Friday the 13th is not all bad luck. On September 13, 2024, the United States Court of Appeals for the Eighth Circuit’s published its much-anticipated decision in United States ex rel. Holt v. Medicare Medicaid Advisors,...more
Although most health care lawyers and compliance officers who review and analyze physician compensation understand that fair market value (FMV) is important, the nuances around FMV are sometimes missed....more
8/13/2024
/ Anti-Kickback Statute ,
Audits ,
Chief Compliance Officers ,
Compensation ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Fair Market Value ,
Healthcare ,
Medical Coding ,
OIG ,
Physician Payments ,
Stark Law ,
Valuation
In its November 2023 Proposed Rule and in its recently issued Final Rule that will be published in the Federal Register later this month, the Centers for Medicare & Medicaid Services (CMS) addressed concerns related to agent...more
4/23/2024
/ Brokers ,
Centers for Medicare & Medicaid Services (CMS) ,
Compensation ,
Contract Renewal ,
Enrollment ,
Fraud and Abuse ,
Health Insurance ,
Medicare Advantage ,
Medicare Part D ,
OIG ,
Proposed Rules ,
Public Health Insurance Marketplace ,
Risk Management
Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more
2/19/2024
/ Artificial Intelligence ,
Collaboration ,
Compensation ,
Compliance ,
Ethics ,
Fair Market Value ,
Governance Standards ,
Health and Safety ,
Health Technology ,
Healthcare ,
Internal Controls ,
Machine Learning ,
OIG ,
Physicians ,
Privacy Laws ,
Regulatory Requirements ,
Value-Based Payments
In connection with the November 2023 Health Care Compliance Association’s (HCCA) Healthcare Enforcement Compliance Conference, and with acknowledgment by the Chief Counsel to the Inspector General, Rob DeConti, of the long...more
11/8/2023
/ Advisory Opinions ,
Anti-Kickback Statute ,
Audits ,
Civil Monetary Penalty ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Enforcement ,
Healthcare Fraud ,
OIG ,
Private Equity ,
Risk Assessment ,
Self-Disclosure Requirements
In this episode, partner Jana Kolarik of Foley’s Health Care Practice Group interviews partner Roger Strode of Foley’s Health Care and Transactional Practice Groups and Michael Ramey, managing principal of PYA's Strategic and...more
10/17/2023
/ Acquisitions ,
Anti-Kickback Statute ,
Compliance ,
Due Diligence ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Hospital Mergers ,
Indemnity ,
Private Equity ,
Recapitalization ,
Self-Disclosure Requirements ,
Stark Law
Session #1: State of the Healthcare Industry Effective Compliance Plans and Enforcement Trends -
In their discussion of compliance program effectiveness and enforcement, attorneys Kolarik and Waltz and Ms. Sumner...more
2/23/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Dispute Resolution ,
Enforcement ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Mental Health ,
No Surprises Act (NSA) ,
Physician Fee Schedule ,
Public Health Emergency ,
Risk Assessment
Based on recent changes and clarifications made by the Centers for Medicare and Medicaid Services (CMS) in the Federal Physician Self-Referral Law (commonly known as the “Stark Law”), hospitals and health systems need to...more
On July 20, 2022, HHS-OIG published a new Special Fraud Alert on arrangements with telemedicine companies, setting forth seven characteristics OIG believes could suggest a given arrangement poses a heighted risk of fraud and...more
In the latest installment of our “Let’s Talk Compliance” series, Foley & Lardner’s Alexis Bortniker and PYA’s Martie Ross answered numerous questions regarding Provider Relief Fund (PRF) reporting requirements. A recording of...more
Three partners in Foley’s health care industry team—Monica Chmielewski, Jana Kolarik, and Lori Rubin—attended the Federation of American Hospitals (FAH) Conference and Business Exposition from June 6-8, 2021 in Nashville,...more
By letter dated April 13, 2021 (Letter), the Democrat and Republican leadership of the House Committee on Energy and Commerce and its Subcommittee on Health, wrote United States Health and Human Services Secretary, Xavier...more
