On April 23, the 113th Tennessee General Assembly passed HB2269/SB2009, Public Chapter No. 985 (New CON Law), which significantly overhauls Tennessee’s certificate of need (CON) program for a second time less than three years...more
5/31/2024
/ Ambulatory Surgery Centers ,
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General Assembly ,
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Organ Transplant Centers ,
Shareholder Meetings ,
Substance Abuse ,
Tennessee
We are pleased to bring you our 12th annual Healthcare Fraud & Abuse Review. Our Review provides comprehensive coverage of the most significant civil and criminal enforcement issues facing healthcare providers. Each year, we...more
2/27/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medical Devices ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Settlement ,
Stark Law ,
Telemedicine
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is tasked with providing objective oversight to protect the integrity and promote the efficiency of Medicare, Medicaid, and more than...more
2/1/2024
/ Advisory Opinions ,
Anti-Kickback Statute ,
Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
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Healthcare ,
Healthcare Fraud ,
Healthcare Reform ,
Information Blocking Rules ,
Litigation Strategies ,
New Guidance ,
OIG ,
Regulatory Agenda ,
Telehealth
In a recent decision, U.S. ex rel. Sibley v. Univ. of Chicago Medical Center, the U.S. Court of Appeals for the Seventh Circuit considered allegations that two medical billing and debt collection companies, Medical Business...more
In 2010, Congress amended the Anti-Kickback Statute (AKS) to provide that claims “resulting from” an AKS violation are “false or fraudulent” for False Claims Act (FCA) purposes. 42 U.S.C. § 1320a-7b(g)...more
The False Claims Act, despite its name, does not define what it means for a claim to be “false” or “fraudulent.” This post examines the primary ways courts have interpreted the False Claims Act’s falsity element and discusses...more
On June 30, in response to Public Chapter No. 557 (new law), which makes significant changes to Tennessee’s certificate of need (CON) program, the Health Services and Development Agency (HSDA) issued draft emergency rules and...more
On May 5, 2021, after several years of extensive debate and negotiations, including a 2020 legislative session ending in an impasse, the 112th Tennessee General Assembly passed a highly anticipated certificate of need (CON)...more
6/8/2021
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Certificate of Need ,
General Assembly ,
Governor Lee ,
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Healthcare ,
Hospitals ,
Legislative Agendas ,
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State and Local Government ,
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Substance Abuse
In a coordinated effort, on November 27, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) published final rules to modernize regulations implementing the federal...more
12/22/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Final Rules ,
Health Care Providers ,
New Value Exception ,
OIG ,
Pharmacy Benefit Manager (PBM) ,
Physicians ,
Rebates ,
Safe Harbors ,
Stark Law ,
Technology Sector
This content was last updated as of Thursday, April 24 at 12:00 p.m. CST-
The Centers for Medicare & Medicaid Services (CMS) continues its issuance of Section 1135 waivers, waiving or modifying certain Medicare, Medicaid,...more
4/27/2020
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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
The Centers for Medicare & Medicaid Services (CMS) continues its issuance of Section 1135 waivers, waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that...more
4/10/2020
/ 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
The Centers for Medicare & Medicaid Services (CMS) continues its issuance of Section 1135 waivers, waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that...more
In a coordinated effort, CMS and the Office of Inspector General (OIG) published proposed rules to modernize regulations implementing the federal physician-self referral law, commonly referred to as the “Stark Law” (Stark),...more
10/30/2019
/ Anti-Kickback Statute ,
Beneficiary Inducement ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Comment Period ,
Department of Health and Human Services (HHS) ,
EHR ,
Health Care Providers ,
OIG ,
Proposed Rules ,
Public Comment ,
Safe Harbors ,
Stark Law ,
Value-Based Care