Health Care Providers

News & Analysis as of

CMS Takes Action Against Network Transparency While New Jersey Legislation Hits a Snag

Just as the Centers for Medicare & Medicaid Services (CMS) began holding federal health care plans accountable for their provider network transparency obligations, the New Jersey legislature stalled in its bid to pass a law...more

Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network,...

The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The...more

Health Alert (Australia) - February 1, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Commonwealth. Administrative Appeals Tribunal 22 January 2016 - JLSP and Innovation Australia [2016] AATA 23 This...more

Blood on the Tracks Hits No. 1 and the Lessons Learned from SciClone

On this week in 1975, Bob Dylan’s 15th studio album, Blood on the Tracks, reached the Number 1 album slot on the Billboard charts. This was in spite of no song rising above the 31st slot on the single charts. It came out in...more

CMS Posts Revised Application for Meaningful Use Hardship Exceptions

On January 22, CMS posted a revised application and instructions for a hardship exception from the Meaningful Use program penalties in 2015. Under the new, streamlined application process, which CMS says is a temporary...more

Important Changes for Physicians from the 2016 Medicare Physician Fee Schedule: Part II (Non-Stark Changes)

On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (Final MPFS).1 The Final MPFS addresses changes to the physician fee schedule and related policies,...more

Third Circuit Court of Appeals Rejects Hospital’s Religious Exemption from ERISA

On December 29, 2015, the U.S. Court of Appeals for the Third Circuit decided in Kaplan v. Saint Peter's Healthcare System, No. 15-1172 (3d. Cir. Dec. 29, 2015) that the pension plan for Saint Peter’s Healthcare System in New...more

Do the Restrictions on Advertising with Nutrition and Health Claims also Apply to Communications Addressed Exclusively to Health...

The Court of Justice of the European Union (ECJ) will soon decide on the issue of whether the restrictions on promoting foodstuffs with nutrition and health claims also apply to communications addressed exclusively to health...more

Health Care Outlook for 2016

In 2016, the Affordable Care Act will continue to be a contentious issue involving opposing legislative efforts and presidential debates. It has already been a major talking point in the campaigns of multiple 2016...more

Governor Christie’s Veto of Hospital Fee Bill Tees Up Additional Litigation

On January 19, 2016, New Jersey Governor Chris Christie vetoed bipartisan legislation that sought to establish hospital “community service contributions” (“CSCs”) in hopes of avoiding litigation concerning the tax burden of...more

Senate Bill Would Strengthen Mandate That People With Disabilities Be Integrated in the Community

Senator Charles Schumer (D-NY) recently introduced the Disability Integration Act of 2015 (DIA) in the U.S. Senate. If passed, the bill would require states and health insurers to provide services to people with disabilities...more

Senate Considering Bill to Speed Medicare Claims Appeals

In early December of last year, Orrin Hatch (Senate Finance Committee Chairman, R-UT) and Ron Wyden (D-OR) introduced the Audit and Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 (AFFIRM Act). The purpose of...more

Are you covered? Emerging issues for health care providers under cyber risk insurance

Providers are focusing on cybersecurity with increased urgency. Cyberattacks on health-care organizations reached an all-time high in 2015 and aren't expected to slow down in 2016, Harry Greenspun, director for Deloitte's...more

HHS Publishes Guidance on Patient Access to Records under HIPAA

On January 7, 2016 the Department of Health and Human Services (“HHS”) released a fact sheet and a series of frequently asked questions to help to clarify an individual’s right to access and obtain a copy of his or her health...more

Is This The Year Florida Recognizes Direct Primary Care?

Florida House Bill 37 and Florida Senate Bill 132, similar bills aiming to expressly authorize and regulate direct primary care medical home plans in the State of Florida (“DPCs”) and both stating that DPCs are not...more

CMS Announces Changes to Medicare Meaningful Use Hardship Exception Application Process

On Jan. 22, 2016, CMS issued a new application and sweeping changes to the Medicare Electronic Health Records (EHR) Incentive Program hardship exception application process. The changes are intended to temporarily ease the...more

Senate Health Committee Seeks Expert Feedback on Draft Health Information Technology Bill

On January 20, 2016, the U. S. Senate Committee on Health, Education, Labor and Pensions released this draft bipartisan bill for staff discussion, which seeks to improve health information technology, including electronic...more

Legal Considerations for Retail Clinics

Retail clinics have grown substantially in number and popularity since their emergence in the early 2000s. Retail clinics are limited healthcare clinics that operate outside of physician offices and hospitals, typically in...more

Healthcare tech meets healthcare reality

As entrepreneurs rush into the healthcare sector, even the most innovative thinkers are encountering a unique set of challenges – and solving them will require every bit as much ingenuity as building groundbreaking new...more

CMS Releases Home Health Compare “Patient Experience of Care” Star Ratings

In yet another move emphasizing the Centers for Medicare & Medicaid Services’ (CMS) focus on quality health care, the agency has released the first patient experience of care star ratings on Home Health Compare. ...more

Recalled Brainlab Digital Neurosurgery Device Could Pose Serious Injury, Death to Patients

A medical device created by Brainlab and marketed as easy-to-use, intuitive, precise and tailored to surgeons’ needs has been recalled by the U.S. Food and Drug Administration. Cranial-navigation systems sold by...more

Clearing Up Confusion Over the Modified HIPAA Privacy Rule

The Department of Health and Human Services issued a final rule under the Health Insurance Portability and Accountability Act of 1996, which will go into effect on February 5, 2016. HHS published the final rule in tandem with...more

Recent Corporate Integrity Agreements Highlight HHS OIG’s Compliance Program Priorities

Corporate Integrity Agreements (CIAs) are among the most important tools in the U.S. Department of Health and Human Services Office of Inspector General’s (OIG) toolbox for promoting compliance in the health care industry....more

Religious Institutions Update: January 2016

Timely Topics - The Internal Revenue Service (IRS) issued on Dec. 17, 2015, a memorandum instructing its examiners not to conduct employment tax audits of churches without getting in touch with a high-ranking Treasury...more

Centene announces search for missing hard drives containing PHI of 950,000 individuals

Centene Corporation, a health insurer headquartered in St. Louis, announced on January 25, in a press release that it is undertaking an, “ongoing comprehensive internal search for six hard drives that are unaccounted for in...more

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