Healthcare Providers

News & Analysis as of

Recent OIG Audits of Home Health and Hospice Surveys May Signal Increased Scrutiny on Worker Qualifications

Recent audits by the Department of Health and Human Services Office of Inspector General (“OIG”) conclude that state survey agencies in a number of states and a leading national accrediting agency serving the home health and...more

Health Law Wire: Court Invalidates DOH Retroactive Clinic Rate Changes (6/15)

The Appellate Division Fourth Department recently invalidated DOH’s attempts to retroactively revise Diagnostic & Treatment Center (D&TC) rates and upheld statutory requirements for 30 day advance notice of capital rate...more

Antitrust Law Issues for Health Care Providers [Video]

During this webinar, panelists examined recent developments in antitrust law and discuss the potential impact on health care providers. Key topics included: • Trends in health care competition after the ACA, with a focus...more

MSSP Final Rule ACO Eligibility Requirements, Application and Renewal Process

This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process. ACO Eligibility Requirements - Under the...more

Health Alert (Australia) - June 22, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: Victoria. Inquest Into the Death of Baby Chloe Lee Kellett - The Victorian Coroner investigated an infant's death from...more

Will Personalized Medicine Survive Alternative Payment Models?

There is no doubt that health care costs in the United States are rising. According to a recent study published by the U.S. Department of Health and Human Services, personal health care expenditures in the United States...more

The False Claims Act – the Basics Every Provider Should Know, Part One

The federal False Claims Act (“FCA”)casts an incredibly long shadow, covering every transaction between the federal government and a private party seeking payment from it. Enacted at the height of the Civil War in 1863, the...more

Health Alert (Australia) - June 15, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: New South Wales. O'Sullivan v Medical Council of New South Wales [2015] NSWCATAD 113 The New South Wales Civil and...more

OIG Again Cautions Providers (And Physicians) About Non-Compliant Physician Compensation Arrangements

On June 9, 2015, the Office of Inspector General ("OIG") of the Department of Health & Human Services issued a Fraud Alert reprising a familiar theme: ensuring that physician compensation arrangements comply with the...more

Pennsylvania Court Dismisses Data Breach Claims

In 2014, the University of Pittsburgh Medical Center’s computer system was hacked, resulting in the disclosure of sensitive personal information of current and former employees, including names, addresses, birthdates, social...more

CMS Releases Latest Medicare Hospital and Physician Utilization, Payment Data

CMS has released detailed Medicare inpatient hospital, outpatient hospital, and physician utilization and payment data for 2013, including data analysis such as spending breakdowns by specialty and region. The hospital data...more

Investors Should Be Aware of an Interesting Blue Cross Antitrust Case

It was recently reported that Blue Cross and Blue Shield (BCBS), along with the Blue Cross Blue Shield Association, was sued across all states in a class action brought by two types of plaintiffs. One plaintiff class reflects...more

Over a Decade in the Making: CMS Releases Long-Awaited Medicaid Managed Care Rule

On May 27, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published a 653-page proposed rule affecting the thirty-nine states (plus the District of Columbia) that use managed care organizations (“MCOs”) to...more

"Supreme Court Decision in FCA Case Both a Win, Setback for Health Care Providers"

On May 26, 2015, the U.S. Supreme Court issued a rare unanimous decision in a False Claims Act (FCA) case that cuts both ways for the health care industry. In an opinion authored by Justice Samuel Alito, the Court held in...more

TCPA FCC Petitions Tracker

Kelley Drye’s Communications Practice Group presents this comprehensive tracker of active Telephone Consumer Protection Act (“TCPA”) petitions before the Federal Communications Commission (“FCC”). ...more

FTC Settles Radioactive Allegations Against Cardinal Health with a Near Record-Breaking Disgorgement Agreement

In a 3-2 decision, as part of its aggressive antitrust enforcement in health care industries, the Federal Trade Commission (FTC or the Commission) announced that Cardinal Health, Inc. (Cardinal) agreed to pay $26.8 million to...more

PilotFish Announces MedDevice Connection App

Applied PilotFish Healthcare Integration, Inc. (APHII) recently announced a new application called HealthConnect. APHII is the healthcare division of PilotFish Technology, a provider of middleware solutions for the...more

Supreme Court Rules That Providers and Suppliers Cannot Challenge Medicaid Reimbursement Rates in Federal Court

On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more

Behavioral Health Billing Alert

Providers of behavioral health services should be aware that the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), released in May 2013 after more than ten years in...more

New York – Emergency Medical Services and Surprise

The Emergency Medical Services and Surprise Bills Law (the "New Law"), which goes into effect March 31, 2015, increases protection of New York consumers from "surprise bills" received for medical services performed by certain...more

The ACA Five Years Later: A Good Investment or Risky Business? We Dare Not Opine!

The enactment of the Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010, represents a significant legislative milestone in healthcare reform and a continuing communications challenge for...more

HHS Releases Two Healthcare Information Technology Proposed Rules

On March 20, 2015, CMS and the HHS Office of the National Coordinator for Health Information Technology (ONC) released proposed rules regarding Stage 3 of the Medicare and Medicaid Electronic Health Records (EHRs) Incentive...more

The Managed Mediation of a Payor-Provider Health Care Dispute

In the health care industry, payors and providers often have claims for both underpayment and overpayment arising from ongoing contracts or other health care services rendered. When claims arise between a payor and a...more

Care Recipients’ Limited Right to Discriminate Based on Protected Characteristics of Care Provider

Healthcare provider institutions including hospitals, clinics, medical practices, nursing homes and home health care providers (here, “Institutions”) are occasionally called upon to balance the preferences of Consumers...more

“Next Generation” Accountable Care Organization: A New Model from CMS

On March 10, 2015, the Centers for Medicare and Medicaid Services (“CMS”) announced the newest iteration of accountable care organization (“ACO”) models. The “Next Generation” model continues CMS’s efforts to incentivize...more

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