Appeals Healthcare

News & Analysis as of

Recent Ninth Circuit En Banc Decision Makes It Easier for Relators to be an Original Source and the First- to-File

On July 7, 2015, the United States Court of Appeals for the Ninth Circuit issued an en banc decision that potentially makes it easier for relators to prevail on pending False Claim Act qui tam suits and bring new actions in...more

Tuomey Judgment Upheld in Novel Stark Law and False Claims Act Case

The U.S. Court of Appeals for the Fourth Circuit recently upheld the judgment against Tuomey Healthcare System, Inc. (Tuomey), in a qui tam False Claims Act case predicated on Stark Law violations. The district court in the...more

"The Stark Law has become a booby trap…" Says the Federal Appeals Court. Why Health Care Providers Should Heed the Warning

After reading through the hundreds of pages of the District Court's and Appeals Court's decisions, including the recent Fourth Circuit Court of Appeals decision that was filed on July 2, 2015, one thing is certain: Mixing one...more

Fourth Circuit Upholds $237M Verdict Against South Carolina Hospital System for Stark Law Violations

On July 2, 2015, the United States Court of Appeals for the Fourth Circuit affirmed a $237 million judgment against Tuomey Healthcare System, Inc., in a federal False Claims Act (FCA) case arising out of violations of the...more

Tuomey’s Appeal of $237M False Claims Act Judgment Denied by the Fourth Circuit

In This Issue: - Background - Tuomey’s Second Appeal to the Fourth Circuit - The Trial Court’s Grant of a New Trial - Tuomey’s Request for Judgement as a Matter of Law on the Stark Law and FCA...more

Health Alert (Australia) - July 13, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: United Kingdom (UK) 7 July 2015 - Ross v A [2015] EWCOP 46 The England and Wales Court of Protection has held that a...more

Tax Court Finds that Non-Profit Hospital Does not Qualify for Property Tax Exemption

In a June 25, 2015 opinion in AHS Hospital Corp. v. Town of Morristown, Judge Bianco of the New Jersey Tax Court ruled, as a matter of first impression, that the Morristown Medical Center ("MMC"), a non-profit hospital, does...more

Health Law Wire: Court Invalidates DOH Retroactive Clinic Rate Changes (6/15)

The Appellate Division Fourth Department recently invalidated DOH’s attempts to retroactively revise Diagnostic & Treatment Center (D&TC) rates and upheld statutory requirements for 30 day advance notice of capital rate...more

Health Alert (Australia) - June 22, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: Victoria. Inquest Into the Death of Baby Chloe Lee Kellett - The Victorian Coroner investigated an infant's death from...more

Senate Committee Passes Bill Addressing Medicare Appeals Inefficiencies

On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more

Fired Nurse Loses Whistleblower Suit over Suspected Drug Use

A federal appeals court recently affirmed the dismissal of a whistleblower-retaliation suit against a Maine nursing home, holding that the plaintiff employee failed to prove that she was fired for telling her supervisor she...more

Emergency Physicians Ostensible Agents of Hospitals?

n Whitlow v. Rideout Memorial Hospital, plaintiffs alleged that the hospital should be held responsible in a wrongful death suit for the actions of an emergency room physician who had failed to diagnose and treat a brain...more

Washington Healthcare Update

This Week: House Ways & Means Committee Holds Markup; Makes Significant Legislative Changes to Health Care Bills... Senate Finance Committee Holds Markup on Medicare Appeals Process Bill... CMS Issues Final Rule on...more

Unfair Business Practices – Hospital’s “Facility Fee” Billed To New Patients

Justin Nolte et al., v. Cedars Sinai Medical Center - Court of Appeal, Second Appellate District (May 21, 2015) - Generally, a business practice is unfair if it violates established public policy or if it is...more

When a Custodian of Records Has a Fifth Amendment Privilege

In a recent decision, the U.S. Court of Appeals for the Third Circuit held that a physician acting as custodian of records may not withhold records subpoenaed from his professional association on Fifth Amendment...more

Court Enjoins Outpatient Primary Care Physician’s New Employment as a Hospitalist

A Pennsylvania appellate court recently granted an employer’s request for enforcement of a restrictive covenant against a hospitalist, finding that his departure from the primary care office setting did not affect the terms...more

Senate Finance Committee Holds Hearing Regarding Medicare Appeals Backlog

On April 28, 2015, the Senate Finance Committee held a hearing titled “Creating a More Efficient and Level Playing Field: Audit and Appeals Issues in Medicare.” The hearing included testimony from Office of Medicare Hearings...more

New CMS Ruling on DSH Appeals for FY 2004 and Earlier

It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued...more

Supreme Court Rules That Providers and Suppliers Cannot Challenge Medicaid Reimbursement Rates in Federal Court

On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more

Laypersons’ Observations of Hospital Staff’s “Lack of Urgency” in Treating Relative Sufficient to Sustain Claim for Negligent...

In Keys v. Alta Bates Summit Medical Center (filed 2/23/2015, certified for publication 3/25/2015, No. A140038) the California Court of Appeal, First District, affirmed a jury verdict for Plaintiffs on a cause of action for...more

Should Health Care Providers Pay Attention to the Seventh Circuit’s New Definition of “Referral”? – Part One

The Seventh Circuit Court of Appeals, in the case of United States v. Patel, just expanded the definition of “referring” under the federal Anti-Kickback Statute (“Statute”). In light of this case, health care providers should...more

FAR Part 12 Applies to CMS Orders on Federal Supply Schedule Contract

On Tuesday, March 10, 2015, the Court of Appeals for the Federal Circuit reversed and remanded a decision by the Court of Federal Claims, which permitted the Centers for Medicare and Medicare Services (CMS) to include...more

Appellate Court Notes

SC18928 - Rathbun v. Health Net of the Northeast, Inc. - In Connecticut, the Department of Social Services manages the federal Medicaid act and awards contracts to Medicaid managed health care providers. The defendant...more

A Cautionary Note On That "Companionship Services" Rule

As we have previously reported, a federal district court for the District of Columbia recently vacated new U.S. Department of Labor regulations promulgated under the Fair Labor Standards Act, which (1) barred third-party...more

Ninth Circuit Affirms Divestiture of Consummated Physician Practice Acquisition

The U.S. Court of Appeals for the Ninth Circuit affirmed an Idaho federal district court’s decision ordering the divestiture of a physician practice group that had been acquired by a competing health system. The case, which...more

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