As a general rule, healthcare employers are required to pay employed physicians and other contracted providers fair market value (FMV) for their services, but many employers do not understand relevant regulatory standards. ...more
8/22/2024
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Compensation ,
EMTALA ,
Fair Market Value ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Healthcare Workers ,
Independent Contractors ,
Medicaid ,
Medicare ,
OIG ,
Penalties ,
Physicians ,
Private Equity ,
Regulatory Standards ,
Stark Law ,
Wages
Although often well-intentioned, offering free or discounted items or services to patients (e.g., gifts, rewards, writing off copays, free screening exams, free supplies, etc.) may violate federal and state laws governing...more
2/28/2024
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Cost-Sharing ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
Ethics ,
Fraud and Abuse ,
Inducements ,
Medicare ,
OIG ,
Patient Referrals ,
Patients ,
Reimbursements ,
Stark Law ,
Waivers
In Idaho, persons under the age of 18 (“minors”) may consent to their own healthcare in only limited circumstances.
General Rule: Obtain Consent from Parent or Surrogate Decision Maker. Idaho Code § 39‑4503 sets forth...more
7/21/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Competency Requirements ,
Consent ,
EMTALA ,
Health Care Providers ,
Healthcare ,
Legislative Agendas ,
Minors ,
New Legislation ,
Parental Consent ,
Physicians
For nearly three years, federal and state agencies have waived or relaxed regulatory requirements and expanded reimbursement for services due to the COVID-19 public health emergency (PHE), but the signs indicate that the...more
11/29/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Consolidated Appropriations Act (CAA) ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
FQHC ,
Medicare ,
Public Health Emergency ,
Regulatory Requirements ,
Reimbursements ,
Telehealth
Since January 1, 2022, the No Surprise Billing Rules (NSBR) have required virtually all healthcare providers to give a good faith estimate of anticipated charges to uninsured (self-pay) patients.1 Unless the Department of...more
On April 12, 2022, CMS issued new guidance for the independent dispute resolution (“IDR”) process under the No Surprise Billing Rules (“Rules”) in response to a U.S. District Court for the Eastern District of Texas judge...more
On January 13, 2022, a divided Supreme Court vacated the injunctions that applied to CMS's vaccine mandate in 24 states, thereby allowing CMS to enforce its mandates in all states except Texas....more
1/19/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Employer Mandates ,
Enforcement ,
Exemptions ,
Healthcare Workers ,
Medicaid ,
Medicare ,
OSHA ,
SCOTUS ,
Vaccinations ,
Virus Testing
In the latest twist in the OSHA Vax-or-Test saga, the Sixth Circuit terminated the nationwide injunction of the Emergency Temporary Standard (ETS), clearing the way for OSHA to begin enforcing the Vax-or-Test ETS. OSHA...more
Today, the federal district court in Louisiana issued a preliminary injunction staying the CMS vaccine mandate nationwide (except for the 10 states subject to yesterday’s injunction in Missouri). A copy of the Order is here. ...more
On November 29, 2021, a federal district court in Missouri entered a preliminary injunction prohibiting CMS from enforcing its COVID-19 vaccine mandate in Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire,...more
In light of the CMS Interim Final Rule (“Interim Rule”) published on November 5, 2021, qualifying healthcare facilities have been tasked with implementing policies and procedures that ensure their staff are fully vaccinated...more
11/18/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Liability Issues ,
Employer Mandates ,
Health and Safety ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Workers ,
Interim Final Rules (IFR) ,
Popular ,
Religious Exemption ,
Vaccinations ,
Workplace Safety
Under the Centers for Medicare & Medicaid Services (CMS)’s new vaccine mandate for healthcare workers, facilities must draft and implement policies and procedures by December 6, 2021 to ensure covered personnel are fully...more
11/8/2021
/ Americans with Disabilities Act (ADA) ,
Centers for Disease Control and Prevention (CDC) ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Rights Act ,
Coronavirus/COVID-19 ,
EEO ,
Enforcement ,
Equal Employment Opportunity Commission (EEOC) ,
GINA ,
Health Care Providers ,
Healthcare ,
OSHA ,
Reasonable Accommodation ,
Religious Exemption ,
Title VII ,
Vaccinations ,
Workplace Safety
Under the federal Stark law, hospitals and other healthcare employers may require that employed or contracted physicians refer items or services to the hospital or another designated provider subject to certain limits. (42...more
On November 20, 2020, CMS and the OIG published their much anticipated amendments to the federal Stark and Anti-Kickback laws. As summarized in our recent client alert, the changes open the door to value-based contracting...more
Many hospitals, physician groups, or other providers compensate employed or contracted practitioners based on the work relative value units (“wRVUs”) they generate, e.g., a physician may be paid $x per wRVU performed....more
The OCR has announced a surprising number of HIPAA settlements in the past few months with penalties ranging from $10,000 to $6.5 million. Here are some of the key takeaways for healthcare providers:
1. Protect against...more
10/27/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Cyber Attacks ,
Data Breach ,
Data Protection ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
OCR ,
Personal Information ,
Phishing Scams ,
Settlement
On March 30, 2020, CMS issued numerous additional blanket waivers to give providers greater flexibility in responding to COVID-19. (See https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf)....more
4/1/2020
/ 1135 Waivers ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Coronavirus/COVID-19 ,
Determination of Need (DoN) ,
EMTALA ,
Fee-for-Service ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Nurses ,
Nursing Homes ,
Pharmacies ,
Prior Authorization ,
Relief Measures ,
Skilled Nursing Facility ,
State and Local Government ,
Waivers
Although often well-intentioned, offering free or discounted items or services to patients (e.g., gifts, rewards, writing off copays, free screening exams, free supplies, etc.) may violate federal and state laws governing...more
Hospitals—especially rural hospitals—may want to divert inbound ambulances to other facilities, especially when the patient requires services that the hospital may be unable to provide. However, improper diversions may...more
The Ethics in Patient Referrals Act (“Stark”) prevents hospitals from paying employed or contracted physicians in the same way that physicians are or were paid by independent physician groups. Specifically, physician groups...more
7/10/2018
/ Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Hospitals ,
Joint Venture ,
Outpatient Services ,
Patient Referrals ,
Physicians ,
Remuneration ,
Safe Harbors ,
Self-Referral ,
Services ,
Stark Law