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The Health Law Guide to Hospital Operations

This operations guide provides a brief look at health law issues hospitals deal with on a daily basis. While a detailed coverage of the elements, drafting, implementation and continued governance of a hospital compliance...more

Kentucky Federal Court Sustains Hospital Insurer’s Denial of Claim Due to Untimely Notice, Declines to Require Insurer Show...

The U.S. District Court for the Eastern District of Kentucky recently held that an insurer properly denied coverage to a hospital because the hospital gave untimely notice of the claim. In Ashland Hospital Corporation v. RLI...more

Health Law Wire: FTC Objects to Legislative Antitrust Immunity in New York (6/15)

The FTC is urging the NY Legislature to withdraw a bill which would grant broad antitrust immunity to the Westchester and Erie County health care public benefit corporations. There is continuing scrutiny of state-sponsored...more

Unfair Business Practices – Hospital’s “Facility Fee” Billed To New Patients

Justin Nolte et al., v. Cedars Sinai Medical Center - Court of Appeal, Second Appellate District (May 21, 2015) - Generally, a business practice is unfair if it violates established public policy or if it is...more

OIG Issues Compliance Guidance for Healthcare Governing Boards

Members of healthcare governing boards now have direction from the OIG as to what is expected of them as they oversee the regulatory compliance of their organizations. And the good news is that the board members don’t have to...more

[Webinar] Benchmarking Your Policy Management Program - May 21, 10:00am PT / 1:00pm ET

Join this free webinar to hear compelling survey results and answers to questions such as: What are organizations doing to address policy management today? What are E&C leaders’ top policy management...more

Spotlight on Responsibility and Accountability: OIG’s New Compliance Guidance for Health Care Governing Boards

On April 20, 2015, the Office of the Inspector General of the U.S. Department of Health and Human Resources (“OIG”), in collaboration with the American Health Lawyers Association, the Association of Healthcare Internal...more

OIG Issues Compliance Oversight Guidance for Governing Boards of Health Care Organizations

On April 20, 2015, the Office of Inspector General (OIG), in collaboration with the Association of Healthcare Internal Auditors, the American Health Lawyers Association, and the Health Care Compliance Association, issued...more

Building a Culture of Health: The Value Proposition of Retail Clinics

Retail clinics offer convenient, low-cost basic primary care treatment, screening and diagnostic services in a variety of settings. Increasingly, these clinics are an integral part of a U.S. health care system in the throes...more

Late Notice of Claim Costs Kentucky Hospital $10 Million

A federal court in Kentucky ruled on March 17 that Ashland Hospital had forfeited $10 million of insurance coverage because it was late in notifying its insurance company of the claim....more

Medical Staff By-laws are Contracts? Minnesota Supreme Court Says “Yes”

That sound you just heard was the simultaneous gasp of hospital boards of directors throughout the state of Minnesota. In Medical Staff of Avera Marshall Regional Medical Center v. Avera Marshall, Minnesota’s highest court...more

IRS Issues Private Letter Ruling on Treatment of Managed Professional Corporations

The Internal Revenue Service (“IRS”) recently published a private letter ruling (“PLR”) that permits a practice management corporation to include two managed professional corporations as members of the management...more

IRS Private Letter Ruling Provides Tax Planning Opportunities for Healthcare Companies

The IRS recently issued PLR 201451009, providing that a management services company and two professional corporations (PCs) were members of the same affiliated group under Section 1504(a) of the Internal Revenue Code...more

How Do I Get Out of this Practice?

For years the goal of many young doctors was to gain ownership in their medical practice entity. For many, when the time came for them to “make partner,” they signed on the dotted line without fully understanding the legal...more

CMS Releases Proposed New Rule for Accountable Care Organizations

On Dec. 1st, the Centers for Medicare and Medicaid Services released a new proposed rule for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). The voluminous proposal covers a...more

IRS provides interim guidance for ACO participation in Medicare Shared Savings Programs and expands safe harbors for management...

On October 24, 2014, the IRS published Notice 2014-67, which expands the Revenue Procedure 97-13 safe harbors regarding management contracts and further provides interim guidance related to a health care organization’s...more

IRS Releases Guidance on Private Business Use, and ACOs and Management Contracts

On October 25, 2014, the Internal Revenue Service (the IRS) released Notice 2014-67 that provides interim guidance on (i) participation in the Medicare Shared Savings Program through an accountable care organization (ACO) and...more

IRS Releases Private Business Use Guidelines for ACO Participants

On Friday, October 24, 2014, the Internal Revenue Service (IRS) released Notice 2014-67, providing guidance regarding the circumstances under which participation by a hospital in an Accountable Care Organization (ACO) will...more

The Reformed Health Care Industry: Creative Structures and Alliances Can Yield Great Benefits, but Also Great Risks

Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more

Finishing at the Top of the Class: The Risks Faced by High Achievers on the Medicare Billings List

In this increasingly competitive world, providers generally want to be at the top of almost any official ranking. CMS’s recently released list of medical groups and physicians receiving the most Medicare reimbursement dollars...more

Risk Taking in the Provider World: Is a Knox-Keene Plan a Good Strategic Move For You?

Reimbursement for health care services in California continues its shift toward capitation, resulting in health care providers increasingly forming their own health plans under the Knox Keene Health Care Service Plan Act (the...more

Critical Considerations in Healthcare Affiliations

The trend of affiliations between healthcare providers (we use the term “affiliation” to include all manner of transactions, including mergers, acquisitions, joint operating arrangements, etc.) continues at a rapid pace....more

Mitigating Successor Liability in Long Term Care Acquisitions

As in any business acquisition, purchasers in the long term care industry can encounter potential liability due to employment claims, seller violations of representations and warranties under the purchase agreement, tort...more

Perspectives - January 2014

In This Issue: - Considerations in the Cloud: Managing the Risks - United States V. Sperry: A Revived Threat to Owners, Directors, Managers and Directors of Distressed Organizations - Board Membership &...more

Major Reforms for New York Nonprofits Signed Into Law

On December 18, 2013, almost six months after the Non-Profit Revitalization Act of 2013 (the “Act”) passed the New York State Legislature, New York Governor Andrew Cuomo signed the Act into law. The Act amends the patchwork...more

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