regulatory agencies to maintain some flexibility and the rights of interested parties to participate in the regulatory process. On...more

OFCCP Withdraws Claim Regarding TRICARE Jurisdiction

Last week, the Office of Federal Contract Compliance Programs (OFCCP) dismissed OFCCP’s 2008 complaint against Florida Hospital of Orlando. In its Order of Dismissal, the Administrative Law Judge (ALJ) reported that OFCCP...more

D.C. Circuit Rules that the Medicare DSH Rule Requiring the Inclusion of Part C Days in the “Medicare Fraction” in the DSH Formula...

Last week, the United States Court of Appeals for the District of Columbia Circuit upheld the ruling of a federal district court vacating HHS’s 2004 Disproportionate Share Hospital (“DSH”) rule regarding Part C days. The...more

California Supreme Court Allows Whistleblowing Doctor To Sue Before Exhausting Judicial Remedies

Fahlen v. Sutter Central Valley Hospitals, S205568 (February 20, 2014): The California Supreme Court recently held that a physician, who claimed that a hospital terminated his staff privileges in retaliation for raising...more

Spring Fever - Cautious Optimism for More Critical Appellate Review of Agency Actions

The calendar tells us that it is now spring – the season of hope and optimism. While this may seem like a legal technicality given the weight of the objective physical evidence to the contrary, I, being a lawyer, have no...more

Highlights from OMHA's Medicare Appellant Forum

The Office of Medicare Hearings and Appeals (OMHA) recently announced that for most hearing requests received after April 1, 2013, it will be deferring assigning to Administrative Law Judges (ALJs). OMHA will continue to...more

California Supreme Court Expands Protections To Whistle-Blowers And Weakens Hospital Peer Review Systems

The recent decision by the California Supreme Court in Fahlen v. Sutter Central Valley Hospitals, No. S205568 , 2014 WL 655995 (Cal. 2014) may significantly weaken the efficacy of hospital peer review proceedings in...more

OMHA's Medicare Appellant Forum Offers Few Meaningful Answers for Frustrated Medicare Providers and Suppliers

On February 12, 2014, the Office of Medicare Hearings and Appeals ("OMHA") hosted a Medicare Appellant Forum ("Forum") to address its current backlog of appeals. OMHA is responsible for hearings before Administrative Law...more

D.C. Circuit Court of Appeals Upholds FDA Oversight of Autologous Stem Cell Therapeutics

A company that developed a stem cell-based therapy for treating diseases and conditions was found to be in violation of the federal Food, Drug, and Cosmetic Act for failing to seek approval for its product. Cellular and...more

Third Circuit Holds Judicial Review of Extrapolated Overpayment Determinations is Precluded

On February 12, 2014, the U.S. Court of Appeals for the Third Circuit held that Federal courts do not have jurisdiction to review HHS’s determination of a “sustained or high level of payment error,” one of two possible...more

OMHA Holds Medicare Appellant Forum

On February 12, 2014, the Office of Medicare Hearings and Appeals (OMHA) held a “Medicare Appellant Forum” in Washington, DC. The event was well-attended, with 300 people signed up to be present in-person, and 500 who signed...more

Illinois Supreme Court to Decide Whether Improper Venue in an Administrative Review Case Deprives the Circuit Court of...

Our previews of the new review grants from the Illinois Supreme Court’s January term continue with Slepicka v. State of Illinois, a case from the Fourth District of the Appellate Court. Slepicka poses a question of general...more

Court Dismisses POD Lawsuit Against OIG

On February 5, 2014, a federal court dismissed a challenge to the U.S. Department of Health and Human Services’ Office of Inspector General’s (“OIG”) March 26, 2013 Special Fraud Alert (“2013 SFA”) on physician-owned...more

Government Imposes Moratorium on Medicare Hearings and Appeals

The Federal Office of Medicare Hearings and Appeals (OMHA) was established in July 2005 to administer the Medicare appeals program. OMHA adjudicates appeals regarding Medicare entitlement and Medicare provider reimbursement....more

Makena Drug Compounding Lawsuit Against FDA Gets New Life

On January 7, 2014, a three-judge panel of the United States Circuit Court for the District of Columbia unanimously vacated the dismissal of claims against the U.S. Food and Drug Administration (“FDA”) and others by K-V...more

OMHA Imposes 24-Month Stay for New ALJ Assignments; Announces Medicare Appellant Forum

The Office of Medicare Hearings and Appeals (OMHA) has issued a Memorandum to OMHA Medicare appellants announcing a temporary stay, effective for cases filed on or after July 15, 2013, in the assignment of new requests for...more

ALJ Hearing Assignment Suspension

As some of you may be aware, the Office of Medicare Hearings and Appeals (OMHA) has recently announced that it temporarily suspended the assignment of most new requests for Administrative Law Judge (“ALJ”) hearings, as of...more

January 28th Appeal Deadline for Medicare 0.2 Rate Cut Approaching

We want to be sure that all of our Health Headlines subscribers are aware of the approaching January 28th deadline by which to file appeals challenging CMS’s 0.2 percent downward adjustment of the FY 2014 IPPS rates. We have...more

California Court Clarifies Controversial Questions About Medical Staff Peer Review Decisions and the Power of Hospital Boards

Two recent California Court of Appeal opinions decide issues of first impression in the medical staff peer review arena, helping to resolve questions that have long been uncertain and controversial. In the first of the two...more

Focus on Regulatory Law -- December issue

This bi-monthly Regulatory Newsletter synthesizes news in the energy, electronic communications, public health and public procurement legal sectors. The decisions and judgements of the French Supreme Administrative Court...more

Orange County Business Journal: What to do if regulators come knocking?

What should you do if regulators knock on the door to your healthcare facility to execute a search warrant or administrative warrant? Healthcare executives need to understand that law enforcement is increasingly relying on...more

NC Medicaid Providers, Are You Required to Seek an Informal Appeal Prior to Filing a Contested Case at OAH?

Recently, numerous clients have come to me asking whether they have the right to appeal straight to the Office of Administrative Appeals or whether they have to attend informal appeals first, whether the informal appeal is...more

Hot Off The Press - Publication Of Discipline Decisions A-Ok, Says Alberta's Top Court

Zakhary v. College of Physicians and Surgeons of Alberta, 2013 ABCA 336 - On October 3, 2013 the Alberta Court of Appeal upheld the decision of the College of Physicians and Surgeons of Alberta (“CPSA”) to publish...more

What Amount of Deference, If Any, Is Accorded to CMS' Interpretation of the State Operations Manual?

On May 17, 2013, the United States Court of Appeals for the Fifth Circuit (Court) ruled on a Petition for Review of a Decision of the United States Department of Health and Human Services (DHHS) in the case styled, Elgin...more

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