Ober|Kaler - Health Law Group

Anatomy of a Provider-Merger Antitrust Challenge (Part 5)

This is the fifth 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 Procedure, Health, Mergers & Acquisitions

OIG Nixes Arrangements Involving Free Tests

Labs Attempt to Counter Exclusive Lab Arrangements - With increasing frequency, clinical laboratories have found themselves unable to receive any payments for tests performed for individuals whose third-party insurer…more
| Health, Science, Computers, & Technology

Open Season on Provider-controlled Licensing Boards

In a closely followed decision with significant consequences for state licensing boards and their members, the Supreme Court in North Carolina State Board of Dental Examiners v. Federal Trade Commission, 135 S. Ct. 1101 (2015),…more
| Administrative Law, Antitrust & Trade Regulation, Civil Procedure, Commercial Law & Contracts, Health

"Next Generation" ACO Model Announced by CMS

In a March 10, 2015 press release, CMS announced a new addition to its existing Accountable Care Model (ACO) portfolio: Next Generation ACOs. As stated by CMS in its press release, this new ACO model will allow for already…more
| Business Organizations, Health

ABN Flunks Medicare Test

In Int’l Rehab. Sci. v. Burwell, No. 08-cv-05442 (W.D. Wash. Feb. 13, 2015), the court found inadequate an advance beneficiary notice (ABN) which stated that “Medicare has not established coverage criteria... or does not cover…more
| Health

Selected CMS Guidance for Billing for Skilled Nursing Facility Services

Skilled nursing facilities (SNFs) should take note of the updates and clarifications set forth in Medlearn Matters article 8997, issued by the CMS on March 13, 2015. Medlearn Matters article 8997 updates the chapters in the…more
| Health

Anatomy of a Provider-Merger Antitrust Challenge (Part 4)

This is the fourth 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, Health, Mergers & Acquisitions

Medigap Deductible Discount Proposal Approved by OIG

The Office of Inspector General (OIG) recently issued Advisory Opinion 15-03 and concluded that a licensed provider (the Requestor) of Medicare Supplemental Health Insurance (Medigap) would not be sanctioned under the civil…more
| Administrative Law, Health, Insurance

Worthless Services Investigations and Settlements: The Enforcement Trend Continues

In recent years, state and federal governments have shown their willingness to criminally pursue skilled nursing home owners and operators for allegedly administering “worthless” or substandard quality of care to their…more
| Civil Remedies, Criminal Law, Government Contracting, Health

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
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