Healthcare

News & Analysis as of

Fraud and Abuse Waivers for MSSP ACOs Extended Another Year

Fridays are for fraud and abuse news-related releases, yet again. Last Friday, the HHS Office of the Inspector General (OIG) released a notice (Notice) informing the public that it has delayed the release of a final rule...more

New CDC Ebola Monitoring Protocol is Good News for Employers

The CDC has just announced new active post-arrival monitoring for all travelers entering the U.S. from Liberia, Sierra Leone or Guinea. ...more

Do You Offer or Accept Copayment Coupons? OIG says YOU are Responsible for Compliance with Federal Law

In recent years, copayment coupon programs have become standard promotional practices for both large and small pharmaceutical manufacturers. Copayment coupons are typically offered to commercially insured patients in order...more

What Falls Under "Medical Compensation" Under North Carolina's Workers' Comp Act

In our last post we discussed how you prove that you're entitled to medical compensation. In this one, we're going to talk about what medical compensation actually mean, what you have to do to get it, and some examples of...more

Recent Nevada Opinion: Retroactivity Rules and Ex-Parte Communication With Treating Physicians Prohibited

On July 10, 2014, the Supreme Court of Nevada published Leavitt v. Siems, 130 Nev. Adv. Op. 54 (2014), which addressed issues related to expert testimony. This case provides two important takeaways: (1) the basic legal...more

Recent Developments in PA and NJ Regarding Scope of Privilege for Health Care Facilities Engaged in Peer Reviews and Self-Critical...

Three recent cases offer guidance to health care entities in Pennsylvania and New Jersey regarding the discovery of documents created in connection with peer reviews, quality of care reviews and adverse event investigations...more

More Turns in the FTC's Antitrust Enforcement Action Against Phoebe Putney Hospital, Inc.

The FTC’s long-running campaign against Phoebe Putney Health System, Inc.’s acquisition of Palmyra Park Hospital, Inc., continues. In an unusual sequence of events, the Commission first conditionally accepted a Consent...more

Health Update - October 2014

Like It or Not, Obamacare Is Reshaping the Healthcare Industry - Editor’s Note: As we approach the one-year anniversary of Obamacare’s launch, the pundits continue to argue over whether or not it’s working. Meanwhile,...more

Hospital Conversion to For-Profit Status Improves Health (i.e., Financial Health)

For years the debate has raged: Does conversion of a nonprofit hospital to for-profit status result in a decline in clinical quality? An improvement? More efficient operations? A decrease in the volume of indigent and...more

Blurring the Lines between False Claims Act Litigation and Putative Federal Malpractice Law: The DOJ Quietly Invokes “Worthless...

On October 10, 2014, the United States Department of Justice (“DOJ”) announced a civil settlement agreement (the “Settlement”) with Extendicare Heath Services, Inc. and its subsidiary Progress Step Corporation (collectively,...more

New York’s “Emergency Medical Services and Surprise Bills” Law

Earlier this year, the New York Legislature enacted, and Governor Cuomo signed, legislation that will impact billing and reimbursement for some out-of-network health care services, require new disclosures from providers...more

Provider of Physical, Speech, and Occupational Therapy Services Agrees to $38,000,000 False Claims Act Settlement

As announced in an recent press release, Extended Care Health Services, Inc. (“Extendicare”), an operator of skilled nursing facilities, and its subsidiary Progressive Step Corporation (“Pro Step”), a provider of physical,...more

Affordable Care Act in Mergers and Acquisitions: New Guidance from Internal Revenue Service

In Notice 2014-49, the Internal Revenue Service (“Service”) issued guidance on how to avoid potential penalties under the Affordable Care Act (“ACA”) in connection with mergers and acquisitions (“M&A”). The notice provides a...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 10: What’s an Employer to Do (with Marketplace Notices)?

Under the Affordable Care Act’s employer shared responsibility rules, applicable large employers (those with 50 or more full-time and full-time equivalent employees on business days during the preceding calendar year) incur...more

Medicare Shared Saving Program Interim Final Rule Extended

On October 17, 2014, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services, Office of Inspector General (OIG) published in the Federal Register (79 FR 62356 et seq) a notice...more

Health Care: Ebola Advisory For Health Care Facilities and Providers (10/14)

Yesterday, the CDC issued revised guidance ("Guidance") detailing personal protective equipment (PPE) standards, including donning and doffing PPE, for all healthcare workers entering the room of a patient hospitalized with...more

North Carolina Legislative Report

The General Assembly adjourned “sine die” on Wednesday, August 20. During the interim, the MVA Public Affairs Legislative Report on North Carolina will be distributed biweekly to keep you up to date on the latest legislative...more

Manatt on Health Reform: Weekly Highlights

Welcome to the first publication of the “Manatt on Health Reform: Weekly Highlights” newsletter. Many of you are familiar with the healthcare reform tracking efforts and weekly newsletters we produced for the KidsWell...more

Pioneer ACOs: Slowed Health Spending, Improved Quality and More Drop Outs?

The Centers for Medicare and Medicaid Services (CMS) recently released second year results on its Pioneer Accountable Care Organization (ACO) program. The Pioneer ACO program is CMS’ ambitious foray into the ACO space and a...more

Big Changes to Administrative Law Hearings for Medicare Providers

Effective October 27, 2014, the Medicare Program Integrity Manual (“Manual”) will require Medicare Administrative Contractors (“MACs”) to participate in administrative hearings concerning medical review decisions. ...more

Ebola and Infectious Disease Risk Management for Hospitals and Health Care Facilities

The onset of active Ebola infections in the U.S. places hospitals and health care facilities in somewhat “uncharted waters” regarding their respective legal risks related to clinical care and the clinicians providing that...more

Changes Coming to Nursing Home Compare

The Centers for Medicare and Medicaid Services (“CMS”) has announced that the Nursing Home Compare Five Star Quality Rating System will soon undergo some changes. The rating system has experienced recent criticism for relying...more

Blog: Business Forward Hosts HHS’s Director of Private Sector Engagement for a Discussion on Health Care for Small Businesses

On Wednesday, October 15, 2014, Business Forward hosted a discussion with Rhett Buttle, the Director of Private Sector Engagement at the U.S. Department of Health and Human Services (HHS). Mr. Buttle began by providing...more

Seventh Circuit Reaffirms Worthlessness of Worthless Services Cases

In August the Seventh Circuit expressed its view that so-called “worthless services” cases don’t state a claim under the False Claims Act. Last Friday the court reaffirmed its view by refusing to rehear the case en banc....more

Health Care Update - October 2014 #3

In This Issue: - Policymakers Scrambling to Contain Ebola Crises - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional Initiatives -...more

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