Healthcare

News & Analysis as of

Check Up on Healthcare Fraud Prosecutions

Chief compliance officers face an overwhelming level of risk in the healthcare sector. I do not mean to belittle the risks of corruption, AML, sanctions and other risks typically associated with global companies. Healthcare...more

Hospital/Physician Leases Compliance Checklist

LEGAL REQUIREMENTS: A "no" answer to any of the following questions may mean your lease is out of compliance with applicable laws. Is the lease in writing? Is the lease signed by both parties? Does it...more

Two-Midnight Rule Update

Medicare and Medicaid Services (CMS) on August 19, 2013, the two-midnight rule provided that an inpatient admission generally would only be payable under Medicare Part A if: (1) the admitting practitioner had an expectation,...more

Is There Coverage for The Pill Mill Lawsuits?

In an effort to deal with the terrible epidemic of drug abuse and the human and economic costs of this dilemma, the state of West Virginia has brought lawsuits in several jurisdictions against pharmaceutical companies and...more

Legal Update: Amendments to the Public School Code - Diabetes Management

On July 13, 2016, Governor Wolf signed into law House Bill 1606, now known as Act 86 of 2016 (“Act 86”). Included among the numerous amendments to the Public School Code, Act 86 establishes new requirements for LEAs related...more

Client Alert: Florida: What the New Balance Billing Law Means for Physicians

This year two bills became law in Florida that are intended to equip Floridians with tools to make health care decisions based on cost and to protect them from significant unanticipated medical bills. The first (HB1175)...more

New Federal Proposal May Make Health-Related Travel Insurance an Excepted Benefit Under ACA

For companies selling travel insurance products, there is major news out of Washington D.C. The Obama administration is seeking to curb short-term, limited duration health policies, which includes insurance products now...more

Brexit will be bad for health of Britons

British experts predict the exit from the EU will be bad for Britons’ health. Brexit advocates, in fact, celebrated their win by immediately conceding a giant campaign falsehood: They suddenly denied claiming that almost...more

Manatt on Medicaid: Leveraging MMC Contracts to Advance Reforms

Editor's Note: This “Manatt on Medicaid” is the fourth in a series of updates focused on CMS’s new Medicaid/CHIP managed care regulations. In the coming weeks, Manatt will be exploring key provisions of the regulations and...more

Groundbreaking Healthcare Nondiscrimination Rule Issued by HHS: What It Means for Covered Entities

HHS late last week issued a Final Rule prohibiting discrimination in healthcare on the basis of race, color, national origin, sex, age or disability. The Rule also broadens protection for individuals with limited English...more

How Will the New Overtime Regulations Affect Healthcare Employers?

The long-awaited U.S. Department of Labor (DOL) regulations on the “white collar” exemptions are finally here. As per the regulations, which are to be issued on May 18, 2016, the new minimum salary level for the executive,...more

Massachusetts Long-Term Services and Supports: Achieving a New Vision for MassHealth

Long-term services and supports (LTSS) enable hundreds of thousands of people of all ages in Massachusetts to live with independence and dignity, participate in their communities and increase their overall quality of life....more

Caution: False Claims Act Penalties Poised to Double

A preview of the effects that a provision in the Bipartisan Budget Act of 2015 will have on healthcare providers came to light this week when the Railroad Retirement Board (Board) published an interim final rule implementing...more

CMS Releases Hospital Inpatient PPS and Long-Term Care Hospital PPS Proposed Rule

CMS released updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) in a proposed rule on April 18, 2016 (Proposed Rule). The Proposed...more

NIH clinical center in Bethesda rebuked for failing to put patients first

A venerated research and care institution that happens to be in our neighborhood got a rebuke and a reminder about its need to put patients first, ensuring that their care doesn’t get trumped by research needs. A...more

Two Adverse Decisions against Church Plans Reached at Appellate Court Level

In Depth - Since 2013, there have been more than 10 lawsuits filed against various health care systems across the country that maintain and operate defined benefit pension church plans. These suits allege that the...more

CMS Announces New Alternative Payment Model for Primary Care

Earlier this week, CMS announced the launch of an initiative aimed at transforming the way primary care is delivered. The Comprehensive Primary Care Plus (CPC+) model will be a voluntary 5 year program accommodating some...more

Manatt on Health Reform: Weekly Highlights - April 2016 #2

California's Marketplace revises its QHP contract to improve care quality and value, and announces its support for a 1332 waiver to allow undocumented immigrants to purchase Marketplace plans; Wisconsin proposes transitioning...more

No Surprises in Recent Vested Rights Decision: Fry v. City of Los Angeles

The recent decision in Fry v. City of Los Angeles (California Second District Court of Appeal Case No. B259791, March 7, 2016) held, after careful parsing of the language in the City Charter and the applicable City...more

New Stark Law Exception Breathes Life into Primary Care, Especially in Underserved Areas

With the recent and significant shortages of primary care providers, the Centers for Medicare & Medicaid Services (“CMS”) recently created a rather important exception to the Stark Law as a means to expand access to primary...more

Difference of Medical Opinions Doesn’t Prove One Was False

A federal court in Alabama dealt a blow to the theory that in matters of medical judgment, a false claim action can rest on expert opinion evidence alone. A patient is eligible for hospice if the prognosis is life...more

FTC Wants to be a Champion for Telemedicine Providers

In a public comment supporting Alaska’s proposed telemedicine legislation, the Federal Trade Commission (FTC or Commission) reiterated its broad support for telemedicine services, quoting its own 2004 analysis: “When used...more

To Refer, Or Not To Refer? OIG’s Outdated Health Care Referral Restrictions

The Office of the Inspector General, which enforces Health and Human Services, has long been averse to referral services that don’t meet certain criteria. To get protection against a possible enforcement action, the referral...more

Program Integrity Changes to the Medicare Provider Enrollment Process

On March 1, 2016, the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) entitled “Medicare, Medicaid, and Children’s Health Insurance...more

Federal Government Recovers $3.5 Billion from False Claims Cases in 2015

The United States Department of Justice has announced that it has recovered over $3.5 Billion from cases brought under the False Claims Act (FCA) in fiscal year 2015. This significant aggregate recovery is a slight decline...more

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