Health Care Update – November 2011


In this issue;

- Illinois Trial Court Upholds Patient Safety Act Privilege Protection of Walgreens Patient Safety Work Product in Case of First Impression

- Health Care Practice and Attorneys Recognized in Chambers, Best Lawyers

- Health Care Litigator

- CMS Issues Final ACO Regulations

- Partner Michael Callahan Quoted in Chicago Tribune Regarding New Regulations Allowing More Liberal Hospital Visitation Policies

- Physician and Vendor Relationships: Operationalizing Compliance with the Stark and Anti-Kickback Laws

- Legal Liabilities of Social Marketing and Creating a Corporate Policy

- Compliance Lessons Learned from Recent Investigations & Transactions

An excerpt from CMS Issues Final ACO Regulations;

After receiving more than 1,300 public comments on its Proposed Rule for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program, CMS published its Final ACO Rule in the Federal Register on November 2. In addition, the FTC and DOJ filed their Final Statement of ACO Antitrust Enforcement Policy and CMS issued an Interim Final Rule with a 60-day comment period describing five separate fraud and abuse waivers applied to Stark, the Anti-Kickback Statute and the Civil Monetary Penalty laws. Finally, the IRS also issued Fact Sheet 2011-11 confirming Notice 2011-20 from April 18, 2011, on its expectations regarding ACOs participating in the Shared Savings Program.

As stated by CMS in the Final ACO Rule, the overall intent of CMS, the IRS, FTC and DOJ in modifying their respective rules and statements (collectively, the Final Rules) was to incorporate greater flexibility in terms of eligibility requirements, ACO governance and legal structure, the antitrust review process, and the timing for shared savings evaluations and repayment of losses. These standards also have reduced and simplified the quality performance standards, increased financial incentives to participate in an ACO, eliminated the downside risk and first-dollar sharing in the Track 1 shared savings model, increased the sharing caps and removed the 25% withhold requirement on shared savings.

Please see full update below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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