Health Care Providers

News & Analysis as of

Second Circuit Reminds Healthcare Providers to Seek Relief from Insurance Companies Under Their Own Contracts, Not the Insureds’...

In Rojas v. Cigna Health and Life Ins. Co., 793 F.3d 253, 258 (2d Cir. 2015), the Second Circuit joined several other circuits in holding that “healthcare providers are not ‘beneficiaries’ of an ERISA welfare plan by virtue...more

OIG’s 2016 Work Plan: Mixed Results for 2015 and New Data Mining and Policy Efforts in 2016

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) annual release of a new Work Plan both summarizes the results achieved last year and highlights new areas for examination in the next....more

Health Alert (Australia) - November 23, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments: Commonwealth. Federal Court - 17 November 2015 - Burnett v Eastern Health [2015] FCA 1247 The Federal Court of Australia...more

Payers Embracing Telemedicine Cost Savings, Ramping Up Reimbursement in 2016

Often considered the primary obstacle to telemedicine implementation, reimbursement changes are now better viewed as one of the most prominent drivers of telemedicine expansion. Payers are finally beginning to realize what...more

Final Stark Law Regulations Published by CMS

As previously discussed here and on our Health Industry Washington Watch blog here the Centers for Medicare & Medicaid Services (CMS) has released final regulations under the physician self-referral law known as the Stark...more

Health Care E-Note - November 2015

With medical device related acquisitions at all-time highs, and regulatory interest intense from the Federal Trade Commission, the Food and Drug Administration, the Securities and Exchange Commission, and the Office of...more

CMS Finalizes Major Changes and Clarification to the Stark Law Regulations

Introduction - Since the passage of the Physician Self-Referral Act, also known as the “Stark Law,” health care providers have had to learn to work within and adjust to certain statutory and regulatory exceptions in...more

District Court Rejects FCA Claim Against Healthcare Provider That Submitted False Claims But Did So Without Necessary Mental State

Healthcare provider Fresenius Medical Care North America claimed victory in a False Claims Act (“FCA”) lawsuit recently when a federal district court ruled that there was no evidence that its practice of billing for...more

Final Rule Issued: Stark Law Modifications Designed to Ease the Burden of Compliance

On October 30, 2015, the Centers for Medicare and Medicaid (“CMS”) issued a final regulation that includes modifications to the Stark Law (the “Final Rule”). Among other things, the Final Rule adds two new exceptions to the...more

CMS Gives Providers Some Leverage in RAC Record Collection Requirements: Five Things to Know about ADRs

The Centers for Medicare & Medicaid Services (“CMS”) announced that it has reduced the maximum percentage of records that providers must submit to Recovery Audit Contractors (“RAC”) through the payment auditing process...more

New Medicaid RCOs Raise Antitrust Issues for All Participating Health Care Providers

Physicians and other health care providers who were practicing in the 1990s were involved in numerous attempts to organize themselves in order to be able to participate in and even financially survive the onslaught of managed...more

Update: HHS Proposed Regulations on Section 1557 of the ACA

On September 8, 2015, HHS published its proposed regulations implementing Section 1557 of the Affordable Care Act. In a previous article on Section 1557, entitled “The Future of Healthcare Discrimination Litigation,” we...more

CMS Finalizes Stark Law Changes in CY 2016 Medicare Physician Fee Schedule Final Rule

This past July, on the heels of a decision in which a judge for the U.S. Court of Appeals for the Fourth Circuit characterized the federal physician self-referral prohibition commonly known as the “Stark Law” as, “even for...more

Medical Device Manufacturers as "Health Care Providers"

We’ve read a fascinating new case out of Texas, Verticor, Ltd. v. Wood, ___ S.W.3d ___, 2015 WL 7166024, No. 03-14-00277-CV, slip op. (Tex. App. Nov. 13, 2015), posing the question whether a medical device company can be a...more

Medical Devices a Target for Online Hackers

In the past few years, medical devices have become a major target for online criminals. Not only are medical devices considered to be one of the easiest and most vulnerable points of entry into a health care enterprise, they...more

Energy and Commerce Health Subcommittee Advances Mental Health, Medicaid, Synthetic Drug Legislation

On November 4, 2015, the House Energy and Commerce Health Subcommittee approved the following health policy bills: ..HR 2646, the Helping Families in Mental Health Crisis Act – includes a series of reforms intended to...more

ERISA: Medical Providers Lack Standing For Reimbursement — Anti-Assignment Provisions Enforceable

You know that patients typically assign rights under a health insurance plan to the provider of medical services. This is accomplished by signing an assignment form upon intake/admission. Then, the healthcare provider sends...more

[Webinar] The Impact of the Finalized Modifications to the Stark Law - Nov. 19th, 12:00pm EDT

Please join LeClairRyan for this 30 minute online event providing an overview of the recently finalized changes to the physician self-referral regulations issued by the Centers for Medicare & Medicaid Services (CMS)....more

UPMC/Highmark Continuity of Care Settlement

PBGH just recently sent out a client alert regarding UPMC/Highmark Continuity of Care Settlement as follows: UPMC and Highmark have announced a settlement agreement that addresses the Consent Decrees’ Continuity of Care...more

CT AG slams Hartford Hospital and EMC for loss of laptop

True to his word, the Connecticut AG has aggressively entered the data privacy and security enforcement arena with a $90,000 settlement with Hartford Hospital and EMC. The AG has agreed to a payment of $90,000 from...more

Meaningful Use Stage 3 Final Rules Encourage Providers to Engage Patients in their Health Care

On October 16, 2015, the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) of the U.S. Department of Health and Human Services published the...more

KBML Issues Guidance to Help Physicians Get the Most out of MOST

The Kentucky Board of Medical Licensure (“KBML”) issued a recent opinion regarding the Medical Orders for Scope of Treatment (“MOST”) form. The stated purpose of the opinion is to “encourage and promote clarification of a...more

New Rule Permits Hospitals to Subsidize Physician Employees

A new 2016 Medicare physician payment rule allows hospitals and other provider institutions to make payments to physicians for the purpose of enabling them to employ nonphysician practitioners, such as nurse practitioners and...more

FTC Comments Discourage Legislation Purporting to Grant Antitrust Immunity for Health Care Providers

In late September, the Federal Trade Commission (FTC) submitted comments to the Virginia and Tennessee Departments of Health regarding each state’s proposed rules concerning hospital cooperation agreements. These proposed...more

Health Alert (Australia) - November 9, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments Queensland 13 October 2015 - Chaudhry v Medical Board of Australia [2015] QCAT 414 The Queensland Civil and...more

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