Health Care Providers

News & Analysis as of

Minnesota Federal Court Says Cross-Plan Offsets Are Unlawful; Certifies Case for Immediate Appeal

The U.S. District of Minnesota has ruled in Peterson v. Unitedhealth Grp. Inc., No. 14-CV-2101 (PJS/BRT), 2017 WL 991043 (D. Minn. Mar. 14, 2017) that ERISA does not permit United Healthcare (“United”) to claw back alleged...more

The Siege Continues: The Justice Department is Investigating Four Additional Medicare Advantage Plans

In our prior blog post, we reported that, at the request of the federal Department of Justice, the FCA qui tam whistleblower lawsuit in the case of United States ex rel Benjamin Poehling v. United HealthGroup, Inc., et. al....more

Ultracare Las Vegas Settles EEOC Sex Discrimination Lawsuit

Placement Agency Fired Male Employee Because Of His Gender, Federal Agency Charged - LAS VEGAS - Ultracare Las Vegas, an ultrasound technician provider, will pay $15,000 and furnish other relief to settle a sex...more

Percentage-Based Billing Contracts Violate Medicaid Regulations and May Constitute Improper Fee-Splitting

The Medicaid Fraud Control Unit (MCFU) of the New York State Office of the Attorney General has recently issued restitution demand letters to providers for allegedly entering into percentage-based contracts with their billing...more

Health Care E-Note - March 2017

Like pain clinics and pharmacies, practitioners treating substance use disorder appear to be a target for federal enforcers. Under President Trump's administration and Alabama Attorney General Steve Marshall, law enforcement...more

Medicare’s Pre-Claim Review Demonstration Project to Begin in Florida

In August 2016, the Centers for Medicare & Medicaid Services (CMS) initiated a three-year Pre-Claim Review Demonstration for home health agencies (HHA) in Illinois, with plans to expand the demonstration shortly afterwards to...more

The Transition to Value-Based Health Care: A View from Washington of President Trump’s First 60 Days

“A View from Washington of President Trump’s First 60 Days,” the inaugural segment of our value-based health care teleconference series, was hosted by Thomas Bulleit, who heads the Ropes & Gray health care practice in the...more

The Telehealth Cost Wars

How to properly evaluate and weigh cost savings in health care has long been a controversial subject—perhaps nowhere more so than when technology-enabled health care is evaluated. A recent study is a case in point. The...more

OIG Exclusion Regulations Go Into Effect This Month

On January 20, 2017, Assistant to President Trump and Chief of Staff Reince Priebus directed Federal agencies to temporarily postpone the effective date of such regulations for sixty days (March 21, 2017) unless such action...more

New York Medical Society Warns Providers to Avoid Percentage-Based Billing

A series of recoupment letters from the New York State Medicaid Fraud Control Unit (MFCU) to healthcare providers who have management or billing company arrangements based on a percentage of collections has prompted the...more

California HMO Timely Access Report Available

California became the first state to set limits on how long HMO patients must wait to see a physician when the California Department of Managed Health Care (“DMHC”) adopted certain “timely access” regulations in 2010, based...more

Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty...more

Fifth Circuit Upholds CMS’s Critical Access Hospital Guidelines

CMS’s definitions of “primary roads” and “secondary roads,” as used to determine what constitutes a critical access hospital, withstood another court challenge last week....more

Sixth Circuit Finds It Has No Jurisdiction Over Appeal Of Order Compelling Arbitration And Enjoining State Court Proceedings

The Sixth Circuit has dismissed the appeal of an order granting a motion to compel arbitration and to enjoin certain state court proceedings, finding the order was not appealable because the district court stayed the matter...more

News from the Vermont Statehouse An - Analysis from DRM’s Government & Public Affairs Team - March 2017 #2

The House Ways and Means Committee is considering a proposal from the Vermont Department of Taxes to reduce the amount of use tax a person can pay without providing records to prove his or her tax liability. The rate would...more

Indiana Medical Malpractice Plaintiffs May Present New Theories of Liability at Trial That Were Not Argued to the Medical Review...

In two decisions issued by the Indiana Court of Appeals on February 22, 2017, the Court held that a medical malpractice plaintiff may raise a new theory of liability in state court that was not previously argued to a medical...more

Health Alert (Australia) March 20, 2017

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: New South Wales - 15 March 2017 - NG v Chinese Medicine Board of Australia [2017] NSWCATOD 36 - PROFESSIONS AND...more

States May See Earliest Opportunities to Alter Health Care Landscape

While the titans on Capitol Hill clash over the best answer to the Affordable Care Act (ACA), the Trump administration is promoting action at the state level that could produce meaningful impact soon. Health industry...more

Is a Nursing Coordinator Exempt From Overtime? Ninth Circuit Biopsies Administrative Exemption

The Ninth Circuit Court of Appeals recently ruled that whether a nursing staffing coordinator met the administrative exemption from federal overtime requirements is a factual issue that must be decided at trial. Quintiliani...more

Drug and Device Makers Suggest Anti-Kickback Safe Harbor Clarifications to Encourage Value-Based Health Care Arrangements

In response to the annual solicitation by the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) for developing new, and modifying existing, safe harbors to the anti-kickback...more

France: Again the Life Science Industry Will Have to Take a Close Look at a New Set Of Regulations Reshaping Transparency-Related...

The relationship between the life sciences industry and health-care practitioners is being reshaped in France through regulatory developments under both the French Anti-Gift Law and the French Sunshine Act. The...more

HHS Secretary Backs Medicare Balance Billing

Generally speaking, patients really dislike balance billing. Sometimes called “surprise billing,” “balance billing” refers to billing a patient for the difference between the health care provider’s charge and the amount a...more

Payor/Provider Convergence: Joint Venture Health Plans

Health Plans and health care providers are getting into each other’s business. This payor/provider convergence has taken different forms. Health systems have ventured into the health insurance business by acquiring or...more

California Court of Appeal Affirms Validity of Hospital Meal Period Waivers

The ability of hospitals to use meal period waivers was called into question by a 2015 Court of Appeal decision in Gerard v. Orange Coast Memorial Medical Center (Gerard I), which held that the provision in Wage Order 5...more

Federal Enforcement Focuses on Drug Treatment Clinics

Like pain clinics and pharmacies, practitioners treating substance use disorder appear to be a target for federal enforcers. Under President Trump’s administration and Alabama Attorney General Steve Marshall, law enforcement...more

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