Health Care Counsel Blog

The Seventh Circuit Court of Appeals recently affirmed a lower court’s conclusion that a doctor in a service corporation was actually an employer, and thus could not bring a claim under federal discrimination statutes based upon her termination

As part of a case we continue to follow, in which the US Department of Justice (DOJ) intervened in a False Claims Act (FCA) suit against Continuum Health Partners and Mount Sinai Health System, the defendant hospital system recently filed a motion to dismiss the DOJ’s complaint-in-intervention.

Representatives for the Centers for Medicare and Medicaid Services (CMS) held a conference call on October 9, 2014 to address ongoing questions and clarify the requirements for hospitals that want to settle the inpatient-status claims whose denials they have appealed.

* The following alert was originally published in California Healthcare News (CHN). To read it on the CHN website, click here.

The exposure frequently arises because physicians bargain hard for the highest possible level of compensation, and the government (or a whistleblower) later alleges that the compensation exceeds fair market value or is not commercially reasonable.

The Department of Health and Human Services Office of Inspector General (OIG) released a proposed rule adding new safe harbor provisions to the Federal Anti-Kickback Statute (AKS) and expanding exceptions to the Beneficiary Inducement Civil Monetary Penalty Statute (Proposed Rule).

The Centers for Medicare & Medicaid Services (CMS) announced plans to reopen and extend the deadline for eligible professionals and eligible hospitals to submit a hardship exception application for not demonstrating “Meaningful Use” of Certified Electronic Health Record Technology (CEHRT).

The Centers for Medicare and Medicaid Services (CMS) recently announced a policy allowing acute care and critical access hospitals to settle inpatient-status claims currently on appeal in exchange for a partial payment equal to 68 percent of the claims’ net allowable amount.

The Study determined that the annual cost of an MET comprising a nurse, respiratory therapist, and ICU fellow, with concurrent patient care responsibilities independent of MET duties, was equivalent to the cost savings associated with a reduction of about 3.5 patient deterioration events per year.

On September 30, 2014, the US Court of Appeals for the Ninth Circuit unanimously held that the first-in-the-nation Safe Drug Disposal Ordinance passed by Alameda County, California is constitutional.

On September 25, 2014, Law360 published an article by Arent Fox partner Peter R. Zeidenberg that addresses just that type of DOJ statement.

Under a manufacturer cost-sharing assistance or copay coupon program, the manufacturer of a brand name drug pays some or all of the copayment and/or co-insurance obligations of individuals under their health plans when they fill a prescription for the drug covered by the company’s program.

On Wednesday, September 17, 2014, Leslie Caldwell, Assistant Attorney General for the Criminal Division of the US Department of Justice (DOJ), joined the chorus of federal officials promising heightened criminal enforcement targeting those engaging in fraud against the federal government.

In the Preamble, ONC states it was driven by its goals and timeline to enhance health information exchange by making the program “more effective and less burdensome in achieving regulatory objectives,” while increasing “regulatory flexibility” and promoting further innovation.

An unfortunate trend for defendants in False Claims Act (FCA) cases is continuing as the Eighth Circuit Court of Appeals joined other federal circuit courts in lowering the pleading standards that qui tam relators (whistleblower plaintiffs) must satisfy in FCA cases.

On August 29, 2014, the United States Department of Justice filed an action against two nursing homes located in Watsonville, California for defrauding the Medicare and Medicaid programs.

Our colleagues who represent retailers, technology, and media companies recently wrote that high profile data breaches have resulted in legislative and commercial industry initiatives to better protect consumers’ financial information from data theft.

* The following alert was originally published in California Healthcare News (CHN). To read it on the CHN website, click here.

A new decision from the California Court of Appeal is a positive development for SNFs and their defense attorneys as it may eliminate the use of certain theories and tactics historically utilized in prosecuting elder abuse and negligence cases.

On July 22, 2014, the California Court of Appeal, Third Appellate District, found that patients whose confidential health information had been stolen could not sustain a class action absent an allegation that the information was actually viewed by unauthorized third parties.

On July 28, 2014, the US Department of Health and Human Services’ Office of Inspector General (OIG) issued a favorable opinion concerning a drug manufacturer’s program to offer a certain branded drug via an online, mail order pharmacy directly to cash-paying customers at a discounted price.

On July 11, 2014, amendments designed to reform Medicare regulations that the Centers for Medicare and Medicaid Services (CMS) has identified as “unnecessary, obsolete, or excessively burdensome on health care providers and suppliers” became effective.

The DC Circuit recently held that the attorney-client privilege applies to internal investigations, even when the investigations are mandated by law and are not conducted with the sole purpose of obtaining or providing legal advice.

The threat of False Claims Act liability based on the failure to promptly return overpayments is a relatively new phenomenon.

The US Supreme Court this morning granted cert in a closely watched False Claims Act (FCA) case, Kellogg Brown & Root Services, Inc. v. United States ex rel. Carter — a case that raises important questions about wartime suspension of the FCA’s statute of limitations.