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Alert: 340B Self-Audits: The Best Defense Is A Good Defense

Federally qualified health centers (FQHCs) participating in the 340B Drug Pricing Program (the “340B Program”) are subject to audits by Health Resources and Services Administration (HRSA) and the drug manufacturers who...more

OIG Issues (Another) Favorable Advisory Opinion Regarding Medigap/Preferred Hospital Network Arrangement in Advisory Opinion 16-01

On January 7, 2016, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 16-01, approving yet another insurer’s proposed contract with a preferred hospital network. The...more

Blood on the Tracks Hits No. 1 and the Lessons Learned from SciClone

On this week in 1975, Bob Dylan’s 15th studio album, Blood on the Tracks, reached the Number 1 album slot on the Billboard charts. This was in spite of no song rising above the 31st slot on the single charts. It came out in...more

Senate Bill Would Strengthen Mandate That People With Disabilities Be Integrated in the Community

Senator Charles Schumer (D-NY) recently introduced the Disability Integration Act of 2015 (DIA) in the U.S. Senate. If passed, the bill would require states and health insurers to provide services to people with disabilities...more

DOJ Reaches $3.28 Million Stark Settlement with San Diego Hospital

Tri-City Medical Center will pay $3.28 million to settle alleged Stark Law violations that stemmed from financial arrangements with its former chief of staff and paperwork problems in more than 90 of its physician agreements....more

Healthcare Regulatory Diligence: “What Does it Mean to Financial Underwriting?”

It’s deal time! The 2016 JP Morgan Healthcare Conference has set the tone for another successful year for healthcare investing. A company’s financial health is a key factor in the underwriting process for any type of loan...more

Employee Benefits Developments - January 2016

IRS Guidance Addresses Numerous ACA Issues Related to HRAs. Just before the New Year, the IRS issued Notice 2015-87 (Notice), addressing the application of Affordable Care Act (ACA) market reform rules to different...more

New York State Requires PBM Contracts to Include a Mechanism for Appealing Disputes Related to Generic Drug Pricing

On December 11, 2015, Senate Bill 3346-B[1] was signed into law by New York State Governor Andrew Cuomo. The new bill requires contracts between pharmacy benefit managers (“PBMs”) and pharmacies (or pharmacies’ contracting...more

Four Questions to Ask before Disclosing (or Withholding) PHI in Transaction Due Diligence

HIPAA’s restrictions on the use or disclosure of protected health information (“PHI”) by a covered entity or business associate may be familiar to many in healthcare. Also familiar may be the exception that allows covered...more

Health Net And Other Payers Ramp Up Audits Against Addiction Treatment Providers

Over the past several months, we have seen a tremendous amount of payer attention directed at addiction treatment providers. Payers are sending increasing numbers of requests seeking a range of medical records, billing...more

Are Referral Sources Protectable Under Florida Law?

The question of whether referral sources constitute legitimate, protectable business interests under Florida's Covenants Against Unfair Competition statute, Fla. Stat. § 542.335 (2014), is likely heading to the Florida...more

Generators of Regulated Medical Waste in New Jersey Must Meet Federal Standards After Preemptions

Generators of regulated medical waste (RMW) in New Jersey may need to revise their handling, marking and storage practices and procedures to meet federal hazardous materials requirements (49 CFR parts 171-180) (the federal...more

Florida 5th DCA Says Referral Relationships Not Protectable

A recent case out of Florida’s Fifth District Court of Appeals raises important raises important issues related to physician non-compete agreements. Let’s take a look: Before addressing the specifics of this case, some...more

Will Your Form of Resident’s Agreement Hinder Potential Eviction?

When a tenant in an independent living community fails to pay rent, an operator will want to remove the tenant as quickly as possible with the fewest administrative hurdles. If a residency agreement does not specify the...more

Highlights of Substantial Tax Changes in the Consolidated Appropriations Act, 2016

Expiring tax provisions and “extenders” legislation have become fairly common in recent years. The typical pattern involves institution of one- or two-year provisions (short-lived due to revenue issues) that have expired with...more

Public disclosure bar prohibits "bounty-hunting" relators from filing duplicative FCA claims

The United States Court of Appeals for the Seventh Circuit has issued an opinion that underscores the importance of the "public disclosure bar" in False Claims Act (FCA) litigation. The court affirmed a lower court’s...more

Illinois Appellate Court Finds Hospital Property Tax Exemption Statute Unconstitutional

In a 46-page decision issued yesterday by the 4th District Appellate Court, a recently enacted provision of the Illinois Property Tax Code, Section 15-86, has been found unconstitutional. Section 15-86 created a separate...more

eCommerce Regulation, Bitcoin, Anti-Money Laundering, Shadow Insurance, 401(k) Litigation [Expect Focus – Vol. IV, Fall 2015]

IN THE SPOTLIGHT - - California Passes Life and Annuity Electronic Transactions Law LIFE INSURANCE - - Under a Spotlight, "Shadow Insurance" Lawsuit Fails Scrutiny - NAIC Evaluates Insurer’s Use of Variable...more

2015 – The Health Law Year in Review

With 2015 in the books, we are pleased to reflect on some of the major developments over the past year in the field of health law. The year was marked by changes in Medicare payment models—from government pronouncements...more

States Launch Hearings on Major Insurance Company Mergers

This summer, in the space of only a few weeks, Aetna announced an intention to acquire Humana, followed by an announcement by Anthem that it was planning to merge with Cigna. As was widely reported at the time, if...more

Federal Spotlight Continues to Shine on Physician-Owned Distributorships

A recent Senate Finance Committee hearing investigated the effects of physician-owned distributorships (“PODs”) on costs of care and patient safety, suggesting that the momentum for greater oversight of such business...more

Obama Signs Omnibus Budget Bill that Includes $622 Million in Tax Extenders

On December 18, 2015, President Obama signed the Protecting Americans from Tax Hikes Act of 2015 (the “PATH Act”) after both houses of Congress voted to approve the budget measure and comprehensive spending bill. The PATH Act...more

Solomon Center Inaugural Conference Explores Implications of Healthcare Consolidation Under the Affordable Care Act

On November 13, the Solomon Center for Health Law and Policy at Yale Law School held its inaugural conference, "The New Healthcare Industry: Integration, Consolidation, Competition in the Wake of the Affordable Care Act." The...more

A Purchaser’s Guide for Preparing a Closing Checklist in a Skilled Nursing Home Property Acquisition

Prior to acquiring any real estate, which will be operated as a skilled nursing facility (“SNF”), a purchaser should perform a thorough due diligence investigation as to any material facts or issues relevant to the intended...more

National Association of Insurance Commissioners Updates Model Network Adequacy Law to Address Narrow Networks and Surprise Bills

On November 22, 2015, the National Association of Insurance Commissioners (“NAIC”) approved an updated version of its Managed Care Plan Network Adequacy Model Act, now known as the Health Benefit Plan Network Access and...more

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