Healthcare Providers

News & Analysis as of

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

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

Practitioners Beware - Unfavorable Allegations And Disclosure Can Be Used Against Your Client

Arizona is a pure comparative fault state, which allows the finder of fact to apportion fault to parties and non-parties alike. As a general rule, defendants will only be responsible for their apportioned share of fault –...more

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