Health Care Counsel Blog

The 7th Circuit just denied ERISA rights to medical providers, but this doesn’t have to be the result.

AB 465, the California bill that sought to eliminate arbitration agreements as a condition of employment and in other settings, was vetoed by Governor Jerry Brown. AB 465 will go back to the House for further consideration and will require a two-thirds vote by both houses to overturn the veto.

Preventing falls is a perpetual task for health care facilities and those who regulate or accredit them. The Joint Commission issued a Sentinel Event Alert addressing fall-prevention and fall-related injuries, providing recommendations to supplement its existing fall-prevention standards.

On September 21, 2015, the US DOJ and whistleblowers’ counsel announced that Florida-headquartered Adventist Health System (Adventist) had agreed to pay $118.7 million to resolve allegations that it violated the FCA by submitting claims in violation of the Stark law and by miscoding claims.

Joyce Branda, the Deputy Assistant Attorney General for the Commercial Litigation Branch of the DOJ, gave the keynote address on September 28, 2015, at the American Health Lawyers Association Fraud and Compliance Forum in Baltimore, providing conference attendees with an update from DOJ.

The US Department of Justice (DOJ) recently announced that Columbus Regional Healthcare System (Columbus Regional) has agreed to pay up to $35 million and enter into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General.

New York insurer Excellus BlueCross BlueShield became the most recent health care company to announce it was the victim of a sophisticated cyberattack after hackers gained access to the Social Security numbers, mailing addresses, and financial information of as many as 10 million customers.

On September 2-3, 2015, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) and the National Institute of Standards and Technology (NIST) hosted the 8th Annual Safeguarding Health Information: Building Assurance through HIPAA Security conference.

The US Department of Health and Human Services, Office for Civil Rights announced a new settlement for $750,000 with Cancer Care Group, P.C. to resolve potential violations of the HIPAA Privacy and Security Rules identified as the result of the theft of a laptop and backup media.

After surviving two challenges that resulted in U.S. Supreme Court decisions that essentially preserved the law, the Affordable Care Act will face additional judicial scrutiny as a federal district court has denied the administration’s motion to dismiss the case brought by the House last year.

The Health Resources and Services Administration, as administrator of the 340B Drug Pricing Program on behalf of the Department of Health and Human Services (HHS), published its proposed 340B Drug Pricing Program Omnibus Guidance on August 28, 2015.

Earlier this summer, Los Angeles hosted the Special Olympics World Summer Games at venues throughout the city. The games featured more than 6,400 athletes from 177 countries who competed in 27 sports, including aquatics, gymnastics, track and field, basketball, football, tennis, and volleyball.

David S. Greenberg co-authored an article published in Bloomberg BNA’s Medicare Report on the implications of the Centers for Medicare & Medicaid Services’ proposed revisions affecting long-term care facilities participating in Medicare and Medicaid programs.

On August 5, 2015, the Department of Health and Human Services Office of Inspector General (OIG) issued Advisory Opinion No. 15-11.

On August 7, 2015, the US District Court for the Southern District of New York issued a significant decision concerning FDA’s regulation of off-label promotion of approved drugs.

On Monday, a federal district court judge in New York issued a ruling that, if adopted broadly, will have a significant – and potentially nightmarish – impact on any provider who receives an overpayment from Medicare or Medicaid.  Kane v. Healthfirst, Inc. and U.S. v. Continuum Health Partners Inc. 

A recent court ruling is a good reminder to health care providers that bankruptcy may not (as is sometimes suggested) be a safe harbor for providers in danger of being forced out of business by the loss of their Medicare and Medicaid provider agreements.

In an unexpected development, the Centers for Medicare and Medicaid Services recently proposed several changes that will generally add greater flexibility to Stark Law regulations in the proposed physician fee schedule for calendar year 2016, which was published on July 15, 2015.

In an unexpected development, the Centers for Medicare and Medicaid Services recently proposed several changes that will generally add greater flexibility to Stark Law regulations in the proposed physician fee schedule for calendar year 2016, which was published on July 15, 2015.

Earlier today, the Senate Finance Committee approved legislation which would resurrect roughly 50 expired tax incentive provisions that lapsed on December 31, 2014. 

On July 7, 2015, the US Court of Appeals for the Ninth Circuit overruled a 23-year-old False Claims Act precedent, relaxing its test for deciding when a whistleblower can overcome a motion to dismiss because the allegations in the complaint were publicly disclosed. 

On June 10, 2015, the U.S. Department of Health and Human Services, Office for Civil Rights, announced that it had entered into a resolution agreement with St. Elizabeth’s Medical Center, a Massachusetts hospital, to resolve potential HIPAA violations.

Last week, the U.S. Department of Health and Human Services Office of Inspector General (OIG) announced the creation of a new litigation team focused solely on using the OIG’s authority to impose civil monetary penalties and exclude individuals and businesses from Medicare and Medicaid.

King v. Burwell understandably took the attention of the health care industry a couple of weeks ago when it upheld a key component of the ACA. A day later, the Supreme Court released another decision that may have a more significant going-forward impact on the health care industry: Obergefell.