Ober|Kaler - Health Law Group

CMS Announces Plans to Streamline the Stark Self-Referral Disclosure Protocol

On May 6, 2016, CMS published a notice (Notice), required under the Paperwork Reduction Act (PRA), seeking public comment on its plans to revise the information collected under the Medicare Self-referral Disclosure Protocol…more
| Administrative Law, Health

OIG Updates Permissive Exclusion Criteria – Suggests Compliance Programs Are Expected

On April 18th, the Office of Inspector General (OIG) issued updated guidance describing the factors it will consider in determining whether to exercise its permissive authority to exclude individuals and entities from federal…more
| Administrative Law, Government Contracting, Health

Another Medigap/Preferred Hospital Network Arrangement Approved by OIG in Advisory Opinion 16-05

On May 3, 2016, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued another favorable advisory opinion, No. 16-05 [PDF], regarding an agreement between a Medicare Supplemental Health…more
| Health

Is This the Beginning of an End to a Long Controversial Debate on Concurrent Surgeries?

Concurrent Surgeries and National Spotlight According to recent guidelines published by the American College of Surgeons (ACS) as Statements on Principles, concurrent (or simultaneous) surgeries occur when “the critical or…more
| Health

NLRB Slams Hospital for Maintaining Work Rules Prohibiting Employees From Engaging in "Improper Conduct"

Over the past several years, employers have been bombarded with news about the National Labor Relations Board (NLRB) and its ever expanding control over employers’ internal workplace policies. In fact, just a few years ago, the…more
| Health, Labor & Employment Law

Physician Payment: CMS Proposes Quality Payment Program, Advanced APMs, and Merit-Based Incentive Payment System

CMS published its 426 page proposed rule on the Quality Payment Program (QPP) – the successor to oft-maligned Sustainable Growth Rate adjustment – on May 9, 2016. The QPP will adjust physician and mid-level provider…more
| Health

D.C. District Court Resolves Challenge to Medicare's Outlier Payment Rules for Banner Health v. Burwell

On March 31, 2016, Judge Colleen Kollar-Kotelly of the United States District Court for the District of Columbia (the “D.C. District Court”) issued a highly anticipated memorandum opinion settling what will probably be the final…more
| Administrative Law, Health

OIG Approves Another Medigap/Preferred Hospital Network in Advisory Opinion 16-04

On April 18th, the OIG issued a new favorable Advisory Opinion, No. 16–04, regarding an agreement between a Medigap insurer and preferred hospital network. The opinion tracked other, similar opinions in favorably addressing…more
| Health

Comprehensive Primary Care Plus Model: Today's Alternative Payment Model for Primary Care Providers Could Be Tomorrow's Obligatory Payment Model

In an effort to affect how approximately 25 million Medicare beneficiaries and other commercial insurance patients receive primary care services, the CMS Innovation Center (the "Innovation Center") announced the Comprehensive…more
| Health

CMS's Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways

On April 18, 2016, CMS released its proposed rule addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), for…more
| Health

Jury Sides with Defendant in Whistleblower's Suit Alleging Defendant "Caused" False Claims

Abbott Laboratories recently won a jury verdict in a high profile qui tam lawsuit alleging that Abbott “caused” health providers to submit false Medicare payment claims for off-label use of biliary stents. U.S. ex rel. Colquitt…more
| Business Torts, Civil Procedure, Government Contracting, Health

Proposed Changes to the Part 2 Regulations: Another Example of Necessary Flexibility in the Wake of Changes to Health Care Delivery

On February 9, 2016, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a proposed rule to update and modernize the Confidentiality of Alcohol and Drug Abuse Patient Records regulations governing…more
| Consumer Protection, Health, Privacy

Yet Again, OIG Approves Medigap Policy Contracts with Preferred Hospital Network

On March 11, 2016, the U.S. Department of Health & Human Service, Office of the Inspector General (OIG) issued an advisory opinion approving the use of a preferred hospital network as part of Medicare Supplemental Health…more
| Health, Insurance

Medicare Appeals 10-Year Backlog: D.C. Circuit Signals Enough is Enough

Issued within a month of one another, two cases regarding the Medicare appeals backlog reached opposite conclusions, providing a circuit-split. The first case from the D.C. Circuit, signaling a major shift toward judicial…more
| Administrative Law, Civil Procedure, Health

Recent Enforcement Under Section 5 of the FTC Act: So That's What a Standalone Claim of Unfair Competition Looks Like

Last August, the Federal Trade Commission issued its Statement of Enforcement Principles Regarding “Unfair Methods of Competition” Under Section 5 of the FTC Act (Statement), in an effort to provide clarity with respect to the…more
| Antitrust & Trade Regulation, Commercial Law & Contracts, Health
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