Over the past few years, there has been tightening enforcement and numerous lawsuits driven by the increasingly complex web of federal and state anti-kickback and anti-inducement statutes. In a new CLE-eligible webinar,...more
9/26/2023
/ Anti-Kickback Statute ,
Continuing Legal Education ,
Defense Strategies ,
Enforcement Actions ,
Fraud Abuse and Waste ,
Fraud Prevention ,
Health Care Providers ,
Health Plan Sponsors ,
Healthcare Fraud ,
Inducement ,
Physicians ,
Webinars
On November 4 and 7, 2022, the California Department of Managed Health Care (DMHC) issued two All Plan Letters (APL 22-026 and APL 22-027) concerning compliance with the state’s network adequacy and timely access...more
Commercials, news articles and targeted social media advertisements abound offering virtual mental health services from providers like Talkspace and Calm. These startups are just a few of the many companies offering...more
9/30/2021
/ Coronavirus/COVID-19 ,
Health Care Providers ,
Health Insurance ,
Health Technology ,
Infectious Diseases ,
Mental Health ,
Online Platforms ,
Patient Access ,
Startups ,
Telehealth ,
Telemedicine ,
Therapeutic Services ,
Unicorns
As the race to vaccinate continues, state and federal enforcement agencies are hard at work investigating and prosecuting COVID-19-related health care fraud. As Acting Assistant Attorney General Nicholas L. McQuaid of the...more
Editor’s Note: Litigators and in-house counsel for both payers and providers in the reimbursement arena should be aware of recently enacted legislation regulating “surprise” medical billing. In this article, we discuss some...more
Increased prescribing of opioid medications over the course of nearly two decades has led to widespread misuse of both prescription and nonprescription opioids. In 2018 alone, 10.3 million people misused prescription opioids,...more
On June 24, 2019, President Donald Trump issued an “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.” The stated purpose of the Order is to “enhance the ability of...more
Editor’s Note: Healthcare organizations are increasingly prime targets for class actions. Below we briefly summarize the recent changes to Federal Rule of Civil Procedure 23 and their impact on class actions. ...more
On June 6, 2018, the Ninth Circuit revived a lawsuit, Danny P. et al. v. Catholic Health Initiatives, No. 16-35609, challenging the denial of a claim for an inpatient stay at a residential mental health treatment facility by...more
On September 23, 2016, the California Legislature passed, and Governor Jerry Brown signed, Assembly Bill 72 (AB 72 or the Act), creating a new regime for the regulation of “surprise bills.” (Health...more
On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Health & Human Services (HHS) Notice of Benefit and Payment Parameters for 2019 (final rule). The final rule is the first time the Trump...more
Connecting Justice-Involved Populations to Health Coverage and Care -
Editor’s Note: The importance of connecting justice-involved populations to health coverage and care is evident from the high levels of physical and...more
On October 13, 2017, the U.S. Department of Justice (DOJ) decided to abandon its lawsuit accusing UnitedHealth Group and affiliated health plans (UnitedHealth) of exaggerating how sick its patients were to procure millions of...more
Since the passage of the Affordable Care Act (ACA), the payment of healthcare premiums by third parties has been the subject of controversy. As Congress develops its plan to repeal and replace the ACA, it is uncertain how...more
Last year, a unanimous U.S. Supreme Court decided Universal Health Services, Inc. v. United States ex rel. Escobar (Escobar), 136 S.Ct. 1989 (2016), creating important implications for Federal False Claims Act (FCA) cases...more
3/25/2017
/ Conditions of Payment ,
Failure To Disclose ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Contractors ,
Health Care Providers ,
Implied Certification ,
Material Misrepresentation ,
Materiality ,
Medicaid ,
Qui Tam ,
SCOTUS ,
Universal Health Services Inc v United States ex rel Escobar ,
Unlicensed Medical Providers
California's "End of Life Option Act" (the Act) went into effect June 9, 2016—making California the fifth state (behind Oregon, Washington, Vermont and Montana) to allow terminally ill adults with fewer than six months to...more
The Vulnerability of Healthcare Information -
According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more
7/28/2016
/ Abortion ,
Affordable Care Act ,
Anti-Steering Rules ,
Antitrust Violations ,
Attorney's Fees ,
Bad Faith ,
Brandt Fees ,
Children's Health Insurance Program (CHIP) ,
Compensatory Damages ,
Contraceptive Coverage Mandate ,
Cybersecurity ,
Data Protection ,
Denial of Benefits ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
Employee Retirement Income Security Act (ERISA) ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Trade Commission (FTC) ,
Food and Drug Administration (FDA) ,
Gobeille v Liberty Mutual Insurance Com. ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Justice Scalia ,
Market Power ,
Materiality ,
Medicaid ,
Medical Devices ,
Medicare ,
Nurses ,
OCR ,
Patient Privacy Rights ,
PHI ,
Preemption ,
Punitive Damages ,
Religious Institutions ,
Right to Privacy ,
SCOTUS ,
Undue Burden ,
Universal Health Services Inc v United States ex rel Escobar ,
Wearable Technology ,
Whole Woman's Health v Hellerstedt ,
Zubik v Burwell