News & Analysis as of


Capitol Hill Healthcare Update

by BakerHostetler on

CONGRESS WORKS TO PASS BUDGET BEFORE FRIDAY’S SHUTDOWN DEADLINE - House leaders are pushing to schedule a vote this week on a $1.3 trillion budget agreement that would give the Senate enough time to pass it before a Friday...more

Bipartisan Budget Act Revises Stark Law, Increases Penalties for AKS and CMP Law Violations, and Expands Telehealth Coverage

On February 9, 2018, Congress passed the Bipartisan Budget Act of 2018 (the Act), which included a number of important health law provisions.. ...more

Attempted Monopolization Suit Based on Alleged Referral Steering Moves Forward with Court’s Acceptance as Plausible of a...

by Mintz Levin on

A private home health care agency’s attempted monopolization suit against a dominant public hospital system and its home health care agency will move forward following a federal district court’s denial of the defendant...more

Healthcare Industry Beware: The Use of Statistical Sampling to Establish Damages and Liability Under the False Claims Act Remains...

The False Claims Act contains numerous requirements that are designed to prevent meritless cases from proceeding to discovery and trial. Among these provisions is the rule that, to establish liability, the government or a...more

U.S. District Court Upholds CMS’s Application of the Statutory Requirement that Hospitals Be “Primarily Engaged” in Providing...

by K&L Gates LLP on

On January 25, 2018, the U.S. District Court for the Eastern District of Pennsylvania granted summary judgment in favor of the Centers for Medicare & Medicaid Services (“CMS”) following an eye hospital’s appeal of the...more

Healthcare Fraud & Abuse Review 2017

by Bass, Berry & Sims PLC on

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Hospital, Cardiology Group Settle False Claims Act Allegations for $20.75 Million

by King & Spalding on

As reported previously, Hamot Medical Center (“Hamot”) and Medicor Associates, Inc. (“Medicor”) entered into a preliminary settlement agreement under which they agreed to pay $20.75 million to resolve kickback allegations...more

DOJ Memoranda Ushering in New Era for Health Care Enforcement

by Foley & Lardner LLP on

In January 2018, the Department of Justice (DOJ) issued two memoranda that, taken together, may usher in a new era of False Claims Act (FCA) enforcement in the health care industry. The first memorandum, dated January 10,...more

CMS Revises National Coverage Determination for Implantable Cardioverter Defibrillators

On February 15, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Decision Memo outlining revisions to its 2005 National Coverage Determination (NCD) for Implantable Automatic Defibrillators (ICDs) ....more

Privacy Tip #129 – As New Medicare Cards are Issued: Beware of Scams

This writer has been lamenting for years about the fact that Medicare recipients’ Social Security numbers are included on the face of the card. This is an unnecessary risk posed to Medicare recipients, which are primarily...more

Data Privacy + Cybersecurity Insider - March 2018 #2

by Robinson & Cole LLP on

Cybersecurity Task Force Launched in Arizona - Arizona Governor Doug Ducey launched the Arizona Cybersecurity Team (ACT) by Executive Order on March 1, 2018. The ACT is comprised of 22 members representing officials from...more

CMS plans complete overhaul of EHR incentive programs, announces new patient access initiatives

by Bricker & Eckler LLP on

The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced on March 6, 2018, at the Health Information and Management Systems Society conference that CMS is planning to overhaul the meaningful use...more

Third Circuit Affirms Dismissal of FCA Claim Premised Upon Alleged Anti-Kickback Scheme, While Clarifying that Plaintiffs Need Not...

The Third Circuit’s decision in Medco Health Solutions, affirming the dismissal of a relator’s qui tam suit against his former employer, offers mixed news for False Claims Act defendants and plaintiffs as to the kind of...more

Ruling: Medical Providers Not Subject to Double Damages Under Medicare Secondary Payer Act

by Holland & Knight LLP on

• In a matter of first impression, the U.S. District Court for the Middle District of Florida has ruled that a private right of action under the Medicare Secondary Payer Act (MSP Act), which provides for double damages in the...more

New Medicare Cards to Debut in April 2018

by McGuireWoods LLP on

In an effort to “prevent fraud, fight identity theft, and keep taxpayer dollars safe,” the Centers for Medicare and Medicaid Services (CMS) is issuing new Medicare cards to Medicare enrollees beginning in April 2018. This...more

Advancing Access to Precision Medicine Act - A Bipartisan Bill

by Foley & Lardner LLP on

On February 15, 2018, representatives Eric Swalwell (CA-15), John Shimkus (IL-15), Scott Peters (CA-52), Erik Paulson (MN-03), and Juan Vargas (CA-51), introduced the Advancing Access to Precision Medicine Act (H.R....more

MedPAC Considers Recommendation to Cut Payment to Off-Campus Emergency Departments, Shift Payments to Rural Facilities

by King & Spalding on

The Medicare Payment Advisory Commission (MedPAC) is considering asking Congress to cut Medicare payments for off-campus emergency departments located in urban areas and increase payments to stand-alone outpatient and...more

False Claims Act 2017 Report Card: $2.4 Billion Recovered

by Shipman & Goodwin LLP on

On December 21, 2017, the Department of Justice (DOJ) issued its yearly report card describing its most noteworthy settlements in fiscal year 2017 with healthcare providers under the False Claims Act (FCA).1 In addition to...more

Civil and Criminal Fraud and Abuse Penalties Increase and Stark Law Changes

by McGuireWoods LLP on

The Bipartisan Budget Act of 2018 (the Act) continues to ratchet up penalties for fraud and abuse violations under the Medicare and Medicaid programs. The Act doubles statutory civil fines and quadruples some criminal fines,...more

Capitol Hill Healthcare Update

by BakerHostetler on

CONGRESS SCRAMBLES TO COMPLETE BUDGET IN ADVANCE OF DEADLINE - Lawmakers are working overtime – including on key healthcare issues – to wrap up work on a $1.2 trillion omnibus budget bill that would fund the government for...more

CMS’s Advance Notice and Call Letter: How Medicare Plans Can Report, Identify, and Address the Opioid Epidemic

CMS has slowly but surely been providing additional guidance to Medicare Plans (Medicare Advantage and Part D plans) regarding steps they can and should take to address the opioid epidemic as it relates to their...more

Alston & Bird Healthcare Week In Review

by Alston & Bird on

I. Regulations, Notices, & Guidance - On February 26, 2018, the Food and Drug Administration (FDA) issued a final order entitled, Medical Devices; Hematology and Pathology Devices; Classification of Lynch Syndrome Test....more

Medicare Electronic Health Record Incentive Program - 2018 Call for Measures

by Pierce Atwood LLP on

Beginning in 2018, the Centers for Medicare and Medicaid Services (CMS) is commencing an annual “Call for Measures” initiative to allow interested parties (i.e., Medicare eligible hospitals and critical access hospitals...more

When big money floods into health care, the results can be crazy and corrosive

With Americans spending more than $3 trillion annually on health care, the corrosive and crazy effects of all that big money can become almost common place. Even still, hospitals, doctors, and Big Pharma still manage to come...more

CMS Expands Reimbursement for Telehealth Services

Despite telehealth’s significant expansion over the past ten years, it has been plagued by a historically unstable regulatory and reimbursement landscape....more

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