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NC Legislative Update for October 2015

This Week - The North Carolina General Assembly has finally ADJOURNED! And they did so just after 4:00 in the morning on Wednesday September 30th, 2015. The close of the nine-month long 2015 session was met with a round...more

Suing the Hand that Feeds You

Jeffrey Jacobs alleges that Idaho’s Pocatello Hospital violated the False Claims Act because of physician recruitment contracts that were overly generous to his practice group. Jeff should know because he was recruited under...more

Uncovering the mysteries behind GME payments for Medicare Advantage patients: Carve-outs and shadow bills

Medicare makes graduate medical education (GME) payments to teaching hospitals to pay Medicare's share of the teaching and patient care costs associated with Medicare Advantage (MA) patients. Under the Balanced Budget Act...more

King v. Burwell & Beyond: ACA Litigation Continues

The Supreme Court’s ruling in King v. Burwell resolved what may be the last existential legal threat to Obamacare. The case upheld the extension of premium tax credits in states operating under federally created insurance...more

Market Allocation = Antitrust Consequences

The U.S. Department of Justice and the State of Michigan recently initiated a civil antitrust action to enjoin certain marketing agreements between four south-central Michigan hospital systems alleging that the agreements...more

Health care consolidations: Complex maneuvers in a high-stakes environment

In today’s shifting health care landscape, providers are consolidating and forming strategic partnerships that position them to offer comprehensive, high-quality services at reasonable costs....more

Bristol-Myers Squibb FCPA Enforcement Action

Yesterday, the Securities and Exchange Commission (SEC) announced a Foreign Corrupt Practices Act (FCPA) enforcement action against Bristol-Myers Squibb Company (BMS) for the actions of the company’s joint venture (JV) in...more

OMB Reviewing New Final Rule on ACO Waivers

Joint waivers issued by the Centers for Medicare and Medicaid Services (CMS) and HHS Office of Inspector General (OIG) relating the application of the physician self-referral law, the Federal anti-kickback statute, and...more

West Coast States Bolster Momentum for Pharmacist Provider Status Reforms

In recent years, legislative reforms have been introduced that recognize pharmacists as reimbursement-eligible providers under government-funded health care programs. While these efforts have attracted significant media and...more

Arbitration of Nursing Home Suits: Take Two

Quasi Tort Reform in Nursing Home Litigation Is on the Way! Last fall, I posted a blog about the national trend of including arbitration provisions in nursing home admission agreements. This trend peaked following the...more

OCR announces launch of Phase 2 of HIPAA audits

Although the Office for Civil Rights (OCR) has indicated in the past that it would start its next round of HIPAA audits, apparently it means business now. In the wake of an Inspector General report that the OCR was merely...more

Ky. Ruling Casts Doubt on Health Care Arbitration Agreements

Health care institutions in Kentucky may want to take a fresh look at their patient arbitration provisions, in light of a September 24 decision by the Kentucky Supreme Court. Out-of-state institutions may want to take a...more

When a Violation of a Rule or Regulation Becomes an FCA Violation: Understanding the Distinction Between Conditions of Payment and...

If you read one thing… - The False Claims Act’s (FCA) language, structure, court precedent and purpose limit its application to only regulatory breaches that are conditions of payment and not conditions of...more

CMS Releases Proposed Rule Reforming Medicare CLFS Payment Rates

The Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule [CMS-1621-P] in accordance with Section 216 of the Protecting Access to Medicare Act of 2014 (“PAMA”), which establishes a new payment methodology...more

Health Systems Alert: Corporate Practice of Dentistry Prohibitions Have Teeth: New York AG Takes a Bite – 8 Key Takeaways

When contemplating a healthcare transaction between licensed healthcare professionals and non-professionals, a key issue is whether the state in question has a prohibition on the corporate practice of medicine, dentistry or...more

Blog: HHS To Launch New HIPAA Audits in Early 2016 in Response to OIG Reports

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued two reports yesterday calling for the HHS Office of Civil Rights (OCR) to strengthen its Health Insurance Portability and...more

UnitedHealthcare Services Denied Injunction Against Out-of-Network Physician Seeking to Bar Balance Billing of the Patient

In UnitedHealthcare Servs., Inc. v Asprinio (2015 NY Slip Op 25298), decided on August 31, 2015, in the Supreme Court of Westchester County, UnitedHealthcare suffered a set-back against attempts to prevent balance billing by...more

Health Care Arbitration Agreements: Five Ways to Improve Enforceability

Common law judicial doctrines in almost every state discourage and restrict arbitration agreements covering personal injury or death claims. This is particularly true regarding admission contracts to nursing homes or...more

Appellate Court Notes

Supreme Court Advance Release Opinions: SC19253 - RBC Nice Bearings, Inc. v. SKF USA, Inc. [An important decision on contract waiver but one all attorneys should recall from the UCC or Contracts course we took...more

Florida Non-Competes: Physicians, Attorneys, Quarterbacks, Oh My…

Regular readers of this blog know that Florida law allows “valid restraints of trade,” under certain circumstances. Those restrictions apply to the employer-employee relationship when written and duly executed in accordance...more

North Carolina General Assembly Week in Review

With the budget finalized and signed by the Governor last Friday, the General Assembly has turned its attention to adjournment. On Wednesday, the Senate Rules Chairman, Sen. Tom Apodaca (R-Henderson) introduced Senate Joint...more

DOJ Clarifies Position on Individual Accountability in Corporate Investigations

Earlier this month, we discussed a memorandum issued by Deputy Attorney General Sally Quillian Yates of the U.S. Department of Justice (DOJ). This memorandum, referred to as the “Yates Memo,” reaffirms the Government’s...more

Huge Stark Law Hospital Settlements and Physician Culpability - The New Normal Post-Tuomey?

After the federal government’s victory against Tuomey Hospital, we have seen an increasing number of large False Claims Act (FCA) settlements with hospitals involving Stark Law allegations. Relators are even citing, as...more

U.S. Department of Justice issues new guidance on individual accountability for corporate wrongdoing

On Sept. 9, 2015, the U.S. Department of Justice issued new guidance (“DOJ Guidance”) instructing DOJ criminal and civil attorneys to place a greater emphasis on accountability of the individuals responsible for corporate...more

U.S. to China Health Care Arrangements: New Rules for Medical Institution and Service Advertisements

As U.S. hospitals and health care providers continue to explore China’s market for international health care business opportunities, including telemedicine, they often consider providing services or products to consumers...more

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