Health Care Providers

News & Analysis as of

Health Plans in Connecticut Must Cover Telehealth Services

Connecticut marks the 28th state to enact a telemedicine commercial reimbursement statute. The legislation (SB-467) was sponsored by Senators Looney, Duff, Crisco and Gerratana with twenty co-sponsor senators, and was signed...more

Healthcare Employers to Get Even More Attention from OSHA

OSHA has released an “Inspection Guidance for Inpatient Healthcare Settings,” that will focus its inspectors attention to musculoskeletal disorders, workplace violence, bloodborne pathogens, tuberculosis, and slips, trips,...more

Healthcare Law Update

Governing boards of health care organizations can greatly benefit from reading a recently released educational document that presents practical tips for board members responsible for overseeing their organizations’ compliance...more

OIG Announces New Penalty and Exclusion Litigation Team to ‘Level the Playing Field’

The federal government’s health care fraud enforcement efforts expanded this week with an announcement by the Office of the Inspector General (OIG), of the U.S. Department of Health and Human Services, that it has created a...more

Chasing Payments: District Court Holds that Providers Lack Standing to Sue ERISA Plans for Benefits if the Patients Remain Liable...

A district court in Tennessee recently rejected ERISA claims by healthcare providers against a plan insurer, holding that the providers lacked standing to sue under ERISA as their patients’ assignees. Brown v. Blue Cross...more

New OSHA Inpatient Facility Review Guidance Focuses on Five Workplace Hazards

On June 25, 2015, the Occupational Safety & Health Administration (OSHA) issued a memorandum regarding inpatient health care settings. The memorandum does not create new law. Rather, it provides guidance to OSHA compliance...more

Health Alert (Australia) - June 29, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgments: Australian Capital Territory (ACT). Medical Board of Australia v Hocking [2015] ACAT 44 - The ACT Civil and...more

Final Rule Will Give ACOs Participating in MSSP Access to More Data for More Beneficiaries

This is the third post in Health Care Law Today’s series on the final rule. This post addresses changes to sharing of beneficiary identifiable data. In its December 8, 2014 proposed rule revising the Medicare Shared...more

Patients poised to record doctor's visits?

The question of whether patients should be permitted to record interactions with their doctors, and when and how it is best to do so, has become a highly contentious issue to navigate in today’s increasingly complex medical...more

Massachusetts Health Care Regulatory Review – Opportunity for Industry Comment

Health care is big business in Massachusetts, and it is a highly regulated business. But Governor Charlie Baker hopes to simplify the Massachusetts regulatory regime. This past March, Governor Baker initiated a year-long...more

Obama Administration Announces Record Medicare Strike Force "Takedown"

On June 18, 2015, HHS Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch announced that a nationwide Medicare Fraud Strike Force sweep resulted in health fraud charges against 243 individuals involving...more

Variables Affecting Medical PL Settlement Values [Video]

From the 2015 PLUS Medical PL Symposium session “Batch Claims: What are the ‘Three P’s?’,” Scott Crockett, Esq. of Wagstaff & Cartmell discusses the variables that impact claim settlement, including “fear of” claims....more

The skinny on narrow networks

The insurance exchanges created under Affordable Care Act have facilitated increased competition. Old version managed care models implemented cost-savings measures like pre-authorizations for medical care, hospital length of...more

New York Attorney General Pursues Dental Management Company for Corporate Practice Violation

Attorney General (AG) Eric Schneiderman announced a settlement With Aspen Dental Management (ADM). The Settlement Agreement requires ADM to pay $450,000 in Civil Penalties, after the AG found that the company was engaged in...more

U.S. Judge Limits False Claims Act Claims Involving Vague Medicare Regulations

A Missouri federal judge has issued a summary judgment order that could serve as an important limitation on the U.S. Department of Justice’s expanding use of the False Claims Act and penalties aimed at recovering funds from...more

Camels and Dogs, Oh My! Defendant Documents Doom Health Provider Trade Association and Insurers’ Motion to Dismiss Antitrust Suit

Over two and one-half years after it was initially filed, an antitrust suit brought by plaintiff ambulatory surgery centers (“ASCs”) against health insurers and a trade association of competing health systems is finally...more

A New Era of HIPAA Enforcement

Traditionally, HIPAA enforcement is assigned to the Department of Health and Human Services’ Office for Civil Rights (OCR). In November 2013, Health and Human Services’ Office of Inspector General sharply criticized OCR’s...more

Medicaid managed care proposed rule expands program integrity obligations

On June 1, 2015, the US Centers for Medicare & Medicaid Services (“CMS”) published its proposed rule on Medicaid managed care (CMS-2390-P). As noted in our two earlier advisories, which provided an overview of the proposed...more

Providers Await Result on Affordable Care Act Challenge

Challenging a holding by the Fourth Circuit Court of Appeals before the U.S. Supreme Court in King v. Burwell, counsel Michael Carvin argued that the Affordable Care Act does not allow the federal government to issue tax...more

Health Care E-Note - June 2015

In This Issue: - Why, Again, Do You Think That Worker is an Independent Contractor? - I-9 and E-Verify Compliance Practices for Temporary Labor and Contractors - Excerpt From Why, Again, Do You Think That...more

Health care worker sent to jail for HIPAA violations

When we train employees on HIPAA, we always remind them that HIPAA violations carry significant penalties-both civil and criminal. Our favorite line is “Keep your day job.” Stealing patient information is never worth the...more

ACOs: The Next Generation of Coordination Care

An Overview of the Medicare Shared Savings Program/Accountable Care Organization Final Rules - The Centers for Medicare and Medicaid Services (CMS) recently released a final rule (Final Rule) that makes changes to the...more

The Biggest Obstacle to Value-Based Care [Video]

In this video, Foley Partner Lawrence Vernaglia discusses the biggest obstacle to realizing a value-based system of health care, and what realistically can be done in the industry by taking "measured steps."...more

Advocate Health data breach class action suit dismissal upheld by Appellate Court

In August of 2013, four computers of Advocate Health and Hospitals Corporation (Advocate Health) were stolen from one of its offices. The computers contained the names, dates of birth, Social Security numbers, health...more

Largest Criminal Health Care Fraud Takedown – 243 Charged and $712 Million in False Billings

On June 18, 2015, HHS Secretary Sylvia M. Burwell and DOJ Attorney General Loretta E. Lynch announced nationwide arrests in Medicare fraud schemes amounting to approximately $712 million in false billings. Attorney General...more

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