News & Analysis as of

Antitrust Law - October 2016

Editor’s Note: On September 27, 2016, the Third Circuit handed the Federal Trade Commission (FTC) a significant victory in its campaign against hospital consolidation, reversing a District Court decision that denied a...more

Hospitals Considering Merger Face Increased Uncertainty

PinnacleHealth System and Penn State Hershey Medical Center have abandoned their merger plans following a Third Circuit defeat last month. The announcement underscores the uncertainty faced by hospitals considering...more

House Republicans Push Back on Medicare’s New Mandatory Bundled Payment Models

On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule that promises to deliver coordinated, high-quality care for Medicare beneficiaries. The proposed rule (effective July 1, 2017)...more

GME benefits of rural status

When Congress first established limits on Medicare payments for graduate medical education (GME) in the Balanced Budget Act of 1997, the resident limits or "caps" on Medicare-funded training positions applied equally to all...more

Massachusetts Licensure of Clinics Proposed Regulations – Key Take-Aways

In previous blog posts, we addressed the Massachusetts Department of Public Health’s (DPH) proposed regulations that affect hospitals, dialysis clinics and medical marijuana programs. In this final post on DPH’s recent...more

Third Circuit Delivers Resounding Victory for FTC in Pennsylvania Hospital Merger Case

On September 27, 2016, the U.S. Court of Appeals for the Third Circuit handed the Federal Trade Commission (FTC) a significant antitrust victory by granting its request for a preliminary injunction to stay the pending merger...more

Health Alert (Australia) October 17, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: New South Wales 13 October 2016 - Coote v Kelly; Northam v Kelly [2016] NSWSC 1447 - On 23 May 2012, Mr Coote died...more

Hospital Short-Stay Review Ban Lifted by CMS

Effective September 12, 2016, the Centers for Medicare & Medicaid Services (CMS) lifted the temporary ban on patient status reviews of hospital short stays for Medicare beneficiaries. Those reviews are currently conducted by...more

The End of the Road for Hershey Medical Center's Merger: Parties Abandon Transaction After Third Circuit Rules That Hospital...

The decision serves as a reminder of the uphill battle that merging health care providers have faced since the FTC’s adoption of its current rigid market definition standard in 2007. The U.S. Court of Appeals for the...more

The IRS Is Checking Hospitals for Compliance with Section 501(r)

The IRS is hard at work reviewing hospitals for compliance with new requirements imposed by section 501(r) of the Internal Revenue Code. A recently released work plan of the IRS Tax Exempt and Government Entities Division...more

Are you ready for Section 1557’s notice requirements?

This is a reminder that beginning October 16, 2016, Covered Entities (as defined below) are required to comply with certain notice requirements under Section 1557 of the Affordable Care Act (“ACA”). Section 1557 of the ACA...more

Health Law Insights Newsletter - Issue 13

McCarter & English, LLP’s Health Care Group presents Issue 13 of the Health Law Insights, which discusses the latest legal issues in the health care industry. - Failure to Update Business Associate Agreement Results in...more

Federal Trade Commission's Pennsylvania Hospital Challenge Moves Forward: Third Circuit Halts Transaction Pending Trial Outcome

A Federal Appeals Court has sided with the FTC and preliminarily blocked the proposed merger of the largest hospitals in the Harrisburg, Pennsylvania area, and Penn State Hershey Medical Center and PinnacleHealth System. The...more

Refusal to Pay Claims to Gain Negotiating Leverage Is Abuse of Discretion Under ERISA, Court Says

A federal district court found that Cigna Healthcare abused its discretion, and thus was liable under section 502(a)(1)(B) of ERISA, when its primary motivation for refusing to pay a hospital’s claims was to enhance its...more

S. Dakota high court asked to pry open hospitals’ secret approval of brutal MD

South Dakota’s highest court has been asked to reject hospitals’ attempts to keep secret why a doctor, who also is a convicted burglar with a checkered medical past that could have easily been uncovered, passed a peer review...more

Watching SCOTUS – ERISA Church-Plan Exemption Revisited

Seyfarth Synopsis: Currently before the Supreme Court are two petitions regarding the thorny legal question of which organizations can qualify for ERISA’s Church-plan exemption. If the Supreme Court grants certiorari and...more

When Outside Compliance Monitors May Be a Blessing: Companies Subjected to Corporate Integrity Agreements May Be Undone by Rogue...

Companies face ever-increasing pressures to implement mechanisms designed to prevent or effectively address employee malfeasance. In today’s environment, even companies who appear to be cooperating with investigative and...more

Mississippi CON Report

1. Mississippi Certificate of Need Meetings during September 2016 - During the September 29, 2016, Certificate of Need meeting, Dr. Mary Currier, State Health Officer, concurred with the health and planning staff...more

A Superficial Analysis of Competitive Foreclosure Won’t Play in Peoria

A federal trial court rejected a hospital’s antitrust claims that it was substantially foreclosed from the market by its rival’s exclusive contracts with payors. The court concluded that foreclosure in healthcare services...more

Overcharging for the Cost of Retrieving Medical Records

Woodland Hills personal injury attorney Barry P. Goldberg must obtain countless medical records for his clients in order to perfect and settle claims. The cost of retrieving these records has become prohibitive with the...more

Congress is focused on FTE caps: New proposed legislation would redistribute hospitals’ unused residency training slots

There has been recent activity in Congress surrounding full-time equivalent (FTE) residency training caps (FTE caps) that limit the number of Medicare-funded graduate medical education (GME) training positions for which a...more

NLRB Permits Off-Duty Employees to Picket on Employer Property

An employer’s ability to prohibit picketing on its property was dealt a serious blow when the National Labor Relations Board (NLRB) recently ruled in Capital Medical Center that an acute care hospital violated Section 8(a)(1)...more

DOJ Announces Settlement with Tuomey CEO Following Yates Memo Directive to Hold Individuals Accountable

The Department of Justice’s recent settlement with a healthcare system executive indicates a continued focus on pursuing individuals in enforcement actions. On September 27, 2016, the DOJ announced it reached a $1 million...more

Manatt on Health Reform: Weekly Highlights - October 2016

Vermont moves closer to launching the country’s first all-payer ACO; CMS approves Arizona’s 1115 waiver extension but rejects the State’s proposed work requirement and premiums for those earning below the FPL; and CMS issues...more

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