News & Analysis as of

Health Care Providers

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

When your Hospital-of-Choice is In-Network but, SURPRISE, your Anesthesiologist is Not: California’s AB-72 and Other State...

Regardless of a patient’s diligence in selecting an in-network hospital, ambulatory surgery center, or other health facility for treatment, patients are still being saddled with surprisingly high medical bills that include...more

Blog: Texas Becomes 50th State to Recognize Physician-Patient Relationship Established through Telemedicine

by Cooley LLP on

On May 27, Texas Governor Greg Abbott signed S.B. 1107 (the “Bill”), making Texas the last state in the nation to allow for the establishment of a physician-patient relationship through a virtual visit. The recently passed...more

Some Will Always Have Paris: Withdrawal from the Climate Change Accord May Not Reduce the Heat on the Health Care Industry

President Trump’s decision earlier this month to withdraw the United States from the Paris Agreement—an international, nonbinding agreement to take steps to limit global temperature rise—followed a series of moves at the...more

Private Needle Exchange Programs Do Not Require Local Approval: Massachusetts Supreme Judicial Court Weighs In

Last week, in a case being watched locally and nationally, the Massachusetts Supreme Judicial Court (“SJC”) ruled that local government approval is not required for the operation of a private needle exchange program and that...more

Florida’s New Medical Marijuana Law: What Physicians and Entrepreneurs Need to Know

by Foley & Lardner LLP on

The Legislation implementing the medical marijuana amendment Florida voters approved last fall is on its way to the Governor. On June 9, 2017, during a special session, the Florida Legislature passed SB 8A and SB 6A,...more

The Changing Telehealth Landscape

by Burr & Forman on

When healthcare providers and information technology (IT) appear together in the news, it is often for less than positive reasons. The cyber security issues that have plagued everyone have not left physicians and hospitals...more

Senate Proposes Expanded Use of Telehealth

On May 18, 2017, the Senate Finance Committee voted to move forward a bill entitled the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S870), which would increase access to...more

FDA Commissioner Forecasts New, Modernized Digital Health Regulatory Framework

by Ropes & Gray LLP on

In his first public statement as Commissioner of the Food and Drug Administration (“FDA”) on the regulation of digital health technologies, Scott Gottlieb, M.D., signaled that FDA is contemplating significant changes. In a...more

Doc, Can You Hear Me Now? Telehealth Finally Comes of Age in Texas

by BakerHostetler on

After many years of heated and contentious debate, and opposition by the Texas Medical Association and the executive director of the Texas Medical Board, Texas has significantly revised its telemedicine statute to permit the...more

Health Alert (Australia) 19 June 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 9 June 2017 - Health Services Union v St John of God Health Care [2017] FWC 2981 - Alleged dispute arising under an enterprise...more

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