CMS made impactful changes to the Federal physician self-referral law’s (i.e., Stark Law’s) regulations in its Final Rule that were effective January 19, 2021 (with the exception of the changes to 42 C.F.R. § 411.352(i) that...more
CMS made impactful changes to the Federal physician self-referral law’s (i.e., Stark Law’s) regulations in its Final Rule that were effective January 19, 2021 (with the exception of the changes to 42 C.F.R. § 411.352(i) that...more
1/21/2021
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Commercially Reasonable Efforts ,
Compensation ,
Cybersecurity ,
Final Rules ,
Physicians ,
Remuneration ,
Stark Law ,
Value-Based Care ,
Value-Based Payments
In the Executive Order on An America-First Healthcare Plan, issued September 24, 2020, President Trump addressed, among other health care issues, the issue of surprise billing (also sometimes characterized as “balance...more
As previously reported in our August 16, 2019 and February 18, 2020 blogs, the Florida Patient Brokering Act (Florida PBA) was amended on July 1, 2019 to change the exception to the Florida PBA from conduct “not prohibited...more
Federal and state legislatures have taken note of the nationwide opioid crisis and recently responded with legislative attempts to—among instituting other legal changes—broaden prohibitions on abusive health care payment...more
For the second year in a row, Foley & Lardner LLP and PYA hosted a compliance master class on various health-related compliance issues. “Let’s Talk Compliance” is an annual one-day event featuring a panel of presenters that...more
2/11/2020
/ Compliance ,
Covered Entities ,
Cyber Threats ,
Cybersecurity ,
Data Privacy ,
Data Protection ,
Data Security ,
Department of Health and Human Services (HHS) ,
Due Diligence ,
Electronic Protected Health Information (ePHI) ,
Enforcement Actions ,
Health Care Providers ,
Medical Records ,
Medicare ,
OCR ,
Overpayment ,
Patient Privacy Rights ,
Patient Rights ,
PHI ,
Physicians ,
Ransomware ,
Right-To-Access ,
Risk Assessment
Welcome to Foley & Lardner LLP’s Health Care MarketTrends. In this issue, we examine private equity investment in specialty areas of the health care industry, specifically dermatology and orthopedics....more
9/17/2019
/ Anti-Kickback Statute ,
Audits ,
Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Coding ,
Health Care Providers ,
Hospitals ,
Investors ,
Medicaid ,
Medicare ,
Private Equity ,
Private Equity Firms ,
Specialty Healthcare ,
Stark Law
This is an uncomfortable summer for health care providers in Florida! The legal landscape changed dramatically over the 4th of July holiday. Buried in Florida’s HB 369 regarding substance abuse services was a dramatic...more
As noted in previous Health Care Law Today blog posts, we have seen an uptick in private equity recapitalization transactions in orthopedics. We expect this trend to continue, and to pick up pace, as the economy remains...more
1/8/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Homeland Security (DHS) ,
Health Care Providers ,
Hospitals ,
Joint Venture ,
Physicians ,
Private Equity ,
Private Equity Funds ,
Recapitalization ,
Stark Law
Florida’s House Bill (HB) 21, enacted to help combat opioid abuse, contains several noteworthy changes to Florida law that impact the dispensing of opioids.
Effective July 1, 2018, dispensing providers must consult...more
Just in time for the New Year, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued final regulations (Final Regulations) that revised two existing Anti-Kickback Statute safe...more
1/19/2017
/ Advertising ,
Ambulance Providers ,
Anti-Kickback Statute ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Discounts ,
FQHC ,
Free Health-Related Services ,
Health Care Providers ,
Medicare Advantage ,
Medicare Coverage Gap Discount Program ,
OIG ,
Pharmacies ,
Safe Harbors ,
Waivers
In response to the Obama Administration’s executive actions to reduce gun violence, on January 4, 2016, the U.S. Department of Health and Human Services’ Office of Civil Rights (OCR) issued a final rule, which modifies the...more