Ober|Kaler - Health Law Group

The Pitfalls of Settling Qui Tam Lawsuits

In a recent federal court case, the federal government and the State of California successfully enforced an oral settlement agreement of a qui tam lawsuit against a health care provider. United States v. North East Medical…more
| Administrative Law, Civil Procedure, Civil Remedies, Government Contracting, Health

Anatomy of a Provider-Merger Antitrust Challenge (Part 3)

This is the third in a six-part series discussing the Federal Trade Commission's challenges to provider mergers. Following the initial Introduction and Background (Part 1), the series discusses The Need for Early Legal Advice…more
| Antitrust & Trade Regulation, Civil Remedies, Commercial Law & Contracts, Health, Mergers & Acquisitions

New and Improved RACs

During the CMS Hospital/Quality Initiative Open Door Forum call on February 24, 2015, CMS issued a 4-page document summarizing the improvements it has implemented to the RAC program. CMS introduced 20 changes to address concerns…more
| Health

Beginning April 1, HHA Payment Will Be Determined By CMS Generated Code Using OASIS Data

Payment for a particular home health agency (HHA) beneficiary’s episode of care is based on a Health Insurance Prospective Payment System (HIPPS) code. There are three sources for the HIPPS code and they do not always agree: (1)…more
| Health

Anatomy of a Provider Merger Antitrust Challenge (Part 2)

This is the second in a six-part series discussing the Federal Trade Commission’s challenges to provider mergers. Following the initial Introduction and Background (Part 1), the series discusses The Need for Early Legal Advice…more
| Antitrust & Trade Regulation, Mergers & Acquisitions, Health

Excluded Individual Not Precluded from Payment for Pre-exclusion Services

In Advisory Opinion 15-02 [PDF], issued February 9, 2015, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) looked favorably on the Requestor’s inquiry as to whether receipt of Federal health care…more
| Health

FTC Notches Yet Another Victory in a Provider Merger Case

On February 10, in Saint Alphonsus Medical Center-Nampa v. St. Luke’s Health System (St. Alphonsus), the U.S. Court of Appeals for the Ninth Circuit handed the Federal Trade Commission yet another provider-merger win…more
| Antitrust & Trade Regulation, Civil Procedure, Mergers & Acquisitions, Health

OIG Approves Free Diapers and Playpen in Connection with Medicaid Program Promoting Pre- and Post-Natal Care

On January 26, 2015, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued an advisory opinion approving an entity’s practice of advertising and providing free diapers and free portable playpen…more
| Health

Anatomy of a Provider Merger Antitrust Challenge (Part 1)

There seems to be unprecedented antitrust interest in mergers between health-care providers, particularly by the Federal Trade Commission (FTC or Commission). Why this interest? What triggers governmental interest? What are the…more
| Antitrust & Trade Regulation, Health, Mergers & Acquisitions

HHS Identifies Specific Goals to Move Toward Paying for Quality of Care

On January 26, 2015, the U.S. Department of Health and Human Services (HHS) announced a new initiative to shift Medicare reimbursements from volume to value using new payment methodologies for physicians and hospitals. Such a…more
| Health

Expedited Licensure Process Supports the Continued Growth of Telemedicine

All signs show that the use and acceptance of telemedicine within the health care industry is growing. Until recently, state medical boards were not as quick to support the provision of medical services across state lines…more
| Health

Preparing for an Active Shooter Incident in a Health Care Facility

The Ober|Kaler Health Care General Counsel Institute presented this webinar discussion of key considerations in addressing an active shooter situation, including specific considerations within health care facilities. Not only is…more
| Health

Paperwork Burden Eased in CMS Voluntary Self-Referral Disclosure Protocol Filings

In late December 2014, CMS made a small change to its voluntary Self-Referral Disclosure Protocol (SRDP) to help reduce some of the paperwork burden associated with filing under the SRDP. Section 6409 of the Affordable…more
| Health

OIG Approves Nonprofit Foundation's Proposed Copayment Assistance Program

On January 5, 2015, the OIG posted a favorable advisory opinion, OIG Advisory Opinion 14-11, regarding a 501(c)(3) charitable foundation’s (Foundation) proposal to establish a patient assistance program that would provide…more
| Health, Nonprofit Law

OHCQ Mandates Submission of Policies on Resident Access to Medical Records

Maryland nursing homes must submit their policies and procedures for resident access to and requests for medical records to the Maryland Department of Health and Mental Hygiene's Office of Health Care Quality (OHCQ) by February…more
| Consumer Protection, Privacy, Health
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