Hospitals

News & Analysis as of

Front End Changes and, Again, More DIR Columns

Since the beginning of the Medicare Part D program, CMS has introduced many reporting mechanisms for trying to understand drug pricing, price concessions, and the cost of providing services to Part D members. The tool CMS...more

High Court hears appeal on hospital’s duty of care to man murdered by mental health patient

Last week, the High Court of Australia heard argument in an appeal against the decision of McKenna v Hunter & New England Local Health District; Simon v Hunter & New England Local Health District [2013] NSWCA 476. The...more

DOL Announces Delay to Home Care Worker Wage Regulations

Last October, the federal Department of Labor’s Wage and Hour Division sent shockwaves through the home health care industry by issuing final rules declaring most of its employees to be subject to FLSA minimum wage and...more

NLRB and Union in Cahoots—Employer Still Loses

An employer’s bid to quash three ridiculously overbroad NLRB subpoenas fell short even though the trial court repeatedly said it disapproved of the NLRB’s tactics. The SEIU filed unfair labor practice charges against a...more

Medical Information More Valuable to Hackers Than Credit Card Numbers

In light of the recently reported large healthcare data breaches that have resulted in the potential theft of the personal information of millions of patients, the FBI warned healthcare providers yet again of the dangers of...more

Georgia Department of Community Health Ruling Jeopardizes FTC Action Against Phoebe Putney Health System, Inc.

On October 6, Ellwood F. Oakley III, an administrative hearing officer at Georgia’s Department of Community Health, reversed an initial staff determination that a new Certificate of Need (CON) would not be required if Phoebe...more

Proposed Updates to the Civil Monetary Penalties Law for Health Care Providers

On October 3, 2014, the Office of Inspector General of the Department of Health and Human Services (“OIG”) published a proposed rule and request for comments (“Proposed Rule”) that would amend certain rules under the Civil...more

Colorado Supreme Court Protects Quality Management Privilege for CDPHE-Licensed Providers

Colorado hospitals and other licensed and certified health care facilities scored a significant victory on October 14, when the Colorado Supreme Court issued its en banc ruling in Simpson v. Cedar Springs Hospital, Inc. (2014...more

Providers Challenge CMS's Non-Hospital Rotation Rules for GME and IME

Prior to the enactment of the Affordable Care Act (ACA), CMS required hospitals to comply with a number of exacting payment and documentation rules in order to include as part of their graduate medical education (GME) and...more

IRS Proposes Key Changes to Schedule H's Community Health Needs Assessment and Financial Assistance Policy Questionss

On October 8, 2014, the IRS released drafts of the 2014 Form 990, Schedule H and Instructions, proposing significant changes related to a hospital facility's compliance with Section 501(r) of the Internal Revenue Code. These...more

Hospital’s Extortion & Fraud Too Quick to Violate RICO

Danielle Bennion and her co-plaintiffs filed a RICO (Racketeer Influenced & Corrupt Practices Act) action alleging that Mountain View Hospital and co-defendants engaged in a plan of extortion and wire fraud for the purpose of...more

Another Federal Court Decertifies FLSA Collective Action of Hospital Workers Challenging Auto-Deduct Policy

We have previously discussed that, while medical providers have become a common target of plaintiffs asserting wage and hour claims arising out of so-called “auto-deduct” policies, more and more courts are realizing that the...more

Critical Access Hospital Soothsayers and the 96-Hour Physician Certification Requirement

This year critical access hospitals (CAH) have struggled to implement procedures to comply with both the "two-midnight" rule and the 96-hour physician certification requirement. The combination of both puts physicians in a...more

District Court Approves Government’s Use of Sampling and Extrapolation to Prove False Claims Act Liability

In United States ex rel. Martin et al. v. Life Care Centers of American, Inc., the Court held that the government could extrapolate from a random sample in order to impose False Claims Act (FCA) liability against Life Care...more

Hardship Exception Applications to Avoid the 2015 Medicare Payment Adjustment Due November 30, 2014

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that it intends to reopen the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015...more

CMS Issues New Cost Reporting Instructions

CMS recently released a transmittal updating Chapter 40 of the Provider Reimbursement Manual and the Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10). ...more

New Challenge to 340B Rule Regarding Orphan Drugs

On October 9, 2014, Pharmaceutical Research and Manufacturers of America (PhRMA) filed a complaint (the October 9 Complaint) against the U.S. Department of Health and Human Services (HHS), the Health Resources and Services...more

From Competitors to Co-Adventurers, Seven Hospital Systems Join with Anthem Blue Cross to Shake Things Up in Southern California

Anthem Blue Cross and seven competing hospital systems in Southern California are joining forces to establish a new health plan offering, Vivity.[1] Operating with a combined 14 hospitals and approximately 6,000 physicians,...more

New Regulations, Same Old Procedures: CDPH Penalties Become More Complex

Regulations effective April 1, 2014, subject California hospitals to a significantly increased risk of being fined when state authorities find deficiencies in compliance with licensing requirements and other health...more

OIG Approves Yet Another Medigap Policy Contract with Preferred Hospital Network

On September 17, 2014, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued Advisory Opinion 14-08 [PDF]. This opinion is yet another favorable advisory opinion approving a Medicare...more

Sunshine Act Update: First Data Set Published

On September 30, the Center for Medicare & Medicaid Services (CMS) published the first set of data reported by pharmaceutical, medical device, biotechnology and medical supply companies, and group purchasing organizations...more

Compliance with Internal Revenue Code §501(r) – the IRS (and Others) are Watching

Two public interest groups recently filed a complaint (Complaint) with the IRS claiming that Jackson Health System (JHS) failed to comply with the requirements of Internal Revenue Code (IRC) § 501(r) as enacted as part of the...more

Health Care E-Note - September 2014

In This Issue: - Doctors, Insurers Critical of Medicare Physician Fee Schedule - Health Spending Expected to Increase Modestly Over Next Decade - U.S. Hospitals Have Highest Administrative Costs...more

Healthcare industry compliance in a shifting world: putting it all together

Health industry clients face regulatory and enforcement challenges on multiple fronts. It can be difficult to prioritize and allocate resources properly when government agencies’ initiatives are constantly shifting. The...more

Illinois Blues Won’t Let Hospitals Jointly Negotiate Unless They’re Married

Remember when Hollywood wouldn’t show an unmarried couple in bed together? Blue Cross-Blue Shield of Illinois is taking that approach to contract negotiations. If hospitals want to negotiate jointly with the insurer, they...more

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