Hospitals

News & Analysis as of

OIG Issues Report on Provider-Based Facilities, Urges CMS to Make Changes

In Depth - On June 16, 2016, the US Department of Health and Human Services Office of Inspector General (OIG) posted a report examining the Centers for Medicare & Medicaid Services’ (CMS’s) oversight of billing by...more

CMS Proposes Updates to Hospital Conditions of Participation

CMS recently published a proposed rule to update certain of the hospital and critical access hospital (CAH) Medicare and Medicaid conditions of participation (CoPs). With its goals of modernizing hospital and CAH CoPs,...more

Health Alert (Australia) June 27, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Victoria 21 June 2016 - Inquest into the death of Summer Emerald Rose Jamsek Summer Jamsek was born at...more

One-Two Punch on Hospital Challenges: Is the FTC Down for the Count?

There was a time not long ago when the odds of beating the Federal Trade Commission on a hospital merger antitrust challenge were slim. Two recent defeats, however, may change that some. Late last year, the FTC, in quick...more

Hospital Mergers: Is the FTC’s Winning Streak Over?

Following a winning streak dating back to its 2007 win in Evanston, the Federal Trade Commission (FTC) has suffered two losses over the last month in two of its three pending hospital merger challenges. On June 14, 2016, a...more

Significant Hospital Related Mid-Year Updated OIG Review Activities

This is the second of three alerts discussing the mid-year update to the Fiscal Year 2016 Work Plan issued by the Office of Inspector General (OIG). In the first alert we discussed the top management performance challenges...more

Broad Examination of Narrow Networks: First-of-Its-Kind Study Examines Hospitals in Medicare Advantage Plans

On June 20, 2016, The Kaiser Family Foundation issued the first ever broad-based study of Medicare Advantage hospital networks. The study — "Medicare Advantage Hospital Networks: How Much Do They Vary?"— analyzed 409 plans in...more

CMS Proposes Changes to Hospital CoPs to Promote Quality, Strengthen Discrimination Protections

CMS has published a proposed rule on June 16, 2016 that would update the standards hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid. Specifically, CMS proposes to revise the...more

OIG Identifies Continued Vulnerabilities in Medicare Provider-Based Facility Payment Policy

A new OIG report examines CMS’s oversight of Medicare billing by provider-based facilities – that is, facilities that operate under the ownership, administrative, and financial control of a hospital and meet other...more

OIG Recommends Eliminating Provider-Based Designation for Facilities Owned by Hospitals

In a report released on June 17, 2016, OIG renewed its call for CMS to either eliminate the provider-based designation, which allows facilities owned by and integrated with a hospital to bill Medicare as a hospital outpatient...more

Why Should Hospitals with “Church Plans” Be Concerned Now? - Hospital Industry Viewpoint

Religiously affiliated hospitals and health systems have recently come under attack by private litigants for exercising the right to remain exempt from ERISA requirements. Such hospitals and health systems should assess their...more

OIG Releases Mid-Year Update to its FY 2016 Work Plan

The HHS OIG has updated its FY 2016 Work Plan to reflect new and/or completed items since initial release of the FY 2016 Work Plan in November 2015. For instance, the mid-year update indicates that the OIG plans to conduct...more

CMS Update on Temporary “Two Midnight” QIO Review Pause

CMS has temporarily “paused” Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) performance of initial patient status reviews under CMS’s “two-midnight policy” for short hospital stays. The...more

House Approves “Helping Hospitals Improve Patient Care Act of 2016”

The House of Representatives has approved H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016,” as amended by the Ways and Means Committee in May. As previously reported, while the bill focuses on Medicare...more

Ransomware Update: The FBI Weighs In

The FBI recently released an article discussing the spate of ransomware attacks on a variety of different entities, including hospitals. In the article, the FBI warned that ransomware attacks and the cybercriminals carrying...more

Healthcare Lessons Learned From Reality TV

On March 31, 2016, a New York court determined that a lawsuit may proceed against a physician and hospital for breach of physician-patient confidentiality arising from a documentary series about medical trauma, NY Med. The...more

Data Security Safeguards Can Help Healthcare Employers Withstand Cyberattacks—and Government Audits

The last couple of years have brought a steady rain of bad news for the healthcare industry when it comes to data security: Insurers faced with massive data breaches affecting thousands of health plans and millions of...more

Alabama CON Report

I. SHPDA Administrative Report - A. Contested Cases - For the following projects no vote was required because the recommended order of the Administrative Law Judge becomes the final order of the Agency when no...more

The Future of Provider-Based Status Post-BBA 2015

This month, hospitals impacted by Section 603 of the Bipartisan Budget Act of 2015 (BBA) may finally get a glimpse of what the future holds for the off-campus departments they operated or were developing when the BBA was...more

New CMS Final Fire Safety Regulations

The Centers for Medicare and Medicaid Services (CMS) has updated its fire safety regulations governing certain Medicare and Medicaid participating health care providers. These include hospitals, critical access hospitals...more

Tennessee Health Services And Facilities Report: June 2016 Newsletter

The Tennessee Health Services and Development Agency ("HSDA") is responsible for regulating the health care industry in Tennessee through the Certificate of Need Program. A Certificate of Need ("CON") is a permit for the...more

FTC Suffers Another Hospital Merger Loss in Advocate-NorthShore

On Tuesday, June 14, 2016, the U.S. District Court for the Northern District of Illinois declined to temporarily block the proposed merger of Advocate Health Care Network and NorthShore University HealthSystem in the Chicago...more

Federal Trade Commission Suffers Setback in Major Hospital Merger Case

On Tuesday, June 14, 2016, U.S. District Judge Jorge Alonso of the Northern District of Illinois declined to grant the Federal Trade Commission (FTC) a preliminary injunction to temporarily stop a merger between Downers...more

Judge Allows Advocate-NorthShore Merger to Proceed; FTC May Appeal

For the second time in just over a month, a federal judge has denied a Federal Trade Commission (FTC) motion to enjoin the merger of two hospital systems, this time the 13-hospital Advocate Health Care and the 4-hospital...more

Can moonlighting residents trigger Medicare GME caps?

In our last edition of GME @ Dentons, we covered the ins and outs of reimbursement for fellow moonlighting. In several prior editions, we have discussed the potential harm, from a Medicare graduate medical education (GME)...more

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