In This Issue:

- DO SUBSIDIZED HEALTH CARE PLANS PURCHASED UNDER THE AFFORDABLE CARE ACT TRIGGER THE ANTI-KICKBACK STATUTE?

The advent of federally subsidized private pay health insurance under the Affordable Care Act has the potential to expand the application of the federal anti-kickback statute beyond just Medicare, Medicaid, and Tricare. The Affordable Care Act (sometimes referred to as “Obamacare”) currently allows individuals to purchase and receive private health insurance coverage from state or federal health insurance exchanges. While not all individuals are eligible for subsidies, a substantial number of people will receive income-based federal subsidies that have the potential to trigger the federal anti-kickback statute, and by extension, the False Claims Act...

- LEGISLATION PERMITTING HEALTHCARE PROVIDERS TO NEGOTIATE JOINTLY WITH HEALTH INSURERS INTRODUCED IN CONGRESS:

Legislation was recently introduced by Representative John Conyers (D-Michigan) that would permit healthcare providers to negotiate jointly with health insurers concerning contract terms without running afoul of the antitrust laws. The bill, the “Quality Health Care Coalition Act of 2014,” (H.R. 4077), has been referred to the House Judiciary’s Subcommittee on Regulatory Reform, Commercial and Antitrust Law for further action...

- PEER REVIEW IS NOT ALWAYS PRIVILEGED:

Hospitals, ambulatory surgery centers and independent diagnostic centers cannot exist without physicians and other medical providers. In order to practice at those facilities, the medical professional often is required to be “admitted” to the medical staff of the facility. Although admission to the medical staff provides privileges, it often requires that the professional agree to a periodic competency review by other members of the medical staff – i.e. a peer review...

- HIPAA VIOLATION RESULTS IN $4.8 MILLION SETTLEMENT:

While most healthcare providers know to pay close attention to the HIPAA rules when setting up their information technology systems, recent events have demonstrated that this close scrutiny should also be applied to computer reconfigurations and other IT system changes. According to the Department of Health and Human Services Office for Civil Rights (“OCR”), a “reconfiguration” of a computer server involving two healthcare providers caused the health information of 6,800 patients to be disclosed to Internet search engines. The healthcare providers, New York-Presbyterian Hospital and Columbia University Medical Center, each entered into a settlement and a Corrective Action Plan with OCR requiring payment of $4.8 million to OCR...

- HHS HEAT INITIATIVE CONTINUES FRAUD CRACKDOWN:

A number of recent cases demonstrate Health and Human Services’ (“HHS”) Health Care Fraud Prevention and Enforcement Action Team’s (“HEAT”) continued success in cracking down on healthcare provider fraud. Since 2009, the federal government has recovered more than $12 Billion dollars under the False Claims Act from cases involving health care programs. Through the HEAT initiative, HHS has brought a number of False Claims Act cases against hospitals and physician groups resulting in several large settlements and verdicts. These cases typically arise in one of three ways: (1) the physician group or hospital self-reports the problem, (2) violations are discovered in the course of an investigation into another matter or entity, or (3) a person or entity brings a “qui tam” whistleblower suit against the group or hospital...

- TENNESSEE ATTORNEY GENERAL STATES THAT PHYSICAL THERAPISTS CANNOT PERFORM TRIGGER-POINT DRY NEEDLING:

In an opinion released on June 19, 2014, the Office of the Tennessee Attorney General stated that Physical Therapists cannot lawfully perform Intramuscular Manual Therapy or Trigger-Point Dry Needling. Dry Needling therapy involves application of a fine, filiform needles to the neuromusculoskeletal system to restore movement, reduce pain and address other musculoskeletal disorders. That practice, the Attorney General found, was similar to acupuncture – a separate branch of medicine...