Physicians Hospitals

News & Analysis as of

Managing Institutional Risk: Fraud-Proofing Your Organization

In this presentation: - Top 5 Fraud and Abuse Risks Facing Health Systems - Results of Enforcement Action - Top 5 Steps Health Systems Can Take To Minimize Fraud & Abuse Risk - Non-Compliant...more

Peer Review Privilege: Facts vs. Conclusions

All states have some degree of confidentiality protection for peer review activities and the information generated by those activities, and there is additional federal protection for information gathered and created by...more

JAMA Releases Study Analyzing Scope and Characteristics of Recent Data Breaches

Reports of security breaches involving health care information have become increasingly prevalent in recent years, and such breaches seem to be continually growing in scope and magnitude. In the April 14, 2015, issue of JAMA,...more

Was This Doctor A "Good Fit"?

A Wisconsin hospital scored an important victory in a recent failure-to-hire case involving an allegation of race discrimination. The underlying facts offer a timely reminder to all healthcare employers about what is...more

Proposed GME Legislation Looks to Increase Residency Slots

Last week, new bi-partisan legislation was introduced to increase the number of graduate medical education (GME) slots over the next five years at teaching hospitals and academic medical centers. If passed, the Resident...more

Ninth Circuit Reviews Enforceability of Waiver of Right to Reemployment

Does California Business and Professions Code § 16600 prohibit employees from waiving their right to reemployment with prior employers? The answer is maybe, according to the Ninth Circuit’s recent decision in Golden v. Calif....more

HHS Issues Proposed Rule for Stage 3 of EHR Incentive Program

On March 30, 2015, the Department of Health and Human Services (“HHS”) published its proposed rule for Stage 3 the Electronic Health Record Incentive Program (the “EHR Program”). The EHR Program is a three stage program that...more

MACRA, the Sustainable Growth Rate (SGR) Reform Bill, Signed into Law - CMS Quality Reporting Programs and Value-Based Payments...

The Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act, or MACRA, was signed into law on April 16, 2015. The law replaces the sustainable growth rate (SGR) formula with statutorily prescribed...more

Washington Healthcare Update

This Week: Energy and Commerce Health Subcommittee Explores Post-Acute Bundling…CMS Releases First-ever Hospital Compare Star Ratings…Fiscal Year 2016 Proposed Inpatient and Long-term Care Hospital Policy and Payment Changes....more

Medicare Access and CHIP Reauthorization Act: Paving the Way for Broader Gainsharing Activities

On April 16, 2015, President Obama signed into law H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a critical piece of health care legislation which represents significant movement towards a health...more

SGR Legislation Includes Gainsharing Fix and More Anti-Fraud Measures

The legislation repealing the Medicare sustainable growth rate formula (SGR), signed by President Obama on April 16, 2015, contained several anti-fraud related provisions that affect the health care industry. The provision...more

President Signs Into Law Changes to Medicare Physician Reimbursement Formula

On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 ("the Act"). The national headlines about the Act’s passage focused on the repeal of the sustainable growth rate...more

MACRA: Program Integrity and Fraud and Abuse Provisions

On Thursday April 16th, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Pub.L. 114-10. In two previous posts, we discussed MACRA’s repeal of the Sustainable Growth Rate...more

Permanent “Doc Fix” Legislation Substitutes Merit-Based Incentive Payment System for SGR, and Contains Other Reimbursement and...

In addition to finally repealing the so-called sustainable growth rate methodology (“SGR”) for adjusting Medicare physician payments that Congress has overridden consistently since 2004, the newly enacted Medicare Access and...more

How New York’s Emergency Medical Services and Surprise Bills Law Impacts Providers and Plans

Last year New York passed legislation known as the “Emergency Medical Services and Surprise Bills” law, a much-heralded consumer protection law primarily intended to guard against surprise bills for out of network (OON)...more

Beyond SGR – MACRA Provides Additional Payment Provisions and Offsets

This is the second post in our continuing series on the Medicare Access and CHIP Reauthorization Act (MACRA). Pub.L. No: 114-10. In addition to repealing the Sustainable Growth Rate (SGR), which was covered in our April 20th...more

“Doc Fix” Signed into Law; 21% Physician Pay Cut Avoided

President Obama has signed the “doc fix” into law, which permanently avoids a 21% pay cut for physicians that was slated to take effect this April. The law received broad bipartisan support, passing in the House of...more

Health Alert (Australia) - April 20, 2015

In This Issue: Judgments; Legislation; and Reports. Excerpt from Judgments: New South Wales (NSW) - 13 April 2015 - Sarah White v The Local Health Authority & Anor - [2015] NSWC 417 - The New South...more

Locke Lord QuickStudy: Doc Fix Statute Contains a Lot More than SGR Repeal

On April 16, 2015, the President signed the Medicare Access and CHIP Reauthorization Act of 2015, commonly known as the “Doc Fix.” As has been extensively reported, the Act repeals the Sustainable Growth Rate or (SGR)...more

SGR Law Brings Changes to CMP Prohibition on Gainsharing

On April 16, President Barack Obama signed into law the “Medicare Access and CHIP Reauthorization Act of 2015,” ending a perennial struggle over the Medicare reimbursement formula for physicians. Although the law is most...more

CMS Issues Proposed Modifications to Meaningful Use Rule

On Friday, April 10, 2015, CMS issued a proposed rule containing several important modifications to the Medicare and Medicaid EHR Incentive Programs. Among the most notable proposals is to move eligible hospitals from a...more

Health Alert (Australia) - April 13, 2015

In This Issue: Judgments; Legislation; and Reports. Excerpt from Reports: 27 March 2015 - Public consultation opens on draft Principles and guidelines for the care and use of non-human primates for scientific...more

Connecticut Law Changes Reporting and Governance Requirements for Health Care Entities: Part 2: Requirements Applicable to...

In recent years, we have seen an acceleration in the rate at which health care entities are consolidating and restructuring their organizations in response to the changing regulatory environment. Recent legislation passed in...more

The Enemy of My Enemy Is My Friend

We don’t normally think of American Hospital Association and the Federation of American Hospitals as friends. After all, the AHA represents nonprofits, while the FAH represents for-profits. ...more

CMS Releases Stage 3 Meaningful Use Proposed Rule

The Centers for Medicare & Medicaid Services (“CMS”) released the Stage 3 proposed rule to the Medicare and Medicaid Electronic Health Records Incentive Programs (“Proposed Rule”) on March 20, 2015. To provide context,...more

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