Ober|Kaler - Health Law Group

OIG Approves Home Health Provider's Free Introductory Visit Policy

On August 6, 2015, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued an advisory opinion approving a for-profit home health provider’s policy to offer free introductory visits to patients…more
| Health

Danger Ahead? The Yates Memo and Some Strategic Considerations for Corporations and Individuals

If you are a corporate executive or employee, the U. S. Department of Justice has a message for you: Investigating you for potential misconduct is clearly a top priority. Recently, the DOJ issued a policy memorandum (Yates…more
| Business Organizations, Business Torts, Criminal Law, Health

Court Upholds CMS Treatment of Multi-Campus Hospitals as Single Entities for Wage Index Purposes

The United States Court of Appeals for the District of Columbia recently upheld the decision of the Secretary of Health and Human Services (Secretary) that a multi-campus hospital straddling two geographic areas should be…more
| Health

Only One Short Bite of the Apple: Change in the Medicare Enrollment Appeals Process

In keeping with the trend to strengthen its authority to deny an enrollment or revoke Medicare billing privileges, CMS has modified the appeals process in a manner that will significantly shorten the time allotted to mount an…more
| Administrative Law, Civil Procedure, Health

Drastic Changes in "Patient" Definition as HHS Releases the Long-Awaited Proposed 340B Omnibus Guidance

After years of fits and starts, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) has finally released its proposed omnibus guidance for the 340B Drug Discount…more
| Health, Science, Computers, & Technology

CMS Prevails in Dual Eligible Bad Debt Challenge

In a decision handed down on August 7, 2015, the United States Court of Appeals for the District of Columbia Circuit upheld the denial of the providers' bad debt claims associated with dual eligible beneficiaries. Grossmont…more
| Civil Procedure, Health

Value-Based Payments Transition to Post-Acute Care: The FY 2016 Skilled Nursing PPS Rule

CMS published the final FY2016 Skilled Nursing Facility Prospective Payment System rule on August 4, 2015. In addition to updating the overall payment rate, the new rule implements key features of the Protecting Access to…more
| Health

Federal Trade Commission Guidance Addresses Stand-alone Claims of Unfair Competition Under Section 5 of the FTC Act

Section 5 of the FTC Act, in effect since 1914, authorizes the FTC to pursue claims of unfair competition beyond the reach of both the Sherman and Clayton Acts. 15 U.S.C. § 45(a)(1). Until now however, the FTC has been reluctant…more
| Antitrust & Trade Regulation, Commercial Law & Contracts, Consumer Protection, Health

Antitrust Enforcement Agencies Release Annual Report Summarizing 2014 Merger Enforcement Activity Under Hart-Scott-Rodino

The Hart-Scott-Rodino Antitrust Improvements Act (HSR) requires parties to a proposed acquisition of voting securities or assets meeting certain size threshold requirements to report the transaction to the Federal Trade…more
| Antitrust & Trade Regulation, Health, Mergers & Acquisitions

OIG Approves Limited, Free Drug Program

On August 12, 2015, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 15-11, approving two pharmaceutical manufacturers’ free starter drug program. Citing the limited scope…more
| Health, Science, Computers, & Technology

CMS's "At a Collection Agency" Bad Debt Policy - Confusion Continues

As we reported in previous Payment Matters articles, the United States District Court for the District of Columbia has issued inconsistent opinions regarding Medicare's policy not to allow bad debt when that bad debt is still at…more
| Administrative Law, Civil Procedure, Health

Home Health, CY 2016 Proposed Rule: Emphasis on Value-Based Purchasing

On July 10, 2015, CMS published the calendar year (CY) 2016 home health prospective payment system (PPS) proposed rule [PDF]. While the proposed rule updates and revises certain payment rates and quality measures, it also places…more
| Health

CMS Issues FY 2016 Final Inpatient and Long-Term Care Hospital Rule

On July 21, 2015, CMS issued a final rule updating the fiscal year (FY) 2016 Medicare payment polices and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment…more
| Health

District Court Issues First Decision Interpreting ACA's 60-day Rule

The first case to interpret when the clock begins to run on the “60-Day Rule” did not go well for health care providers. On August 3rd, the Southern District of New York rejected defendants HealthFirst, Inc.’s and Continuum…more
| Government Contracting, Health

King v. Burwell: An Interchangeable Exchange

The Supreme Court ruled recently in favor of the Obama Administration and its defense of another provision of the Patient Protection and Affordable Care Act (ACA or the Act). King v. Burwell, No. 14-114 (U.S. June 25, 2015). The…more
| Constitutional Law, Health, Insurance, Taxation
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