News & Analysis as of

Health Care Providers

The Circuits are Split: The Ambiguity of a Regulation May Not ‘Foreclose a Finding of Scienter’ in False Claims Act Cases

by K&L Gates LLP on

A split now exists among the circuit courts as to whether a defendant’s assertion of a “reasonable interpretation defense” precludes a finding of a “knowing” mens rea under the False Claims Act (the “FCA”). On May 26, 2017,...more

FTC Challenges North Dakota Healthcare Provider Merger

by King & Spalding on

On Thursday, June 22, 2017, the Federal Trade Commission (“FTC”) and the North Dakota Attorney General filed a complaint challenging the merger of North Dakota providers, Sanford Health, Sanford Bismarck (together “Sanford”),...more

Round Two: Significant Telehealth Expansion Re-Proposed in Bipartisan Senate Bill

by McDermott Will & Emery on

On May 3, 2017, the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2017 (S. 1016) (CONNECT Act of 2017) was reintroduced by the same six senators who had initially introduced the...more

Health Care E-Note - June 2017

by Burr & Forman on

When a physician leaves a medical practice, especially if the physician stays in the area to compete against his/her former employer, the situation can become stressful and acrimonious. Please see full E-Note below for...more

Senate Finance Committee Advances Bipartisan CHRONIC Care Act

by Baker Donelson on

On May 18, the Senate Finance Committee unanimously approved the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S. 870). The bipartisan bill aims to modernize care...more

After Escobar, Lower Courts Build On The “Materiality” Analysis for False Claims Act Lawsuits

by Saul Ewing LLP on

It’s been just over a year since the Supreme Court’s seminal False Claims Act (“FCA”) decision Universal Health Servs., Inc. v. United States ex rel. Escobar. In the wake of Escobar, the lower courts are confronted with...more

Suit Over Hospitals’ Alleged Anticompetitive Marketing Sent to Trial

Conspiracies between competitors can be hard to prove, even when other parties to the alleged conspiracy have settled. On May 31, 2017, a federal judge denied summary judgment and ruled that the Department of Justice (DOJ)...more

Amendments to Illinois Hospital Licensing Act Align Illinois Law with CoPs

by McDermott Will & Emery on

On June 23, 2017, the Illinois register will publish a number of significant amendments to the rules and regulations promulgated under the Illinois Hospital Licensing Act (the Act), at 77 Ill. Admin. Code § 250 et seq. These...more

CMS Releases MACRA Proposed Rule for 2018

by Baker Ober Health Law on

On June 20, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled, "Medicare Program; CY 2018 Updates to the Quality Payment Program." CMS proposes changes for the second year (2018) of the...more

New York State Revises Final Guidance on Health Care Privacy and Data Exchange

Just three weeks after releasing a "final" guidance statement on New York State and federal laws on privacy and data sharing ("Final Guidance"), the New York State Department of Health issued a revised final guidance...more

False Claims Act: Circuit Court Questionably Construes Scienter Requirement

by Jones Day on

The U.S. Court of Appeals for the Eleventh Circuit recently issued an opinion addressing the False Claims Act's intent requirement. U.S. ex rel. Phalp v. Lincare Holdings, Inc., No. 16-10532, ___ F.3d ___ (11th Cir. May 26,...more

FCA Deeper Dive: Original Sources under the FCA’s Public Disclosure Bar

by Bass, Berry & Sims PLC on

The FCA continues to be the federal government’s primary civil enforcement tool for investigating allegations that healthcare providers or government contractors defrauded the federal government. In the coming weeks, we...more

Why Isn’t My “Free” Preventive Health Care Free?

by Snell & Wilmer on

In my opinion, one of the best changes made by the Affordable Care Act is the mandate that requires health plans to provide certain specified preventive services without imposing any cost sharing. This is sometimes referred...more

Exclusive Agreement Between Hospital and Insurance Plan Does Not Violate Section 1

The Seventh Circuit refused to revive an exclusive dealing claim by one hospital against its competitor because of an exclusivity agreement with an insurance plan. Judge Richard Posner wrote the short opinion strongly...more

Latest Court Decision Addresses New York’s Limits on Executive Compensation and Administrative Costs of State-Funded Providers --...

On June 22, 2017, the New York State Appellate Division, Third Department issued a decision in LeadingAge New York v. Shah on the validity of regulations promulgated by the Department of Health (“DOH”), pursuant to Executive...more

Big Tobacco, preying on poor and uneducated, also hikes health inequities

Although most Americans finally may be breaking out of cigarette smoking’s killer grip, Big Tobacco keeps inflicting terrible harm on some of the nation’s most vulnerable—the poor, uneducated, and those who live in rural...more

CMS Requires Participating Providers to Prepare for Emergencies

by Carlton Fields on

On March 24, 2017, the Centers for Medicare & Medicaid Services (CMS) released a memorandum encouraging participating providers to “seek out and participate in a full-scale, community-based exercise with their local and/or...more

Mandatory Bundled Payments Delayed, CMS seeking comments

by Carlton Fields on

CMS Administrator, Seema Verma, and Secretary of Health and Human Services Secretary, Tom Price delayed implementation of the Comprehensive Care for Joint Replacement (“CJR”) program via an interim final rule. See CMS – 5519...more

Are You Ready for AB 72?

by Buchalter on

To protect patients from receiving an unexpected surprise bill when they seek care at in-network facilities from out-of-network providers, Governor Brown signed AB 72: California’s surprise out-of-network law. The new law...more

Indiana Reverses Course on Telemedicine Prescribing and Controlled Substances Laws

by Foley & Lardner LLP on

Indiana has taken another step towards expanding the meaningful use of telemedicine in connection with clinical services and prescribing. HB 1337, signed by Governor Eric Holcomb and effective July 1, 2017, will allow...more

New York Times Obtains Copy of Draft Executive Order on Drug Prices; FDA Blogs that it is Working to Lift Barriers to Generic Drug...

by Dorsey & Whitney LLP on

On June 20, 2017, the New York Times reported that it had obtained a draft proposal of President Trump’s Executive Order on drug prices. The draft Executive Order, which has not been published, has been characterized as...more

CMS continues to tinker with new physician Quality Payment Program created by MACRA

by Dorsey & Whitney LLP on

The Centers for Medicare & Medicaid Services (CMS) released an advanced copy of its latest proposed rule revising the Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The...more

Healthcare Providers Beware: HIPAA Isn’t Your Only Concern Following a Data Breach–State Law Matters

by McGuireWoods LLP on

Healthcare service provider CoPilot Support Services (“CoPilot”) recently agreed to pay a $130,000 settlement after it waited over a year to notify patients of a data breach, in violation of New York’s breach notification...more

Value-based health care: fraud & abuse laws

by Ropes & Gray LLP on

Michael Lampert, Ropes & Gray health care partner, discusses fraud and abuse law application to value-based health care arrangements. __ Much has been made about how the fraud and abuse laws, which were designed in order...more

Drug Companies – Peddlers of opiates?

Opioids put nearly 1.3 million people in the hospital in one year. Yet another example of the devastating effects of Fentanyl and other opiate abuse in our country. We have had a front row seat to this epidemic in Palm...more

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