Innovation, regulation and evolution in the health care industry have all spawned complex business arrangements that span financial, operational and professional services issues. As with any other sophisticated business,...more
Like other players in the healthcare industry, physician groups are facing increased antitrust scrutiny from the Biden administration, with the Federal Trade Commission (the “FTC”) and Department of Justice, Antitrust...more
In this week's episode, Limo Cherian, Carla Dewberry, and Steve Pine discuss EKRA - the 'Eliminating Kickbacks in Recovery Act of 2018,' which introduces new criminal penalties for kickbacks associated with referrals to...more
Editor’s Note: There is considerable overlap in the nature and goals of the “alphabet soup” of network structures—Accountable Care Organizations (ACOs), Independent Practice Associations (IPAs), Clinically Integrated Networks...more
When a physician network or a multiprovider network lacks sufficient integration (either financial or clinical), agreements on price among the competing providers in the network must be avoided. One way to do this is through...more
As payment reforms, such as bundled payments and Accountable Care Organizations (ACOs), drive further provider collaboration to achieve lower costs with enhanced outcomes, post- acute providers, especially assisted living...more
Join us for an informative webinar to discuss: Healthcare Contracting -- Legal Issues and Practical Considerations Clinical Integration -- ACO's, Super Groups and Other Integration Structures Hospital...more
CMS has proposed significant changes in the Medicare physician self-referral (typically referred to as the “Stark Law”) regulations, including new compensation exceptions and several clarifications and refinements of existing...more
In Medical Center at Elizabeth Place v. Premier Health Partners et. al, Case No. 12-cv-26 (S.D. Oh. Oct. 20, 2014), the Southern District of Ohio held that previously-competing health care systems who join together in a...more
Remember when Hollywood wouldn’t show an unmarried couple in bed together? Blue Cross-Blue Shield of Illinois is taking that approach to contract negotiations. If hospitals want to negotiate jointly with the insurer, they...more
Medicaid plays a central role in financing mental health and substance use disorder (SUD) services, accounting for 26 percent of all spending on behavioral health services in this country. Medicaid beneficiaries with...more
Clinical integration is a somewhat imprecisely defined concept in the health care industry. Lawyers and health care executives have identified components and elements of clinical integration and frequently ask how many of...more
The Federal Trade Commission (FTC) has provided additional guidance, and comfort, to physicians seeking to clinically integrate for the purpose of, among other things, jointly negotiating payor contracts. This additional...more
In This Issue: - Norman PHO - Key Conclusions - Implications for Established and Newly Forming Networks - Excerpt from Norman PHO: The Norman PHO is comprised of a single hospital system and...more
The Federal Trade Commission (FTC) recently issued its first advisory opinion addressing clinical integration programs since the enactment of the Affordable Care Act (ACA). Without a doubt the advisory opinion is useful for...more
The Federal Trade Commission (FTC) provided its first guidance for clinically integrated networks since passage of the Affordable Care Act (ACA) and the joint FTC/DOJ Accountable Care Organization (ACO) Antitrust Policy...more
On February 13, 2013, the FTC issued an advisory opinion letter that it did not plan to challenge the proposed creation of the Norman Physician Hospital Organization (“Norman PHO”)—which includes approximately 280...more
In a February 13, 2013, advisory opinion, the Federal Trade Commission (FTC) Bureau of Competition stated that it has no present intention to recommend that the FTC challenge a clinical integration program (CIP) proposed by...more
FTC staff advisory opinions are not issued all that frequently and advisory opinions regarding clinical integration are issued even less frequently. The latest advisory opinion, issued last week, is therefore noteworthy, not...more
Since the passage of the Affordable Care Act (ACA), much attention has been paid to the antitrust treatment of Accountable Care Organizations, provider ventures contemplated by the ACA that the Federal Trade Commission and...more