False Claims Act (FCA) civil fraud recoveries in Fiscal Year (FY) 2020 dropped over US$850 million when compared to those in FY 2019. While the more than US$2.2 billion in recoveries in FY 2020 continued a general downward...more
In this week’s episode, Richard Church and Mary Beth Johnston discuss a number of critical issues in the health care industry that are likely to be points of focus in the coming year, including the COVID-19 pandemic, False...more
In this episode, Mary Beth Johnston and Nora Becerra discuss recent COVID-19 federal data and the disparate impact of the disease on ethnic and racial minorities; they examine the data through the lens of social determinants...more
Recently, the dialogue surrounding the coronavirus pandemic has shifted focus to the reopening of communities that have been shut down over the past few months. The discussion around this reopening has extended to health care...more
In this week’s episode, Mary Beth Johnston, Carolyn Merritt and Leah Richardson discuss the ways in which the Centers for Medicare and Medicaid Services’ (CMS) response to the ongoing COVID-19 outbreak is easing certain...more
4/2/2020
/ Accelerated Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Financial Distress ,
Health Care Providers ,
Medicaid ,
Medicare ,
Physicians ,
Secretary of HHS ,
Self-Referral Disclosure Protocol ,
Stark Law ,
Waivers
The respiratory disease caused by a novel coronavirus was first detected in China and has now been detected in almost 70 locations internationally, including in the United States....more
In 2019, the False Claims Act (“FCA”) remained the federal government’s (“Government”) primary method of civil fraud enforcement. While the more than $3 billion in civil fraud recoveries in Fiscal Year (“FY”) 2019 resulted...more
In 2018, the False Claims Act (“FCA”) continued to be one of the federal government’s (“Government”) preferred civil fraud enforcement tools across a variety of industries. The healthcare industry, however, remained the...more
On June 25, 2018, the Centers for Medicare and Medicaid Services (“CMS”) published a request for information (“RFI”) seeking public input on how to address “undue regulatory impact and burden” of the federal physician...more
We expect 2018 to be another year of rapid change within the health care industry. In this episode, Mary Beth Johnston highlights some of the key topics that the health care practice group will monitor in the coming year,...more
2/28/2018
/ Bundled Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Cybersecurity ,
Data Privacy ,
Drug Pricing ,
Employee Retirement Income Security Act (ERISA) ,
Exclusions ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Fraud and Abuse ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Audits ,
Materiality ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
MIPS ,
OCR ,
OIG ,
ONC ,
Opioid ,
Out of Network Provider ,
Overpayment ,
Pharmaceutical Industry ,
Physician Medicare Reimbursements ,
Prescription Drugs ,
Provider Payments ,
Quality Payment Program (QPP) ,
Section 340B ,
Stark Law ,
State Medicaid Programs ,
Telemedicine ,
Underpayment ,
Universal Health Services Inc v United States ex rel Escobar ,
Value-Based Care
If you work in the health care industry, you have grown accustomed to frequent changes in laws and regulations. On some days, it may seem like an insurmountable task to keep up with every change, especially as a new...more
Originally published in Haig, Business and Commercial Litigation in Federal Courts, Fourth Edition §§ 87:1 et seq. © 2016 American Bar Association.
This chapter discusses federal court litigation relating to health care...more
12/30/2016
/ Administrative Law Judge (ALJ) ,
Anti-Kickback Statute ,
Breach of Duty ,
Centers for Medicare & Medicaid Services (CMS) ,
Cybersecurity ,
Data Protection ,
Department of Health and Human Services (HHS) ,
Employee Retirement Income Security Act (ERISA) ,
EMTALA ,
False Claims Act (FCA) ,
Fiduciary Duty ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medicaid ,
Medicare ,
OIG ,
Preemption ,
Price-Fixing ,
Recovery Audit Contractors (RACs) ,
Reimbursements ,
Stark Law
On June 25, 2015, the U.S. Supreme Court ended the latest legal challenge to the Affordable Care Act (“ACA”) with its 6–3 ruling in King v. Burwell. With Chief Justice Roberts writing for the majority, the Supreme Court held...more
9/4/2015
/ Affordable Care Act ,
Cadillac Tax ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
IRS ,
King v Burwell ,
Medicaid ,
Medical Device Tax ,
Medicare ,
Popular ,
Public Health Insurance Marketplace ,
SCOTUS ,
Tax Credits
On June 12, 2015, the U.S. Court of Appeals for the District of Columbia (the “Court”) issued an opinion questioning the Department of Health & Human Services’ (“HHS”) interpretation of congressional intent when it...more
On July 15, 2015, the Centers for Medicare and Medicaid Services (“CMS”) published proposed regulations governing policies and payments made under the Physician Fee Schedule (“PFS”) for calendar year 2016 (the “Proposed...more
7/27/2015
/ CDS ,
Centers for Medicare & Medicaid Services (CMS) ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Access and CHIP Reauthorization (MACRA) ,
Medicare Part B ,
Opt-Outs ,
Physician Fee Schedule ,
Physicians ,
Stark Law ,
Telemedicine
The Patient Protection and Affordable Care Act of 2010 (“ACA”) requires a provider of services, supplier, Medicaid Managed Care Organization, Medicare Advantage Organization, or Prescription Drug Plan Sponsor receiving an...more
On December 31, 2014, the Treasury Department and the Internal Revenue Service (“IRS”) published a final rule (the “Final Rule”) implementing the requirements in Internal Revenue Code Section 501(r) for tax-exempt hospitals...more
In a pending False Claims Act (“FCA”) case stemming from alleged violations of the physician self-referral law (the “Stark Law”), 42 U.S.C. § 1395nn, and the federal Anti-Kickback Statute (“AKS”), 42 U.S.C. §1320a-7b, the...more
This week, a federal district court in Florida concluded that a hospital violated Stark as a matter of law by entering into employment agreements with physicians that included bonus compensation that was not based exclusively...more
Centers for Medicare and Medicaid Services (CMS) finalized a new rule, effective October 1, 2013, under which hospital inpatient admissions are considered reasonable and medically necessary if the physician expects a...more