Commercial Law & Contracts, Insurance, Health Law

Groundhog Day for Tuomey: Jury Finds Hospital Violated Stark Law and False Claims Act

by Darby C. Allen, Donna S. Clark | BakerHostetler on 5/22/2013

On May 8, 2013, a jury in the Columbia Division of the U.S. District Court for the District of South Carolina returned a verdict finding that Tuomey Healthcare Systems, Inc. (Tuomey) violated the Stark Law and the federal...more

Retired County Employees Can Amend Their Complaint In An Attempt To Prove Existence Of A Contract for Health Benefits

by Laura Izon Powell, Bruce A. Scheidt, Kristianne Seargeant, David W. Tyra | Kronick, Moskovitz, Tiedemann & Girard on 5/22/2013

In 2008, the Sonoma County Board of Supervisors (“County”) acted to cap the county’s contributions for health care benefits for retired employees at $500 per month. The Sonoma County Association of Retired Employees...more

Rx for HIPAA Compliance

by Mintz Levin - Privacy & Security on 5/20/2013

Weighing in at half the length of Tolstoy’s legendary tome War and Peace, it is no surprise that the thought of the impending deadline for compliance with the 538-page HIPAA Omnibus Rule has left many small clinical...more

Health Law Alert: OIG Issues Updated Special Advisory Bulletin On The Effect Of Exclusion From Participation In Federal Health...

by Jessica Kracl, Sheva J. Sanders | Leonard, Street and Deinard on 5/17/2013

On May 8, 2013, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) issued an updated Special Advisory Bulletin on the effect of exclusion from participating in federal health care programs....more

Insurance Recovery Law -- May 16, 2013

by Manatt, Phelps & Phillips, LLP on 5/17/2013

In This Issue: Prepare For A Storm of Lawsuits; To Ensure Coverage, Read Policy Carefully; and Ticketmaster Wins Reversal, Possible Coverage For Class Action Over Ticket Fees ...more

SuperVision Today - 2nd Quarter 2013

by Erin Jones Adams, R. Scott Adams, Alyesha Asghar Dotson, Carrie Harris, Eric W. Iskra, Eric E. Kinder, Richard Wallace | Spilman Thomas & Battle, PLLC on 5/16/2013

In This Issue: - Notes from the Chair & Executive Editor - The Board Plays On: The NLRB Clarifies Its Position on At-Will Disclaimers - Interns This Summer? Evaluating Your Unpaid Internship Programs...more

Updated OIG Bulletin on Effect of Exclusion from Federal Health Care Programs

by Thompson Coburn LLP on 5/15/2013

On May 8, 2013, the U.S. Department of Health & Human Services, Office of Inspector General (“OIG”), issued an updated “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs”...more

NC Governor Signs Law Banning Most Favored Nations Provisions in Health Care Contracts

by Jonathan Lewis, Lee Simowitz | BakerHostetler on 5/14/2013

Despite opposition and Blue Cross Blue Shield of North Carolina’s claim that it “has not used ‘most favored nation’ clauses in [its] new contracts and in fact [they are] not part of our strategy to use those clauses on...more

Five Takeaways from the OIG’s Special Advisory Bulletin on Exclusion

by Ellyn L. Sternfield | Mintz Levin - Health Law on 5/13/2013

This week the Office of Inspector General for the Department of Health and Human Services (“OIG”) issued an updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs, an...more

Absent a Contract With the Provider, HMOs Are Not Liable for Unpaid Services

by Michael Klein | Sedgwick LLP on 5/10/2013

On April 19, 2013, the Texas Supreme Court handed down its opinion in Christus Health Gulf Coast, et al. v. Aetna, Inc. et al. The court’s ruling put an end to the so-called “double pay” theory of liability by downstream...more

OIG Revises Special Advisory Bulletin on Exclusions

by Howard Young | Morgan Lewis on 5/10/2013

OIG continues its aggressive interpretation of scope and effect of exclusion from participation in Federal health care programs and clarifies several open questions....more

PODs Beware: OIG Releases Special Fraud Alert

by Matthew Murer | Polsinelli on 5/10/2013

The Office of the Inspector General (OIG) released a Special Fraud Alert on March 26, 2013 warning that physician-owned distributorships (PODs) are "inherently suspect" under the Anti-Kickback Statute (AKS). Generally...more

In North Carolina, Will There Be “Freedom to Negotiate Health Care Rates”?

by Jonathan Lewis, Lee Simowitz | BakerHostetler on 5/9/2013

Despite opposition and the claim from BlueCross BlueShield of North Carolina that it “has not used ’most favored nation’ clauses in [its] new contracts and in fact [they are] not part of our strategy to use those clauses on...more

