Insurance, Health Law

Justice Department Lawsuit Reveals Roadmap to Avoid False Claims Act Liability

by James Holloway | Ober|Kaler on 5/23/2013

Earlier this month, the Justice Department filed a lawsuit against Vitas Hospice Services, LLC, and related entities, alleging that Vitas fraudulently billed the Medicare program in violation of the False Claims Act (FCA)....more

OIG's Special Advisory Bulletin on the Effect of Exclusion—Continuing the Focus on Individual Accountability

by George Breen, Jonah Retzinger, Carrie Valiant | Epstein Becker & Green, P.C. on 5/23/2013

On May 8, 2013, the U.S. Department of Health and Human Services' Office of Inspector General ("OIG") released an Updated Special Advisory Bulletin on the Effect of Exclusion from the Participation in Federal Health Care...more

Healthcare Law -- May 21, 2013

by Manatt, Phelps & Phillips, LLP on 5/22/2013

Clearing up the Rumors around Health Reform Delays: What Really Happened, What Won’t and Steps Employers and Insurers Can Take Now - Rumors are flying in health policy circles that the Obama Administration might delay...more

Exclusions: OIG Offers Relationship Counseling to Providers

by Summer Swallow | BakerHostetler on 5/22/2013

On May 8, 2013, the U.S. Department of Health and 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

CMS Issues Final MLR Rule for Medicare Advantage and Part D Programs

by Roy M. Albert, Susan Berson | Mintz Levin - Health Law on 5/22/2013

Last week, CMS published a final rule implementing the ACA’s medical loss ratio (“MLR”) requirements that will apply to the Medicare Advantage (Part C) and prescription drug (Part D) programs beginning in contract year 2014. ...more

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

U.S. Department Of Labor Issues Model Notices Of Health Insurance Options

by Michael N. Morea | Cole Schotz on 5/22/2013

By October 1, 2013, most employers will be required to provide their current employees and new hires with notices of health insurance options. The notice is required to, among other things, inform employees of the existence...more

The Employer's Playbook for ACA Compliance: Are You In The 2014 "Pay Or Play" Game?

by Dan S. Brandenburg, Sarah Lockwood Church, Joanne G. Jacobson, Paul Kasicky, Joni Landy, Kevin Wiggins | Saul Ewing LLP on 5/22/2013

For better or worse, the ACA or Health Care Reform is still with us. If you do not want to end up in the penalty box in 2014, you must know whether you are subject to the employer shared responsibility provisions of the ACA...more

CMS Prevails in DSH Challenge Involving Waiver-Expansion Days

by Thomas W. Coons | Ober|Kaler on 5/22/2013

Over the years, CMS and its contractors have wrestled with how days approved under a Medicaid demonstration project should be counted, if at all, for purposes of the Medicare disproportionate share hospital (DSH) calculation....more

CMS Updates Manual to Reflect Ambulance Fee Schedule Reduction for Non-Emergency BLS Transports of Patients With ESRD

by King & Spalding on 5/22/2013

On May 10, 2013, CMS issued a transmittal clarifying the requirement in Section 637 of the American Taxpayer Relief Act of 2012 (ATRA) that ambulance payments for non-emergency basic life support (BLS) transports for end...more

Act Now Advisory: Important Affordable Care Act Deadline: Employee Notices of the Health Insurance Marketplace (Exchange) Due by...

by Michelle Capezza, Gretchen Harders | Epstein Becker & Green, P.C. on 5/22/2013

On May 8, 2013, the Employee Benefits Security Administration of the U.S. Department of Labor ("DOL") issued Technical Release No. 2013-02 ("Release") providing important guidance under the Patient Protection and Affordable...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

Proper Disclosure and Documentation the Focal Point in New HIPAA and Medicare Rules

by Stacey Borowicz, Tyler N. Williams | Dinsmore & Shohl LLP on 5/21/2013

New HIPAA Rule Affects Providers’ Notice of Privacy Practices - The Health Insurance Portability and Accountability Act (“HIPAA”) requires health care providers to inform patients of the providers’ legal duties and the...more

Health Care Reform Blog: Bare Bones" Health Plans- Are They Legal?

by Susan J. Freed | Davis Brown Law Firm on 5/21/2013

You may have woken up today to media reports of large employers exploring the idea of dropping traditional health plans in favor of very limited health care plans as a way to lessen the burden imposed on large employers for...more

Florida Legislative Session 2013: Healthcare Summary

by Martin Dix, Steven Grigas, Bruce Platt, Sheryl D. Rosen | Akerman Senterfitt on 5/21/2013

The 2013 Florida Legislative Session concluded on May 3, 2013. The following is a partial summary of healthcare-related bills that may impact your business or practice. Note that some of these bills have become law, but...more

CMS Announces $1 Billion in Funding for Innovation Grants

by King & Spalding on 5/21/2013

On May 15, 2013, CMS released a funding opportunity announcement for round two of the Health Care Innovation Awards. The grants are administered by the CMS Innovation Center, which is authorized by the Affordable Care Act to...more

Health Care Reform Update -- May 20th, 2013

by Joseph P. Hammang, Alexander Hecht, Abby Matousek, Jeremy Rabinovitz | Mintz Levin - Health Law on 5/21/2013

In This Issue: Implementation of the Affordable Care Act; Other HHS and Federal Regulatory Initiatives; Other Congressional and State Initiatives; Other Health Care News; and Hearings and Mark-Ups...more

OIG Releases Updated Provider Self-Disclosure Protocol

by John T. Bentivoglio, Jennifer L. Bragg, Maya Florence, Michael K. Loucks, Gregory M. Luce | Skadden, Arps, Slate, Meagher & Flom LLP on 5/21/2013

On April 17, 2013, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services released an updated Provider Self-Disclosure Protocol (SDP). As self-described, OIG updated the SDP to...more

CMS Announces Additional Open Period for Bundling Model 1

by King & Spalding on 5/21/2013

On Friday, May 17, 2013, CMS announced that its Center for Medicare and Medicaid Innovation Center (Innovation Center) is providing an open period for additional organizations to be considered for participation in Model 1 of...more

RAC Relief (Sort Of)

by Paul Kim | Ober|Kaler on 5/21/2013

CMS announced that it would reduce the number of additional documentation requests (ADRs) available to its Recovery Audit Contractors (RACs). ...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

The Affordable Care Act's Marketplace Notice: What Employers Need to Know

by Katie Morton, Mary Turk-Meena, Lynne Shore Wakefield | K&L Gates LLP on 5/20/2013

On May 8, 2013, the Department of Labor (“DOL”) issued long-awaited guidance on the notice that must be provided to employees by October 1, 2013, the first day of the Health Insurance Marketplace open enrollment period (the...more

Affordable Care Act Standards Related to Essential Health Benefits, Minimum Value, Actuarial Value and Accreditation

by Erin Jones Adams | Spilman Thomas & Battle, PLLC on 5/20/2013

On February 25, 2013, the Department of Health and Human Services (HHS) released its final rule (the Final Rule) setting forth standards for health insurance issuers under the Patient Protection and Affordable Care Act (the...more

Obamacare Loophole Allows Large Employers To Offer Bare-Bones Health Plans

by Joe Conley on 5/20/2013

On May 20, 2013, the Wall Street Journal reported that many large employers are looking to comply with the Affordable Care Act’s (“ACA”) employer mandate by offering bare-bones coverage that does not even cover...more

NOIs Due Soon to Apply for 2014 ACO Program

by Sarah E. Swank | Ober|Kaler on 5/20/2013

The Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) established under the Affordable Care Act is about to kick-off its second year with a new round of applications for the January 1, 2014...more

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