General Business Health

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DOJ and Michigan Sue Four Hospital Systems for Agreeing Not to Compete with Each Other

Together with the State of Michigan, the United States Department of Justice’s Antitrust Division has filed a civil suit against four Michigan hospital systems for allegedly agreeing to limit marketing in each other’s...more

Chasing Payments: District Court Holds that Providers Lack Standing to Sue ERISA Plans for Benefits if the Patients Remain Liable...

A district court in Tennessee recently rejected ERISA claims by healthcare providers against a plan insurer, holding that the providers lacked standing to sue under ERISA as their patients’ assignees. Brown v. Blue Cross...more

Recent DOJ and OIG Actions Show Growing Federal Scrutiny of Physician Financial Arrangements

Over the last month the Office of Inspector General (OIG) of the Department of Health and Human Services and the Department of Justice (DOJ) have each taken actions that suggest an increasing appetite to examine the financial...more

House and Senate Appropriations Committees Approve Funding Bills with Riders Targeting DOL, NLRB Initiatives

Both the House and Senate Appropriations Committees advanced bills this week to fund various federal agencies for FY 2016. Each chamber approved versions of spending measures that include riders prohibiting funding for a...more

Beyond Ebola: Environmental Regulatory Issues Creating Business Risks for Health Care Providers

Business and legal risks to health care companies reach far beyond scientific uncertainties in the prevention protocols for infectious diseases due to lack of clarity among regulators with public health...more

New York Attorney General Pursues Dental Management Company for Corporate Practice Violation

Attorney General (AG) Eric Schneiderman announced a settlement With Aspen Dental Management (ADM). The Settlement Agreement requires ADM to pay $450,000 in Civil Penalties, after the AG found that the company was engaged in...more

Medicaid managed care proposed rule expands program integrity obligations

On June 1, 2015, the US Centers for Medicare & Medicaid Services (“CMS”) published its proposed rule on Medicaid managed care (CMS-2390-P). As noted in our two earlier advisories, which provided an overview of the proposed...more

NLRB Affirms Its Previous Decision Requiring Employer to Continue Providing Annual Wage Increases Beyond Contract Expiration

We previously blogged about the NLRB’s relatively shocking September 2012 decision in Finley Hospital (359 NLRB No. 9), in which the Board held that an employer was required to continue providing wage increases after the...more

Locke Lord QuickStudy: Duke Hit with Antitrust Suit for Non-Poaching Agreement with UNC

Universities and medical institutions in close geographic proximity may have faced the same issues as Duke and UNC when their faculties started departing for richer positions at the other’s campuses. With ever-increasing...more

Questionable Physician Compensation Agreements May Lead to Liability

The Office of the Inspector General (OIG) has recently been targeting physicians who enter into compensation arrangements such as medical directorships. Physicians need to be aware that while their compensation arrangement...more

North Carolina General Assembly Week in Review

The Senate budget process continued this week, though at a slower pace than members had planned for in the schedule released last month. Budget votes originally scheduled for Wednesday and Thursday of this week were delayed...more

Alert: Second Circuit Rules that "Product Hopping" May Constitute Unlawful Monopolization; Pharmaceutical Companies are Likely...

Recent antitrust challenges to pharmaceutical companies' efforts to transition patients from drugs nearing the end of their patent life to next-generation drugs have increased the risk of pursuing such "product hopping"...more

Blog: General Wellness Products: Will the FDA Regulate Your Medical App or Device?

In January 2015, the U.S. Food and Drug Administration (FDA) released its draft guidance on general wellness products, a reassuring indication that the FDA will focus its efforts on regulating higher risk products rather than...more

Physician Directorships the Focus of New Fraud Alert

On June 9, 2015, the Department of Health and Human Services Office of Inspector General (OIG) published a one-page fraud alert entitled, "Physician Compensation Arrangements May Result in Significant Liability." This is the...more

How to Keep What is Yours: Practical Considerations for Healthcare IT Protection

One of the worst kept secrets is the experienced and expected growth in healthcare IT. In 2013, over $650 million was invested into healthcare IT companies, and the trend is continuing to grow. Combined with the fact that...more

Investors Should Be Aware of an Interesting Blue Cross Antitrust Case

It was recently reported that Blue Cross and Blue Shield (BCBS), along with the Blue Cross Blue Shield Association, was sued across all states in a class action brought by two types of plaintiffs. One plaintiff class reflects...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

Competition News, June 2015

It is a cardinal rule of antitrust that – absent very limited exceptions – parties can do business, or refuse to do business, with whomever they choose. The Supreme Court solidified that premise in United States v. Colgate &...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

Impact of the Cigna Health Decision on the Use of the Merger Structure in Private Acquisitions

When buying a private company controlled by a private equity sponsor but with a substantial number of other shareholders, a common technique to avoid the need to obtain signatures from all the shareholders to a stock purchase...more

Insurer Seeks Declaratory Judgment Against Policyholder for Data Breach

Late last month, Columbia Casualty Company instituted a declaratory judgment lawsuit in the United States District Court for the Central District of California against its insured, Cottage Health System. Columbia Casualty...more

Insurer Escapes Antitrust Suit, But Hospital Must Continue the Fight

A large regional health insurer extricated itself from an antitrust suit, leaving the dominant local hospital to square off alone versus an ambulatory surgical center (ASC). The U.S. District Court for the Southern District...more

Blog: HIPAA FAQ Series: Are Covered Entities and Business Associates Required to Encrypt PHI?

The Health Insurance Portability and Accountability Act (HIPAA) mandates that both Covered Entities and Business Associates protect the security of Protected Health Information (PHI) in a variety of ways. Specifically,...more

Court Enjoins Outpatient Primary Care Physician’s New Employment as a Hospitalist

A Pennsylvania appellate court recently granted an employer’s request for enforcement of a restrictive covenant against a hospitalist, finding that his departure from the primary care office setting did not affect the terms...more

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