Hospitals

News & Analysis as of

Health Update - November 2014

“Healthcare-Related” Calls: Ambiguity at the Intersection of HIPAA and TCPA - Editor’s Note: The Federal Communications Commission (FCC) has established exemptions from certain requirements of the Telephone Consumer...more

Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and...more

Mississippi CON Report - November 2014

In This Report: - I. October 2014 – Mississippi Certificate of Need Meeting - II. Certificate of Need Program Report – Filings/Reports Since September 2014 - Excerpt from October 2014 – Mississippi...more

HHS Issues Special HIPAA Guidance for Ebola Outbreak

The U.S. Department of Health and Human Services ("HHS"), Office for Civil Rights ("OCR"), released a bulletin last week addressing how covered entities (including certain health care providers and employer group health...more

Hospitals Should Be Aware of ACA Requirement to “Make Public” Their “Standard Charges”

A provision of the Affordable Care Act includes a requirement that hospitals disclose their standard charges to the public. 42 U.S.C. § 300gg-18(e) states that “[e]ach hospital operating within the United States shall for...more

DC Circuit Dismisses Appeal By Three Hospitals Challenging Subcontractor Status

On November 14, 2014, the United States Court of Appeals for the District of Columbia dismissed as moot an appeal by three hospitals affiliated with the University of Pittsburgh Medical Center. The hospitals had challenged...more

CFO’s Thirst for Wine Club Invitation Costs Hospital Millions

You can’t make this stuff up. Last Monday a federal court in Rhode Island ordered two insurance companies to pay a $30 million claim by hospital management company Lifespan Corp. Lifespan filed the claim after being ordered...more

DOJ Criminal Division Renews Efforts to Investigate Whistleblower Allegations

The Department of Justice (DOJ) has signaled a heightened effort to bring criminal prosecutors into the loop regarding False Claims Act referrals and other whistleblower complaints. In recent remarks at a conference comprised...more

Health Care Financing Trends: What Do They Foreshadow?

This article explores some current health care financing trends and speculates on what they may portend for work in a health care restructuring professional’s “pipeline.” While there are many kinds of health care enterprises...more

Highlights of the 2015 OPPS and ASC Final Rule

On October 31, 2014, CMS published its 2015 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule. This annual rule affects the 4,000...more

Birmingham Medical News: Are You Ready for the Upcoming HIPAA Compliance Audits?

Earlier this year, the U.S. Department of Health and Human Services Office of Civil Rights ("OCR") announced its plan for a number of audits regarding compliance with the Health Insurance Portability and Accountability Act of...more

District Court Weighs in on Level of Integration Required to Shield Health Care Collaborations from Section 1 Scrutiny

In Medical Center at Elizabeth Place v. Premier Health Partners et. al, Case No. 12-cv-26 (S.D. Oh. Oct. 20, 2014), the Southern District of Ohio held that previously-competing health care systems who join together in a...more

MedPAC Considering Changes to Hospital Short-Stay Policies and Associated RAC Audits

Last week at its monthly meeting, the Medicare Payment Advisory Commission (MedPAC) discussed current issues with hospital short-stay policies. Specifically, MedPAC discussed the possibility of reducing the incentive to admit...more

The Game Plan for Health Care Enforcement: Office of Inspector General Releases 2015 Work Plan

The Office of Inspector General (“OIG”) within the federal Department of Health and Human Services (“HHS”) is charged with protecting the integrity of HHS programs by combating fraud, abuse and waste. On Halloween of 2014,...more

Health Care Companies Beware: Prosecutors Focus on Conduct Alleged in FCA Lawsuits

On September 17, 2014, during a speech at the Taxpayers Against Fraud Education Fund Conference in Washington, D.C., Assistant Attorney General for the Criminal Division of the Department of Justice (DOJ) Leslie Caldwell...more

HHS Seeks Public Input To Address Growing Backlog of Medicare Appeals

The Office of Medicare Hearings and Appeals (OMHA), a division of HHS that administers the Administrative Law Judge (ALJ) hearing program for Medicare claims appeals, recently issued a Request for Information (RFI) seeking...more

Blog: CMS Explains New Data Matching and Resubmission Process During Open Payments Webinar Today

The Centers for Medicare and Medicaid Services (CMS) held a webinar today to address the process for correcting and resubmitting records that were removed from the Open Payments system in August 2014 by CMS due to data...more

Health Law Wire: Expanding HIPAA Liability for Healthcare Providers (11/14)

The Health Insurance Portability and Accountability Act (HIPAA), while requiring protected health information be kept private, does not provide for a private right of action based on a HIPAA violation. Rather, an individual...more

Is Provider-Based Reimbursement Going Away?

We get this question every year: will Medicare, Medicaid or other payors continue to recognize hospital-level facility fee reimbursement for hospital outpatient departments meeting the provider-based designation criteria at...more

High Court finds no duty of care

In Hunter and New England Local Health District v McKenna; Hunter and New England Local Health District v Simon & Anor [2014] HCA 44, the High Court unanimously allowed appeals from the New South Wales Court of Appeal, and...more

Ohio District Court Deems Hospital Alliance a Single Entity Incapable of Conspiring Under the Antitrust Laws

On October 21, 2014, the U.S. District Court for the Southern District of Ohio granted Defendants’ motion for summary judgment, holding that Premier Health Partners (“Premier”) and its affiliate hospitals, Atrium Health...more

Shift Worker Rules Warrant Special Attention

The long-term-care industry depends on shift workers to provide patient care 24 hours per day, seven days per week. But even experienced and sophisticated employers can find the application of state and federal labor and...more

California Health Care Providers Successfully Ward Off Data Breach Lawsuits

In a pair of recent cases, two California health care providers successfully warded off lawsuits arising from unauthorized data breaches of patient files. These cases illustrate that improper disclosure of electronically...more

NNU Ebola “Day of Action” Slated for November 12, 2014

Registered nurses in 16 states and the District of Columbia are planning a national “Day of Action” by engaging in strikes, picketing, leafleting, rallies, and candlelight vigils on Wednesday, November 12, in support of...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 7: IRS Puts the Kibosh on Health Plans that Fail to Cover...

In a previous post, we described an Affordable Care Act compliance strategy—referred to commercially as a “minimum value plan” or “MVP”—that involves an offer of group health plan coverage that, while similar in most respects...more

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