Health Care Providers

News & Analysis as of

CMS Steps Up Efforts to Recover Overpayments from Providers/Suppliers Sharing TINs

CMS has just announced that it has enhanced its financial accounting system to allow it to recover Medicare payments made to a provider or supplier that shares the same Tax Identification Number (TIN) with a provider or...more

Justice Department Announces Unprecedented National Health Care Fraud Takedown

In what is being billed as the largest coordinated Medicare fraud takedown in Justice Department history, Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell...more

HIPAA Does Not Preempt Statutory Right to Ex Parte Interviews of Treating Physicians in Tennessee Health Care Liability Actions

A key tool for the defense of medical providers in Tennessee facing malpractice liability has been held to be not preempted by federal law. On June 3, 2016, the Tennessee Court of Appeals, in Caldwell v. Baptist Memorial...more

Four Takeaways from the FTC’s Healthcare Merger Losses

The Federal Trade Commission has made clear that it considers the regulation of competition in health care markets one of its top priorities, but in recent weeks the FTC has been dealt a string of tough losses in its...more

Effect of Public Act 16-95 on Physician Non-Compete Agreements

Effective Date: The restrictions imposed by the Act apply to any covenant not to compete “entered into, amended, extended or renewed” on or after July 1, 2016....more

Defend Trade Secrets Act Signed Into Law

In an era of unprecedented integration and collaboration in the healthcare industry, providers, payors, contractors and patients are exchanging information at an ever expanding pace. This collaboration includes sharing best...more

Defend Trade Secrets Act Signed Into Law

In an era of unprecedented integration and collaboration in the healthcare industry, providers, payors, contractors and patients are exchanging information at an ever expanding pace. This collaboration includes sharing best...more

Higher Education Highlights - Summer 2016

On March 21, 2016, the U.S. Department of Health and Human Services, Office for Civil Rights (“OCR”), announced the launch of the 2016 Phase 2 Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) Audit...more

Caps on damages remain an open question in medical malpractice cases

Caps on non-economic damages from malpractice suits remain an issue for the courts to decide, which complicates understanding your rights even more. There are still questions about whether Tennessee’s laws concerning...more

CMS Finalizes Changes to Medicare Clinical Lab Test Payment Policy, Pushes Back Effective Date to 2018

On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) is publishing a major final rule to base Medicare clinical laboratory fee schedule (CLFS) reimbursement on private insurance payment amounts, as required by...more

Health Care IT Program Discusses Alternative Payment Model Opportunities

A distinguished panel of providers, consultants and IT firms convened on Tuesday, June 21st in New York at the Foley and Lardner LLP offices to share a discussion focused on the convergence of IT spend and new value based...more

CMS Announces Pre-Claim Review Demonstration for Medicare Home Health Services

CMS has announced a new three-year Medicare “pre-claim review” demonstration for home health services in five states — Illinois, Florida, Texas, Michigan, and Massachusetts — with “high incidences of fraud and improper...more

Managing the Transition to Transformation: Is Your Organization Ready for the Shift to Alternative and Quality-Based Payment...

For many decades, at least since the passage of the Health Maintenance Organization Act of 1973, there have been reform efforts focused on moving the United States health care system away from fee-for-service (FFS)...more

What does the Escobar Decision Mean for Healthcare Providers?

On June 16, 2016, the U.S. Supreme Court in Universal Health Servs., Inc. v. United States ex rel Escobar, No. 13-317, — S. Ct. — (June 16, 2016), confirmed that the implied certification theory may serve as a basis for...more

Medicare Launches Home Health Pre-Claim Review Demonstration in Five States

The Centers for Medicare and Medicaid Services (CMS) recently announced it will implement a pre-claim review demonstration for home health services. The three-year demonstration will apply to home health services performed in...more

Understanding the Implications of MACRA, MIPS and APMs

On May 9, 2016, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking to implement the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Although the...more

Compliance Reminder — DOJ Announces Largest Healthcare Fraud Takedown

On Wednesday, June 22, 2016, the DOJ announced the largest nationwide heath care fraud takedown in history, which resulted in criminal and civil charges against 301 individuals for alleged participation in health care fraud...more

HHS Issues Final Rule on ACA Nondiscrimination in Health Programs and Activities

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations interpreting the nondiscrimination provisions of Section 1557 of the Affordable Care Act (“ACA”). The rule mainly impacts insurers...more

Medicaid in Iowa: What's Next

In my previous blog post, I provided a brief history of Medicaid in Iowa, including sharing details on it’s current modernization and challenges. In this post, we’ll cover what’s next for Medicaid members with the move to...more

OIG Identifies Continued Vulnerabilities in Medicare Provider-Based Facility Payment Policy

A new OIG report examines CMS’s oversight of Medicare billing by provider-based facilities – that is, facilities that operate under the ownership, administrative, and financial control of a hospital and meet other...more

Supreme Court ruling potentially expands false claims liability for healthcare providers

In a much-anticipated decision, the U.S. Supreme Court ruled recently that the implied false certification theory may form the basis for liability under the False Claims Act (FCA), resolving a split of among the federal...more

Connecticut's New "Right to Try" Law Provides Hope for Patients and Providers, but FDA Remains in the Driver's Seat

Connecticut has recently joined the wave of states enacting a so-called “Right to Try” law, which ostensibly permits terminally ill patients access to investigational drugs (including biologics) and medical devices as a...more

Manatt on Medicaid: CMS Revises Process for Determining MMC Payments

In its April 25, 2016 Medicaid managed care final rule, the Centers for Medicare and Medicaid Services (CMS) provides a revised framework for determining how managed care plans should be paid by state Medicaid programs. A...more

Supreme Court Rejects Government's FCA Implied Certification Theory

The Supreme Court of the United States in Universal Health Services, Inc. v. Escobar et al., weighed in on and embraced the implied certification theory of liability within the False Claims Act (FCA)....more

Supreme Court Endorses FCA Implied False Certification Theory of Liability with Limitations

In a unanimous decision, the U.S. Supreme Court issued its highly anticipated False Claims Act (“FCA”) opinion in Universal Health Services, Inc. v. United States ex rel. Escobar. The June 16, 2016, Court decision resolves a...more

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