Hospitals

News & Analysis as of

HHS Asserts the Everybody-Does-It Defense

If that sounds familiar, your child may have a future as a lawyer for Health & Human Services. Because that’s one of the primary arguments asserted by HHS last Friday in its motion to dismiss the lawsuit by the American...more

Trends in New Jersey Employment Law - September 2014

Third Circuit Renders Important Decisions on FMLA and FLSA - In recent weeks, the U.S. Court of Appeals for the Third Circuit rendered a trio of significant employment law decisions....more

EEOC Sues McLeod Health for Disability Discrimination

Non-Profit Medical Institution Subjected Employee to Illegal Medical Examinations And Fired Her in Violation of Federal Law, Federal Agency Charges - FLORENCE, S.C. - McLeod Health, Inc., a South Carolina regional...more

Attention Hospitals! Act Now To Get 68 Cents For Your Medicare Dollar!

It’s no secret that CMS is drowning in appeals from denials of Medicare claims for inpatient care. The number of pending appeals was estimated at half a million back in February, and it’s only grown since then. One reason...more

Bankruptcy sales for distressed hospitals: 4 questions to ask before you begin

Over the last several years, a wide range of healthcare companies, among them hospitals, home health agencies and continuing care facilities, have faced financial distress as a result of declining revenues, high operating...more

CMS Offers Global Settlement of Inpatient Status Claims with Pending Appeals

On August 29, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced a global settlement offer to acute care and critical access hospitals with currently pending appeals of inpatient status claims denials....more

North Carolina’s Medicaid RAC Program - Don't Let Your Guard Down

With Section 6411(a) of the Patient Protection and Affordable Care Act (ACA) and the Final Rules found at 42 CFR Part 455, the Recovery Audit Contractor (RAC) program has been expanded to the North Carolina Medicaid program,...more

Hospitals File Lawsuit Over Medicare ALJ Hearings Delays

Over 460,000 appeals requesting hearings before an administrative law judge (ALJ) were pending in the Office of Medicare Hearings and Appeals (OMHA) at the end of 2013, with 15,000 new appeals being submitted each week. At...more

A Primer on Medicare Requirements for Physician Supervision of "Incident to" Services

Services provided by a physician’s auxiliary staff that are “incident to” the physician’s services are paid under the physician fee schedule at a higher rate, as though the physician had personally furnished the services....more

Fire Safety Requirements for Hospitals and Other Health Care Facilities: How CMS Is Interpreting Occupancy Classifications and...

On April 16, 2014, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule amending the fire safety standards for hospitals and other types of health care facilities. Compliance with the fire safety...more

U.S. Department of Justice Files False Claims Action Against 3 PODs and Physician Investors for Physician and Hospital Claims

On September 8, 2014, the U.S. Department of Justice (DOJ) filed a False Claims Act (FCA) case in the Central District of California against Reliance Medical Systems, two related distributors (Apex Medical Technologies and...more

Court Rejects Hospital’s ADA Argument That Proves Too Much

Dr. Robinson is an obstetrician at St. Francis Hospital. A diabetic, he underwent surgery for a broken foot and can’t always remain standing throughout deliveries. So he uses a rolling stool and practices from a seated...more

Hospital Options for Unused Long Term Care Beds - Corridors Newsletter Fall 2014

A number of hospitals in North Carolina have skilled nursing beds in their bed inventory. According to the Proposed 2015 State Medical Facilities Plan (SMFP), 1,652 of the 45,724 (or approximately 4 percent) of the licensed...more

Corridors Fall 2014 - News for NC Hospitals

In this issue: - North Carolina’s Medicaid RAC Program – Don’t Let Your Guard Down - A Primer on Medicare Requirements for Physician Supervision of “Incident to” Services - Hospital Options for Unused...more

Health Law Blog: CMS Offers Settlement to Hospitals for Resolving Patient Status Denials

On September 9, 2014, the Centers for Medicare & Medicaid Services (CMS) held a conference call with providers and other interested parties regarding CMS’s recent offer to resolve any acute care or critical access hospitals’...more

Independent Hospitals Innovating, Finding New Partnerships in Response to Market Pressures

Standard & Poor’s (S&P) Rating Services recently warned the health care sector was at “a tipping point where negative forces have started to outweigh many providers’ ability to implement sufficient countermeasures.” S&P noted...more

HealthCare Fraud and Courtesies: What to Know Before Waiving a Copayment

Many healthcare facilities and physicians waive the insurance copayment for physicians and their families (known as professional courtesy) or other patients. Yet, despite how prevalent the practice is and the limited...more

CMS Offers Deal to Hospitals to Drop RAC Appeals

On August 29, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a deal to hospitals willing to drop pending inpatient-status claims appeals. These appeals have grown exponentially in recent years due to the...more

Most-Invasive-Procedure-of-the-Month Award

Back in 2010 the police asked Dr. LaPaglia to conduct a body cavity search of Felix Booker. They were looking for illegal drugs. Dr. LaPaglia said yes and proceeded. First, he paralyzed Felix with drugs (legal ones). Then...more

Health Care: Tackling DSRIP - Legal, Financial, and Clinical Issues for Non-Lead Providers (9/14)

Designed by New York State to seek a federal waiver for the expenditure of Medicaid funds, the Delivery System Reform Incentive Program (DSRIP) will allocate 6.42 billion dollars to health care providers in New York State to...more

CMS Waves Partial White Flag in Appeals of Payment Status Denials

For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more

Hospital's Lab Testing for Non-Patients Held to be Related Activity

On July 11, 2014, the IRS released a Technical Advice Memorandum ("TAM") finding that a tax-exempt hospital's income from the performance of laboratory services for non-patients was not subject to the unrelated business...more

Advocacy Organizations’ Complaint Puts a Spotlight on Potential Noncompliance by Nonprofit Hospitals

On August 25, two advocacy organizations filed a complaint with the Internal Revenue Service (IRS) alleging noncompliance by a hospital system with respect to certain community benefit requirements imposed by the Patient...more

Telehealth and Health IT Policy: Considerations for Stakeholders

In recent months, as the conversation about reforming the health care system has shifted to achieving greater delivery system efficiencies, cost containment, and patient satisfaction, the role of health care...more

VA Whistleblower in Phoenix Punished for Alerting Authorities

In 2010, Paula Pedene helped reveal a scandal in the Phoenix Veterans Affair Hospital revolving around mismanagement that ultimately led to the hospital being $11.4 million short in its budget. Now, it’s being reported that...more

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