News & Analysis as of

CMS Proposes Elimination of CME Exception to Sunshine Act Reporting

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule that includes a plan to eliminate the continuing medical education (“CME”) exclusion to the reporting requirements under the federal Physician...more

Medicare Fee Schedule and Florida PIP Coverage

In the state of Florida and other states that use no-fault auto insurance systems, specific issues involving insurance payouts are often part of traffic accident personal injury claims. Florida personal injury lawyers need to...more

The Government Intervenes In False Claims Act Case Alleging Failure To Return Overpayments Within 60 Days

On June 27, 2014, the United States intervened in a qui tam action under the False Claims Act alleging that certain New York hospitals failed to refund Medicaid overpayments within 60 days of identifying them, as required by...more

Healthcare Legal News - July 2014 • Volume 4, Number 2

In This Issue: - DO SUBSIDIZED HEALTH CARE PLANS PURCHASED UNDER THE AFFORDABLE CARE ACT TRIGGER THE ANTI-KICKBACK STATUTE? The advent of federally subsidized private pay health insurance under the Affordable...more

Harris v. Quinn Decision May Set Stage for Further Rulings Limiting Public Unions

On Monday, the U.S. Supreme Court decided Harris v. Quinn. As readers of my June 10 posting will recall, the plaintiffs in that case objected on First Amendment grounds to being required to contribute public union dues as a...more

Manatt on Medicaid: The Emerging Conversation About the Future of CHIP

During passage of the Affordable Care Act (ACA), a debate erupted over the future of the Children’s Health Insurance Program (CHIP), a well-established program that now offers coverage to 8 million children in low- and...more

Agency Fees Can’t Be Required for Illinois Rehab Personal Assistants, SCOTUS Rules

The State of Illinois cannot require Rehabilitation Program “personal assistants” (PAs) who decide not to join a union, to pay compulsory union dues, commonly known as “agency fees,” the U.S. Supreme Court ruled in Harris v....more

Radical Shift Coming In Public Sector Agency Fees

On Monday, the Supreme Court took a swipe at public sector compulsory unionism. In doing so, the Court took a slice out of decades of Supreme Court jurisprudence and suggested a future re-thinking of agency fees in the public...more

Commission-Based Sales Agreements for Medical Supplies and Equipment: More Whistleblower Activity on the Horizon? - A Wide Range...

The common industry practice of compensating independent contractor sales representatives on a "percentage of sales" commission basis may be creating an enhanced risk of False Claims Act liability for illegal kickbacks in...more

Supreme Court Rejects Labor’s Mandatory Dues Collection Initiative in Favor of Workers’ First Amendment Rights

Yesterday, the Supreme Court of the United States held that the First Amendment of the U.S. Constitution prohibits a public-employee union from collecting an agency fee from home-care workers who do not want to join or...more

Supreme Court Decides Harris v. Quinn

On June 30, 2014, the U.S. Supreme Court decided Harris v. Quinn, No. 11-681, holding that the First Amendment does not permit a state to compel public employees to subsidize speech on matters of public concern by a union...more

Two Significant Decisions Affecting Employers Issued the Final Day of the U.S. Supreme Court Session

On the last day of its 2013-2014 session, the U.S. Supreme Court held today that (1) for-profit companies are protected as "persons" under the federal Religious Freedom Restoration Act of 1993 (RFRA) and (2) that the...more

Supreme Court Strikes Down Mandatory Union "Fair Share" Deductions For Public Sector Employees

Today, in a 5 to 4 decision, the U.S. Supreme Court declined to extend its previous holdings regarding “fair-share” fees (fees that an employee who refuses to join a union is required to pay in lieu of union dues) to...more

United States Supreme Court Strikes Down Illinois Regulatory Framework Requiring Personal Assistants for Medicaid Recipients to...

In its much anticipated decision in Harris v. Quinn, 573 U.S. __ (2014), the Supreme Court of the United States in a five to four ruling struck down an Illinois regulatory framework that required personal assistants (PAs) for...more

Senior Care Franchises: Important Regulatory News

Effective July 1, a home health agency that is not Medicare or Medicaid certified and does not provide skilled care is exempt from the requirement to be accredited in 400.471(2)(h), Florida Statutes. An amendment was passed...more

SCOTUS Preview: Is the End in Sight for Public Employee Unionism (and Fair Share Fees)?

Does a collective bargaining agreement that requires nonunion home-care workers to pay a fee to a union representative violate the First Amendment of the U.S. Constitution? In the next few days the Supreme Court of the United...more

#HealthyPA Takes the Next Step

The governor’s recent announcement that 9 commercial insurers successfully applied to participate in Healthy PA is another positive development as negotiations between Department of Public Welfare and the Centers for Medicare...more

GAO Concludes States Should Strengthen Medicaid Managed Care Program Integrity Efforts

The Government Accountability Office (GAO) recently released a report examining why Medicaid managed care programs made an estimated $14.4 billion in improper payments for fiscal year 2013. GAO found that the improper...more

Health Care Update - June 2014 #3

In This Update: - CMS Getting New Leadership Roles - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other...more

The Self-Referral Disclosure Protocol: Settlement and Enforcement Trends (Presentation)

The Self-referral Disclosure Protocol (SRDP) permits health care providers to voluntarily disclose violations of the federal physician self-referral law, also called the Stark law. Emily Wein has presented a webinar...more

The ONC’s Health IT Vision Plan: A Building Under Construction

The HHS Office of the National Coordinator (ONC) released its report “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure” (the “Vision Plan”) last week to help...more

As Sunshine Act Reporting Deadline Looms, CMS Issues Additional Guidance

With the June 30 deadline for Phase 2 Sunshine Act reports by pharmaceutical and medical device manufacturers (“Applicable Manufacturers”) and group purchasing organizations (“GPOs’) quickly approaching, the Centers for...more

Brace for Medicaid data mining and recoupment demands

The federal Health and Human Services Office of Inspector General (OIG) is escalating its war against Medicaid fraud and abuse, just as it has over the past years with Medicare. The OIG’s focus has turned to early prevention...more

Medicaid Enrollment Continues to Grow

The U.S. Department of Health and Human Services (HHS) has reported that at the close of April, an additional 6 million Americans have enrolled in Medicaid and related health programs for the poor since the launch of coverage...more

Provider Reimbursement Review Board Issues 60 Day Deadline to Supplement Record in All DSH Medicaid Eligible Days Appeals

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers of an important new 60 day deadline concerning certain appeals before the Provider Reimbursement Review Board (PRRB or Board). By the end of...more

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