Healthcare Providers

News & Analysis as of

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

Is This the Perfect Storm for Union Organizing of Health Care Providers?

In This Issue: - Recent Developments for Multiemployer Pension Plans - Posting of Pre-Election Employee Rights Poster - Pre-hearing Statement of Position - The Pre-hearing Election — Held Sooner,...more

CMS Invites Stakeholders to Join "Health Care Payment Learning and Action Network" to Promote Alternative Payment Models

As previously reported, CMS has established a public-private partnership, the Health Care Payment Learning and Action Network, to support HHS’s goal of moving Medicare and the broader health industry from a FFS model towards...more

House to Vote Today on DMEPOS Competitive Bidding, Hospital Observation Policy, and Other Health Policy Bills

On March 16, 2015, the House of Representatives is scheduled to consider the following health policy legislation...more

State Legislatures React To Latest Health Data Breaches By Updating State Data Breach Notification Laws And Encryption...

Recent, large-scale breaches of health information have served to highlight the fact that federal agencies have only rarely assessed penalties against companies as a result of these breaches, while many states do not have...more

Fifth Circuit Preserves Provider Flexibility In Collecting Patient Responsibility

Last week, the Fifth Circuit Court of Appeals issued its opinion in North Cypress Medical Center Operating Co. v. Cigna Healthcare, a case concerning the ability of a non-participating healthcare provider to discount a...more

Can Mergers Between Healthcare Providers in Different Markets Raise Antitrust Concerns? "Yes," Say Top Enforcers at FTC and DOJ

In reviewing mergers of healthcare providers, government antitrust enforcers have historically focused on horizontal mergers between competing providers—in particular, those that result in high market shares in a specific...more

CMS Call on Physician Quality Reporting Programs (March 18)

On March 18, 2015, CMS is hosting a call to discuss how providers may report once across various 2015 Medicare Quality Reporting Programs, including the Physician Quality Reporting System (PQRS), the Medicare Electronic...more

Big Data Creates New Opportunities for Health Care Entities

Big Data — the ability to collect, process, and interpret massive amounts of information — has reached health care. Technology has created new business opportunities for health care entities — covered entities, business...more

Ninth Circuit Holds that Acquisition Violates Antitrust Laws

On February 10, 2015, the U.S. Court of Appeals for the Ninth Circuit affirmed a district court decision finding that the merger of two healthcare providers in Idaho violated antitrust laws. St. Alphonsus Medical Center-Nampa...more

Before Your Nonprofit Health System Considers a Merger – Three Important Board Preps

The Governing Board of every nonprofit health system considering a merger, change in control, sale or significant affiliation has a key role in the process and needs to be engaged throughout the planning, research,...more

This Just in: OIG Rules Free Diapers Are Not an Illegal Kickback

The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services. In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider...more

Task Force of Healthcare Providers and Insurers are Shifting to Incentive Based Contracts

Some of the largest healthcare providers and insurers in the country have joined to form the Healthcare Transformation Task Force in an effort to change healthcare industry payment models.  ...more

New state law mandates education about end-of-life treatment

Beginning in 2015, the newly enacted Medical Treatment Laws Information Act imposes educational requirements on Oklahoma health care providers related to patient end-of-life treatment decision-making. Two groups of...more

Brain damage from birth injury leads to $32 million award

Birth injuries are often some of the most devastating injuries that a family can experience. When a healthy baby is expected, but preventable injuries occur due to the actions of negligent medical personnel, families are...more

CMS Issues Final Rule Designed to Enhance Agency Oversight of Medicare Providers and Strengthen Protections for Medicare...

On December 3, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (CMS-6045-F) that updates various requirements for providers and suppliers wishing to enroll in the Medicare program. CMS issued...more

The Unique Risks Of Investing In Out-Of-Network Providers

For several years, industry observers have been predicting the demise of out-of-network business models, yet they still survive. For some providers in certain specialties and certain geographies, a predominantly...more

Blog: Cyberthieves Collect Confidential Information, Apparently To Conduct Insider Trading

Here is an unnerving warning from FireEye, a cybersecurity firm, discussed in this article from MarketWatch, regarding a sophisticated, native-English-speaking group, designated FIN4, that has targeted almost 100 public...more

Mintz Levin Health Care Qui Tam Update - Recent Developments & Unsealed Cases: November 2014

Trends & Analysis - In the period covered by this issue, we have identified 68 whistleblower cases related to health care that were unsealed. In this Qui Tam Update, we analyze the trends and take an in-depth look at...more

Changes Proposed for Anti-Kickback Statute

It has been said before—healthcare is changing. Most often providers must adapt their practices to comply with governing regulations. Sometimes, governing regulations must be revised to adapt to providers practices. And on...more

For Single-Enterprise Immunity, the Bottom Line May Be Having One Bottom Line

A federal court in Ohio has provided some of the clearest guidance to date on the application of the single-enterprise immunity doctrine to healthcare organizations. The single-enterprise immunity doctrine is critically...more

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