Checklist for Timely Compliance with HIPAA Omnibus Rule

by Lori Oliphant | Winstead PC on 5/7/2013

The deadline for compliance with the new HIPAA Omnibus Rule is looming for group health plans. As explained in a prior blog, stiff penalties may be imposed on employers whose plans fail to comply. Accordingly, employers...more

Massachusetts Mandates Prompt Investigation, Encourages Insurers to Offer Deadline Extensions to Bombing Victims

by Richard Bennett | Cozen O'Connor on 5/3/2013

On Monday of this week, the Massachusetts’s Division of Insurance issued a bulletin mandating prompt investigation of business interruption, property damage and medical insurance claims by policyholders victimized by the...more

Insurance Antitrust Legal News - May 2013 • Volume 2, Number 3

by James M. Burns | Dickinson Wright on 5/2/2013

In This Issue: - STATE EFFORTS TO RESTRICT HEALTH INSURER USE OF “MOST FAVORED NATION” CLAUSES IN PROVIDER CONTRACTS CONTINUE TO MULTIPLY: Over the last several years, several states have considered legislation...more

HIPAA Task Force – May 2013

by Jennifer Spiegel Berman, Molly E. G. Ferraioli, Thora A. Johnson, Jessica Kuester, Peter Parvis | Venable LLP on 5/2/2013

In this issue: - What Your Business Needs To Do About Hipaa — Now - Action Items for Covered Entities and Business Associates (including Subcontractors) - Changes Impacting Business Associates (including...more

OIG and CMS Issue Proposals to Extend Safe Harbor and Exception for EHR Donations

by Darby C. Allen, Donna S. Clark | BakerHostetler on 4/22/2013

In the April 10 Federal Register, two agencies within the U.S. Department of Health and Human Services published proposed rules that many healthcare providers have been anxiously awaiting affecting donations of electronic...more

CMS and OIG Issue Proposed Rules Modifying the Stark Exception and Anti-Kickback Safe Harbor for Donation of EHR

by C. Frederick Geilfuss II, Shilpa Patel, Richard Rifenbark, Donald H. Romano | Foley & Lardner LLP on 4/19/2013

On April 10, 2013, the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) each published proposed rules in the Federal Register...more

340B Drug Pricing Program: Recent Developments

by Elizabeth Elson, Anil Shankar | Foley & Lardner LLP on 4/19/2013

The 340B Drug Pricing Program (340B Program) continues to undergo a period of intense scrutiny and debate over how compliance with program rules is enforced. As previously reported in the May 30, 2012 edition of Foley’s Legal...more

HHS Office of Inspector General Issues Updated Self-Disclosure Protocol

by Ropes & Gray LLP on 4/19/2013

On April 17, 2013, the Office of Inspector General of the Department of Health and Human Services (“OIG”) released an Updated Provider Self-Disclosure Protocol (“SDP”). The Updated SDP replaces OIG’s original Provider...more

CMS Creates "Open Payments" Website For Reporting Under The Physician Payment Sunshine Act

by Thomas Donohoe, Lauren Groebe, Lindsay Kessler, Matthew Murer | Polsinelli on 4/18/2013

On April 12, 2013, the Center for Medicare and Medicaid Services (“CMS”) created the “Open Payments” website where reported information under Section 6002 of the Affordable Care Act (“ACA”), commonly referred to as the...more

CMS Officially Launches National Physician Payment Transparency Program Website

by Karen S. Lovitch, Kate Stewart | Mintz Levin - Health Law on 4/16/2013

The Centers for Medicare & Medicaid Services (“CMS”) recently launched the National Physician Payment Transparency Program: OPEN PAYMENTS website, which provides Sunshine Act compliance resources, including Fact Sheets and...more

When Most-Favored Is Disfavored: A Counselor’s Guide to MFNs

by W. Stephen Smith | Morrison & Foerster LLP on 4/3/2013

Originally published in the American Bar Association on April 1, 2013. The U.S. Antitrust Agencies Have turned the spotlight on most-favored-nation (MFN) clauses. The Department of Justice is currently litigating two...more

HIPAA’S FINAL RULE: Putting Things in Perspective – Comments from OCR

by Patricia Shea | K&L Gates LLP on 4/2/2013

On March 22, 2013, Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) Director Leon Rodriguez presented the keynote address to attendees of the American Health Lawyers’ Association HIPAA/HITECH Conference in...more

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Commercial Law & Contracts › Insurance › Health Law